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De Groef A, Meeus M, Heathcote LC, Wiles L, Catley M, Vogelzang A, Olver I, Runciman WB, Hibbert P, Dams L, Morlion B, Moseley GL. Treating persistent pain after breast cancer: practice gaps and future directions. J Cancer Surviv 2023; 17:1698-1707. [PMID: 35275361 PMCID: PMC8914454 DOI: 10.1007/s11764-022-01194-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022]
Abstract
This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Louise Wiles
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Mark Catley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna Vogelzang
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - William B Runciman
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter Hibbert
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Bart Morlion
- Section Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
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Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain?: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:41-52. [PMID: 36524771 DOI: 10.1097/ajp.0000000000001086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. METHODS Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. RESULTS Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12 wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. DISCUSSION These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).
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Barbari V, Storari L, Maselli F, Testa M. Applicability of pain neuroscience education: Where are we now? J Back Musculoskelet Rehabil 2021; 34:511-520. [PMID: 33749636 DOI: 10.3233/bmr-200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. RESULTS This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice.
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Barbari V, Storari L, Ciuro A, Testa M. Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:908-929. [PMID: 31839351 DOI: 10.1016/j.pec.2019.11.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/12/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effectiveness of communicative and educative strategies on 1) patient's low back pain awareness/knowledge, 2) maladaptive behavior modification and 3) compliance with exercise in patients with chronic low back pain. METHODS A systematic review was conducted. Searches were performed on 13 databases. Only randomized controlled trials enrolling patients ≥ 18 years of age were included. Risk of bias was assessed with the Cochrane Collaboration's tool and interrater agreement between authors for full-texts selection was evaluated with Cohen's Kappa. No meta-analysis was performed and qualitative analysis was conducted. RESULTS 24 randomized controlled trials which intervention included communicative and educative strategies were selected. Most of the studies were judged as low risk of bias and Cohen's Kappa was excellent ( = 0.822). Interventions addressed were cognitive behavioral therapy as unique treatment or combined with other treatments (multimodal interventions), coaching, mindfulness, pain science education, self-management, graded activity and graded exposure. CONCLUSIONS, PRACTICE IMPLICATION Patient's low back pain awareness/knowledge is still a grey area of literature. Pain science education, graded exposure and multimodal interventions are the most effective for behavior modification and compliance with exercise with benefits also in the long-term, while self-management, graded activity and coaching provide only short-term or no benefits.
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Affiliation(s)
- Valerio Barbari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova - Campus of Savona, Savona, Italy; Studio Fisioterapico - Dott. Valerio Barbari, Rimini, Italy
| | - Lorenzo Storari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova - Campus of Savona, Savona, Italy; Centro Retrain, Verona, Italy
| | - Aldo Ciuro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova - Campus of Savona, Savona, Italy; Madonna delle Grazie Hospital, Matera, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova - Campus of Savona, Savona, Italy.
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Goudman L, Huysmans E, Ickmans K, Nijs J, Moens M, Putman K, Buyl R, Louw A, Logghe T, Coppieters I. A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective. Phys Ther 2019; 99:933-945. [PMID: 30921465 DOI: 10.1093/ptj/pzz053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.
