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Sidiq M, Muzaffar T, Janakiraman B, Masoodi S, Vasanthi RK, Ramachandran A, Bansal N, Chahal A, Kashoo FZ, Rizvi MR, Sharma A, Rai RH, Verma R, Sharma M, Alam S, Vajrala KR, Sharma J, Muthukrishnan R. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial. PLoS One 2024; 19:e0294302. [PMID: 38805446 PMCID: PMC11132453 DOI: 10.1371/journal.pone.0294302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. METHODS The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. FINDINGS Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). CONCLUSION The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain.
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Affiliation(s)
- Mohammad Sidiq
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Tufail Muzaffar
- Departmet of Physical Medicine & Rehabilitation, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Balamurugan Janakiraman
- SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chennai, Tamil Nadu, India
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Shariq Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | | | - Arunachalam Ramachandran
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Nitesh Bansal
- Jindal School of Public Health & Human Development, O P Jindal Global University, Sonipat, Haryana, India
| | - Aksh Chahal
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Moattar Raza Rizvi
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Ankita Sharma
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Richa Hirendra Rai
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Rituraj Verma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Monika Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Sajjad Alam
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Krishna Reddy Vajrala
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Jyoti Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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Longtin C, Lacasse A, Cook CE, Tousignant M, Tousignant-Laflamme Y. Management of low back pain by primary care physiotherapists using the pain and disability drivers management model: An improver analysis. Musculoskeletal Care 2023; 21:916-925. [PMID: 36762893 DOI: 10.1002/msc.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Departement of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Michel Tousignant
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
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Longtin C, Décary S, Cook CE, Tousignant M, Lacasse A, Tousignant-Laflamme Y. Optimising management of low back pain through the pain and disability drivers management model: Findings from a pilot cluster nonrandomised controlled trial. Musculoskeletal Care 2023; 21:667-682. [PMID: 36749025 DOI: 10.1002/msc.1738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Low back pain (LBP) remains the leading cause of disability. The Low Back Pain and Disability Drivers Management (PDDM) model aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the feasibility of conducting a pragmatic controlled trial of the PDDM model and to explore its effectiveness compared to clinical practice guidelines' recommendations for LBP management. METHODS A pilot cluster nonrandomised controlled trial. Participants included physiotherapists and their patients aged 18 years or older presenting with a primary complaint of LBP. Primary outcomes were the feasibility of the trial design. Secondary exploratory analyses were conducted on LBP-related outcomes such as pain severity and interference at 12-week follow-up. RESULTS Feasibility of study procedures were confirmed, recruitment exceeded our target number of participants, and the eligibility criteria were deemed suitable. Lost to follow-up at 12 weeks was higher than expected (43.0%) and physiotherapists' compliance rates to the study protocol was lower than our predefined threshold (75.0% vs. 57.5%). A total of 44 physiotherapists and 91 patients were recruited. Recommendations for a larger scale trial were formulated. The PDDM model group demonstrated slightly better improvements in all clinical outcome measures compared to the control group at 12 weeks. CONCLUSION The findings support the feasibility of conducting such trial contingent upon a few recommendations to foster proper future planning to determine the effectiveness of the PDDM model. Our results provide preliminary evidence of the PDDM model effectiveness to optimise LBP management. CLINICAL TRIAL REGISTRATION Clinicaltrial.gov, NCT04893369.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michel Tousignant
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Departement of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
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Rabey M, Kendell M, Shea YL, Mattinson D, Koh YFN, Seow KC, Beales D. Interaction analyses: Enhancing understanding of chronic low back pain. Musculoskelet Sci Pract 2023; 64:102728. [PMID: 36804720 DOI: 10.1016/j.msksp.2023.102728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is complex. Statistical examination of influences of exposures (e.g. characteristics) upon outcomes (e.g. pain) facilitates understanding of complexity and personalized care. Psychological factors may be associated with higher disability following exercise in CLBP. Examining interactions of psychological variables with exercise on disability might further understanding of CLBP. OBJECTIVES Secondary analysis of data from a CLBP cohort evaluating interactions between psychological variables and exercise on disability. DESIGN Longitudinal cohort study. METHOD Variables from a published prognostic model for disability: disability (baseline/one-year follow-up), psychological principal component scores (principal component score two (PC2) - Fear-avoidance beliefs, pain catastrophizing, pain self-efficacy; principal component score three (PC3) - thought suppression, behavioral endurance), exercise (during follow-up), forward-bending time, punishing significant other responses. Differences between exercisers and non-exercisers were assessed using Chi-Squared/Mann-Whitney tests. Multivariable linear regression models for follow-up disability included a term examining interaction between principal component scores and exercise. RESULTS Exercisers had significantly different scores for PC2 (p = .02) and PC3 (p = .03), lower baseline (p = .005) and follow-up pain intensity (p < .001), follow-up disability (p < .001) and faster forward-bend times (p = .014). There was no significant interaction between exercise and PC2 (p = .92) or PC3 (p = .75). CONCLUSIONS This study showed no interaction between psychological factors and exercise on disability at follow-up. These findings suggest that the disability outcome of people with CLBP who undertake exercise as an intervention does not differ from those who do not undertake exercise, irrespective of their baseline psychological status.
