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Arnbak BAM, Jensen TS, Lund RA, Hartvigsen J, Søndergaard J, Thomsen JL, Andersen JS, Møller A, Nørgaard B, Rossen CB, Kongsted A. Usual care for low back pain and barriers to best practice: A cross-sectional study in Danish general practice. Musculoskeletal Care 2024; 22:e1911. [PMID: 38923268 DOI: 10.1002/msc.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To describe the current content of low back pain (LBP) care in Danish general practice, the patients' self-management activities, and the clinicians' experienced barriers to providing best practice care. METHODS This cross-sectional observational study included adults with LBP seeking care in Danish general practice from August 2022 to June 2023. Patient-reported information included demographics, pain intensity, medical history, treatments, and self-management strategies. Clinicians provided data specific to each consultation, detailing the content of these consultations, and barriers to best practice in the specific cases. RESULTS The study involved 71 clinicians from 42 general practice clinics, with patient-reported data from 294 patients, and clinician-reported data from 283 (95%) consultations. The mean age for the included patients was 53 years, 56% were female, and 31% had been on sick leave for LBP during the previous 3 months. Moreover, 44% had seen two or more healthcare professionals in the previous month, 55% had previously undergone diagnostic imaging for LBP, 81% reported using any type of analgesics, and 14% reported using opioids. The majority (91%) reported engaging in self-management activities to alleviate pain. Consultations typically included a physical examination (84%), information about the cause of the pain (74%), and management advice (68%), as reported by clinicians or patients. In general, clinicians reported consultation elements more frequently than patients. Clinicians reported providing best practice care in 84% of cases, with time constraints (23%) and patient expectations (10%) being the most common barriers. CONCLUSIONS This study provides detailed insights into the management of LBP in Danish general practice. It reveals a complex landscape of patient engagement, varying management strategies, and differing perceptions of care content between patients and clinicians. Patients were often engaged in self-management activities and clinicians reported few barriers to providing best practice care.
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Affiliation(s)
- Bodil Al-Mashhadi Arnbak
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Hospital Lillebaelt, Vejle, Denmark
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Diagnostic Imaging & University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Rikke Arnborg Lund
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jens Søndergaard
- Department of Public Health, The Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Center for General Practice, Aalborg University, Aalborg, Denmark
| | - John Sahl Andersen
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit of General Practice in Region Zealand and Copenhagen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, The Research Unit of User Perspectives and Community-based Interventions, University of Southern Denmark, Odense, Denmark
| | - Camilla Blach Rossen
- University Clinic for Interdisciplinary Orthopaedic Pathways, Elective Surgery Center, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Reis FJJ, Bonfim IDS, Corrêa LA, Nogueira LC, Meziat-Filho N, Almeida RSD. Uncovering emotional and network dynamics in the speech of patients with chronic low back pain. Musculoskelet Sci Pract 2024; 70:102925. [PMID: 38430821 DOI: 10.1016/j.msksp.2024.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Computational linguistics allows an understanding of language structure and different forms of expression of patients' perceptions. AIMS The aims of this study were (i) to carry out a descriptive analysis of the discourse of people with chronic low back pain using sentiment analysis (SA) and network analysis; (ii) to verify the correlation between patients' profiles, pain intensity and disability levels with SA and network analysis; and (iii) to identify clusters in our sample according to language and SA using an unsupervised machine learning technique. METHODS We performed a secondary analysis of a qualitative study including participants with chronic non-specific low back pain. We used the data related to participants' feelings when they received the diagnosis. The SA and network analysis were performed using the Valence Aware Dictionary and sEntiment Reasoner, and the Speech Graph, respectively. Clustering was performed using the K-means algorithm. RESULTS In the SA, the mean composite score was -0.31 (Sd. = 0.58). Most participants presented a negative discourse (n = 41; 72%). Word Count (WC) and Largest Strongly connected Component (LSC) positively correlated with education. No statistically significant correlations were observed between pain intensity, disability levels, SA, and network analysis. Two clusters were identified in our sample. CONCLUSION The SA showed that participants reported their feeling when describing the moment of the diagnosis using sentences with negative discourse. We did not find a statistically significant correlation between pain intensity, disability levels, SA, and network analysis. Education level presented positive correlation with WC and LSC.
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Affiliation(s)
- Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Igor da Silva Bonfim
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Leandro Calazans Nogueira
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil; Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Renato Santos de Almeida
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil; Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
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Plener J, Mior S, Atkinson-Graham M, Hogg-Johnson S, Côté P, Ammendolia C. Information is power: a qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy. Pain 2024; 165:347-356. [PMID: 37625188 PMCID: PMC10785052 DOI: 10.1097/j.pain.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
ABSTRACT Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' lives. Therefore, this study aimed to explore the everyday experiences of individuals living with DCR. A qualitative study was conducted through an interpretivist lens exploring the experiences of participants. Participants were purposefully recruited and interviewed with 2 research team members. Transcripts were independently analyzed by 2 reviewers and coding was finalized by consensus. Analysis was performed using an interpretative phenomenological approach, with emergent themes mapped onto the 5 domains of the International Classification of Functioning, Disability and Health framework. Eleven participants were interviewed between December 2021 and April 2022. Three themes emerged: the biopsychosocial impact of DCR, role of the health care provider, and uncertainty surrounding DCR. Pain and paraesthesia were the most common symptoms experienced by participants, leading to significant psychological distress and impact to daily activities, most notably driving, housecleaning, sleep, and ability to work. Participants described the uncertainty they experienced as a result of the unpredictable nature of DCR and the important role that health care providers play in their journey with DCR. Health care providers were seen acting as either a facilitator or a barrier to their recovery. The findings from this study can be used by clinicians providing patient-centered care to better understand the experiences of people with DCR.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Silvano Mior
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melissa Atkinson-Graham
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carlo Ammendolia
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain 2024; 28:181-198. [PMID: 37874300 DOI: 10.1002/ejp.2190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Low back pain (LBP), and in particular non-specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into 'specific' versus 'non-specific' and 'acute' versus 'chronic' pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients. DATABASES AND DATA TREATMENT Narrative review. RESULTS NSLBP is a multi-dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive-behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re-assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively. CONCLUSIONS The identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient. SIGNIFICANCE STATEMENT Here, a comprehensive review of the challenges associated with the diagnostic label 'non-specific low back pain' is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.
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Affiliation(s)
- Brigitte Wirth
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Fernández-Lorenzo L, Pértega-Díaz S, Sobrido-Prieto M. [Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review]. Rehabilitacion (Madr) 2024; 58:100817. [PMID: 37879144 DOI: 10.1016/j.rh.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 10/27/2023]
Abstract
Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.
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Affiliation(s)
- L Fernández-Lorenzo
- Facultad de Ciencias de la Salud, Universidade da Coruña (UDC), Campus de Oza, A Coruña, España.
