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MacKean A, Godfrey E, Jones GD, Kedroff L, Sparks L, Jones GL. Effectiveness of remotely delivered motivational conversations on health outcomes in patients living with musculoskeletal conditions: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2024; 123:108204. [PMID: 38402714 DOI: 10.1016/j.pec.2024.108204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the efficacy of remotely delivered motivational conversations on health outcomes in musculoskeletal populations. METHODS Four electronic databases (inception-March 2022) were searched and combined with grey literature. Randomised control trials (RCTs) evaluating the effect of remotely delivered motivational conversation-based interventions within musculoskeletal populations, using valid measures of pain, disability, quality of life (QoL), or self-efficacy were included. Overall quality was assessed using GRADE criteria. Meta-analyses were performed using random effects models with pooled effect sizes expressed as standardised mean differences ( ± 95%CIs). RESULTS Twelve RCTs were included. Meta-analyses revealed very-low to moderate quality evidence that remote interventions have a positive effect on pain and disability both immediately post intervention and at long-term follow-up compared to control, and have a positive effect on self-efficacy immediately post intervention. There was no effect on QoL immediately post intervention or at long-term follow up. CONCLUSION Remotely delivered motivation-based conversational interventions have a positive effect on pain, disability, and self-efficacy but not on QoL. PRACTICE IMPLICATIONS Motivational conversations, delivered remotely, may be effective in improving some health-related outcomes in MSK populations. However, higher quality evidence is needed to determine optimal intervention durations, and dosing frequencies using sufficient sample sizes and follow-up time frames.
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Affiliation(s)
- Alice MacKean
- Guy's and St Thomas' NHS Foundation Trust Physiotherapy Department, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gareth D Jones
- Guy's and St Thomas' NHS Foundation Trust Physiotherapy Department, London, UK; Centre for Human and Applied Physiological Sciences (CHAPS), Faculty of Life Sciences & Medicine, King's College London, UK
| | - Louise Kedroff
- Physiotherapy Dept, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Lucinda Sparks
- University College London Hospitals NHS Foundation Trust Physiotherapy Department, London, UK
| | - Gareth L Jones
- Guy's and St Thomas' NHS Foundation Trust Physiotherapy Department, London, UK.
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Barnet-Hepples T, Dario A, Oliveira J, Maher C, Tiedemann A, Amorim A. Health coaching improves physical activity, disability and pain in adults with chronic non-cancer pain: a systematic review. J Physiother 2024; 70:115-123. [PMID: 38494402 DOI: 10.1016/j.jphys.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
QUESTION What is the effect of health coaching on physical activity, disability, pain and quality of life compared with a non-active control in adults with chronic non-cancer pain? DESIGN Systematic review and meta-analysis of randomised controlled trials. Evidence was synthesised as standardised mean differences with 95% confidence intervals using random-effects models. Risk of bias was assessed using the revised Cochrane risk of bias tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine evidence certainty. DATA SOURCES MEDLINE, Embase, CENTRAL, CINAHL, Scopus and PEDro were searched from inception to November 2023. PARTICIPANTS Adults with chronic non-cancer pain. INTERVENTION Health coaching to increase physical activity. OUTCOME MEASURES Measures of physical activity, disability, pain and quality of life. RESULTS Twenty-six randomised trials (n = 4,403) were included. Trials had moderate to high risk of bias. Health coaching had a trivial to small effect on improving physical activity compared with control (15 trials; SMD 0.21, 95% CI 0.07 to 0.35; low certainty evidence). Health coaching had a small effect on improving disability (19 trials; SMD 0.25, 95% CI 0.17 to 0.32; moderate certainty evidence) and pain (19 trials; SMD 0.31, 95% CI 0.18 to 0.43; very low certainty evidence) compared with control. The effect of health coaching on quality of life was unclear due to significant imprecision in the effect estimate (five trials; SMD 0.19, 95% CI -0.14 to 0.53; moderate certainty evidence). CONCLUSION Health coaching promotes a trivial to small improvement in physical activity and small improvements in disability and pain in adults with chronic non-cancer pain. The effect of health coaching on quality of life remains unclear. REGISTRATION PROSPERO CRD42020182740.
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Affiliation(s)
- Talia Barnet-Hepples
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Amabile Dario
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juliana Oliveira
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Christopher Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Anne Tiedemann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Anita Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Gamble CJ, van Haastregt JCM, van Dam van Isselt EF, Zwakhalen SMG, Schols JMGA. Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil 2024; 38:457-477. [PMID: 38013415 PMCID: PMC10898211 DOI: 10.1177/02692155231217411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. DATA SOURCES Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. REVIEW METHODS Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. RESULTS A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. CONCLUSION The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.
