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Reneman MF, Coenen P, Kuijer PPFM, van Dieën JH, Holtermann A, Igwesi-Chidobe CN, Parker R, Reezigt R, Stochkendahl MJ, Hoegh M. Tensions of Low-Back Pain and Lifting; Bridging Clinical Low-Back Pain and Occupational Lifting Guidelines. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:473-480. [PMID: 38842652 DOI: 10.1007/s10926-024-10210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Michiel F Reneman
- Department of Rehabilitation / Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Musculoskeletal Health, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, People and Work Outpatient Clinic, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Romy Parker
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Roland Reezigt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physiotherapy, Academy of Health, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Mette J Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Morten Hoegh
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Thompson HM, Govindarajulu U, Doucette J, Nabeel I. Short-acting opioid prescriptions and Workers' Compensation using the National Ambulatory Medical Care Survey. Am J Ind Med 2024; 67:474-482. [PMID: 38491940 DOI: 10.1002/ajim.23581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Short-acting opioids have been utilized for pain management with little known about their use in patients on Workers' Compensation (WC) insurance. Our goal was to investigate this association in the ambulatory care setting. METHODS Using the National Ambulatory Medical Care Survey, visits from patients aged 18-64 during the years 2010 until 2018 were evaluated (excluding 2017 due to data availability). Demographic and co-morbidity data from each visit was obtained along with the visit year. The first short-acting opioid medication prescribed in the database was considered. Survey-weighted frequencies were evaluated. Logistic regression estimated the crude and adjusted odds ratios (OR) with 95% confidence intervals for the use of short-acting opioid prescription. RESULTS There were 155,947 included visits with 62.5% for female patients. Most patients were White with 11.7% identifying as Black, and 6% identifying as another race. Over 13% of the sample was of Hispanic descent. WC was the identified insurance type in 1.6% of the sample population. Of these patients, 25.6% were prescribed a short-acting opioid, compared with 10.1% of those with another identified insurance. On multivariable regression, Black patients had increased odds of being prescribed a short-acting opioid compared to white patients (OR: 1.22, 95% CI: 1.11-1.34). Those on WC had 1.7-fold higher odds of being prescribed short-acting opioids (95% CI: 1.46-2.06). CONCLUSION Certain patient characteristics, including having WC insurance, increased the odds of a short-acting opioid prescription. Further work is needed to identify prescribing patterns in specific high-risk occupational groups, as well as to elicit potential associated health outcomes.
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Affiliation(s)
- Hannah M Thompson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usha Govindarajulu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Biostatistics, New York, New York, USA
| | - John Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ismail Nabeel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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3
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Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskelet Disord 2024; 25:344. [PMID: 38693474 PMCID: PMC11061926 DOI: 10.1186/s12891-024-07468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world. METHODS MEDLINE, EMBASE, CINAHL, PEDro, and major guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS Our analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture. CONCLUSIONS Current CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the guidelines.
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Affiliation(s)
- Tianyu Zhou
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK.
| | - David Salman
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Alison H McGregor
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK
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4
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Silişteanu SC, Antonescu E, Duică L, Totan M, Cucu AI, Costea AI. Lumbar Paravertebral Muscle Pain Management Using Kinesitherapy and Electrotherapeutic Modalities. Healthcare (Basel) 2024; 12:853. [PMID: 38667615 PMCID: PMC11050304 DOI: 10.3390/healthcare12080853] [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: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Low back pain is considered a public health problem internationally. Low back pain is a cause of disability that occurs in adolescents and causes negative effects in adults as well. The work environment and physical and psychosocial factors can influence the occurrence and evolution of low back pain. METHODS The purpose of this paper is to highlight the physiological and functional changes in young adults with painful conditions of the lumbar spine, after using exercise therapy. The study was of the longitudinal type and was carried out over a period 6 months in an outpatient setting. The rehabilitation treatment included electrotherapeutic modalities and kinesitherapy. RESULTS The results obtained when evaluating each parameter, for all moments, show statistically significant values in both groups. The results obtained regarding the relationship between the therapeutic modalities specific to rehabilitation medicine and low back pain are consistent with those reported in studies. CONCLUSIONS Depending on the clinical-functional status of each patient, kinesitherapy can accelerate the heart rate and increase the blood pressure and oxygen saturation of the arterial blood, values that can later return to their initial levels, especially through training.