| | - S Pértega-Díaz
- Facultad de Ciencias de la Salud, Universidade da Coruña (UDC), Campus de Oza, A Coruña, España
| | - M Sobrido-Prieto
- Facultad de Ciencias de la Salud, Universidade da Coruña (UDC), Campus de Oza, A Coruña, España
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van Rysewyk S, Blomkvist R, Chuter A, Crighton R, Hodson F, Roomes D, Smith BH, Toye F. Understanding the lived experience of chronic pain: A systematic review and synthesis of qualitative evidence syntheses. Br J Pain 2023; 17:592-605. [PMID: 37969135 PMCID: PMC10642495 DOI: 10.1177/20494637231196426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Although multiple measures of the causes and consequences of chronic non-cancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom. Methods Four bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives who co-created twenty survey statements. The survey was developed for testing the QES themes for validity in people living with pain. Results The research team identified and screened 1323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to myself; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a 2-week period in November 2021, and was completed by 1219 people, largely confirming the above themes. Conclusion/Implications This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic non-malignant musculoskeletal pain and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
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Affiliation(s)
- Simon van Rysewyk
- Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart, TAS, Australia
| | - Renée Blomkvist
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Rhea Crighton
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | | | - Blair H Smith
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Møller A, Bond CB, Andersen LN, Hartvigsen J, Stochkendahl MJ. General practitioners' stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program. Scand J Prim Health Care 2023; 41:445-456. [PMID: 37837433 PMCID: PMC11001345 DOI: 10.1080/02813432.2023.2268674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVES To describe current stay-at-work practices among Danish general practitioners (GPs) in relation to patients with musculoskeletal disorders, to identify potential avenues for improvement, and to suggest a training program for the GPs. DESIGN AND SETTING We followed the principles of Intervention Mapping. Data were collected by means of literature searches, focus group interviews with GPs, and interaction with stakeholder representatives from the Danish labour market. RESULTS GPs' current stay-at-work practices were influenced by systemic, organisational, and legislative factors, and by personal determinants, including knowledge and skills relating to stay-at-work principles and musculoskeletal disorders, recognition of the patient's risk of long-term work disability, their role as a GP, and expectations of interactions with other stay-at-work stakeholders. GPs described themselves as important partners and responsible for the diagnostic and holistic assessments of the patient but placed themselves on the side line relying on the patient or workplace stakeholders to act. Their practices are influenced both by patients, employers, and by other stakeholders. We propose a training course for GPs that incorporate both concrete tools and behaviour change techniques. CONCLUSIONS We have identified varied perspectives on the roles and responsibilities of GPs, as well as legislative and organisational barriers, and proposed a training program. Not all barriers identified can be addressed by a training course, and some questions are left unanswered, among others - who are best suited to help patients staying at work?
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Affiliation(s)
- A. Møller
- Research Unit for General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C. B. Bond
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L. N. Andersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J. Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - M. J. Stochkendahl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Straszek CL, Skrubbeltrang LS, O'Sullivan K, Thomsen JL, Rathleff MS. Competences to self-manage low back pain among care-seeking adolescents from general practice - a qualitative study. BMC PRIMARY CARE 2023; 24:252. [PMID: 38030978 PMCID: PMC10685513 DOI: 10.1186/s12875-023-02212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND There is limited knowledge about when and how adolescents with low back pain (LBP) interact with health care providers. This limits our understanding of how to best help these young patients. This study aimed to understand when and how care-seeking adolescents with LBP interact with health care providers and which health literacy competencies and strategies do they use to self-managing their LBP. METHOD Ten semi-structured interviews (duration 20-40 min) were conducted online among adolescents aged 15-18 with current or recent LBP (pain duration range; 9 months - 5 years). The interview guide was informed by literature on health literacy and self-management in patients. We conducted a semantic and latent thematic data analyses. RESULTS Three major themes emerged from the analysis: (1) Self-management, (2) Pain and Function, and (3) Communication. All adolescents were functionally limited by their pain but the main reason to consult a health care provider was an increase in pain intensity. Many were able to navigate the healthcare system, but experienced difficulties in communicating with health care providers, and many felt that they were not being taken seriously. Their first line self-management option was often over-the-counter pain medicine with limited effects. Most adolescents expressed a desire to self-manage their LBP but needed more guidance from health care providers. CONCLUSION Adolescents with LBP seek care when pain intensifies, but they lack self-management strategies. Many adolescents want to self-manage their LBP with guidance from health care providers, but insufficient communication is a barrier for collaboration on self-management.
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Affiliation(s)
- Christian Lund Straszek
- Center for General Practice at Aalborg University, Aalborg, Denmark.
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
- Department of Physiotherapy, University of Northern Denmark, Aalborg, Denmark.
| | | | - Kieran O'Sullivan
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | | | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Abudoush AN, Ali K, Kiran T, Panagioti M, Poliakoff E, Mo Hom N, Husain N. Exploring chronic pain related attentional experiences, distress and coping strategies among Arabic-speaking individuals in Jordan and the United Kingdom. Front Psychol 2023; 14:1268179. [PMID: 37849474 PMCID: PMC10577280 DOI: 10.3389/fpsyg.2023.1268179] [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: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction The lived experiences of chronic pain (CP) among Arabic-speaking populations remain underexplored. A better understanding of these experiences and their associations with attention difficulties, coping mechanisms, and treatment options could lead to improved support for this group. Methods This qualitative study utilised a descriptive design and involved one-to-one interviews with 51 participants with CP who had just completed two attention tasks. Interviews were conducted using a semi-structured topic guide, transcribed verbatim and translated from Arabic to English before agreeing on the coding framework. Themes and subthemes were extracted using a framework analysis approach. Results The study identified six main themes: Factors contributing towards developing or exacerbating CP, the impact of CP on psychosocial functions, including attention, the perceived role of social support, coping strategies for managing CP, perceptions about available treatments and recommendations for interventions. Discussion CP significantly impacts individuals' physical and psychosocial functions, and it is reciprocally associated with attentional difficulties. Despite using various approaches to manage their CP, none of the participants used psychological interventions or counselling. Understanding the diverse impacts of CP and the coping strategies employed to develop culturally sensitive interventions, review current related policies, and improve healthcare services is crucial to managing CP among this population.
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Affiliation(s)
- Ahmad N. Abudoush
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Psychology, The University of Jordan, Amman, Jordan
| | - Khalifa Ali
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Tayyeba Kiran
- Department of Research and Development, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maria Panagioti
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Ellen Poliakoff
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Nang Mo Hom
- Research Capacity and Capability Program, Ethnic Health Forum, Manchester, United Kingdom
| | - Nusrat Husain
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
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Roberts KE, Beckenkamp PR, Ferreira ML, Ho EK, Carvalho-E-Silva AP, Calais-Ferreira L, Ferreira PH. The impact of aggregate positive lifestyle behaviors on low back pain resilience and care seeking. Spine J 2023; 23:1405-1413. [PMID: 37393016 DOI: 10.1016/j.spinee.2023.06.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a global issue, and the high associated costs are mainly attributed to a small proportion of people with LBP who seek care. Importantly, the impact of aggregate positive lifestyle behaviors on LBP resilience and care seeking is not known. PURPOSE This study aimed to evaluate the relationship between positive lifestyle behaviors and LBP resilience. STUDY DESIGN This study was a prospective longitudinal cohort study. PATIENT SAMPLE Data was collected as part of the AUstralian Twin BACK Study (AUTBACK). Participants who reported a lifetime previous history of LBP at baseline were included in this analysis (n = 340). OUTCOME MEASURES The outcomes of interest were the number of weeks without activity limiting LBP and total number of days of healthcare usage, health practitioner care, self-management care, and medication intake. METHODS A lifestyle behavior score was built using variables of body mass index (BMI), physical activity, smoking status, and sleep quality. Negative binomial regression analyses were used to assess the relationship between the positive lifestyle behavior score and the count outcomes of number of weeks without activity limiting LBP and number of days participants used care. RESULTS After adjusting for covariates, no association was found between participants' positive lifestyle behavior score and their number of weeks without activity limiting LBP (IRR: 1.02, 95% CI 1.00-1.05). There was a statistically significant relationship between higher positive lifestyle behavior scores and fewer number of days of participants' total healthcare usage (IRR:0.69, 95% CI 0.56-0.84), healthcare practitioner visits (IRR:0.62, 95% CI 0.45-0.84), use of self-management strategies (IRR:0.74, 95% CI 0.60-0.91), and use of pain medication (IRR:0.55, 95% CI 0.44-0.68). CONCLUSION People who adopt optimal lifestyle behaviors, such as engaging in adequate physical activity, achieving optimal quality sleep, maintaining an ideal BMI, and not smoking, may not experience less time suffering from activity limiting LBP, but are less likely to use healthcare and pain medication for their LBP.
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Affiliation(s)
- Katharine E Roberts
- Faculty of Medicine and Health, The University of Sydney, Western Avenue Camperdown, Sydney, Australia.
