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Lehuede C, Elliott JM, MacDermid JC, Walton DM. Cross-cultural translation and validation of the traumatic injuries distress scale - Spanish version. Disabil Rehabil 2022:1-6. [PMID: 35758162 DOI: 10.1080/09638288.2022.2089920] [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: 11/03/2022]
Abstract
PURPOSE The Traumatic Injuries Distress Scale is a patient-reported measure capturing experiences of distress following non-catastrophic musculoskeletal injuries. The original English version has shown adequate accuracy for predicting recovery trajectories up to 12 months later. Herein we describe the translation of the English TIDS into the TIDS-Spanish. MATERIALS AND METHODS The prototype version was developed through a two-step forwards-back translation involving four independent bilingual speakers. 73 participants (51% female, mean age 47 years, 32% acute) with musculoskeletal pain responded to the prototype through an online platform or in paper format through a single administration. A series of hypotheses including correlation with an external standard and factor structure were tested for both concurrent and factorial validity compared to those of the English version. RESULTS Despite an overall higher mean TIDS score in the Spanish-speaking participants compared to the original English development cohort, all hypotheses for concurrent associations with external pain criteria were satisfied and the three-factor structure of the original was replicated in the new TIDS-Spanish (CFI = 0.97, TLI = 0.96, RMSEA = 0.05). CONCLUSION While prospective data collection is needed to explore the equivalence in prognostic validity, all other analyses indicated psychometric equivalence of the new TIDS-Spanish with the original English version. Implications for RehabilitationThe Traumatic Injuries Distress Scale has previously shown prognostic validity for stratifying people with acute musculoskeletal injury into risk-recovery trajectories.A Spanish-translated version of the TIDS was developed and evaluated for psychometric equivalence with the original English version.Results indicate that we were successful in creating a conceptually and empirically equivalent version of the TIDS for use in Spanish-speaking populations.
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Affiliation(s)
- Carlos Lehuede
- Physical Therapy Section, Hospital del Trabajador, Asociación Chilena de Seguridad, Santiago, Chile
| | - James M Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Joy C MacDermid
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - David M Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
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[Patient education for acute low back pain : Contents of pain education in patients with acute non-specific low back pain - a scoping review]. Schmerz 2022; 36:266-271. [PMID: 35133466 DOI: 10.1007/s00482-022-00622-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of the review is to map the content of intervention education in people with acute nonspecific lumbar low back pain (LBP) to make it available in a synopsis. BACKGROUND In the care of people with acute non-specific LBP, education is recommended as an elementary treatment component. However, the proposed content is proving to be heterogenic and the question arises as to how education should be designed in the future. METHOD A systematic literature search and content analysis of studies with content on pain education was conducted as part of a scoping review. Inclusion criteria were: provision of relevant information on the content of pain education, patients with acute nonspecific low back pain, 18 years or older, publication in English or German. The search was conducted in the Medline, CINAHL, Cochrane Library, and PEDro databases and supplemented by a hand search. The search was completed in February 2021. RESULTS A total of 4239 hits were identified, of which 90 studies were included. A wide range of content was found and clustered into ten categories. The most frequent statements were in the categories "recommendations for dealing with LRS," "education, reassuring aspects, and relieving basic messages," and "information and recommendations about medications." CONCLUSION The teaching of pathoanatomical information can potentially trigger or increase anxiety and worry, whereas information on neurophysiological mechanisms of pain development and processing is more likely to have an anxiety-reducing effect. The results can contribute to the design of the intervention in different settings.
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Bomberg H, Lorenzana D, Schlickeiser J, Dünki A, Farshad M, Eichenberger U. [Noninvasive Treatments for Acute and Chronic Back Pain]. PRAXIS 2022; 111:797-813. [PMID: 36285410 DOI: 10.1024/1661-8157/a003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
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Affiliation(s)
- Hagen Bomberg
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - David Lorenzana
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - Jannis Schlickeiser
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | - Alexandro Dünki
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | | | - Urs Eichenberger
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
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Freed B, Williams B, Situ X, Landsman V, Kim J, Moroz A, Bang H, Park JJ. Blinding, sham, and treatment effects in randomized controlled trials for back pain in 2000-2019: A review and meta-analytic approach. Clin Trials 2021; 18:361-370. [PMID: 33478258 PMCID: PMC8172416 DOI: 10.1177/1740774520984870] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Blinding aims to minimize biases from what participants and investigators know or believe. Randomized controlled trials, despite being the gold standard to evaluate treatment effect, do not generally assess the success of blinding. We investigated the extent of blinding in back pain trials and the associations between participant guesses and treatment effects. METHODS We did a review with PubMed/OvidMedline, 2000-2019. Eligibility criteria were back pain trials with data available on treatment effect and participants' guess of treatment. For blinding, blinding index was used as chance-corrected measure of excessive correct guess (0 for random guess). For treatment effects, within- or between-arm effect sizes were used. Analyses of investigators' guess/blinding or by treatment modality were performed exploratorily. RESULTS Forty trials (3899 participants) were included. Active and sham treatment groups had mean blinding index of 0.26 (95% confidence interval: 0.12, 0.41) and 0.01 (-0.11, 0.14), respectively, meaning 26% of participants in active treatment believed they received active treatment, whereas only 1% in sham believed they received sham treatment, beyond chance, that is, random guess. A greater belief of receiving active treatment was associated with a larger within-arm effect size in both arms, and ideal blinding (namely, "random guess," and "wishful thinking" that signifies both groups believing they received active treatment) showed smaller effect sizes, with correlation of effect size and summary blinding indexes of 0.35 (p = 0.028) for between-arm comparison. We observed uniformly large sham treatment effects for all modalities, and larger correlation for investigator's (un)blinding, 0.53 (p = 0.046). CONCLUSION Participants in active treatments in back pain trials guessed treatment identity more correctly, while those in sham treatments tended to display successful blinding. Excessive correct guesses (that could reflect weaker blinding and/or noticeable effects) by participants and investigators demonstrated larger effect sizes. Blinding and sham treatment effects on back pain need due consideration in individual trials and meta-analyses.