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Affiliation(s)
- CJ Gamble
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
- Stichting Valkenhof, Valkenswaard, The Netherlands
| | - JCM van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - EF van Dam van Isselt
- University Network for the Care sector Zuid-Holland, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - SMG Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - JMGA Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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Lentz TA, Coffman CJ, Cope T, Stearns Z, Simon CB, Choate A, Gladney M, France C, Hastings SN, George SZ. If You Build It, Will They Come? Patient and Provider Use of a Novel Hybrid Telehealth Care Pathway for Low Back Pain. Phys Ther 2024; 104:pzad127. [PMID: 37756618 PMCID: PMC10851867 DOI: 10.1093/ptj/pzad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 07/09/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the referrals and use of a hybrid care model for low back pain that includes on-site care by physical therapists, physical activity training, and psychologically informed practice (PiP) delivered by telehealth in the Improving Veteran Access to Integrated Management of Low Back Pain (AIM-Back) trial. METHODS Data were collected from November 2020 through February 2023 from 5 Veteran Health Administration clinics participating in AIM-Back, a multisite, cluster-randomized embedded pragmatic trial. The authors extracted data from the Veteran Health Administration Corporate Data Warehouse to describe referral and enrollment metrics, telehealth use (eg, distribution of physical activity and PiP calls), and treatments used by physical therapists and telehealth providers. RESULTS Seven hundred one veterans were referred to the AIM-Back trial with 422 enrolling in the program (consult-to-enrollment rate = 60.2%). After travel restrictions were lifted, site visits resulted in a significant increase in referrals and a number of new referring providers. At initial evaluation by on-site physical therapists, 92.2% of veterans received pain modulation (eg, transcutaneous electrical nerve stimulation, manual therapy). Over 81% of enrollees completed at least 1 telehealth physical activity call, with a mean of 2.8 (SD = 2.0) calls out of 6. Of the 167 veterans who screened as medium to high risk of persistent disability, 74.9% completed at least 1 PiP call, with a mean of 2.5 (SD = 2.0) calls out of 6. Of those who completed at least 1 PiP call (n = 125), 100% received communication strategies, 97.6% received pain coping skills training, 89.6% received activity-based treatments, and 99.2% received education in a home program. CONCLUSION In implementing a hybrid care pathway for low back pain, the authors observed consistency in the delivery of core components (ie, pain modulation, use of physical activity training, and risk stratification to PiP), notable variability in telehealth calls, high use of PiP components, and increased referrals with tailored provider engagement. IMPACT These findings describe variability occurring within a hybrid care pathway and can inform future implementation efforts.
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Affiliation(s)
- Trevor A Lentz
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Tyler Cope
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Zachary Stearns
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corey B Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley Choate
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Micaela Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Courtni France
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Z George
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Santos AEDN, Nunes ACL, Pereira LSM, Ferreira ML, Ferreira PH, Macedo LG, de Jesus-Moraleida FR. Physical Activity Supported by Low-Cost Mobile Technology for Back Pain (PAT-Back) to Reduce Disability in Older Adults: Results of a Feasibility Study. Phys Ther 2024; 104:pzad153. [PMID: 37941491 DOI: 10.1093/ptj/pzad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/26/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. METHODS This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. RESULTS A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. CONCLUSION Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. IMPACT This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing.
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Affiliation(s)
- Ana Ellen do Nascimento Santos
- Master Program in Physiotherapy and Functioning, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Ana Carla Lima Nunes
- Master Program in Physiotherapy and Functioning, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculty of Medical Sciences of Minas Gerais, Graduate Program in Health Sciences, Belo Horizonte, Brazil
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, Sydney School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Luciana Gazzi Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Lam N, Green J, Hallas S, Forster A, Crocker TF, Andre D, Ellwood A, Clegg A, Brown L. Mapping review of pain management programmes and psychological therapies for community-dwelling older people living with pain. Eur Geriatr Med 2024; 15:33-45. [PMID: 37853269 PMCID: PMC10876761 DOI: 10.1007/s41999-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Persistent pain is common in older people and people living with frailty. Pain or the impact of pain on everyday life is potentially modifiable. We sought to map research evidence and information from randomised controlled trials (RCTs) of pain management programmes and psychological therapies targeting community-dwelling older people, and explore appropriate strategies and interventions for managing or reducing the negative impact of pain for older people, particularly those with frailty. METHOD A mapping review of pain management programmes and psychological therapies for community-dwelling older people living with chronic pain. We searched for systematic reviews of randomised controlled trials and for individual randomised controlled trials and extracted data from eligible studies. RESULTS Searches resulted in 3419 systematic review records and 746 RCT records from which there were 33 eligible interventions identified in 31 eligible RCTs (48 reports). Broad aims of the interventions were to: improve physical, psychological, or social functioning; adjust the effects or sensation of pain psychologically; enhance self-care with self-management skills or knowledge. Common mechanisms of change proposed were self-efficacy enhanced by self-management tasks and skills, using positive psychological skills or refocusing attention to improve responses to pain, and practising physical exercises to improve physiological well-being and reduce restrictions from pain. Content of interventions included: skills training and activity management, education, and physical exercise. Interventions were delivered in person or remotely to individuals or in groups, typically in 1-2 sessions weekly over 5-12 weeks. CONCLUSION All the evaluated interventions appeared to show potential to provide some benefits to older people. None of the included studies assessed frailty. However, some of the included interventions appear appropriate for community-dwelling older people living with both frailty and pain.