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Emma K Ho
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Ana P Carvalho-E-Silva
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Lucas Calais-Ferreira
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Grattan Street Parkville, Melbourne, Australia
| | - Paulo H Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana. BMJ Open 2023; 13:e073538. [PMID: 37474173 PMCID: PMC10360413 DOI: 10.1136/bmjopen-2023-073538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana. OBJECTIVES To explore the psychosocial impact of CLBP among patients with CLBP in Ghana. DESIGN Qualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP attending physiotherapy at two hospitals in Ghana. RESULTS Five categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived. CONCLUSION CLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients' psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Chiropractic and Sports Rehabilitation, London South Bank University, London, UK
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Claire Diver
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
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13
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Mescouto K, Olson RE, Setchell J. Towards an ethical multiplicity in low back pain care: Practising beyond the biopsychosocial model. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:522-541. [PMID: 36541421 PMCID: PMC10947319 DOI: 10.1111/1467-9566.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non-human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical settings as 'becoming more-than-sterile environments' where objects, furniture and elements such as tears and laughter help to provide a relational, welcoming and comfortable space to all bodies with LBP; (2) differences through 'becoming minoritarian' where considering power relations allows actions towards connectiveness and belonging; and (3) disciplinary boundaries through 'becoming interdisciplinary within' where actions expand traditional scopes of practice. The flux of these multiple becomings moves clinical practice and conceptualisations beyond the biopsychosocial approach to consider a new ethico-onto-epistemological approach to LBP care. They invite clinical practices that engage with an ethical multiplicity of LBP care, providing a better understanding of how places, objects, emotions, power, bodies and professions are interconnected and come together in everyday practice.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | | | - Jenny Setchell
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
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14
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Ng JY, Anagal M, Bhowmik T. Low back pain patients' perceived effectiveness of utilizing complementary and alternative medicine: a systematic review of qualitative studies. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:47-80. [PMID: 34461012 DOI: 10.1515/jcim-2021-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of this systematic review of qualitative studies is to explore patients' perceived effectiveness of utilizing complementary and alternative medicine (CAM) for the treatment and/or management of low back pain (LBP). METHODS MEDLINE, EMBASE, AMED, and CINAHL were systematically searched from database inception until May 2020. Eligible articles included qualitative data about LBP patients' perceptions of using CAM. RESULTS Of 1,567 items, 1,542 items were excluded; the remaining 25 articles were included in this review. Three themes emerged as follows: physical benefits; mental health benefits; and negative or no perceived effectiveness of CAM on patients with LBP. CONCLUSIONS This study explores perceptions of CAM effectiveness among patients with LBP. These findings provide valuable information to CAM and non-CAM practitioners regarding the importance of individualized patient care based on their preferences, values, needs, and perspectives. Further exploration could include practitioners' perceptions of CAM and their impact on the patient-practitioner relationship.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mrinal Anagal
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Trisha Bhowmik
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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15
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O'Hagan ET, Cashin AG, Traeger AC, McAuley JH. Person-centred education and advice for people with low back pain: Making the best of what we know. Braz J Phys Ther 2023; 27:100478. [PMID: 36657216 PMCID: PMC9868342 DOI: 10.1016/j.bjpt.2022.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care. OBJECTIVE This Masterclass will draw on recent evidence to explore how physical therapy clinicians could deliver person-centred education and advice to people with low back pain to refine their clinical consultation. DISCUSSION First, we highlight the potential value of providing validation to acknowledge the distressing experience and consequences of low back pain. Second, we describe a tool to open channels of communication to provide education and advice in a patient-centred and efficient way. Clinicians could consider using the Attitude toward Education and advice for Low back pain Questionnaire to gain an insight into patient attitudes toward education and advice at the outset of a clinical encounter. Finally, we provide options for tailoring patient education and advice to promote self-management of low back pain based on patient attitudes. We present evidence that a positive attitude toward messages about causes rather than messages about physical activity predicts intention to self-manage low back pain. We combine this evidence to suggest a pathway for clinicians to provide education and advice to people with low back pain within the time constraints of a clinical consultation.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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16
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Riipinen P, Holmes M, Ogilvie S, Newell D, Byfield D, du Rose A. Patient's perception of exercise for management of chronic low back pain: A qualitative study exercise for the management of low back pain. Musculoskeletal Care 2022; 20:848-859. [PMID: 35384268 DOI: 10.1002/msc.1637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pathoanatomical beliefs about the cause of low back pain may negatively influence patients' perceptions of 'best care', such as the inclusion of exercise for low back pain (LBP) management. The aims of this study were to explore what patients receiving manual therapy are told and understand about their LBP diagnosis, and how this affects their perceptions regarding the role of exercise in the management of their LBP. DESIGN An interpretative phenomenological analysis (IPA) study design was utilised using semi-structured telephone interviews of patients who experience persistent LBP and seek care at an outpatient clinic at the University of South Wales. Ten participants were interviewed for the study (six male). Interviews were transcribed verbatim and analysed using an IPA approach. RESULTS Three main themes were generated: (1) Constructing explanation of pain. (2) Expectations of exercise within care seeking behaviours. (3) Resolving conflict between exercise and back pain narratives. Participants linked their pain to a pathoanatomical cause, impacting their beliefs on exercise as a treatment approach. CONCLUSION Diagnostic models used by clinicians which are grounded within a pathoanatomical framework influence patients' perceptions and rationale for exercise. Exercise prescription using contemporary pain science and biopsychosocial approaches should be emphasised in practice and education.
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Affiliation(s)
- Perttu Riipinen
- Welsh Institute of Chiropractic, University of South Wales, Treforest, UK
| | | | - Samantha Ogilvie
- Welsh Institute of Chiropractic, University of South Wales, Treforest, UK
| | | | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Treforest, UK
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17
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Caeiro C, Moore A, Price L. Clinical encounters may not be responding to patients' search for meaning and control over non-specific chronic low back pain - an interpretative phenomenological analysis. Disabil Rehabil 2022; 44:6593-6607. [PMID: 34420461 DOI: 10.1080/09638288.2021.1966679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Considering the need to study the experiences of individuals with musculoskeletal problems in contexts that have not yet been investigated as well as the relevance of fostering a research agenda towards person-centred care, this study aimed to explore the experiences of non-specific chronic low back pain from the perspective of Portuguese individuals living with it. MATERIAL AND METHODS An interpretative phenomenological analysis was employed to explore the experiences of eight participants, who were recruited purposefully from two primary care centres and one clinic. Semi-structured one-to-one interviews were carried out, audio-recorded and transcribed verbatim. RESULTS Three themes were generated as interrelated parts of an extended account that explored the participants' meaning making of their experience: "Non-specific chronic low back pain as a disruptive experience"; "Searching for the meaning of non-specific chronic low back pain"; and, "Clinical encounters that perpetuate the lack of understanding about non-specific chronic low back pain." CONCLUSIONS This study offers insight into the Portuguese individuals' experiences of non-specific chronic low back pain. Particularly, it suggests that clinical encounters may not be aligned with patients' needs and expectations. These findings may help clinicians in transferring this knowledge to therapeutic approaches to individuals with similar experiences/contexts.IMPLICATIONS FOR REHABILITATIONPatients with NSCLBP need to understand their pain and to retain a sense of control over their lives.Encounters with health professionals may perpetuate the lack of understanding about pain and strategies to control it, as patients consider themselves unable to have an active role in the decision-making and are disempowered to deal with their pain.Health professionals should involve patients and promote the co-construction of an explanation that integrates both health professionals' knowledge and patients' narratives.There is a need to align both the patients' and health professionals' perspectives regarding health care in order to implement patient-centred and individually tailored treatment.
