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Svensson NH, Thorlund JB, Olsen PØ, Søndergaard J, Wehberg S, Andersen HS, Caserotti P, Thilsing T. The effect of exercise referral schemes and self-management strategies on use of prescription analgesics among community-dwelling older adults: registry linkage with randomised controlled trials. BMC Geriatr 2024; 24:641. [PMID: 39085817 PMCID: PMC11293001 DOI: 10.1186/s12877-024-05235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Exercise referral schemes and self-management strategies have shown positive effects on patient-reported and objectively measured outcomes, such as increased functional capacity and physical activity level. However, the impact of these interventions on analgesic use remains uncertain. We hypothesised that exercise referral schemes, either utilised alone or in combination with self-management strategies, is more effective in reducing use of prescription analgesics compared with a self-management strategy only. SUBJECTS AND METHODS We utilised data from two completed randomised controlled trials, namely The Welfare Innovation in Primary Prevention (n = 121) and The SITLESS project (n = 338), and information from the national Danish health registries, including the National Prescription Registry. The two trials have investigated the effectiveness of interventions, which include exercise referral schemes and self-management strategies, on various aspects such as physical function and levels of physical activity among community-dwelling older adults. The studies were conducted in the period 2015-2020 and comprised older adults aged 65+ years, living in three different Danish municipalities. Participants were recruited through nationally regulated preventive home-visits. To estimate changes in use of prescription analgesics over time, a linear fixed effects regression model was applied. The outcome measure was the mean total yearly defined daily dose of analgesics. RESULTS All intervention groups showed a within-group increase in overall analgesic use, though not statistically significantly different from zero. There were no differences in estimated changes in mean total yearly defined daily dose when comparing the intervention groups to the group receiving the least extensive intervention (self-management strategies/control). The findings indicated that exercise referral schemes and self-management strategies, whether administrated individually or in combination, did not result in a reduction in analgesic use over time.
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Affiliation(s)
- Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
| | - Jonas Bloch Thorlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Pia Øllgaard Olsen
- Department of Health, Culture and Development, Municipality of Tønder, Wegners plads 2, Tønder, 6270, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Helene Støttrup Andersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Paolo Caserotti
- Centre for Active and Healthy Aging, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
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Browne A, Cahalan R, O’ Sullivan K. How is cognitive behavioural therapy for insomnia delivered to adults with comorbid persistent musculoskeletal pain and disordered sleep? A scoping review. PLoS One 2024; 19:e0305931. [PMID: 39024361 PMCID: PMC11257322 DOI: 10.1371/journal.pone.0305931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Disordered sleep and persistent musculoskeletal pain are highly comorbid. Behavioural interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) have shown promise in the management of both disordered sleep and persistent musculoskeletal pain. The aim of this review was to examine how CBT-I is delivered in randomised controlled trials involving people with comorbid disordered sleep and persistent musculoskeletal pain. METHODS The protocol for this scoping review was registered with the Open Science Framework. Electronic searches of ten database and three clinical trials registries were performed up to 25 October 2023. The methodological quality of each study was evaluated by two independent reviewers using the PEDro tool. The reporting of CBT-I interventions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Twelve studies met the eligibility criteria. TIDieR scores ranged from 7-11/12, with a mean score of 8.8/12. CBT-I always involved two core components-sleep restriction and stimulus control. Furthermore, an additional five components were usually involved-a cognitive component, sleep hygiene, sleep education, relaxation/deactivation procedures and relapse planning. There was also considerable consistency in the frequency (weekly) and duration (5-9 weeks) of CBT-I programmes. Aspects inconsistently reported included who delivered the intervention; what modifications were made, if any; and the session content and duration. PEDro scores ranged from 5-8/10, with a mean score of 6.7/10. CONCLUSIONS These findings demonstrate considerable consistency in the components of CBT-I delivered in clinical trials along with the number of sessions. The frequency of sessions was also consistent where almost all studies held weekly session. However, some aspects were either not reported (e.g., precise content of components) or inconsistent (e.g., use of terminology). CBT-I was delivered both individually and in groups. Greater consistency, and more detailed reporting regarding who delivered the intervention, the training provided, and the specific content of CBT-I components would add clarity, and may enhance CBT-I efficacy and allow better replication.
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Affiliation(s)
- Abigail Browne
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Kieran O’ Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Sports and Human Performance Centre, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
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Mingels S, Granitzer M, Luedtke K, Dankaerts W. Therapeutic Patient Education as Part of the Physiotherapy Management of Adults with Headache: A Scoping Review. Curr Pain Headache Rep 2024; 28:547-564. [PMID: 38613735 DOI: 10.1007/s11916-024-01253-3] [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] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE OF REVIEW Physiotherapy interventions for headache mostly include exercise and manual therapy. Yet, the complex nature of headache, sometimes characterized by symptoms of facilitated central pain mechanisms, demands an individualized approach in which therapeutic patient education could be supportive. This scoping review aimed to summarize the position of therapeutic patient education within the physiotherapy management of adults with headache. PubMed, EMBASE, Web of Science, and Scopus were searched. The search-query comprised terminology relating to "headache", "education", and "physiotherapy". Eligibility criteria were: adults with headache, interventions including education within the domain of physiotherapy, reviews, clinical trials, cohort, case report, case-control studies. RECENT FINDINGS Eleven publications were included from the 281 retrieved publications. These publications were clinical trials (n = 4), reviews (n = 4), case-reports (n = 2), and a guideline (n = 1). Type of headaches studied were migraine (n = 3), post-traumatic headache (n = 2), tension-type headache (n = 2), cervicogenic headache (n = 1), primary headaches (n = 1), chronic daily headache (n = 1), and mixed migraine-cervicogenic headache (n = 1). Education seems an umbrella-term for postural education, lifestyle advice, and pain education. Three themes emerged across the publications: handling headache triggers (migraine, post-traumatic headache), promoting active lifestyle (post-traumatic headache, chronic daily headache, migraine), evaluating posture (post-traumatic headache, chronic daily headache, tension-type headache, cervicogenic headache). All publications recommended education in the management of headache. Only one (of the 11 included) publication described the educational program and determined its efficacy. Based on this scoping review, therapeutic patient education seems supported within physiotherapy management of headache. However, it is unclear how such education is tailored to the specific needs of the individual, the headache subtype, or when it should be added to physiotherapy management of headache.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Universität Zu Lübeck, Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium
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Veillon J, Preuilh A, Wormser J. Cognitive behavioural interventions led by a physiotherapist in chronic non-specific low back pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2024; 39:635-644. [PMID: 38876697 DOI: 10.1016/j.jbmt.2024.03.057] [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: 06/06/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The effectiveness of physiotherapist-led Cognitive Behavioural Interventions (CBI) with or without physiotherapy is still unclear. OBJECTIVE This systematic review (PROSPERO registration number CRD42022321073) aims to determine the effectiveness of physiotherapist-led CBI with or without physiotherapy in comparison to physiotherapy alone on quality of life, disabilities and catastrophization. METHODS MEDLINE, Web of Science, Science Direct, and PEDro were searched for randomized controlled trials that investigate the use of CBI versus conventional physiotherapy in chronic NSLBP. To be included CBI had to be performed by a physiotherapist. The primary and secondary outcomes were respectively quality of life and disability. RESULTS Fourteen studies were included in qualitative analysis, in which 4 did not meet the PEDro score of 6 or higher. Pooled standardized mean differences from 3 studies showed no difference in quality of life between groups for mental and physical sub-scores at 3 months (SMD 0.02, 95% CI -0.17 to 0.21 and SMD 0.07, 95% CI -0.12 to 0.26 respectively). Pooled standardized mean differences from 9 studies showed no difference in disability between groups at 3, 6 and 12 months (SMD = - 0.40, CI 95% -0.80 to 0.01; SMD -0.18, CI 95% = -0.41 to 0.05; and SMD -0.24, CI 95% = -0.48 to 0.00 respectively). CONCLUSION Results of CBI, especially cognitive functional therapy, seem promising in disability management despite a substantial heterogeneity. Furthermore, we found no difference in quality of life.
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Affiliation(s)
- Juliane Veillon
- School of Physiotherapy and Rehabilitation, IFMK CEERRF, France.
| | - Arnaud Preuilh
- Sorbonne University, INSERM, U 1146, CNRS UMR 7371, Laboratoire d'imagerie biomédicale, France.
| | - Johan Wormser
- Department of Rehabilitation and Department of Intensive Care, Paris Saint Joseph Hospital Group, France.
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Ploutarchou G, Korakakis V, Lazoura E, Savva C, Pavlou K, Christofi I, Sotiriou K, Savvidou C, Panteli A, Karagiannis C, Mamais I. Individualized Cognitive Functional Therapy Compared with Conservative Treatment for Patients with Chronic Neck Pain-Study Protocol for a Single Blind Pragmatic Randomized Controlled Trial. Clin Pract 2024; 14:1225-1233. [PMID: 39051292 PMCID: PMC11270437 DOI: 10.3390/clinpract14040098] [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: 03/26/2024] [Revised: 04/26/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Chronic neck pain (CNP) is one of the most common musculoskeletal conditions, is considered the second leading cause of pain, and is among the leading causes of disability. Cognitive Functional Therapy (CFT) is a novel behavioral therapy for individualizing the management of spinal pain targeting the multidimensional aspect of musculoskeletal pain. This study outlines the protocol for an assessor-blind randomized controlled trial (RCT) designed to compare an individualized Cognitive Functional Therapy (CFT) intervention with usual care in terms of pain and disability. Aiming for a pragmatic intervention, the CFT group will receive 16 sessions based on patient's condition characteristics, and clinical presentation and progression. The control group will receive 16 sessions of standardized usual care (electrotherapy, massage, posture exercise, and educations). Both groups will have the same intervention duration. Patients will be randomly allocated into groups and will be assessed at baseline, at the 8th session, at the 16th session, and 3 months after randomization. Primary outcomes will be pain, disability, cervical range of motion, and neck muscle isometric strength. To our knowledge, this study will be the first RCT to compare the clinical effectiveness of CFT compared to UC for adults with CNP. The study results will provide information about the use of CFT in clinical practice.
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Affiliation(s)
- George Ploutarchou
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | | | - Evi Lazoura
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Christos Savva
- Department of Life and Health Science, Federick University, Limassol 3080, Cyprus;
| | - Kyriakos Pavlou
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Iacovos Christofi
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Katerina Sotiriou
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Chara Savvidou
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Andreas Panteli
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Christos Karagiannis
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
| | - Ioannis Mamais
- Department of Health Science, European University of Cyprus, Nicosia 2404, Cyprus; (E.L.); (K.P.); (I.C.); (K.S.); (C.S.); (A.P.); (C.K.); (I.M.)