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Affiliation(s)
- Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Health Sciences, University of York, York, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sarah Hallas
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
- University of Leeds, Leeds, UK.
| | | | - Alison Ellwood
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
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Zheng DKY, Kawchuk GN, Bussières AE, Al Zoubi FM, Hartvigsen J, Fu SN, de Luca K, Weiner DK, Karppinen J, Samartzis D, Ferreira ML, Wu J, Dennett L, Wong AYL. Trends of Low Back Pain Research in Older and Working-Age Adults from 1993 to 2023: A Bibliometric Analysis. J Pain Res 2023; 16:3325-3341. [PMID: 37808461 PMCID: PMC10557964 DOI: 10.2147/jpr.s425672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p<0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal "Spine". Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.
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Affiliation(s)
- Daniel K Y Zheng
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - André E Bussières
- Université McGill, Montreal, Canada
- Université du Québec à Trois-Rivières, Trois‑Rivières, Canada
| | - Fadi M Al Zoubi
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - Siu Ngor Fu
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - Debra K Weiner
- University of Pittsburgh, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jaro Karppinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | | | | | - Jinlong Wu
- Southwest University, Chongqing, People’s Republic of China
| | | | - Arnold Y L Wong
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
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Soares Fonseca L, Pereira Silva J, Bastos Souza M, Gabrich Moraes Campos M, de Oliveira Mascarenhas R, de Jesus Silva H, Souza Máximo Pereira L, Xavier Oliveira M, Cunha Oliveira V. Effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain: a systematic review with meta-analysis. 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 2023; 32:3245-3271. [PMID: 37464184 DOI: 10.1007/s00586-023-07857-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND PURPOSE The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain. METHODS Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach. RESULTS AND DISCUSSION Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] = - 1.38 [95% CI - 2.02 to - 0.73]); low-quality evidence that mixed exercise (MD = - 50.33 [95% CI - 57.11 to - 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = - 8.26 [95% CI - 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86-2.86]). CONCLUSIONS The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies-both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.
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Affiliation(s)
- Letícia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil.
| | - Juliana Pereira Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Mateus Bastos Souza
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | | | - Rodrigo de Oliveira Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Murilo Xavier Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
| | - Vinicius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367, Km 583, 5000, Campus JK, Diamantina, CEP 39.100-000, Brazil
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Syroyid Syroyid I, Cavero-Redondo I, Syroyid Syroyid B. Effects of Resistance Training on Pain Control and Physical Function in Older Adults With Low Back Pain: A Systematic Review With Meta-analysis. J Geriatr Phys Ther 2023:00139143-990000000-00023. [PMID: 36805624 DOI: 10.1519/jpt.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP. METHODS A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z-test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications. RESULTS AND DISCUSSION Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies. CONCLUSIONS The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.
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Affiliation(s)
- Ivan Syroyid Syroyid
- Servicio de Salud de Castilla-La Mancha, Castilla-La Mancha, Spain.,Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Ivan Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Bohdan Syroyid Syroyid
- Universidad de Castilla-La Mancha, Ciudad Real, Spain.,Universidad de Salamanca, Salamanca, Spain
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Shayo MJ, Shayo P, Haukila KF, Norman K, Burke C, Ngowi K, Goode AP, Allen KD, Wonanji VT, Mmbaga BT, Bettger JP. Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:982175. [PMID: 36684685 PMCID: PMC9853889 DOI: 10.3389/fresc.2022.982175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
Introduction Musculoskeletal (MSK) disorders such as low back pain and osteoarthritis are a leading cause of disability and the leading contributor to the need for rehabilitation services globally. This need has surpassed the availability of trained clinicians; even in urban areas where services and providers are thought to be more abundant, access can be challenged by transportation options and financial costs associated with travel, care and lost time from work. However, continuing standard of fully in-person rehabilitation care for MSK-associated pain and disability may no longer be necessary. With increased ownership or access to even a basic mobile phone device, and evidence for remote management by trained clinicians, some individuals with MSK disorders may be able to continue their rehabilitation regimen predominantly from home after initial evaluation in primary care or an outpatient clinic. Methods This manuscript describes application of a framework we used to culturally and contextually adapt an evidence-based approach for leveraging digital health technology using a mobile phone (mHealth) to expand access to rehabilitation services for MSK-associated pain and disability. We then conducted a multi-level analysis of policies related to the adapted approach for rehabilitation service delivery to identify opportunities to support sustainability. Results Our study was conducted in Tanzania, a lower-middle income country with their first National Rehabilitation Strategic Plan released in 2021. Lessons learned can be applied even to countries with greater infrastructure or fewer barriers. The seven-step adaptation framework used can be applied in other regions to improve the likelihood of local mHealth adoption and implementation. Our practice and policy assessment for Tanzania can be applied in other regions and used collaboratively with government officials in support of building or implementing a national rehabilitation strategic plan. Conclusion The work described, lessons learned and components of the plan are generalizable globally and can improve access to rehabilitation services using mHealth to address the significant and increasing burden of disability.
