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Fandim JV, Hinman RS, Øverås CK, Sharma S, Belton J, Oliveira VC, Dear BF, Parker R, Ghai B, Bennell KL, Ferreira P, Hartvigsen J, Saragiotto BT. One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study. BMC Musculoskelet Disord 2023; 24:783. [PMID: 37789304 PMCID: PMC10546725 DOI: 10.1186/s12891-023-06866-0] [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: 05/26/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER Open Science Framework ( https://osf.io/tqmz2/ ).
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Affiliation(s)
- Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil.
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joletta Belton
- IASP Global Alliance of Partners for Pain Advocacy (GAPPA), Washington D.C, USA
| | - Vinícius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babita Ghai
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Sydney School of Health Sciences, Camperdown, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Longtin C, Lacasse A, Cook CE, Tousignant M, Tousignant-Laflamme Y. Management of low back pain by primary care physiotherapists using the pain and disability drivers management model: An improver analysis. Musculoskeletal Care 2023; 21:916-925. [PMID: 36762893 DOI: 10.1002/msc.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Departement of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Michel Tousignant
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
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Treatment effect modifiers for individuals with acute low back pain: secondary analysis of the TARGET trial. Pain 2023; 164:171-179. [PMID: 35543647 PMCID: PMC9703897 DOI: 10.1097/j.pain.0000000000002679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/04/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Treatment effect modifiers identify patient characteristics associated with treatment responses. The purpose of this secondary analysis was to identify potential treatment effect modifiers for disability from the TARGET trial that compared usual care (control) with usual care + psychologically informed physical therapy (PIPT). The sample consisted of a STarT Back tool identified high-risk patients with acute low back pain that completed Oswestry Disability Index (ODI) data at index visit and 6 months later (n = 1250). Candidate treatment effect modifiers were identified a priori and informed by the literature. Linear mixed models tested for treatment effect modification through tests of statistical interaction. All statistical interactions ( P ≤ 0.20) were stratified by modifier to inspect for specific effects ( P ≤ 0.05). Smoking was identified as a potential effect modifier (treatment * smoking interaction, P = 0.08). In participants who were smokers, the effect of PIPT was (ODI = 5.5; 95% CI: 0.6-10.4; P = 0.03) compared with usual care. In participants who were nonsmokers, the effect of PIPT was (ODI = 1.5; 95% CI: -1.4 to 4.4; P = 0.31) compared with usual care. Pain medication was also identified as a potential effect modifier (treatment × pain medication interaction, P = 0.10). In participants prescribed ≥3 pain medications, the effect of PIPT was (ODI = 7.1; 95% CI: -0.1 to 14.2; P = 0.05) compared with usual care. The PIPT effect for participants prescribed no pain medication was (ODI = 3.5; 95% CI: -0.4 to 7.4; P = 0.08) and for participants prescribed 1 to 2 pain medications was (ODI = 0.6; 95% CI: -2.5 to 3.7; P = 0.70) when compared with usual care. These findings may be used for generating hypotheses and planning future clinical trials investigating the effectiveness of tailored application of PIPT.
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García-Dopico N, De La Torre-Luque A, Wand BM, Velasco-Roldán O, Sitges C. The cross-cultural adaptation, validity, and reliability of the Spanish version of the Fremantle Back Awareness Questionnaire. Front Psychol 2023; 14:1070411. [PMID: 36935999 PMCID: PMC10017493 DOI: 10.3389/fpsyg.2023.1070411] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction In chronic low back pain (CLBP), disturbed body image has been highlighted as a contributor to the condition and a potential target for treatment. The Fremantle Back Awareness Questionnaire (FreBAQ) allows its assessment. Following international guidelines for the cross-cultural translation of questionnaires, we aimed to translate the FreBAQ into Spanish (FreBAQ-S) and validate the new questionnaire in a sample of Spanish-speaking people with CLBP. Methods Two hundred and sixty-four adults with CLBP (91 males) and 128 healthy controls (34 males) completed an online form including the FreBAQ-S and questionnaires related to the pain experience. All participants were Spanish and no gender identities differing from biological sex were reported. A week later, 113 CLBP participants and 45 healthy controls (41 and 13 males, respectively), re-answered the FreBAQ-S to evaluate test-retest reliability. Confirmatory factor and multigroup analysis assessed the scale consistency on the patient sample. Discriminant and convergent validity were explored by between-group differences and the relationship with clinical characteristics. Reliability relied on Cronbach's alpha estimates and test-retest (intraclass correlation coefficient, standard error of measurement, minimal detectable change). Results and discussion Confirmatory factor analysis showed a one-factor structure of the questionnaire, without supporting evidence for item deletion (CFI = 0.97; TLI = 0.96; RMSEA = 0.06; SRMR = 0.07; SRMRu = 0.064). Multigroup analyses do not support mean invariance between groups regarding health condition or sex. The FreBAQ-S demonstrated good discriminant and convergent validity, internal consistency (α = 0.82), and test-retest reliability (ICC = 0.78; SE = 3.41; MDC = 5.12). The FreBAQ-S is a valid and reliable tool to assess back awareness in clinical and non-clinical samples.
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Affiliation(s)
- Nuria García-Dopico
- University of the Balearic Islands (UIB), Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Department and Faculty of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
- *Correspondence: Nuria García-Dopico,
| | - Alejandro De La Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Benedict Martin Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Olga Velasco-Roldán
- University of the Balearic Islands (UIB), Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Department and Faculty of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Carolina Sitges
- University of the Balearic Islands (UIB), Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Department and Faculty of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Shokouhyan SM, Davoudi M, Hoviattalab M, Abedi M, Bervis S, Parnianpour M, Brumagne S, Khalaf K. Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis. Front Bioeng Biotechnol 2022; 10:1078805. [PMID: 36582840 PMCID: PMC9792676 DOI: 10.3389/fbioe.2022.1078805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait ML and Entropy ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation.
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Affiliation(s)
| | - Mehrdad Davoudi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran,Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Maryam Hoviattalab
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohsen Abedi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soha Bervis
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kinda Khalaf
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,*Correspondence: Kinda Khalaf,
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Keller AV, Torres-Espin A, Peterson TA, Booker J, O’Neill C, Lotz JC, Bailey JF, Ferguson AR, Matthew RP. Unsupervised Machine Learning on Motion Capture Data Uncovers Movement Strategies in Low Back Pain. Front Bioeng Biotechnol 2022; 10:868684. [PMID: 35497350 PMCID: PMC9047543 DOI: 10.3389/fbioe.2022.868684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic low back pain (LBP) is a leading cause of disability and opioid prescriptions worldwide, representing a significant medical and socioeconomic problem. Clinical heterogeneity of LBP limits accurate diagnosis and precise treatment planning, culminating in poor patient outcomes. A current priority of LBP research is the development of objective, multidimensional assessment tools that subgroup LBP patients based on neurobiological pain mechanisms, to facilitate matching patients with the optimal therapies. Using unsupervised machine learning on full body biomechanics, including kinematics, dynamics, and muscle forces, captured with a marker-less depth camera, this study identified a forward-leaning sit-to-stand strategy (STS) as a discriminating movement biomarker for LBP subjects. A forward-leaning STS strategy, as opposed to a vertical rise strategy seen in the control participants, is less efficient and results in increased spinal loads. Inefficient STS with the subsequent higher spinal loading may be a biomarker of poor motor control in LBP patients as well as a potential source of the ongoing symptomology.
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Affiliation(s)
- Anastasia V. Keller
- Brain and Spinal Injury Center (BASIC), Weill Institute for Neuroscience, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA, United States
| | - Abel Torres-Espin
- Brain and Spinal Injury Center (BASIC), Weill Institute for Neuroscience, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas A. Peterson
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jacqueline Booker
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Conor O’Neill
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Adam R. Ferguson
- Brain and Spinal Injury Center (BASIC), Weill Institute for Neuroscience, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA, United States
| | - Robert P. Matthew
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Robert P. Matthew,
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Braun T, Bahns C, Elsner B, Kopkow C. Forschungsprioritäten in der physiotherapeutischen Forschung in Deutschland – Eine systematische Analyse von Publikationen der physioscience der letzten 10 Jahre. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1549-5166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Forschungsprioritäten können dazu beitragen, Evidenz in den Bereichen zu entwickeln, die für Patient*innen und Kliniker*innen am wichtigsten sind. Forschungsprioritäten werden jedoch in der biomedizinischen Forschung nur unzureichend berücksichtigt.
Ziel Beschreibung der Berücksichtigung von Forschungsprioritäten in der physiotherapeutischen Forschung in Deutschland.
Methode Analyse von physiotherapeutischen Berichten aus Deutschland, die zwischen 2011 und 2020 in der Fachzeitschrift physioscience publiziert wurden. Für jeden eingeschlossenen Bericht wurde die primäre Forschungsfrage und/oder der Hauptgegenstandsbereich identifiziert und, falls möglich, einem spezifischen Gesundheitszustand zugeordnet. Danach wurde für jeden Bericht geprüft, ob eine gesundheitszustandsspezifische Forschungspriorität (von der James Lind Alliance oder aus wissenschaftlichen Datenbanken) bzw. eine der Top 26 der physiotherapiespezifischen Forschungsprioritäten des britischen Berufsverbandes „The Chartered Society of Physiotherapy (CSP)“ aus 2018 adressiert wurde. Die Datenanalyse erfolgte deskriptiv.