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Affiliation(s)
- Sînziana Călina Silişteanu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
| | - Elisabeta Antonescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Lavinia Duică
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Maria Totan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania;
| | - Andrei Ionuţ Cucu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
| | - Andrei Ioan Costea
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; (S.C.S.); (A.I.C.); (A.I.C.)
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5
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Daniels CJ, Cupler ZA, Napuli JG, Walsh RW, Ziegler AML, Meyer KW, Knieper MJ, Walters SA, Salsbury SA, Trager RJ, Gliedt JA, Young MD, Anderson KR, Kirk EJ, Mooring SA, Battaglia PJ, Paris DJ, Brown AG, Goehl JM, Hawk C. Development of Preliminary Integrated Health Care Clinical Competencies for United States Doctor of Chiropractic Programs: A Modified Delphi Consensus Process. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241275944. [PMID: 39157778 PMCID: PMC11329915 DOI: 10.1177/27536130241275944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
Background There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. Objective The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. Methods A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Results Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. Conclusion We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment.
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Affiliation(s)
- Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA, USA
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Zachary A Cupler
- Physical Medicine and Rehabilitation Services, Butler VA Health Care, Butler PA, USA
- Institute of Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason G Napuli
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | - Robert W Walsh
- Integrated Primary Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Palmer College of Chiropractic, Palmer West College of Chiropractic, San Jose, CA, USA
| | - Anna-Marie L Ziegler
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | - Kevin W Meyer
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA, USA
| | - Matthew J Knieper
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | | | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Robert J Trager
- Connor Whole Health, University Hospitals, Cleveland, OH, USA
- Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan D Young
- Washington State Department of Labor and Industries, Olympia, WA, USA
| | | | - Eric J Kirk
- Aurora Health Care, Milwaukee, WI, USA
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Scott A Mooring
- Northwestern University Health Sciences, Bloomington, MN, USA
- Athletic Medicine Department, University of Minnesota, Minneapolis, MN, USA
| | - Patrick J Battaglia
- Community-Based Clinical Education, University of Western States, Portland, OR, USA
| | - David J Paris
- Physical Medicine and Rehabilitation, VA Northern California Health Care, Redding, CA, USA
- Mercy Medical Center Mt. Shasta, Mount Shasta, CA, USA
| | - Amanda G Brown
- Center for Integrative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Justin M Goehl
- Family Medicine, Dartmouth Health, Dartmouth, Lebanon, NH, USA
- Community and Family Medicine, Geisel School of Medicine, Dartmouth, Lebanon, NH, USA
| | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
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Canós-Verdecho Á, Robledo R, Izquierdo RM, Bermejo A, Gallach E, Abejón D, Argente-Navarro MP, Peraita-Costa I, Morales-Suárez-Varela M. Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy. J Clin Med 2023; 13:234. [PMID: 38202241 PMCID: PMC10779544 DOI: 10.3390/jcm13010234] [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: 11/15/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.