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Affiliation(s)
- Martin Rabey
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia.
| | - Michelle Kendell
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Yik Lui Shea
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Deb Mattinson
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Yi Fan Nathan Koh
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Kuang Cheng Seow
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
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Naye F, Décary S, Tousignant-Laflamme Y. Inter-rater agreement of the Pain and Disability Drivers Management rating scale. J Back Musculoskelet Rehabil 2022; 35:893-900. [PMID: 34957991 DOI: 10.3233/bmr-210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A framework to establish the biopsychosocial patient profile for persons with low back pain has been recently proposed and validated: The Pain and Disability Drivers Management model (PDDM). In order to facilitate its clinical integration, we developed the PDDM rating scale. OBJECTIVES To determine the inter-rater agreement of the PDDM rating scale. A second objective was to determine if this inter-rater agreement varies according to the complexity of patients' clinical presentation. METHODS We recruited physiotherapists during one-day workshops on the PDDM. We asked each participant to assess two clinical vignettes using the rating scale. One vignette presented a typical clinical presentation (moderate level of difficulty) and one presented an atypical presentation (complex level of difficulty). We determined inter-rater agreement with the proportion of participants who gave the same answer for each PDDM domain. RESULTS For the typical vignette, the inter-rater agreement per domain was moderate to good (between 0.54 and 0.97). For the complex vignette, the inter-rater agreement per domain was poor to good (between 0.49 and 0.81). The comparison between the two vignettes showed a significant difference (p< 0.01) for nociceptive and cognitive-emotional domains. CONCLUSION Overall performance indicates that the rating scale present adequate agreement for clinical use, but specific domains require further development.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Waller R, Smith AJ, Graven-Nielsen T, Arendt-Nielsen L, Sterling M, Karppinen JI, O'Sullivan PB, Straker LM, Slater H. Role of population-based cohorts in understanding the emergence and progression of musculoskeletal pain. Pain 2022; 163:58-63. [PMID: 33883537 DOI: 10.1097/j.pain.0000000000002316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Waller
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Anne Julia Smith
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg DK, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg DK, Denmark
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland, Herston, Australia
| | - Jaro Ilari Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Leon Melville Straker
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Rabey M, Buldo B, Duesund Helland M, Pang C, Kendell M, Beales D. Significant other interactions in people with chronic low back pain: Subgrouping and multidimensional profiles. Br J Pain 2021; 16:326-340. [DOI: 10.1177/20494637211062045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Back pain is complex. Social support and significant other interactions influence the pain experience. Purpose: To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Research Design: Longitudinal cohort study. Study Sample: People with chronic axial low back pain ( n = 262). Data Collection and Analysis: Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Results: Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. Conclusions: These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people’s presentation.