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Affiliation(s)
- Carmen Caeiro
- School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Ann Moore
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Lee Price
- School of Health Sciences, University of Brighton, Eastbourne, UK
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Hayashi K, Ikemoto T, Shiro Y, Arai YC, Marcuzzi A, Costa D, Wrigley PJ. A Systematic Review of the Variation in Pain Catastrophizing Scale Reference Scores Based on Language Version and Country in Patients with Chronic Primary (Non-specific) Pain. Pain Ther 2022; 11:753-769. [PMID: 35567720 PMCID: PMC9314526 DOI: 10.1007/s40122-022-00390-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/20/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This systematic review aimed to investigate variations of reference scores for the Pain Catastrophizing Scale (PCS) between language versions and between countries in patients with chronic primary pain (CPP) or chronic primary pain, not otherwise specified (CPP-NOS). METHODS Electronic searches of the Ovid/Embase, Ovid/MEDLINE, and Ovid/PsycINFO databases were conducted to retrieve studies assessing PCS scores in adults with CPP or CPP-NOS proposed by the International Classification of Diseases, Eleventh Revision for any country where the translated PCS was available. The protocol for this systematic review was prospectively registered on the International Prospective Register of Systematic Reviews 2018 (registration number: CRD 42018086719). RESULTS A total of 3634 articles were screened after removal of duplicates. From these, 241 articles reporting on 32,282 patients with chronic pain were included in the review. The mean (± standard deviation) weighted PCS score across all articles was 25.04 ± 12.87. Of the 12 language versions and 21 countries included in the review, the weighted mean PCS score in Asian languages or Asian countries was significantly higher than that in English, European, and other languages or Western and other countries. The highest mean score of the weighted PCS based on language was in Japanese (mean 33.55), and the lowest was in Russian (mean 20.32). The highest mean score of the weighted PCS based on country was from Japan (mean 33.55), and the lowest was from Australia (mean 19.80). CONCLUSION The weighted PCS scores for people with CPP or CPP-NOS were significantly higher in Asian language versions/Asian countries than in English, European and other language versions or Western and other countries.
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Affiliation(s)
- Kazuhiro Hayashi
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA, USA
| | - Tatsunori Ikemoto
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan.
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Yukiko Shiro
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
| | - Young-Chang Arai
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
| | - Anna Marcuzzi
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Costa
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Paul J Wrigley
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
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Falsiroli Maistrello L, Zanconato L, Palese A, Geri T, Turolla A, Gianola S, Dell’Isola A, Rossettini G. Perceptions and Experiences of Individuals With Neck Pain: A Systematic Critical Review of Qualitative Studies With Meta-Summary and Meta-Synthesis. Phys Ther 2022; 102:6609052. [PMID: 35708498 PMCID: PMC9384136 DOI: 10.1093/ptj/pzac080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies. METHODS A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool. RESULTS Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical ("My neck has gone wrong"); psychological ("I am worried about my recovery"); and social ("Pain limits my life"). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively). CONCLUSION An individual's experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual's experiences to offer a truly patient-centered care pathway. IMPACT This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.
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Affiliation(s)
- Luca Falsiroli Maistrello
- School of Physiotherapy, University of Verona, Verona, Italy,Department of Physical Medicine and Rehabilitation, AULSS9 Scaligera, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater University of Bologna, Bologna, Italy,Division of Occupational Medicine, Sant’Orsola-Malpighi Hospital IRCCS, Bologna, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences, Orthopaedic, Faculty of Medicine, Lund University, Lund, Sweden,Address all correspondence to Dr Dell’Isola at:
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Bourke MJ, Ferguson D, Cooke M. Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study. Phys Ther 2022; 102:6556165. [PMID: 35358311 DOI: 10.1093/ptj/pzac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 11/08/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is a lifelong condition causing disability and distress. One aim of treatment is to enhance self-management. To date, self-management interventions have had limited effectiveness. A greater understanding of self-management for CLBP has the potential to improve future interventional trials. The purpose of this study was to identify the experience of CLBP self-management for patients attending outpatient physical therapy and assess how the experience of CLBP self-management changes over time. METHODS This qualitative study used constructivist grounded theory. Patients with CLBP who were attending an outpatient physical therapy department were recruited using convenience sampling. Each participant attended a semistructured interview. These were audio recorded and transcribed verbatim. The data were coded and thematically analyzed by the lead researcher. Recruitment continued until data saturation. Participants reviewed preliminary themes for validation. RESULTS Six subthemes emerged from 9 interviews: (1) self-doubt, (2) coping day to day, (3) independent discovery, (4) developing resilience, (5) health care: opportunity and threat, and (6) living with pain differently. Two themes took on greatest significance. Self-doubt appeared most strongly and was prevalent in all experiences. However, living with pain differently appeared in those who had developed a level of pain acceptance. These themes formed a conceptual model, "Fluctuating Uncertainty." CONCLUSION The experience of CLBP self-management is one of fluctuating self-doubt. Self-doubt is the predominant experience and is characterized by the perception of pain as a threat and low pain self-efficacy. During times of greater clarity, individuals develop strategies that increase pain self-efficacy and reinforce the perception of pain without threat. These are features of learning to live well with pain. IMPACT CLBP is a lifelong condition requiring self-management. The current study characterizes the self-management strategies used by patients attending physical therapy. The fluctuating nature of these strategies is dependent upon perception of pain and pain self-efficacy. LAY SUMMARY People with CLBP who self-manage their pain fluctuate between attempting to control pain and learning to live with pain. People who understand their condition develop wider-ranging self-management strategies.
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Affiliation(s)
- Maurice John Bourke
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Diarmaid Ferguson
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Horment-Lara G, Lüttges-Sciaccaluga C, Espinoza-Ordóñez C, Aliaga-Castillo V. "I don't want to be a burden" A qualitative study of the beliefs of women with chronic low back pain in relation to their painful experience. Musculoskelet Sci Pract 2022; 59:102539. [PMID: 35278835 DOI: 10.1016/j.msksp.2022.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women's pain is still poorly understood. Moreover, maladaptive pain beliefs contribute to the disability associated with low back pain and play a key role in the transition from acute to chronic symptoms. OBJECTIVES To explore the beliefs of women with non-specific chronic low back pain in terms of nature of symptoms, fears associated with pain, expectations for recovery, family, social and work-related limitations, and perceived self-efficacy. DESIGN AND METHODS A qualitative study with an interpretative approach was undertaken. Face-to-face, semi-structured individual interviews were performed. Study participants were 10 women with non-specific chronic low back pain living in the Metropolitan Region of Chile. Thematic analysis was used to analyze the data. A deductive process was used to code the text and categorize the data. RESULTS Participants described maladaptive beliefs about pain, leading to fearful attitudes and low expectations for recovery. These beliefs seemed to perpetuate pain and limit engagement in daily tasks and meaningful activities. Some of these beliefs were associated with information provided by healthcare professions. Despite having maladaptive beliefs, women perceived themselves as self-effective. CONCLUSION Women with chronic low back pain described a range of different pain beliefs across a complex categorial structure. The contents of such structure may interfere with their decisions about therapeutic options. Their beliefs were often ungrounded in scientific principles, even if the information may have been provided by healthcare providers. Physical therapists would benefit from these findings to improve communication with their patients and assess the role of beliefs in decision-making.
