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Wong JJ, Tricco AC, Côté P, Liang CY, Lewis JA, Bouck Z, Rosella LC. Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain: a Systematic Review and Meta-analysis. J Gen Intern Med 2022; 37:1233-1246. [PMID: 34383230 PMCID: PMC8971223 DOI: 10.1007/s11606-021-07079-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Study results vary on whether depressive symptoms are associated with worse prognosis for low back pain (LBP). We assessed the association between depressive symptoms or depression and health outcomes in persons with LBP. METHODS We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to June 2020. Eligible studies were cohort and case-control studies assessing the association between depressive symptoms (questionnaires) or depression (diagnoses) and health outcomes in persons aged ≥16 years with LBP in the absence of major pathology. Reviewers independently screened articles, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. We classified exploratory versus confirmatory studies based on phases of prognostic factor investigation. We conducted random-effects meta-analyses and descriptive synthesis where appropriate. RESULTS Of 13,221 citations screened, we included 62 studies (63,326 participants; 61 exploratory studies, 1 confirmatory study). For acute LBP, depressive symptoms were associated with self-reported disability (descriptive synthesis: 6 studies), worse recovery (descriptive synthesis: 5 studies), and slower traffic injury-related claim closure (1 study), but not pain or work-related outcomes. Depressive symptoms were associated with greater primary healthcare utilization for acute LBP (1 confirmatory study). For chronic LBP, depressive symptoms were associated with higher pain intensity (descriptive synthesis: 9 studies; meta-analysis: 3 studies, 2902 participants, β=0.11, 95% confidence interval (CI) 0.05-0.17), disability (descriptive synthesis: 6 studies; meta-analysis: 5 studies, 3549 participants, β=0.16, 95% CI 0.04-0.29), and worse recovery (descriptive synthesis: 2 studies; meta-analysis: 2 studies, 13,263 participants, relative risk (RR)=0.91, 95% CI 0.88-0.95), but not incident chronic widespread pain (1 study). DISCUSSION Depressive symptoms may be associated with self-reported disability and worse recovery in persons with acute and chronic LBP, and greater primary healthcare utilization for acute LBP. Our review provides high-quality prognostic factor information for LBP. Healthcare delivery that addresses depressive symptoms may improve disability and recovery in persons with LBP. Confirmatory studies are needed to assess the association between depressive symptoms and health outcomes in persons with LBP. PROTOCOL REGISTRATION PROSPERO database (CRD42019130047).
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada. .,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.
| | - Andrea C Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada.,Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
| | - Catherine Y Liang
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Jeremy A Lewis
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Zachary Bouck
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Drug Policy and Evaluation, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,ICES, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario, L5B 1B8, Canada
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Alhowimel AS, Alotaibi MA, Alenazi AM, Alqahtani BA, Alshehri MA, Alamam D, Alodaibi FA. Psychosocial Predictors of Pain and Disability Outcomes in People with Chronic Low Back Pain Treated Conservatively by Guideline-Based Intervention: A Systematic Review. J Multidiscip Healthc 2022; 14:3549-3559. [PMID: 35002245 PMCID: PMC8722685 DOI: 10.2147/jmdh.s343494] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Previous evidence has recommended conservative interventions as the best treatment in individuals with chronic low back pain (CLBP). However, the influence of psychosocial factors on the treatment outcomes is unclear. Therefore, this systematic review aimed to address the psychosocial factors that influence changes in pain and disability in patients with CLBP after a guideline-based conservative intervention. Methods Four electronic databases were systematically searched from inception until September 2020 for prospective studies examining the relationship between psychosocial factors and the outcomes of pain and disability after conservative intervention. All included studies were selected, extracted, and critically evaluated by two independent reviewers. Results In total, 15 studies were included in this systematic review. The results support the link between the baseline fear of movement, depression, self-efficacy, and catastrophizing with future functional disability outcomes after conservative interventions. However, these factors were less likely to predict changes in pain intensity outcomes after conservative interventions. Self-efficacy seems to mediate between some of the baseline psychosocial factors (eg, fear) and future pain and disability. Conclusion Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention. This highlights the importance of addressing these factors in conservative management of CLBP.
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Affiliation(s)
- Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mansour A Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.,NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Dalyah Alamam
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
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Gerdle B, Cervin M, Rivano Fischer M, Ringqvist Å. Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory - A Study From the Swedish Quality Registry for Pain Rehabilitation. Pain Pract 2021; 21:662-679. [PMID: 33759355 DOI: 10.1111/papr.13007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. METHODS Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. RESULTS The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. CONCLUSION The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matti Cervin
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Can We Change Health Care Costs in Patients With Complex Back Pain?: Results From a 5-year Before and After Study. Spine (Phila Pa 1976) 2020; 45:1443-1450. [PMID: 32502071 PMCID: PMC7515478 DOI: 10.1097/brs.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A before and after study cohort study. OBJECTIVES The aim of this study was to examine changes in health care costs after multidisciplinary spine care in patients with complex chronic back pain (CBP), to analyze the predictive value of patient and disease characteristics on health care costs, and to study the potential impact of biases concerning the use of real world data. SUMMARY OF BACKGROUND DATA Due to high direct and indirect societal costs of back pain there is a need for interventions that can assist in reducing the economic burden on patients and society. METHODS All patients referred to a university-based spine center insured at a major health care insurer in the Netherlands were invited. Personal and disease-related data were collected at baseline. Health care costs were retrieved from the health care insurer from 2 years before to 2 years after intervention. Repeated measures analysis of variances were calculated to study changes in health care costs after intervention. Multivariable regression analyses and cluster robust fixed effect models were applied to predict characteristics on health care costs. To study regression to the mean, a fixed effect model was calculated comparing 2 years before and 2 years post-intervention. RESULTS In total 428,158 declarations during 4.6 years were filed by 997 participants (128,666 considered CBP-related). CBP-related costs significantly increased during the intervention period and reduced 2 years after the intervention. Total health care costs kept rising. The intervention was associated with a 21% to 34% (P < 0.01) reduction in costs depending on the model used. Reduction in costs was related to being male and lower body mass index. CONCLUSION This study suggests that reduction in CBP-related health care utilization in patients with complex CBP can be achieved after a multidisciplinary spine intervention. The results are robust to controlling for background characteristics and are unlikely to be fully driven by regression to the mean. LEVEL OF EVIDENCE 4.