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Affiliation(s)
- Martin Rabey
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
- Thrive Physiotherapy, Guernsey
| | - Brendan Buldo
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Magnus Duesund Helland
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Courtenay Pang
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Michelle Kendell
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health Curtin University, Perth, WA, Australia
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Chang JR, Wang X, Lin G, Samartzis D, Pinto SM, Wong AYL. Are Changes in Sleep Quality/Quantity or Baseline Sleep Parameters Related to Changes in Clinical Outcomes in Patients With Nonspecific Chronic Low Back Pain?: A Systematic Review. Clin J Pain 2021; 38:292-307. [PMID: 34939973 DOI: 10.1097/ajp.0000000000001008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sleep disturbance is prevalent among patients with chronic low back pain (CLBP). This systematic review aimed to summarize the evidence regarding the: (1) temporal relations between changes in sleep quality/quantity and the corresponding changes in pain and/or disability; and (2) role of baseline sleep quality/quantity in predicting future pain and/or disability in patients with CLBP. METHODS Four databases were searched from their inception to February 2021. Two reviewers independently screened the abstract and full text, extracted data, assessed the methodological quality of the included studies, and evaluated the quality of evidence of the findings using the Grading of Recommendations Assessment Development and Evaluation (GRADE). RESULTS Of 1995 identified references, 6 articles involving 1641 participants with CLBP were included. Moderate-quality evidence substantiated that improvements in self-reported sleep quality and total sleep time were significantly correlated with the corresponding LBP reduction. Low-quality evidence showed that self-reported improvements in sleep quality were related to the corresponding improvements in CLBP-related disability. There was conflicting evidence regarding the relation between baseline sleep quality/quantity and future pain/disability in patients with CLBP. DISCUSSION This is the first systematic review to accentuate that improved self-reported sleep quality/quantity may be associated with improved pain/disability, although it remains unclear whether baseline sleep quality/quantity is a prognostic factor for CLBP. These findings highlight the importance of understanding the mechanisms underlying the relation between sleep and CLBP, which may inform the necessity of assessing or treating sleep disturbance in people with CLBP.
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Affiliation(s)
- Jeremy R Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xiaoyue Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Guohui Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery
- Rush International Spine Research and Innovation Initiative, Rush University Medical Center
- Rush University Graduate College, Chicago, IL
| | - Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Rebbeck T, Evans K, Ferreira P, Beales D, Sterling M, Bennell KL, Cameron I, Nicholas M, Ritchie C, Jull G, Treleaven J, Trevena L, Refshauge K, Connelly L, Foster N, Black D, Hodges P, Ferreira M, Shaw TJ, Simic M. Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial). BMJ Open 2021; 11:e057705. [PMID: 37039086 PMCID: PMC8718479 DOI: 10.1136/bmjopen-2021-057705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Musculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a novel clinical PAthway of CarE programme (PACE programme), where care is provided based on people’s risk of poor outcome. Methods and analysis Multicentre randomised controlled trial. 716 people with MSK conditions (low back pain, neck pain or knee osteoarthritis) will be recruited in primary care. They will be stratified for risk of a poor outcome (low risk/high risk) using the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMSPQ) then randomised to usual care (n=358) or the PACE programme (n=358). Participants at low risk in the PACE programme will receive up to 3 sessions of guideline based care from their primary healthcare professional (HCP) supported by a custom designed website (mypainhub.com). Those at high risk will be referred to an allied health MSK specialist who will conduct a comprehensive patient-centred assessment then liaise with the primary HCP to determine further care. Primary outcome (SF 12-item PCS) and secondary outcomes (eg, pain self-efficacy, psychological health) will be collected at baseline, 3, 6 and 12 months. Cost-effectiveness will be measured as cost per quality-adjusted life-year gained. Health economic analysis will include direct and indirect costs. Analyses will be conducted on an intention-to-treat basis. Primary and secondary outcomes will be analysed independently, using generalised linear models. Qualitative and mixed-methods studies embedded within the trial will evaluate patient experience, health professional practice and interprofessional collaboration. Ethics and dissemination Ethics approval has been received from the following Human Research Ethics Committees: The University of Sydney (2018/926), The University of Queensland (2019000700/2018/926), University of Melbourne (1954239), Curtin University (HRE2019-0263) and Northern Sydney Local Health District (2019/ETH03632). Dissemination of findings will occur via peer-reviewed publications, conference presentations and social media. Trial registration number ACTRN12619000871145.