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Affiliation(s)
- Lisa Goudman
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium; I-CHER, Interuniversity Center for Health Economics Research; Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Kelly Ickmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Jo Nijs
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel; Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Manual Therapy (MANU), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Koen Putman
- Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel and Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Adriaan Louw
- International Spine and Pain Institute, Story City, Iowa
| | - Tine Logghe
- Department of Physical Medicine and Revalidation, Sint-Dimpna Ziekenhuis Geel, Geel, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group and Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University
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Louw A, Puentedura EJ, Reed J, Zimney K, Grimm D, Landers MR. A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clin Rehabil 2019; 33:1722-1731. [DOI: 10.1177/0269215519857782] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to determine if a preoperative pain neuroscience education program would result in superior outcomes compared to usual preoperative education for total knee arthroplasty. Design: Controlled clinical trial with alternating allocation. Setting: Community-based hospital. Subjects: Consecutive sample of 120 patients scheduled for total knee arthroplasty. Intervention: Traditional hospital preoperative total knee arthroplasty education program on its own, or with an additional 30-minute group pain neuroscience education session. Main measures: Primary outcomes were measurements at one, three, and six months for pain, function, fear of movement, and pain catastrophization. We also compared opioid usage, healthcare expenses, and patient satisfaction between groups. Results: There were no statistically significant differences in any outcome measures between the two groups over time, except for patient satisfaction. Those in the experimental group had more agreement with statements about “preparation for surgery” ( P = .038), “would do again” ( P = .032), and “met expectations” ( P = .033) compared to those in the control group averaged over the three measurement times. Patients improved in several outcome measures over time regardless of group assignment, with a 34% improvement in pain, 36% improvement in function, 16% improvement in fear of movement, and 23% improvement in pain catastrophization scores. Conclusion: Adding a brief 30-minute pain neuroscience education session to a traditional preoperative total knee arthroplasty education program did not result in any significant improvements, except patient satisfaction.
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Affiliation(s)
- Adriaan Louw
- International Spine Pain Institute, Story City, IA, USA
| | - Emilio J Puentedura
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, Baylor University, Waco, TX, USA
| | - Jordan Reed
- Department of Physical Therapy, Spencer Hospital, Spencer, IA, USA
| | - Kory Zimney
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Derek Grimm
- Department of Pharmacy Services, Spencer Hospital, Spencer, IA, USA
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Louw A, Zimney K, Reed J, Landers M, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract 2018; 35:543-553. [PMID: 29589782 DOI: 10.1080/09593985.2018.1455120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective. DESIGN AND SETTING Case Series. AIM To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures. PARTICIPANTS Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA). INTERVENTION Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet. MAIN OUTCOME MEASURES Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT). RESULTS Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion. CONCLUSIONS Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Jordan Reed
- c Rehabilitation Services , Spencer Hospital , Spencer , IA , USA
| | - Merrill Landers
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Emilio J Puentedura
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
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Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2016; 32:332-55. [PMID: 27351541 DOI: 10.1080/09593985.2016.1194646] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Systematic review of randomized control trials (RCTs) for the effectiveness of pain neuroscience education (PNE) on pain, function, disability, psychosocial factors, movement, and healthcare utilization in individuals with chronic musculoskeletal (MSK) pain. DATA SOURCES Systematic searches were conducted on 11 databases. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. STUDY SELECTION All experimental RCTs evaluating the effect of PNE on chronic MSK pain were considered for inclusion. Additional Limitations: Studies published in English, published within the last 20 years, and patients older than 18 years. No limitations were set on specific outcome measures. DATA EXTRACTION Data were extracted using the participants, interventions, comparison, and outcomes (PICO) approach. DATA SYNTHESIS Study quality of the 13 RCTs used in this review was assessed by 2 reviewers using the PEDro scale. Narrative summary of results is provided for each study in relation to outcomes measurements and effectiveness. CONCLUSIONS Current evidence supports the use of PNE for chronic MSK disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Emilio J Puentedura
- c Department of Physical Therapy, School of Allied Health Sciences , University of Nevada, Las Vegas , Las Vegas , NV , USA
| | - Ina Diener
- d Department of Physiotherapy , Stellenbosch University , Stellenbosch , South Africa