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Affiliation(s)
- Brian Freed
- Department of Pain Management, Summit Medical Group, Berkeley Heights, NJ, USA
| | - Brian Williams
- Departments of Physiatry and Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Xiaolu Situ
- Graduate Group of Biostatistics, Department of Statistics, University of California, Davis, CA, USA
| | - Victoria Landsman
- Institute for Work and Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeehyoung Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Alex Moroz
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Heejung Bang
- Graduate Group of Biostatistics, Department of Statistics, University of California, Davis, CA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
- Center for Healthcare Policy and Research & Clinical and Translational Science Center Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Jongbae J Park
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
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Knoop J, Rutten G, Lever C, Leemeijer J, de Jong LJ, Verhagen AP, van Lankveld W, Staal JB. Lack of Consensus Across Clinical Guidelines Regarding the Role of Psychosocial Factors Within Low Back Pain Care: A Systematic Review. THE JOURNAL OF PAIN 2021; 22:1545-1559. [PMID: 34033963 DOI: 10.1016/j.jpain.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/15/2022]
Abstract
It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (ie, psychological factors ["yellow flags"], perceptions about the relationship between work and health, ["blue flags"], system or contextual obstacles ["black flags") and psychiatric symptoms ["orange flags"]). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15 guidelines. Psychosocial prognostic factors were addressed in 13 of 15 guidelines regarding their assessment and in 14 of 15 guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned "yellow" or "black flags," and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. PERSPECTIVE: This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.
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Affiliation(s)
- Jesper Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Geert Rutten
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Cato Lever
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jaap Leemeijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lieke J de Jong
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Wim van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. 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. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Van Hoof W, O'Sullivan K, Verschueren S, O'Sullivan P, Dankaerts W. Evaluation of Absenteeism, Pain, and Disability in Nurses With Persistent Low Back Pain Following Cognitive Functional Therapy: A Case Series Pilot Study With 3-Year Follow-Up. Phys Ther 2021; 101:5904882. [PMID: 32949123 DOI: 10.1093/ptj/pzaa164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/06/2019] [Accepted: 08/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention. METHODS In this case series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase (phase A; no intervention), outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, participants received an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12, and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (numerical pain rating scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes. RESULTS Days of absenteeism due to LBP were significantly reduced in the first and second calendar years after the CFT intervention but not the third and fourth. Disability was significantly reduced immediately after (-4.4; 95% CI = -6.5 to -2.2) and at 3 months (-4.3; 95% CI = -6.6 to -2.0), 9 months (-6.0; 95% CI = -8.1 to -3.9), and 12 months (-4.9; 95% CI = -7.0 to -2.8) after the intervention. Pain was significantly reduced immediately after (-1.2; 95% CI = -1.7 to -0.8) and at 3 months (-1.5; 95% CI = -2.0 to -0.9), 9 months (-1.1; 95% CI = -1.9 to -0.3), and 12 months (-0.9; 95% CI = -1.5 to -0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-up assessments. CONCLUSIONS This case series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until the 1-year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among nurses is recommended.
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Affiliation(s)
- Wannes Van Hoof
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Kieran O'Sullivan
- M Manip Ther, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland, and Ageing Research Centre, Health, Research Institute, University of Limerick
| | - Sabine Verschueren
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
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Raad M, Harris AB, Puvanesarajah V, El Dafrawy MH, Kebaish FN, Neuman BJ, Skolasky RL, Cohen DB, Kebaish KM. Preoperative patient expectations and pain improvement after adult spinal deformity surgery. J Neurosurg Spine 2020; 33:496-501. [PMID: 32534485 DOI: 10.3171/2020.3.spine191311] [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] [Received: 11/01/2019] [Accepted: 03/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients' expectations for pain relief are associated with patient-reported outcomes after treatment, although this has not been examined in patients with adult spinal deformity (ASD). The aim of this study was to identify associations between patients' preoperative expectations for pain relief after ASD surgery and patient-reported pain at the 2-year follow-up. METHODS The authors analyzed surgically treated ASD patients at a single institution who completed a survey question about expectations for back pain relief. Five ordinal answer choices to "I expect my back pain to improve" were used to categorize patients as having low or high expectations. Back pain was measured using the 10-point numeric rating scale (NRS) and Scoliosis Research Society-22r (SRS-22r) patient survey. Preoperative and postoperative pain were compared using analysis of covariance. RESULTS Of 140 ASD patients eligible for 2-year follow-up, 105 patients (77 women) had pre- and postoperative data on patient expectations, 85 of whom had high expectations. The mean patient age was 59 ± 12 years, and 46 patients (44%) had undergone previous spine surgery. The high-expectations and low-expectations groups had similar baseline demographic and clinical characteristics (p > 0.05), except for lower SRS-22r mental health scores in those with low expectations. After controlling for baseline characteristics and mental health, the mean postoperative NRS score was significantly better (lower) in the high-expectations group (3.5 ± 3.5) than in the low-expectations group (5.4 ± 3.7) (p = 0.049). The mean postoperative SRS-22r pain score was significantly better (higher) in the high-expectations group (3.3 ± 1.1) than in the low-expectations group (2.6 ± 0.94) (p = 0.019). CONCLUSIONS Despite similar baseline characteristics, patients with high preoperative expectations for back pain relief reported less pain 2 years after ASD surgery than patients with low preoperative expectations.