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Affiliation(s)
- Trudy Rebbeck
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, New South Wales, Australia, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Kerrie Evans
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Healthia Limited, Brisbane, Queensland, Australia
| | - Paulo Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, The University of Queensland, Brisbane, Queensland, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian Cameron
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, The University of Queensland, Brisbane, Queensland, Australia
| | - Gwen Jull
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Julia Treleaven
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Lyndal Trevena
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathryn Refshauge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Luke Connelly
- Department of Sociology and Business Law, The University of Queensland, Centre for the Business and Economics of Health, The University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Surgical, Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Deborah Black
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Hodges
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Manuela Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Tim J Shaw
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Milena Simic
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Rabey M, Kendell M, Koren S, Silva I, Watts L, Wong C, Slater H, Smith A, Beales D. Do chronic low back pain subgroups derived from dynamic quantitative sensory testing exhibit differing multidimensional profiles? Scand J Pain 2021; 21:474-484. [PMID: 33639047 DOI: 10.1515/sjpain-2020-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The relationship of pain sensitivity with pain and disability in low back pain (LBP) is complicated. It has been suggested increased understanding of dynamic quantitative sensory testing (QST) might be useful in increasing understanding of these relationships. This study aimed to create subgroups based on participant responses to dynamic QST, profile these subgroups based on multidimensional variables (including clinical measures of pain and disability, psychological and lifestyle variables and static QST), and investigate the association of subgroup membership with levels of pain intensity, LBP-related disability and disability risk at 12-month follow up. METHODS Participants (n=273) with dominant axial chronic non-specific LBP with duration of pain >3 months were included in this study. At baseline, eligible participants completed a self-report questionnaire to collect demographic, clinical, psychological and lifestyle data prior to dynamic and static QST. Dynamic QST measures were conditioned pain modulation (CPM) and temporal summation (TS). At 12-months follow up, clinical data were collected, including pain intensity and LBP-related disability. Sub-groups were formed by cross-tabulation. Analysis was undertaken to profile dynamic QST subgroup on demographic, clinical, psychological, lifestyle and static QST measures. Associations between dynamic QST subgroups and follow-up clinical variables were examined. RESULTS Based on dynamic QST, participants were allocated into four subgroups; normal CPM and normal TS (n=34, 12.5%); normal CPM and facilitated TS (n=6, 2.2%); impaired CPM and normal TS (n=186, 68.1%); impaired CPM and facilitated TS (n=47, 17.2%). At baseline no differences were demonstrated between subgroups across most clinical variables, or any psychological or lifestyle measures. The two subgroups with impaired CPM were more likely to have a higher number of painful body areas. Cold pain sensitivity was heightened in both the subgroups with facilitated TS. Subgroups did not differ across pain intensity, LBP-related disability and disability risk stratification at follow-up. CONCLUSIONS The profiles of people with axial LBP did not vary significantly across dynamic QST subgroups, save for those in groups with impaired CPM being more likely to have more widespread symptoms and those with facilitated TS having heightened cold pain sensitivity. Further, subgroup membership was not related to future pain and disability. The role of dynamic QST profiles in LBP remains unclear. Further work is required to understand the role of pain sensitivity in LBP. The utility of dynamic QST subgrouping might not be in determining of future disability. Future research might focus on treatment modifying effects of dynamic QST subgroups.
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Affiliation(s)
- Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,Thrive Physiotherapy, Guernsey, Guernsey
| | - Michelle Kendell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Shani Koren
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Isabela Silva
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Lauren Watts
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Chris Wong
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
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11
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Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep 2021; 6:e919. [PMID: 33981936 PMCID: PMC8108595 DOI: 10.1097/pr9.0000000000000919] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention. Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.