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Vugts MA, Zedlitz AM, Joosen MC, Vrijhoef HJ. Serious Gaming During Multidisciplinary Rehabilitation for Patients With Chronic Pain or Fatigue Symptoms: Mixed Methods Design of a Realist Process Evaluation. J Med Internet Res 2020; 22:e14766. [PMID: 32149720 PMCID: PMC7091046 DOI: 10.2196/14766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/31/2019] [Accepted: 12/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Serious gaming could support patients in learning to cope with chronic pain or functional somatic syndromes and reduce symptom burdens. OBJECTIVE To realize this potential, insight is needed into how, why, for whom, and when it works in actual treatment circumstances. METHODS Following a realist approach, process evaluations were performed before, during, and after a two-armed, natural quasi-experiment (n=275). A group of patients with interfering chronic pain or fatigue symptoms received a short additional blended mindfulness-based serious gaming intervention during a multidisciplinary rehabilitation program. A control group only received the regular rehabilitation program. During two sessions before and one session after the experiment, expectations about serious gaming processes were discussed in focus groups with local care providers, implementers, and experts. Patients participated in a survey (n=114) and in semistructured interviews (n=10). The qualitative data were used to develop tentative expectations about aspects of serious gaming that, in certain patients and circumstances, trigger mechanisms of learning and health outcome change. Hypotheses about indicative quantitative data patterns for tentative expectations were formulated before inspecting, describing, and analyzing-with regression models-routinely collected clinical outcome data. An updated program theory was formulated after mixing the qualitative and quantitative results. RESULTS Qualitative data showed that a subset of patients perceived improvement of their self-awareness in moments of daily social interactions. These results were explained by patients, who played the serious game LAKA, as a "confrontation with yourself," which reflected self-discrepancies. Important characteristics of serious gaming in the study's context included innovation factors of relative advantage with experiential learning opportunity, compatibility with the treatment approach, and the limited flexibility in regard to patient preferences. Perceived patient factors included age and style of coping with stress or pain. Learning perceptions could also depend on care provider role-taking and the planning and facilitating (ie, local organization) of serious gaming introduction and feedback sessions in small groups of patients. Quantitative data showed very small average differences between the study groups in self-reported depression, pain, and fatigue changes (-.07<beta<-.17, all 95% CI upper bounds <0), which were mediated by small group differences in mindfulness (beta=.26, 95% CI .02-.51). Mindfulness changes were positively associated with patient involvement in serious gaming (n=114, beta=.36, P=.001). Acceptance of serious gaming was lower in older patients. Average health outcome changes went up to a medium size in patients that reported lower active coping with stress and lower pain coping before serious gaming. Mindfulness changes and gaming acceptance perceptions covaried with group structure and immediate feedback sessions after serious gaming. CONCLUSIONS This study developed transferable insight into how and why serious gaming can facilitate additional learning about coping in order to reduce burdens of chronic pain or fatigue symptoms in certain patients and in actual treatment circumstances. Future studies are needed to continue the development of this fallible theory. Such research will further support decisions about using, designing, allocating, and tailoring serious gaming to optimize important patient health benefits. TRIAL REGISTRATION Netherlands Trial Register NTR6020; https://www.trialregister.nl/trial/5754.
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Affiliation(s)
- Miel Ap Vugts
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Aglaia Mee Zedlitz
- Leiden Institute for Brain and Cognition, Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Margot Cw Joosen
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hubertus Jm Vrijhoef
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands.,Panaxea, Amsterdam, Netherlands
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Fiegl S, Lahmann C, O'Rourke T, Probst T, Pieh C. Depression According to ICD-10 Clinical Interview vs. Depression According to the Epidemiologic Studies Depression Scale to Predict Pain Therapy Outcomes. Front Psychol 2019; 10:1862. [PMID: 31481912 PMCID: PMC6711408 DOI: 10.3389/fpsyg.2019.01862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/29/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose Pain and depression have been shown to have a bidirectional interaction. Although several outcome studies have been conducted, it is still unclear if and how depression influences pain outcome. The current study aims to further clarify this relationship by comparing the predicting value of an interview- and a questionnaire-based assessment of depression. Patients and Methods This retrospective study analyzed data of N = 496 chronic pain patients who received a multimodal pain management program. Multilevel models were performed with depression as predictor, pain measures as dependent variables, and the respective pain score at baseline as covariate. Depression was measured at baseline with (1) a semi-structured psychiatric interview corresponding to the ICD-10 and (2) the Center for Epidemiologic Studies Depression Scale (CES-D). Pain outcomes were pain intensity assessed with the Numeric Rating Scale (NRS), pain disability measured with the pain disability index (PDI), and affective as well as sensory pain perception assessed with the Pain Perception Scale (PPS-A/PPS-S). Results At post-treatment, pain intensity (NRS) was higher in patients with depression. This result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression. These results were significant after correction for multiple testing as well. Moreover, affective pain perception (PSS-A) at post-treatment was higher in patients with depression. Again, this result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression but it was not significant anymore after correction for multiple testing. Furthermore, pain disability (PDI) was higher at post-treatment in patients with depression according to the CES-D than in those without CES-D depression and this difference in the PDI did not emerge for interview-based depression. Yet, this difference on the PDI between the CES-D depression group and the CES-D no depression group was not significant anymore after correction for multiple testing. Conclusion The hypothesis that how depression is assessed – interview-based corresponding to the ICD-10 or with the CES-D – contributes to the association between depression and pain treatment outcome could not be confirmed. Future research should use more than one interview and questionnaire to assess depression, since our results are limited to the clinical ICD-10 interview and the CES-D.
