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Sullivan N, Schorpp H, Crosky S, Thien S, Helmer DA, Litke DR, Pigeon WR, Quigley KS, McAndrew LM. Treatment and life goals among veterans with Gulf War illness. PLoS One 2023; 18:e0295168. [PMID: 38033143 PMCID: PMC10688846 DOI: 10.1371/journal.pone.0295168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Medically unexplained syndromes (MUS), also termed persistent physical symptoms, are both prevalent and disabling. Yet treatments for MUS are marked by high rates of patient dissatisfaction, as well as disagreement between patients and providers on the management of persistent physical symptoms. A better understanding of patient-generated goals could increase collaborative goal setting and promote person-centered care, a critical component of MUS treatment; yet research in this area is lacking. This paper aimed to develop a typology of treatment and life goals among Gulf War veterans with a medically unexplained syndrome (Gulf War Illness). We examined participants' responses to open-ended questions about treatment and life goals using Braun and Clarke's thematic analysis methodology. Results showed that treatment goals could be categorized into four overarching themes: 1) Get better/healthier, 2) Improve quality of life, 3) Improve or seek additional treatment, and 4) Don't know/Don't have any. Life goals were categorized into six overarching themes: 1) Live a fulfilling life, 2) Live a happy life, 3) Live a healthy life, 4) Be productive/financially successful, 5) Manage GWI, and 6) Don't know/Don't have any. Treatment goals were largely focused on getting better/healthier (e.g., improving symptoms), whereas life goals focused on living a fulfilling life. Implications for the treatment of Gulf War Illness and patient-provider communication are discussed. ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Hannah Schorpp
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America
| | - Sarah Crosky
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
| | - Scott Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - David R. Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States of America
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States of America
| | - Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
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Kühn L, Lindert L, Kuper P, Prill R, Choi KE(A. Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review. BMC Health Serv Res 2023; 23:193. [PMID: 36823581 PMCID: PMC9949696 DOI: 10.1186/s12913-023-09166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The provision of low-value physiotherapy services in low back pain management is a known but complex phenomenon. Thus, this scoping review aims to systematically map existing research designs and instruments of the field in order to discuss the current state of research methodologies and contextualize results to domains and perspectives of a referred low-value care typology. Ultimately, results will be illustrated and transferred to conditions of the German health care setting as care delivery conditions of physiotherapy in Germany face unique particularities. METHODS The development of this review is guided by the analysis framework of Arksey and O'Malley. A two-stage, audited search strategy was performed in Medline (PubMed), Web of Science, and google scholar. All types of observational studies were included. Identified articles needed to address a pre-determined population, concept, and context framework and had to be published in English or German language. The publication date of included articles was not subject to any limitation. The applied framework to assess the phenomenon of low-value physiotherapy services incorporated three domains (care effectiveness; care efficiency; patient alignment of care) and perspectives (provider; patient; society) of care. RESULTS Thirty-three articles met the inclusion criteria. Seventy-nine percent of articles focused on the appropriateness of physiotherapeutic treatments, followed by education and information (30%), the diagnostic process (15%), and goal-setting practice (12%). Study designs were predominantly cross-sectional (58%). Data sources were mainly survey instruments (67%) of which 50% were self-developed. Most studies addressed the effectiveness domain of care (73%) and the provider perspective (88%). The perspective of patient alignment was assessed by 6% of included articles. None of included articles assessed the society perspective. Four methodical approaches of included articles were rated to be transferrable to Germany. CONCLUSION Identified research on low-value physiotherapy care in low back pain management was widely unidimensional. Most articles focused on the effectiveness domain of care and investigated the provider perspective. Most measures were indirectly and did not monitor low-value care trends over a set period of time. Research on low-value physiotherapy care in secondary care conditions, such as Germany, was scarce. REGISTRATION This review has been registered on open science framework ( https://osf.io/vzq7k https://doi.org/10.17605/OSF.IO/PMF2G ).