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Netzer O, Shechtman Z. Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors). Int J Group Psychother 2020; 70:349-374. [PMID: 38449218 DOI: 10.1080/00207284.2020.1727746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition-change were more prevalent in group treatment.
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Yellow flag on prognostic factors for non-specific chronic low back pain patients subjected to mini-invasive treatment: a cohort 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; 29:1879-1886. [PMID: 32495278 DOI: 10.1007/s00586-020-06475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/10/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Research was conducted to study the efficacy of analgesic infiltration treatment in a well-selected population of patients with non-specific drug-resistant chronic low back pain. It studied the pain on a numeric rating scale and the physical and mental condition of patients using a short-form health survey-36, before and six months after invasive pain treatment. DESIGN This is a prospective observational single center cohort study. SETTING The study took place in the Multimodal Pain Therapy Unit of the IRCCS Institute of Neurological Sciences in Bologna, Italy. SUBJECTS Four hundred and thirteen out of a total 538 patients admitted to the unit with non-specific drug-resistant chronic low back pain were enrolled in the study. METHOD Patients were enrolled with written consent between April 2017 and November 2018. The study assessed NRS, BDI and SF-36 scores before and six months after mini-invasive treatment. RESULTS There is an inverse correlation between Mental Component Scale (MCS) and Physical component scale as measured by SF-36. Older patients in a worse physical condition but with a more positive outlook on their quality of life were more likely to improve after invasive treatment (p < 0.001). The BDI scale is more effective in the diagnosis of depression than MCS. CONCLUSIONS The prognostic value of MCS given to the patient before mini-invasive treatment could lead physicians to adopt a multimodal approach that includes consideration of the psychological features of pain and possibly antidepressant therapy.
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11
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[Effectiveness of a risk-tailored short intervention to prevent chronic low back pain : A cluster-randomized study in general practice]. Schmerz 2019; 33:226-235. [PMID: 30796580 DOI: 10.1007/s00482-019-0362-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A subgroup of patients with acute low back pain (LBP) will develop chronic LBP. Risk factors summarized as yellow flags are fear-avoidance beliefs, depression, catastrophizing, and work-related problems. OBJECTIVE The aim was to evaluate the effectiveness of screening for yellow flags in general practice followed by a risk-tailored group intervention compared to care as usual. METHODS This is a cluster-randomized controlled trial in 35 general practices with 354 patients with acute LBP. Information or a standardized group intervention was offered to patients in the intervention group according to the screening algorithm with a short questionnaire for physical and psychosocial risk factors for chronic LBP. Standardized group information contained education concerning back pain and strategies for physical activities and planning of actions. Primary outcome was functional capacity assessed after 6 and 12 months with a questionnaire. Secondary outcomes were pain severity, fear avoidance beliefs, depression score, self-rated health and health service utilization. RESULTS The intervention had no clinically relevant effect on the primary outcome functional capacity and secondary outcomes, although the course was consistently slightly better. Adherence to the offered intervention was low. Health service utilization was not altered to a relevant extent. A subgroup analysis comparing adherent and non-adherent patients showed a consistently better course of adherent patients. CONCLUSIONS A risk-tailored short intervention to prevent chronic LBP in general practice had no significant impact on the clinical course compared to care as usual. A subgroup analysis comparing adherent and non-adherent patients suggests that it is possible to have a positive impact on patient-relevant outcomes.
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12
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Khan Y, Lawrence D, Vining R, Derby D. Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey. Chiropr Man Therap 2019; 27:2. [PMID: 30675336 PMCID: PMC6332914 DOI: 10.1186/s12998-018-0228-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background The Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care. Methods The SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores). Results Of 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]). Conclusion The sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.
