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Wilson L, Denham A, Ionova Y, O’Neill C, Greco CM, Hassett AL, Hanmer J, Shaikh S, Wolf M, Bervin S, Williams D, Ma Y, Lotz J, Zheng P. Preferences for risks and benefits of treatment outcomes for chronic low back pain: Choice-based conjoint measure development and discrete choice experiment. PM R 2024; 16:836-847. [PMID: 38040670 PMCID: PMC11251494 DOI: 10.1002/pmrj.13112] [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: 05/10/2023] [Revised: 10/10/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited. OBJECTIVE To develop and test a choice-based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid. DESIGN We developed a survey-based CBC measure to allow patients to make risk/benefit trade-off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Random-parameters logit models were used to estimate strength of preferences, and latent class analysis was used to identify patient characteristics associated with distinct preference. SETTING Online study using the Sawtooth web-based platform. PARTICIPANTS Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions. INTERVENTIONS Not applicable. RESULTS The most valued outcome was the highest level of physical activity (β = 1.6-1.98; p < .001), followed by avoiding cognitive difficulties (β = -1.48; p < .001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β = -0.99, -1.02); p < .001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability have stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk-seeking and willing to accept worse outcomes (56%); and (2) more risk-averse with a stronger preference for achieving maximum benefits (44%). CONCLUSIONS Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences to aid informed, shared decisions.
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Affiliation(s)
- Leslie Wilson
- University of California San Francisco, San Francisco
| | | | - Yelena Ionova
- University of California San Francisco, San Francisco
| | - Conor O’Neill
- University of California San Francisco, San Francisco
| | | | - Afton L. Hassett
- University of Michigan Medical School, Department of Anesthesiology, 1500 E. Medical Center Drive, Ann Arbor, MI 48109
| | | | | | - M. Wolf
- University of California San Francisco, San Francisco
| | - Sigurd Bervin
- University of California San Francisco, San Francisco
| | | | | | - Jeffrey Lotz
- University of California San Francisco, San Francisco
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Siviter LM, Morretta M, Petosky T, Klopper M, Rhon DI, Young JL. Self-acknowledged limitations in exercise therapy trials for low back pain. J Eval Clin Pract 2024. [PMID: 38837313 DOI: 10.1111/jep.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/09/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
RATIONALE Despite the widespread recommendation to engage in therapeutic exercise for the treatment of low back pain (LBP), there is conflicting evidence regarding clinical outcomes and effectiveness. Poor methodological quality may be to blame for reducing the overall strength of evidence for this intervention, yet little is known about the difficulties researchers encounter when designing and implementing their study methods. AIMS AND OBJECTIVES The aim of this study was to characterize the extent and type of self-acknowledged limitations (SALs) in exercise therapy trials for LBP to gain a better understanding of challenges encountered when conducting this research. METHODS This is a methodological review of clinical trials in which SALs were extracted, categorized by theme and subcategorized within each theme. Counts and prevalence rates were tabulated for the number of SALs in each category and subcategory. RESULTS There were 914 SALs among the 312 included trials, with a mean of 2.93 (95% confidence interval [CI], 2.77-3.09) per trial. Analysis of the data resulted in the development of 13 distinct categories of limitations, among which were 37 subcategories. The top three categories pertained to statistical power (14.3% of total SALs), study length and/or follow-up (14.3%) and inclusion criteria (14.2%). The top three subcategories were lack of long-term follow-up (13.8% of total SALs), inadequate sample size (13.3%) and inclusion of specific populations (12.3%). CONCLUSION Statistical power, study length and/or follow-up, and inclusion criteria were the three most commonly reported categories of SALs in exercise trials for LBP. Lack of long-term follow-up, inadequate sample size and inclusion of specific populations were the most common subcategories. Research protocols recognizing and avoiding these limitations will enhance the overall quality of evidence of exercise therapy trials for LBP.