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Newton C, Singh G, Nolan D, Booth V, Diver C, O'Neill S, Purtill H, Logan P, O'Sullivan K, O'Sullivan P. Cognitive Functional Therapy compared with usual physiotherapy care in people with persistent low back pain: a mixed methods feasibility randomised controlled trial in the United Kingdom National Health Service. Physiotherapy 2024; 123:118-132. [PMID: 38479068 DOI: 10.1016/j.physio.2024.02.003] [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: 12/15/2022] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To determine the feasibility of completing a definitive randomised controlled trial (RCT), evaluating the clinical and cost-effectiveness of Cognitive Functional Therapy (CFT) in comparison to usual physiotherapy care (UPC), for people with persistent low back pain (LBP). DESIGN AND SETTING A two-arm parallel feasibility RCT completed in a United Kingdom (UK) Secondary Care National Health Service (NHS) physiotherapy service. PARTICIPANTS Sixty adult participants who reported LBP lasting for more than three months, that was not attributable to a serious (e.g. cancer) or specific (e.g. radiculopathy) underlying cause, were invited to participate. Participants were allocated at random to receive CFT or UPC. INTERVENTIONS Cognitive Functional Therapy and Usual Physiotherapy Care for persistent LBP. MAIN OUTCOME MEASURES The primary outcome was the feasibility of completing a definitive RCT, defined by recruitment of at least 5 participants per month, delivery of CFT per protocol and securing relevant and acceptable outcome measures. Data concerning study processes, resources, management and participant reported outcome measures were collected at baseline, 3, 6 and 12-month follow-up. RESULTS Sixty participants (n = 30 CFT and n = 30 UPC) were recruited with 80% (n = 48), 72% (n = 43) and 53% (n = 32) retained at 3, 6 and 12-month follow-up respectively. NHS physiotherapists were trained to competence and delivered CFT with fidelity. CFT was tolerated by participants with no adverse events. Relevant and clinically important outcome data were collected at all time points (0.4%, 3%, 1% and 0.8% of data was missing from the returned outcome measure booklets at baseline and 3, 6 and 12-month follow-up respectively). The Roland-Morris disability questionnaire was considered the most suitable primary outcome measure with a proposed sample size of 540 participants for a definitive cluster RCT. CONCLUSION It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future study should incorporate an internal pilot to address aspects of feasibility further, including participant retention strategies. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN12965286 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Christopher Newton
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK; Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Nolan
- Physiotherapy Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Vicky Booth
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Claire Diver
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Seth O'Neill
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | - Helen Purtill
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Pip Logan
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland; Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Caneiro JP, O'Sullivan P, Tan JS, Klem NR, de Oliveira BIR, Choong PF, Dowsey M, Bunzli S, Smith A. Process of change for people with knee osteoarthritis undergoing cognitive functional therapy: a replicated single-case experimental design study. Disabil Rehabil 2024; 46:2348-2364. [PMID: 37317550 DOI: 10.1080/09638288.2023.2221459] [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: 02/07/2023] [Revised: 05/21/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To examine the applicability and process of change of Cognitive Functional Therapy (CFT) in the management of pain and disability in people with knee osteoarthritis who were offered knee replacement surgery and had risk factors for poor response to surgery. METHODS Single-case experimental design with a mixed-methods, repeated measures approach was used to investigate the process of change through CFT in four participants. Qualitative interviews investigated beliefs, behaviours and coping responses, and self-reported measures assessed pain, disability, psychological factors, and function at 25 timepoints. Study registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619001491156). RESULTS Qualitative data indicate that CFT promoted helpful changes in all participants, with two responses observed. One reflected a clear shift to a biopsychosocial conceptualisation of osteoarthritis, behavioural re-engagement and the view that a knee replacement was no longer necessary. The other response reflected a mixed conceptualisation with dissonant beliefs about osteoarthritis and its management. Psychological and social factors were identified as potential treatment barriers. Overall, quantitative measures supported the qualitative findings. CONCLUSION The process of change varies between and within individuals over time. Psychological and social barriers to treatment have implications for future intervention studies for the management of knee osteoarthritis.IMPLICATIONS FOR REHABILITATIONCognitive Functional Therapy is applicable in the management of knee osteoarthritis.Reconceptualisation of osteoarthritis reflected a helpful change.Psychological and social factors emerged as barriers to recovery.
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Affiliation(s)
- J P Caneiro
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
| | - Jay-Shian Tan
- School of Allied Health, Curtin University, Perth, Australia
| | - Nardia-Rose Klem
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
| | | | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Anne Smith
- School of Allied Health, Curtin University, Perth, Australia
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Dupuis F, Perreault K, Hébert LJ, Perron M, Fredette A, Desmeules F, Roy JS. Group Physical Therapy Programs for Military Members With Musculoskeletal Disorders: A Pragmatic Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:417-426. [PMID: 38530230 DOI: 10.2519/jospt.2024.12342] [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] [Indexed: 03/27/2024]
Abstract
OBJECTIVE: To compare the effects of personalized, supervised group-based programs (ie, group physical therapy programs) and usual one-on-one physical therapy care (ie, usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome, or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life, and patients' satisfaction with their condition and care. DESIGN: Non-inferiority pragmatic randomized clinical trial. METHODS: One hundred twenty military personnel from the Canadian Armed Forces, experiencing 1 of 4 targeted musculoskeletal disorders, were consecutively recruited and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality-of-life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-square tests were used to compare satisfaction. RESULTS: There were no significant Time × Group interactions for any of the primary and secondary outcomes (Time × Group: P>.67). Satisfaction with treatment also did not differ between groups (P>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: P<.01), except for health-related quality of life (P = .13). CONCLUSION: Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care. J Orthop Sports Phys Ther 2024;54(6):1-10. Epub 26 Mar 2024. doi:10.2519/jospt.2024.12342.
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Van Oirschot G, Doherty C. Designing multimedia patient education materials for adolescent idiopathic scoliosis: A protocol for a feasibility randomized controlled trial of patient education videos. PLoS One 2024; 19:e0297394. [PMID: 38781168 PMCID: PMC11115215 DOI: 10.1371/journal.pone.0297394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Triple-masked three-armed feasibility parallel randomized controlled trial. Multimedia patient education materials are increasingly used in healthcare. While much research focuses on optimising their scientific content, research is equally needed to optimise design and implementation. This study aims to determine the feasibility of a study examining how the implementation of scientific advice on design affects patient outcomes. Participants aged 10-18 with radiographically confirmed adolescent idiopathic scoliosis will be recruited from community settings in Ireland and randomized into usual care or receiving multimedia educational videos with or without evidence-informed design principles. Participants will be masked in the two video intervention arms, as will the therapist sending the educational videos. Outcomes will include the number of participants recruited and randomized, the number analysed post-intervention and at week eight, and the outcomes for baseline, post-intervention, and week 8. Adverse events will also be reported. This feasibility randomized controlled trial will offer insight into the feasibility of implementing advice from the literature in designing a trial of multimedia patient education materials for a population with adolescent idiopathic scoliosis. Trial registration: Clinical Trail: Trial is registered on ClinicalTrials.gov as NCT06090344.
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Affiliation(s)
- Garett Van Oirschot
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Baroncini A, Maffulli N, Schäfer L, Manocchio N, Bossa M, Foti C, Klimuch A, Migliorini F. Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis. Sci Rep 2024; 14:11546. [PMID: 38773302 PMCID: PMC11109223 DOI: 10.1038/s41598-024-62276-9] [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: 09/12/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.
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Affiliation(s)
- Alice Baroncini
- GSpine4, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milano, Italy
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Nicola Manocchio
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Michela Bossa
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Alexandra Klimuch
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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11
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Hartley T, Hicks Y, Davies JL, Cazzola D, Sheeran L. BACK-to-MOVE: Machine learning and computer vision model automating clinical classification of non-specific low back pain for personalised management. PLoS One 2024; 19:e0302899. [PMID: 38728282 PMCID: PMC11086851 DOI: 10.1371/journal.pone.0302899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a major global disability contributor with profound health and socio-economic implications. The predominant form is non-specific LBP (NSLBP), lacking treatable pathology. Active physical interventions tailored to individual needs and capabilities are crucial for its management. However, the intricate nature of NSLBP and complexity of clinical classification systems necessitating extensive clinical training, hinder customised treatment access. Recent advancements in machine learning and computer vision demonstrate promise in characterising NSLBP altered movement patters through wearable sensors and optical motion capture. This study aimed to develop and evaluate a machine learning model (i.e., 'BACK-to-MOVE') for NSLBP classification trained with expert clinical classification, spinal motion data from a standard video alongside patient-reported outcome measures (PROMs). METHODS Synchronised video and three-dimensional (3D) motion data was collected during forward spinal flexion from 83 NSLBP patients. Two physiotherapists independently classified them as motor control impairment (MCI) or movement impairment (MI), with conflicts resolved by a third expert. The Convolutional Neural Networks (CNNs) architecture, HigherHRNet, was chosen for effective pose estimation from video data. The model was validated against 3D motion data (subset of 62) and trained on the freely available MS-COCO dataset for feature extraction. The Back-to-Move classifier underwent fine-tuning through feed-forward neural networks using labelled examples from the training dataset. Evaluation utilised 5-fold cross-validation to assess accuracy, specificity, sensitivity, and F1 measure. RESULTS Pose estimation's Mean Square Error of 0.35 degrees against 3D motion data demonstrated strong criterion validity. Back-to-Move proficiently differentiated MI and MCI classes, yielding 93.98% accuracy, 96.49% sensitivity (MI detection), 88.46% specificity (MCI detection), and an F1 measure of .957. Incorporating PROMs curtailed classifier performance (accuracy: 68.67%, sensitivity: 91.23%, specificity: 18.52%, F1: .800). CONCLUSION This study is the first to demonstrate automated clinical classification of NSLBP using computer vision and machine learning with standard video data, achieving accuracy comparable to expert consensus. Automated classification of NSLBP based on altered movement patters video-recorded during routine clinical examination could expedite personalised NSLBP rehabilitation management, circumventing existing healthcare constraints. This advancement holds significant promise for patients and healthcare services alike.