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12
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Richards KV, Beales DJ, Smith AL, O'Sullivan PB, Straker LM. Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Phys Ther 2021; 101:6094842. [PMID: 33444448 DOI: 10.1093/ptj/pzab007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether sagittal neck sitting posture subgroup membership in late adolescence was a risk factor for persistent neck pain (PNP) in young adults. METHODS There were 686 participants enrolled in the Raine Study at the 17- and 22-year follow-ups. At 17 years of age, posture was measured by photographs, and 4 subgroups of sitting neck posture were determined by cluster analysis. Height and weight were measured, and exercise frequency, depression, and PNP were assessed by questionnaire. At 22 years of age, participants answered questions about neck pain and occupation type. Logistic regression examined if neck posture subgroups at 17 years of age were a risk factor for PNP at 22 years of age, taking into account other factors. RESULTS Female sex (odds ratio [OR] = 1.75, 95% CI = 1.16-2.65) and PNP at 17 years of age (OR = 3.78, 95% CI = 2.57-5.57) were associated with PNP at 22 years of age. In females, neck posture subgroup at 17 years of age was a risk factor for PNP at 22 years of age. Compared with the upright subgroup, both the slumped thorax/forward head subgroup groups and the intermediate subgroup had decreased odds for PNP at 22 years of age (OR = 0.24, 95% CI = 0.08-0.76; OR = 0.38, 95% CI = 0.15-0.99, respectively). No association was found in males. CONCLUSION After taking into account PNP at 17 years, sitting neck posture at 17 was not a risk factor for PNP at 22 years of age in males, whereas in females, more relaxed postures (slumped thorax/forward head and Intermediate postures) were protective of neck pain compared with upright posture. IMPACT Females in late adolescence who sat in slumped thorax/forward head or intermediate posture rather than upright sitting posture had a lower risk of PNP as a young adult. The practice of generic public health messages to sit up straight to prevent neck pain needs rethinking.
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Affiliation(s)
- Karen V Richards
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,Physiotherapy Department, Midland Public Hospital, Western Australia.,Physiotherapy Department, Fiona Stanley Hospital Murdoch, Western Australia
| | - Darren J Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,Pain Options, South Perth, Western Australia
| | - Anne L Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,The Raine Study, Crawley, Western Australia
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,Body Logic Physiotherapy, Shenton Park, Western Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,The Raine Study, Crawley, Western Australia
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13
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Longtin C, Décary S, Cook CE, Martel MO, Lafrenaye S, Carlesso LC, Naye F, Tousignant-Laflamme Y. Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial. PLoS One 2021; 16:e0245689. [PMID: 33471827 PMCID: PMC7817044 DOI: 10.1371/journal.pone.0245689] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings. METHODS This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures. RESULTS Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05). CONCLUSION These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness. TRIAL REGISTRATION Clinicaltrial.gov: NCT03949179.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- Faculty of Medecine, Laval University, Quebec, Quebec, Canada
| | - Chad E. Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, United States of America
| | - Marc O. Martel
- Faculty of Dentistry & Departmet of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Sylvie Lafrenaye
- Faculty of Medecine, University of Sherbrooke, Quebec, Quebec, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Florian Naye
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l’Estrie, Sherbrooke, Quebec, Canada
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Holopainen R, Vuoskoski P, Piirainen A, Karppinen J, O'Sullivan P. Patients' conceptions of undergoing physiotherapy for persistent low back pain delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in cognitive functional therapy. Disabil Rehabil 2020; 44:3388-3399. [PMID: 33353430 DOI: 10.1080/09638288.2020.1861116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT). METHODS As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions. RESULTS The analysis revealed four descriptive categories: "hung out to dry," "stuck," "making sense and taking control," and "holistic approach to care and living," that varied based on six themes. CONCLUSIONS Although the participants accepted this approach to care well, there was significant variation in patients' conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.Implications for rehabilitationThe participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don't feel abandoned by the system.Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.
