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Muller RD, Schielke A, Gliedt JA, Cooper J, Martinez S, Eklund A, Pohlman KA. A scoping review to explore the use of the Health Care Providers' Pain and Impairment Relationship Scale. PM R 2024. [PMID: 38958442 DOI: 10.1002/pmrj.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/09/2024] [Accepted: 03/02/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Patients' interactions with health care providers influence back pain-related outcomes. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) is an instrument that assesses providers' attitudes and beliefs about patients with persistent back pain, with lower scores implying that persistent pain does not indicate disability or limitation of activities. This scoping review aims to explore the extent of research involving the HC-PAIRS. LITERATURE SURVEY PubMed, Embase, and PEDro databases were searched from inception to April 2022. METHODS Extracted HC-PAIRS scores were standardized to 15-item scores and categorized by profession, student or professional status, and pre/post-educational intervention to evaluate scores. Psychometric properties and educational interventions of the HC-PAIRS were described. RESULTS After screening, 51 studies representing 10,416 participants were included. Student and professional scores were investigated in 24 and 29 studies, respectively. Twenty-one studies included educational interventions, with heterogenous follow-up. Psychometric properties of the HC-PAIRS were assessed in 10 studies and demonstrated acceptable reliability and validity. The overall baseline mean score among all participants was 55.34 (95% CI: 53.54-57.14) (students: 56.54 [56.54-60.87]; professionals: 51.67 [49.08-54.27]). Nurses (61.99 [55.66-68.31]) and non-health care professionals (65.30 [57.33-73.28]) had the highest overall baseline mean scores, whereas chiropractors (51.69 [33.73-69.66]), MDs/PAs (52.64 [47.27-58.00]), physical therapists (53.42 [50.67-56.17]), and exercise professionals (57.36 [49.39-65.33]) had lower scores. CONCLUSIONS The HC-PAIRS has been used across many disciplines in both students and professionals and demonstrated acceptable reliability and validity. Professionals commonly treating back pain had lower HC-PAIRS scores. Future research could benefit from standardization of interventions and timing of follow-up assessments.
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Affiliation(s)
- Ryan D Muller
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Research Center, Parker University, Dallas, Texas, USA
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Alec Schielke
- VA Palo Alto Health Care System, Palo Alto, California, USA
- Palmer College of Chiropractic West Campus, San Jose, California, USA
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jesse Cooper
- Baylor Scott & White Health, Round Rock, Texas, USA
| | - Shae Martinez
- American Heart Association, Dallas, Texas, USA
- American College of Cardiology, Washington, District of Columbia, USA
| | - Andreas Eklund
- Department of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Intitutet, Stockholm, Sweden
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Bise CG, Schneider M, Freburger J, Fitzgerald GK, Switzer G, Smyda G, Peele P, Delitto A. First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization. Phys Ther 2023; 103:pzad067. [PMID: 37379349 DOI: 10.1093/ptj/pzad067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/03/2022] [Accepted: 03/23/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and largely depend on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. We sought to examine the association between the first provider seen and health care utilization. METHODS Using 2015-2018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider. RESULTS The primary outcome was the timing and use of health care resources. Total health care use was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care use was seen in those patients who chose the emergency department. CONCLUSION Overall, there appears to be an association between the first choice of provider and future health care use. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP. IMPACT The first provider seen for an acute episode of LBP influences immediate treatment decisions, the trajectory of a specific patient episode, and future health care choices in the management of LBP.