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Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany. .,Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Lara Lindert
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Paulina Kuper
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Robert Prill
- grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.473452.3Center of Orthopaedics and Traumatology, Universtiy Hospital Brandenburg/Havel, Brandenburg Medical School, Neuruppin, Germany
| | - Kyung-Eun (Anna) Choi
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.465811.f0000 0004 4904 7440Health Services Research, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, 3500 Krems-Stein, Austria
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Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG102. [PMID: 34338006 DOI: 10.2519/jospt.2021.0303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of restricted work, unemployment, and work disability. The primary purpose of this clinical practice guideline (CPG) is to systematically review available scientific evidence and provide a set of evidence-based recommendations for effective physical therapy evaluation, treatment, and management of individuals experiencing limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.
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Calmon Almeida V, da Silva Junior WM, de Camargo OK, de Santana Filho VJ, Oliveira GU, Santana MS, de Farias Neto JP. Do the commonly used standard questionnaires measure what is of concern to patients with low back pain? Clin Rehabil 2020; 34:1313-1324. [DOI: 10.1177/0269215520941042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Evaluate whether questionnaires identified all the self-reported patient outcomes raised in focus groups. Design: Mixed methods research combined with qualitative analysis of focus groups. Settings: Physical therapy clinic in a teaching hospital in Brazil. Subjects: A total of 27 patients (aged >18 years, mean age 55.2 years) with chronic non-specific low back pain. Interventions: Three focus groups were conducted by the same investigator and analyzed by meaning unit condensation. The results obtained from the focus groups were codified according to the International Classification of Functioning. A similar process was adopted to codify the Roland-Morris Disability Questionnaire, the Quebec Back Pain Disability Scale and the Oswestry Disability Index according to the International Classification of Functioning. The results of both coding processes were compared. Results: In the analysis, seven main concepts were identified, comprising 77 meaning units. Only three meaning units were not linked to the International Classification of Functioning. Most of the codes present in the questionnaires and focus groups represent limitations to activities. Some codes were identified in the questionnaires that were not mentioned by the focus group participants. No questionnaire assessed environmental factors or problems related to specific parts of the body, and very few assessed body function, all of which were issues raised in the focus groups. Conclusion: This study shows that not all fields considered important by patients to their function are being evaluated, and emotional and contextual factors should be included in clinical assessments in order to fully understand patient need.
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Affiliation(s)
| | | | | | | | | | | | - Jader Pereira de Farias Neto
- Physical Therapy Department, Center for Life Sciences and Health, Federal University of Sergipe, São Cristóvão, SE, Brazil
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O'Connell N, Jones A, Chalder T, David AS. Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study. Neuropsychiatr Dis Treat 2020; 16:1795-1805. [PMID: 32801714 PMCID: PMC7399446 DOI: 10.2147/ndt.s251328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A proportion of patients admitted to acute-stroke settings have not had a stroke, but have conditions mimicking a stroke. Approximately 25% of suspected stroke cases are "stroke mimics" and 2% are patients with functional symptoms - "functional stroke mimics". This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyperacute stroke wards. METHODS This study used mixed methods. Patients with functional stroke symptoms participated in semistructured qualitative interviews immediately after admission to one of two acute-stroke units in London and again 2 months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at 2-month follow-up. RESULTS A total of 36 participants completed baseline interviews and 25 completed follow-up. Six themes emerged: physical symptom experience, emotional and coping responses, symptom causes, hospital experiences, views on the future, and uncertainty after hospital discharge. Mean Brief-IPQ score at admission was 49.3 (SD: 9.9), indicating a moderate-high level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this had decreased at 2-month follow-up. Two months later, many were confused as to the cause of their admission. CONCLUSION This is the first study to examine functional stroke patients' experiences of acute-stroke admission. At admission, patients expressed confusion regarding their diagnosis, experienced high levels of emotional distress, and were concerned they were perceived as time wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant subgroup for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.