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Affiliation(s)
- Ángeles Canós-Verdecho
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Ruth Robledo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Rosa M. Izquierdo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Ara Bermejo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
| | - Elisa Gallach
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Psychiatry Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - David Abejón
- Multidisciplinary Pain Management Unit, Hospital Universitario Quirónsalud, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Spain
| | - María Pilar Argente-Navarro
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
- Surgical Specialties Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
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Davidovic K, Cotofana S, Heisinger S, Savic S, Alfertshofer M, Antonić T, Jovanović S, Ercegovac M, Muto M, Jeremić D, Janićijević A, Rasulić L, Janošević V, Šarić L, Chua D, Masulovic D, Maksimović R. Percutaneous Computed Tomography-Guided Oxygen-Ozone (O 2O 3) Injection Therapy in Patients with Lower Back Pain-An Interventional Two-Year Follow-Up Study of 321 Patients. Diagnostics (Basel) 2023; 13:3370. [PMID: 37958266 PMCID: PMC10650810 DOI: 10.3390/diagnostics13213370] [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: 10/06/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVES To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. METHODS A total of 321 patients (192 males and 129 females, mean age: 51.5 ± 15.1 years) with LBP were assigned to three treatment groups: group A) oxygen-ozone only, group B) corticosteroids only, group C) oxygen-ozone and corticosteroids. Treatment was administered via CT-guided injections to the intervertebral disc (i.e., intradiscal location). Clinical improvement of pain and functionality was assessed via self-reported pain scales and magnetic resonance (MR) and CT imaging. RESULTS At all follow-up times, the mean score of the numeric rating scale and the total global pain scale (GPS) of study groups receiving oxygen-ozone (groups A and C) were statistically significantly lower than the study group receiving corticosteroids only (group B), with p < 0.001. There was a statistically significant difference between groups A and C at 30 days for the numeric rating scale. CONCLUSIONS The percutaneous application of oxygen-ozone in patients with LBP due to degeneration of the lumbosacral spine showed long-lasting significant pain reduction of up to two years post-treatment when compared to corticosteroids alone. Combination therapy of oxygen-ozone and corticosteroids can be useful as corticosteroids showed statistically significant improvement in LBP earlier than the oxygen-ozone-only treatment.
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Affiliation(s)
- Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.D.)
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London E1 4NS, UK
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Stephan Heisinger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Slavica Savic
- Medical Faculty, University of Belgrade, 11120 Belgrade, Serbia
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, 80336 Munich, Germany
| | - Tatjana Antonić
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.D.)
| | | | - Marko Ercegovac
- Clinic of Neurology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Mario Muto
- Neuroradiology Department, Ospedale Cardarelli Napoli, 80131 Napoli, Italy
| | - Danilo Jeremić
- Institute for Orthopedic Surgery “Banjica”, 11000 Belgrade, Serbia
| | | | - Lukas Rasulić
- Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Vesna Janošević
- Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Lidija Šarić
- Clinic of Neurosurgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | | | - Dragan Masulovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.D.)
| | - Ružica Maksimović
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (K.D.)
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8
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Gilliam JR, George SZ, Norman KS, Hendren S, Sahu PK, Silfies SP. Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis. Arch Phys Med Rehabil 2023; 104:776-789. [PMID: 36535419 PMCID: PMC10546903 DOI: 10.1016/j.apmr.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP). DATA SOURCES MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020. STUDY SELECTION Randomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included. DATA EXTRACTION Data were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively. DATA SYNTHESIS 21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low. CONCLUSIONS Physical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.
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Affiliation(s)
- John R Gilliam
- Department of Exercise Science, University of South Carolina, Columbia, SC.
| | - Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Katherine S Norman
- Departments of Orthopaedic Surgery and Population Health Sciences, Duke University, Durham, NC
| | | | - Pradeep K Sahu
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Sheri P Silfies
- Department of Exercise Science, University of South Carolina, Columbia, SC
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9
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Chronic Low Back Pain: A Narrative Review of Recent International Guidelines for Diagnosis and Conservative Treatment. J Clin Med 2023; 12:jcm12041685. [PMID: 36836220 PMCID: PMC9964474 DOI: 10.3390/jcm12041685] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/15/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization.