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Affiliation(s)
- Christopher G Bise
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Michael Schneider
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Freburger
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - G Kelley Fitzgerald
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Garry Smyda
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Pamela Peele
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony Delitto
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Health and Rehabilitation Science, Office of the Dean, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Jermini-Gianinazzi I, Blum M, Trachsel M, Trippolini MA, Tochtermann N, Rimensberger C, Liechti FD, Wertli MM. Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey. BMJ Open 2023; 13:e071893. [PMID: 37541755 PMCID: PMC10407374 DOI: 10.1136/bmjopen-2023-071893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES Clinical guidelines for acute non-specific low back pain (LBP) recommend avoiding imaging studies or invasive treatments and to advise patients to stay active. The aim of this study was to evaluate the management of acute non-specific LBP in the emergency departments (ED). SETTING We invited all department chiefs of Swiss EDs and their physician staff to participate in a web-based survey using two clinical case vignettes of patients with acute non-specific LBP presenting to an ED. In both cases, no neurological deficits or red flags were present. Guideline adherence and low-value care was defined based on current guideline recommendations. RESULTS In total, 263 ED physicians completed at least one vignette, while 212 completed both vignettes (43% residents, 32% senior/attending physicians and 24% chief physicians). MRI was considered in 31% in vignette 1 and 65% in vignette 2. For pain management, non-steroidal anti-inflammatory drugs, paracetamol and metamizole were mostly used. A substantial proportion of ED physicians considered treatments with questionable benefit and/or increased risk for adverse events such as oral steroids (vignette 1, 12% and vignette 2, 19%), muscle relaxants (33% and 38%), long-acting strong opioids (25% and 33%) and spinal injections (22% and 43%). Although guidelines recommend staying active, 72% and 67% of ED physicians recommended activity restrictions. CONCLUSION Management of acute non-specific LBP in the ED was not in agreement with current guideline recommendations in a substantial proportion of ED physicians. Overuse of imaging studies, the use of long-acting opioids and muscle relaxants, as well as recommendations for activity and work restrictions were prevalent and may potentially be harmful.
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Affiliation(s)
- Ilaria Jermini-Gianinazzi
- Emergency Department, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Ticino, Switzerland
| | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Trachsel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Alen Trippolini
- School of Health Professions, Berne University of Applied Sciences, Bern, Switzerland
- Evidence-based Insurance Medicine (EbIM), Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicole Tochtermann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Dominik Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, Kantonsspital Baden AG, Baden, Aargau, Switzerland
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4
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McGhie-Fraser B, Lucassen P, Ballering A, Abma I, Brouwers E, van Dulmen S, Olde Hartman T. Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments. J Psychosom Res 2023; 166:111161. [PMID: 36753936 DOI: 10.1016/j.jpsychores.2023.111161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. METHODS A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. RESULTS We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. CONCLUSION No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.
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Affiliation(s)
- Brodie McGhie-Fraser
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Aranka Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Inger Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
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5
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Aydin SM. Blood Products. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Alhowimel A, Alodaibi F, Alotaibi M, Alamam D, Fritz J. Comparison of attitudes and beliefs of physical therapists and primary care physicians regarding low back pain management: A cross-sectional study. J Back Musculoskelet Rehabil 2022; 35:803-809. [PMID: 34657870 PMCID: PMC9398080 DOI: 10.3233/bmr-200295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists' (PTs) beliefs and attitudes regarding LBP with those of PCPs. OBJECTIVE We compared PCPs' and PTs' attitudes and beliefs regarding LBP management. METHODS We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia. RESULTS In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs. CONCLUSIONS HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs' treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.
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Affiliation(s)
- Ahmed Alhowimel
- Department of Health and Rehabilitation Science, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia,Corresponding author: Ahmed Alhowimel, Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia. Tel.: +966 115886354; E-mails: ;
| | - Faris Alodaibi
- College of Applied Medical Sciences, Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mazyad Alotaibi
- Department of Health and Rehabilitation Science, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Dalyah Alamam
- College of Applied Medical Sciences, Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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7
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Factors associated with the low back pain-related attitudes and beliefs of physical therapists. Musculoskelet Sci Pract 2022; 58:102518. [PMID: 35131592 DOI: 10.1016/j.msksp.2022.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinicians who believe in a strong connection between pain and disability, and who have biomedically oriented beliefs recommend less physical activity, more time off work, and promote unhelpful beliefs in patients. Understanding how these beliefs develop may assist in identifying ways to reduce unhelpful beliefs in clinicians. OBJECTIVE To identify factors that are associated with the LBP-related attitudes and beliefs of US-based physical therapists. DESIGN Cross-sectional design METHOD: An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), pain science knowledge was measured using the Neurophysiology of Pain Questionnaire (NPQ), and professional and demographic information were collected. RESULTS Completed surveys were obtained from 420 physical therapists. More helpful attitudes and beliefs were associated with board certification in orthopedics or sports, higher NPQ scores, and working in a hospital-based clinic. Less helpful attitudes and beliefs were associated with working in private practice and a personal history of LBP that had a minimum or significant impact on life. The factors included in this study explained 16.8% of the variability in HC-PAIRS scores (p < .001), 13% of the variability in PABS-BM scores (p < .001), and 8.3% of the variability in PABS-BPS scores (p < .001). CONCLUSION Several modifiable and non-modifiable factors are associated with the LBP-related attitudes and beliefs of US physical therapists.