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Affiliation(s)
- Mathew J. Shayo
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Pendo Shayo
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kelvin F. Haukila
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, United States
| | - Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, United States
- Department of Veterans Affairs Health Services Research & Development Service, Durham, NC, United States
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States
| | - Kelli D. Allen
- Department of Veterans Affairs Health Services Research & Development Service, Durham, NC, United States
- Thurston Arthritis Research Center, University of North Carolina Chapel Hill, NC, United States
| | - Vivian Timothy Wonanji
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States
- Department of Health and Rehabilitation Sciences, TempleUniversity College of Public Health, Philadelphia, United States
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Efficacy of Hip Strengthening on Pain Intensity, Disability, and Strength in Musculoskeletal Conditions of the Trunk and Lower Limbs: A Systematic Review with Meta-Analysis and Grade Recommendations. Diagnostics (Basel) 2022; 12:diagnostics12122910. [PMID: 36552918 PMCID: PMC9776732 DOI: 10.3390/diagnostics12122910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
To investigate the efficacy of hip strengthening on pain, disability, and hip abductor strength in musculoskeletal conditions of the trunk and lower limbs, we searched eight databases for randomized controlled trials up to 8 March 2022 with no date or language restrictions. Random-effect models estimated mean differences (MDs) with 95% confidence intervals (CIs), and the quality of evidence was assessed using the GRADE approach. Very low quality evidence suggested short-term effects (≤3 months) of hip strengthening on pain intensity (MD of 4.1, 95% CI: 2.1 to 6.2; two trials, n = 48 participants) and on hip strength (MD = 3.9 N, 95% CI: 2.8 to 5.1; two trials, n = 48 participants) in patellofemoral pain when compared with no intervention. Uncertain evidence suggested that hip strengthening enhances the short-term effect of the other active interventions on pain intensity and disability in low back pain (MD = -0.6 points, 95% CI: 0.1 to 1.2; five trials, n = 349 participants; MD = 6.2 points, 95% CI: 2.6 to 9.8; six trials, n = 389 participants, respectively). Scarce evidence does not provide reliable evidence of the efficacy of hip strengthening in musculoskeletal conditions of the trunk and lower limbs.
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12
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Fritz JM, Del Fiol G, Gibson B, Wetter DW, Solis V, Bennett E, Thackeray A, Goode A, Lundberg K, Romero A, Ford I, Stevens L, Siaperas T, Morales J, Yack M, Greene T. BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers. BMJ Open 2022; 12:e067732. [PMID: 36351735 PMCID: PMC9664275 DOI: 10.1136/bmjopen-2022-067732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although evidence-based guidelines recommend non-pharmacologic treatments as first-line care for chronic low back pain (LBP), uptake has been limited, particularly in rural, low-income and ethnically diverse communities. The BeatPain study will evaluate the implementation and compare the effectiveness of two strategies to provide non-pharmacologic treatment for chronic LBP. The study will use telehealth to overcome access barriers for persons receiving care in federally qualified health centres (FQHCs) in the state of Utah. METHODS AND ANALYSIS BeatPain Utah is a pragmatic randomised clinical trial with a hybrid type I design investigating different strategies to provide non-pharmacologic care for adults with chronic LBP seen in Utah FQHCs. The intervention strategies include a brief pain consult (BPC) and telehealth physical therapy (PT) component provided using either an adaptive or sequenced delivery strategy across two 12-week treatment phases. Interventions are provided via telehealth by centrally located physical therapists. The sequenced delivery strategy provides the BPC, followed by telehealth PT in the first 12 weeks for all patients. The adaptive strategy uses a stepped care approach and provides the BPC in the first 12 weeks and telehealth PT to patients who are non-responders to the BPC component. We will recruit 500 English-speaking or Spanish-speaking participants who will be individually randomised with 1:1 allocation. The primary outcome is the Pain, Enjoyment and General Activity measure of pain impact with secondary outcomes including the additional pain assessment domains specified by the National Institutes (NIH) of Health Helping to End Addiction Long Initiative and implementation measures. Analyses of primary and secondary measures of effectiveness will be performed under longitudinal mixed effect models across assessments at baseline, and at 12, 26 and 52 weeks follow-ups. ETHICS AND DISSEMINATION Ethics approval for the study was obtained from the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with NIH data sharing policies. TRIAL REGISTRATION NUMBER NCT04923334.
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Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy & Athletic Training, The University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Victor Solis
- Department of Physical Therapy & Athletic Training, The University of Utah, Salt Lake City, Utah, USA
| | - Emily Bennett
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, The University of Utah, Salt Lake City, Utah, USA
| | - Adam Goode
- Orthopedic Surgery and Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Adrianna Romero
- Department of Physical Therapy & Athletic Training, The University of Utah, Salt Lake City, Utah, USA
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, The University of Utah, Salt Lake City, Utah, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Tracey Siaperas
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Jennyfer Morales
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Melissa Yack
- Center for Health Outcomes and Population Equity - Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
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Solis-Navarro L, Gismero A, Fernández-Jané C, Torres-Castro R, Solá-Madurell M, Bergé C, Pérez LM, Ars J, Martín-Borràs C, Vilaró J, Sitjà-Rabert M. Effectiveness of home-based exercise delivered by digital health in older adults: a systematic review and meta-analysis. Age Ageing 2022; 51:afac243. [PMID: 36346736 PMCID: PMC9642810 DOI: 10.1093/ageing/afac243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults. DESIGN systematic review and meta-analysis. PARTICIPANTS community-dwelling older adults over 65 years. INTERVENTION exercises at home through DHI. OUTCOMES MEASURES physical function, HRQoL and falls. RESULTS twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56 s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004). CONCLUSION the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.