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Affiliation(s)
- Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Bodylogic Physiotherapy, Perth, Australia
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15
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Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain 2020; 161:2476-2493. [DOI: 10.1097/j.pain.0000000000001944] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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16
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Positive recovery for low-risk injuries screened by the short form - Örebro musculoskeletal pain screening questionnaire following road traffic injury: evidence from an inception cohort study in New South Wales, Australia. BMC Musculoskelet Disord 2019; 20:531. [PMID: 31722704 PMCID: PMC6854715 DOI: 10.1186/s12891-019-2881-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk of poor recovery for people with musculoskeletal injuries after road traffic crash is not available. This study aimed to examine differences in recovery, return to work and health related quality of life between low and high-risk of poor recovery people with musculoskeletal injuries stratified by the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (SF-OMPSQ). Methods In an inception cohort study, participants with non-fracture musculoskeletal injury with the main site being the neck, lower back or lower limb were stratified into low (score ≤ 50) and high (score > 50) risk of poor recovery using the SF-OMPSQ score at baseline. We assessed the proportion of fully recovered participants (Global Perceived Effect scale ≥4), the proportion returning to work and changes in short form 12-item (SF-12) scores between baseline and 6-month follow-up in low and high-risk groups. Modified Poisson regression was used to estimate the adjusted risk ratio (RR) of being recovered and return to work in the low and high-risk groups. Paired t-test was used to compare changes in SF-12 physical and mental component summary scales, and chi-square test was used to assess the significance of the risk ratio of fully recovered between low and high-risk groups. Results The study included 498 participants (166 with neck, 78 with lower back and 254 with lower limb injuries). The proportion of being recovered was significantly higher in the low than the high-risk groups (Adjusted risk ratio: 2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low-risk group returned to work (91.0%) than the high-risk group (54.6%). People at low-risk had higher SF-12 scores at baseline and 6-month follow-up than those at high-risk. There were no differences between injury types for recovery and return to work at 6 months. Conclusion The SF-OMPSQ could be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after road traffic injury, who would have a higher or lower likelihood of recovering or returning fully to pre-injury work. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Registered 09 August 2013.
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Alamam DM, Moloney N, Leaver A, Alsobayel HI, Mackey MG. Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population. Spine J 2019; 19:1548-1558. [PMID: 31125695 DOI: 10.1016/j.spinee.2019.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. PURPOSE To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors. DESIGN A prospective cohort study. PARTICIPANTS One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration. MAIN OUTCOME MEASUREMENTS The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months. METHODS At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses. RESULTS The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted. CONCLUSION The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.
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Affiliation(s)
- Dalyah M Alamam
- Faculty of Health Sciences, The University of Sydney, Australia; Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Niamh Moloney
- Faculty of Medicine and Health Sciences, Department of Health Professions, Macquarie University, Australia; THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Andrew Leaver
- Faculty of Health Sciences, The University of Sydney, Australia
| | - Hana I Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Martin G Mackey
- Faculty of Health Sciences, The University of Sydney, Australia
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Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population. Spine (Phila Pa 1976) 2019; 44:E889-E898. [PMID: 30817741 DOI: 10.1097/brs.0000000000003002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. SUMMARY OF BACKGROUND DATA CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. METHODS Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. RESULTS One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants' age were all found to be associated with disability, accounting for 52.9% (adjusted R = 0.529) of variability. CONCLUSION This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures. LEVEL OF EVIDENCE 3.