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Affiliation(s)
- Yasmeen Khan
- 1Parker University, 2500 Walnut Hill Lane, Dallas, TX 75229 USA
| | - Dana Lawrence
- 1Parker University, 2500 Walnut Hill Lane, Dallas, TX 75229 USA
| | - Robert Vining
- 2Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Dustin Derby
- 3Palmer College of Chiropractic, 1000 Brady Street, Davenport, IA 52803 USA
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13
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van Erp RMA, Huijnen IPJ, Jakobs MLG, Kleijnen J, Smeets RJEM. Effectiveness of Primary Care Interventions Using a Biopsychosocial Approach in Chronic Low Back Pain: A Systematic Review. Pain Pract 2018; 19:224-241. [PMID: 30290052 PMCID: PMC7379915 DOI: 10.1111/papr.12735] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023]
Abstract
Background and Objective Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process‐related factors (practical implementation). Methods We searched in scientific databases and reference lists. Randomized controlled trials (RCTs) evaluating primary care physiotherapist‐led BPS interventions in adults (≥18 years) with nonspecific CLBP (≥12 weeks) were included. Results Our search resulted in 943 references; 7 RCTs were included (1,426 participants). Results show moderate‐quality evidence (3 trials; 991 participants) that a BPS intervention is more effective than education/advice for reducing disability and pain in the short, medium, and long term. Low‐quality evidence (4 trials; 435 participants) was found for no difference with physical activity treatments. Conclusions BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).
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Affiliation(s)
- Reni M A van Erp
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Marluuke L G Jakobs
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jos Kleijnen
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.,CIR Rehabilitation Location Eindhoven, Eindhoven, the Netherlands
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14
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Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, Skou ST, Andersen TE, Hartvigsen J. GLA:D ® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord 2018; 19:418. [PMID: 30497440 PMCID: PMC6267880 DOI: 10.1186/s12891-018-2334-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.
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Affiliation(s)
- Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Applied Health Services, University College Lillebaelt, Niels Bohrs Alle 1, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Sandbäcksgatan 7/3, University Hospital Campus, Linköping University, 581 83 Linköping, Sweden
| | | | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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15
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Heidari J, Özen E, Kellmann M. Evaluation of the effect of psychological recovery tools on back pain in an out-patient prevention program. Work 2018; 60:555-566. [DOI: 10.3233/wor-182763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jahan Heidari
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Germany
| | - Ersan Özen
- medicos.AufSchalke, Unit of Training and Health Management, Gelsenkirchen, Germany
| | - Michael Kellmann
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Germany
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
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16
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Both positive and negative beliefs are important in patients with spine pain: findings from the Occupational and Industrial Orthopaedic Center registry. Spine J 2018; 18:1463-1474. [PMID: 28756302 DOI: 10.1016/j.spinee.2017.07.166] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/23/2017] [Accepted: 07/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Negative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. PURPOSE We aimed to assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. STUDY DESIGN/SETTING A retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP was carried out. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). PATIENT SAMPLE Patients with SP with a baseline assessment and follow-up assessment comprised the study sample. OUTCOME MEASURE Perceived disability was measured using the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). A clinical meaningful change (minimum clinically important difference [MCID]) was defined as decrease in ODI or NDI of ≥30%. METHODS We used the Akaike Information Criterion from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. RESULTS In the cross-sectional analysis, 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. STarT Back Screening Tool (SBST)-distress was positively associated with perceived disability in both LBP (beta 2.31, 95% confidence interval [CI] 1.75-2.88) and NP (beta 2.57, 95% CI 1.47-3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (beta 0.50, 95% CI 0.29-0.72) but not for NP, whereas less positive expectations was associated with more perceived disability in NP (beta 0.57, 95% CI 0.02-1.12) but not in LBP. In the longitudinal analysis, 607 LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience an MCID in perceived disability (odds ratio [OR] per point increase 0.89, 95% CI 0.83-0.96), and there was a similar trend in NP (OR per point increase 0.90, 95% CI 0.79-1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 95% CI 1.01-1.19). In NP, self-efficacy was not included in the final model. CONCLUSIONS Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability. However, in this study, only positive beliefs were associated with treatment outcome.
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Sanders ARJ, Bensing JM, Magnée T, Verhaak P, de Wit NJ. The effectiveness of shared decision-making followed by positive reinforcement on physical disability in the long-term follow-up of patients with nonspecific low back pain in primary care: a clustered randomised controlled trial. BMC FAMILY PRACTICE 2018; 19:102. [PMID: 29954333 PMCID: PMC6022513 DOI: 10.1186/s12875-018-0776-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 05/25/2018] [Indexed: 01/13/2023]
Abstract
Background Although the recovery of patients suffering from low back pain is highly context dependent, patient preferences about treatment options are seldom incorporated into the therapeutic plan. Shared decision-making (SDM) offers a tool to overcome this deficiency. The reinforcement by the general practitioner (GP) of a ‘shared’ chosen therapy might increase patients’ expectations of favourable outcomes and thus contribute to recovery. Methods In the Netherlands, a clustered randomised controlled trial was performed to assess the effectiveness of shared decision-making followed by positive reinforcement of the chosen therapy (SDM&PR) on patient-related clinical outcomes. Overall, 68 GPs included 226 patients visiting their GP for a new episode of non-chronic low back pain. GPs in the intervention group were trained in implementing SDM&PR using a structured training programme with a focus on patient preferences in reaching treatment decisions. GPs in the control group provided care as usual. The primary outcome was the change in physical disability measured with the Roland-Morris disability questionnaire (RMD) during the six-month follow-up after the first consultation. Physical disability (RMD), pain, adequate relief, absenteeism and healthcare consumption at 2, 6, 12 and 26 weeks were secondary outcomes. A multivariate analysis with a mixed model was used to estimate the differences in outcomes. Results Of the patients in the intervention and the control groups, 66 and 62%, respectively, completed the follow-up. Most patients (77%) recovered to no functional restrictions due to back pain within 26 weeks. No significant differences in the mean scores for any outcome were observed between intervention patients and controls during the follow-up, and in multivariate analysis, there was no significant difference in the main outcome during the six-month follow-up. Patients in the intervention group reported more involvement in decision-making. Conclusion This study did not detect any improvement in clinical outcome or in health care consumption of patients with non-chronic low back pain after the training of GPs in SDM&PR. The implementation of SDM merely introduces task-oriented communication. The training of the GPs may have been more effective if it had focused more on patient-oriented communication techniques and on stressing the expectation of favourable outcomes. Trial registration The Netherlands National Trial Register (NTR) number: NTR1960. The trial was registered in the NTR on August 20, 2009. Electronic supplementary material The online version of this article (10.1186/s12875-018-0776-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariëtte R J Sanders
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500 3508, GA, Utrecht, the Netherlands.