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Affiliation(s)
- Laura M Siviter
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- University of St. Augustine for Health Sciences, Physical Therapy Department, San Marcos, California, USA
| | - Matthew Morretta
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- University of St. Augustine for Health Sciences, Physical Therapy Department, San Marcos, California, USA
| | - Teressa Petosky
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- Faulkner University, Physical Therapy Department, Montgomery, Alabama, USA
| | - Mareli Klopper
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- Graceland University, Physical Therapy Department, Lamoni, Iowa, USA
| | - Daniel I Rhon
- Uniformed Services University, Rehabilitation Medicine Department, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
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Agger N, Bøjstrup JN, Christiansen DH. Patient Preferences and Their Effects on Rehabilitation Outcomes: A Secondary Analysis of a Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:408-416. [PMID: 38530232 DOI: 10.2519/jospt.2024.12314] [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 assess the effect of aligning patients' preferences with specific rehabilitation delivery modes on rehabilitation outcomes. DESIGN: A secondary analysis of a randomized controlled trial. METHODS: The study cohort comprised 208 patients referred for physiotherapy rehabilitation after nonsurgical or surgical interventions for rotator cuff injury, shoulder impingement, or acromioclavicular osteoarthritis. Participants were randomly assigned to 1 of 3 rehabilitation modalities: (1) group-based exercise, (2) individual exercise, or (3) home exercise. In this study, participants were categorized into 2 groups: "matched preference" and "unmatched preference." The primary outcome measure was change in function, measured with the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH). Secondary outcome measures were change in pain, assessed using the Numeric Rating Scale (NRS), mental well-being measured with the World Health Organization Five Well-Being Index (WHO-5), health-related quality of life assessed using the EuroQol-5 Domain questionnaire (EQ-5D), fear avoidance assessed using the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and overall treatment satisfaction. Outcomes were assessed at 3 and 6 months. RESULTS: The primary outcome measure, QuickDASH, showed no significant differences between groups at either 3 months (-3.0 [-8.2 to 2.3]) or 6 months (0.5 [-5.7 to 6.7]). Additionally, no significant differences were observed in the secondary outcome measures. CONCLUSION: Matching patients' preferences for specific rehabilitation delivery modes did not seem to effect rehabilitation outcomes. J Orthop Sports Phys Ther 2024;54(6):1-9. Epub 26 March 2024. doi:10.2519/jospt.2024.12314.
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Iqbal J, Roy JM, Kazim SF, Bowers CA. Frailty-based prehabilitation for patients undergoing spinal deformity surgery. J Neurosurg Sci 2024; 68:248-249. [PMID: 37721773 DOI: 10.23736/s0390-5616.23.06132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan -
| | - Joanna M Roy
- Topiwala National Medical College, Mumbai, India
| | - Syed F Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
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Bastiaens F, Wegener JT, Ostelo RWJG, van Roosendaal BKWP, Vissers KCP, van Hooff ML. Clinical Patient-Relevant Outcome Domains for Persistent Spinal Pain Syndrome-A Scoping Review and Expert Panels. J Clin Med 2024; 13:1975. [PMID: 38610739 PMCID: PMC11012536 DOI: 10.3390/jcm13071975] [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: 02/13/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient's perspective. The study objectives were to identify patient-relevant outcome domains for PSPS and to establish a PSPS outcomes framework. PubMed, CINAHL, Cochrane, and EMBASE were searched to identify studies reporting views or preferences of PSPS patients on outcome domains. The Arksey and O'Malley framework was followed to identify outcome domains. An expert panel rated the domains based on the importance for PSPS patients they have treated. A framework of relevant outcome domains was established using the selected outcome domains by the expert panel. No studies were found for PSPS type 1. Five studies with 77 PSPS type 2 patients were included for further analysis. Fourteen outcome domains were identified. An expert panel, including 27 clinical experts, reached consensus on the domains pain, daily activities, perspective of life, social participation, mobility, mood, self-reliance, and sleep. Eleven domains were included in the PSPS type 2 outcomes framework. This framework is illustrative of a more holistic perspective and should be used to improve the evaluation of care for PSPS type 2 patients. Further research is needed on the prioritization of relevant outcome domains.