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Affiliation(s)
- Nicola O'Connell
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Abbeygail Jones
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- UCL Institute of Mental Health, University College London, London, UK
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Phillips LA, McAndrew LM. Empirical Evaluation of Veterans' Perceived Non-Concordance with Providers Regarding Medically Unexplained Symptoms. COUNSELING PSYCHOLOGIST 2019; 47:770-795. [PMID: 32015569 DOI: 10.1177/0011000019890317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, including primary care and counseling psychologists. Non-concordance between veterans' and providers' views of MUS may contribute to poor veteran satisfaction with care and possibly disengagement with care (e.g., non-adherence to treatment recommendations, including counseling and graded exercise). The current study surveyed 243 veterans with MUS post-deployment and evaluated the degree of non-concordance perceived by veterans with their primary care providers regarding their MUS and the effect of perceived non-concordance on treatment behaviors and outcomes. Many veterans in the current sample perceived non-concordance with their provider regarding their MUS (19% reporting quite a bit or complete disagreement). Perceived non-concordance (regarding MUS overall and specific causal perceptions) predicted important outcomes of interest, particularly veterans' satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. Research should evaluate the effect of perceived concordance with the counseling psychologist on adherence to and outcomes from counseling for MUS.
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Affiliation(s)
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Healthcare System, East Orange, USA.,Department of Educational and Counseling Psychology EDU220, University at Albany, Albany, USA
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Hudon A, Lippel K, MacEachen E. Mapping first-line health care providers' roles, practices, and impacts on care for workers with compensable musculoskeletal disorders in four jurisdictions: A critical interpretive synthesis. Am J Ind Med 2019; 62:545-558. [PMID: 31074020 DOI: 10.1002/ajim.22972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND First-line health care providers are the primary access point for workers' benefits. However, little is known about their impact on quality of care and return-to-work. Our objective was to critically compare literature on the practices of first-line providers for workers with musculoskeletal injuries in Ontario and Quebec (Canada), Washington State (United States), and Victoria (Australia). METHODS A critical interpretive synthesis of peer-reviewed scientific literature was conducted. The search across six databases yielded 59 relevant publications that were critically appraised. RESULTS Three themes emerged: 1) how policies about first-line health care providers' modulate worker access to care, 2) how these providers' roles, practices, and training shape disability management, and 3) how the quality of care and disability outcomes are evaluated. CONCLUSIONS First-line health care providers have a critical influence on workers' trajectories of care. A focus on their role while taking the complexity of the context into account will help orient future policy changes.
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Affiliation(s)
- Anne Hudon
- Faculty of Applied Health SciencesSchool of Public Health and Health Systems, University of WaterlooOntario Canada
- Faculty of LawCivil Law Section, University of OttawaOntario Canada
| | - Katherine Lippel
- Faculty of LawCivil Law Section, University of OttawaOntario Canada
| | - Ellen MacEachen
- Faculty of Applied Health SciencesSchool of Public Health and Health Systems, University of WaterlooOntario Canada
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McAndrew LM, Friedlander ML, Alison Phillips L, L Santos S, Helmer DA. Concordance of illness perceptions: The key to improving care of medically unexplained symptoms. J Psychosom Res 2018; 111:140-142. [PMID: 29935748 DOI: 10.1016/j.jpsychores.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System, East Orange, NJ United States.