| | - Jozien M Bensing
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568 3500, BN, Utrecht, the Netherlands.,Faculty of Social and Behavioural Science, Utrecht University, Utrecht, the Netherlands
| | - Tessa Magnée
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568 3500, BN, Utrecht, the Netherlands
| | - Peter Verhaak
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568 3500, BN, Utrecht, the Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500 3508, GA, Utrecht, the Netherlands
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18
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Tousignant-Laflamme Y, Martel MO, Joshi AB, Cook CE. Rehabilitation management of low back pain - it's time to pull it all together! J Pain Res 2017; 10:2373-2385. [PMID: 29042813 PMCID: PMC5633330 DOI: 10.2147/jpr.s146485] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches. Moreover, there is no theoretical framework that has been proposed that guides the rehabilitation management process of mechanical LBP. In this commentary, we propose a model constituted of five domains (nociceptive drivers, nervous system dysfunction drivers, comorbidities drivers, cognitive–emotional drivers, and contextual drivers) grounded as mechanisms driving pain and/or disability in LBP. Each domain is linked to the International Classification of Functioning, Disability and Health, where once a patient is deemed suitable for rehabilitation, the clinician assesses elements of each domain in order to identify where the relative treatment efforts should be focused. This theoretical model is designed to provide a more comprehensive management overview, by appreciating the relative contribution of each domain driving pain and disability. Considering that the multiple domains driving pain and disability, and their interaction, requires a model that is comprehensive enough to identify and address each related issue, we consider that the proposed model has several positive implications for rehabilitation of this painful and highly prevalent musculoskeletal disorder.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Clinicial Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Anand B Joshi
- Duke Health, Department of Orthopaedic Surgery, Duke University Medical Center
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
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Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017; 18:188. [PMID: 28499364 PMCID: PMC5429540 DOI: 10.1186/s12891-017-1549-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Petersen
- Back Center Copenhagen, Mimersgade 41, 2200, Copenhagen N, Denmark.
| | - Mark Laslett
- PhysioSouth Ltd, 7 Baltimore Green, Shirley, Christchurch, 8061, New Zealand.,Southern Musculoskeletal Seminars, Christchurch, New Zealand
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Niels Andersen Vej 65, 2900, Hellerup, Denmark
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Frederiksen P, Indahl A, Andersen LL, Burton K, Hertzum-Larsen R, Bendix T. Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial. PLoS One 2017; 12:e0172003. [PMID: 28346472 PMCID: PMC5367686 DOI: 10.1371/journal.pone.0172003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce. DESIGN A cluster-randomized controlled trial. METHODS Publically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP-the 'functional-disturbance'-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression. RESULTS There was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08-3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs. CONCLUSION Reassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.
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Affiliation(s)
- Pernille Frederiksen
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Metropolitan University College, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Aage Indahl
- Uni Health, University of Bergen, Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
| | - Lars L. Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Physical Activity and Human Performance group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kim Burton
- Centre for Applied Psychological and Health Research, University of Huddersfield, Huddersfield, United Kingdom
| | | | - Tom Bendix
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles. Clin J Pain 2016; 32:1015-1027. [DOI: 10.1097/ajp.0000000000000363] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Woodhouse A, Pape K, Romundstad PR, Vasseljen O. Health care contact following a new incident neck or low back pain episode in the general population; the HUNT study. BMC Health Serv Res 2016; 16:81. [PMID: 26955969 PMCID: PMC4782331 DOI: 10.1186/s12913-016-1326-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022] Open
Abstract
Background Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. The main aim of this study was to describe the determinants of health care contact during a 1-year period in a general population with recent onset spinal pain. Methods From 9056 participants in a general health survey in Norway we identified 219 persons reporting a recent onset (<1 month) of low back or neck pain. Questionnaires were given at 1 (baseline), 2, 3, 6 and 12 months after pain debut. The main outcome was self-reported health care contact due to spinal pain. Associations between health care contact and pain-related factors, other somatic and mental health factors, pain-related work limitations, physical activity and sociodemographic factors were explored. Results Conventional health care was sought by 93 persons (43 %) at least once throughout the year following the onset of pain. 18 persons (8 %) sought alternative health care only and 108 persons (49 %) sought no kind of health care. Baseline reports of coexisting low back and neck pain of equal intensity, poor self-reported health, symptoms of anxiety or depression, obesity and smoking were all associated with an increased tendency to seek conventional health care. Pain intensity and pain-related work limitations at each occasion were strongly associated with concurrent health care contact throughout the year. Higher education was associated with a reduced tendency to contact health care and no association was found for physical activity. Conclusion The main finding in this study was that people from the general population who seek health-care for a new incident of neck or low back pain report more symptoms of mental distress, poorer self-reported health and more intense pain with stronger work limitations compared to those who do not. The findings suggest that identification of complementary symptoms is highly relevant in the examination of spinal pain patients, even for those with recent onset of symptoms.