Ergebnisse Es konnten 78 Berichte in die Analyse eingeschlossen werden. Die häufigsten Studientypen waren Übersichtsarbeiten (17/78, 22 %), Beobachtungsstudien (16/78, 21 %) und Umfragen (13/78, 17 %). Für die Analyse der gesundheitszustandsspezifischen Forschungsprioritäten konnten 51 Berichte berücksichtigt werden. In 51 % dieser Berichte (26/51) wurde eine der 10 wichtigsten Forschungsprioritäten des jeweiligen Themengebiets adressiert. In den übrigen Berichten wurde keine gesundheitszustandsspezifische Forschungspriorität berücksichtigt (13/51, 25 %) oder die Priorität gehörte nicht zu den Top Ten (12/51, 24 %).Für die Analyse der physiotherapeutischen Forschungsprioritäten wurden alle 78 Berichte berücksichtigt. In 21 % dieser Berichte (16/78) wurde eine Top-Ten-Priorität adressiert. In den übrigen Berichten wurde eine weniger wichtige Priorität adressiert (Listenplatz 11–26; 25/78, 32 %) oder das Forschungsthema des Berichts gehörte nicht zu den Top 26 (37/78, 47 %).
Schlussfolgerung Die vorliegende Studie liefert erste Hinweise darauf, dass Forschungsprioritäten in der physiotherapeutischen Forschung in Deutschland nur unzureichend berücksichtigt werden. Ein erheblicher Teil der Forschung scheint somit an den Bedürfnissen von Patient*innen und Kliniker*innen vorbeizugehen. Die Berücksichtigung existierender Forschungsprioritäten und die Entwicklung nationaler Forschungsprioritäten für die Physiotherapie in Deutschland könnten dazu beitragen, den Nutzen der physiotherapeutischen Forschung für die öffentliche Gesundheit zu vergrößern.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit, Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Bochum, Deutschland
- HSD Hochschule Döpfer, Fachbereich Gesundheit, Köln, Deutschland
| | - Carolin Bahns
- Brandenburgische Technische Universität Cottbus-Senftenberg, Fachgebiet Therapiewissenschaften, Senftenberg, Deutschland
| | - Bernhard Elsner
- SRH Hochschule für Gesundheit, Department Therapiewissenschaften, Campus Gera, Gera, Deutschland
- Technische Universität Dresden, Gesundheitswissenschaften/Public Health, Dresden, Deutschland
| | - Christian Kopkow
- Brandenburgische Technische Universität Cottbus-Senftenberg, Fachgebiet Therapiewissenschaften, Senftenberg, Deutschland
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García-Dopico N, de la Torre-Luque A, Sitges C, Velasco-Roldán O. Proprioceptive acuity is core for back awareness in chronic low back pain: Further analysis of the content validity of the Spanish version of the Fremantle Back Awareness Questionnaire. Front Hum Neurosci 2022; 16:1070402. [PMID: 36875741 PMCID: PMC9983349 DOI: 10.3389/fnhum.2022.1070402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/28/2022] [Indexed: 02/19/2023] Open
Abstract
Treatments aimed at increasing self-perception may improve chronic low back pain (CLBP) symptomatology and present novel management approaches. Consequently, it is important to have valid, complete, and reliable tools for its assessment, and to understand which variables influence altered back awareness. We aimed to evaluate the face/content validity of the Spanish version of the Fremantle Back Awareness Questionnaire (FreBAQ-S) among people with and without CLBP, and to explore additional variables suggested to be involved in back awareness. A total of 264 individuals with CLBP and 128 healthy controls (HC) answered an online survey, including the FreBAQ-S, and questions regarding the completeness, comprehensibility, time-to-complete adequacy, and time spent completing it. If participants declared a lack of completeness, they had to report which aspects would be incorporated into the questionnaire to explore additional back-awareness-related variables. A statistically significant difference in completeness emerged between groups (p < 0.01). The questionnaire was comprehensible for more than 85% of participants, regardless of the group (p = 0.45). CLBP participants spent significantly more time in completing the questionnaire than controls (p < 0.01), but no differences were found between groups regarding the time-to-complete adequacy (p = 0.49). Regarding the back-awareness-related variables, 77 suggestions from CLBP group and seven from the HC were received. Most of them were related to proprioceptive acuity such as posture, weight, or movement patterns, among others. The FreBAQ-S demonstrated adequate face/content validity, completeness, comprehensibility, and adequate time of response. The feedback provided will help improve currently available assessment tools.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, CIBERSAM ISCIII, Complutense University of Madrid (UCM), Madrid, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Hochheim M, Ramm P, Wunderlich M, Amelung V. Cost-effectiveness analysis of a chronic back pain multidisciplinary biopsychosocial rehabilitation (MBR) compared to standard care for privately insured in Germany. BMC Health Serv Res 2021; 21:1362. [PMID: 34952585 PMCID: PMC8705190 DOI: 10.1186/s12913-021-07337-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended for chronic lower back pain (CLBP) treatment, but its economic benefit remains to be clearly demonstrated. The purpose of this study is to analyse the effect of a 12-month MBR programme of behavioural change coaching and device-supported exercise on direct medical costs, sick leave and health-related quality of life (HRQOL) at 24 months. Methods An incremental cost-effectiveness analysis was conducted in Germany from a private health insurance perspective using data from a multi-centre, two-arm randomised controlled trial with parallel-group Zelen's randomisation and 24-month follow-up. After removing dissimilarities in characteristics between MBR and usual care (control) via propensity score matching, treatment effects were calculated using a difference-in-difference approach. Results Base-case analysis of the MBR (n=112) and usual care group (n=111) showed an incremental cost-effectiveness ratio (ICER) of €8,296 per quality-adjusted life year (QALY) gained, indicating that the intervention was cost-effective. Compared to the controls, MBR reduced economically unaccounted sick leave due to back pain in the last six months by 17.5 days (p = 0.001) and had a positive effect on health-related quality of life (HRQOL) (0.046, p=0.026). Subgroup analysis of participants with major impairment demonstrated that a dominant intervention was possible, as reflected by an ICER of - €7,302 per QALY. Savings were driven by a - €1,824 reduction in back pain-specific costs. Moreover, sick leave was 27 days (p = 0.006) less in the MBR group. Conclusions This first cost-effectiveness study with combined data from a private health insurer and a controlled trial in Germany demonstrated that long term MBR for the treatment of CLBP is cost-effective. Subgroups with major impairment from back pain benefitted more from the intervention than those with minor impairment. MBR significantly reduced sick leave in all participants. Hence, it is a profitable intervention from a societal point of view. Trial registration The trial of the evaluation study was retrospectively registered in the German Clinical Trials Register under trial number DRKS00015463 retrospectively (dated 4 Sept 2018).
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Affiliation(s)
- M Hochheim
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany. .,Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany.
| | - P Ramm
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany
| | - M Wunderlich
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany
| | - V Amelung
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain. J Manipulative Physiol Ther 2021; 44:433-444. [PMID: 34470698 DOI: 10.1016/j.jmpt.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/04/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate pain self-efficacy (PSE) and coping self-efficacy (CSE) for people with chronic low back pain (CLBP), and to assess whether lower income may be associated with less PSE and CSE in the United States. METHODS We conducted a cross-sectional study using survey data collected between June 2016 and February 2017 from n = 1364 patients with CLBP from chiropractic clinics in the United States to measure the relationship between income and both types of self-efficacy. We created 4 multivariate models predicting PSE and CSE scores. We used both a parsimonious set of covariates (age, sex) and a full set (age, sex, education, neck pain comorbidity, catastrophizing, and insurance). We also calculated effect sizes (Cohen's d) for unadjusted differences in PSE and CSE score by income. RESULTS Lower income was associated with lower PSE and CSE scores across all 4 models. In the full models, the highest-income group had an average of 1 point (1-10 scale) higher PSE score and CSE score compared to the lowest income group. Effect sizes for the unadjusted differences in PSE and CSE scores between the highest and lowest income groups were 0.94 and 0.84, respectively. CONCLUSIONS Our findings indicate that people with lower income perceive themselves as less able to manage their pain, and that this relationship exists even after taking into account factors like health insurance and educational attainment. There is a need to further investigate how practitioners and policymakers can best support low-income patients with chronic pain.
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Education With Therapeutic Alliance Did Not Improve Symptoms in Patients With Chronic Low Back Pain and Low Risk of Poor Prognosis Compared to Education Without Therapeutic Alliance: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2021; 51:392-400. [PMID: 33962515 DOI: 10.2519/jospt.2021.9636] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effectiveness of an education intervention with or without the addition of the therapeutic alliance to no education intervention in patients with nonspecific chronic low back pain (LBP) and low risk of poor prognosis. DESIGN Randomized controlled trial. Randomization was performed using randomly generated numbers. METHODS Two hundred twenty-two patients with nonspecific chronic LBP and low risk of poor prognosis from 2 university physical therapy services in Taubaté, Brazil were randomized into 3 groups: education plus therapeutic alliance, education only, and no education. Primary outcomes were pain (measured with the numeric pain-rating scale) and patient-specific disability (measured with the Patient-Specific Functional Scale), assessed 1 month after randomization. The patients, therapists, and assessors were not blinded due to the nature of the intervention and self-reported outcomes. RESULTS Patients were recruited between November 2015 and February 2017. There was a loss of 17 (7.6%) follow-up assessments at 1 month, 28 (12.6%) at 6 months, and 31 (13.9%) at 12 months after randomization, and intention-to-treat analyses were conducted. There were no significant differences in pain between groups. However, there was a significant improvement in patient-specific disability for the education-plus-therapeutic alliance and education-only groups compared to no education after 1 month (mean difference, -1.41; 95% confidence interval: -2.31, -0.51 and -0.95; 95% confidence interval: -1.85, -0.04, respectively). CONCLUSION An education intervention did not provide clinically relevant improvements in patient-specific disability and did not influence pain in patients with nonspecific chronic LBP and low risk of poor prognosis. Additionally, there was no difference between interventions with or without emphasis on the therapeutic alliance. J Orthop Sports Phys Ther 2021;51(8):392-400. Epub 7 May 2021. doi:10.2519/jospt.2021.9636.