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Affiliation(s)
- Lilian Solis-Navarro
- Departmentof Physical Therapy, Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Department of Physical Therapy, University of Chile, Santiago, Chile
| | - Aina Gismero
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Carles Fernández-Jané
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, University of Chile, Santiago, Chile
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Clara Bergé
- Department of Physiotherapy, School of Health Sciences, TecnoCampus-Pompeu Fabra University, Barcelona, Spain
| | - Laura Mónica Pérez
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Joan Ars
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, Barcelona, Spain
- Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carme Martín-Borràs
- Departmentof Physical Therapy, Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Facultat de Psicologia, Ciències de l’Educació i l’Esport (FPCEE), Universitat Ramon Llull, Barcelona, Spain
| | - Jordi Vilaró
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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14
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The biopsychosocial model of pain 40 years on: time for a reappraisal? Pain 2022; 163:S3-S14. [DOI: 10.1097/j.pain.0000000000002654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
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15
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Werneke MW, Deutscher D, Hayes D, Grigsby D, Mioduski JE, Resnik LJ. Is Telerehabilitation a Viable Option for People With Low Back Pain? Associations Between Telerehabilitation and Outcomes During the COVID-19 Pandemic. Phys Ther 2022; 102:6535134. [PMID: 35202466 PMCID: PMC9383506 DOI: 10.1093/ptj/pzac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/26/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aims of this study were to examine associations between frequency of telerehabilitation (TR) and outcomes of functional status (FS), number of visits, and patient satisfaction during COVID-19 and to compare FS outcomes by TR delivery mode for individuals with low back pain. METHODS Propensity score matching was used to match episodes of care with or without TR exposure by the probability of receiving TR. FS, visits, and satisfaction were compared for individuals without TR and those who received care by TR for "any," "few," "most," or "all" frequencies (4 matched samples), and FS was compared for individuals receiving synchronous, asynchronous, and mixed TR modes (3 matched samples). Standardized differences were used to compare samples before and after matching. Outcomes between matched samples were compared using z tests with 95% CI. RESULTS The sample consisted of 91,117 episodes of care from 1398 clinics located in 46 states (58% women; mean age = 55 [SD = 18]). Of those, only 5013 episodes (5.5%) involved any amount of TR. All standardized differences between matched samples were <0.1. There was no significant difference in FS points (range = 0-100, with higher representing better FS) between matched samples, except for episodes that had ``few'' (-1.7) and ``all'' (+2.0) TR frequencies or that involved the asynchronous (-2.6) TR mode. These point differences suggest limited clinical importance. Episodes with any TR frequency involved significantly fewer visits (0.7-1.3) than episodes with no TR, except that those with the "most" TR frequency had non-significantly fewer visits (0.6). A smaller proportion of individuals with TR (-4.0% to -5.0%) than of individuals with no telerehabilitation reported being very satisfied with treatment results, except for those with the "all" TR frequency. CONCLUSIONS A positive association between TR and rehabilitation outcomes was observed, with a trend for better FS outcomes and fewer visits when all care was delivered through TR. Satisfaction tended to be lower with TR use. Overall, this observational study showed that for people with low back pain, physical therapy delivered through TR was equally effective as and more efficient than in-person care, with a trend of higher effectiveness when used for all visits during the episode of care. No differences in FS outcomes were observed between care delivered with synchronous and mixed TR delivery modes and care delivered with no TR. However, the asynchronous mode of TR was associated with worse functional outcomes than no TR. Although the majority of people were very satisfied with their treatment results with and without TR, very high satisfaction rates were reported by a slightly smaller proportion of individuals with TR versus those without TR. Our results suggest that TR is a viable option for rehabilitation care for individuals with low back pain and should also be considered in the post-COVID-19 era.
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Affiliation(s)
| | - Daniel Deutscher
- Net Health Systems, Inc., Pittsburgh, Pennsylvania, USA,MaccabiTech Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Deanna Hayes
- Net Health Systems, Inc., Pittsburgh, Pennsylvania, USA
| | - David Grigsby
- MidSouth Orthopaedic Rehabilitation, Cordova, Tennessee, USA
| | | | - Linda J Resnik
- Department of Health Services, Policy and Practice, School of Public Health, Brown University Providence, Rhode Island, USA,Research, Providence VA Medical Center, Providence, Rhode Island, USA
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Kelly M, Fullen B, Martin D, McMahon S, McVeigh JG. eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther 2022; 102:6506314. [PMID: 35079826 PMCID: PMC8994513 DOI: 10.1093/ptj/pzab307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature. METHODS Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer. RESULTS After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%). CONCLUSIONS There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice. IMPACT This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland,Department of Physiotherapy, Mercy University Hospital, Cork, Ireland,Address all correspondence to Marie Kelly at:
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom,NIHR Applied Research Collaborative, North East and North Cumbria, United Kingdom
| | - Sinéad McMahon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Jesus-Moraleida FRD, Santos AEDN, Máximo Pereira LS, Ferreira ML, Ferreira PH, Macedo LG, Nunes ACL. Physical activity supported by mobile technology program (PAT-Back) for older adults with back pain at primary care: a feasibility study protocol. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220020321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kechichian A, Lafrance S, Matifat E, Dubé F, Lussier D, Benhaim P, Perreault K, Filiatrault J, Rainville P, Higgins J, Rousseau J, Masse J, Desmeules F. Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials. J Geriatr Phys Ther 2021; 45:34-49. [PMID: 34928239 DOI: 10.1519/jpt.0000000000000279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. METHODS A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. RESULTS Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval [CI] -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate. CONCLUSION Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.