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Affiliation(s)
| | | | - César Espinoza-Ordóñez
- Clínica Quilín, Universidad de Chile, Santiago, Chile; Department of Health Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
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"My Pain Is Unbearable…I Cannot Recognize Myself!" Emotions, Cognitions, and Behaviors of People Living With Musculoskeletal Disorders: An Umbrella Review. J Orthop Sports Phys Ther 2022; 52:243-A102. [PMID: 35536247 DOI: 10.2519/jospt.2022.10707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize (1) the emotions, cognitions, and behaviors of people who are living with musculoskeletal disorders related to symptoms and (2) the interactions of emotions, cognitions, and behaviors with the person's environment (family, social, and work roles). DESIGN An umbrella review of qualitative research syntheses and meta-summaries (metasynthesis, meta-ethnographies, meta-aggregation, meta-summary). LITERATURE SEARCH We searched CINAHL, EMBASE, PsycARTICLES, PsycEXTRA, PsycINFO, PubMed, and PubPsych from database inception to January 2021. We also searched gray literature via Open Grey and Google Scholar. STUDY SELECTION CRITERIA We included qualitative evidence syntheses evaluating adults with musculoskeletal disorders, based on the multidimensional diagnostic criteria for acute and chronic pain. Emotions, cognitions, and behaviors were the phenomenon of interest. DATA SYNTHESIS We developed 3 categories of themes ([1] emotions, [2] cognitions, and [3] behaviors) for each objective. We selected the 3 most common emotions, cognitions, and behaviors that appear as themes in our narrative synthesis. RESULTS We included 20 qualitative evidence syntheses that retrieved 284 original qualitative studies. Despair, distress, and fear were the main emotions reported by people living with musculoskeletal disorders. The alterations of the self and how people described their symptoms, what caused them, and how the symptoms impacted their lives were the most common cognitions. Cognitive strategies (ie, acceptance) and perceptions about social support emerged. People often used passive behaviors (eg, social isolation or hiding symptoms) to cope with the challenges that arose related to musculoskeletal symptoms. However, some people actively faced their symptoms, planning their activities or practicing them despite their symptoms. CONCLUSION Clinicians who support people living with musculoskeletal disorders should consider (1) assessing other emotions than pain-related fear (eg, despair and distress), (2) observing their cognitive responses (ie, acceptance), and (3) evaluating what type of behaviors people use (eg, active or passive). J Orthop Sports Phys Ther 2022;52(5):243-261. doi:10.2519/jospt.2022.10707.
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Liew BXW, Ford JJ, Briganti G, Hahne AJ. Understanding how individualised physiotherapy or advice altered different elements of disability for people with low back pain using network analysis. PLoS One 2022; 17:e0263574. [PMID: 35143552 PMCID: PMC8830646 DOI: 10.1371/journal.pone.0263574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose
The Oswestry Disability Index (ODI) is a common aggregate measure of disability for people with Low Back Pain (LBP). Scores on individual items and the relationship between items of the ODI may help understand the complexity of low back disorders and their response to treatment. In this study, we present a network analysis to explore how individualised physiotherapy or advice might influence individual items of the ODI, and the relationship between those items, at different time points for people with LBP.
Methods
Data from a randomised controlled trial (n = 300) comparing individualised physiotherapy versus advice for low back pain were used. A network analysis was performed at baseline, 5, 10, 26 and 52 weeks, with the 10 items of the Oswestry Disability Index modelled as continuous variables and treatment group (Individualised Physiotherapy or Advice) modelled as a dichotomous variable. A Mixed Graphical Model was used to estimate associations between variables in the network, while centrality indices (Strength, Closeness and Betweenness) were calculated to determine the importance of each variable.
Results
Individualised Physiotherapy was directly related to lower Sleep and Pain scores at all follow-up time points relative to advice, as well as a lower Standing score at 10-weeks, and higher Lifting and Travelling scores at 5-weeks. The strongest associations in the network were between Sitting and Travelling at weeks 5 and 26, between Walking and Standing at week 10, and between Sitting and Standing scores at week 52. ODI items with the highest centrality measures were consistently found to be Pain, Work and Social Life.
Conclusion
This study represents the first to understand how individualised physiotherapy or advice differentially altered disability in people with LBP. Individualised Physiotherapy directly reduced Pain and Sleep more effectively than advice, which in turn may have facilitated improvements in other disability items. Through their high centrality measures, Pain may be considered as a candidate therapeutic target for optimising LBP management, while Work and Socialising may need to be addressed via intermediary improvements in lifting, standing, walking, travelling or sleep. Slower (5-week follow-up) improvements in Lifting and Travelling as an intended element of the Individualised Physiotherapy approach did not negatively impact any longer-term outcomes.
Trials registration
ACTRN12609000834257.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
- * E-mail: ,
| | - Jon J. Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne Australia
| | - Giovanni Briganti
- Department of Psychology, Harvard University, Cambridge, Massachusetts United States of America
| | - Andrew J. Hahne
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne Australia
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Pellekooren S, Ben ÂJ, Bosmans JE, Ostelo RWJG, van Tulder MW, Maas ET, Huygen FJPM, Oosterhuis T, Apeldoorn AT, van Hooff ML, van Dongen JM. Can EQ-5D-3L utility values of low back pain patients be validly predicted by the Oswestry Disability Index for use in cost-effectiveness analyses? Qual Life Res 2022; 31:2153-2165. [PMID: 35040002 PMCID: PMC9188530 DOI: 10.1007/s11136-022-03082-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Purpose To assess whether regression modeling can be used to predict EQ-5D-3L utility values from the Oswestry Disability Index (ODI) in low back pain (LBP) patients for use in cost-effectiveness analysis. Methods EQ-5D-3L utility values of LBP patients were estimated using their ODI scores as independent variables using regression analyses, while adjusting for case-mix variables. Six different models were estimated: (1) Ordinary Least Squares (OLS) regression, with total ODI score, (2) OLS, with ODI item scores as continuous variables, (3) OLS, with ODI item scores as ordinal variables, (4) Tobit model, with total ODI score, (5) Tobit model, with ODI item scores as continuous variables, and (6) Tobit model, with ODI item scores as ordinal variables. The models’ performance was assessed using explained variance (R2) and root mean squared error (RMSE). The potential impact of using predicted instead of observed EQ-5D-3L utility values on cost-effectiveness outcomes was evaluated in two empirical cost-effectiveness analysis. Results Complete individual patient data of 18,692 low back pain patients were analyzed. All models had a more or less similar R2 (range 45–52%) and RMSE (range 0.21–0.22). The two best performing models produced similar probabilities of cost-effectiveness for a range of willingness-to-pay (WTP) values compared to those based on the observed EQ-5D-3L values. For example, the difference in probabilities ranged from 2 to 5% at a WTP of 50,000 €/QALY gained. Conclusion Results suggest that the ODI can be validly used to predict low back pain patients’ EQ-5D-3L utility values and QALYs for use in cost-effectiveness analyses. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03082-6.
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Affiliation(s)
- Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
- Department Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Ângela J Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Esther T Maas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Frank J P M Huygen
- Center of Pain Medicine Erasmusmc, Rotterdam, The Netherlands
- Center of Pain Medicine UMCU, Utrecht, The Netherlands
| | - Teddy Oosterhuis
- Netherlands Society of Occupational Medicine, Centre of Excellence, Utrecht, the Netherlands
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Adri T Apeldoorn
- Rehabilitation Departement, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands, Breederode Hogeschool, Rotterdam, Netherlands
| | - Miranda L van Hooff
- Departement Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Disrupted everyday life in the trajectory of low back pain: A longitudinal qualitative study of the cross-sectorial pathways of individuals with low back pain over time. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Meiling JB, Moman R, Pagan-Rosado R, Kinzelman-Vesely E, Hunt C, Hooten WM. Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review. J Pain Res 2021; 14:2851-2858. [PMID: 34539187 PMCID: PMC8445100 DOI: 10.2147/jpr.s327504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
The association between electromyography (EMG)-confirmed lumbosacral (LS) radiculopathy and pain outcomes following epidural steroid injection (ESI) has not been systematically summarized. The primary objective of this systematic review was to summarize the effects of EMG-confirmed LS radiculopathy on pain intensity following ESI. A secondary objective was to summarize the effects of EMG-confirmed LS radiculopathy on physical functioning following ESI. An a priori protocol was registered and a database search conducted by a reference librarian from January 2000 through December 2020. The search was date-limited to ensure the results of the systematic review represented contemporary clinical practice. Study-inclusion criteria included randomized trials, prospective and retrospective studies, cross-sectional studies, case series, and case reports, age ≥18 years, and use of EMG as a prognostic tool prior to an ESI. Two independent reviewers screened all titles, abstracts, and full texts. Data were extracted using a templated electronic database. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool and certainty in evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Due to clinical heterogeneity in study characteristics, a meta-analysis was not performed. A total of 454 studies were screened, and eight nonrandomized studies met the inclusion criteria. Five studies had a moderate risk of bias, two serious risks, and one a critical risk. The key findings included four of eight nonrandomized studies reporting a significant association between EMG-confirmed radiculopathy and ESI response and four of eight nonrandomized studies reporting no significant association. Important sources of bias limited interpretation of individual study findings, and multiple sources of clinical heterogeneity limited between-study comparisons. The findings of this systematic review demonstrate that associations existed between EMG-confirmed LS radiculopathy and pain outcomes after ESI in some, but not all studies. These results should be carefully interpreted with full understanding of the risk of bias and very low certainty in evidence that characterize the nonrandomized studies comprising this systematic review.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Rajat Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert Pagan-Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Christine Hunt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
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Enthoven P, Eddeborn F, Abbott A, Schröder K, Fors M, Öberg B. Patients' experiences of the BetterBack model of care for low back pain in primary care - a qualitative interview study. Int J Qual Stud Health Well-being 2021; 16:1861719. [PMID: 33393455 PMCID: PMC7782354 DOI: 10.1080/17482631.2020.1861719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; “Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems”, comprising the following categories: “Knowledge translation”, “Interaction and dialogue”, “The health care professional support” and “Form organization”. Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain.