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Poquet N, Lin CC, Heymans MW, van Tulder MW, Esmail R, Koes BW, Maher CG. Back schools for acute and subacute non-specific low-back pain. Cochrane Database Syst Rev 2016; 4:CD008325. [PMID: 27113258 PMCID: PMC11074243 DOI: 10.1002/14651858.cd008325.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating people with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. In this review we defined back school as a therapeutic programme given to groups of people, which includes both education and exercise. This is an update of a Cochrane review first published in 1999, and updated in 2004. For this review update, we split the review into two distinct reviews which separated acute from chronic LBP. OBJECTIVES To assess the effectiveness of back schools on pain and disability for people with acute or subacute non-specific LBP. We also examined the effect on work status and adverse events. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and two clinical trials registers up to 4 August 2015. We also checked the reference lists of articles and contacted experts in the field of research on LBP. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs that reported on back school for acute or subacute non-specific LBP. The primary outcomes were pain and disability. The secondary outcomes were work status and adverse events. Back school had to be compared with another treatment, a placebo (or sham or attention control) or no treatment. DATA COLLECTION AND ANALYSIS We used the 2009 updated method guidelines for this Cochrane review. Two review authors independently screened the references, assessed the quality of the trials and extracted the data. We set the threshold for low risk of bias, a priori, as six or more of 13 internal validity criteria and no serious flaws (e.g. large drop-out rate). We classified the quality of the evidence into one of four levels (high, moderate, low or very low) using the adapted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS The search update identified 273 new references, of which none fulfilled our inclusion criteria. We included four studies (643 participants) in this updated review, which were all included in the previous (2004) update. The quality of the evidence was very low for all outcomes. As data were too clinically heterogeneous to be pooled, we described individual trial results. The results indicate that there is very low quality evidence that back schools are no more effective than a placebo (or sham or attention control) or another treatment (physical therapies, myofascial therapy, joint manipulations, advice) on pain, disability, work status and adverse events at short-term, intermediate-term and long-term follow-up. There is very low quality evidence that shows a statistically significant difference between back schools and a placebo (or sham or attention control) for return to work at short-term follow-up in favour of back school. Very low quality evidence suggests that back school added to a back care programme is more effective than a back care programme alone for disability at short-term follow-up. Very low quality evidence also indicates that there is no difference in terms of adverse events between back school and myofascial therapy, joint manipulation and combined myofascial therapy and joint manipulation. AUTHORS' CONCLUSIONS It is uncertain if back schools are effective for acute and subacute non-specific LBP as there is only very low quality evidence available. While large well-conducted studies will likely provide more conclusive findings, back schools are not widely used interventions for acute and subacute LBP and further research into this area may not be a priority.
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Affiliation(s)
- Nolwenn Poquet
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthPO Box M201Missenden RoadSydneyAustraliaNSW 2050
| | - Chung‐Wei Christine Lin
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthPO Box M201Missenden RoadSydneyAustraliaNSW 2050
| | - Martijn W Heymans
- VU University Medical CenterDepartment of Epidemiology and BiostatisticsPO Box 7057AmsterdamNetherlands1007 MB
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Rosmin Esmail
- Alberta Health ServicesHealth Technology Assessment and Adoption, Research, Innovation and Analytics PortfolioCalgaryABCanada
| | - Bart W Koes
- Erasmus Medical CenterDepartment of General PracticePO Box 2040RotterdamNetherlands3000 CA
| | - Christopher G Maher
- Sydney Medical School, The University of SydneyThe George Institute for Global HealthPO Box M201Missenden RoadSydneyNSWAustralia2050
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Hurley J, O'Keeffe M, O'Sullivan P, Ryan C, McCreesh K, O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. ACTA ACUST UNITED AC 2016; 23:e1-2. [PMID: 27026111 DOI: 10.1016/j.math.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- John Hurley
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Mary O'Keeffe
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Peter O'Sullivan
- School of Physiotherapy, Curtin University of Technology, Perth, Australia.
| | - Cormac Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, UK.
| | - Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Kieran O'Sullivan
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
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Sharafkhani N, Khorsandi M, Shamsi M, Ranjbaran M. The Effect of an Educational Intervention Program on the Adoption of Low Back Pain Preventive Behaviors in Nurses: An Application of the Health Belief Model. Global Spine J 2016; 6:29-34. [PMID: 26835199 PMCID: PMC4733379 DOI: 10.1055/s-0035-1555658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/20/2015] [Indexed: 12/19/2022] Open
Abstract
Study Design Randomized controlled trial. Objective The purpose of this study was to identify the effect of a theory-based educational intervention program on the level of knowledge and Health Belief Model (HBM) constructs among nurses in terms of the adoption of preventive behaviors. Methods This pretest/posttest quasi-experimental study was conducted on 100 nurses who were recruited through the multistage sampling method. The nurses were randomly assigned to intervention and control groups. The participants were evaluated before and 3 months after the educational intervention. A multidimensional questionnaire was prepared based on the theoretical structures of the HBM to collect the data. Data analysis was performed using descriptive and inferential statistics. Results There was no significant difference in the mean values of HBM constructs prior to the intervention between the intervention and control groups. However, after the administration of the educational program, the mean scores of knowledge and HBM constructs significantly increased in the intervention group when compared with the control group (p < 0.0001). Conclusion The results of the current study revealed that the educational intervention based on the HBM was effective in improving the nurses' scores of knowledge and HBM constructs; therefore, theory-based health educational strategies are suggested as an effective alternative to traditional educational interventions.