| | | | | | - Susan L Santos
- Veterans Affairs New Jersey Health Care System, United States
| | - Drew A Helmer
- Veterans Affairs New Jersey Health Care System, United States
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Evers S, Hsu C, Sherman KJ, Balderson B, Hawkes R, Brewer G, La Porte AM, Yeoman J, Cherkin D. Patient Perspectives on Communication with Primary Care Physicians about Chronic Low Back Pain. Perm J 2018; 21:16-177. [PMID: 29035178 DOI: 10.7812/tpp/16-177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Chronic low back pain (CLBP) is a common health problem with challenges for providing satisfactory care. This study was undertaken to identify opportunities to improve key aspects of physicians' communications with CLBP-affected patients. METHODS A series of 3 focus groups, each with 7 to 11 patients with CLBP, were recruited from primary care settings and grouped by risk level of reduced function resulting from back pain, to elicit perspectives about interactions with their primary care physicians. Analysis of focus group transcripts used an iterative process based on a thematic approach and a priori concepts. RESULTS A total of 28 patients participated in the focus groups. Patient comments about communicating with physicians around CLBP fit into themes of listening and empathy, validating pain experiences, conducting effective CLBP assessment, providing clear diagnosis and information, and collaboratively working on treatment. Patients shared that physicians can foster positive interactions with CLBP-affected patients by sharing personal experiences of chronic pain, being truthful about not having all the answers and being clear about how patients can benefit from referrals, reviewing the patient's previous treatments before beginning conversations about treatment options, providing follow-up instructions, giving patients a diagnosis beyond "chronic pain," and explaining the role of imaging in their care. CONCLUSION This study provides specific steps that physicians in the US can take to improve physician-patient interactions during primary care visits pertaining to CLBP. The findings could inform physician training, development of educational materials for patients, and future research.
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Affiliation(s)
- Sarah Evers
- Research Associate at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Clarissa Hsu
- Assistant Investigator at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Karen J Sherman
- Scientific Investigator at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Ben Balderson
- Research Associate at Kaiser Permanente Washington Health Research Institute and a Psychologist for Kaiser Permanente Washington-Behavioral Health in Seattle.
| | - Rene Hawkes
- Project Manager at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Georgie Brewer
- Patient Partner at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Anne-Marie La Porte
- Patient Partner at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - John Yeoman
- Patient Partner at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Dan Cherkin
- Emeritus Senior Scientific Investigator at Kaiser Permanente Washington Health Research Institute in Seattle.
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Spinal fusion surgery: From relief to insecurity. Int J Orthop Trauma Nurs 2017; 24:31-39. [DOI: 10.1016/j.ijotn.2016.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/26/2022]
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Damsgaard JB, Norlyk A, Jørgensen LB, Birkelund R. Back pain – a feeling of being mistrusted and lack of recognition: a qualitative study. Int J Orthop Trauma Nurs 2016; 21:11-20. [DOI: 10.1016/j.ijotn.2016.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/11/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
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Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil 2014; 36:1841-56. [PMID: 24472007 DOI: 10.3109/09638288.2014.882418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). METHODS A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. RESULTS Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. CONCLUSIONS The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. IMPLICATIONS FOR REHABILITATION Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.
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Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
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Cheville AL, Basford JR, Dos Santos K, Kroenke K. Symptom burden and comorbidities impact the consistency of responses on patient-reported functional outcomes. Arch Phys Med Rehabil 2013; 95:79-86. [PMID: 23988394 DOI: 10.1016/j.apmr.2013.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/22/2013] [Accepted: 08/11/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs). DESIGN Two data sources were used. The first, a cross-sectional database of patients with breast cancer who completed functional PROs and were administered the FIM, was used to examine whether average pain intensity (as measured with an 11-point numeric rating scale [NRS]) and Rand Mental Health inventory scores differed among those rating their functional independence as different than clinicians. The second, a longitudinal database of 311 adults with late-stage lung cancer who completed the Activity Measure for Post Acute Care Computer Adaptive Test (AM PAC CAT) with differences between their expected and actual responses as reflected in their AM PAC CAT SEs. SETTING Two tertiary medical centers. PARTICIPANTS Data source #1, 163 women with stage IV breast cancer; data source #2, 311 adults with late-stage lung cancer. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data source #1, FIM, pain NRS, Older Americans Resource Study activities of daily living subscale, Physical Function-10, Mental Health Inventory-17. Data source #2, AM PAC CAT and NRS symptom ratings. RESULTS Pain intensity was significantly higher when clinicians and patients disagreed regarding a patient's independence in the ability to transfer (NRS pain severity, 3.78 vs 2.40; P=.014), groom (3.71 vs 2.36, P=.009), bathe (3.76 vs 2.40, P=.016), and dress (3.09 vs 2.44, P=.034). The magnitude of AM PAC CAT SEs was significantly associated with the severity of participants' pain, dyspnea, and fatigue, as well as the presence of musculoskeletal disorders and coronary artery disease. Neither mood nor emotional distress was associated with clinician-patient agreement or AM PAC CAT SE. CONCLUSIONS Pain intensity is associated with disagreement between patients and clinicians about the patient's level of functioning. Moreover, physical symptoms (pain, dyspnea, fatigue) as well as specific medical comorbidities (musculoskeletal disorders, coronary artery disease), but not mood, are associated with inconsistency in patients' assessment of their functional abilities.