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Affiliation(s)
- Thomas Hartley
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Yulia Hicks
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Jennifer L. Davies
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for Health, Injury and Illness Prevention in Sport, University of Bath, Bath, United Kingdom
| | - Liba Sheeran
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
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12
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Pericot-Mozo X, Suñer-Soler R, Reig-Garcia G, Patiño-Masó J, Sitjar-Suñer M, Masià-Plana A, Bertran-Noguer C. Quality of Life in Patients with Chronic Low Back Pain and Differences by Sex: A Longitudinal Study. J Pers Med 2024; 14:496. [PMID: 38793078 PMCID: PMC11121820 DOI: 10.3390/jpm14050496] [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: 03/30/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The experience of chronic low back pain has a significant impact on the quality of life of affected people, resulting in difficulties in performing basic activities of daily living. AIM To study the perceived quality of life of people affected by chronic low back pain and the associated factors by sex. METHODS A prospective, longitudinal and observational design was used. RESULTS A total of 129 people (58.1% women) with chronic low back pain were studied. The mean pain intensity scores were of moderate severity (6.42 points), with a modest improvement at follow-up (6.17 points). Epidural nerve blocks were the most effective therapeutic intervention in reducing the intensity of pain. Participants described a negative perception of their health with regard to quality of life, with low scores for the two constructs both at baseline (health index, 0.444; perception of health, 38.76 points) and at follow-up (health index, 0.447; perception of health, 40.43 points). Participants had severe functional limitation scores (50.79 points). The results were significantly better among men. There was an inverse relationship between the average pain intensity (β = -0.304; p < 0.001), functional limitation (β = -0.466; p < 0.001) and mental health (β = -0.565; p < 0.001) and quality of life. CONCLUSIONS The chronification of low back pain complicates people's biopsychosocial adaptation to life. There is a longitudinal inverse association between pain and functional limitation and health-related quality of life.
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Affiliation(s)
- Xavier Pericot-Mozo
- Pain Unit, Institut Català de la Salut, 17007 Girona, Spain;
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Rosa Suñer-Soler
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Glòria Reig-Garcia
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Josefina Patiño-Masó
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Miquel Sitjar-Suñer
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Afra Masià-Plana
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Carme Bertran-Noguer
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
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Wang N, Wang K, Lu X, Zhang S, Sun X, Zhang Y. Effects of family dignity interventions combined with standard palliative care on family adaptability, cohesion, and anticipatory grief in adult advanced cancer survivors and their family caregivers: A randomized controlled trial. Heliyon 2024; 10:e28593. [PMID: 38576586 PMCID: PMC10990954 DOI: 10.1016/j.heliyon.2024.e28593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
Background Family involvement and comfort are equally important in palliative care. Dignity undertook a new meaning and novel challenges as a result of restrictions on visits and companionship during the pandemic. Family-centered family dignity interventions have been shown to be effective in increasing patients' sense of dignity, increasing levels of hope, and reducing psychological distress; however, the effectiveness in enhancing family adaptability and intimacy in the survivor-caregiver binary and reducing expected grief have been inconclusive. Objectives The primary objective of this study was to assess the efficacy of family dignity interventions on family adaptability and cohesion. The secondary objective was to explore the effects of the interventions on anticipatory grief and psychological distress, and the lasting effect 1 month after the intervention. Design A single-blinded, two-arm parallel group, randomized controlled trial was conducted in China. Settings and methods: Ninety-eight dyads who met the inclusion criteria were randomly assigned to the family dignity intervention (n = 51) or standard palliative care group (n = 47) between June and August 2022. Study outcomes were measured at baseline, immediately post-intervention, and at the 1-month follow-up post-intervention evaluation. Data were analyzed using the Kolmogorov-Smirnov test, chi-square test, Fisher's exact test, independent sample t-test, Wilcoxon rank-sum test, and generalized estimation equations. The Intention-To-Treat analysis was performed for all available data. Results In comparison to the control group, significant improvements in family adaptability and cohesion and anticipatory grief over post-intervention and 1-month follow-up were demonstrated among the patients in the intervention group. The intervention group of caregivers had significant improvement in anticipatory grief at post-intervention and 1-month follow-up. The level of psychological distress was significantly lower in the intervention group than the control group (p < 0.05) at 1-month follow-up but the differences were not statistically significant at post-intervention. All outcomes showed clear differences from baseline after the intervention and at the 1-month follow-up evaluation but not between post-intervention and at the 1-month follow-up evaluation. Conclusion This study further verifies the actual effect of family dignity intervention program through randomized controlled trials, and provides a reference for improving the family relationship between advanced cancer patients and their family caregivers, and improving their mental health. The addition of family dignity intervention to standard palliative care greatly increased the adaptability and cohesion between survivors and their families, lessened the anticipatory grief of the survivor-caregiver pair, and relieved caregivers' anxiety and despair. We did not detect a statistically significant difference between post-intervention and the 1-month follow-up evaluation, suggesting that the intervention may have a durable impact at least 1 month.
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Affiliation(s)
| | - Kun Wang
- The First Affiliated Hospital of Dalian Medical University, China
| | - Xinyu Lu
- Nanjing University of Chinese Medicine, China
| | - Shuyu Zhang
- Nanjing University of Chinese Medicine, China
| | - Xuhan Sun
- Nanjing University of Chinese Medicine, China
| | - Yuxi Zhang
- Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, China
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14
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Sepiddar F, Barati AH, Yarahmadi Y. The effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in middle-aged women with chronic nonspecific low back pain (CNSLBP). J Bodyw Mov Ther 2024; 38:615-620. [PMID: 38763616 DOI: 10.1016/j.jbmt.2023.11.019] [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: 01/05/2023] [Revised: 08/03/2023] [Accepted: 11/12/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low-back pain (LBP) is one of the most common causes of disability in adults. There are many non-invasive interventions to improve this condition, of which the use of exercise therapy is one of the most widely used. But there is contradictory evidence regarding the effectiveness of different types of exercise methods. Therefore, the current research aimed to investigate the effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in women with chronic nonspecific low back pain (CNSLBP). MATERIALS AND METHODS This was a quasi-experimental study with a controlled pre-test-post-test design. The study population included middle-aged women with CNSLBP with an age range of 35-50 years. A total of 30 eligible middle-aged women with CNSLBP were selected using purposive and convenience sampling. The pelvic clock exercise was carried out by the researcher in a gym for eight 45- min sessions each week (three sessions each week). A visual analog scale (VAS) and goniometer were used to measure pain and lumbopelvic proprioception, respectively. However, the control group only participated in the pre-test and post-test stages. For intra-group and inter-group comparisons, paired t-test and independent t-test were used at P < 0.05, respectively. RESULTS The results showed that eight-week pelvic clock exercises had an effect on decreased pain and increase lumbopelvic proprioception in middle-aged women with CNSLBP, but no effect was observed in the control group (P > 0.05). CONCLUSION According to the results of the present study, pelvic clock exercises should be used as a new and practical method to reduce pain and improve lumbopelvic proprioception in middle-aged women with CNSLBP.
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Affiliation(s)
- Forough Sepiddar
- Islamic Azad University, Science and Research Branch, Faculty of Literature and Humanities, Department of Physical Education and Sports Science, Tehran, Iran
| | - Amir Hosein Barati
- Department of Health and Sports Rehabilitation, Faculty of Sports Science, Shahid Beheshti University, Tehran, Iran.
| | - Yousef Yarahmadi
- Department of Biomechanics and Sport Injuries, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
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15
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Wolf EJ, Higgins DM, Zhao X, Hawn SE, Sanborn V, Todd CA, Fein-Schaffer D, Houranieh A, Miller MW. MMPI-2-RF Profiles of Treatment-Seeking Veterans in a VA Pain Clinic and Associations with Markers of Physical Performance. J Clin Psychol Med Settings 2024; 31:58-76. [PMID: 37418093 PMCID: PMC10771538 DOI: 10.1007/s10880-023-09967-z] [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] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
Chronic pain is a debilitating condition for many military Veterans and is associated with posttraumatic stress disorder (PTSD). This study examined the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in 144 Veterans (88.2% male, mean age = 57.95 years) recruited from a VA outpatient pain clinic and associations with self-reported pain severity, pain-related interference in daily activities, prescription opioid use, and objective metrics of physical performance on tasks impacted by pain (walking, stair climbing, grip strength, indexed by a single latent variable). Among the cohort with valid responses on the MMPI-2-RF (n = 117) and probable PTSD, mean Somatic Complaints (RC1) and Ideas of Persecution (RC6) scores were clinically elevated. All MMPI-2-RF scales were more strongly correlated with self-reported pain interference than severity. Regressions revealed associations between self-rated pain interference (but not pain or PTSD severity) and physical performance scores (β = .36, p = .001). MMPI-2-RF overreporting Validity and Higher-Order scales contributed incremental variance in predicting physical performance, including Infrequent Psychopathology Responses (β = .33, p = .002). PTSD severity was associated with prescription opioid use when accounting for the effects of over-reported somatic and cognitive symptoms (odds ratio 1.05, p ≤ .025). Results highlight the role of symptom overreporting and perceptions of functional impairment to observable behaviors among individuals with chronic pain.
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Affiliation(s)
- Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, USA.
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA.
| | - Diana M Higgins
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
| | - Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Sage E Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- Department of Psychology, Old Dominion University, Norfolk, USA
| | - Victoria Sanborn
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Catherine A Todd
- VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
| | | | - Antoun Houranieh
- VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
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16
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Zhai H, Zhang L, Xia J, Li C. The Efficiency of Respiratory Exercises in Rehabilitation of Low Back Pain: A Systematic Review and Meta-Analysis. J Sport Rehabil 2024; 33:189-200. [PMID: 38377983 DOI: 10.1123/jsr.2023-0207] [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: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Low back pain (LBP) is a common musculoskeletal disorder, and respiratory exercise is considered a nonsurgical management method. Therefore, this systematic review and meta-analysis aims to estimate the results of randomized controlled trials on the effect of respiratory training in reducing LBP and its dose relationship. METHODS The present study was conducted from January 2020 to January 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (2020). Relevant studies were searched in multiple databases including PubMed, Web of Science, the Cochrane Library, EBSCO, Scopus, ScienceDirect, Wan Fang and China Knowledge Network, ClinicalTrials.gov, and Google Scholar, using a combination of MeSH/Emtree terms and free-text words. The heterogeneity of the studies was assessed using the I2 statistic. RESULTS A total of 14 publications were included in the meta-analysis, with a total sample size of 698 individuals, aged 60-80 years. Respiratory exercise was effective in relieving LBP (standardized mean difference = -0.87, P < .00001) and improving physical disability (standardized mean difference = -0.79, P < .00001). The type of breathing and the total duration of breathing exercises were found to be the source of heterogeneity in this study by subgroup analysis. Subgroup analysis revealed that the most significant effect sizes of breathing resistance exercise to reduce LBP and the most significant effect sizes of breathing relaxation techniques to alleviate physical disability were performed 3 to 5 times per week and period >4 weeks. Respiratory exercise reducing LBP and improving functional disability was most effective when the total duration of the intervention was >500 minutes. Funnel plots showed that the results of the 2 overall studies were reliable without publication bias. CONCLUSIONS Respiratory exercise can effectively reduce LBP and improve physical disability. Therefore, these exercises can be regarded as a part of a LBP management plan. We recommend an exercise program with 30 to 50 minutes, 3 to 5 times per week, and >4 weeks of breathing resistance exercise program as the most effective for treating LBP.