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Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Fredrik Eddeborn
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Rehab West, Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
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Petrozzi MJ, Spencer G, Mackey MG. A process evaluation of the Mind Your Back trial examining psychologically informed physical treatments for chronic low back pain. Chiropr Man Therap 2021; 29:32. [PMID: 34404446 PMCID: PMC8369773 DOI: 10.1186/s12998-021-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called ‘Mind Your Back’ was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result. Methods In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5–6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically. Results Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support. Conclusion It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00389-y.
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Affiliation(s)
- M John Petrozzi
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia.
| | - Grace Spencer
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Martin G Mackey
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia
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Stensland M. "If You Don't Keep Going, You're Gonna Die": Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain. THE GERONTOLOGIST 2021; 61:907-916. [PMID: 33033826 DOI: 10.1093/geront/gnaa150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP. RESEARCH DESIGN AND METHODS Using van Manen's phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding. RESULTS Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going. DISCUSSION AND IMPLICATIONS This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio
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O'Hagan ET, Traeger AC, Bunzli S, Leake HB, Schabrun SM, Wand BM, O'Neill S, Harris IA, McAuley JH. What do people post on social media relative to low back pain? A content analysis of Australian data. Musculoskelet Sci Pract 2021; 54:102402. [PMID: 34058728 DOI: 10.1016/j.msksp.2021.102402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Low back pain is the leading contributor to the global disability burden. The Global Spine Care Initiative (GSCI) recommend patient-centred care to stem the cost of low back pain. One way to enhance patient-centred care is by better understanding what is relevant for people with low back pain. Exploring social media posts about low back pain could offer this insight and provide valuable information for health care professionals to facilitate active participation in patient-centred care. METHODS We used an inductive content analysis method. In the form of social media posts, data on Twitter and Instagram were collected from June to August 2018. The posts were geo-targeted to Australia. We recorded the number of status broadcasts that contained a low back pain keyword and responses. We developed a codebook to describe the data and applied it to identify low back pain themes. RESULTS We analysed 768 posts containing 457 status broadcasts and 311 responses. Almost half (49%) of status broadcasts about low back pain seemed to seek validation. Expressing sympathy (31%) was the most common response to a status broadcast about low back pain. There were no public responses to 76% of status broadcasts about low back pain. Our analysis yielded two core themes, "hear my pain" and "I feel for you". CONCLUSIONS Posts about low back pain on social media often seem to suggest that the person posting is seeking validation. Responses typically express sympathy or a shared experience; yet, there is no response to most social media posts about low back pain.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Bunzli
- The University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Sean O'Neill
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, New South Wales, Australia; Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Medical Science, University of New South Wales, Sydney, New South Wales, Australia
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Volinn E, Loeser JD. Upsurges in the joblessness and opioid epidemics in the United States after the COVID-19 epidemic: the plight of the jobless patient in the clinic. Pain 2021; 162:1608-1611. [PMID: 33657577 DOI: 10.1097/j.pain.0000000000002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ernest Volinn
- Department of Sociology, University of Utah, Salt Lake City, UT, United States
| | - John D Loeser
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
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Stensland M. Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:405-422. [PMID: 33719939 DOI: 10.1080/01634372.2021.1898073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio, San Antonio, Texas, USA
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Boswell MR, Moman RN, Burtoft M, Gerdes H, Martinez J, Gerberi DJ, Wittwer E, Murad MH, Hooten WM. Lidocaine for postoperative pain after cardiac surgery: a systematic review. J Cardiothorac Surg 2021; 16:157. [PMID: 34059093 PMCID: PMC8166031 DOI: 10.1186/s13019-021-01549-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 05/24/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. METHODS A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. RESULTS Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. CONCLUSIONS Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.
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Affiliation(s)
- Michael R Boswell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Melissa Burtoft
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Harrison Gerdes
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Jacob Martinez
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | | | - Erica Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Hassan Murad
- Division of Preventative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA. .,Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
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Maxwell C, Robinson K, McCreesh K. Managing shoulder pain: a meta-ethnography exploring healthcare providers' experiences. Disabil Rehabil 2021; 44:3772-3784. [PMID: 33847548 DOI: 10.1080/09638288.2021.1897886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To review and synthesize qualitative research studies exploring the experiences of Healthcare Providers (HCPs) of managing shoulder pain. METHODS A meta-ethnographic approach was adopted to review and synthesize eligible studies. The findings from each included study were translated into one another using Noblit and Hares' seven-stage process. A systematic search of eleven electronic databases was conducted in February 2021. Methodological quality was assessed using the CASP Appraisal Tool. RESULTS Ten studies were included in the meta-synthesis, all deemed of high methodological quality. Three themes were identified; (1) Lack of consensus: "we all have different approaches." (2) Challenges to Changing Practice: It's "really hard to change and switch to a different approach," (3) Getting "Buy in" to Treatment: "…so you have to really sell it early". CONCLUSION Healthcare providers working with people with shoulder pain struggle to reconcile, often conflicting, research recommendations with their own clinical experience, beliefs and patient expectations. These findings help explain the continued lack of consensus on how best to manage shoulder pain in clinical practice.IMPLICATIONS FOR REHABILITATIONHealthcare providers (HCPs) working with people with shoulder pain struggle to resolve conflicts between evidence-based recommendations, clinical experience, their own shoulder pain beliefs and patient expectations and preferences.Stronger collaboration across professional disciplines is needed to address the current lack of consensus on the management of shoulder pain.Many HCP's find it difficult to engage patients with shoulder pain in exercise and they work hard to "sell" this approach to patients using strategies such as education, shared decision making and therapeutic alliance.
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Affiliation(s)
- Christina Maxwell
- Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
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Toye F, Belton J, Hannink E, Seers K, Barker K. A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies. PAIN MEDICINE 2021; 22:1333-1344. [DOI: 10.1093/pm/pnaa373] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objective
There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery.
Design
A synthesis of qualitative research using meta-ethnography.
Methods
We used the seven stages of meta-ethnography. We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
Results
We screened 1,328 titles and included 195 studies. Our conceptual model indicates that validation and reconnection can empower a person with chronic pain to embark on a journey of healing. To embark on this journey requires commitment, energy, and support.
Conclusions
The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.