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Affiliation(s)
- Astrid Woodhouse
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, P.O. Box 8905, Trondheim, 7491, Norway. .,National Competence Centre for Complex Symptom Disorders, St Olav's Hospital, Trondheim, Norway.
| | - Kristine Pape
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, P.O. Box 8905, Trondheim, 7491, Norway
| | - Pål R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, P.O. Box 8905, Trondheim, 7491, Norway
| | - Ottar Vasseljen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, P.O. Box 8905, Trondheim, 7491, Norway
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Suni JH, Rinne M, Kankaanpää M, Taulaniemi A, Lusa S, Lindholm H, Parkkari J. Neuromuscular exercise and back counselling for female nursing personnel with recurrent non-specific low back pain: study protocol of a randomised controlled trial (NURSE-RCT). BMJ Open Sport Exerc Med 2016; 2:e000098. [PMID: 27900169 PMCID: PMC5117067 DOI: 10.1136/bmjsem-2015-000098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 12/19/2022] Open
Abstract
Introduction Nursing personnel have high risk for incidence of low back pain (LBP) followed by development of chronic pain and disability. Multiple risk factors such as patient handling, night shift work and lack of supporting work culture have been identified. In subacute LBP, high-fear avoidance is prognostic for more pain, disability and not returning to work. Lack of leisure-time physical activity predicts long-term sickness absence. The purpose of this study is to compare effectiveness of 6-month neuromuscular exercise and counselling in treating back pain in female nursing personnel with recurrent non-specific LBP pain compared with either (exercise or counselling) alone and a non-treatment control group. Methods and analysis The design is of a double-blinded four-arm randomised controlled trial with cost-effectiveness evaluation at 12 and 24 months. The study is conducted in 3 consecutive substudies. The main eligibility criteria are experience of LBP during the past 4 weeks with intensity of at least 2 (Numeric Rating Scale 0–10) and engagement in patient handling. Sample size was estimated for the primary outcome of pain intensity (visual analogue scale). Study measurements are outlined according to the model of International Classification of Functioning, Disability and Health, which incorporates the biopsychosocial processes assessed. Ethics and dissemination This study is carried out conforming to the guidelines of good scientific practice and provisions of the declaration of Helsinki. Increasing physical and mental capacity with interventions taking place immediately after working hours near the worksite may reduce development of chronic LBP and work disability in female nursing personnel with recurrent non-specific LBP. Trial registration number NCT04165698.
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Affiliation(s)
- Jaana H Suni
- UKK Institute for Health Promotion Research , Tampere , Finland
| | - Marjo Rinne
- UKK Institute for Health Promotion Research , Tampere , Finland
| | - Markku Kankaanpää
- Pirkanmaa Hospital District, Physical and Rehabilitation Medicine Outpatient Clinic , Tampere , Finland
| | | | - Sirpa Lusa
- Finnish Institute of Occupational Medicine , Helsinki , Finland
| | - Harri Lindholm
- Finnish Institute of Occupational Medicine , Helsinki , Finland
| | - Jari Parkkari
- UKK Institute for Health Promotion Research , Tampere , Finland
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Díaz-Cerrillo JL, Rondón-Ramos A, Pérez-González R, Clavero-Cano S. [Non-randomised trial of an educational intervention based on cognitive-behavioural principles for patients with chronic low back pain attended in Primary Care Physiotherapy]. Aten Primaria 2016; 48:440-8. [PMID: 26724987 PMCID: PMC6877809 DOI: 10.1016/j.aprim.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 10/06/2015] [Accepted: 10/17/2015] [Indexed: 11/07/2022] Open
Abstract
Objetivo Valorar la influencia de una intervención educativa en la reducción del «miedo-evitación» (ME) y del «catastrofismo al dolor» (CAT) en población con lumbalgia crónica inespecífica (LCI) atendida en fisioterapia de atención primaria (AP). Diseño Estudio cuasiexperimental. Emplazamiento Centros de salud (CS) del Distrito Sanitario Costa del Sol. Participantes Pacientes con LCI entre 18-65 años con comprensión del idioma español; ausencia de intervenciones educativas paralelas; ausencia de banderas rojas; ausencia de deterioro cognitivo y/o fibromialgia; ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico. Intervenciones El grupo control recibió la EdE grupal habitual. El experimental recibió, además, un instrumento escrito para lectura domiciliaria, más la posterior puesta en común, aclaración de dudas y reestructuración de creencias y metas durante el desarrollo de las sesiones. Ambas intervenciones duraron unos 280 min (7 sesiones de 40 min). Resultados Las variables principales incluyeron ME y CAT. Secundariamente se valoraron dolor y discapacidad. Algunas variables «sociodemográficas» y «relacionadas con el trastorno» fueron tenidas en cuenta en el análisis. Se observaron diferencias estadísticamente significativas en el grupo experimental versus control en la variación del ME −14 (−25,5; 0) vs −4 (−13; 0) (p = 0,009), y del CAT −9 (−18; −4) vs −4,5 (−8,25; 0) (p = 0,000). Igualmente se observaron diferencias en discapacidad (p = 0,046), pero no en dolor (p = 0,280). Conclusiones Los resultados deben ser considerados a la luz de las posibles limitaciones que plantea el estudio. Su naturaleza pragmática permitiría una potencial transferencia a la dinámica asistencial habitual.