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Affiliation(s)
- Naser Sharafkhani
- Department of Health Education and Promotion, Arak University of Medical Sciences, Arak, Iran
| | - Mahboobeh Khorsandi
- Department of Health Education and Promotion, Arak University of Medical Sciences, Arak, Iran,Address for correspondence Mahboobeh Khorsandi Associate Professor of Arak University of Medical SciencesMostafa Khomeini St. Golestan alley, Arak, Markazi ProvinceIran
| | - Mohsen Shamsi
- Department of Health Education and Promotion, Arak University of Medical Sciences, Arak, Iran
| | - Mehdi Ranjbaran
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
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Louw A, Puentedura EJ, Diener I, Peoples RR. Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report. Physiother Theory Pract 2015; 31:496-508. [DOI: 10.3109/09593985.2015.1038374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Louw A, Diener I, Puentedura EJ. The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series. Int J Spine Surg 2015; 9:11. [PMID: 26056626 DOI: 10.14444/2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. METHODS A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. RESULTS Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. CONCLUSIONS The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - Ina Diener
- University Stellenbosch and University Western Cape, Stellenbosch, South Africa
| | - Emilio J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy
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Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine (Phila Pa 1976) 2015; 39:1449-57. [PMID: 24875964 DOI: 10.1097/brs.0000000000000444] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Multicenter, randomized, controlled trial on preoperative pain neuroscience education (NE) for lumbar radiculopathy. OBJECTIVE To determine if the addition of NE to usual preoperative education would result in superior outcomes with regard to pain, function, surgical experience, and health care utilization postsurgery. SUMMARY OF BACKGROUND DATA One in 4 patients after lumbar surgery (LS) for radiculopathy experience persistent pain and disability, which is nonresponsive to perioperative treatments. NE focusing on the neurophysiology of pain has been shown to decrease pain and disability in populations with chronic low back pain. METHODS Eligible patients scheduled for LS for radiculopathy were randomized to receive either preoperative usual care (UC) or a combination of UC plus 1 session of NE delivered by a physical therapist (verbal one-on-one format) and a NE booklet. Sixty-seven patients completed the following outcomes prior to LS (baseline), and 1, 3, 6, and 12 months after LS: low back pain (numeric rating scale), leg pain (numeric rating scale), function (Oswestry Disability Index), various beliefs and experiences related to LS (10-item survey with Likert scale responses), and postoperative utilization of health care (utilization of health care questionnaire). RESULTS At 1-year follow-up, there were no statistical differences between the experimental and control groups with regard to primary outcome measure of low back pain (P = 0.183), leg pain (P = 0.075), and function (P = 0.365). In a majority of the categories regarding surgical experience, the NE group scored significantly better: better prepared for LS (P = 0.001); preoperative session preparing them for LS (P < 0.001) and LS meeting their expectations (P = 0.021). Health care utilization post-LS also favored the NE group (P = 0.007) resulting in 45% less health care expenditure compared with the control group in the 1-year follow-up period. CONCLUSION NE resulted in significant behavior change. Despite a similar pain and functional trajectory during the 1-year trial, patients with LS who received NE viewed their surgical experience more favorably and used less health care facility in the form of medical tests and treatments. LEVEL OF EVIDENCE 2.