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Cashin AG, Lee H, Bagg MK, Wand BM, O'Hagan E, Rizzo RRN, Stanton TR, Moseley GL, McAuley JH. Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial. JMIR Res Protoc 2021; 10:e26053. [PMID: 34255720 PMCID: PMC8285749 DOI: 10.2196/26053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. Objective This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. Methods We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. Results Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. Conclusions The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/26053
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Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Hopin Lee
- Oxford Clinical Trials Research Unit and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Matthew K Bagg
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Randwick, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Randwick, Australia
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Braun T, Kopkow C. Warum wir Forschungsprioritäten zur Vermeidung von Research Waste brauchen. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1392-8428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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14
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Knoop J, Rutten G, Lever C, Leemeijer J, de Jong LJ, Verhagen AP, van Lankveld W, Staal JB. Lack of Consensus Across Clinical Guidelines Regarding the Role of Psychosocial Factors Within Low Back Pain Care: A Systematic Review. THE JOURNAL OF PAIN 2021; 22:1545-1559. [PMID: 34033963 DOI: 10.1016/j.jpain.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/15/2022]
Abstract
It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (ie, psychological factors ["yellow flags"], perceptions about the relationship between work and health, ["blue flags"], system or contextual obstacles ["black flags") and psychiatric symptoms ["orange flags"]). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15 guidelines. Psychosocial prognostic factors were addressed in 13 of 15 guidelines regarding their assessment and in 14 of 15 guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned "yellow" or "black flags," and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. PERSPECTIVE: This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.
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Affiliation(s)
- Jesper Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Geert Rutten
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Cato Lever
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jaap Leemeijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lieke J de Jong
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Wim van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep 2021; 6:e919. [PMID: 33981936 PMCID: PMC8108595 DOI: 10.1097/pr9.0000000000000919] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention. Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.
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Roseen EJ, Gerlovin H, Felson DT, Delitto A, Sherman KJ, Saper RB. Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:165-180. [PMID: 32662833 PMCID: PMC7861465 DOI: 10.1093/pm/pnaa153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e., a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions. DESIGN Secondary analysis of a randomized controlled trial. SETTING Academic safety net hospital and seven federally qualified community health centers. SUBJECTS Adults with cLBP (N = 299). METHODS We report patient characteristics that were predictors of response and/or modified treatment effect across three 12-week treatments: yoga, physical therapy [PT], and a self-care book. Using preselected characteristics, we used logistic regression to identify predictors of "response," defined as a ≥30% improvement in the Roland Morris Disability Questionnaire. Then, using "response" as our outcome, we identified baseline characteristics that were treatment effect modifiers by testing for statistical interaction (P < 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT. RESULTS Overall, 39% (116/299) of participants were responders, with more responders in the yoga-or-PT group (42%) than the self-care (23%) group. There was no difference in proportion responding to yoga (48%) vs PT (37%, odds ratio [OR] = 1.5, 95% confidence interval = 0.88 - 2.6). Predictors of response included having more than a high school education, a higher income, employment, few depressive symptoms, lower perceived stress, few work-related fear avoidance beliefs, high pain self-efficacy, and being a nonsmoker. Effect modifiers included use of pain medication and fear avoidance beliefs related to physical activity (both P = 0.02 for interaction). When comparing yoga or PT with self-care, a greater proportion were responders among those using pain meds (OR = 5.3), which differed from those not taking pain meds (OR = 0.94) at baseline. We also found greater treatment response among those with lower (OR = 7.0), but not high (OR = 1.3), fear avoidance beliefs around physical activity. CONCLUSIONS Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes.
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Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Hanna Gerlovin
- Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Anthony Delitto
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Macedo LG, Hodges PW, Bostick G, Hancock M, Laberge M, Hanna S, Spadoni G, Gross A, Schneider J. Which Exercise for Low Back Pain? (WELBack) trial predicting response to exercise treatments for patients with low back pain: a validation randomised controlled trial protocol. BMJ Open 2021; 11:e042792. [PMID: 33472786 PMCID: PMC7818834 DOI: 10.1136/bmjopen-2020-042792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis. METHODS AND ANALYSIS Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable. ETHICS AND DISSEMINATION This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04283409.
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Affiliation(s)
- Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Maude Laberge
- Faculty of Administration, Universite Laval, Quebec, Quebec, Canada
| | - Steven Hanna
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Greg Spadoni
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Anita Gross
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julia Schneider
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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18
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Kapitza C, Lüdtke K, Tampin B, Ballenberger N. Application and utility of a clinical framework for spinally referred neck-arm pain: A cross-sectional and longitudinal study protocol. PLoS One 2020; 15:e0244137. [PMID: 33370389 PMCID: PMC7769468 DOI: 10.1371/journal.pone.0244137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/02/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time. METHOD We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course. CONCLUSION The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.
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Affiliation(s)
- Camilla Kapitza
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
| | - Kerstin Lüdtke
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany
| | - Brigitte Tampin
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physiotherapy and Exercises Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nikolaus Ballenberger
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
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Tsuge T, Takasaki H, Toda M. Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain? Diagnostics (Basel) 2020; 10:diagnostics10080536. [PMID: 32751595 PMCID: PMC7460228 DOI: 10.3390/diagnostics10080536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Mechanical diagnosis and therapy (MDT) and the stratified approach using the Keele STarT Back Screening Tool (SBST) are examples of stratified low back pain (LBP) management. We investigated whether the medium–high risk in SBST can contribute to the time and sessions until discharge from MDT (Question 1) and to the loss of follow-up before identifying a promising management strategy (Question 2). Methods: A retrospective chart study was conducted. Multiple regression modeling was constructed using 10 independent variables, including whether the SBST was medium–high risk or not for Question 1, and the 9/10 independent variables for Question 2. Results: The data of 89 participants for Question 1 and 166 participants for Question 2 were analyzed. SBST was not a primary contributing factor for Question 1 (R2 = 0.17–0.19). The model for Question 2 included SBST as a primary contributing factor and the shortest distance from the patient address to the hospital as a secondary contributing factor (93.4% correct classification). Conclusion: SBST status was not a primary contributing factor for time and sessions until discharge from MDT, but was a critical factor for the loss of MDT follow-up before identifying a promising management strategy.
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Affiliation(s)
- Takahiro Tsuge
- Department of Rehabilitation, Kurashiki Medical Center, 250 Bakuro, Kurashiki, Okayama 710-8522, Japan;
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama 343-8540, Japan
- Correspondence: ; Tel.: +81-48-973-4706
| | - Michio Toda
- Department of Orthopaedic Surgery, Kurashiki Medical Center, 250 Bakuro, Kurashiki, Okayama 710-8522, Japan;
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Skolasky RL, Wegener ST, Aaron RV, Ephraim P, Brennan G, Greene T, Lane E, Minick K, Hanley AW, Garland EL, Fritz JM. The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain. BMC Musculoskelet Disord 2020; 21:293. [PMID: 32393216 PMCID: PMC7216637 DOI: 10.1186/s12891-020-03324-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Low back pain is a prevalent condition that causes a substantial health burden. Despite intensive and expensive clinical efforts, its prevalence is growing. Nonpharmacologic treatments are effective at improving pain-related outcomes; however, treatment effect sizes are often modest. Physical therapy (PT) and cognitive behavioral therapy (CBT) have the most consistent evidence of effectiveness. Growing evidence also supports mindfulness-based approaches. Discussions with providers and patients highlight the importance of discussing and trying options to find the treatment that works for them and determining what to do when initial treatment is not successful. Herein, we present the protocol for a study that will evaluate evidence-based, protocol-driven treatments using PT, CBT, or mindfulness to examine comparative effectiveness and optimal sequencing for patients with chronic low back pain. METHODS The Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back Pain (OPTIMIZE) Study will be a multisite, comparative effectiveness trial using a sequential multiple assessment randomized trial design enrolling 945 individuals with chronic low back pain. The co-primary outcomes will be disability (measured using the Oswestry Disability Index) and pain intensity (measured using the Numerical Pain Rating Scale). After baseline assessment, participants will be randomly assigned to PT or CBT. At week 10, participants who have not experienced at least 50% improvement in disability will be randomized to cross-over phase-1 treatments (e.g., PT to CBT) or to Mindfulness-Oriented Recovery Enhancement (MORE). Treatment will consist of 8 weekly sessions. Long-term outcome assessments will be performed at weeks 26 and 52. DISCUSSION Results of this study may inform referring providers and patients about the most effective nonoperative treatment and/or sequence of nonoperative treatments to treat chronic low back pain. TRIAL REGISTRATION This study was prospectively registered on March 1, 2019, with Clinicaltrials.gov under the registration number NCT03859713 (https://clinicaltrials.gov/ct2/show/NCT03859713).