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Affiliation(s)
- Haiting Zhai
- Sports Coaching College, Beijing Sport University, Beijing, China
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
| | - Liqing Zhang
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - JiXiang Xia
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
| | - Cheng Li
- School of Basic Sciences for Aviation, Naval Aviation University, Yantai, China
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17
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Zhang J, Jiang N, Xu H, Wu Y, Cheng S, Liang B. Efficacy of cognitive functional therapy in patients with low back pain: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104679. [PMID: 38219428 DOI: 10.1016/j.ijnurstu.2023.104679] [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: 10/19/2022] [Revised: 11/19/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Low back pain is a major public health problem worldwide, and there exists evidence that cognitive functional therapy may help improve patients' health condition. However, the utilization of cognitive functional therapy for low back pain is limited, and its clinical efficacy remains unclear. OBJECTIVES To determine the efficacy of cognitive functional therapy in the management of disability, pain intensity, and fear-avoidance beliefs in low back pain patients. DESIGN Systematic review and meta-analysis. METHOD A comprehensive study search of Pubmed, Web of Science, Medline, CINAHL, Embase, PsycINFO, and the Cochrane Library databases was conducted from their inception to August 14th, 2023. Two researchers independently conducted the literature search and data extraction. All statistical analysis was performed using Stata Version 17.0. RESULTS A total of eight randomized controlled trials were included. In the short-term, cognitive functional therapy significantly improved disability (7 studies, SMD = -1.05, 95 % CI = -1.74 to -0.35, I2 = 95.37 %, GRADE = very low), pain intensity (7 studies, SMD = -1.02, 95 % CI = -1.89 to -0.15, I2 = 97.21 %, GRADE = very low), and fear-avoidance beliefs (4 studies, SMD = -0.89, 95 % CI = -1.30 to -0.47, I2 = 82.49 %, GRADE = very low). In the medium-term, cognitive functional therapy also significantly improved disability (3 studies, SMD = -0.48, 95 % CI = -0.82 to -0.14, I2 = 77.97 %, GRADE = very low), pain intensity (3 studies, SMD = -0.34, 95 % CI = -0.58 to -0.10, I2 = 55.55 %, GRADE = very low), and fear-avoidance beliefs (2 studies, SMD = -0.62, 95 % CI = -1.19 to -0.04, I2 = 88.24 %, GRADE = very low). In the long-term, cognitive functional therapy significantly improved disability (4 studies, SMD = -0.54, 95 % CI = -0.95 to -0.13, I2 = 85.87 %, GRADE = very low) and fear-avoidance beliefs (3 studies, SMD = -0.76, 95 % CI = -1.17 to -0.34, I2 = 80.34 %, GRADE = very low). CONCLUSION Cognitive functional therapy might be effective in reducing disability and fear-avoidance beliefs at any of short-, medium- and long-term follow-ups, and reducing pain at short- and medium-term follow-ups. No definitive conclusions can be drawn about the impact of cognitive functional therapy on low back pain patients due to the very low certainty evidence base. Additional rigorous randomized controlled trials are needed to further confirm these findings. REGISTRATION NUMBER CRD42022287123 (PROSPERO).
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Affiliation(s)
- Jiaxin Zhang
- Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Nan Jiang
- School of Nursing, Jilin University, Changchun 130021, China
| | - Huiying Xu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, China
| | - Yi Wu
- School of Nursing, Peking University, 100191, China
| | - Siming Cheng
- Jilin General Aviation Vocational and Technical College, Jilin 132000, China
| | - Bing Liang
- School of Nursing, Jilin University, Changchun 130021, China.
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Mauck MC, Aylward AF, Barton CE, Birckhead B, Carey T, Dalton DM, Fields AJ, Fritz J, Hassett AL, Hoffmeyer A, Jones SB, McLean SA, Mehling WE, O'Neill CW, Schneider MJ, Williams DA, Zheng P, Wasan AD. [Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. Schmerz 2024:10.1007/s00482-024-00798-x. [PMID: 38381187 DOI: 10.1007/s00482-024-00798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Affiliation(s)
- Matthew C Mauck
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA.
| | - Aileen F Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chloe E Barton
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Brandon Birckhead
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane M Dalton
- Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Hoffmeyer
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Conor W O'Neill
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Michael J Schneider
- Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Zheng
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Ajay D Wasan
- Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Miki T, Kondo Y, Kurakata H, Takebayashi T, Samukawa M. Physical therapist-led interventions based on the biopsychosocial model provide improvement in disability and pain for spinal disorders: A systematic review and meta-analysis. PM R 2024; 16:60-84. [PMID: 37265083 DOI: 10.1002/pmrj.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/01/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To summarize the effects of physical therapist-led interventions based on the biopsychosocial (BPS) model in spinal disorders compared to interventions with no BPS model through a systematic review and meta-analysis of randomized-controlled trials. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY We searched the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27, 2022. METHODOLOGY Pain intensity and disability were primary outcomes and psychological factors were secondary outcomes in spinal disorders. The included intervention was physical therapist-led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMDs) and 95% confidence intervals (CIs), and the random-effects model was used for the meta-analysis. The subgroup analysis was divided into low back pain group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model. SYNTHESIS Fifty-seven studies with 5471 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect for the BPS model led by physical therapists in the short, medium, and long terms. The SMDs with 95% CIs were -0.44 (-0.62, -0.27), -0.24 (-0.37, -0.12), and -0.17 (-0.28, -0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium, and long terms. The SMDs with 95% CIs were -0.48 (-0.69, -0.27), -0.44 (-0.64, -0.25), and -0.37 (-0.58, -0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms. CONCLUSION Physical therapist-led interventions based on the BPS model effectively improve pain intensity and disability in patients with spinal disorders based on low-quality evidence.
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Affiliation(s)
- Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Graduate school, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Hiroshi Kurakata
- Department of Rehabilitation, Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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21
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Avila L, da Silva MD, Neves ML, Abreu AR, Fiuza CR, Fukusawa L, de Sá Ferreira A, Meziat-Filho N. Effectiveness of Cognitive Functional Therapy Versus Core Exercises and Manual Therapy in Patients With Chronic Low Back Pain After Spinal Surgery: Randomized Controlled Trial. Phys Ther 2024; 104:pzad105. [PMID: 37548608 DOI: 10.1093/ptj/pzad105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/28/2023] [Accepted: 06/25/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy (CORE-MT) in improving pain and function for patients with chronic low back pain after spinal surgery. METHODS This study was a randomized controlled superiority trial in a university hospital and a private physical therapist clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or CORE-MT once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention. RESULTS We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than CORE-MT in reducing pain intensity (mean difference [MD] = 2.42; 95% CI = 1.69-3.14; effect size [d] = 0.85) and improving function (MD = -2.47; 95% CI = -3.08 to -1.87; effect size = 0.95) after intervention (mean = 10.4 weeks [standard deviation = 2.17] after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD = 1.64; 95% CI = 0.98-2.3; effect size = 0.68) and function (MD = -2.01; 95% CI = -2.6 to -1.41; effect size = 0.81). CONCLUSION CFT was more effective than CORE-MT, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery. IMPACT CFT reduces pain and improves function, with large effect sizes, compared with CORE-MT. The difference between CFT and CORE-MT was sustained at the midterm follow-up. Treatment with CFT may be an option for patients with chronic low back pain after spinal surgery.
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Affiliation(s)
- Leonardo Avila
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Morgana Duarte da Silva
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcos Lisboa Neves
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Andre Rogerio Abreu
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Cibelle Ramos Fiuza
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Multicenter Postgraduate Program in Physiological Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Leandro Fukusawa
- Masters and Doctoral Programs in Medical Sciences, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
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da Silva AAC, Gomes SRA, do Nascimento RM, Fonseca AK, Pegado R, Souza CG, Macedo LDB. Effects of transcranial direct current stimulation combined with Pilates-based exercises in the treatment of chronic low back pain in outpatient rehabilitation service in Brazil: double-blind randomised controlled trial protocol. BMJ Open 2023; 13:e075373. [PMID: 38159941 PMCID: PMC10759071 DOI: 10.1136/bmjopen-2023-075373] [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: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Chronic low back pain may be associated with pathoanatomical, neurophysiological, physical, psychological and social factors; thus, treatments to reduce symptoms are important to improve the quality of life of this population. We aimed to evaluate the effects of transcranial direct current stimulation (tDCS) combined with Pilates-based exercises compared with sham stimulation on pain, quality of life and disability in patients with chronic non-specific low back pain. METHODS AND ANALYSIS This is a protocol for a double-blind randomised controlled trial with participants, outcome assessor and statistician blinded. We will include 36 individuals with a history of non-specific chronic low back pain for more than 12 weeks and minimum pain intensity of 3 points on the Numerical Pain Rating Scale. Individuals will be randomised into two groups: (1) active tDCS combined with Pilates-based exercises and (2) sham tDCS combined with Pilates-based exercises. Three weekly sessions of the protocol will be provided for 4 weeks, and individuals will be submitted to three assessments: the first (T0) will be performed before the intervention protocol, the second (T1) immediately after the intervention protocol and the third (T2) will be a follow-up 1 month after the end of the intervention. We will assess pain, disability, central sensitisation, quality of life, pressure pain threshold, global impression of change, adverse events and medication use. The Numerical Pain Rating Scale and the Roland-Morris Disability Questionnaire will be used at T1 to assess pain and disability, respectively, as primary outcome measures. ETHICS AND DISSEMINATION This trial was prospectively registered in ClinicalTrials.gov website and ethically approved by the Ethics and Research Committee of the Faculty of Health Sciences of Trairi (report number: 5.411.244) before data collection. We will publish the results in a peer-reviewed medical journal and on institution websites. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT05467566).