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Affiliation(s)
- Ferdinand Bastiaens
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Jessica T. Wegener
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Kristian W. P. van Roosendaal
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Miranda L. van Hooff
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Iannuzzelli K, Suzuki S, Karavolos K, Powell LH. Patient Preferences for Lifestyle Management in a Multi-site Randomized Lifestyle Trial for Remission of the Metabolic Syndrome. Int J Behav Med 2024:10.1007/s12529-024-10278-2. [PMID: 38519811 DOI: 10.1007/s12529-024-10278-2] [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: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Randomized behavioral clinical trials are the gold standard for evaluating efficacy of a behavioral treatment. However, because participants are generally unblinded to treatment, preference for a specific treatment option can lead to biased results and/or reduced treatment efficacy. The purpose was to describe the relative frequency and correlates of existence of a preference and patient preference for either an in-person group-based or a remote self-directed, lifestyle treatment prior to randomization to one of these treatments. METHODS The Enhanced Lifestyles for Metabolic Syndrome (ELM) trial is a multi-site behavioral clinical trial that compares efficacy of a group-based vs. a self-directed approach to lifestyle change on 2-year remission of the metabolic syndrome. Prior to randomization, participants were asked whether they had a preference for a particular treatment and, if so, which approach they preferred. Baseline data were used for a series of logistic regression models to determine behavioral correlates of treatment preference, independent of socioeconomic factors. RESULTS Of the 331 participants, 131 (39.6%) had no preference for either treatment. Among the 200 with a preference, 56 (28.0%) preferred the self-directed program. Strength of a pre-existing habit of eating vegetables on most days was an independent correlate of no preference (adjusted OR, 1.27; 95% CI, 1.01-1.61; p = 0.03) and preference for a self-directed program (adjusted OR, 1.55; 95% CI, 1.09-2.22; p = 0.01). CONCLUSION A pre-existing habit of eating vegetables was associated with no preference and preference for a less intensive lifestyle treatment. Post-treatment follow-up of the trial results will determine if concordance between preference and treatment assignment influences outcomes.
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Affiliation(s)
- Katherine Iannuzzelli
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Sumihiro Suzuki
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kelly Karavolos
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Lynda H Powell
- Department of Preventative Medicine, Rush University Medical Center, Chicago, IL, USA
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López-Marcos JJ, Díaz-Arribas MJ, Valera-Calero JA, Navarro-Santana MJ, Izquierdo-García J, Ortiz-Gutiérrez RM, Plaza-Manzano G. The Added Value of Face-to-Face Supervision to a Therapeutic Exercise-Based App in the Management of Patients with Chronic Low Back Pain: A Randomized Clinical Trial. SENSORS (BASEL, SWITZERLAND) 2024; 24:567. [PMID: 38257659 PMCID: PMC10819225 DOI: 10.3390/s24020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
Low back pain (LBP) is a significant global health challenge due to its high prevalence, and chronicity and recurrence rates, with projections suggesting an increase in the next years due to population growth and aging. The chronic and recurrent nature of LBP, responsible for a significant percentage of years lived with disability, underscores the need for effective management strategies, including self-management strategies advocated by current guidelines, to empower patients and potentially improve healthcare efficiency and clinical outcomes. Therefore, the aim of this study was to analyze the added value of face-to-face visits in patients with chronic LBP undergoing a self-management program based on therapeutic exercises on pain intensity, disability, quality of life and treatment adherence and satisfaction. A randomized clinical trial was conducted, allocating 49 patients into a experimental group with a mobile health (mHealth) app usage and face-to-face sessions and 49 patients into an active control group without face-to-face sessions. Pain intensity, disability and quality of life were assessed at baseline, 4 weeks postintervention and 12 weeks postintervention. Patients' satisfaction and adherence were assessed at the end of the study. The multivariate general model revealed no statistically significant time × group interaction for any outcome (p > 0.0068) but mental quality of life (p = 0.006). Within-group differences revealed significant improvements for all the clinical indicators (all, p < 0.001). Patients allocated to the experimental group reported greater satisfaction and adherence (both, p < 0.001) compared to the control group. The use of mHealth apps such as Healthy Back® as part of digital health initiatives may serve as a beneficial approach to enhance the management of LBP.