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Affiliation(s)
- Juan Luis Díaz-Cerrillo
- Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Málaga, España.
| | - Antonio Rondón-Ramos
- U.G.C. Las Lagunas, Unidad de Fisioterapia, Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Mijas-Costa, Málaga, España; Área de conocimiento de Fisioterapia, Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España
| | | | - Susana Clavero-Cano
- U.G.C. Las Albarizas, Unidad de Fisioterapia, Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Mijas-Costa, Málaga, España
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Ramond-Roquin A, Bouton C, Bègue C, Petit A, Roquelaure Y, Huez JF. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care. Front Med (Lausanne) 2015; 2:73. [PMID: 26501062 PMCID: PMC4597113 DOI: 10.3389/fmed.2015.00073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients' or HCPs' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.
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Affiliation(s)
- Aline Ramond-Roquin
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Céline Bouton
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of General Practice, University of Nantes, L’Université Nantes Angers Le Mans, Nantes, France
| | - Cyril Bègue
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Audrey Petit
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Jean-François Huez
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
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26
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Mbada CE, Ayanniyi O, Ogunlade SO. Comparative efficacy of three active treatment modules on psychosocial variables in patients with long-term mechanical low-back pain: a randomized-controlled trial. Arch Physiother 2015; 5:10. [PMID: 29340179 PMCID: PMC5759898 DOI: 10.1186/s40945-015-0010-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/14/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Psychosocial factors precipitate and perpetuate the risk of developing long-term Low-Back Pain (LBP) with resultant disability. However, management of psychosocial aspects of LBP still remains a major challenge. This study investigated the effect of static or dynamic back extensors endurance exercise on psychosocial variables of Fear-Avoidance Behaviour (FAB), Pain Self-Efficacy Belief (PSEB) and Back Pain Consequences Belief (BPCB) in patients with LBP. METHODS A randomized-controlled trial of 67 patients assigned into McKenzie Protocol (MP) group (n = 25), MP and Static Endurance Exercise Group (MPSEEG; n = 22); and MP and Dynamic Endurance Exercise Group (MPDEEG; n = 20) was carried out. Treatment was applied thrice weekly for eight weeks. RESULTS The groups were comparable in general and baseline psychosocial parameters (p > 0.05). The different regimens had significant effects on all outcome parameters across baseline, 4th and 8th week (p < 0.05). The regimens were comparable in mean change scores on BPCB and FAB at the 4th and 8th week respectively (p > 0.05). MPDBEEG had higher mean change in PSEB at the 4th and 8th week respectively. CONCLUSIONS McKenzie Protocol alone, or in combination with static or dynamic back extensors endurance exercise has comparable effect on FAB, PSEB and BPCB in patients with LBP. The addition of dynamic endurance exercise to the MP led to significantly higher positive effects on PSEB.
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Affiliation(s)
- Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- African Population and Health Research Center, Nairobi, Kenya
| | - Olusola Ayanniyi
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel Olusegun Ogunlade
- Department of Orthopaedic and Trauma, College of Medicine, University of Ibadan, Ibadan, Nigeria
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27
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Construct and predictive validity of the German Örebro questionnaire short form for psychosocial risk factor screening of patients with low back pain. 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 2015; 25:325-332. [DOI: 10.1007/s00586-015-4196-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 08/15/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
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Lorenzo A, Schildt P, Lorenzo M, Falcoff H, Noel F. Acute low back pain management in primary care: a simulated patient approach. Fam Pract 2015; 32:436-41. [PMID: 26060210 DOI: 10.1093/fampra/cmv030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent medical guidelines for acute low back pain (aLBP) are unevenly followed. Based on financial criteria or associated with a desirability bias, studies incompletely describe the actual management provided by general practitioners (GPs) in terms of diagnosis, treatment and prevention of progression towards chronicity. OBJECTIVE To compare actual practices of French GPs for aLBP management with clinical guidelines. METHODS A young simulated patient (SP) consulted, using a single scenario of aLBP, in 30 primary care practices in the Paris region. RESULTS Heterogeneous data were collected according to the grid items: during the questioning, 29 GPs (97%) asked for age and 1 GP (3%) for pregnancy; during the clinical examination, 21 GPs (70%) asked for spinal stiffness and 3 GPs (10%) for cauda equina syndrome. Non-steroidal anti-inflammatory drugs were prescribed by 27 GPs (90%). Imaging (2 GPs or 7%) and physiotherapy (3 GPs or 10%) was rarely prescribed. A sick leave was prescribed by 22 GPs (73%). Twenty-seven GPs (90%) reassured the patient. CONCLUSION aLBP management was in line with international guidelines in terms of clinical examination, physiotherapy and imaging prescriptions and some risk factors for chronicity were taken into account. However, patient questioning was brief, and drug and sick leave prescriptions did not meet international guidelines. The SP approach seems to be a useful tool for assessing actual GP practices.