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Affiliation(s)
- Richard L. Skolasky
- grid.21107.350000 0001 2171 9311Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA ,grid.21107.350000 0001 2171 9311Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA
| | - Stephen T. Wegener
- grid.21107.350000 0001 2171 9311Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA
| | - Rachel V. Aaron
- grid.21107.350000 0001 2171 9311Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA
| | - Patti Ephraim
- grid.21107.350000 0001 2171 9311Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Gerard Brennan
- grid.420884.20000 0004 0460 774XIntermountain Healthcare, 36 S State St, Salt Lake City, UT 84111 USA
| | - Tom Greene
- grid.223827.e0000 0001 2193 0096Department of Population Health Sciences, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112 USA
| | - Elizabeth Lane
- grid.223827.e0000 0001 2193 0096Department of Physical Therapy and Athletic Training, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112 USA
| | - Kate Minick
- grid.420884.20000 0004 0460 774XIntermountain Healthcare, 36 S State St, Salt Lake City, UT 84111 USA
| | - Adam W. Hanley
- grid.223827.e0000 0001 2193 0096College of Social Work, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112 USA
| | - Eric L. Garland
- grid.223827.e0000 0001 2193 0096College of Social Work, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112 USA
| | - Julie M. Fritz
- grid.223827.e0000 0001 2193 0096Department of Physical Therapy and Athletic Training, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112 USA
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Lavallee DC, Lawrence SO, Avins AL, Nerenz DR, Edwards TC, Patrick DL, Bauer Z, Truitt AR, Monsell SE, Scott MR, Jarvik JG. Comparing three approaches for involving patients in research prioritization: a qualitative study of participant experiences. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:18. [PMID: 32377376 PMCID: PMC7195769 DOI: 10.1186/s40900-020-00196-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/16/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND By participating in priority-setting activities in research, patients and members of the public help ensure that important questions are incorporated into future research agendas. Surveys, focus groups, and online crowdsourcing are increasingly used to obtain input, yet little is known about how they compare for prioritizing research topics. To address this gap, the Study of Methods for Assessing Research Topic Elicitation and pRioritization (SMARTER) evaluated participant satisfaction with the engagement experience across three prioritization activities. METHODS Respondents from Back pain Outcomes using Longitudinal Data (BOLD), a registry of patients 65 years and older with low back pain (LBP), were randomly assigned to one of three interactive prioritization activities: online crowd-voting, in-person focus groups using nominal group technique, and two rounds of a mailed survey (Delphi). To assess quality of experience, participants completed a brief survey; a subset were subsequently interviewed. We used descriptive statistics to characterize participants, and we analyzed responses to the evaluation using a mixed-methods approach, tabulating responses to Likert-scale questions and using thematic analysis of interviews to explore participant understanding of the activity and perceptions of experience. RESULTS The crowd-voting activity had 38 participants, focus groups 39, and the Delphi survey 74. Women outnumbered men in the focus groups and Delphi survey; otherwise, demographics among groups were similar, with participants being predominantly white, non-Hispanic, and college educated. Activities generated similar lists of research priorities, including causes of LBP, improving physician-patient communication, and self-care strategies. The evaluation survey was completed by 123 participants. Of these, 31 across all activities were interviewed about motivations to participate, understanding of activity goals, logistics, clarity of instructions, and the role of patients in research. Focus group participants rated their experience highest, in both the evaluation and interviews. CONCLUSION Common methods for research prioritization yielded similar priorities but differing perceptions of experience. Such comparative studies are rare but important in understanding methods to involve patients and the public in research. Preferences for different methods may vary across stakeholder groups; this warrants future study. TRIAL REGISTRATION NICHSR, HSRP20152274. Registered 19 February 2015.
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Affiliation(s)
- Danielle C. Lavallee
- Dept. of Surgery, University of Washington, Surgical Outcomes Research Center, 1107 NE 45th St., Suite 502, Seattle, WA 98105 USA
- Dept. of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
| | - Sarah O. Lawrence
- Dept. of Surgery, University of Washington, Surgical Outcomes Research Center, 1107 NE 45th St., Suite 502, Seattle, WA 98105 USA
| | - Andrew L. Avins
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - David R. Nerenz
- Henry Ford Health System, Suite 3A, One Ford Place, Detroit, MI 48202 USA
| | - Todd C. Edwards
- Dept. of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
| | - Donald L. Patrick
- Dept. of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
| | - Zoya Bauer
- Division of Medical Oncology, University of Washington, 825 Eastlake Ave. E, Seattle, WA 98109 USA
- Dept. of Radiology, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE, Seattle, WA 98105 USA
| | - Anjali R. Truitt
- Dept. of Surgery, University of Washington, Surgical Outcomes Research Center, 1107 NE 45th St., Suite 502, Seattle, WA 98105 USA
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN 55425 USA
| | - Sarah E. Monsell
- Dept. of Biostatistics, University of Washington, 1705 NE Pacific St, Seattle, WA 98195 USA
| | - Mary R. Scott
- Dept. of Surgery, University of Washington, Surgical Outcomes Research Center, 1107 NE 45th St., Suite 502, Seattle, WA 98105 USA
| | - Jeffrey G. Jarvik
- Dept. of Health Services, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
- Dept. of Radiology, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE, Seattle, WA 98105 USA
- Dept. Neurological Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
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Sullivan N, Hebron C, Vuoskoski P. "Selling" chronic pain: physiotherapists' lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients. Physiother Theory Pract 2019; 37:973-992. [PMID: 31744369 DOI: 10.1080/09593985.2019.1672227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients.Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences.Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty).Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training.
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Affiliation(s)
- Nick Sullivan
- Sutton Health & Care Alliance, Physiotherapy Department, St Helier Hospital, Carshalton, UK
| | - Clair Hebron
- Faculty of Health and Social Science, Department of Physiotherapy, University of Brighton, Eastbourne, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences (Physiotherapy), University of Jyväskylä, Jyväskylä, Finland
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Abstract
BACKGROUND Though a large amount of research on neck pain has been conducted, no coordinated agenda has identified and addressed high-priority research questions. OBJECTIVES To identify and rank the neck pain research priorities of neck pain researchers. METHODS A total of 400 experts in the field of neck pain were invited to participate in this modified Delphi study. The study was conducted in 3 rounds. The first round aimed to identify the most important relevant questions that neck pain researchers should address. These questions were then categorized and ranked during the second and third rounds. RESULTS A total of 117 experts agreed to participate (29% response rate). A total of 15 neck pain research priorities were identified. The top 5 research priorities were to (1) establish effectiveness and cost-effectiveness of available treatments for neck pain, (2) translate research evidence into clinical settings, (3) identify the effectiveness of education and self-care in prevention and treatment of neck pain, (4) identify causal factors in the development of neck pain, and (5) define the natural course and prognostic factors in people with neck pain. CONCLUSION A new research-priority agenda was developed through a consensus process from a group of neck pain researchers. This agenda can be used as a guide for researchers and funding agencies to ensure that future research addresses the most important research questions in this area. J Orthop Sports Phys Ther 2019;49(9):666-674. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8704.
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The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain. J Clin Med 2019; 8:jcm8091334. [PMID: 31466408 PMCID: PMC6780711 DOI: 10.3390/jcm8091334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential of being more effective for people with LBP; however, there is limited evidence supporting this approach. A series of studies supporting the mechanisms underpinning and effectiveness of the Specific Treatment of Problems of the Spine (STOPS) approach to individualised physiotherapy have been published. The clinical and research implications of these findings are presented and discussed. Treatment based on the STOPS approach should also be considered as an approach to individualised physiotherapy in people with LBP.
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Ford JJ, Hahne AJ, Surkitt LD, Chan AYP, Richards MC, Slater SL, Pizzari T, Davidson M, Taylor NF. STOPS trial versus Costa et al: a more accurate analysis. Br J Sports Med 2019; 53:914-916. [DOI: 10.1136/bjsports-2017-098821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/03/2022]
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Rabey M, Smith A, Kent P, Beales D, Slater H, O'Sullivan P. Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses. Scand J Pain 2019; 19:743-753. [PMID: 31256070 DOI: 10.1515/sjpain-2019-0073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Chronic low back pain (CLBP) is a complex disorder where central and peripheral nociceptive processes are influenced by factors from multiple dimensions associated with CLBP (e.g. movement, pain sensitivity, psychological). To date, outcomes for treatments matched to unidimensional subgroups (e.g. psychologically-based) have been poor. Therefore, unidimensional subgrouping may not reflect the complexity of CLBP presentations at an individual level. The aim of this study was therefore to explore patterns of classification at an individual level across the three previously-published, data-driven, within-dimension subgrouping studies. METHODS Cross-sectional, multidimensional data was collected in 294 people with CLBP. Statistical derivation of subgroups within each of three clinically-important dimensions (pain sensitivity, psychological profile, pain responses following repeated spinal bending) was briefly reviewed. Patterns of classification membership were subsequently tabulated across the three dimensions. RESULTS Of 27 possible patterns across these dimensions, 26 were represented across the cohort. CONCLUSIONS This result highlights that while unidimensional subgrouping has been thought useful to guide treatment, it is unlikely to capture the full complexity of CLBP. The amount of complexity important for best patient outcomes is currently untested. IMPLICATIONS For clinicians this study highlights the high variability of presentations of people with CLBP at the level of the individual. For example, clinician's should not assume that those with high levels of pain sensitivity will also have high psychological distress and have pain summation following repeated spinal bending. A more flexible, multidimensional, clinically-reasoned approach to profile patient complexity may be required to inform individualised, patient-centred care. Such individualised care might improve treatment efficacy. This study also has implications for researchers; highlighting the inadequacy of unidimensional subgrouping processes and methodological difficulties in deriving subgroups across multidimensional data.