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Affiliation(s)
| | | | | | | | - Rodrigo Pegado
- Graduate Program in Health Sciences. Graduate Program in Physical Therapy, UFRN, Natal, Brazil
| | - Clécio Gabriel Souza
- Faculty of Health Sciences of Trairi, Post Graduation Program in Rehabilitation Science, UFRN, Santa Cruz, Brazil
| | - Liane de Brito Macedo
- Faculty of Health Sciences of Trairi, Post Graduation Program in Rehabilitation Science, UFRN, Santa Cruz, Brazil
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Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [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: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
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Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
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Bemani S, Sarrafzadeh J, Dehkordi SN, Talebian S, Salehi R, Zarei J. Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial. Adv Rheumatol 2023; 63:57. [PMID: 38049905 DOI: 10.1186/s42358-023-00329-9] [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: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. METHODS 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. RESULTS There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. CONCLUSIONS In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
- Department of Rehabilitation Management, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Neilson BD, Dickerson C, Young JL, Shepherd MH, Rhon DI. Measures of sleep disturbance are not routinely captured in trials for chronic low back pain: a systematic scoping review of 282 trials. J Clin Sleep Med 2023; 19:1961-1970. [PMID: 37259893 PMCID: PMC10620655 DOI: 10.5664/jcsm.10672] [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: 02/16/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
STUDY OBJECTIVES To investigate the extent to which sleep measures are reported in intervention trials for chronic low back pain. METHODS A systematic scoping review was conducted. Ovid MEDLINE, Cochrane CENTRAL, and CINAHL were queried for trials published between January 2010 and December 2022 using keywords related to chronic low back pain. Two reviewers screened and reviewed abstracts and full texts for eligibility criteria and extracted data. Randomized intervention trials with the aim to treat pain or disability related to chronic low back pain in adults were included. Data were pooled and synthesized from trials that included a measure of sleep. RESULTS Two hundred eighty-two trials conducted in 40 different countries were included in the final review. Twenty-six trials (9.2%) assessed any sleep measure, and 13 (4.6%) collected a formal sleep disturbance measure at multiple time points. Three trials analyzed the mediating effects of sleep disturbance on pain. Reporting of sleep measures was no better in more recently published trials; trials published in 2010 (22%; n = 2/9) and 2022 (23%; n = 3/13) had the highest reporting rates. CONCLUSIONS The poor adherence to guideline recommendations for capturing measures of sleep quality or disturbance limits clinicians' and researchers' understanding of how sleep may influence treatment effects for chronic low back pain. There is an opportunity to improve the understanding of the relationship between sleep and pain with improved collection and reporting of sleep disturbance measures. CITATION Neilson BD, Dickerson C, Young JL, Shepherd MH, Rhon DI. Measures of sleep disturbance are not routinely captured in trials for chronic low back pain: a systematic scoping review of 282 trials. J Clin Sleep Med. 2023;19(11):1961-1970.
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Affiliation(s)
- Brett D Neilson
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
- Doctor of Physical Therapy Program, Hawai'i Pacific University, Honolulu, Hawaii
| | - Chris Dickerson
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
| | - Jodi L Young
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
| | - Mark H Shepherd
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
| | - Daniel I Rhon
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, Wisconsin
- Department of Rehab Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
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Wu Q, Cui X, Guan LC, Zhang C, Liu J, Ford NC, He S, Chen X, Cao X, Zang L, Guan Y. Chronic pain after spine surgery: Insights into pathogenesis, new treatment, and preventive therapy. J Orthop Translat 2023; 42:147-159. [PMID: 37823035 PMCID: PMC10562770 DOI: 10.1016/j.jot.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 10/13/2023] Open
Abstract
Chronic pain after spine surgery (CPSS) is often characterized by intractable low back pain and/or radiating leg pain, and has been reported in 8-40% of patients that received lumbar spine surgery. We conducted a literature search of PubMed, MEDLINE/OVID with a focus on studies about the etiology and treatments of CPSS and low back pain. Our aim was to provide a narrative review that would help us better understand the pathogenesis and current treatment options for CPSS. This knowledge will aid in the development of optimal strategies for managing postoperative pain symptoms and potentially curing the underlying etiologies. Firstly, we reviewed recent advances in the mechanistic study of CPSS, illustrated both structural (e.g., fibrosis and scaring) and non-structural factors (e.g., inflammation, neuronal sensitization, glial activation, psychological factor) causing CPSS, and highlighted those having not been given sufficient attention as the etiology of CPSS. Secondly, we summarized clinical evidence and therapeutic perspectives of CPSS. We also presented new insights about the treatments and etiology of CPSS, in order to raise awareness of medical staff in the identification and management of this complex painful disease. Finally, we discussed potential new targets for clinical interventions of CPSS and future perspectives of mechanistic and translational research. CPSS patients often have a mixed etiology. By reviewing recent findings, the authors advocate that clinicians shall comprehensively evaluate each case to formulate a patient-specific and multi-modal pain treatment, and importantly, consider an early intraoperative intervention that may decrease the risk or even prevent the onset of CPSS. Translational potential statement CPSS remains difficult to treat. This review broadens our understanding of clinical therapies and underlying mechanisms of CPSS, and provides new insights which will aid in the development of novel mechanism-based therapies for not only managing the established pain symptoms but also preventing the development of CPSS.
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Affiliation(s)
- Qichao Wu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100149, China
| | - Xiang Cui
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Leo C. Guan
- McDonogh School, Owing Mills, Maryland, 21117, USA
| | - Chi Zhang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Jing Liu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Neil C. Ford
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Shaoqiu He
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 100149, China
| | - Xu Cao
- Department of Orthopedics, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100149, China
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurological Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA
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Gombatto SP, Archer KR, Wegener ST, Hernandez Y, Lin SF, Godino J, Van Dyke J, Liu J, Monroe KS. Protocol for a Parallel Group Randomized Clinical Trial Comparing a Culturally Adapted Cognitive Behavioral Telerehabilitation Intervention to Usual Physical Therapy for Latino Patients With Chronic Spine Pain. Phys Ther 2023; 103:pzad068. [PMID: 37364033 PMCID: PMC10492001 DOI: 10.1093/ptj/pzad068] [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: 10/26/2022] [Revised: 02/24/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral-based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral-based hybrid telerehabilitation intervention for Latino patients with chronic spine pain. METHODS A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses. IMPACT This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain.
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Affiliation(s)
- Sara P Gombatto
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
| | - Kristin R Archer
- Orthopaedic Surgery and Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yessenia Hernandez
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
| | - Shih-Fan Lin
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
| | - Job Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, California, USA
| | - Jason Van Dyke
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, California, USA
| | - Jie Liu
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, California, USA
| | - Katrina S Monroe
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
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Bondesson E, Jöud A, Rivano Fischer M, Trulsson Schouenborg A. Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain? Pain Res Manag 2023; 2023:5182996. [PMID: 37360748 PMCID: PMC10289872 DOI: 10.1155/2023/5182996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Background No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions. Methods In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating. Results Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes. Conclusions Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health.
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Affiliation(s)
- Elisabeth Bondesson
- Lund University, Department of Clinical Sciences Lund, Lund, Sweden
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
| | - Anna Jöud
- Lund University, Department of Clinical Sciences Lund, Lund, Sweden
- Lund University, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund, Sweden
- Skåne University Hospital, Department of Research and Education, Lund, Sweden
| | - Marcelo Rivano Fischer
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
- Lund University, Department of Health Sciences, Research Group Rehabilitation Medicine, Lund, Sweden
| | - Anna Trulsson Schouenborg
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
- Lund University, Department of Health Sciences, Research Group Human Movement-Health and Rehabilitation, Lund, Sweden
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Kent P, Haines T, O'Sullivan P, Smith A, Campbell A, Schutze R, Attwell S, Caneiro JP, Laird R, O'Sullivan K, McGregor A, Hartvigsen J, Lee DCA, Vickery A, Hancock M. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet 2023; 401:1866-1877. [PMID: 37146623 DOI: 10.1016/s0140-6736(23)00441-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. METHODS RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. FINDINGS Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference -4·6 [95% CI -5·9 to -3·4] and CFT plus biofeedback mean difference -4·6 [-5·8 to -3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; -AU$5276 [-10 529 to -24) and -8211 (-12 923 to -3500). INTERPRETATION CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. FUNDING Australian National Health and Medical Research Council and Curtin University.
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Affiliation(s)
- Peter Kent
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Peter O'Sullivan
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Robert Schutze
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Stephanie Attwell
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - J P Caneiro
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | | | | | - Alison McGregor
- Department of Surgery & Cancer, Imperial College, London, UK
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Den-Ching A Lee
- Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | | | - Mark Hancock
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
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Meziat-Filho N, Fernandez J, Castro J. Cognitive functional therapy for chronic disabling low back pain. Lancet 2023:S0140-6736(23)00571-8. [PMID: 37146624 DOI: 10.1016/s0140-6736(23)00571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Rio de Janeiro 21041-010, Brazil.
| | - Jessica Fernandez
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Rio de Janeiro 21041-010, Brazil
| | - Julia Castro
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Rio de Janeiro 21041-010, Brazil
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31
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Peabody Smith A, Pouratian N, Feinsinger A. Two Practices to Improve Informed Consent for Intraoperative Brain Research. Neurosurgery 2023; 92:e97-e101. [PMID: 36700725 PMCID: PMC10158867 DOI: 10.1227/neu.0000000000002336] [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: 08/13/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023] Open
Abstract
As the clinical applications of neurologically implanted devices increase, so do opportunities for intracranial investigations in human patients. In some of these studies, patients participate in research during their awake brain surgery, performing additional tasks without the prospect of personal therapeutic benefit. These intraoperative studies raise persistent ethical challenges because they are conducted during a clinical intervention, in a clinical space, and often by the treating clinician. Whether intraoperative research necessitates innovative informed consent methods has become a pressing conversation. Familiar worries about inadequate participant understanding and undue influence dominate these discussions, as do calls for increasing information retention (e.g., using methods such as "teach-back") and minimizing enrollment pressures (e.g., preventing surgeons from consenting their own patients). However, efforts have yet to inspire widespread consent practices that mirror the scope of ethical concern. Focusing on awake, intraoperative intracranial research, we identify 2 underappreciated problems in approaches to informed consent. The first is epistemic: Many practices do not fully consider when and under which conditions participants are adequately informed. The second is relational: Many practices do not fully consider the effects of trust between patient-participants and surgeon-researchers. In exploring these concerns, we also raise questions about whether additional steps beyond preoperative consent may improve the process because decisions at this time are decoupled from both the experiences and vulnerability of awake brain surgery. Motivated by these considerations, we propose 2 practices: first, requiring a third-party patient advocate in initial consent and second, requiring verbal intraoperative reconsent before initiating research.