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Affiliation(s)
- José Javier López-Marcos
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Faculty of Life and Natural Sciences, Nebrija University, 28015 Madrid, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Izquierdo-García
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Multidisciplinary Cardiac Rehabilitation Unit, University Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Rosa María Ortiz-Gutiérrez
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (J.J.L.-M.); (J.A.V.-C.); (M.J.N.-S.); (J.I.-G.); (R.M.O.-G.); (G.P.-M.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Taylor RS, Soliday N, Leitner A, Hunter CW, Staats PS, Li S, Thomson S, Kallewaard JW, Russo M, Duarte RV. Association Between Levels of Functional Disability and Health-Related Quality of Life With Spinal Cord Stimulation for Chronic Pain. Neuromodulation 2022:S1094-7159(22)00650-X. [DOI: 10.1016/j.neurom.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
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Lee S, Jang SH, Suzuki-Narita M, Gregoire S, Millecamps M, Stone LS. Voluntary running attenuates behavioural signs of low back pain: dimorphic regulation of intervertebral disc inflammation in male and female SPARC-null mice. Osteoarthritis Cartilage 2022; 30:110-123. [PMID: 34534663 DOI: 10.1016/j.joca.2021.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/12/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the effect of running exercise on behavioral measures of pain and intervertebral disc (IVD) inflammation in the SPARC-null mouse model. METHODS Male and female 8-month old SPARC-null and age-matched control mice received a home cage running wheel or a control, fixed wheel for 6 months. Behavioral assays were performed to assess axial discomfort (grip test) and radiating leg pain (von Frey, acetone tests) and voluntary running was confirmed. Expression of inflammatory mediators (TNF-α, IL-1β, IL-2, IL-10, CCL5, CXCL1, CXCL5, RANKL, M-CSF, and VEGF) in IVDs was determined. Additional inflammatory (IL-1β, IL-1Ra, CXCR1, CXCR2) and macrophage phenotypic markers (ITGAM, CD80, CD86, CD206, Arg1) in IVDs were investigated by qPCR. RESULTS Voluntary running attenuated behavioral measures of pain in male and female SPARC-null mice. Increases in mediators including IL-1β, CXCL1 and CXCL5 were observed in SPARC-null compared to control IVDs. After 6 months of running, increases in M-CSF and VEGF were observed in male SPARC-null IVDs. In females, pro-inflammatory mediators, including CXCL1 and CXCL5 were downregulated by running in SPARC-null mice. qPCR analysis further confirmed the anti-inflammatory effect of running in female IVDs with increased IL-1Ra mRNA. Running induced upregulation of the macrophage marker ITGAM mRNA in males. CONCLUSIONS Voluntary running reversed behavioral signs of pain in male and female mice and reduced inflammatory mediators in females, but not males. Thus, the therapeutic mechanism of action may be sex-specific.
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Affiliation(s)
- S Lee
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - S H Jang
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - M Suzuki-Narita
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Gregoire
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - M Millecamps
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - L S Stone
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada; Department of Anesthesiology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Pharmacology & Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Anesthesiology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA.
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Higuita-Gutiérrez LF, Estrada-Mesa DA, Cardona-Arias JA. Preferences in a Group of Patients with Cancer: A Grounded Theory. Patient Prefer Adherence 2021; 15:2313-2326. [PMID: 34703214 PMCID: PMC8526945 DOI: 10.2147/ppa.s328971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia. METHODS A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory. RESULTS A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life. CONCLUSION The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.