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Borys C, Nodop S, Tutzschke R, Anders C, Scholle HC, Strauß B. [Evaluation of the German new back school: pain-related and psychological characteristics]. Schmerz 2015; 27:588-96. [PMID: 24337425 DOI: 10.1007/s00482-013-1370-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Results related to the outcome of the classical back schools are inconsistent. Accordingly, a reformulation of the program integrating psychological and social aspects was performed as a necessary step for the development of the new back school in Germany. The aim of this study was to assess the effectiveness and sustainability of the new back school in subjects with non-specific back pain in the prevention setting. MATERIAL AND METHODS In a modified waiting design, individuals were investigated with respect to demographical, pain-related and psychological characteristics 3 months before the start, at the start and at the end of the back school and as well as 12 months after completion. In addition, predictors for a successful participation were analyzed. RESULTS A total of 88 subjects with back pain initially participated in the study. In the short and long-term course, low to moderate effects were detected; however, during follow-up a reduction of pain showed high effects. Depression as assessed by the hospital anxiety and depression scale (HADS) and passive coping strategies assessed using the coping strategies questionnaire (CSQ) were identified as predictors for response to the intervention. CONCLUSION On the basis of the sample studied, the new back school proved to be an effective treatment for short and long-term reduction of pain-related stress and associated psychological aspects. Maladaptive, passive coping strategies and higher depression scores were associated with a higher probability of success in terms of pain reduction and functional improvement.
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Affiliation(s)
- C Borys
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Stoystr. 3, 07740, Jena, Deutschland,
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Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy. Am J Phys Med Rehabil 2013; 92:446-52. [PMID: 23478459 DOI: 10.1097/phm.0b013e3182876aa4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Postoperative rehabilitation for lumbar radiculopathy has shown little effect on reducing pain and disability. Current preoperative education programs with a focus on a biomedical approach feature procedural and anatomical information, and these too have shown little effect on postoperative outcomes. This report describes the development of an evidence-based educational program and booklet for patients undergoing lumbar surgery for radiculopathy using a recently conducted systematic review of neuroscience education for musculoskeletal pain. The previous systematic review produced evidence for neuroscience education as well as best-evidence synthesis of the content and delivery methods for neuroscience education for musculoskeletal pain. These evidence statements were extracted and developed into patient-centered messages and a booklet, which was then evaluated by peer and patient review. The neuroscience educational booklet and preoperative program convey key messages from the previous systematic review aimed at reducing fear and anxiety before surgery and assist in developing realistic expectations regarding pain after surgery. Key topics include the decision to undergo surgery, pain processing, peripheral nerve sensitization, effect of anxiety and stress on pain, surgery and the nervous system, and decreasing nerve sensitization. Feedback from the evaluations of the booklet and preoperative program was favorable from all review groups, suggesting that this proposed evidence-based neuroscience educational program may be ready for clinical application.
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Abstract
Osteoarthritis is one of the most frequent, disabling, and costly pathologies of modern society. Among the main aims of osteoarthritis management are pain control and functional ability improvement. The exact cause of osteoarthritis pain remains unclear. In addition to the pathological changes in articular structures, changes in central pain processing or central sensitization appear to be involved in osteoarthritis pain. The latter calls for a broader approach to the management of patients with osteoarthritis. Yet, the scientific literature offers scant information addressing the treatment of central sensitization, specifically in patients with osteoarthritis. Interventions such as cognitive-behavioral therapy and neuroscience education potentially target cognitive-emotional sensitization (and descending facilitation), and centrally acting drugs and exercise therapy can improve endogenous analgesia (descending inhibition) in patients with osteoarthritis. Future studies should assess these new treatment avenues.
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Reis FJJ, Gomes MK, Saadi L, Gosling AP, Cunha AJLA. Chronic pain in leprosy: new aspects to be considered. Pain Manag 2013; 3:201-10. [DOI: 10.2217/pmt.13.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Leprosy is still considered to be endemic in several developing countries, such as India and Brazil. Infection with Mycobacterium leprae leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Since the disease causes severe sensory loss, little attention has been given to pain in leprosy. However, chronic pain in leprosy is being increasingly recognized as an important late complication of leprosy. This article discusses the assessment of pain in leprosy and suggests factors that can contribute to the chronicity. We also consider pain as a multiple system output, bringing the possibility of new treatment options for chronic pain in leprosy.