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Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley Feinsinger
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Devonshire JJ, Wewege MA, Hansford HJ, Odemis HA, Wand BM, Jones MD, McAuley JH. Effectiveness of Cognitive Functional Therapy for Reducing Pain and Disability in Chronic Low Back Pain: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2023; 53:244–285. [PMID: 36812100 DOI: 10.2519/jospt.2023.11447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE: We aimed to evaluate whether cognitive functional therapy (CFT) is an effective treatment for adults with chronic low back pain (LBP). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched 4 electronic databases (CENTRAL, CINAHL, MEDLINE, and Embase) and 2 clinical trial registers (ClinicalTrials. gov and the EU Clinical Trials Register) from inception up to March 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials evaluating CFT for adults with LBP. DATA SYNTHESIS: The primary outcomes were pain intensity and disability. Secondary outcomes were psychological status, patient satisfaction, global improvement, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate pooled effects. RESULTS: Fifteen trials were included (9 ongoing and 1 terminated), of which 5 provided data (n = 507; n = 262 CFT, and n = 245 control). There was very low certainty for the effectiveness of CFT compared to manual therapy plus core exercises (2 studies, n = 265) for reducing pain intensity (mean difference: -1.02/10, 95% confidence interval: -14.75, 12.70) and disability (mean difference: -6.95/100, 95% confidence interval: -58.58, 44.68). Narrative synthesis showed mixed results for pain intensity, disability, and secondary outcomes. No adverse events were reported. All studies were judged to be at high risk of bias. CONCLUSION: Cognitive functional therapy may not be more effective than other common interventions for reducing pain and disability in adults with chronic LBP. The effectiveness of CFT is very uncertain and will remain so until higher-quality studies are available. J Orthop Sports Phys Ther 2023;53(5):1-42. Epub: 23 February 2023. doi:10.2519/jospt.2023.11447.
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Affiliation(s)
- Jack J Devonshire
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Harrison J Hansford
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Hasibe A Odemis
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Matthew D Jones
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Nim CG, Hansen A, Backmann T, Ziegler DS, O'Neill S. Multidisciplinary team-based management approach for secondary-care patients with severe and persistent low back pain: A mixed-method feasibility trial. J Back Musculoskelet Rehabil 2023:BMR220369. [PMID: 37092217 DOI: 10.3233/bmr-220369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Persistent and severe low back pain is challenging to treat. Multidisciplinary care with systematic follow-up may be more effective than usual care. However, such a model has yet to be developed and tested. OBJECTIVE Our objectives were to develop and test the feasibility of a three-month multidisciplinary intervention with systematic follow-up in a specialized hospital spine center for patients with severe and persistent low back pain. METHODS Using the Medical Research Council and National Institute for Health and Care Research framework for the development and testing of complex interventions, we developed a multidisciplinary intervention with systematic follow-up and tested its feasibility, using a-priori-determined outcomes during three months for 24 patients seen at a regional diagnostic spine center unit. As part of the evaluation, we conducted semi-structured interviews with participants and a focus-group interview with clinicians. RESULTS Of the 24 patients included, only 17 completed the course of care and provided complete data for feasibility assessment. We failed to reach our a-priori feasibility outcomes, had difficulty with inclusion, and participants did not find the intervention effective or satisfactory. CONCLUSIONS The intervention was not feasible as barriers existed on multiple levels (e.g., clinical, administrative, and patient). Excessive study moderations must be made before the intervention is feasible in a randomized trial.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Anders Hansen
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Tina Backmann
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Dorthe Schøler Ziegler
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Wyns A, Hendrix J, Lahousse A, De Bruyne E, Nijs J, Godderis L, Polli A. The Biology of Stress Intolerance in Patients with Chronic Pain—State of the Art and Future Directions. J Clin Med 2023; 12:jcm12062245. [PMID: 36983246 PMCID: PMC10057496 DOI: 10.3390/jcm12062245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Stress has been consistently linked to negative impacts on physical and mental health. More specifically, patients with chronic pain experience stress intolerance, which is an exacerbation or occurrence of symptoms in response to any type of stress. The pathophysiological mechanisms underlying this phenomenon remain unsolved. In this state-of-the-art paper, we summarised the role of the autonomic nervous system (ANS) and hypothalamus-pituitary-adrenal (HPA) axis, the two major stress response systems in stress intolerance. We provided insights into such mechanisms based on evidence from clinical studies in both patients with chronic pain, showing dysregulated stress systems, and healthy controls supported by preclinical studies, highlighting the link between these systems and symptoms of stress intolerance. Furthermore, we explored the possible regulating role for (epi)genetic mechanisms influencing the ANS and HPA axis. The link between stress and chronic pain has become an important area of research as it has the potential to inform the development of interventions to improve the quality of life for individuals living with chronic pain. As stress has become a prevalent concern in modern society, understanding the connection between stress, HPA axis, ANS, and chronic health conditions such as chronic pain is crucial to improve public health and well-being.
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Affiliation(s)
- Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
- Correspondence:
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Elke De Bruyne
- Department of Hematology and Immunology-Myeloma Center Brussels, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- External Service for Prevention and Protection at Work, IDEWE, 3001 Heverlee, Belgium
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
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Baumann H, Heuel L, Bischoff LL, Wollesen B. mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial. Trials 2023; 24:163. [PMID: 36869368 PMCID: PMC9985281 DOI: 10.1186/s13063-023-07182-7] [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: 06/12/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Causes and consequences of chronic stress levels in the context of healthcare work are well examined. Nevertheless, the implementation and evaluation of high-quality interventions to reduce stress of healthcare workers is still missing. Internet and app-based interventions are a promising venue for providing interventions for stress reduction to a population that is otherwise difficult to reach due to shift work and time constraints in general. To do so, we developed the internet and app-based intervention (fitcor), a digital coaching of individual stress coping for health care workers. METHODS We applied the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement as a guideline for the present protocol. A randomized controlled trial will be conducted. There are five different intervention groups and one waiting control group. To achieve the sample sizes required by power analysis (G*Power) (β-error 80%; effect size 0.25), the sample sizes of the respective scenarios will be at best as follows: 336 care workers from hospitals, 192 administrative health personnel, 145 care workers from stationary elderly care homes, and 145 care workers from ambulatory care providers in Germany. Participants will randomly be assigned to one of five different intervention groups. A crossover design with a waiting control group is planned. Interventions will be accompanied by three measurement points, first a baseline measure, second a post-intervention measure directly after completion of the intervention, and a follow-up measure 6 weeks after completion of the intervention. At all three measurement points, perceived team conflict, work-related experience patterns, personality, satisfaction with internet-based training, and back pain will be assessed using questionnaires, as well as heart rate variability, sleep quality, and daily movement will be recorded using an advanced sensor. DISCUSSION Workers in the health care sector increasingly face high job demands and stress levels. Traditional health interventions fail to reach the respective population due to organizational constraints. Implementation of digital health interventions has been found to improve stress coping behavior; however, the evidence in health care settings has not been established. To the best of our knowledge, fitcor is the first internet and app-based intervention to reduce stress among nursing and administrative health care personnel. TRIAL REGISTRATION The trial was registered at DRKS.de on 12 July 2021, registration number: DRKS00024605.
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Affiliation(s)
- Hannes Baumann
- Institute of Biological Psychology and Neuroergonomics, Technical University of Berlin, Fasanenstr. 1, 10623, Berlin, Germany. .,Institute of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany. .,Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, Am Kaiserkai 1, Hamburg, Hamburg, 20457, Germany.
| | - Luis Heuel
- Institute of Biological Psychology and Neuroergonomics, Technical University of Berlin, Fasanenstr. 1, 10623, Berlin, Germany
| | - Laura L Bischoff
- Institute of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany
| | - Bettina Wollesen
- Institute of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany
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Grande-Alonso M, Pro-Marín D, Piedra-Garrosa I, La Touche R, Paris-Alemany A. Sensorimotor, cognitive and affective behavior according to perceived level of disability in patients with chronic low back pain: an observational cross-sectional study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:72-83. [PMID: 36856102 PMCID: PMC9976176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVES The aim was to evaluate the influence of the level of disability on sensorimotor and psychological variables in nonspecific chronic low back pain (NCLBP). METHODS A cross-sectional observational study was performed with 90 participants, divided into one group with NCLBP (60 participants) and one asymptomatic group (30 participants). Symptomatic participants were divided into a "major" or "minor" disability group using the Roland Morris Disability Questionnaire score, resulting in two groups of 30 participants. All participants completed a series of self-administered questionnaires and performed sensorimotor tests. RESULTS There were no statistically significant differences in the sensorimotor variables except in pain intensity, which was greater in the NCLBP group with high lumbar disability. There were statistically significant differences between the symptomatic groups in the degree of self-efficacy, pain catastrophism and kinesiophobia. CONCLUSIONS Patients with NCLBP and high levels of disability present greater pain intensity and significantly poorer results in psychological variables compared with those with NCLBP and low levels of disability. In contrast, there were no differences for sensorimotor variables between the patients with NCLBP and high levels of disability and those with low levels of disability.
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Affiliation(s)
- Mónica Grande-Alonso
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, Madrid, Spain.,Instituto de Rehabilitación Funcional La Salle, Aravaca, Calle Ganímedes, Madrid, Spain
| | - Diego Pro-Marín
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, Madrid, Spain.,Instituto de Rehabilitación Funcional La Salle, Aravaca, Calle Ganímedes, Madrid, Spain
| | - Irene Piedra-Garrosa
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, Madrid, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Calle Luisa Fernanda, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Calle Luisa Fernanda, Spain
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Baumann H, Heuel L, Bischoff LL, Wollesen B. Efficacy of Individualized Sensory-Based mHealth Interventions to Improve Distress Coping in Healthcare Professionals: A Multi-Arm Parallel-Group Randomized Controlled Trial. SENSORS (BASEL, SWITZERLAND) 2023; 23:2322. [PMID: 36850920 PMCID: PMC9963645 DOI: 10.3390/s23042322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Detrimental effects of chronic stress on healthcare professionals have been well-established, but the implementation and evaluation of effective interventions aimed at improving distress coping remains inadequate. Individualized mHealth interventions incorporating sensor feedback have been proposed as a promising approach. This study aimed to investigate the impact of individualized, sensor-based mHealth interventions focusing on stress and physical activity on distress coping in healthcare professionals. The study utilized a multi-arm, parallel group randomized controlled trial design, comparing five intervention groups (three variations of web-based training and two variations of an app training) that represented varying levels of individualization to a control group. Both self-reported questionnaire data (collected using Limesurvey) as well as electrocardiography and accelerometry-based sensory data (collected using Mesana Sensor) were assessed at baseline and post-intervention (after eight weeks). Of the 995 eligible participants, 170 (26%) completed the post-intervention measurement (Group 1: N = 21; Group 2: N = 23; Group 3: N = 7; Group 4: N = 34; Group 5: N = 16; Control Group: N = 69). MANOVA results indicated small to moderate time-by-group interaction effects for physical activity-related outcomes, including moderate to vigorous physical activity (F(1,5) = 5.8, p = ≤0.001, η2p = 0.057) and inactivity disruption (F(1,5) = 11.2, p = <0.001, η2p = 0.100), in the app-based intervention groups, but not for step counts and inactivity. No changes were observed in stress-related heart rate variability parameters over time. Despite a high dropout rate and a complex study design, the individualized interventions showed initial positive effects on physical activity. However, no significant changes in stress-related outcomes were observed, suggesting that the intervention duration was insufficient to induce physiological adaptations that would result in improved distress coping.