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Affiliation(s)
| | | | - Katiuska Dos Santos
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Kurt Kroenke
- Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Health Services and Outcomes, Indianapolis, IN
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Georgy EE, Carr ECJ, Breen AC. Met or matched expectations: what accounts for a successful back pain consultation in primary care? Health Expect 2013; 16:143-54. [PMID: 21679288 PMCID: PMC5060651 DOI: 10.1111/j.1369-7625.2011.00706.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' as well as doctors' expectations might be key elements for improving the quality of health care; however, previous conceptual and theoretical frameworks related to expectations often overlook such complex and complementary relationship between patients' and doctors' expectations. The concept of 'matched patient-doctor expectations' is not properly investigated, and there is lack of literature exploring such aspect of the consultation. AIM The paper presents a preliminary conceptual model for the relationship between patients' and doctors' expectations with specific reference to back pain management in primary care. METHODS The methods employed in this study are integrative literature review, examination of previous theoretical frameworks, identification of conceptual issues in existing literature, and synthesis and development of a preliminary pragmatic conceptual framework. OUTCOME A simple preliminary model explaining the formation of expectations in relation to specific antecedents and consequences was developed; the model incorporates several stages and filters (influencing factors, underlying reactions, judgement, formed reactions, outcome and significance) to explain the development and anticipated influence of expectations on the consultation outcome. CONCLUSION The newly developed model takes into account several important dynamics that might be key elements for more successful back pain consultation in primary care, mainly the importance of matching patients' and doctors' expectations as well as the importance of addressing unmet expectations.
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Affiliation(s)
- Ehab E Georgy
- School of Health and Social Care, Bournemouth University, Dorset, UK.
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Rethinking yellow flags. ACTA ACUST UNITED AC 2010; 16:196-8. [PMID: 21185221 DOI: 10.1016/j.math.2010.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/05/2010] [Accepted: 11/10/2010] [Indexed: 11/21/2022]
Abstract
The use of Yellow Flags has become widespread in clinical practice, as a means to identify clients with low back pain who might not respond favourably to physical treatments. However, using questionnaires to identify psychosocial risk factors that can result in ongoing pain and suffering is not a straightforward matter, and if used without due thought could result in an impoverished service for the client. This discussion article aims to raise awareness of the issues that emerge when relying on Yellow Flags; including the practicalities of using forced-choice questionnaires to identify complex interactions between a client's social environment and their psychological state. Yellow Flags are based on a biopsychosocial model of health, yet this paper argues that the use of Yellow Flags, in practice, belongs within a reductionist paradigm. By calling attention to the issues raised, we envisage a better utilization of the biopsychosocial model; whereby taking account of a client's unique experience and meaning of pain will enable the individual to be managed with a more genuine and insightful understanding than seemingly occurs at the present time.