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8
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Mankelow J, Ryan CG, Green PW, Taylor PC, Martin D. An exploration of primary care healthcare professionals' understanding of pain and pain management following a brief pain science education. BMC MEDICAL EDUCATION 2022; 22:211. [PMID: 35351106 PMCID: PMC8962069 DOI: 10.1186/s12909-022-03265-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Persistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this. PURPOSE OF THE STUDY 1) Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE). METHODS An exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention. RESULTS Clinicians' relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients' passive and often oppositional biomedical treatment expectations; and clinicians' lack of readily understandable language to communicate with patients. CONCLUSION The findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles. TRIAL REGISTRATION This study was prospectively registered at ClinicalTrials.Gov ( NCT04587596 ) in October 2020.
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Affiliation(s)
- Jagjit Mankelow
- School of Health and Life Sciences, Centuria Building, Teesside University, Middlesbrough, Tees Valley TS1 3BX England
| | - Cormac G. Ryan
- School of Health and Life Sciences, Centuria Building, Teesside University, Middlesbrough, Tees Valley TS1 3BX England
| | - Paul W. Green
- Linthorpe Surgery, 378 Linthorpe Road, Middlesbrough, TS5 6HA England
| | - Paul C. Taylor
- School of Social Sciences, Humanities and Law Education and Social Work, Teesside University Middlesbrough, Middlesbrough, Tees Valley TS1 3BX England
| | - Denis Martin
- NIHR Applied Research Collaboration for the North East and North Cumbria, Newcastle Upon Tyne, England
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Fullen B, Morlion B, Linton SJ, Roomes D, van Griensven J, Abraham L, Beck C, Wilhelm S, Constantinescu C, Perrot S. Management of Chronic Low Back Pain and the Impact on Patients’ Personal and Professional Lives: Results From an International Patient Survey. Pain Pract 2022; 22:463-477. [PMID: 35156770 PMCID: PMC9306505 DOI: 10.1111/papr.13103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 10/19/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Brona Fullen
- University College Dublin Dublin Ireland
- European Pain Federation EFIC® Brussels Belgium
| | - Bart Morlion
- European Pain Federation EFIC® Brussels Belgium
- University of Leuven Leuven Belgium
| | | | - David Roomes
- Chief Medical Officer Rolls‐Royce PLC Derby United Kingdom
| | | | | | | | | | | | - Serge Perrot
- University of Paris Cochin Hospital Paris France
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10
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Cashin AG, Booth J, McAuley JH, Jones MD, Hübscher M, Traeger AC, Fried K, Moseley GL. Making exercise count: Considerations for the role of exercise in back pain treatment. Musculoskeletal Care 2021; 20:259-270. [PMID: 34676659 DOI: 10.1002/msc.1597] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Chronic low back pain (CLBP) is pain that has persisted for greater than three months. It is common and burdensome and represents a significant proportion of primary health presentations. For the majority of people with CLBP, a specific nociceptive contributor cannot be reliably identified, and the pain is categorised as 'non-specific'. Exercise therapy is recommended by international clinical guidelines as a first-line treatment for non-specific CLBP. AIM This comprehensive review aims to synthesise and appraise the current research to provide practical, evidence-based guidance concerning exercise prescription for non-specific CLBP. We discuss detailed initial assessment and being informed by patient preferences, values, expectations, competencies and goals. METHODS We searched the Cochrane Database of Systematic Reviews, PubMed and the Physiotherapy Evidence Database (PEDro) using broad search terms from January 2000 to March 2021, to identify the most recent clinical practice guidelines, systematic reviews and randomised controlled trials on exercise for CLBP. RESULTS/DISCUSSION Systematic reviews show exercise is effective for small, short-term reductions in pain and disability, when compared with placebo, usual care, or waiting list control, and serious adverse events are rare. A range of individualised or group-based exercise modalities have been demonstrated as effective in reducing pain and disability. Despite this consensus, controversies and significant challenges remain. CONCLUSION To promote recovery, sustainable outcomes and self-management, exercise can be coupled with education strategies, as well as interventions that enhance adherence, motivation and patient self-efficacy. Clinicians might benefit from intentionally considering their own knowledge and competencies, potential harms of exercise and costs to the patient. This comprehensive review provides evidence-based practical guidance to health professionals who prescribe exercise for people with non-specific CLBP.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - John Booth