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Affiliation(s)
- Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Erin Hannink
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Maxwell C, Robinson K, McCreesh K. Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience. Phys Ther 2021; 101:6054190. [PMID: 33373455 DOI: 10.1093/ptj/pzaa229] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments. METHODS A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme appraisal tool. RESULTS Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact ("It has been a big upheaval"); (2) developing an understanding ("Why is it hurting so much?"); and (3) exercise ("Am I going to go through a lot of pain in moving it…?"). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a "permanent" solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations. CONCLUSION These findings deepen our understanding of the impact of shoulder pain on peoples' lives and provide novel insight into the experience of treatment. Enhanced awareness of people's experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation. IMPACT To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms. LAY SUMMARY Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People's understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.
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Affiliation(s)
- Christina Maxwell
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
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Santos JJAD, Tiburciom FLDA, Kremer AP. ADAPTATION AND TRANSCULTURAL VALIDATION OF THE BRAZILIAN VERSION OF THE BACK PAIN FUNCTIONAL SCALE. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212001221852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: The Back Pain Functional Scale (BPFS) was designed to evaluate the functional state of individuals with low back pain. The scale consists of twelve items, covering functional aspects of the daily life activities of these individuals. The final score is calculated by summing the responses to each item, the values of which range from 0 to 5, obtaining a total result of 0 to 60 points. Methods: The validation process was developed in accordance with the World Health Organization (WHO) protocol, covering translation, back translation, semantic equivalence, evaluation by specialists from previous stages, pre-test of the tool, and final version. Subsequently, the final version was applied in a sample of 90 individuals and the data obtained were subjected to descriptive statistical analysis, factorial analysis, evaluation of internal consistency, and correlation with other validated tools. Results: The tool was adapted to Brazilian Portuguese, making use of terms to approximate the language of everyday expressions. The final version presented results similar to those from the original version, as demonstrated by the factorial analysis, the internal consistency (Cronbach's alpha: 0.990), and the strong correlation with tools validated for the Portuguese language. Conclusion: The Brazilian version of BPFS proved to be easy to apply and understand, and presented high internal consistency and construct validity similar to that of the original instrument. Level of evidence 1B; Study of adaptation of a valid score.
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Stilwell P, Stilwell C, Sabo B, Harman K. Painful metaphors: enactivism and art in qualitative research. MEDICAL HUMANITIES 2020; 47:medhum-2020-011874. [PMID: 33077504 DOI: 10.1136/medhum-2020-011874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Enactivism is an emerging theory for sense-making (cognition) with increasing applications to research and medicine. Enactivists reject the idea that sense-making is simply in the head or can be reduced to neural processes. Instead, enactivists argue that cognisers (people) are embodied and action-oriented, and that sense-making emerges from relational processes distributed across the brain-body-environment. We start this paper with an overview of a recently proposed enactive approach to pain. With rich theoretical and empirical roots in phenomenology and cognitive science, conceptualising pain as an enactive process is appealing as it overcomes the problematic dualist and reductionist nature of current pain theories and healthcare practices. Second, we discuss metaphor in the context of pain and enactivism, including a pain-related metaphor classification system. Third, we present and discuss five paintings created alongside an enactive study of clinical communication and the co-construction of pain-related meanings. Each painting represents pain-related metaphors delivered by clinicians during audio-recorded clinical appointments or discussed by clinicians and patients during interviews. We classify these metaphors, connecting them to enactive theory and relevant literature. The art, metaphors and associated narratives draw attention to the intertwined nature of language, meaning and pain. Of clinical relevance to primary and allied healthcare, we explore how clinicians' taken-for-granted pain-related metaphors can act as scaffolding for patients' pain and agency, for better or worse. We visually depict and give examples of clinical situations where metaphors became enactive, in that they were clinically reinforced and embodied through assessment and treatment. We conclude with research and clinical considerations, suggesting that enactive metaphor is a widely overlooked learning mechanism that clinicians could consider employing and intentionally shape.
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Affiliation(s)
- Peter Stilwell
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christie Stilwell
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brenda Sabo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katherine Harman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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Crawford JO, Berkovic D, Erwin J, Copsey SM, Davis A, Giagloglou E, Yazdani A, Hartvigsen J, Graveling R, Woolf A. Musculoskeletal health in the workplace. Best Pract Res Clin Rheumatol 2020; 34:101558. [DOI: 10.1016/j.berh.2020.101558] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Toye F, Seers K, Barker K. "It's like she's talking about me" - Exploring the value and potential impact of a YouTube film presenting a qualitative evidence synthesis about chronic pain: An analysis of online comments. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:61-70. [PMID: 33987512 PMCID: PMC7942787 DOI: 10.1080/24740527.2020.1785853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is very limited research exploring the value and impact of qualitative research in chronic pain despite the large volume of research. Aims The aim of this study was to find out whether viewers’ comments in response to a YouTube film, portraying findings from a qualitative evidence synthesis about living with pain, revealed any potential value or impact to viewers. Methods We collected online data posted in response to the film Struggling to Be Me. We used themes from a large review of qualitative research as an a priori analytic framework. We used inductive thematic analysis to distil the essence of data that did not fit this framework. A thematic analysis of online comments to evaluate the impact of an arts-based health research film on people living with chronic pain is presented. Results We developed two inductive themes that explored the value and potential impact of watching the film online: (1) It has given voice to our suffering and (2) it makes me feel that I am not alone. Two subthemes added insight to the a priori framework: First, I have had enough of me added insight to the theme my life is impoverished and confined; second, I am treated like a criminal because I take opioids added insight to the theme lost personal credibility. Conclusions Our findings indicate that watching the YouTube film has potential value and impact, giving voice to suffering and making people feel that they are not alone. There are specific ethical challenges relating to internet-mediated research.
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Affiliation(s)
- Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Effects of a workplace exercise program on physical capacity and lower back symptoms in hospital nursing assistants: a randomized controlled trial. Int Arch Occup Environ Health 2020; 94:275-284. [PMID: 32936370 DOI: 10.1007/s00420-020-01572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Considering the relevance of muscle strength for sustaining good musculoskeletal health among workers who perform physically demanding work, the aim of this study was to evaluate the effectiveness of a therapeutic exercise program on muscle strength and low back symptoms among hospital nursing assistants. METHODS One hundred and twenty-nine nursing assistants filled out a questionnaire on personal, occupational information and health status, which allowed the identification of workers able to exercise. Ninety participants were randomly allocated to an intervention and a reference group. The therapeutic exercise program (TEP) lasted 12 weeks and included warm-up, strengthening and stretching exercises. Muscle strength of trunk flexors and trunk extensors, hamstring flexibility, and low back symptoms were evaluated before and after the intervention period by two blinded assessors. The comparison between groups was carried out using Mann-Whitney and χ2 tests at a significance level of 0.05. RESULTS The average participation in the exercise program was 17.5 sessions. Results showed increased trunk flexors muscle strength (p = 0.002; effect size: 0.77), improved pressure pain threshold for dorsal longissimus (p = 0.001; effect size > 0.8), and reduced low back symptoms (p = 0.002; OR = 6.25). No differences between groups were identified for back extensor muscle strength or flexibility. CONCLUSION The exercise program applied is a feasible intervention which resulted clinically relevant results for nursing assistants' musculoskeletal health expressed through trunk flexors muscle strength improvement and low back symptoms control among nursing assistants. This RCT brings contribution to the Occupational Health field as the exercise program applied resulted in clinically relevant results for nursing assistants' musculoskeletal health. This study brings contribution especially for low-income and middle-income countries where low back pain and disability can be considered more severe as adequate resources to address the problem are scarce. Thus, we must highlight the importance of low-cost preventive strategies, like exercise programs carried out in hospital settings to avoid the progress of disability among active nursing personnel.
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Smith T, Fletcher J, Lister S. Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography. Br J Pain 2020; 15:187-198. [PMID: 34055340 DOI: 10.1177/2049463720925110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain. Methods A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool. Results From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad. Conclusion The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.