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Allegretti A, Borkan J, Reis S, Griffiths F. Paired interviews of shared experiences around chronic low back pain: classic mismatch between patients and their doctors. Fam Pract 2010; 27:676-83. [PMID: 20671000 DOI: 10.1093/fampra/cmq063] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND current treatments for chronic low back pain (LBP) appear to be inadequate and there are growing calls for new approaches. This study explores the paired interviews of shared experiences among chronic LBP patients and their physicians with the ultimate goal of improving doctor-patient communication and clinical outcomes. METHODS in-depth interviews of a purposeful sample of paired chronic LBP patients and their doctors were conducted, transcribed and analysed using a multistep iterative process. Interview pairs were examined for important themes and major areas of convergence and divergence/mismatch. RESULTS patients' stories focused on their suffering from severe and disabling LBP while conveying a high level of reliance on their family physicians. Physicians described many challenges in treating this patient population. Patient and doctor stories were convergent regarding the severity/seriousness of illness, the lack of effective treatments and the existence of many barriers to care. Notable areas of mismatch: biomedical/biomechanical versus biopsychosocial (BPS) models of illness, treatment expectations/goals of reducing pain versus improving function and the importance of a definitive diagnosis. DISCUSSION patient and physician stories revealed shared themes and convergences, as well as significant discordance and mismatch. Family physicians, trained in and adherent to the BPS model, may have great difficulty when matched with biomechanically oriented patients. Re-conceptualizing doctors and LBP patients as a single teachable dyad may be useful. Clinical application of paired interviews of shared experiences may be useful in bridging communication and paradigmatic gaps, reducing mismatch and developing shared treatment plans.
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Affiliation(s)
- Andrew Allegretti
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Wallace AS, Freburger JK, Darter JD, Jackman AM, Carey TS. Comfortably numb? Exploring satisfaction with chronic back pain visits. Spine J 2009; 9:721-8. [PMID: 19535299 DOI: 10.1016/j.spinee.2009.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 03/01/2009] [Accepted: 04/20/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Chronic back pain is a condition characterized by high rates of disability, health-care service use, and costs. PURPOSE The purpose of this study was to identify factors associated with patients' satisfaction with their last health-care provider visit for chronic low back pain (LBP). STUDY DESIGN/SETTING A cross-sectional, state-level, telephone survey was administered to patients with chronic LBP. PATIENT SAMPLE The sample consisted of 624 individuals with chronic LBP who reported seeing a health-care provider in the previous year. OUTCOME MEASURES Dependent variables included satisfaction with last visit for LBP and intent to seek care from additional providers. Independent variables included the Roland-Morris Disability Questionnaire, 3-month pain ratings using a 0 to 10 Likert scale, the Medical Outcomes Survey Short Form 12, and self-reported health service utilization (provider type, number of visits to health-care providers, medication use during the previous month, and treatments and diagnostic tests during the previous year). METHODS Bivariate and multivariate analyses were used to explore how demographic, insurance-related, and health-related characteristics were associated with patient satisfaction. RESULTS Participants who were not satisfied with one or more aspects of their last clinic visit were younger (51.0 vs. 54.21 years), reported higher 3-month pain ratings (7.23 vs. 6.53), and were more commonly Hispanic (53.2% vs. 46.8% for other ethnicities) and uninsured (43.1% vs. 29.3% for other insurance groups). Those who intended to seek care from additional providers were younger (50.05 vs. 55.49 years), had higher 3-month pain ratings (7.20 vs. 6.46), had lower Short Form 12 mental health component scores (44.75 vs. 49.55) and physical component scores (30.07 vs. 31.55), and were more commonly black (54.6% vs. 45.4% for other racial groups) and uninsured (56.9% vs. 43.1% for other insurance groups). Narcotic use was associated with satisfaction (odds ratio=2.12, p=.01), whereas lack of insurance was associated with respondents' intent to seek care from additional providers (odds ratio=2.97, p<.01). CONCLUSIONS Factors other than disability were associated with satisfaction with chronic LBP visits. Understanding the role of medication in satisfaction and its implications for the health behaviors of this highly disabled population may be particularly important.