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Affiliation(s)
- Sabine Fiegl
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Teresa O'Rourke
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
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Wittevrongel V, Reneman MF. Capturing case complexity: is clinician selected dose of vocational rehabilitation related to questionnaire results? Disabil Rehabil 2018; 42:692-697. [PMID: 30372651 DOI: 10.1080/09638288.2018.1506514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To establish an optimum dosage interdisciplinary vocational rehabilitation, it is important to be able to reliably and validly assess case complexity. Assessment of case complexity is currently clinician based because no validated means to assess case complexity is presently available. Indices assumed to associate with case complexity can contribute to the choice of dosage. The objective of this study was to explore the extent in which results of questionnaires were associated with the choice of treatment dosage in vocational rehabilitation.Methods: Design: cross-sectional study of observational data. The study population consisted of workers on part-time or full-time sick leave due to chronic multifactorial problems. Thousand eighty-nine patients who were referred to a privately owned organization with outpatient vocational rehabilitation centers in the Netherlands between July 2016 and March 2017 were allocated to one of the three programs based on case complexity as determined by clinicians based on clinical interview and questionnaires.Results: Questionnaires accounted for 13% of the variance in the total group, 13% in patients with chronic musculoskeletal pain (n = 662) and 29% in patients with chronic fatigue (n = 235).Conclusion: The results of the questionnaires contribute little in the assessment of case complexity and dose recommendation.Implications for RehabilitationAssessment of case complexity of patients with chronic multifactorial complaints and disability is complex.The results of this study suggest that case complexity and choice of treatment dose is slightly explained by questionnaire results. It is largely determined on heuristics developed by knowledge and experience of clinicians.No reliable and validated means to assess case complexity is presently available in the field of rehabilitation and optimum treatment dose cannot be determined transparently.Routinely collected clinical data of baseline characteristics, process measures and results are a valuable source that can be used to answer research questions.
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Affiliation(s)
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mendonça L, Monteiro-Soares M, Azevedo LF. Prediction of clinical outcomes in individuals with chronic low back pain: a protocol for a systematic review with meta-analysis. Syst Rev 2018; 7:149. [PMID: 30285903 PMCID: PMC6169105 DOI: 10.1186/s13643-018-0818-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most prevalent and recurrent conditions in the general population, with personal, professional, social and economic impact. However, there is a lack of consistent evidence about chronic low back pain (CLBP) prognosis, especially highlighting predictors that influence CLBP outcome. Existing systematic reviews are scarce, outdated and incomplete. The primary aim of this systematic review is to identify multivariable models and/or predictors associated with clinical outcomes in subjects with CLBP (namely pain intensity, disability, return to work, psychological well-being and quality of life). METHODS We will systematically search Ovid MEDLINE (PubMed), Scopus and Web of Science databases for longitudinal studies, published until June 2017, including adults with CLBP (defined as persistent pain with ≥ 3 months duration), which studied the association between multivariable models and/or predictors with at least one of the selected clinical outcomes after ≥ 3 months of follow-up. Articles' screening and selection will be conducted by two reviewers, blindly and independently. Disagreements will be resolved by a third reviewer. Models' discriminative ability will be assessed using C-statistic. The link between multivariable models and predictors with the clinical outcome will be analysed through association measures. Qualitative and quantitative synthesis of the available evidence will be performed. Meta-analysis will be conducted to aggregate each type of measure. In the absence or in the presence of only slight to moderate of heterogeneity, we will use the fixed or random effects model, respectively. In case of moderate to severe heterogeneity, an attempt to explain variability in detail will be made through subgroups and sensitivity analyses. Subgroup analysis will be conducted according to clinical outcome, follow-up duration (≤ 6 months versus > 6 months) and type of context (pain management clinics versus other therapeutic settings). DISCUSSION We consider that it is urgent to highlight the available evidence about CLBP prognosis. This systematic review will help identify multivariable models and individual predictors that may enhance pain management success. One potential limitation will be the difficulty of aggregating quantitative measures from several prognostic models and predictors, with different clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017079233.
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Affiliation(s)
- Liliane Mendonça
- OBSERVDOR - Centro Nacional de Observação em Dor / NOPain - National Observatory for Pain, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Matilde Monteiro-Soares
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
- MEDCIDS - Departamento Medicina da Comunidade, Informação e Decisão em Saúde, Oporto, Portugal
| | - Luís Filipe Azevedo
- OBSERVDOR - Centro Nacional de Observação em Dor / NOPain - National Observatory for Pain, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
- MEDCIDS - Departamento Medicina da Comunidade, Informação e Decisão em Saúde, Oporto, Portugal
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van Hooff ML, van Dongen JM, Coupé VM, Spruit M, Ostelo RWJG, de Kleuver M. Can patient-reported profiles avoid unnecessary referral to a spine surgeon? An observational study to further develop the Nijmegen Decision Tool for Chronic Low Back Pain. PLoS One 2018; 13:e0203518. [PMID: 30231051 PMCID: PMC6145570 DOI: 10.1371/journal.pone.0203518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/22/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Chronic Low Back Pain (CLBP) is a heterogeneous condition with lack of diagnostic clarity. Therapeutic interventions show small effects. To improve outcomes by targeting interventions it is recommended to develop a triage system to surgical and non-surgical treatments based on treatment outcomes. The objective of the current study was to develop and internally validate prognostic models based on pre-treatment patient-reported profiles that identify patients who either respond or do not respond to two frequently performed treatments (lumbar spine surgery and multidisciplinary pain management program). METHODS A consecutive cohort study in a secondary referral spine center was performed. The study followed the recommendations of the PROGRESS framework and was registered in the Dutch Trial Register (NTR5946). Data of forty-seven potential pre-consultation (baseline) indicators predicting 'response' or 'non-response' at one-year follow-up for the two treatments were obtained to develop and validate four multivariable logistic regression models. The source population consisted of 3,410 referred CLBP-patients. Two treatment cohorts were defined: elective 'spine surgery' (n = 217 [6.4%]) and multidisciplinary bio-psychosocial 'pain management program' (n = 171 [5.0%]). Main inclusion criteria were age ≥18, CLBP (≥6 months), and not responding to primary care treatment. The primary outcome was functional ability: 'response' (Oswestry Disability Index [ODI] ≤22) and 'non-response' (ODI ≥41). RESULTS Baseline indicators predictive of treatment outcome were: degree of disability (all models), ≥2 previous spine surgeries, psychosocial complaints, age (onset <20 or >50), and patient expectations of treatment outcomes. The explained variances were low for the models predicting response and non-response to pain management program (R2 respectively 23% and 26%) and modest for surgery (R2 30% and 39%). The overall performance was acceptable (c-index; 0.72-0.83), the model predicting non-response to surgery performed best (R2 = 39%; c-index = 0.83). CONCLUSION This study was the first to identify different patient-reported profiles that predict response to different treatments for CLBP. The model predicting 'non-response' to elective lumbar spine surgery performed remarkably well, suggesting that referrals of these patients to a spine surgeon could be avoided. After external validation, the patient-reported profiles could potentially enhance timely patient triage to the right secondary care specialist and improve decision-making between clinican and patient. This could lead to improved treatment outcomes, which results in a more efficient use of healthcare resources.