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Affiliation(s)
- Martin Rabey
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia
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Abstract
Low back pain (LBP) is an important medical and socioeconomic problem. Impaired sensorimotor control has been suggested to be a likely mechanism underlying development and/or maintenance of pain. Although early work focused on the structural and functional abnormalities within the musculoskeletal system, in the past 20 years there has been an increasing realization that patients with LBP might also have extensive neuroplastic changes within the central nervous system. These include changes related to both the structure (eg, gray matter changes) and function (eg, organization of the sensory and motor cortices) of the nervous system as related to processing of pain and nociception and to motor and somatosensory systems. Moreover, clinical interventions increasingly aim to drive neuroplasticity with treatments to improve pain and sensorimotor function. This commentary provides a contemporary overview of neuroplasticity of the pain/nociceptive and sensorimotor systems in LBP. This paper addresses (1) defining neuroplasticity in relation to control of the spine and LBP, (2) structural and functional nervous system changes as they relate to nonspecific LBP and sensorimotor function, and (3) related clinical implications. Individuals with recurrent and persistent LBP differ from those without LBP in several markers of the nervous system's function and structure. Neuroplastic changes may be addressed by top-down cognitive-based interventions and bottom-up physical interventions. An integrated clinical approach that combines contemporary pain neuroscience education, cognition-targeted sensorimotor control, and physical or function-based treatments may lead to better outcomes in patients with recurrent and persistent LBP. This approach will need to consider variation among individuals, as no single finding/mechanism is present in all individuals, and no single treatment that targets neuroplastic changes in the sensorimotor system is likely to be effective for all patients with LBP. J Orthop Sports Phys Ther 2019;49(6):402-414. doi:10.2519/jospt.2019.8489.
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Donelson R, Spratt K, McClellan WS, Gray R, Miller JM, Gatmaitan E. The cost impact of a quality-assured mechanical assessment in primary low back pain care. J Man Manip Ther 2019; 27:277-286. [DOI: 10.1080/10669817.2019.1613008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Kevin Spratt
- Geisel School of Medicine Department of Orthopaedics, Lebanon, NH, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Richard Gray
- Integrated Musculoskeletal Care, Tallahassee, FL, USA
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Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain: A Critical Review. Am J Phys Med Rehabil 2019; 97:200-211. [PMID: 29112509 DOI: 10.1097/phm.0000000000000859] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Low back pain (LBP) coincides with sensorimotor impairments, for example, reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available functional magnetic resonance imaging studies on brain activation related to nonnociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area, and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. In addition, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Overactivation in these regions could indicate an overresponsiveness to sensory inputs that signal potential harm to the spine, thereby inducing overgeneralized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.
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30
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Rabey M, Kendell M, Godden C, Liburd J, Netley H, O'Shaughnessy C, O'Sullivan P, Smith A, Beales D. STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients. Eur J Pain 2019; 23:823-834. [PMID: 30582876 DOI: 10.1002/ejp.1351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/28/2018] [Accepted: 12/18/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Investigation of movement and sensory profiles across STarT Back risk subgroups. METHODS A chronic low back pain cohort (n = 290) were classified as low, medium or high risk using the STarT Back Tool, and completed a repeated spinal bending task and quantitative sensory testing. Pain summation, time taken and the number of protective behaviours with repeated bending were measured. Sensory tests included two-point discrimination, temporal summation, pressure/thermal pain thresholds and conditioned pain modulation. Subgroups were profiled against movement and sensory variables. RESULTS The high-risk subgroup demonstrated greater pain summation following repeated forward bending (p < 0.001). The medium-risk subgroup demonstrated greater pain summation following repeated backward bending (p = 0.032). Medium- and high-risk subgroups demonstrated greater forward/backward bend time compared to the low-risk subgroup (p = 0.001, p = 0.005, respectively). Medium- and high-risk subgroups demonstrated a higher number of protective behaviours per forward bend compared to the low-risk subgroup (p = 0.008). For sensory variables, only two-point discrimination differed between subgroups, with medium- and high-risk subgroups demonstrating higher thresholds (p = 0.016). CONCLUSIONS This study showed altered movement characteristics and sensory discrimination across SBT risk subgroups in people with CLBP. Membership of the high SBT risk subgroup was associated with greater pain and disability levels, greater pain summation following repeated bending, slower bending times, a greater number of protective behaviours during forward bending, and a higher TPD threshold. Treatment outcomes for higher risk SBT subgroups may be enhanced by interventions specifically targeting movement and sensory alterations. SIGNIFICANCE In 290 people with chronic low back pain movement profile and two-point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.
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Affiliation(s)
- Martin Rabey
- Curtin University, Perth, Western Australia, Australia
| | | | - Chris Godden
- Curtin University, Perth, Western Australia, Australia
| | | | - Hayley Netley
- Curtin University, Perth, Western Australia, Australia
| | | | | | - Anne Smith
- Curtin University, Perth, Western Australia, Australia
| | - Darren Beales
- Curtin University, Perth, Western Australia, Australia
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Bourne AM, Johnston RV, Cyril S, Briggs AM, Clavisi O, Duque G, Harris IA, Hill C, Hiller C, Kamper SJ, Latimer J, Lawson A, Lin CWC, Maher C, Perriman D, Richards BL, Smitham P, Taylor WJ, Whittle S, Buchbinder R. Scoping review of priority setting of research topics for musculoskeletal conditions. BMJ Open 2018; 8:e023962. [PMID: 30559158 PMCID: PMC6303563 DOI: 10.1136/bmjopen-2018-023962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified. DESIGN Scoping review. SETTING AND POPULATION Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included. METHODS AND ANALYSIS We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted. RESULTS Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities. CONCLUSIONS While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value. PROSPERO REGISTRATION NUMBER CRD42017059250.
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Affiliation(s)
- Allison M Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renea V Johnston
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheila Cyril
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Hill
- Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Claire Hiller
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Latimer
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Christopher Maher
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, Australian Capital Territory, Australia
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bethan L Richards
- Rheumatology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Sam Whittle
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Does Duration of Pain at Baseline Influence Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-based Pathway? Spine (Phila Pa 1976) 2018; 43:E998-E1004. [PMID: 29470277 DOI: 10.1097/brs.0000000000002612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal observational study. OBJECTIVE To investigate the association between the duration of pain at baseline and the clinical outcomes of patients with low back pain (LBP) enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). SUMMARY OF BACKGROUND DATA The NERBPP is a clinical pathway based upon National Institute for Health and Care Excellence (NICE) guidelines (2009) for LBP of <1-year duration. Recent changes to NICE guidelines (2016) advocate the same management for all LBP patients regardless of pain duration. METHODS Patients with LBP referred onto the NERBPP by their General Practitioner between May 2015 and January 2017 were included. Data from 667 patients, who provided pre- and post data for pain (Numerical rating scale), function (Oswestry Disability Index), quality-of-life (EuroQol five-dimension, five-level questionnaire), anxiety (the Generalized Anxiety Disorder Screener), and depression (the Patient Health Questionnaire), were analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months. RESULTS Each group showed improved outcomes greater than the minimal clinically important difference (MCID) for each measure as defined in NICE guidelines (2016). There was a trend toward better outcomes for those with shorter pain durations. The magnitude of the differences between the groups, in most instances, was below the MCID. For example, mean improvement in function for those with baseline pain duration <3 months was 20 points and 12 points for those of pain duration ≥12 months, both above the MCID of ≥10. CONCLUSION Patients with different durations of LBP at baseline improved on the NERBPP, supporting the recent modification to NICE guidelines. However, those with shorter durations of pain may have superior outcomes in the short term, suggesting added benefit in getting patients onto the pathway in the early stages of LBP. LEVEL OF EVIDENCE 3.
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Laird RA, Keating JL, Kent P. Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain. BMC Musculoskelet Disord 2018; 19:309. [PMID: 30153815 PMCID: PMC6114878 DOI: 10.1186/s12891-018-2233-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Movement dysfunctions have been associated with persistent low back pain (LBP) but optimal treatment remains unclear. One possibility is that subgroups of persistent LBP patients have differing movement characteristics and therefore different responses to interventions. This study examined if there were patterns of flexion-related lumbo-pelvic kinematic and EMG parameters that might define subgroups of movement. METHODS This was a cross-sectional, observational study of 126 people without any history of significant LBP and 140 people with persistent LBP (n = 266). Wireless motion and surface EMG sensors collected lumbo-pelvic data on flexion parameters (range of motion (ROM) of trunk, lumbar, and pelvis), speed, sequence coordination and timing, and EMG extensor muscle activity in forward bending (flexion relaxation)), and sitting parameters (relative position, pelvic tilt range and tilt ratio). Latent class analysis was used to identify patterns in these parameters. RESULTS Four subgroups with high probabilities of membership were found (mean 94.9%, SD10.1%). Subgroup 1 (n = 133 people, 26% LBP) had the greatest range of trunk flexion, fastest movement, full flexion relaxation, and synchronous lumbar versus pelvic movement. Subgroup 2 (n = 73, 71% LBP) had the greatest lumbar ROM, less flexion relaxation, and a 0.9 s lag of pelvic movement. Subgroup 3 (n = 41, 83% LBP) had the smallest lumbar ROM, a 0.6 s delay of lumbar movement (compared to pelvic movement), and less flexion relaxation than subgroup 2. Subgroup 4 (n = 19 people, 100% LBP) had the least flexion relaxation, slowest movement, greatest delay of pelvic movement and the smallest pelvic ROM. These patterns could be described as standard (subgroup 1), lumbar dominant (subgroup 2), pelvic dominant (subgroup 3) and guarded (subgroup 4). Significant post-hoc differences were seen between subgroups for most lumbo-pelvic kinematic and EMG parameters. There was greater direction-specific pain and activity limitation scores for subgroup 4 compared to other groups, and a greater percentage of people with leg pain in subgroups 2 and 4. CONCLUSION Four subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. Such subgroups may have implications for which patients are likely to respond to movement-based interventions.