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Affiliation(s)
- Andrea S Wallace
- University of New Mexico, College of Nursing, MSC 09 5350, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Abstract
PURPOSE Back conditions are a group of impairments that induce limitation of activities and restriction of participation, in particular delaying the Return to work (RTW). The purpose of this review is to analyse the components involved in RTW. METHOD We have included the studies and reviews about the intervention, assessment tools, variables used to forecast the RTW and the cost-benefit ratio. RESULTS We found a relevant number of studies concerning back conditions and Return to work. The evidence is moderate and the meta-analysis failed to show strong indications of efficacy. The better interventions to facilitate RTW are multidisciplinary, not necessarily intensive but taking into account a bio-psycho-social approach. The predictor of RTW does not only concern impairment (pain, rigidity etc.), but the self-estimation of ability is also important to forecast RTW. Intervention seems to be cost-effective if we calculate the saving cost in pension. CONCLUSIONS Comprehensive bio-psycho-social approaches seem to be the better modality of intervention to facilitate the RTW. More research is needed to obtain more knowledge about these issues. Particular attention should be placed on the choice of outcome measures and the cost-effectiveness of interventions.
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Affiliation(s)
- Mauro Zampolini
- Department of Rehabilitation, Local Health Service (ASL3), Umbria, 06039 Trevi, Perugia, Italy.
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Exercise therapy and low back pain: insights and proposals to improve the design, conduct, and reporting of clinical trials. Spine (Phila Pa 1976) 2008; 33:1782-8. [PMID: 18628711 DOI: 10.1097/brs.0b013e31817b8fd6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A report on plenary presentations and discussions of an expert panel and workshop ("Exercise as a treatment for subacute low back pain") that was held at the Amsterdam Forum VIII on Low Back Pain Research in Primary Care. OBJECTIVE To highlight important issues regarding the design, conduct, and reporting of exercise trials and to provide suggestions for improvement in each domain. SUMMARY OF BACKGROUND DATA Despite improvements in the methodologic quality of randomized clinical trials on low back pain (LBP), current trials on exercise therapy still show methodologic flaws in the design and reporting of studies. METHODS Important issues in the design, conduct, and reporting of exercise trials for LBP were introduced by 4 presenters, and this was followed by a group discussion among 40 attendees. Conclusions and recommendations were extracted by the workshop panelists and summarized in this paper. RESULTS.: Workshop discussion led to the following recommendations: (1) specify a theoretical framework for exercise therapy for designing the intervention and selecting appropriate treatment efficacy measures; (2) to overcome blinding problems in exercise trials, include sham interventions and assess the success of blinding; (3) evaluate the role of patient-provider interactions through the use of self-report or observational measures; (4) to assure quality of treatment, use exercise interventions that reference existing exercise guidelines; (5) use subgroup analyses to identify subgroups of patients most likely to benefit; (6) in reporting exercise trials, include an extensive description of the study population, a detailed exercise protocol, and some measure of patient compliance; (7) further categorization of exercise interventions is needed, in terms of concept, mode, intensity, duration, frequency, and length; and (8) trial;1>registration and publication of detailed study protocols may help to strengthen the evidence-based concerning exercise therapy for LBP. CONCLUSION By paying proper attention to issues concerning the design and reporting of exercise protocols when conducting future exercise trials, research may provide a stronger evidence basis for recommending or not recommending various exercise therapies for LBP.
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Perreault K, Dionne CE. Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study. BMC Musculoskelet Disord 2006; 7:76. [PMID: 16987418 PMCID: PMC1609117 DOI: 10.1186/1471-2474-7-76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 09/20/2006] [Indexed: 11/12/2022] Open
Abstract
Background Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later. Methods Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up. Results Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes. Conclusion The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings.
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Affiliation(s)
- Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Pavillon Ferdinand-Vandry, Laval University, Quebec, Quebec, G1K 7P4, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525, boulevard Wilfrid-Hamel, H-1412, Quebec, Quebec, G1M 2S8, Canada
| | - Clermont E Dionne
- Department of Rehabilitation, Faculty of Medicine, Pavillon Ferdinand-Vandry, Laval University, Quebec, Quebec, G1K 7P4, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525, boulevard Wilfrid-Hamel, H-1412, Quebec, Quebec, G1M 2S8, Canada
- Population Health Research Unit, Research Centre of the Laval University Affiliated Hospital, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy Quebec, Quebec, G1S 4L8, Canada
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