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Affiliation(s)
- Miranda L. van Hooff
- Department Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Johanna M. van Dongen
- Department of Health Sciences and the Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Veerle M. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten Spruit
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences and the Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial. Spine (Phila Pa 1976) 2017; 42:E1215-E1224. [PMID: 28263227 DOI: 10.1097/brs.0000000000002148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial. OBJECTIVE To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice. SUMMARY OF BACKGROUND DATA Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders. METHODS The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0-10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up. RESULTS Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis. CONCLUSION These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores. LEVEL OF EVIDENCE 2.
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Adnan R, Van Oosterwijck J, Cagnie B, Dhondt E, Schouppe S, Van Akeleyen J, Logghe T, Danneels L. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study. J Manipulative Physiol Ther 2017; 40:659-667. [DOI: 10.1016/j.jmpt.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
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Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study. Spine (Phila Pa 1976) 2016; 41:E1257-E1264. [PMID: 27802253 PMCID: PMC5113231 DOI: 10.1097/brs.0000000000001878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized, controlled, single-center pilot study. OBJECTIVE The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list. SUMMARY OF BACKGROUND DATA Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW. METHODS Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work. RESULTS The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up. CONCLUSION A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW. LEVEL OF EVIDENCE 3.
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Patel S, Hee SW, Mistry D, Jordan J, Brown S, Dritsaki M, Ellard DR, Friede T, Lamb SE, Lord J, Madan J, Morris T, Stallard N, Tysall C, Willis A, Underwood M. Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThere is good evidence that therapist-delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority.Aim and objectivesTo improve the clinical effectiveness and cost-effectiveness of LBP treatment by providing patients, their clinical advisors and health-service purchasers with better information about which participants are most likely to benefit from which treatment choices. Our objectives were to synthesise what is already known about the validity, reliability and predictive value of possible treatment moderators (patient factors that predict response to treatment) for therapist-delivered interventions; develop a repository of individual participant data from randomised controlled trials (RCTs) testing therapist-delivered interventions for LBP; determine which participant characteristics, if any, predict clinical response to different treatments for LBP; and determine which participant characteristics, if any, predict the most cost-effective treatments for LBP. Achieving these objectives required substantial methodological work, including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse the main effect of interventions and no such interpretations should be made.MethodsFirst, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with > 179 participants to share their data with us; some further smaller trials that were offered to us were also included. Using these trials we developed a repository of individual participant data of therapist-delivered interventions for LBP. Using this data set we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical effectiveness and cost-effectiveness outcomes. We undertook an analysis of covariance to identify potential moderators to apply in our main analyses. Subsequently, we developed and applied three methods of subgroup identification: recursive partitioning (interaction trees and subgroup identification based on a differential effect search); adaptive risk group refinement; and an individual participant data indirect network meta-analysis (NWMA) to identify subgroups defined by multiple parameters.ResultsWe included data from 19 RCTs with 9328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of subgroup identification that we identified. Additionally, we explored the application of Bayesian indirect NWMA. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile.ConclusionsThese data lack clinical effectiveness or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas. The pooled repository database will serve as a valuable resource to the LBP research community.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands (AWM) and the Wolfson Foundation.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Jordan
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Surrey Health Economic Centre, School of Economics, University of Surrey, Guildford, UK
| | - Sally Brown
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David R Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah E Lamb
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joanne Lord
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Colin Tysall
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Adrian Willis
- Warwick Medical School, University of Warwick, Coventry, UK
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Kvam L, Vik K, Eide AH. Importance of participation in major life areas matters for return to work. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:368-77. [PMID: 25319539 PMCID: PMC4436658 DOI: 10.1007/s10926-014-9545-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. METHODS This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. RESULTS The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. CONCLUSION To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs.