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Affiliation(s)
- Robert A. Laird
- Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria 3199 Australia
- Superspine, Forest Hills, Melbourne, Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria 3199 Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, Croft P. Low back pain: a call for action. Lancet 2018; 391:2384-2388. [PMID: 29573871 DOI: 10.1016/s0140-6736(18)30488-4] [Citation(s) in RCA: 682] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 10/25/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023]
Abstract
Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain.
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Affiliation(s)
- Rachelle Buchbinder
- Cabrini-Monash Department of Clinical Epidemiology, Cabrini Institute and Monash University, Malvern, VIC, Australia.
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Lucíola Menezes Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Anthony Woolf
- Royal Cornwall Hospital and University of Exeter Medical School, Truro, UK
| | | | - Peter Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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Stynes S, Konstantinou K, Ogollah R, Hay EM, Dunn KM. Novel approach to characterising individuals with low back-related leg pain: cluster identification with latent class analysis and 12-month follow-up. Pain 2018; 159:728-738. [PMID: 29319608 PMCID: PMC6485623 DOI: 10.1097/j.pain.0000000000001147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Traditionally, low back-related leg pain (LBLP) is diagnosed clinically as referred leg pain or sciatica (nerve root involvement). However, within the spectrum of LBLP, we hypothesised that there may be other unrecognised patient subgroups. This study aimed to identify clusters of patients with LBLP using latent class analysis and describe their clinical course. The study population was 609 LBLP primary care consulters. Variables from clinical assessment were included in the latent class analysis. Characteristics of the statistically identified clusters were compared, and their clinical course over 1 year was described. A 5 cluster solution was optimal. Cluster 1 (n = 104) had mild leg pain severity and was considered to represent a referred leg pain group with no clinical signs, suggesting nerve root involvement (sciatica). Cluster 2 (n = 122), cluster 3 (n = 188), and cluster 4 (n = 69) had mild, moderate, and severe pain and disability, respectively, and response to clinical assessment items suggested categories of mild, moderate, and severe sciatica. Cluster 5 (n = 126) had high pain and disability, longer pain duration, and more comorbidities and was difficult to map to a clinical diagnosis. Most improvement for pain and disability was seen in the first 4 months for all clusters. At 12 months, the proportion of patients reporting recovery ranged from 27% for cluster 5 to 45% for cluster 2 (mild sciatica). This is the first study that empirically shows the variability in profile and clinical course of patients with LBLP including sciatica. More homogenous groups were identified, which could be considered in future clinical and research settings.
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Affiliation(s)
- Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Reuben Ogollah
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
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Miyamoto GC, Franco KFM, van Dongen JM, Franco YRDS, de Oliveira NTB, Amaral DDV, Branco ANC, da Silva ML, van Tulder MW, Cabral CMN. Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation. Br J Sports Med 2018. [DOI: 10.1136/bjsports-2017-098825] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesTo evaluate the effectiveness and cost-utility of the addition of different doses of Pilates to an advice for non-specific chronic low back pain (NSCLBP) from a societal perspective.DesignRandomised controlled trial with economic evaluation.SettingPhysiotherapy clinic in São Paulo, Brazil.Participants296 patients with NSCLBP.InterventionsAll patients received advice and were randomly allocated to four groups (n=74 per group): booklet group (BG), Pilates once a week (Pilates group 1, PG1), Pilates twice a week (Pilates group 2, PG2) and Pilates three times a week (Pilates group 3, PG3).Main outcome measuresPrimary outcomes were pain and disability at 6-week follow-up.ResultsCompared with the BG, all Pilates groups showed significant improvements in pain (PG1, mean difference (MD)=−1.2, 95% CI −2.2 to −0.3; PG2, MD=−2.3, 95% CI −3.2 to −1.4; PG3, MD=−2.1, 95% CI −3.0 to −1.1) and disability (PG1, MD=−1.9, 95% CI −3.6 to −0.1; PG2, MD=−4.7, 95% CI −6.4 to −3.0; PG3, MD=−3.3, 95% CI −5.0 to −1.6). Among the different doses, PG2 showed significant improvements in comparison with PG1 for pain (MD=−1.1, 95% CI −2.0 to −0.1) and disability (MD=−2.8, 95% CI −4.5 to −1.1). The cost-utility analysis showed that PG3 had a 0.78 probability of being cost-effective at a willingness-to-pay of £20 000 per quality-adjusted life-year gained.ConclusionsAdding two sessions of Pilates exercises to advice provided better outcomes in pain and disability than advice alone for patients with NSCLBP; non-specific elements such as greater attention or expectation might be part of this effect. The cost-utility analysis showed that Pilates three times a week was the preferred option.Trial registration numberNCT02241538, Completed.
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Bäckryd E, Persson EB, Larsson AI, Fischer MR, Gerdle B. Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study). PLoS One 2018; 13:e0192623. [PMID: 29420607 PMCID: PMC5805304 DOI: 10.1371/journal.pone.0192623] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination. DESIGN Cross-sectional, registry-based study. SETTING AND SUBJECTS Chronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015. METHODS Data from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares-discriminant analysis. RESULTS Four subgroups were identified. Group 1 was characterized by low "psychological strain", the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high "psychological strain" and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high "social distress", the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low "social distress", and high pain intensity. CONCLUSIONS The identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived "social distress" raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth B. Persson
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Marcelo Rivano Fischer
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Azevedo DC, Ferreira PH, Santos HDO, Oliveira DR, de Souza JVL, Costa LOP. Movement System Impairment-Based Classification Treatment Versus General Exercises for Chronic Low Back Pain: Randomized Controlled Trial. Phys Ther 2018; 98:28-39. [PMID: 29077963 DOI: 10.1093/ptj/pzx094] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Treatment for chronic low back pain (LBP) includes different forms of exercises, that to date have resulted in only small to moderate treatment effects. To enhance the treatment effects, different classification systems have been developed to classify people with LBP into more homogeneous subgroups leading to specific treatments for each subgroup.
Objective
The purpose of this study was to compare the efficacy of a treatment based on the Movement System Impairment (MSI) model with a treatment consisting of symptom-guided stretching and strengthening exercises in people with chronic LBP.
Design
The study was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor.
Setting
The study setting was a university physical therapy clinic in Brazil.
Patients
A total of 148 participants with chronic LBP participated in the study.
Interventions
Participants were randomly allocated to an 8-week treatment of either treatment based on the MSI-based classification system or symptom-guided stretching and strengthening exercises.
Measurements
Measures of pain intensity, disability, and global impression of recovery were obtained by a blinded assessor at baseline and at follow-up appointments at 2, 4, and 6 months after randomization.
Results
There were no significant between-group differences for the primary outcomes of pain intensity at 2 months (mean difference = 0.05, 95% CI = –0.90 to 0.80) and disability at 2 months (mean difference = 0.00, 95% CI = –1.55 to 1.56). There also were no statistically significant differences between treatment groups for any of the secondary outcome measures.
Limitations
Participants and physical therapists were not masked.
Conclusions
People with chronic LBP had similar improvements in pain, disability, and global impression of recovery with treatment consisting of symptom-guided stretching and strengthening exercises and treatment based on the MSI model.
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Affiliation(s)
- Daniel Camara Azevedo
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil, and Physical Therapy Department-Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Daniel Ribeiro Oliveira
- Physical Therapy Department-Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte
| | | | - Leonardo Oliveira Pena Costa
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 448/475, Tatuapé, Sao Paulo, SP, Brazil
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French SD, Beliveau PJH, Bruno P, Passmore SR, Hayden JA, Srbely J, Kawchuk GN. Research priorities of the Canadian chiropractic profession: a consensus study using a modified Delphi technique. Chiropr Man Therap 2017; 25:38. [PMID: 29255593 PMCID: PMC5727882 DOI: 10.1186/s12998-017-0169-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background Research funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance. Methods We conducted a modified Delphi consensus study between August 2015 and May 2017 to determine the views of Canadian chiropractic organisations (e.g. Canadian Chiropractic Association; provincial associations) and stakeholder groups (e.g. chiropractic educational institutions; researchers). Participants completed three online Delphi survey rounds. In Round 1, participants suggested research areas within four broad research themes: 1) Basic science; 2) Clinical; 3) Health services; and 4) Population health. In Round 2, researchers created sub-themes by categorising the areas suggested in Round 1, and participants judged the importance of the research sub-themes. We defined consensus as at least 70% of participants agreeing that a research area was "essential" or "very important". In Round 3, results from Round 2 were presented to the participants to re-evaluate the importance of sub-themes. Finally, participants completed an online pairwise ranking activity to determine the rank order of the list of important research sub-themes. Results Fifty-seven participants, of 85 people invited, completed Round 1 (response rate 67%). Fifty-six participants completed Round 2, 55 completed Round 3, and 53 completed the ranking activity. After three Delphi rounds and the pairwise ranking activity was completed, the ranked list of research sub-themes considered important were: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services; 4) Effects of chiropractic care; 5) Safety/side effects of chiropractic care; 6) Chiropractic care for older adults; 7) Neurophysiological mechanisms and effects of spinal manipulative therapy; 8) General mechanisms and effects of spinal manipulative therapy. Conclusions This project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.