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Affiliation(s)
- Amélie Kechichian
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Simon Lafrance
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - François Dubé
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - David Lussier
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Patrick Benhaim
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, University of Laval, Quebec, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Pierre Rainville
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Departement of Stomatology, Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Higgins
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Jacqueline Rousseau
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Julie Masse
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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19
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Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
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20
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Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168430. [PMID: 34444189 PMCID: PMC8391468 DOI: 10.3390/ijerph18168430] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. METHOD PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. RESULTS We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = -0.89. 95% CI -0.99 to -0.80) and in the group which conducted exercise both at-home and at another setting (-0.73. -0.86 to -0.59). Similarly, functional limitation also decreased in both groups (-0.75. -0.91 to -0.60, and -0.70, -0.92 to -0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. CONCLUSION Home-based exercise training improved pain intensity and functional limitation parameters in LBP.
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21
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Werneke MW, Deutscher D, Grigsby D, Tucker CA, Mioduski JE, Hayes D. Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study. Phys Ther 2021; 101:6224412. [PMID: 33848335 PMCID: PMC8083284 DOI: 10.1093/ptj/pzab110] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE COVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) to describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR versus traditional in-person care, and (2) to describe TR frequency levels by condition and telecommunication modes. METHODS A descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR. RESULTS Sample consisted of 222,680 patients (59% female; mean [SD] age = 55 [18] years). Overall TR rate was 6% decreasing from 10% to 5% between second and third quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared with in-person care were more likely to be younger and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for nonorthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared with TR. CONCLUSIONS These results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the United States. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high-quality care. IMPACT This study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and telerehabilitation (TR) administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. The finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.
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Affiliation(s)
- Mark W Werneke
- Address all correspondence to Mark Werneke PT, MS, E-mail address: , Postal address: 95-1031 Ohiaha St Mililani HI USA
| | - Daniel Deutscher
- Net Health Systems, Inc., Pittsburgh PA, USA,MaccabiTech Institute for Research & Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - David Grigsby
- MidSouth Orthopaedic Rehabilitation, Cordova, TN, USA
| | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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22
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Santini A, Petruzzo A, Giannetta N, Ruggiero A, Di Muzio M, Latina R. Management of chronic musculoskeletal pain in veterans: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021011. [PMID: 33855991 PMCID: PMC8138808 DOI: 10.23750/abm.v92is2.11352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Veterans are military with health problems due to military conditions. The improved body armor and operational conditions has reduced the number of deaths, but increased the number of veterans with severe injuries, affected by musculoskeletal pain and associated syndromes, such as post-traumatic stress disorder. Multimodal approaches are considered in USA the gold standard for the treatment of these problems, while in Europe and Italy the data are unknown. The aim of this review was to describe and summarize multimodal therapeutic approaches that apply to the veteran population for chronic musculoskeletal pain and relate syndromes management. METHODS A comprehensive systematic review of the literature on Cochrane Library, PubMed, CINAHL e PsycINFO databases was conducted, from 2001 to 2020. RESULTS 228 papers have been found, 134 were selected after the first screening. 24 quantitative studies were included in the review, all from USA. Different multimodal interventions with different kind of treatment types emerged. The analyzed studies' sample size was 11 million (mean age = 57.67 years; SD=±11.94). The multimodal approaches showed a significant improvement in all outcomes (pain reduction and control, opioid therapy reduction, psychosocial outcomes) compared to traditional therapy. CONCLUSIONS Multimodal therapeutic approaches seem to guarantee a good management chronic musculoskeletal pain and related mental disorders, and the reduction and control to opioid use. Military nurses emerged as professionals who have a central role in this approach. European and Italian authorities should consider veterans, in order to assess their expected increase in the future.