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew D Jones
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kal Fried
- Rehabilitation Medicine Group, Moorabbin, Victoria, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
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11
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Farquhar-Smith P. Clinical practice guidelines for cancer pain: problems and solutions. Curr Opin Support Palliat Care 2021; 15:84-90. [PMID: 33843763 DOI: 10.1097/spc.0000000000000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Clinical practice guidelines (CPGs) should allow practitioners to follow the best evidence-based management for patients. The increasing specialisation of medicine and pain medicine has increased the number of CPGs, but practitioners are still facing contradictory advice that can be difficult to implement and follow. RECENT FINDINGS A recent comprehensive metareview of 25 reviews have highlighted that the same issues of quality, barriers to implementation and difficulties in applicability are as prevalent as they were years ago when assessment tools (e.g. AGREE II) and recommendations for CPG development were introduced. There remains a lack of consistency of recommendations and quality of evidence for CPGs in cancer pain that impedes the ability to provide the 'best' management for patients. SUMMARY Even the most renowned and apparently high-quality CPGs in many specialities, including cancer pain, still are potentially deficient especially in terms of applicability, implementation, and transparency of conflicts of interest. Despite the increased scrutiny, in part related to the opioid crisis, the situation has not changed. The development of CPGs should engender collaboration with multiple stakeholder groups and focus on transparency and facilitating implementation.
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12
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Sorondo D, Delpierre C, Côté P, Salmi LR, Cedraschi C, Taylor-Vaisey A, Lemeunier N. Determinants of clinical practice guidelines' utilization for the management of musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord 2021; 22:507. [PMID: 34074285 PMCID: PMC8170973 DOI: 10.1186/s12891-021-04204-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Context Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. Aim To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs. Method A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. Conclusion Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04204-w.
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Affiliation(s)
- Delphine Sorondo
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France. .,Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère-31,300, Toulouse, France.
| | - Cyrille Delpierre
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Nadège Lemeunier
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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13
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Simula AS, Malmivaara A, Booth N, Karppinen J. A classification-based approach to low back pain in primary care - protocol for a benchmarking controlled trial. BMC FAMILY PRACTICE 2020; 21:61. [PMID: 32252643 PMCID: PMC7137427 DOI: 10.1186/s12875-020-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/29/2020] [Indexed: 12/03/2022]
Abstract
Background Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients’ understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care. Methods We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up. Discussion The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway. Trial registration ISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.
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Affiliation(s)
- A S Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. .,Department of General Medicine, The South Savo Social and Health Care Authority, Mikkeli, Finland.