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Affiliation(s)
- Hannes Baumann
- Department of Biopsychology and Neuroergonomics, Technical University Berlin, 10623 Berlin, Germany
- Institute of Human Movement Science, University of Hamburg, 20146 Hamburg, Germany
- Medical School Hamburg, Institute of Interdisciplinary Exercise Science and Sports Medicine, 20457 Hamburg, Germany
| | - Luis Heuel
- Department of Biopsychology and Neuroergonomics, Technical University Berlin, 10623 Berlin, Germany
| | | | - Bettina Wollesen
- Institute of Human Movement Science, University of Hamburg, 20146 Hamburg, Germany
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Han CS, Hancock MJ, Maher CG. Reconsidering non-specific low back pain: where to from here? Spine J 2022; 22:1927-1930. [PMID: 35944828 DOI: 10.1016/j.spinee.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Christopher S Han
- The Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, PO Box M179, Missenden Rd, NSW 2050, Sydney, Australia.
| | - Mark J Hancock
- The Faculty of Medicine, Health and Human Sciences Level 3, 75 Talavera Rd, Macquarie University, NSW 2109, Australia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, PO Box M179, Missenden Rd, NSW 2050, Sydney, Australia
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The effect of exercise engagement on low back disability at 12-months is mediated by pain and catastrophizing in a community sample of people with chronic low back pain. Behav Res Ther 2022; 159:104205. [PMID: 36215852 DOI: 10.1016/j.brat.2022.104205] [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: 04/04/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
Despite being a first-line treatment recommendation, there is uncertainly for how exercise helps people with chronic low back pain. We designed this study to examine how exercise might help people with chronic low back pain by following a large community sample for 1-year. Qualitative questionnaires and self-report measures were collected every 3-months for 1-year in 400 people with chronic low back pain. People were not provided any specific treatment advice as part of this study but were allowed to engage with any normal physical activity, treatment, or medication as part of their normal life. Exercise engagement was defined from inspection of participant qualitative responses, according to minimum acceptable levels of exercise that elicit symptom reduction. Multiple mediation analysis was performed to examine the effect of exercise engagement on disability through the proposed mediators (pain, fear, catastrophizing, depression, anxiety, self-efficacy). The significant effect of exercise engagement on reductions in disability at 6- and 12-months was explained through pain and catastrophizing. People with chronic low back pain who reported worsening of symptoms over the year had similar reporting of exercise throughout the 12-months to people who had improvements in disability. Exercise can reduce disability through the effect on pain and catastrophizing, but how this effect occurs (i.e., an active or passive component of exercise) is unclear.
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Boyle EM, Fary RE, Lee S, Mikhailov A, Evans K, Rebbeck T, Beales DJ. Patient perspectives of care pathways for people with low back pain: A qualitative study. Musculoskelet Sci Pract 2022; 62:102657. [PMID: 36058010 DOI: 10.1016/j.msksp.2022.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low back pain (LBP) care pathways aim to enhance health outcomes through patient-clinician mutual decision-making and care coordination. However, challenges to successful translation into practice include patients' understanding, expectation, and acceptance of treatment and management strategies for LBP. This study explored patients' perspectives and/or experience of care pathways and their involvement in decision-making in primary care. METHODS A qualitative descriptive design was adopted. Semi-structured interviews were conducted with 14 participants with LBP recruited from the community. Inductive thematic analysis of the qualitative data was conducted within the design framework to enable a systematic comparison of experiences across participants and within individual cases. RESULTS Five themes described participant perspectives and understanding of care pathways: i) care pathways can guide decision-making; ii) familiarity with no and/or stepped care pathway, but preference for matched or blend of care pathways; iii) engaging in shared decision-making; iv) patient-related barriers to implementation; v) patient-related facilitators to implementation. CONCLUSIONS Participants felt that existing care pathways did not meet their needs when pain persisted. Participants preferred matched or hybrid care pathways and suggested that implementation of such pathways should focus on addressing an individual's needs. Adopting a holistic approach, and clarity in shared decision-making, were deemed crucial for effective implementation of LBP pathways in practice. Consumer (patient) engagement in the design of LBP care pathways is recommended.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Samantha Lee
- Department of Allied Health, SingHealth Polyclinics, Singapore
| | - Anton Mikhailov
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Healthia Limited, Brisbane, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Pain Education in the Management of Patients with Chronic Low Back Pain: A Systematic Review. J Funct Morphol Kinesiol 2022; 7:jfmk7040074. [PMID: 36278735 PMCID: PMC9590060 DOI: 10.3390/jfmk7040074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
New prospective of chronic low back pain (CLBP) management based on the biopsychosocial model suggests the use of pain education, or neurophysiological pain education, to modify erroneous conceptions of disease and pain, often influenced by fear, anxiety and negative attitudes. The aim of the study is to highlight the evidence on the outcomes of a pain education-oriented approach for the management of CLBP. The search was conducted on the Pubmed, Scopus, Pedro and Cochrane Library databases, leading to 2673 results until September 2021. In total, 13 articles published in the last 10 years were selected as eligible. A total of 6 out of 13 studies support a significant reduction in symptoms in the medium term. Disability is investigated in only 11 of the selected studies, but 7 studies support a clear reduction in the medium-term disability index. It is difficult to assess the effectiveness of the treatments of pain education in patients affected by CLBP, due to the multimodality and heterogeneity of the treatments administered to the experimental group. In general, methods based on pain education or on cognitive-behavioral approaches, in association with physical therapy, appear to be superior to physiotherapeutic interventions alone in the medium term.
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Treatment of low back pain with exercise language Author: Amir Mohammadamini Published by Lambert Publications, No. Shaik ISBN: 978-613-9-95598-5 This book is in Farsi, Kurdish, English, Russian, Italian, Polish, Dutch, French languages. , German, Spanish, Portuguese
edition Kurdish 9786229434529
”Treatment of low back pain with exercise language“
Author:Amir Mohammadamini
Edition Persian
9876229876886
”Treatment of low back pain with exercise language“
Author:Amir Mohammadamini
ISBN-13
978-6200987136
Amir Mohammadamini
Traitement de la lombalgie par l'exercice du langage
Edition Français
ISBN-13
978-6200987082
Amir Mohammadamini
Behandeling van lage rugpijn met oefentaal (Dutch Edition)
Dutch Edition ISBN-13
978-6200987112
Амир Мохаммадамини
Лечение болей в пояснице с помощью языка упражнений
Edition Russe
ISBN-13
978-6200987129
Tratamiento del dolor de espalda baja con lenguaje de ejercicios-edition Spanish
ISBN
9786200987099
Amir Mohammadamini
Amir Mohammadamini
Behandlung von Kreuzschmerzen mit Bewegungssprache (German Edition)
German Edition ISBN-13
978-6200987075
Amir Mohammadamini
Leczenie bólu w okolicy lędźwiowej kręgosłupa za pomocą języka ćwiczeń
Edition Polonais
ISBN-13
978-6200987143
Amir Mohammadamini
Tratamento de dores lombares (Portuguese Edition)
Portuguese Edition
ISBN-13
978-6200987105
https://www.lap-publishing.com/. PLoS One 2022; 17:e0273983. [PMID: 36048791 PMCID: PMC9436074 DOI: 10.1371/journal.pone.0273983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Best outpatient treatment of nonspecific chronic low back pain is high-dosed exercise that is maintained after therapy. Primary care biopsychosocial intervention (PCBI) is an outpatient multicomponent intervention that includes an active component (exercise, physical activity, or physiotherapy) and at least one psychological, social, or occupational component. Research has shown that PCBI can reduce pain intensity and disability. While scattered studies support low-dosed (<15 treatment hours) PCBI, there is no systematic review comparing the effectiveness of low-dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). Inclusion criteria Randomised controlled trials that evaluate low-dosed outpatient biopsychosocial interventions compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older) who suffer from nonspecific CLBP will be included. Methods A comprehensive search of multiple databases will be used to find relevant studies. The databases will be searched from inception to December 2021, with English or German language restrictions imposed. Keywords and derivatives of “chronic back pain”, “exercise intervention”, “cognitive-behavioral therapy”, “primary care” and “randomized controlled trials” will be used. Sources will include CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. Discussion To our knowledge, this will be the first systematic review and meta-analysis of narrowly defined low- dosed PCBI across populations with nonspecific chronic low back pain. The objective of this review is to evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus physical active interventions on pain intensity and disability in adults with CLBP. This study will provide evidence that could improve treatment options for patients with nonspecific CLBP. Trail registration Systematic review registration number: PROSPERO 2022 CRD42022302771. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302771
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Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach. Pain Rep 2022; 7:e1019. [PMID: 36203645 PMCID: PMC9529058 DOI: 10.1097/pr9.0000000000001019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Literature on current treatments for chronic low back pain (cLBP) were reviewed and 4 interventions were recommended for inclusion in a multisite cLBP clinical trial. Introduction: Objective: Methods: Conclusion:
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Efficacy of the cognitive functional therapy (CFT) in patients with chronic nonspecific low back pain: a study protocol for a randomized sham-controlled trial. Trials 2022; 23:544. [PMID: 35788240 PMCID: PMC9252077 DOI: 10.1186/s13063-022-06466-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy (CFT) is a promising new intervention that deals with potentially modifiable multidimensional aspects of pain (e.g., provocative cognitive, movement, and lifestyle behaviors). Methods To investigate the efficacy of CFT compared with a sham intervention for pain intensity and disability post-intervention (immediately after the last session) in patients with non-specific chronic low back pain (CLBP). This study is a randomized controlled trial in which 152 (18–60 years old) patients with CLBP will be enrolled. The patients will be randomly allocated to receive (1) CFT intervention or (2) sham intervention. The experimental group will receive individualized CFT in a pragmatic manner (5 to 7 sessions) based on the clinical progression of the participants. The sham group will attend six sessions: consisting of 30 min of photobiomodulation using a detuned device and more than 15 min of talking about neutral topics. Patients from both groups also will receive an educational booklet (for ethical reasons). Participants will be assessed pre and post-intervention, 3 months, and 6 months after randomization. The primary outcomes will be pain intensity and disability post-intervention. The secondary outcomes will be: pain intensity and disability at 3- and 6-month follow-up, as well as self-efficacy, global perceived effect of improvement, and functioning post-intervention, 3-, and 6-month follow-up. The patients and the assessor will be blinded to the treatment administered (active vs. sham). Statistical analysis The between-group differences (effects of treatment), as well as the treatment effect for the primary and secondary outcomes, and their respective 95% confidence intervals will be calculated by constructing linear mixed models. Discussion To the best of our knowledge, the current study will be the first to compare CFT vs. sham intervention. Sham-controlled RCTs may help to understand the influence of non-specific factors on treatment outcomes. Considering complex interventions as CFT, it is imperative to understand the impact of contextual factors on outcomes. Trial registration ClinicalTrials.gov NCT04518891. First Posted: August 19, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06466-8.