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Affiliation(s)
- Felipe JJ Reis
- Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | | | - Licia Saadi
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Parkin-Smith GF, Norman IJ, Briggs E, Angier E, Wood TG, Brantingham JW. A Structured Protocol of Evidence-Based Conservative Care Compared With Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial. Arch Phys Med Rehabil 2012; 93:11-20. [DOI: 10.1016/j.apmr.2011.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 10/14/2022]
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Louw A, Diener I, Butler DS, Puentedura EJ. The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain. Arch Phys Med Rehabil 2011; 92:2041-56. [DOI: 10.1016/j.apmr.2011.07.198] [Citation(s) in RCA: 326] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/18/2011] [Accepted: 07/19/2011] [Indexed: 10/14/2022]
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Louw A, Puentedura E“L, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: A case report. Physiother Theory Pract 2011; 28:50-62. [DOI: 10.3109/09593985.2011.562602] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Back Care Programmes: The Low Participation of Target Groups and Unclear Effectiveness as Primary Prevention. HUMAN MOVEMENT 2011. [DOI: 10.2478/v10038-011-0010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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El metaanálisis en el ámbito de las Ciencias de la Salud: una metodología imprescindible para la eficiente acumulación del conocimiento. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.ft.2009.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rebolho MCT, Casarotto RA, João SMA. Estratégias para ensino de hábitos posturais em crianças: história em quadrinhos versus experiência prática. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo experimental verificou os efeitos de um programa de educação postural comparando duas estratégias de ensino, a utilização de uma história em quadrinhos (HQ) e a experiência prática de posturas corretas e incorretas (EP). O programa de educação postural foi aplicado em três encontros com escolares das 2ª e 3ª séries, com idades entre 7 e 11 anos; 40 meninas e 40 meninos foram divididos igualmente em dois grupos, cada um submetido a uma estratégia de ensino: GHQ e GEP. O conhecimento dos hábitos posturais foi verificado por meio de questionários aplicados antes e após 6 meses do término das sessões. Foram ensinadas as posturas corretas em pé, sentado, de transportar mochilas, de abaixar, de mudar objetos de lugar e jeito de dormir. Os resultados do estudo indicaram que, para todas as variáveis estudadas houve aumento significativo no aprendizado e memorização dos hábitos posturais corretos em ambos os grupos, e que não houve diferença significativa entre as duas estratégias educativas. Não foram detectadas diferenças no aprendizado e memorização dos hábitos posturais corretos em crianças de ambos os sexos submetidas às duas metodologias de ensino.
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Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR. Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J 2008; 8:948-58. [PMID: 18024224 DOI: 10.1016/j.spinee.2007.07.389] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 07/03/2007] [Accepted: 07/04/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND Seven previous systematic reviews (SRs) have evaluated back schools, and one has evaluated brief education, with the latest SR including studies until November 2004. The effectiveness of fear-avoidance training has not been assessed. PURPOSE To assess the effectiveness of back schools, brief education, and fear-avoidance training for chronic low back pain (CLBP). STUDY DESIGN A SR. METHODS We searched the MEDLINE database of randomized controlled trials (RCT) until August 2006 for relevant trials reported in English. Assessment of effectiveness was based on pain, disability, and sick leave. RCTs that reported back schools, or brief education as the main intervention, were included. For fear-avoidance training, evaluation of domain-specific outcome was required. Two reviewers independently reviewed the studies. RESULTS Eight RCTs including 1,002 patients evaluated back schools, three studies were of high quality. We found conflicting evidence for back schools compared with waiting list, placebo, usual care, and exercises, and a cognitive behavioral back school. Twelve trials including 3,583 patients evaluated brief education. Seven trials, six of high quality, evaluated brief education in the clinical setting. We found strong evidence of effectiveness on sick leave and short-term disability compared with usual care. We found conflicting or limited evidence for back book or Internet discussion (five trials, two of high quality) compared with waiting list, no intervention, massage, yoga, or exercises. Three RCTs of high quality, including 364 patients, evaluated fear-avoidance training. We found moderate evidence that there is no difference between rehabilitation including fear-avoidance training and spinal fusion. CONCLUSIONS Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting. The discordance between reviews can be attributed differences in inclusion criteria and application of evidence rules.