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Affiliation(s)
| | - Antonio Petruzzo
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
| | - Noemi Giannetta
- Vita-Salute San Raffaele University, Tor Vergata, University of Rome, Italy.
| | - Antonio Ruggiero
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
| | - Marco Di Muzio
- Department of Molecular Medicine, Sapienza University of Rome, Italy.
| | - Roberto Latina
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
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George SZ, Coffman CJ, Allen KD, Lentz TA, Choate A, Goode AP, Simon CB, Grubber JM, King H, Cook CE, Keefe FJ, Ballengee LA, Naylor J, Brothers JL, Stanwyck C, Alkon A, Hastings SN. Improving Veteran Access to Integrated Management of Back Pain (AIM-Back): Protocol for an Embedded Pragmatic Cluster-Randomized Trial. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:S62-S72. [PMID: 33313728 PMCID: PMC7734660 DOI: 10.1093/pm/pnaa348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain treatments. This is an encouraging development; however, what constitutes best practice for nonpharmacologic management of low back pain (LBP) is largely unknown. DESIGN The Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) trial is an embedded pragmatic cluster-randomized trial that will examine the effectiveness of two different care pathways for LBP. Sixteen primary care clinics will be randomized 1:1 to receive training in delivery of 1) an integrated sequenced-care pathway or 2) a coordinated pain navigator pathway. Primary outcomes are pain interference and physical function (Patient-Reported Outcomes Measurement Information System Short Form [PROMIS-SF]) collected in the electronic health record at 3 months (n=1,680). A subset of veteran participants (n=848) have consented to complete additional surveys at baseline and at 3, 6, and 12 months for supplementary pain and other measures. SUMMARY AIM-Back care pathways will be tested for effectiveness, and treatment heterogeneity will be investigated to identify which veterans may respond best to a given pathway. Health care utilization patterns (including opioid use) will also be compared between care pathways. Therefore, the AIM-Back trial will provide important information that can inform the future delivery of nonpharmacologic treatment of LBP.
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Affiliation(s)
- Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Cynthia J Coffman
- Department of Biostatistics and Bioinformatics, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Duke University Medical Center, Durham, North Carolina
| | - Kelli D Allen
- University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Lentz
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Ashley Choate
- Durham VA Health Care System, Health Services Research & Development, Durham, North Carolina
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke Clinical Research Institute, Durham, North Carolina
| | - Corey B Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Janet M Grubber
- Durham VA Health Care System, Health Services Research & Development, Durham, North Carolina
| | - Heather King
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Division of General Internal Medicine, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Health Services Research & Development, Duke University, Durham, North Carolina
| | - Chad E Cook
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Lindsay A Ballengee
- Durham VA Health Care System, Health Services Research & Development, Duke University, Durham, North Carolina
| | - Jennifer Naylor
- Durham VA Health Care System, Mental Illness Research Education and Clinical Center, Duke University, Durham, North Carolina
| | | | - Catherine Stanwyck
- Durham VA Health Care System, Health Services Research & Development, Duke University, Durham, North Carolina
| | - Aviel Alkon
- Durham VA Health Care System, Health Services Research & Development, Duke University, Durham, North Carolina
| | - Susan N Hastings
- Durham Center of Innovation to Accelerate Discovery and Practice, Durham VA Health Care System, Geriatric Research, Education and Clinical Center at Durham VAHCS Health Services Research & Development, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina, USA
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24
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Adaptive and maladaptive coping strategies in older adults with chronic pain after lumbar surgery. Int J Rehabil Res 2020; 43:116-122. [PMID: 31842023 DOI: 10.1097/mrr.0000000000000389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study investigated whether adaptive and maladaptive coping strategies mediate the association between chronic pain and health-related quality of life among older adults experiencing chronic pain after lumbar surgery. Participants were 103 older adults with either or both of chronic lower back pain and leg pain after lumbar surgery (median age = 75 years, men = 44, women = 59). Intensity of chronic lower back and leg pain (11-point numerical rating scale), physical activities (Physical Activity Scale for the Elderly) as an adaptive coping strategy, maladaptive coping strategies (e.g. guarding, resting; Chronic Pain Coping Inventory), and health-related quality of life (12-item Short-Form Health Survey) were measured. Hypothetical models with adaptive and maladaptive coping strategies as mediators of pain intensity and health-related quality of life were tested using structural equation modeling. Model fitness was acceptable (adjusted goodness of fit index: 0.94-0.98, comparative fit index: 1.00, root mean square error of approximation: 0.00). The results showed that (1) the adaptive coping strategy of physical activity positively mediated the association between lower back and leg pain, and physical health but not mental and social health; (2) maladaptive coping strategies negatively mediated the association between pain and physical, mental, and social health; (3) physical activities were negatively associated with maladaptive coping strategies. This study demonstrated that adaptive and maladaptive coping strategies serve as mediators of the relationship between chronic pain and health-related quality of life in older adults after lumbar surgery.
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25
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Dias JF, Oliveira VC, Borges PRT, Dutra FCMS, Mancini MC, Kirkwood RN, Resende RA, Sampaio RF. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med 2020; 55:155-162. [PMID: 33060156 DOI: 10.1136/bjsports-2019-101375] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Investigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities. DESIGN Systematic review of randomised controlled trials. DATA SOURCES Searches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO. ELIGIBILITY CRITERIA Trials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence. RESULTS Forty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: -0.4 to 0.1), physical function (95% CI: -0.2 to 0.2) and quality of life (95% CI: -0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: -0.1 to 0.5) and quality of life (95% CI: -0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term. CONCLUSIONS Exercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.