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Lena O, Todri J, Todri A, Papajorgji P, Martínez-Fuentes J. A randomized controlled trial concerning the implementation of the postural Mézières treatment in elite athletes with low back pain. Postgrad Med 2022; 134:559-572. [PMID: 35708481 DOI: 10.1080/00325481.2022.2089464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of adding the Mézières Method (MM) to the standard rehabilitation protocol for the elite athletes with low back pain (LBP) in reducing lumbar pain than only using the traditional rehabilitation protocol treatment. The disciplines considered in this study were soccer, rhythmic gymnastics, and basketball. DESIGN Randomized controlled trial. SETTING Training Camp. PARTICIPANTS One hundred thirty-nine elite athletes with low back pain of whom 69 were assigned to the experimental group. INTERVENTION The intervention consists of treatment with three lying postures in a 40-minutes long session twice a week. The session goal was to focus on breathing exercises, spine mobility, and stretching of the back muscles, with particular attention to the diaphragmatic, paravertebral, and latissimus dorsi muscles. OUTCOME MEASURES Assessments as Visual Analogue Scale (VAS), Sit and Reach flexibility test, Roland-Morris Questionnaire, and health status questionnaire (SF12) were used. RESULTS The evaluation of all outcomes in 4 measurement periods of the study (baseline, 4, 12, and 24 weeks) showed a significant difference between groups. Also, at the 6-month of the intervention, a significant difference in the means (SD) was observed in pain (VAS), back flexibility (Sit & Reach) and back disability (QRM) outcomes in favor of the experimental group with a medium-large effect size comparing with the control group. CONCLUSION The MM approach can also be applied in established conventional protocols to alleviate pain and functionality. The obtained results include improving the quality of life of the athletes and their physical and emotional states. Clinical trial registration number ID: NCT03849053.
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Affiliation(s)
- Orges Lena
- Health Sciences Department, Universidad Catolica de Murcia UCAM, Spain
| | - Jasemin Todri
- Health Sciences Department, Universidad Catolica de Murcia UCAM, Spain
| | - Ardita Todri
- Statistics Specialist Area. Economics Department, Universiteti "Aleksander Xhuvani", Elbasan, Albania
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Miki T, Kondo Y, Kurakata H, Buzasi E, Takebayashi T, Takasaki H. The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis. Biopsychosoc Med 2022; 16:12. [PMID: 35597961 PMCID: PMC9123771 DOI: 10.1186/s13030-022-00241-6] [Citation(s) in RCA: 4] [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: 11/23/2021] [Accepted: 04/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives This study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design This study was a systematic review and meta-analysis of a randomised controlled trial. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. Trial registration PROSPERO registration number CRD42020158182. Supplementary Information The online version contains supplementary material available at 10.1186/s13030-022-00241-6.
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Affiliation(s)
- Takahiro Miki
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan. .,Faculty of Health Sciences, Hokkaido University, Sapporo, Japan. .,Graduate school, Saitama Prefectural University, Koshigaya, Saitama , Japan.
| | - Yu Kondo
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan
| | - Hiroshi Kurakata
- Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan
| | - Eva Buzasi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Tsuneo Takebayashi
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama, Japan
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Cerini T, Hilfiker R, Riegler TF, Felsch QTM. 12 weeks high intensity interval training versus moderate intensity continuous training in chronic low back pain subjects: a randomised single-blinded feasibility study. Arch Physiother 2022; 12:12. [PMID: 35491417 PMCID: PMC9059354 DOI: 10.1186/s40945-022-00136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, very little is known about the effects of an endurance high intensity interval training (HIIT) in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT must be assessed first before Currently, very little is known about the effects of an endurance high intensity interval training in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT has to be assessed first before it can be integrated safely into research and daily practice it can be integrated safely into research and daily practice. This study aims to answers the question if high intensity interval training and moderate intensity continuous training (MICT) have comparable adherence and feasibility. METHODS Participants (age from 29 to 69 years) with non-specific chronic low back pain were recruited in this randomised, single-blinded, allocation concealed, feasibility study. The participants trained 30 min on a cycle ergometer for 12 weeks. One group had HIIT and the other MICT. RESULTS Of 45 screened subjects 30 participated. The adherence rate was 94% in the HIIT group (median 0.94, IQR 0.23) versus 96% in the MICT group (median 0.96, IQR 0.08), without between-group differences: estimated median of the difference of - 0,01 [95% CI, - 0.11 to 0.06; p = 0.76]. Similar results in enjoyability (median 3, IQR 1 vs median 2, IQR 1.8) and willingness to continue the training (median 3, IQR 1 vs median 3, IQR 0.4). Both groups improved in pain and disability, without between-group differences in pain [median of the difference, 0.5; 95% CI, - 1 to 2; p = 0.95] nor in disability [median of the difference, 1.78; 95% CI, - 6.44 to 9.56; p = 0.64]. CONCLUSION There were no differences in adherence rates. HIIT is as feasible as MICT in non-specific chronic low back pain and can be used in future larger trials to deepen the knowledge about HIIT in this specific population. TRIAL REGISTRATION ClinicalTrials.gov, NCT04055545 . Registered 13 August 2019.
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Affiliation(s)
- Tamara Cerini
- Department of Physiotherapy, Schulthess Klinik, Zurich, Switzerland
| | - Roger Hilfiker
- Department of Physiotherapy, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Leukerbad, Switzerland
| | - Thomas F. Riegler
- Department of Physiotherapy, University of Applied Sciences of Zurich (ZHAW), Winterthur, Switzerland
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Fuming Z, Weihui X, Jiajia Y, Shufeng L, Yiyi Z, Wenjian L, Yan L, Zhicheng L, Siyun Z, Yingmin Z, Yuyin W, Chuhuai W. Effect of m-health-based core stability exercise combined with self-compassion training for patients with non-specific chronic low back pain: study protocol for a randomized controlled trial. Trials 2022; 23:265. [PMID: 35392974 PMCID: PMC8989123 DOI: 10.1186/s13063-022-06258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Non-specific chronic low back pain (NCLBP) has a high incidence, which has a significant impact on a patient’s body and mind and is a common condition affecting people’s quality of life. Core stability exercise (CSE) is a modestly effective treatment for NCLBP; however, CSE has only been shown to be a useful treatment option in the short term. Many clinical practice guidelines recommend the use of a biopsychosocial framework to guide the management of NCLBP. Self-compassion training (SCT) is a promising psychotherapy treatment option for NCLBP; however, there is still a lack of research on CSE combined with SCT. In this study, we will seek to determine whether CSE combined with SCT is an effective treatment option for patients with NCLBP compared to CSE alone. Methods In this study, we will randomize 166 adults with NCLBP to a combined SCT and CSE arm or a CSE alone arm (83 participants per group). Both interventions will consist of four weekly 1.5-h group sessions of CSE supplemented by home practice. The combined group protocol also includes 2 h of SCT before CSE. Interviewers masked to the treatment assignments will assess the outcomes at 4 and 16 weeks post-randomization. The primary outcomes are back pain disability (based on the Roland-Morris Disability Questionnaire) and pain intensity (NRS; average pain, worst pain, average pain) at 16 weeks. Discussion If SCT is found to enhance the effectiveness of CSE for patients with chronic back pain, the results of the study may promote the development of mind-body therapies for chronic low back pain. Trial registration Chinese Clinical Trial Registry ChiCTR2100042810. Registered on 21 January 2021
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Affiliation(s)
- Zheng Fuming
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao Weihui
- Department of Psychology, Sun Yat-sen University, Guangzhou, 510006, China
| | - Yang Jiajia
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Liu Shufeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zheng Yiyi
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Liang Wenjian
- Department of Psychology, Sun Yat-sen University, Guangzhou, 510006, China
| | - Li Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li Zhicheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhang Siyun
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zou Yingmin
- Department of Psychology, Sun Yat-sen University, Guangzhou, 510006, China
| | - Wang Yuyin
- Department of Psychology, Sun Yat-sen University, Guangzhou, 510006, China.
| | - Wang Chuhuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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Cognitive functional therapy compared with core exercise and manual therapy in patients with chronic low back pain: randomised controlled trial. Pain 2022; 163:2430-2437. [PMID: 35384931 DOI: 10.1097/j.pain.0000000000002644] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cognitive functional therapy (CFT) is a physiotherapy-led intervention which has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of chronic low back pain (CLBP). The current evidence about the comparative effectiveness of CFT for CLBP is still scarce. We aimed to investigate whether CFT is more effective than core training exercise and manual therapy (CORE-MT) in pain and disability in patients with CLBP. A total of 148 adults with CLBP were randomly assigned to receive five one-hour individualised sessions of either CFT (n = 74) or CORE-MT (n = 74) within a period of 8 weeks. Primary outcomes were pain intensity (numeric pain rating scale, 0-10) and disability (Oswestry Disability Index, 0-100) at 8 weeks. Patients were assessed pre-intervention, at 8 weeks, 6 and 12 months after the first treatment session. Altogether, 97.3% (n=72) of patients in each intervention group completed the 8 weeks of the trial. CFT was more effective than CORE-MT in disability at 8 weeks (MD= -4.75; 95% CI -8.38 to -1.11; p=0.011, effect size= 0.55), but not in pain intensity (MD= -0.04; 95% CI -0.79 to 0.71; p=0.916). Treatment with CFT reduced disability, but the difference was not clinically important compared with CORE-MT post-intervention (short term) in patients with CLBP. There was no difference in pain intensity between interventions, and the treatment effect was not maintained in the mid-term and long-term follow-ups.
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Ho EKY, Chen L, Simic M, Ashton-James CE, Comachio J, Wang DXM, Hayden JA, Ferreira ML, Ferreira PH. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. BMJ 2022; 376:e067718. [PMID: 35354560 PMCID: PMC8965745 DOI: 10.1136/bmj-2021-067718] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN Systematic review with network meta-analysis. DATA SOURCES Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138074.
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Affiliation(s)
- Emma Kwan-Yee Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lingxiao Chen
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire Elizabeth Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Josielli Comachio
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Xin Mo Wang
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jill Alison Hayden
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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