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Affiliation(s)
- J I Brox
- Orthopedic Department, Rikshospitalet-Radiumhospitalet Medical University Center, 0027 Oslo, Norway.
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26
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Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR. Evidence-informed management of chronic low back pain with back schools, brief education, and fear-avoidance training. Spine J 2008; 8:28-39. [PMID: 18164451 DOI: 10.1016/j.spinee.2007.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 10/13/2007] [Indexed: 02/03/2023]
Abstract
The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
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Affiliation(s)
- Jens Ivar Brox
- Orthopedic Department, Rikshospitalet University, 0027 Oslo, Norway.
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Liddle SD, Gracey JH, Baxter GD. Advice for the management of low back pain: A systematic review of randomised controlled trials. ACTA ACUST UNITED AC 2007; 12:310-27. [PMID: 17395522 DOI: 10.1016/j.math.2006.12.009] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 12/15/2006] [Accepted: 12/15/2006] [Indexed: 11/24/2022]
Abstract
To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of 'high' or 'medium' methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area. Advice to stay active is sufficient for acute LBP; however, it appears that RCTs do not commonly reflect these recommendations. No conclusions could be drawn as to the content and frequency of advice that is most effective for subacute LBP, due to the limited number and poor quality of RCTs in this area: this review provides preliminary support for advice as part of a back school approach. Given that the effectiveness of treatment for subacute symptoms will directly influence the development of chronicity, these results would suggest that education and awareness of the causes and consequences of back pain may be a valuable treatment component for this patient subgroup. For chronic LBP there is strong evidence to support the use of advice to remain active in addition to specific advice relating to the most appropriate exercise, and/or functional activities to promote active self-management. More investigation is needed into the role of follow-up advice for chronic LBP patients.
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Affiliation(s)
- S Dianne Liddle
- Health and Rehabilitation Sciences Research Institute, University of Ulster at Jordanstown, Shore Road, Newtownabbey Co. Antrim, BT37 OQB, Northern Ireland.
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Abstract
Low back pain is an extremely common patient complaint. Most cases resolve fairly quickly after the acute episode. However, a small but significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired. Multiple patient characteristics have been identified that place patients at risk for developing chronic low back pain. Currently, it is difficult to find clinical guidelines on how best to manage chronic low back pain, and it remains a substantial treatment challenge for both physicians and patients. The causes, risk factors, prognosis and treatment strategies for chronic low back pain will be discussed in this chapter. The evidence regarding different pharmacological and non-pharmacological treatment modalities will be reviewed and a logical, focused treatment strategy will be outlined.
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Affiliation(s)
- Shari Diamond
- Division of Rheumatology, The George Washington University Medical Center, Washington, DC 20037, USA.
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Schneider S, Schiltenwolf M. Preaching to the converted: Über- und Unterversorgung in der Schmerzprävention am Beispiel bundesdeutscher Rückenschulen. Schmerz 2005; 19:477-82, 484-8. [PMID: 16012815 DOI: 10.1007/s00482-005-0414-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In response to the growing incidence of back pain, increasing emphasis is being placed on individualized preventive measures. The purpose of the present study was to investigate representative data for back pain, participation rates of back care programs, and their correlates in the German general population. METHODS The first National Health Survey was carried out in the Federal Republic of Germany in the period from October 1997 to March 1999. It comprised a representative, cross-sectional study of the population with a total sample of 6235 participants between the ages of 18 and 79. RESULTS The 7-day prevalence for back pain in Germany was found to be 36%, and 7% of all Germans had participated in a back care program within the past year. The 1-year participation rate was significantly lower in persons with higher risk for back pain (men, full-time workers, unmarried people, and those with an unhealthy lifestyle). CONCLUSIONS The user profile for back care programs indicates that genuine needs are not being met and the target group is not being reached. A "preaching to the converted" phenomenon is evident, as indicated by the fact that the user group is made up of individuals who already have a healthy lifestyle and few risks while the population group most likely to develop back pain is significantly less likely to participate in preventive back care programs.