| | - A Malmivaara
- Centre for Health and Social Economics, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - N Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - J Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
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14
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Clouzeau B, Caujolle M, San-Miguel A, Pillot J, Gazeau N, Tacaille C, Dousset V, Bazin F, Vargas F, Hilbert G, Molimard M, Gruson D, Boyer A. The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. PLoS One 2019; 14:e0214802. [PMID: 31042718 PMCID: PMC6493704 DOI: 10.1371/journal.pone.0214802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Few studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory testing can decrease the number of tests, is sustainable, is not associated with additional morbidity and represents a potential cost saving. MATERIAL AND METHODS An open-label prospective cohort study in two separated units of the same medical intensive care unit (ICU) including respectively 3315 and 2392 consecutive patients. After the observation period (2010), a reduction in ICU A of unnecessary diagnostics tests as part of a program including senior supervisory of juniors' orders, encouragements for orders containment at each everyday round discussions (period 2; 2011). Period 3 (2012) consisted in the prolongation of the protocol as a routine care without supervision; Period 4 (2013) was a new period of observation without intervention. No modification was implemented in ICU B in periods 2-4. RESULTS After the intervention, a decrease in the overall number of tests per ICU-patient-days (37.3±5.5 (baseline) to 15.2±3.2 (- 59%); p<0.0001) was observed. The total cost of the tests decreased from 239±41 to 104±28 euros per ICU-patient days; p<0.0001. The effect on laboratory test orders was sustainable in period 3 (-49%) and 4 (-30%). No significant secondary effect of the intervention was observed in period 2. In ICU B, there was no significant change in the overall laboratory test orders in between the periods. CONCLUSIONS Laboratory test containment is effective, likely safe and sustainable provided that an educational program is repeatedly promoted, that it makes sense for the whole team, that senior and junior physicians are both committed in the program, and that encouragements for laboratory orders containment at each everyday round discussions.
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Affiliation(s)
- Benjamin Clouzeau
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Marie Caujolle
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Aurelie San-Miguel
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Jerome Pillot
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Nathalie Gazeau
- Economic and Financial Department, Pellegrin Hospital, Bordeaux, France
- Departments of Laboratories, Pellegrin Hospital, Bordeaux, France
| | | | - Vincent Dousset
- Department of Radiology, Pellegrin Hospital, Bordeaux, France
| | - Fabienne Bazin
- INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, France
| | - Frederic Vargas
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Gilles Hilbert
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Mathieu Molimard
- Departments of Laboratories, Pellegrin Hospital, Bordeaux, France
- INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, France
| | - Didier Gruson
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
| | - Alexandre Boyer
- Department of Intensive Care Medicine, Pellegrin Hospital, Bordeaux, France
- INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, France
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15
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Roitenberg N. Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter? J Eval Clin Pract 2019; 25:224-229. [PMID: 30270574 DOI: 10.1111/jep.13038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP. METHOD A self-administered questionnaire was used to collect the data which included a socio-demographic section, self-reports about the work setting, and a clinical experience section. Participants also completed the 15-item Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) questionnaire. The HC-Pairs is scored on a 7-point Likert scale, a high score indicating a stronger belief that pain limits daily function. RESULTS A total of 213 physiotherapists completed the questionnaire. The mean HC-Pairs score of community-orthopaedics physiotherapists was significantly lower than that of non community-orthopaedics physiotherapists (mean 44.02- + 9.44 vs 48.69- + 10.89, t = -3.29, P < 0.001) indicating that community-orthopaedics physiotherapists hold a weaker belief that pain limits daily function. Analysis suggests that there is a statistically significant difference in the mean HC-Pairs scores between the high-frequency and the low-frequency group (F = 4.688, P < 0.05) implicating that as physiotherapists experience more frequent encounters with LBP patients, their belief that pain limits daily function of these patients weakens. Work setting is the only variable that predicts the HC-Pairs scores. CONCLUSIONS There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.
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Affiliation(s)
- Neta Roitenberg
- Sociology and Anthropology Department, Bar-Ilan University, Ramat-Gan, Israel
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16
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Rankin L, Stålnacke BM, Fowler CJ, Gallego G. Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught. Scand J Pain 2018; 18:533-544. [PMID: 29794271 DOI: 10.1515/sjpain-2018-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 12/16/2022]
Abstract
Background and aims Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician's knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student's attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education. Methods An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers' Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management. Results A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training. Conclusions Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement. Implications This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies.
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Affiliation(s)
- Linda Rankin
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden
| | | | - Christopher J Fowler
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
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