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Affiliation(s)
- Luis Felipe Higuita-Gutiérrez
- School of Medicine, Universidad Cooperativa de Colombia, Medellín, Antioquia, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín, Antioquia, Colombia
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Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain. BMC Musculoskelet Disord 2021; 22:191. [PMID: 33593341 PMCID: PMC7885433 DOI: 10.1186/s12891-021-04028-8] [Citation(s) in RCA: 3] [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: 02/24/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Proven treatments for low back pain, at best, only provide modest overall benefits. Matching people to treatments that are likely to be most effective for them may improve clinical outcomes and makes better use of health care resources. Methods We conducted an individual participant data meta-analysis of randomised controlled trials of three types of therapist delivered interventions for low back pain (active physical, passive physical and psychological treatments). We applied two statistical methods (recursive partitioning and adaptive risk group refinement) to identify potential subgroups who might gain greater benefits from different treatments from our individual participant data meta-analysis. Results We pooled data from 19 randomised controlled trials, totalling 9328 participants. There were 5349 (57%) females with similar ratios of females in control and intervention arms. The average age was 49 years (standard deviation, SD, 14). Participants with greater psychological distress and physical disability gained most benefit in improving on the mental component scale (MCS) of SF-12/36 from passive physical treatment than non-active usual care (treatment effects, 4.3; 95% confidence interval, CI, 3.39 to 5.15). Recursive partitioning method found that participants with worse disability at baseline gained most benefit in improving the disability (Roland Morris Disability Questionnaire) outcome from psychological treatment than non-active usual care (treatment effects, 1.7; 95% CI, 1.1 to 2.31). Adaptive risk group refinement did not find any subgroup that would gain much treatment effect between psychological and non-active usual care. Neither statistical method identified any subgroups who would gain an additional benefit from active physical treatment compared to non-active usual care. Conclusions Our methodological approaches worked well and may have applicability in other clinical areas. Passive physical treatments were most likely to help people who were younger with higher levels of disability and low levels of psychological distress. Psychological treatments were more likely to help those with severe disability. Despite this, the clinical importance of identifying these subgroups is limited. The sizes of sub-groups more likely to benefit and the additional effect sizes observed are small. Our analyses provide no evidence to support the use of sub-grouping for people with low back pain. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04028-8.
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de Oliveira Meirelles F, de Oliveira Muniz Cunha JC, da Silva EB. Osteopathic manipulation treatment versus therapeutic exercises in patients with chronic nonspecific low back pain: A randomized, controlled and double-blind study. J Back Musculoskelet Rehabil 2020; 33:367-377. [PMID: 31658037 DOI: 10.3233/bmr-181355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteopathic manipulation treatment is widely used in the clinical practice in the care of patients with chronic nonspecific low back pain, however, its benefits still seem uncertain. OBJECTIVE This study aimed to verify the efficacy of osteopathic manipulation for chronic nonspecific low back pain. MATERIALS AND METHODS Forty-two participants with chronic nonspecific low back pain were selected and randomized into two groups: active control group (ACG - n= 19) and osteopathic manipulation treatment group (OMTG - n= 23). Therapeutic exercises were performed with the ACG and osteopathic manipulation techniques with the OMTG. The interventions were carried out over 5 weeks of treatment, totaling 10 treatments for the ACG and 5 for the OMTG.The visual analogue scale (VAS) was used to measure chronic nonspecific low back pain and the Oswestry Disability Index 2.0, Tampa Scale of Kinesiophobia and Beck Depression Inventory were used to measure disability, kinesiophobia and depression, respectively. RESULTS The final chronic nonspecific low back pain in both groups was significantly lower than the initial low back pain (p⩽ 0.01) and the final chronic nonspecific low back pain of the OMTG was significantly lower than that of the ACG (p= 0.001). CONCLUSION This study demonstrated that the treatments were effective in both groups. However, the efficacy of the osteopathic manipulation treatment was greater than that of the therapeutic exercises.
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Affiliation(s)
- Frederico de Oliveira Meirelles
- Estacio de Sá University, Rio de Janeiro, Brazil.,Instituto de Educação Física e Desportos, Rio de Janeiro State University, Brazil, Rio de Janeiro
| | | | - Elirez Bezerra da Silva
- Instituto de Educação Física e Desportos, Rio de Janeiro State University, Brazil, Rio de Janeiro
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Hanel J, Owen PJ, Held S, Tagliaferri SD, Miller CT, Donath L, Belavy DL. Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis. Sports Med 2020; 50:2193-2207. [PMID: 32946074 DOI: 10.1007/s40279-020-01345-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours. OBJECTIVE We examined the effectiveness of exercise training on improving fear-avoidance beliefs. METHODS A systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted. RESULTS After screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] - 0.378 [- 0.623, - 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (- 0.407 [- 0.750, - 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (- 0.243 [- 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (- 0.530 [- 0.755, - 0.304], P < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low). CONCLUSION There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation. TRAIL REGISTRATION PROSPERO Registration Number: CRD42019139678.