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Affiliation(s)
- Lisbeth Kvam
- Department of Occupational Therapy, Faculty of Health and Social Work, Sør-Trøndelag University College, Trondheim, Norway
| | - Kjersti Vik
- Department of Occupational Therapy, Faculty of Health and Social Work, Sør-Trøndelag University College, Trondheim, Norway
| | - Arne Henning Eide
- Department of Occupational Therapy, Faculty of Health and Social Work, Sør-Trøndelag University College, Trondheim, Norway
- Sintef, Technology and Society, Oslo, Norway
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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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Haskins R, Osmotherly PG, Rivett DA. Validation and impact analysis of prognostic clinical prediction rules for low back pain is needed: a systematic review. J Clin Epidemiol 2015; 68:821-32. [PMID: 25804336 DOI: 10.1016/j.jclinepi.2015.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/05/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify prognostic forms of clinical prediction rules (CPRs) related to the nonsurgical management of adults with low back pain (LBP) and to evaluate their current stage of development. STUDY DESIGN AND SETTING Systematic review using a sensitive search strategy across seven databases with hand searching and citation tracking. RESULTS A total of 10,005 records were screened for eligibility with 35 studies included in the review. The included studies report on the development of 30 prognostic LBP CPRs. Most of the identified CPRs are in their initial phase of development. Three CPRs were found to have undergone validation--the Cassandra rule for predicting long-term significant functional limitations and the five-item and two-item Flynn manipulation CPRs for predicting a favorable functional prognosis in patients being treated with lumbopelvic manipulation. No studies were identified that investigated whether the implementation of a CPR resulted in beneficial patient outcomes or improved resource efficiencies. CONCLUSION Most of the identified prognostic CPRs for LBP are in the initial phase of development and are consequently not recommended for direct application in clinical practice at this time. The body of evidence provides emergent confidence in the limited predictive performance of the Cassandra rule and the five-item Flynn manipulation CPR in comparable clinical settings and patient populations.
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Affiliation(s)
- Robin Haskins
- School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Peter G Osmotherly
- School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Darren A Rivett
- School of Health Sciences, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
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Verkerk K, Luijsterburg PA, Heymans MW, Ronchetti I, Miedema HS, Koes BW, Pool-Goudzwaard A. Prognostic factors and course for successful clinical outcome quality of life and patients' perceived effect after a cognitive behavior therapy for chronic non-specific low back pain: A 12-months prospective study. ACTA ACUST UNITED AC 2015; 20:96-102. [DOI: 10.1016/j.math.2014.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 07/05/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J 2014; 14:2658-78. [PMID: 24614254 DOI: 10.1016/j.spinee.2014.02.033] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 12/12/2013] [Accepted: 02/26/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Psychological factors are believed to influence the development of chronic low back pain. To date, it is not known how fear-avoidance beliefs (FABs) influence the treatment efficacy in low back pain. PURPOSE To summarize the evidence examining the influence of FABs measured with the Fear-Avoidance Belief Questionnaire or the Tampa Scale of Kinesiophobia on treatment outcomes in patients with low back pain. STUDY DESIGN/SETTING This is a systematic review. PATIENT SAMPLE Patients with low back pain. OUTCOME MEASURES Work-related outcomes and perceived measures including return to work, pain, and disability. METHODS In January 2013, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. A hand search of the six most often retrieved journals and a bibliography search completed the search. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS research studies that included patients with low back pain who participated in randomized controlled trials (RCTs) investigating nonoperative treatment efficacy. Out of 646 records, 78 articles were assessed in full text and 17 RCTs were included. Study quality was high in five studies and moderate in 12 studies. RESULTS In patients with low back pain of up to 6 months duration, high FABs were associated with more pain and/or disability (4 RCTs) and less return to work (3 RCTs) (GRADE high-quality evidence, 831 patients vs. 322 in nonpredictive studies). A decrease in FAB values during treatment was associated with less pain and disability at follow-up (GRADE moderate evidence, 2 RCTs with moderate quality, 242 patients). Interventions that addressed FABs were more effective than control groups based on biomedical concepts (GRADE moderate evidence, 1,051 vs. 227 patients in studies without moderating effects). In chronic patients with LBP, the findings were less consistent. Two studies found baseline FABs to be associated with more pain and disability and less return to work (339 patients), whereas 3 others (832 patients) found none (GRADE low evidence). Heterogeneity of the studies impeded a pooling of the results. CONCLUSIONS Evidence suggests that FABs are associated with poor treatment outcome in patients with LBP of less than 6 months, and thus early treatment, including interventions to reduce FABs, may avoid delayed recovery and chronicity. Patients with high FABs are more likely to improve when FABs are addressed in treatments than when these beliefs are ignored, and treatment strategies should be modified if FABs are present.
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Affiliation(s)
- Maria M Wertli
- NYU Hospital for Joint Disease, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY 10014, USA; Department of Internal Medicine, Horten Centre for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, Zurich 8032, Switzerland.
| | - Eva Rasmussen-Barr
- NYU Hospital for Joint Disease, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY 10014, USA; Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm SE-17177, Sweden
| | - Ulrike Held
- Department of Internal Medicine, Horten Centre for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, Zurich 8032, Switzerland
| | - Sherri Weiser
- NYU Hospital for Joint Disease, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY 10014, USA
| | - Lucas M Bachmann
- Department of Internal Medicine, Horten Centre for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, Zurich 8032, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland
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Boonstra AM, Reneman MF, Waaksma BR, Schiphorst Preuper HR, Stewart RE. Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain. Disabil Rehabil 2014; 37:1242-50. [PMID: 25228388 DOI: 10.3109/09638288.2014.961657] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems. METHODS A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential predictors were patient characteristics, duration of complaints, baseline functioning, pain, personality, coping style, fear of movement, psychological distress and type of treatment. Outcome measures were physical functioning, mental health, pain and patient-reported effect. Multiple (logistic) regression models were used to identify predictors. RESULTS Patients who were more disabled and patients with more pain benefitted more from the rehabilitation treatment than less disabled patients or those with less pain. Age, work status, vitality, depression and coping style also predicted outcomes significantly. The models explained between 27 and 80% of the outcomes. There was an interaction between type of treatment, work status and the baseline pain score as regards the outcome in terms of pain. CONCLUSIONS No strong predictors of treatment outcome were found other than the baseline scores of the respective outcome variables. More disabled patients and patients with more pain benefitted more from the rehabilitation program. Other predictors improved the prediction models slightly. Implications for Rehabilitation It remains challenging to correctly predict the outcome of treatment from patients' baseline sociodemographic and psychological characteristics; predictors other than baseline scores of the outcome variables are only slightly associated with treatment outcome. Patients with chronic musculoskeletal pain and poor physical functioning or mental health benefit most from pain rehabilitation. Older patients benefit less from a pain rehabilitation program than younger patients in terms of physical functioning. Pain reduction during a pain rehabilitation program is greatest in patients with high pain intensity who are not at work at the start of the rehabilitation program. Coping style influences the outcome of rehabilitation of patients with chronic musculoskeletal pain.