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Affiliation(s)
- S Schneider
- Tagesklinik für orthopädische Schmerztherapie, Orthopädische Universitätsklinik Heidelberg.
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Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ. How to prevent low back pain. Best Pract Res Clin Rheumatol 2005; 19:541-55. [PMID: 15949775 DOI: 10.1016/j.berh.2005.03.001] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.
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Affiliation(s)
- A Kim Burton
- Centre for Health and Social Care Research, University of Huddersfield, 30 Queen Street, Huddersfield HD1 2SP, UK.
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Smidt N, de Vet HCW, Bouter LM, Dekker J, Arendzen JH, de Bie RA, Bierma-Zeinstra SMA, Helders PJM, Keus SHJ, Kwakkel G, Lenssen T, Oostendorp RAB, Ostelo RWJG, Reijman M, Terwee CB, Theunissen C, Thomas S, van Baar ME, van 't Hul A, van Peppen RPS, Verhagen A, van der Windt DAWM. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. ACTA ACUST UNITED AC 2005; 51:71-85. [PMID: 15924510 DOI: 10.1016/s0004-9514(05)70036-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy for patients with disorders of the musculoskeletal, nervous, respiratory, and cardiovascular systems. Systematic reviews were identified by means of a comprehensive search strategy in 11 bibliographic databases (08/2002), in combination with reference tracking. Reviews that included (i) at least one randomised controlled trial investigating the effectiveness of exercise therapy, (ii) clinically relevant outcome measures, and (iii) full text written in English, German or Dutch, were selected by two reviewers. Thirteen independent and blinded reviewers participated in the selection, quality assessment and data-extraction of the systematic reviews. Conclusions about the effectiveness of exercise therapy were based on the results presented in reasonable or good quality systematic reviews (quality score > or = 60 out of 100 points). A total of 104 systematic reviews were selected, 45 of which were of reasonable or good quality. Exercise therapy is effective for patients with knee osteoarthritis, sub-acute (6 to 12 weeks) and chronic (> or = 12 weeks) low back pain, cystic fibrosis, chronic obstructive pulmonary disease, and intermittent claudication. Furthermore, there are indications that exercise therapy is effective for patients with ankylosing spondylitis, hip osteoarthritis, Parkinson's disease, and for patients who have suffered a stroke. There is insufficient evidence to support or refute the effectiveness of exercise therapy for patients with neck pain, shoulder pain, repetitive strain injury, rheumatoid arthritis, asthma, and bronchiectasis. Exercise therapy is not effective for patients with acute low back pain. It is concluded that exercise therapy is effective for a wide range of chronic disorders.
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Silverstein B, Clark R. Interventions to reduce work-related musculoskeletal disorders. J Electromyogr Kinesiol 2004; 14:135-52. [PMID: 14759759 DOI: 10.1016/j.jelekin.2003.09.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Work-related Musculoskeletal Disorders (WMSDs) continue to present a major challenge to workers and their employers in virtually every industry sector. Many disciplines have been involved in providing advice and working on interventions to prevent WMSDs or reduce their consequences. Since the early 1990s, 15 systematic reviews (excluding specific treatment modalities) have appeared in the peer-reviewed literature addressing musculoskeletal disorder reduction. The National Research Council-Institute of Medicine summarized many of these efforts in 2001. Using a systematic literature search strategy, we identified 20 randomized controlled studies, 17 quasi-experimental studies with control groups, and 36 paper reporting case studies with in the peer-reviewed literature between 1999-2003. Evidence is continuing to build that demonstrates combinations of measures appear to have the greatest effect in reducing WMSDs, although individual engineering and administrative controls can also have positive effects.
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Affiliation(s)
- Barbara Silverstein
- Safety & Health Assessment and Research for Prevention (SHARP), Washington State Department of Labor and Industries, PO Box 44330, Olympia, Washington 98504-4330, USA.
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