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Affiliation(s)
- Jane Fonseca Dias
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vinicius Cunha Oliveira
- Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | | | - Marisa Cotta Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renata Noce Kirkwood
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renan Alves Resende
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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26
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Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis. Orthop Nurs 2020; 39:340-352. [PMID: 32956277 DOI: 10.1097/nor.0000000000000699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. PURPOSE The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. METHODS The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. RESULTS A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. CONCLUSION Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.
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27
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Amaral LK, Souza MB, Campos MG, Mendonça VA, Bastone A, Pereira LS, Mascarenhas RO, Oliveira VC. Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations. Arch Gerontol Geriatr 2020; 90:104177. [DOI: 10.1016/j.archger.2020.104177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
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28
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Jansson MM, Rantala A, Miettunen J, Puhto AP, Pikkarainen M. The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis. J Telemed Telecare 2020; 28:96-114. [PMID: 32316837 DOI: 10.1177/1357633x20917868] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. METHODS A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. RESULTS Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. DISCUSSION Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.
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Affiliation(s)
- Miia M Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Oulu University Hospital, Finland
| | - Arja Rantala
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Martti Ahtisaari Institute, University of Oulu, Finland.,VTT, Technical Research Centre of Finland, Finland
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29
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Jansson M, Vuorinen AL, Harjumaa M, Similä H, Koivisto J, Puhto AP, Vesty G, Pikkarainen M. The digital patient journey solution for patients undergoing elective hip and knee arthroplasty: Protocol for a pragmatic randomized controlled trial. J Adv Nurs 2020; 76:1436-1448. [PMID: 32133684 DOI: 10.1111/jan.14343] [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: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. BACKGROUND There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. DESIGN A pragmatic RCT with two parallel arms. METHODS The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020. IMPACT This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.
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Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | - Heidi Similä
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Jonna Koivisto
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Gillian Vesty
- School of Accounting, RMIT University, Melbourne, Australia
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
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O’Brien KM, Hodder RK, Wiggers J, Williams A, Campbell E, Wolfenden L, Yoong SL, Tzelepis F, Kamper SJ, Williams CM. Effectiveness of telephone-based interventions for managing osteoarthritis and spinal pain: a systematic review and meta-analysis. PeerJ 2018; 6:e5846. [PMID: 30397549 PMCID: PMC6214231 DOI: 10.7717/peerj.5846] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/29/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Osteoarthritis and spinal pain are common and burdensome conditions; however, the majority of patients with these conditions do not receive care that is consistent with clinical practice guidelines. Telehealth models of care have the potential to improve care for osteoarthritis and spinal pain patients. The aim of this review was to assess the effectiveness of verbal real-time telehealth interventions, including telephone-based and videoconferencing interventions to reduce pain intensity and disability in patients with osteoarthritis of the knee or hip and spinal pain (back or neck pain). METHODS We searched seven electronic databases from inception to May 2018. Randomised controlled trials (RCTs), cluster-RCTs, and non-randomised controlled trials were included. Two review authors independently extracted data for each included study. Primary outcomes were pain intensity and disability. We conducted primary meta-analyses combining all conditions with similar interventions and comparators. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. We used the Cochrane Risk of Bias tool to assess risk of bias, and GRADE to evaluate the quality of evidence. RESULTS We included 23 studies with 56 trial arms and 4,994 participants. All studies utilised telephone-based interventions. Only two studies used a telephone only approach and the remainder included educational materials and/or face-to-face components. We found no studies utilising videoconferencing. Meta-analysis showed telephone-based interventions (with educational materials) for osteoarthritis and spinal pain improved pain intensity (n = 5 trials, n = 1,357 participants, SMD -0.27, 95% CI [-0.53, -0.01], Tau2 = 0.06, I 2 = 74%; moderate-quality evidence) and disability (n = 7 trials, n = 1,537 participants, SMD -0.21, 95% CI [-0.40, -0.02], Tau2 = 0.03, I 2 = 56%; moderate-quality evidence) compared to usual care. Meta-analyses found telephone with face-to-face interventions does not improve pain and disability compared to usual care or face-to-face care alone. DISCUSSION We are moderately confident that telephone-based interventions reduce pain intensity and disability in patients with osteoarthritis and spinal pain compared to usual care, but telephone plus face-to-face interventions are no more effective than usual care or face-to-face interventions alone.
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Affiliation(s)
- Kate M. O’Brien
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
| | - Rebecca K. Hodder
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Amanda Williams
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Steven J. Kamper
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Christopher M. Williams
- Hunter New England Population Health, Wallsend, NSW, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
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George SZ, Greenspan AI. Nonpharmacological Management of Pain: Convergence in Priorities Fuels the Drive for More Evidence. Phys Ther 2018; 98:287-289. [PMID: 29617872 DOI: 10.1093/ptj/pzy034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Steven Z George
- Duke Clinical Research Institute, and Vice Chair of Clinical Research, Orthopaedic Surgery, Duke University, Durham, North Carolina. He is a Catherine Worthingham Fellow of the American Physical Therapy Association
| | - Arlene I Greenspan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Dr Greenspan's contribution as guest co-editor was done as a personal outside activity. The content of this editorial is that of the authors and does not necessarily represent the official position of the Centers for Disease Control and Prevention
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