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Affiliation(s)
- Anne M Boonstra
- Department of Rehabilitation, 'Revalidatie Friesland' Center for Rehabilitation , Beetsterzwaag , The Netherlands
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Silvemark A, Källmén H, Molander C. Improved life satisfaction and pain reduction: follow-up of a 5-week multidisciplinary long-term pain rehabilitation programme. Ups J Med Sci 2014; 119:278-86. [PMID: 24878367 PMCID: PMC4116768 DOI: 10.3109/03009734.2014.908252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Multidisciplinary rehabilitation programmes can improve physical functioning and help patients with long-term pain back to work. Little is known, however, of the extent to which such rehabilitation also affects life satisfaction, pain severity, and disability. We wanted to evaluate if a 5-week rehabilitation programme for patients with long-term pain improves life satisfaction and decreases pain severity and disability. METHODS The subjects were 164 patients aged 18-65 years from a pain rehabilitation clinic. Most of them were referred from primary care units. One group of repeated tests was used. Participants were asked to fill out the LiSat-11 checklist and parts of the Multidimensional Pain Inventory (MPI), including pain severity, at admission, at discharge, and 1 year after the rehabilitation programme. RESULTS Satisfaction with life as a whole, and six of ten LiSat-11 domains improved during the follow-up, though none reached the levels for the general population. MPI subscales pain severity, pain interference, life control, and affective distress improved, whereas no change was observed for general activity. Patients older than 38 years decreased more in MPI affective distress than younger patients. Gender, pain severity, and work status before the programme did not significantly influence the outcome. CONCLUSIONS The results indicate that multidisciplinary rehabilitation improves life satisfaction, reduces pain severity, and reduces negative psychological, social, and behavioural effects of pain. These outcome variables relate to domains known to be of interest for patients and should therefore be considered for evaluation of rehabilitation programmes for long-term pain.
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Affiliation(s)
- Annika Silvemark
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Källmén
- Department of Clinical Neuroscience, STAD, Karolinska Institutet, Stockholm, Sweden
| | - Carl Molander
- Department of Clinical Sciences Danderyd Hospital, Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden
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Evaluating the quality of subgroup analyses in randomized controlled trials of therapist-delivered interventions for nonspecific low back pain: a systematic review. Spine (Phila Pa 1976) 2014; 39:618-29. [PMID: 24480951 DOI: 10.1097/brs.0000000000000231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To evaluate the quality, conduct, and reporting of subgroup analyses performed in randomized controlled trials of therapist-delivered interventions for nonspecific low back pain (NSLBP). SUMMARY OF BACKGROUND DATA Randomized controlled trials of therapist-delivered interventions for NSLBP to date have, at best, shown small to moderate positive effects. Identifying subgroups is an important research priority. This review evaluates the quality, conduct, and reporting of subgroup analyses performed in the NSLBP literature. METHODS Multiple electronic databases were searched for randomized controlled trials of therapist-delivered interventions for NSLBP. Of the identified articles, only articles reporting subgroup analyses (confirmatory or exploratory) were included in the final review. Methodological criteria were used to evaluate the quality of subgroup analyses. The quality of conduct and reporting was also evaluated. RESULTS Thirty-nine articles were included in the final review. Of these, only 3 (8%) tested hypotheses about moderators (confirmatory findings), 18 (46%) generated hypotheses about moderators to inform future research (exploratory findings), and 18 (46%) provided insufficient findings. The appropriate statistical test for interaction was performed in 27 of the articles, of which 10 reported results from interaction tests, 4 incorrectly reported results within individual subgroups, and the remaining articles reported either P values or nothing at all. CONCLUSION Subgroup analyses performed in NSLBP trials have been severely underpowered, are only able to provide exploratory or insufficient findings, and have rather poor quality of reporting. Using current approaches, few definitive trials of subgrouping in back pain are very likely to be performed. There is a need to develop new approaches to subgroup identification in back pain research.
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van Hooff ML, Spruit M, O'Dowd JK, van Lankveld W, Fairbank JCT, van Limbeek J. Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:102-12. [PMID: 23771553 PMCID: PMC3897840 DOI: 10.1007/s00586-013-2844-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/01/2013] [Accepted: 05/28/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological (CPP) programme in chronic low back pain (CLBP) patients. METHODS A prospective cohort of 524 selected consecutive CLBP patients was followed. Potential predictive factors included demographic characteristics, disability, pain and cognitive behavioural factors as measured at pre-treatment assessment. The primary outcome measure was the oswestry disability index (ODI). A successful 1-year follow-up outcome was defined as a functional status equivalent to 'normal' and healthy populations (ODI ≤22). The 2-week residential programme fulfills the recommendations in international guidelines. For statistical analysis we divided the database into two equal samples. A random sample was used to develop a prediction model with multivariate logistic regression. The remaining cases were used to validate this model. RESULTS The final predictive model suggested being 'in employment' at pre-treatment [OR 3.61 (95 % CI 1.80-7.26)] and an initial 'disability score' [OR 0.94 (95 % CI 0.92-0.97)] as significant predictive factors for a successful 1-year outcome (R (2) = 22 %; 67 % correctly classified). There was no predictive value from measures of psychological distress. CONCLUSION CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme are most likely to benefit from it and to have a successful treatment outcome. In these patients, the disability score falls to values seen in healthy populations. This small set of factors is easily identified, allowing selection for programme entry and triage to alternative treatment regimes.