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Affiliation(s)
- Simon D. French
- School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George St, Kingston, ON K7L 3N6 Canada
- Department of Chiropractic, Macquarie University, Sydney, NSW Australia
| | - Peter J. H. Beliveau
- School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George St, Kingston, ON K7L 3N6 Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON Canada
| | - Paul Bruno
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK Canada
| | - Steven R. Passmore
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB Canada
| | - Jill A. Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS Canada
| | - John Srbely
- Human Health & Nutritional Sciences, University of Guelph, Guelph, ON Canada
| | - Greg N. Kawchuk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
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Janssens L, Goossens N, Wand BM, Pijnenburg M, Thys T, Brumagne S. The development of the Dutch version of the Fremantle Back Awareness Questionnaire. Musculoskelet Sci Pract 2017; 32:84-91. [PMID: 28917134 DOI: 10.1016/j.msksp.2017.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/05/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Disturbed body perception may play a role in the aetiology of chronic low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is currently the only self-report questionnaire to assess back-specific body perception in individuals with LBP. OBJECTIVES To perform a cross-cultural adaptation of the FreBAQ into Dutch. DESIGN Psychometric study. METHODS A Dutch version of the FreBAQ was generated through forward-backward translation, and was completed by 73 patients with LBP and 73 controls to assess discriminant validity. Structural validity was assessed by principal component analysis. Internal consistency was assessed by the Cronbach's alpha coefficient. Construct validity was assessed by examining the relationship with clinical measures (Numerical Rating Scale pain, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia). Test-retest reliability was assessed in a subgroup (n = 48 with LBP and 48 controls) using intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC 95%) RESULTS: The Dutch FreBAQ showed one component with eigenvalue >2. Cronbach's alpha values were respectively 0.82 and 0.73 for the LBP and control group. ICC values were respectively 0.69 and 0.70 for the LBP and control group. In the LBP group, the SEM was 3.9 and the MDC (95%) was 10.8. The LBP group (ODI 22 ± 21%) scored significantly higher on the Dutch FreBAQ than the control group (ODI 0%) (11 ± 7 vs. 3 ± 9, p < 0.001). Within the LBP group, higher Dutch FreBAQ scores correlated significantly with higher ODI scores (rho = 0.30, p = 0.010), although not with pain (rho = 0.10, p = 0.419) or kinesiophobia (r = 0.14, p = 0.226). CONCLUSIONS The Dutch version of the FreBAQ can be considered as unidimensional and showed adequate internal consistency, sufficient test-retest reliability and adequate discriminant and construct validity in individuals with and without LBP. It can improve our understanding on back-specific perception in the Dutch-speaking population with LBP.
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Affiliation(s)
- Lotte Janssens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Hasselt University, BIOMED, REVAL, Agoralaan, 3590 Diepenbeek, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nina Goossens
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat Street, Fremantle, WA 6959, Australia.
| | - Madelon Pijnenburg
- Department of Allied Health Professions, Fontys University of Applied Sciences, Ds. Th. Fliednerstraat 2, 5631 BN Eindhoven, The Netherlands.
| | - Tinne Thys
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Simon Brumagne
- KU Leuven - Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3000 Leuven, Belgium; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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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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Harrisson SA, Stynes S, Dunn KM, Foster NE, Konstantinou K. Neuropathic Pain in Low Back-Related Leg Pain Patients: What Is the Evidence of Prevalence, Characteristics, and Prognosis in Primary Care? A Systematic Review of the Literature. THE JOURNAL OF PAIN 2017; 18:1295-1312. [PMID: 28619698 DOI: 10.1016/j.jpain.2017.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/31/2017] [Accepted: 04/19/2017] [Indexed: 01/10/2023]
Abstract
This systematic review synthesizes literature describing prevalence, characteristics, and prognosis of low back-related leg pain (LBLP) patients with neuropathic pain in primary care and/or similar settings. Inclusion and exclusion criteria were developed and used by independent reviewers to screen citations for eligibility. The initial search yielded 24,948 citations; after screening 12 studies were included. Neuropathic pain was identified using case ascertainment tools (n = 5), clinical history with examination (n = 4), and using LBLP samples assumed neuropathic (n = 3). Neuropathic pain prevalence varied from 19% to 80%. There was consistent evidence for higher back-related disability (n = 3), poorer health-related quality of life (n = 2), and some evidence for more severe depression (n = 2), anxiety (n = 3), and pain intensity (n = 4) in patients with neuropathic pain. Results were less consistent when cases were identified through clinical history with examination than those identified using case ascertainment tools. Prognosis (n = 1) of LBLP patients with neuropathic pain was worse compared with those without, in all outcomes (leg pain intensity, leg and back-related disability, self-reported general health) except back pain intensity. No studies described prognostic factors. This systematic review highlights the evidence gap in neuropathic pain in LBLP in primary care, especially with respect to prognosis. PERSPECTIVE Patients with LBLP may have neuropathic pain. This systematic review emphasizes the paucity of evidence describing the characteristics and prognosis of neuropathic pain in this patient population. Future research investigating prognosis of these patients with neuropathic pain is likely to contribute to better understanding and management.
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Affiliation(s)
- Sarah A Harrisson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.
| | - Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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Bartek MA, Truitt AR, Widmer-Rodriguez S, Tuia J, Bauer ZA, Comstock BA, Edwards TC, Lawrence SO, Monsell SE, Patrick DL, Jarvik JG, Lavallee DC. The Promise and Pitfalls of Using Crowdsourcing in Research Prioritization for Back Pain: Cross-Sectional Surveys. J Med Internet Res 2017; 19:e341. [PMID: 28986339 PMCID: PMC5650676 DOI: 10.2196/jmir.8821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 11/13/2022] Open
Abstract
Background The involvement of patients in research better aligns evidence generation to the gaps that patients themselves face when making decisions about health care. However, obtaining patients’ perspectives is challenging. Amazon’s Mechanical Turk (MTurk) has gained popularity over the past decade as a crowdsourcing platform to reach large numbers of individuals to perform tasks for a small reward for the respondent, at small cost to the investigator. The appropriateness of such crowdsourcing methods in medical research has yet to be clarified. Objective The goals of this study were to (1) understand how those on MTurk who screen positive for back pain prioritize research topics compared with those who screen negative for back pain, and (2) determine the qualitative differences in open-ended comments between groups. Methods We conducted cross-sectional surveys on MTurk to assess participants’ back pain and allow them to prioritize research topics. We paid respondents US $0.10 to complete the 24-point Roland Morris Disability Questionnaire (RMDQ) to categorize participants as those “with back pain” and those “without back pain,” then offered both those with (RMDQ score ≥7) and those without back pain (RMDQ <7) an opportunity to rank their top 5 (of 18) research topics for an additional US $0.75. We compared demographic information and research priorities between the 2 groups and performed qualitative analyses on free-text commentary that participants provided. Results We conducted 2 screening waves. We first screened 2189 individuals for back pain over 33 days and invited 480 (21.93%) who screened positive to complete the prioritization, of whom 350 (72.9% of eligible) did. We later screened 664 individuals over 7 days and invited 474 (71.4%) without back pain to complete the prioritization, of whom 397 (83.7% of eligible) did. Those with back pain who prioritized were comparable with those without in terms of age, education, marital status, and employment. The group with back pain had a higher proportion of women (234, 67.2% vs 229, 57.8%, P=.02). The groups’ rank lists of research priorities were highly correlated: Spearman correlation coefficient was .88 when considering topics ranked in the top 5. The 2 groups agreed on 4 of the top 5 and 9 of the top 10 research priorities. Conclusions Crowdsourcing platforms such as MTurk support efforts to efficiently reach large groups of individuals to obtain input on research activities. In the context of back pain, a prevalent and easily understood condition, the rank list of those with back pain was highly correlated with that of those without back pain. However, subtle differences in the content and quality of free-text comments suggest supplemental efforts may be needed to augment the reach of crowdsourcing in obtaining perspectives from patients, especially from specific populations.
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Affiliation(s)
- Matthew A Bartek
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Anjali R Truitt
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Sierra Widmer-Rodriguez
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Jordan Tuia
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Zoya A Bauer
- Comparative Effectiveness, Cost and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Bryan A Comstock
- Center for Biomedical Statistics, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Todd C Edwards
- Department of Heath Services, School of Public Health, University of Washington, Seattle, WA, United States
| | - Sarah O Lawrence
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Sarah E Monsell
- Center for Biomedical Statistics, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Donald L Patrick
- Department of Heath Services, School of Public Health, University of Washington, Seattle, WA, United States
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Danielle C Lavallee
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
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Lavallee DC, Comstock B, Scott MR, Avins AL, Nerenz DR, Edwards TC, Patrick DL, Lawrence SO, Bauer Z, Truitt AR, Jarvik JG. Study of Methods for Assessing Research Topic Elicitation and pRioritization (SMARTER): Study Protocol to Compare Qualitative Research Methods and Advance Patient Engagement in Research. JMIR Res Protoc 2017; 6:e168. [PMID: 28882810 PMCID: PMC5608987 DOI: 10.2196/resprot.7565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/13/2017] [Accepted: 07/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background Involving patients as partners in research is a defining characteristic of patient-centered outcomes research (PCOR). While patients’ experiential knowledge of a health condition or treatment may yield research priorities not reflected by researchers and policy makers, the methods for identifying and effectively collaborating with patients are still evolving. Patient registries and crowdsourcing may offer ease of access and convenience to both researchers and patients. Surveys and focus groups, including online modalities, have been described for prioritizing research topics. However, little is known about how these different methods compare in producing consistent priorities and similar perceptions of engagement quality among participants. Objective The aims of this study are (1) to compare how different engagement methods used to elicit patient priorities for research perform as measured by rankings for priorities generated and participant satisfaction; and (2) to determine characteristics of individuals choosing to participate in research prioritization activities. Methods Participants in the Back pain Outcomes using Longitudinal Data (BOLD) patient registry, established to evaluate the natural history of back pain among individuals 65 years and older, and participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform, to provide input on priorities for research via a questionnaire, are invited. For BOLD participants, we subsequently randomize interested respondents to 1 of 3 interactive prioritization activities to further develop priorities: a Delphi panel, an online crowd voting activity, or an in-person facilitated prioritization activity using nominal group technique (NGT). Participants involved in each activity complete a survey to evaluate the quality of the experience and a subset of these participants discuss their experience further in an interview. Descriptive statistics are used to characterize the rankings produced by each method and compare the top 5 rated topics resulting from each prioritization activity. We use rank-ordered logistic regression models to identify associations of the ranked priority topics with baseline patient characteristics. We analyze responses to the evaluation using a mixed-methods approach wherein we tabulate responses to Likert-scale questions and use content analysis to enumerate themes emerging from interviews for the 3 activities. Results In Phase I, we invite approximately 3000 BOLD participants and 500 Amazon MTurk workers to complete a research topic prioritization survey. Based on these results, we include additional topics into a subsequent prioritization survey. In Phase II, we invite BOLD participants to join 1 of 3 activities: 90 participants for Delphi panel, 100 participants for crowd voting, and 60 participants for focus groups. Of the Phase II participants, 30 will be interviewed to evaluate the activities. Conclusions This study informs decisions about how to conduct outreach to patient registry participants for providing input on research priorities, how individuals 65 years and older wish to participate in engagement activities, and how different research prioritization methods compare in terms of rankings generated and participant satisfaction.