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Rabey M, Smith A, Kent P, Beales D, Slater H, O'Sullivan P. Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses. Scand J Pain 2019; 19:743-753. [PMID: 31256070 DOI: 10.1515/sjpain-2019-0073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Chronic low back pain (CLBP) is a complex disorder where central and peripheral nociceptive processes are influenced by factors from multiple dimensions associated with CLBP (e.g. movement, pain sensitivity, psychological). To date, outcomes for treatments matched to unidimensional subgroups (e.g. psychologically-based) have been poor. Therefore, unidimensional subgrouping may not reflect the complexity of CLBP presentations at an individual level. The aim of this study was therefore to explore patterns of classification at an individual level across the three previously-published, data-driven, within-dimension subgrouping studies. METHODS Cross-sectional, multidimensional data was collected in 294 people with CLBP. Statistical derivation of subgroups within each of three clinically-important dimensions (pain sensitivity, psychological profile, pain responses following repeated spinal bending) was briefly reviewed. Patterns of classification membership were subsequently tabulated across the three dimensions. RESULTS Of 27 possible patterns across these dimensions, 26 were represented across the cohort. CONCLUSIONS This result highlights that while unidimensional subgrouping has been thought useful to guide treatment, it is unlikely to capture the full complexity of CLBP. The amount of complexity important for best patient outcomes is currently untested. IMPLICATIONS For clinicians this study highlights the high variability of presentations of people with CLBP at the level of the individual. For example, clinician's should not assume that those with high levels of pain sensitivity will also have high psychological distress and have pain summation following repeated spinal bending. A more flexible, multidimensional, clinically-reasoned approach to profile patient complexity may be required to inform individualised, patient-centred care. Such individualised care might improve treatment efficacy. This study also has implications for researchers; highlighting the inadequacy of unidimensional subgrouping processes and methodological difficulties in deriving subgroups across multidimensional data.
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Affiliation(s)
- Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
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21
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Moloney N, Beales D, Azoory R, Hübscher M, Waller R, Gibbons R, Rebbeck T. Are measures of pain sensitivity associated with pain and disability at 12-month follow up in chronic neck pain? Musculoskeletal Care 2018; 16:415-424. [PMID: 29901261 DOI: 10.1002/msc.1247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain. METHODS The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni- and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up). RESULTS Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability. CONCLUSIONS Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis.
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Affiliation(s)
- Niamh Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Darren Beales
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Roxanne Azoory
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | | | - Robert Waller
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Rebekah Gibbons
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Trudy Rebbeck
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Kendell M, Beales D, O'Sullivan P, Rabey M, Hill J, Smith A. The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study. J Physiother 2018; 64:107-113. [PMID: 29602747 DOI: 10.1016/j.jphys.2018.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/03/2017] [Accepted: 02/06/2018] [Indexed: 12/24/2022] Open
Abstract
QUESTIONS In people with chronic non-specific low back pain (LBP), what is the predictive and discriminative validity of the STarT Back Tool (SBT) for pain intensity, self-reported LBP-related disability, and global self-perceived change at 1-year follow-up? What is the profile of the SBT risk subgroups with respect to demographic variables, pain intensity, self-reported LBP-related disability, and psychological measures? DESIGN Prospective cohort study. PARTICIPANTS A total of 290 adults with dominant axial LBP of≥3months' duration recruited from the general community, and private physiotherapy, psychology, and pain-management clinics in Western Australia. OUTCOME MEASURES The 1-year follow-up measures were pain intensity, LBP-related disability, and global self-perceived change. RESULTS Outcomes were collected on 264 participants. The SBT categorised 82 participants (28%) as low risk, 116 (40%) as medium risk, and 92 (32%) as high risk. The risk subgroups differed significantly (p<0.05) on baseline pain, disability, and psychological scores. The SBT's predictive ability was strongest for disability: RR was 2.30 (95% CI 1.28 to 4.10) in the medium-risk group and 2.86 (95% CI 1.60 to 5.11) in the high-risk group. The SBT's predictive ability was weaker for pain: RR was 1.25 (95% CI 1.04 to 1.51) in the medium-risk group and 1.26 (95% CI 1.03 to 1.52) in the high-risk group. For the SBT total score, the AUC was 0.71 (95% CI 0.64 to 0.77) for disability and 0.63 (95% CI 0.55 to 0.71) for pain. CONCLUSION This was the first large study to investigate the SBT in a population exclusively with chronic LBP. The SBT provided an acceptable indication of 1-year disability, had poor predictive and discriminative ability for future pain, and was unable to predict or discriminate global perceived change. In this cohort with chronic non-specific LBP, the SBT's predictive and discriminative abilities were restricted to disability at 1year. [Kendell M, Beales D, O'Sullivan P, Rabey M, Hill J, Smith A (2018) The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study. Journal of Physiotherapy 64: 107-113].
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Affiliation(s)
- Michelle Kendell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Jonathan Hill
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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