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Salgueiro M, Basogain X, Collado A, Torres X, Bilbao J, Doñate F, Aguilera L, Azkue JJ. An Artificial Neural Network Approach for Predicting Functional Outcome in Fibromyalgia Syndrome after Multidisciplinary Pain Program. PAIN MEDICINE 2013; 14:1450-60. [DOI: 10.1111/pme.12185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heiskanen T, Roine RP, Kalso E. Multidisciplinary pain treatment - Which patients do benefit? Scand J Pain 2012; 3:201-207. [PMID: 29913864 DOI: 10.1016/j.sjpain.2012.05.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/16/2012] [Indexed: 10/27/2022]
Abstract
Background The prevalence of chronic non-malignant pain in developed countries is high, ranging from 14% to 50%. Patients with chronic pain are active users of health-care services and they report impaired health-related quality of life (HRQoL) when compared with the general population. Psychological distress has been identified as one of the risk factors for pain chronicity. Depression, anxiety and negative beliefs are associated with pain interference and perceived disability. Multidisciplinary pain management (MPM) aims to rehabilitating chronic pain patients by addressing both physical, psychological, social and occupational factors related to the pain problem. MPM programmes have been shown to be effective in reducing pain and improving function in patients with diverse chronic pain states. However, MPM programmes are often heterogeneous and predicting MPM treatment results in different patients groups may be difficult. Methods The present study examined changes in HRQoL after MPM in 439 patients treated at a multidisciplinary pain clinic using the 15D HRQoL questionnaire. The characteristics of the 100 patients with the greatest improvement and the 100 patients with the largest decrease in HRQoL were examined more closely (demographics, characteristics of pain, pain interference, psychiatric comorbidity, employment status, details of MPM) after answering a follow-up 15D questionnaire at three years after their MPM had ended. Result During MPM, HRQoL was significantly improved in 45.6% of the 439 patients, decreased in 30.7% of the patients and did not change in 23.7% of the patients. Patient-related factors that predicted a better HRQoL among the 100 patients with good MPM outcome compared with the 100 patients with poor MPM outcome were higher education and better employment status. Age, gender, marital status, duration of pain, number of pain sites, pain intensity or pain interference at baseline did not differ between the patient groups. Patient expectations regarding MPM were similar. A tendency towards more psychiatric comorbidity in the non-responder group was seen. The duration of MPM in the two patient groups was similar, as well as the number of medications started, the variety of specialists seen and psychiatric counselling with supportive therapy included. More non-responder than responder patients had died during the three-year follow-up period, some of the deaths were related to substance abuse. Conclusions and Implications HRQoL in chronic pain patients was significantly improved during MPM compared with the baseline. Pain duration of several years, multiple pain sites and neuropathic pain were not discerning factors between the responders and non-responders of the present study, implying that a positive change in HRQoL may be achieved by MPM even in these pain patients. In agreement with previous studies, factors predicting poor treatment outcome in the non-responder group of chronic pain patients were not treatment related. To further improve MPM outcome even in pain patients with risk factors for less benefit of treatment such as low education and poor general health, more individualized MPM approaches with emphasis on analysis and treatment of psychological symptoms and patient beliefs is essential.
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Affiliation(s)
- Tarja Heiskanen
- Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - Risto P Roine
- Helsinki and Uusimaa Hospital District, University of Oslo, Faculty of Medicine and Oslo University Hospital, Administration/Research and Development, P.O. Box 705, 00029 HUS Helsinki, Finland
| | - Eija Kalso
- Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
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Preliminary state of development of prediction models for primary care physical therapy: a systematic review. J Clin Epidemiol 2012; 65:1257-66. [PMID: 22959592 DOI: 10.1016/j.jclinepi.2012.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 05/17/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To summarize the methodological quality and developmental stage of prediction models for musculoskeletal complaints that are relevant for physical therapists in primary care. STUDY DESIGN AND SETTING A systematic literature search was carried out in the databases of Medline, Embase, and Cinahl. Studies on prediction models for musculoskeletal complaints that can be used by primary care physical therapists were included. Methodological quality of the studies was assessed and relevant study characteristics were extracted. RESULTS The search retrieved 4,702 references of which 29 studies were included in this review. The study quality of the included studies showed substantial variation. The studied populations consisted mostly of back (n=10) and neck pain (n=6) patients, and patients with knee complaints (n=4). Most studies (n=22) used "perceived recovery" as primary outcome. Most prediction models (n=18) were at the derivation level of development. CONCLUSIONS Many prediction models are available for a wide range of patient populations. The developmental stage of most models is preliminary and the study quality is often moderate. We do not recommend physiotherapist to use these models yet. All models reviewed here are in the developmental stage and need validation and impact evaluation before using them in daily practice.
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Abstract
BACKGROUND Few data are available on predictors for a favorable outcome in patients with chronic nonspecific low back pain (CNLBP). PURPOSE The aim of this study was to assess prognostic factors for pain intensity, disability, return to work, quality of life, and global perceived effect in patients with CNLBP at short-term (≤ 6 months) and long-term (>6 months) follow-up. DATA SOURCES Relevant studies evaluating the prognosis of CNLBP were searched in PubMed, CINAHL, and EMBASE (through March 2010). Study Selection Articles with all types of study designs were included. Inclusion criteria were: participants were patients with CNLBP (≥ 12 weeks' duration), participants were older than 18 years of age, and the study was related to prognostic factors for recovery. Fourteen studies met the inclusion criteria. DATA EXTRACTION Two reviewers extracted the data and details of each study. DATA SYNTHESIS A qualitative analysis using "level of evidence" was performed for all included studies. Data were summarized in tables and critically appraised. LIMITATIONS The results of the studies reviewed were limited by their methodological weaknesses. CONCLUSIONS At short-term follow-up, no association was found for the factors of age and sex with the outcomes of pain intensity and disability. At long-term follow-up, smoking had the same result. At long-term follow-up, pain intensity and fear of movement had no association with disability. At short-term follow-up, conflicting evidence was found for the association between the outcomes pain intensity and disability and the factor of fear of movement. At long-term follow-up, conflicting evidence was found for the factors of age, sex, and physical job demands. At long-term follow-up, conflicting evidence also was found for the association between return to work and age, sex, and activities of daily living. At baseline, there was limited evidence of a positive influence of lower pain intensity and physical job demands on return to work. No high-quality studies were found for the outcomes of quality of life and global perceived effect.