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Affiliation(s)
- Joshua Hanel
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Steffen Held
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Scott D Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia
| | - Lars Donath
- German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia.
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Cheng JOS, Cheng ST. Effectiveness of physical and cognitive-behavioural intervention programmes for chronic musculoskeletal pain in adults: A systematic review and meta-analysis of randomised controlled trials. PLoS One 2019; 14:e0223367. [PMID: 31600270 PMCID: PMC6786598 DOI: 10.1371/journal.pone.0223367] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
This systematic review and meta-analysis aimed to examine the effects of physical exercise cum cognitive-behavioural therapy (CBT) on alleviating pain intensity, functional disabilities, and mood/mental symptoms in those suffering with chronic musculoskeletal pain. MEDLINE, EMBASE, PubMEd, PsycINFO and CINAHL were searched to identify relevant randomised controlled trials from inception to 31 December 2018. The inclusion criteria were: (a) adults ≥18 years old with chronic musculoskeletal pain ≥3 months, (b) randomised controlled design, (c) a treatment arm consisting of physical intervention and CBT combined, (d) the comparison arm being waitlist, usual care or other non-pharmacological interventions such as physical exercise or CBT alone, and (e) outcomes including pain intensity, pain-related functional disabilities (primary outcomes), or mood/mental symptoms (secondary outcome). The exclusion criteria were: (a) the presence of comorbid mental illnesses other than depression and anxiety and (b) non-English publication. The search resulted in 1696 records and 18 articles were selected for review. Results varied greatly across studies, with most studies reporting null or small effects but a few studies reporting very large effects up to 2-year follow-up. Pooled effect sizes (Hedges’ g) were ~1.00 for pain intensity and functional disability, but no effect was found for mood/mental symptoms. The effects were mainly driven by several studies reporting unusually large differences between the exercise cum CBT intervention and exercise alone. When these outliers were removed, the effect on pain intensity disappeared at post-intervention while a weak effect (g = 0.21) favouring the combined intervention remained at follow-up assessment. More consistent effects were observed for functional disability, though the effects were small (g = 0.26 and 0.37 at post-intervention and follow-up respectively). More importantly, the value of adding CBT to exercise interventions is questionable, as consistent benefits were not seen. The clinical implications and directions for future research are discussed.
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Affiliation(s)
- Joyce Oi Suet Cheng
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- * E-mail:
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Delevry D, Le QA. Effect of Treatment Preference in Randomized Controlled Trials: Systematic Review of the Literature and Meta-Analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:593-609. [PMID: 31372909 DOI: 10.1007/s40271-019-00379-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A significant limitation of the traditional randomized controlled trials is that strong preferences for (or against) one treatment may influence outcomes and/or willingness to receive treatment. Several trial designs incorporating patient preference have been introduced to examine the effect of treatment preference separately from the effects of individual interventions. In the current study, we summarized results from studies using doubly randomized preference trial (DRPT) or fully randomized preference trial (FRPT) designs and examined the effect of treatment preference on clinical outcomes. METHODS The current systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies using DRPT or FRPT design were identified using electronic databases, including PubMed, Cochrane Library, EMBASE, and Google Scholar between January 1989 and November 2018. All studies included in this meta-analysis were examined to determine the extent to which giving patients their preferred treatment option influenced clinical outcomes. The following data were extracted from included studies: study characteristics, sample size, study duration, follow-up, patient characteristics, and clinical outcomes. We further appraised risk of bias for the included studies using the Cochrane Collaboration's risk of bias tool. RESULTS The search identified 374 potentially relevant articles, of which 27 clinical trials utilized a DRPT or FRPT design and were included in the final analysis. Overall, patients who were allocated to their preferred treatment intervention were more likely to achieve better clinical outcomes [effect size (ES) = 0.18, 95% confidence interval (CI) 0.10-0.26]. Subgroup analysis also found that mental health as well as pain and functional disorders moderated the preference effect (ES = 0.23, 95% CI 0.11-0.36, and ES = 0.09, 95% CI 0.03-0.15, respectively). CONCLUSIONS Matching patients to preferred interventions has previously been shown to promote outcomes such as satisfaction and treatment adherence. Our analysis of current evidence showed that allowing patients to choose their preferred treatment resulted in better clinical outcomes in mental health and pain than giving them a treatment that is not preferred. These results underline the importance of incorporating patient preference when making treatment decisions.
