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Custódio LA, Marques YA, de Toledo AM, de Sá Ferreira A, van Tulder M, da Silva EN, Carregaro RL. The care pathway of individuals with spinal disorders in a Health Care Network in the Federal District, Brazil: a retrospective study. Braz J Phys Ther 2023; 27:100553. [PMID: 37862916 PMCID: PMC10692366 DOI: 10.1016/j.bjpt.2023.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/11/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Understanding the care pathway is essential to identify how to effectively treat spinal disorders. However, there is no specific data on the pathway of these individuals in the Health Care Networks (HCN) in Brazil. OBJECTIVE To investigate the pathway of individuals with non-specific spinal disorders (NSD) in the HCN in the Federal District, Brazil, and verify the interventions adopted, and to test whether sociodemographic and clinical variables predict the number of imaging tests, prescribed medication, and the first HCN access. METHODS Retrospective study that analysed electronic records of 327 individuals with NSD between 2012 and 2018. Generalized linear models estimated the association between sociodemographic and clinical data and number of drugs prescribed and imaging tests requested. Multinomial logistic regression estimated the association between clinical and demographic variables and setting of first access. RESULTS The median age was 57 years, and 75.5% were women. Emergency Department (ED) was the most accessed setting (43.7%), and back pain was the most prevalent condition (84.5%). Most individuals underwent imaging tests (60%) and drug prescriptions (86%). Physical exercises were prescribed to 13%, and 55% were referred to physical therapy. Women were more likely to first access the ED. CONCLUSION The ED was the most used setting by people with NSD. Few participants received exercise prescriptions and half were referred to physical therapists. Individuals who used outpatient clinics and primary care received less drug prescriptions, and women were more likely to first access the ED. Increasing age was associated with greater chance of first accessing Outpatient Clinics.
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Affiliation(s)
- Luciana Alves Custódio
- Graduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB), UnB Ceilândia Campus, Brasília, DF, Brazil
- Evidence and Health Technology Center (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, DF, Brazil
- State Health Department of the Federal District (SES/DF), Brasília, DF, Brazil
| | - Yara Andrade Marques
- Graduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB), UnB Ceilândia Campus, Brasília, DF, Brazil
- Evidence and Health Technology Center (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, DF, Brazil
| | - Aline Martins de Toledo
- Graduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB), UnB Ceilândia Campus, Brasília, DF, Brazil
- Evidence and Health Technology Center (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, DF, Brazil
| | - Arthur de Sá Ferreira
- Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty of Behavioural & Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
- Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Everton Nunes da Silva
- Evidence and Health Technology Center (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, DF, Brazil
- Graduate Program in Health Sciences and Technologies, Universidade de Brasília (UnB), UnB Ceilândia Campus, Brasília, DF, Brazil
| | - Rodrigo Luiz Carregaro
- Graduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB), UnB Ceilândia Campus, Brasília, DF, Brazil
- Evidence and Health Technology Center (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, DF, Brazil
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Fear-Avoidance Beliefs, Kinesiophobia, and Disability Risk Among Indians with Spine Pain. Indian J Orthop 2022; 56:1782-1788. [PMID: 36187595 PMCID: PMC9485369 DOI: 10.1007/s43465-022-00692-7] [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: 09/23/2021] [Accepted: 06/17/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the burden of fear-avoidance beliefs (FAB), kinesiophobia, and risk of persistent disability among Indians with spine pain. METHODS Demographic and clinical data collected from 139 patients who attended a spine rehabilitation clinic for assessment and treatment of their spine pain were analyzed. Fear-avoidance beliefs, kinesiophobia, and risk of persistent disability were measured using the Fear-avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and the STarT Back Tool (SBT). A multivariate analysis was performed to determine the effect of pain, disability, age, gender, BMI, lifestyle, pain duration, and pain location on FAB, TSK, and SBT scores. RESULTS A majority of patients had medium to high-risk FAB-physical activities (FAB-P) (50.5%) and SBT (54%) scores. The percentage of patients with medium or high-risk FAB-P (p = 0.03), FAB-work (FAB-W) (p = 0.03), and SBT (p = 0.03) scores were significantly higher in patients with pain score > 7, and the percentage of patients with medium or high-risk with FAB-P (p < 0.0001), TSK (p = 0.0003), and SBT (p < 0.0001) scores were significantly higher in patients with severe, crippled or bed-ridden disability. Disability was the only significant predictor for FAB-W, FAB-P, and SBT scores. CONCLUSION The prevalence of fear-avoidance beliefs and risk of persistent disability was significant among Indians and should be taken into account while planning treatment for their spine pain.
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Beyera GK, O'Brien J, Campbell S. Profile of individuals with low back pain and factors defining chronicity of pain: a population-based study in Ethiopia. Qual Life Res 2022; 31:2645-2654. [PMID: 35568766 PMCID: PMC9356953 DOI: 10.1007/s11136-022-03148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/08/2022]
Abstract
Purpose Low back pain (LBP) is the most prevalent public health problem globally, second only to headaches in the ranking of painful disorders that affect human beings. However, evidence about the profile of LBP patients is lacking in low-income countries for appropriate management approaches. This study examined the profile of individuals with LBP and factors defining chronicity of pain in Ethiopia. Methods A population-based cross-sectional study design was used to collect data from 1812 adults (≥ 18 years) with LBP at present. Data were collected by interviewing the study participants using an instrument developed and validated in the same study population. The instrument includes socio-demographic information, health behaviours/lifestyle habits, beliefs about pain, and pain and general health-related characteristics of the participants. Data analysis was performed using R version 3.5.1. Both unconditional and conditional logistic regression models were fitted and Odds Ratio (OR) with 95% confidence intervals (95% CIs) were computed to identify factors significantly associated with chronicity of pain at p ≤ 0.05 significance level. Results Negative beliefs about pain, a varying degree of pain interference with daily and social activities, complaining of pain in other anatomical sites other than the low back region, general health status rated as not excellent, depressive symptomology, and sleeping problems/insomnia were common within the profile of individuals with LBP. Age, educational level, residential setting, beliefs about pain, and depressive symptomology were found to have a statistically significant association with chronicity of pain. Conclusions This study provides an overview of the profile of individuals with LBP and factors defining chronicity of pain, assisting clinicians to design appropriate management strategies to improve patients' outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03148-5.