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Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain 2012; 28:344-54. [PMID: 22001667 DOI: 10.1097/ajp.0b013e31822ed2f3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of the study was to report the evidence for effectiveness of different self-management course characteristics and components for chronic musculoskeletal pain. METHODS We searched 9 relevant electronic databases for randomized, controlled trials (RCTs). Two reviewers selected studies against inclusion criteria and assessed their quality. We classified RCTs according to type of course delivery (group, individual, mixed or remote), tutor (healthcare professional, lay or mixed), setting (medical, community or occupational), duration (more or less than 8 weeks), and the number and type of components (psychological, lifestyle, pain education, mind body therapies, and physical activity). We extracted data on pain intensity, physical function, self-efficacy, global health, and depression and compared these outcomes for self-management and usual care or waiting list control. We used random effects standardized mean difference meta-analysis. We looked for patterns of clinically important and statistically significant beneficial effects for courses with different delivery characteristics and the presence or absence of components across outcomes over 3 follow-up intervals. RESULTS We included 46 RCTs (N=8539). Group-delivered courses that had healthcare professional input showed more beneficial effects. Longer courses did not necessarily give better outcomes. There was mixed evidence of effectiveness for components of courses, but data for courses with a psychological component showed slightly more consistent beneficial effects over each follow-up period. DISCUSSION Serious consideration should be given to the development of short (<8 weeks) group and healthcare professional-delivered interventions but more research is required to establish the most effective and cost-effective course components.
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Milesl CL, Pincusl T, Carnesl D, Homerl KE, Taylorl SJ, Bremnerl SA, Rahmanl A, Underwoodl M. Review: Can we identify how programmes aimed at promoting self‐management in musculoskeletal pain work and who benefits? A systematic review of sub‐group analysis within RCTs. Eur J Pain 2012; 15:775.e1-11. [DOI: 10.1016/j.ejpain.2011.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/04/2011] [Accepted: 01/31/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Clare L. Milesl
- Royal Holloway University of London, Department of Psychology, Egham, Surrey TW20 0EX, UK
| | - Tamar Pincusl
- Royal Holloway University of London, Department of Psychology, Egham, Surrey TW20 0EX, UK
| | - Dawn Carnesl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Kate E. Homerl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Stephanie J.C. Taylorl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Stephen A. Bremnerl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Anisur Rahmanl
- University College London, Centre for Rheumatology Research, UK
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Bergström G, Bergström C, Hagberg J, Bodin L, Jensen I. A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups? Eur J Pain 2012; 14:426-33. [DOI: 10.1016/j.ejpain.2009.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 06/16/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment. Clin J Pain 2012; 28:23-31. [DOI: 10.1097/ajp.0b013e31822019d0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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May S, Rosedale R. Prescriptive clinical prediction rules in back pain research: a systematic review. J Man Manip Ther 2011; 17:36-45. [PMID: 20046564 DOI: 10.1179/106698109790818214] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Prescriptive clinical prediction rules (CPRs) are a way of using a small selection of clinical findings to match patients to optimal interventions. A number of CPRs have been developed for use with back pain patients, but these have not been systematically reviewed. The purpose of this review was to evaluate existing CPRs against established criteria to determine the quality of the studies and the overall development of the CPR against a set number of stages. Medline was searched up until June 2008, and 16 studies were reviewed that related to 9 different CPRs. These studies investigated and attempted to find clinical characteristics for responders to manipulation, stabilization exercise, physical therapy, chiropractic, traction, rehabilitation, usual care, and zygapophyseal joint injections. Eleven of these studies related to the derivation stage and five to the validation stage. The manipulation and stabilization CPRs had been the most studied. The derivation studies were mostly high quality, whereas none of the validation studies were. Some of the validation studies did not provide evidence that validated the CPR. Most of these CPRs need further evaluation before they can be applied clinically; most did not pass the lowest level of evidence hierarchy. As regards the manipulation CPR, evidence to date for its clinical utility is limited and contradictory. For the stabilization CPR, there was limited evidence that it may be considered but only with caution and in similar patients. Overall, there is limited evidence to support the general application of spinal CPRs.
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Van Abbema R, Van Wilgen CP, Van Der Schans CP, Van Ittersum MW. Patients with more severe symptoms benefit the most from an intensive multimodal programme in patients with fibromyalgia. Disabil Rehabil 2010; 33:743-50. [DOI: 10.3109/09638288.2010.510177] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Helmhout PH, Staal JB, Heymans MW, Harts CC, Hendriks EJM, de Bie RA. Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:650-9. [PMID: 20035358 PMCID: PMC2899835 DOI: 10.1007/s00586-009-1254-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 09/30/2009] [Accepted: 12/10/2009] [Indexed: 12/02/2022]
Abstract
The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 ± 10.5 years, range 20–56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland–Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment.
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Affiliation(s)
- Pieter H Helmhout
- Department of Training Medicine and Training Physiology, Personnel Command, Royal Netherlands Army, PO Box 90004, 3509 AA Utrecht, The Netherlands.
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Elfving B, Åsell M, Ropponen A, Alexanderson K. What factors predict full or partial return to work among sickness absentees with spinal pain participating in rehabilitation? Disabil Rehabil 2009; 31:1318-27. [DOI: 10.1080/09638280802572965] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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