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Affiliation(s)
- Alain Lorenzo
- Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and
| | - Pauline Schildt
- Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and
| | - Mathieu Lorenzo
- Faculty of Medicine, Department of General Practice, Université de Strasbourg, Strasbourg, France
| | - Hector Falcoff
- Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and
| | - Fréderique Noel
- Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and
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29
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Ramond-Roquin A, Pecquenard F, Schers H, Van Weel C, Oskam S, Van Boven K. Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Fam Pract 2015; 32:297-304. [PMID: 25911506 DOI: 10.1093/fampra/cmv027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Better insight into frequent comorbidities in patients with chronic (≥ 3 months) low back pain (LBP) may help general practitioners when planning comprehensive care for these patients. OBJECTIVE To prospectively study the prevalence of psychological, social, musculoskeletal and somatoform disorders in patients presenting with chronic non-specific LBP to general practitioners, in comparison to a contrast group of patients consulting in the same setting. METHODS This case-control study is embedded in a historical cohort, based on a primary care practice-based research network. All the health problems presented by the patients were prospectively coded according to the international classification of primary care between 1996 and 2013. The prevalence of psychological, social, musculoskeletal and somatoform disorders presented by the adult patients from 1 year before the onset of chronic LBP to 2 years after onset was compared to that of matched patients consulting without LBP, using conditional logistic regressions. RESULTS The 1511 patients with chronic LBP more often presented musculoskeletal disorders than the contrast group during the year before the onset of LBP and during the second year after it, with odds ratios (95%confidence intervals) of 1.39 (1.20-1.61) and 1.56 (1.35-1.81), respectively. They did not more often present psychological, social or non-musculoskeletal somatoform disorders. CONCLUSIONS General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning.
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Affiliation(s)
- Aline Ramond-Roquin
- Department of General Practice, PRES LUNAM, Angers, France, Laboratory of Ergonomics and Epidemiology in Occupational Health, PRES LUNAM, Angers, France,
| | | | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris Van Weel
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands, Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia and
| | - Sibo Oskam
- Formerly of the Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Van Boven
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Innes SI, Werth PD, Tuchin PJ, Graham PL. Attitudes and beliefs of Australian chiropractors' about managing back pain: a cross-sectional study. Chiropr Man Therap 2015; 23:17. [PMID: 26085924 PMCID: PMC4470072 DOI: 10.1186/s12998-015-0062-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Chiropractors are frequent providers of care for patients with lower back pain. Biopsychosocial approaches to managing patients are regarded as best practice and are gaining wider acceptance. Recent evidence suggests that practitioners’ attitudes and beliefs may also have an important effect on patients’ recovery from back pain. Past studies have pooled manual therapists from differing professions. Dissonant findings have been hypothesised as being a result of the chiropractic subpopulation within multi-practitioner participant pools who are hypothesised to focus on biomedical aspects of treatment and minimize biopsychosocial dimensions. The aim of this study is to determine whether a study population of only chiropractors would demonstrate similar attitudes and beliefs to other manual therapists’ biopsychosocial or biomedical approach to the management of their patients. Methods A survey of chiropractors in Victoria Australia in September 2010 was undertaken utilising the Pain Attitude and Belief Scale (PABS.PT), a tool which has been developed to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. The survey also obtained demographic data from respondents to determine whether variables such as education, gender or practice related factors influenced their orientation. Results The overall response rate was 29% (n = 218). The majority of the sample was male (68%), with a mean age of 44 years. The 6 point Likert scale scores were 34.5 (6.3) for the biomedical factor scale and 31.4 (4.1) for the biopsychosocial scale. Internal consistency of the psychosocial subscale was poor. None of the demographic variables were found to influence the biomedical or psychosocial scales. Conclusions Chiropractors in the state of Victoria were found to have similar biomedical and psychosocial orientations in their attitudes and beliefs when compared to other manual therapists’ levels of previous studies from differing cultural and educational backgrounds. This study was unable to replicate any of the relationships from past studies with any of the demographic variables. The psychosocial scale internal consistency may be a significant factor in this non-finding. Future research should address the identification of more robust items of the biopsychosocial attitudes of Victorian chiropractors toward treating lower back pain.
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Affiliation(s)
- Stanley I Innes
- Discipline of Chiropractic, Health Professions, Murdoch University, Murdoch, WA 6150 Australia
| | - Peter D Werth
- Private Practice, Australian Injury Management Consulting, 117 Hall Road, Carrum Downs, VIC 3201 Australia
| | - Peter J Tuchin
- Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109 Australia
| | - Petra L Graham
- Department of Statistics, Faculty of Science, Macquarie University, Sydney, NSW 2109 Australia
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