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Whalen WM, Hawk C, Farabaugh RJ, Daniels CJ, Taylor DN, Anderson KR, Crivelli LS, Anderson DR, Thomson LM, Sarnat RL. Best Practices for Chiropractic Management of Adult Patients With Mechanical Low Back Pain: A Clinical Practice Guideline for Chiropractors in the United States. J Manipulative Physiol Ther 2022; 45:551-565. [PMID: 37341675 DOI: 10.1016/j.jmpt.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States. METHODS Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations. RESULTS The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP. CONCLUSION This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.
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Affiliation(s)
| | - Cheryl Hawk
- Clinical Sciences, Texas Chiropractic College, Pasadena, Texas
| | | | - Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, Washington
| | - David N Taylor
- Clinical Sciences, Texas Chiropractic College, Pasadena, Texas
| | | | | | - Derek R Anderson
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, Washington
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Vance CGT, Dailey DL, Chimenti RL, Van Gorp BJ, Crofford LJ, Sluka KA. Using TENS for Pain Control: Update on the State of the Evidence. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1332. [PMID: 36295493 PMCID: PMC9611192 DOI: 10.3390/medicina58101332] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention used in the treatment of acute and chronic pain conditions. The first clinical studies on TENS were published over 50 years ago, when effective parameters of stimulation were unclear and clinical trial design was in its infancy. Over the last two decades, a better understanding of the mechanisms underlying TENS efficacy has led to the development of an adequate dose and has improved outcome measure utilization. The continued uncertainty about the clinical efficacy of TENS to alleviate pain, despite years of research, is related to the quality of the clinical trials included in systematic reviews. This summary of the evidence includes only trials with pain as the primary outcome. The outcomes will be rated as positive (+), negative (-), undecided (U), or equivalent to other effective interventions (=). In comparison with our 2014 review, there appears to be improvement in adverse events and parameter reporting. Importantly, stimulation intensity has been documented as critical to therapeutic success. Examinations of the outcomes beyond resting pain, analgesic tolerance, and identification of TENS responders remain less studied areas of research. This literature review supports the conclusion that TENS may have efficacy for a variety of acute and chronic pain conditions, although the magnitude of the effect remains uncertain due to the low quality of existing literature. In order to provide information to individuals with pain and to clinicians treating those with pain, we suggest that resources for research should target larger, high-quality clinical trials including an adequate TENS dose and adequate timing of the outcome and should monitor risks of bias. Systematic reviews and meta-analyses should focus only on areas with sufficiently strong clinical trials that will result in adequate sample size.
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Affiliation(s)
- Carol G. T. Vance
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Dana L. Dailey
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Barbara J. Van Gorp
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Leslie J. Crofford
- Division of Rheumatology & Immunology, Medical Center, Vanderbilt University, Nashville, TN 37232, USA
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
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12
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Luites JWH, Kuijer PPFM, Hulshof CTJ, Kok R, Langendam MW, Oosterhuis T, Anema JR, Lapré-Utama VP, Everaert CPJ, Wind H, Smeets RJEM, van Zaanen Y, Hoebink EA, Voogt L, de Hoop W, Boerman DH, Hoving JL. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:337-352. [PMID: 34313903 PMCID: PMC9576671 DOI: 10.1007/s10926-021-09993-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 05/06/2023]
Abstract
Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.
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Affiliation(s)
- J W H Luites
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands.