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Affiliation(s)
- Dimittri Delevry
- College of Pharmacy, Western University of Health Sciences, 309 East Second Street, Pomona, CA, 91766, USA
| | - Quang A Le
- College of Pharmacy, Western University of Health Sciences, 309 East Second Street, Pomona, CA, 91766, USA.
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Kellett S, Hall J, Compton Dickinson S. Group cognitive analytic music therapy: a quasi-experimental feasibility study conducted in a high secure hospital. NORDIC JOURNAL OF MUSIC THERAPY 2018. [DOI: 10.1080/08098131.2018.1529697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stephen Kellett
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Jo Hall
- University of Sheffield, Sheffield, UK
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Vagnoni E, Biavati GR, Felisatti M, Pomidori L. Moderating healthcare costs through an assisted physical activity programme. Int J Health Plann Manage 2018; 33:1146-1158. [PMID: 30074649 DOI: 10.1002/hpm.2596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/04/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During the last decades, physical inactivity has become increasingly important due to its effects on health; in the medical field, it has been highlighted that physical inactivity is one of the leading cause of death. Moreover, the increasing trend in a sedentary lifestyle has also led to economic concerns; for this reason, the need to develop healthcare programmes to raise awareness of the benefits of physical exercise among the global population has arisen. OBJECTIVE This paper analyses the relationship between moderate physical activity, cost of pharmaceuticals and health services utilization with regard to a primary care community programme based on moderate exercise intervention. The study highlights the effect of an exercise programme for people in sheltered accommodation in terms of effects on their quality of life and in terms of economic sustainability. METHODOLOGY A randomized controlled trial of an exercise programme was designed. A total of 150 patients were randomized in two groups. The intervention group was recruited from Centro Esercizio Vita whereas the participants of the control group were recruited from general practitioners. RESULTS At 9 months after randomization, the exercise-based group presented a lower average cost for drugs (p-value 0.039), an overall better health status perception (p-value 0.0019) and accessed general practitioners less frequently (p-value 0.058). CONCLUSIONS Our study shows that assisted physical activity practiced on the basis of an exercise programme, over a period of nine months, has overall positive consequences in terms of reduction in health expenditure and quality of life.
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Affiliation(s)
- Emidia Vagnoni
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
| | - Giulia Rita Biavati
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
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Does an Aerobic Exercise Improve Outcomes in Older Sedentary Nonspecific Low Back Pain Subjects? A Randomized Controlled Study. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Dose-Response Effects of Aerobic Exercise on Quality of Life in Postmenopausal Women: Results from the Breast Cancer and Exercise Trial in Alberta (BETA). Ann Behav Med 2018; 51:356-364. [PMID: 27837524 DOI: 10.1007/s12160-016-9859-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exercise generally improves quality of life (QoL) and psychosocial functioning in adult populations but few randomized trials have examined dose-response effects. PURPOSE The purpose of the present study was to report the QoL and psychosocial outcomes from the Breast Cancer and Exercise Trial in Alberta (BETA). METHODS Healthy but inactive postmenopausal women at risk for breast cancer were randomized to a year-long aerobic exercise intervention consisting of either 150 min/week (moderate volume group, n = 200) or 300 min/week (high volume group, n = 200). QoL was assessed at baseline and 1 year using the short form-36 health survey. Sleep quality, depression, anxiety, stress, self-esteem, and happiness were also assessed. Participant preference for group assignment (i.e., exercise volume) was assessed at baseline and tested as a moderator. RESULTS There were no statistically significant dose-response effects of aerobic exercise on any QoL, sleep quality, or psychosocial outcome. Participant preference for group assignment did not moderate any QoL, sleep quality, or psychosocial responses. Marital status was a significant moderator (p for interaction = 0.01) and obesity showed a trend towards being a moderator (p for interaction = 0.08) of the dose-response effects of aerobic exercise on global sleep quality such that unmarried and obese women improved sleep quality with the higher volume of aerobic exercise. CONCLUSIONS A higher volume of aerobic exercise, approximately double the minimum public health guideline, did not provide additional QoL or psychosocial benefits compared to the minimum public health guideline in inactive postmenopausal women, even for women who preferred the higher volume of exercise at baseline. TRIAL REGISTRATION Trial Registration clinicaltrials.gov identifier: NCT1435005.