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Affiliation(s)
- Getahun Kebede Beyera
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia.
| | - Jane O'Brien
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Steven Campbell
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Li W, Xiong Z, Dong C, Song J, Zhang L, Zhou J, Wang Y, Yi P, Yang F, Tang X, Tan M. Distribution and imaging characteristics of spina bifida occulta in young people with low back pain: a retrospective cross-sectional study. J Orthop Surg Res 2021; 16:151. [PMID: 33618758 PMCID: PMC7898417 DOI: 10.1186/s13018-021-02285-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Spina bifida occulta (SBO) is one of the most common congenital spinal deformities. Although many studies have demonstrated the influence of lumbosacral dysplasia on low back pain (LBP) in young athletes, there have been few studies on SBO among young people in other occupations. The purpose of this study is to investigate the distribution of SBO in young people with LBP and to classify SBO from the perspective of lamina development. METHODS The X-ray films of 148 young patients with LBP were analyzed to quantify the distribution of SBO and classify abnormal laminae. RESULTS Of the 148 patients, 93 (61.49%) had SBO: 83 cases involved S1 alone, 2 involved L5-S1, 5 involved S1-2, 2 involved S1-4, and 1 involved L4-S4. According to the degree of the defect, the patients with SBO were divided on the basis of five grades: 9 patients with grade I, 53 with grade II, 23 with grade III, and 8 with grade IV. The cases were classified by the shape of the laminae into 4 types: 15 cases of type a, 11 cases of type b, 37 cases of type c, and 30 cases of type d. CONCLUSION Among the young people with LBP that we surveyed, SBO is the most common lumbosacral dysplasia, which frequently involves the S1 segment. Most laminae in SBO are in the developmental stage of the spinous process, and an abnormal laminar growth direction and laminar stenosis are the most common laminar morphologies in SBO.
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Affiliation(s)
- Wenhao Li
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhencheng Xiong
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.,Peking University Third Hospital, Beijing, 100191, China
| | - Chunke Dong
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jipeng Song
- Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China.,Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Liubo Zhang
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jun Zhou
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yanlei Wang
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Ping Yi
- Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Feng Yang
- Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiangsheng Tang
- Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Mingsheng Tan
- Orthopaedic Department II, China-Japan Friendship Hospital, Beijing, 100029, China.
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Machado GC, Ghinea N, Rogan E, Day RO, Maher CG. Emergency department care for low back pain: Should we adopt recommendations from primary care guidelines? Emerg Med Australas 2020; 32:890-892. [PMID: 32743874 DOI: 10.1111/1742-6723.13593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
ED visits for low back pain are increasing, but the lack of specific guidance for emergency physicians impedes evidence-based care, and adopting primary care recommendations may not be appropriate. The ED sees a different spectrum of low back pain presentations, where physicians are likely to encounter a larger proportion of patients with an underlying serious pathology or non-spinal diseases than in primary care. Current low back pain guidelines do not adequately cover screening for these conditions, but making a differential diagnosis is crucial in emergency patients with low back pain. In this article, we also discuss the challenges in developing specific ED guidelines for low back pain, the limited evidence on the profile of these patients and the surprising dearth of randomised trials.
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Affiliation(s)
- Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Narcyz Ghinea
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Richard O Day
- Clinical Pharmacology and Toxicology Department, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Use of the STarT Back Screening Tool in patients with chronic low back pain receiving physical therapy interventions. Braz J Phys Ther 2020; 25:286-295. [PMID: 32773289 DOI: 10.1016/j.bjpt.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The STarT Back Screening Tool (SBST) is used to stratify care. It is unclear if the SBST approach works as well for patients in low- and medium-income countries as for patients from high-income countries. OBJECTIVES (1) To investigate whether patients with chronic low back pain (LBP) stratified by the SBST are different at baseline; (2) to describe the clinical course for each SBST subgroup; (3) to investigate the SBST utility to predict clinical outcomes; and (4) to determine which SBST subgroup show greater clinical improvement. DESIGN This is a secondary analysis of data derived from a previously published clinical trial. METHODS 148 patients with chronic nonspecific LBP were included. Pain intensity, disability, global perceived effect, and the SBST were assessed at baseline and at 5, 12, and 24 weeks after baseline. Descriptive data were provided and ANOVA, unadjusted and adjusted regression models, and linear mixed models were used for data analysis. RESULTS Duration of symptoms, use of medication, pain, disability, and global perceived effect were different between SBST subgroups. Clinical improvements over a 6-month period were consistently greater in patients classified as high risk. The SBST was able to predict disability but this predictability decreased when the analysis was adjusted for possible confounders. CONCLUSION Clinical outcomes were different between SBST subgroups over 6 months. Adjusting for confounders influenced the predictability of SBST. Patients classified as high risk presented higher improvements in terms of disability.
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