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - C T J Hulshof
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - R Kok
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - M W Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Institute of Public Health, Amsterdam, The Netherlands
| | - T Oosterhuis
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - V P Lapré-Utama
- Dutch Association of Medical Officers in Private Insurances (GAV), Utrecht, The Netherlands
| | - C P J Everaert
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
- Arbo Unie, Arnhem, The Netherlands
| | - H Wind
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
- Netherlands Society of Physical and Rehabilitation Medicine (VRA), Utrecht, The Netherlands
| | - Y van Zaanen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Association of Physiotherapists Working in Occupational Health and Ergonomics (NVBF-KNGF), Amersfoort, The Netherlands
| | - E A Hoebink
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education (FORCE), Amphia Hospital, Breda, The Netherlands
| | - L Voogt
- Dutch Association for Patients With Back Problems (NVvR), Rotterdam, The Netherlands
| | - W de Hoop
- Dutch Association for Labour Experts (NVvA), Nijkerk, The Netherlands
| | - D H Boerman
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Netherlands Society for Neurology (NVN), Utrecht, The Netherlands
| | - J L Hoving
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
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13
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Salik E, Ozden AV, Alptekin HK. Chiropractic Care and Quality of Life Among Office Workers With Nonspecific Pain: A Cross-Sectional Study. J Chiropr Med 2022; 21:157-167. [PMID: 36118107 PMCID: PMC9479198 DOI: 10.1016/j.jcm.2022.03.006] [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: 12/23/2020] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study was to evaluate the quality of life by a self-administered World Health Organization Quality of Life short version survey (WHOQoL-BREF) among office workers with nonspecific pain receiving chiropractic care in Istanbul, Turkey. Methods This cross-sectional study included 77 office workers (age interval, 18-65) with nonspecific neck, thoracic, back and/or extremity pain who underwent chiropractic care. Two weeks later, the quality of life was evaluated by a self-administered WHOQoL-BREF. The Numeric Pain Scale to evaluate the perceived pain was administered to all of the participants in the beginning and at the end of the study. Group-level changes on WHOQoL-BREF total score and subdimensions were compared according to descriptive data of office workers. The significance level was set at P ≤ .05. Results WHOQoL-BREF scale scores after chiropractic care (mean ± standard deviation) were 71.21% ± 7.91% (total score), 81.49% ± 14.43% (general health), 80.38% ± 10.49% (physical health), 73.16% ± 11.68% (psychological), 70.41% ± 12.43% (social), and 65.58% ± 10.91% (environment). Numeric Pain Scale scores decreased in a statistically significant way when compared with baseline (P ≤ .05). The descriptive statistical analysis of WHOQoL-BREF dimensions revealed that women had significantly higher scores than men, the 18-to-35 age group had higher scores compared with the 50-to-65 age group, and those married had significantly higher scores than those who were not married (P ≤ .05). Conclusion The findings of our study suggest that chiropractic care had positive effects on the quality of life of office workers.
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Affiliation(s)
- Emsal Salik
- Corresponding author: Emsal Salik, MD, PhD, DC, Faculty of Health Sciences, Bahcesehir University, Abbasaga, Ihlamur Yildiz Cd. No:8, 34353 Besiktas, Istanbul, Turkey
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14
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Impacts of a Re-designed Care Path for Back Pain Directing Patients to Physiotherapists: A Pre-Post Intervention Study. J Occup Environ Med 2021; 63:e276-e282. [PMID: 33605653 DOI: 10.1097/jom.0000000000002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of directing patients with back pain for first visit to a physiotherapist on sick leaves, healthcare utilization, and patient satisfaction. METHODS Pre-post intervention study of 70,138 patients treated in Poland for back pain: 27,034 before the care pathway redesign and 43,104 after. RESULTS After the redesign, all per-patient measures (mean ± SD) significantly decreased over the 12-month follow-up: sick leaves number from 0.32 ± 0.87 to 0.29 ± 0.86, sick leaves days from 2.78 ± 11.56 to 2.56 ± 11.25, doctors' visits from 2.02 ± 1.70 to 1.51 ± 1.63, diagnostic imaging services from 0.63 ± 0.79 to 0.43 ± 0.71 and rehabilitation services from 7.55 ± 14.90 to 4.70 ± 12.61.The Net Promoter Score was higher for physiotherapist (83), than for orthopedists (59), primary care (74), or neurologists (67). CONCLUSIONS Involving physiotherapists early in the back pain care may result in benefits for patients and healthcare organizations.
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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