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Affiliation(s)
- Danielle C Lavallee
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Bryan Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Mary R Scott
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Andrew L Avins
- Kaiser Permanente Northern California, Oakland, CA, United States
| | | | - Todd C Edwards
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Sarah O Lawrence
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Zoya Bauer
- Comparative Effectiveness, Cost and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Anjali R Truitt
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, WA, United States
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Coupé VMH, van Hooff ML, de Kleuver M, Steyerberg EW, Ostelo RWJG. Decision support tools in low back pain. Best Pract Res Clin Rheumatol 2017; 30:1084-1097. [PMID: 29103551 DOI: 10.1016/j.berh.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 12/16/2022]
Abstract
Information from individual classification systems or clinical prediction rules that aim to facilitate stratified care in low back pain is important but often not comprehensive enough to be used to support clinical decision-making. The development and implementation of a clinically useful decision support tool (DST) that considering all key features is a challenging enterprise, requiring a multidisciplinary approach. Key features are inclusion of all relevant treatment options, patient characteristics, and benefits and harms and presentation as an accessible and easy to use toolkit. To be of clinical value, a DST should (1) be based on large numbers of high-quality data, allowing robust estimation of benefits and harms; (2) be presented using visually attractive and easy-to-use software; (3) be externally validated with a clinical beneficial impact established; and (4) include a procedure for regular updating and monitoring. As an illustration, we describe the development; presentation; and plans for further validation, implementation, and updating of the Nijmegen Decision Tool for Chronic Low Back Pain (NDT-CLBP).
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Affiliation(s)
- Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewout W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Raymond W J G Ostelo
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
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Measurement Properties of the Brazilian-Portuguese Version of the Lumbar Spine Instability Questionnaire. Spine (Phila Pa 1976) 2017; 42:E810-E814. [PMID: 27851665 DOI: 10.1097/brs.0000000000001977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-cultural adaptation and analysis of measurement properties. OBJECTIVE To translate and cross-culturally adapt the Lumbar Spine Instability Questionnaire (LSIQ) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with low back pain. SUMMARY OF BACKGROUND DATA The selection of subgroup of patients that respond better to specific interventions is the top research priority in the field of back pain. The LSIQ is a tool able to stratify patients with low back pain who responds better to motor control exercises. There is no Brazilian-Portuguese version of the LSIQ available. METHODS The original version of the LSIQ was translated and cross-culturally adapted. We collected data from 100 patients with low back pain. In addition to LSIQ, we also collected information about physical activity levels (measured by the International Physical Activity Questionnaire short version), disability (measured by the Roland Morris Disability Questionnaire), pain intensity (measured by the Pain numerical Rating Scale), kinesiophobia (measured by the Tampa Scale of Kinesiophobia), and depression (measured by the Beck Depression Inventory). The measurement properties tested were internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects. RESULTS The Brazilian-Portuguese version of the LSIQ showed good measurement properties with a Cronbach alpha of 0.79, an intraclass correlation coefficient of 0.75, a standard error of measurement of 1.65 points, and a minimal detectable change of 3.54 points. We did not detect ceiling and floor effects. The construct validity analysis was observed a moderate correlation between the LSIQ and Pain Numerical Rating Scale r = 0.46, Roland Morris Disability Questionnaire r = 0.66, Tampa Scale of Kinesiophobia r = 0.49, and Beck Depression Inventory r = 0.44. CONCLUSION The Brazilian-Portuguese version of LIQ has adequate measurement properties and can be used in clinical practice and research. LEVEL OF EVIDENCE NA.
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Lee H, Mansell G, McAuley JH, Kamper SJ, Hübscher M, Moseley GL, Wolfenden L, Hodder RK, Williams CM. Causal mechanisms in the clinical course and treatment of back pain. Best Pract Res Clin Rheumatol 2017; 30:1074-1083. [PMID: 29103550 DOI: 10.1016/j.berh.2017.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
Abstract
In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field.
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Affiliation(s)
- H Lee
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia.
| | - G Mansell
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - J H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S J Kamper
- Centre for Pain, Health and Lifestyle, Australia; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - M Hübscher
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - G L Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - L Wolfenden
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Hunter New England Population Health, Hunter New England Local Health District, NSW, Australia
| | - R K Hodder
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Hunter New England Population Health, Hunter New England Local Health District, NSW, Australia
| | - C M Williams
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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Prioritizing research topics: a comparison of crowdsourcing and patient registry. Qual Life Res 2017; 27:41-50. [PMID: 28382522 DOI: 10.1007/s11136-017-1566-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE A cornerstone of patient-centered outcome research is direct patient involvement throughout the research process. Identifying and prioritizing research topics is a critical but often overlooked point for involvement, as it guides what research questions are asked. We assess the feasibility of involving individuals with low back pain in identifying and prioritizing research topics using two approaches: an existing patient registry and an online crowdsourcing platform. We compare and contrast the diversity of participants recruited, their responses, and resources involved. METHODS Eligible participants completed a survey ranking their five highest priority topics from an existing list and supplying additional topics not previously identified. We analyzed their responses using descriptive statistics and content analysis. RESULTS The patient registry yielded older (mean age 72.4), mostly White (70%), and well-educated (95% high school diploma or higher) participants; crowdsourcing yielded younger (mean age 36.6 years), mostly White (82%), and well-educated (98% high school diploma or higher) participants. The two approaches resulted in similar research priorities by frequency. Both provided open-ended responses that were useful, in that they illuminate additional and nuanced research topics. Overall, both approaches suggest a preference towards topics related to diagnosis and treatment over other topics. CONCLUSION Using a patient registry and crowdsourcing are both feasible recruitment approaches for engagement. Researchers should consider their approach, community, and resources when choosing their recruitment approach, as each approach has its own strengths and weaknesses. These approaches are likely most appropriate to supplement or to complement in-person and ongoing engagement strategies.
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Andronis L, Kinghorn P, Qiao S, Whitehurst DGT, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:173-201. [PMID: 27550240 DOI: 10.1007/s40258-016-0268-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Low back pain (LBP) is a major health problem, having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear. OBJECTIVES To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP. METHODS Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), 'similar article' searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms. RESULTS Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy, (2) physical exercise therapy only, (3) information and education, and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective. CONCLUSIONS The identified evidence suggests that combined physical and psychological treatments, medical yoga, information and education programmes, spinal manipulation and acupuncture are likely to be cost-effective options for LBP.
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Affiliation(s)
- Lazaros Andronis
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Philip Kinghorn
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| | - Suyin Qiao
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Susie Durrell
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucester, UK
| | - Hugh McLeod
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
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Outcomes of Patients With Acute Low Back Pain Stratified by the STarT Back Screening Tool: Secondary Analysis of a Randomized Trial. Phys Ther 2017; 97:330-337. [PMID: 28204740 PMCID: PMC5804017 DOI: 10.2522/ptj.20160298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/11/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The impact of physical therapy on the outcomes of patients with acute low back pain (LBP) stratified by the STart Back Screening Tool (SBST) is unclear. OBJECTIVE The purpose of this study was to compare the outcomes of patients with acute LBP who were stratified as medium or high risk. DESIGN This was a secondary analysis of a randomized trial. SETTING Patients were recruited between March 2011 and November 2013 from primary care clinics in Salt Lake City, Utah. PARTICIPANTS One hundred eighty-one participants with acute LBP who were stratified as medium risk (n = 120) or high risk (n = 61) by the SBST were included. They were aged 18 through 60 years, with duration of symptoms less than 16 days, no symptoms below the knee, no treatment for LBP in the past 6 months, and an Oswestry Disability Index (ODI) score of 20% or greater. INTERVENTION After participants received education on how to manage their LBP, they were randomized to receive usual care (n = 97) by their primary care provider or early intervention (n = 84) by a physical therapist. MEASUREMENTS The primary (3-month ODI score) outcome measure was obtained at baseline and at 4 weeks, 3 months, and 1 year. RESULTS No differences were detected in the effect of intervention between participants stratified as medium or high risk. For the high-risk subgroup, there was a significant difference between the early intervention and usual care groups for the 3-month ODI (mean difference = -5.87 [95% CI = -11.24, -0.50]) favoring early intervention. LIMITATIONS The primary study was not designed to examine the SBST. CONCLUSIONS Patients with acute LBP stratified as high risk seem likely to respond well to one session of education. They may experience additional benefit by 3 months from evidence-based physical therapy treatments. These effects disappear at 1 year.
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