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Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jessica Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Department, Connect Health, Milton Keynes, UK
| | - Sarah Lister
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Christine C, Marco C, Louis-Rachid S, Pierre C. Clinicians' views about the experience of disability due to low back pain. Results from a focus group study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1953-1958. [PMID: 32436076 DOI: 10.1007/s00586-020-06463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For clinicians, treating the cause of non-pathological low back pain (LBP) is central. For patients, it is how LBP limits their activities of daily living. Little is known about clinicians' understanding of disability and the patient's perspective. We conducted a qualitative study to examine how clinicians involved in the care of patients with BP describe and define disability, its associated changes, and rehabilitation. METHODS Two focus groups (FGs) were conducted with spine specialists including eleven confirmed orthopedic surgeons and neurosurgeons, ten advanced residents, and five other clinicians. Participants were questioned about their views on disability, what it means to them and to the patients. Responses were collected by two independent observers using Metaplan techniques. Large stickers were used to collect participants' responses/ideas; the stickers were posted on billboards so the FGs could check them during the discussion. Metaplan was used to aggregate responses. RESULTS Disability was viewed as a major source of physical limitations, difficulties in performing daily activities, associated with emotional distress, and raising legitimacy issues. Changes in roles engaged the social component. Considered from the patients' perspective, negative emotions and social issues were emphasized, along with the patients' resources. For rehabilitation, the participants emphasized patient-centered care, teamwork, and objectives for care. CONCLUSION The participants pointed to disability as an umbrella term for impairments, activity limitations, and participation restrictions. They underlined the necessity for clinicians to help patients define their level of optimal functioning when faced with BP, utilizing adaptation and teamwork within the therapeutic relationship.
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Affiliation(s)
- Cedraschi Christine
- Division of General Medical Rehabilitation, Geneva Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 14, 1211, Geneva, Switzerland. .,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, University Hospitals, Geneva University, Geneva, Switzerland.
| | - Campello Marco
- NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY, 10014, USA.,NYU Robert I Grossman School of Medicine, New York, USA
| | - Salmi Louis-Rachid
- University Bordeaux, ISPED, Centre INSERM U1219 Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health, 33000, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, 33000, Bordeaux, France
| | - Côté Pierre
- Center for Disability Prevention and Rehabilitation,, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Oshawa, ON, Canada.,Ontario Tech University, Oshawa, ON, Canada
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Horler C, Hebron C, Martyn K. Personalizing education: The clinical reasoning processes of physiotherapists using education for the treatment of people with chronic low back pain. Physiother Theory Pract 2020; 38:412-421. [DOI: 10.1080/09593985.2020.1765437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christopher Horler
- School of Health Sciences, University of Brighton, Eastbourne, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Kathy Martyn
- School of Health Sciences, University of Brighton, Eastbourne, UK
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Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience. J Immigr Minor Health 2020; 21:1123-1136. [PMID: 30182206 DOI: 10.1007/s10903-018-0820-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.
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48
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Lam WWK, Loke AY, Wong CK. Personal and physical factors affecting the decision of patients to opt for spinal surgery: A case-control study. Int J Orthop Trauma Nurs 2020; 37:100753. [PMID: 32014468 DOI: 10.1016/j.ijotn.2020.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVES To explore the personal and physical factors influencing the decision of patients to opt for spinal surgery. METHODS The medical records of patients who attended the Spine Nurse Clinic of a hospital in Hong Kong in the year 2017 were retrieved and reviewed. Comparisons were made of the physical symptoms, myelopathy, sensory deficits, and level of disability of patients who decided to undergo spinal surgery (case) and those who did not (control). RESULTS Among the 122 medical records that were reviewed, it was found that 102 (83.6%) patients decided to undergo spinal surgery (case) while 20 (16.4%) chose not to (control). The patients in the case group were more likely to be unemployed than those in the control group (67% vs. 35%, p = 0.01), to have higher scores in primary pain (4.75 vs. 2.6, p = 0.003), higher scores in radiated pain (4.4 vs. 2.55, p = 0.021), a higher level of disability as reflected in a higher Oswestry Disability Index (ODI) score (41.6 vs. 30.9, p = 0.021), and a lower Japanese Orthopedic Association (JOA) score (13.7 vs. 15.6, p = 0.008). Point biserial correlation showed that exercise tolerance was associated with the decision to undergo the surgery. A multiple regression analysis of the factors predictive of the decision to opt for spinal surgery showed that these factors were: unemployment (OR = 5.42, 95% CI: 1.689-17.44, p = 0.005); severe primary pain (OR = 3.83, 95% CI: 1.241-11.832, p = 0.02); and the presence of radicular symptoms (OR = 5.372, 95% CI: 1.704-16.93, p = 0.004). CONCLUSION The results of this study showed that besides physical factors such as pain radiation and disability level, which influenced the decision of patients to take the surgical option, patients who were unemployed were also more likely to choose surgery. This indicates that patients were worried about the possible impact of surgery on their employment, or on their ability to continue to work. It is important that patients be given a clear picture of the expected outcomes of their surgery, and that the information needs of patients regarding the surgery be explored and addressed.
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Affiliation(s)
- William Wing-Kuen Lam
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region.
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong Special Administrative Region.
| | - Chun-Kwan Wong
- Deputizing Department Operations Manager, Orthopaedic and Traumatology Department, United Christian Hospital, Hong Kong, Hong Kong Special Administrative Region.
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49
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Lundberg T, Melander S. Key Push and Pull Factors Affecting Return to Work Identified by Patients With Long-Term Pain and General Practitioners in Sweden. QUALITATIVE HEALTH RESEARCH 2019; 29:1581-1594. [PMID: 30920899 DOI: 10.1177/1049732319837227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research shows that working is positive for people with long-term pain but that work-related support from health professionals is inadequate. One explanation for this inadequacy is that patients and providers differ in terms of perspectives on motivation to work. In this article, we compare factors that 31 patients and 15 general practitioners consider important to promote return to work for people with long-term pain. We analyzed the interviews with thematic analysis and a motivational push and pull framework to cover different motivational factors, societal and individual, that might push or pull patients from or toward work. Providers said that a difference between working and nonworking patients is their level of individual motivation, while the patients' stories showed that the main difference was the physical (non)ability to push themselves to work. We suggest that work-related support can be improved by addressing such differences in clinical practice.
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50
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Hooten WM, Dvorkin J, Warner NS, Pearson AC, Murad MH, Warner DO. Characteristics of physicians who prescribe opioids for chronic pain: a meta-narrative systematic review. J Pain Res 2019; 12:2261-2289. [PMID: 31413625 PMCID: PMC6662164 DOI: 10.2147/jpr.s202376] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023] Open
Abstract
Background: The primary objective of this systematic review was to identify the characteristics of physicians who prescribe opioids to adults with chronic pain. This review was limited to studies examining fully-trained physicians, as relevant characteristics of resident physicians and non-physician clinicians may differ. Methods: A comprehensive search of databases from January 1, 1980 to December 5, 2017 was conducted. Eligible study designs included (1) randomized trials; (2) nonrandomized prospective and retrospective studies; and (3) cross-sectional observational studies. The risk of bias in the included studies was assessed using an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. A total of 2508 records were screened and 22 studies met inclusion criteria. The majority of studies were cross-sectional (n=20) and the total number of participants was 8433. Results: The risk of bias was high overall. The majority of physicians were confident managing and prescribing opioids for chronic pain but had high levels of dissatisfaction. Physicians reported high awareness of the potential for opioid misuse and were concerned about inadequate prior training in pain management. The majority of physicians were less likely to prescribe for patients with a history of substance abuse and reported major concerns about regulatory scrutiny. Conclusion: This systematic review provides the foundation for the development of prospective studies aimed at further elucidating the constellation of mechanisms that influence physicians who manage pain and prescribe opioids.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jodie Dvorkin
- Institute for Clinical Systems Improvement , Minneapolis, MN, USA
| | - Nafisseh S Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amy Cs Pearson
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - M Hassan Murad
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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