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Beasley MJ, Ferguson-Jones EA, Macfarlane GJ. Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017. [PMID: 29521378 PMCID: PMC5824705 DOI: 10.1080/24740527.2017.1384297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In unblinded trials this can affect outcomes. Aims: The aim of this analysis was to examine the association between treatment preference and expectation and outcome in a trial of pain treatments. Methods: In a randomized trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time points after treatment were compared between those matched or unmatched with their preference and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation. Results: Four hundred forty-two participants were recruited to the trial (69.5% female). The proportion reporting positive outcomes among participants matched to their preference compared to those unmatched was 33.3% vs. 34.4% at the end of treatment (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.44-1.46), 34.4% vs. 29.0% at 3 months (aOR = 1.23, 95% CI, 0.67-2.26), and 34.8% vs. 30.3% at 2 years (aOR = 1.31, 95% CI, 0.70-2.46). The proportion of participants reporting positive outcomes among those expecting improvement compared to those not expecting improvement was 36.6% vs. 15.0% at the end of treatment (aOR = 2.03, 95% CI, 1.07-3.85), 34.1% vs. 13.2% at 3 months (aOR = 2.31, 95% CI, 1.22-4.38), and 32.8% vs. 19.1% at 2 years (aOR = 1.16, 95% CI, 0.67-2.36). Conclusions: Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, and researchers assessing treatments should take into account this expectation effect.
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Affiliation(s)
- Marcus John Beasley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Elizabeth Alice Ferguson-Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Gary John Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
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Marin TJ, Van Eerd D, Irvin E, Couban R, Koes BW, Malmivaara A, van Tulder MW, Kamper SJ. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev 2017; 6:CD002193. [PMID: 28656659 PMCID: PMC6481490 DOI: 10.1002/14651858.cd002193.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Low back pain (LBP) is associated with enormous personal and societal burdens, especially when it reaches the chronic stage of the disorder (pain for a duration of more than three months). Indeed, individuals who reach the chronic stage tend to show a more persistent course, and they account for the majority of social and economic costs. As a result, there is increasing emphasis on the importance of intervening at the early stages of LBP.According to the biopsychosocial model, LBP is a condition best understood with reference to an interaction of physical, psychological, and social influences. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.This review is an update of a Cochrane Review on MBR for subacute LBP, which was published in 2003. It is part of a series of reviews on MBR for musculoskeletal pain published by the Cochrane Back and Neck Group and the Cochrane Musculoskeletal Group. OBJECTIVES To examine the effectiveness of MBR for subacute LBP (pain for a duration of six to 12 weeks) among adults, with a focus on pain, back-specific disability, and work status. SEARCH METHODS We searched for relevant trials in any language by a computer-aided search of CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and two trials registers. Our search is current to 13 July 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with subacute LBP. We included studies that investigated a MBR program compared to any type of control intervention. We defined MBR as an intervention that included a physical component (e.g. pharmacological, physical therapy) in combination with either a psychological, social, or occupational component (or any combination of these). We also required involvement of healthcare professionals from at least two different clinical backgrounds with appropriate training to deliver the component for which they were responsible. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In particular, the data extraction and 'risk of bias' assessment were conducted by two people, independently. We used the Cochrane tool to assess risk of bias and the GRADE approach to assess the overall quality of the evidence for each outcome. MAIN RESULTS We included a total of nine RCTs (981 participants) in this review. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years.All included studies were judged as having high risk of performance bias and high risk of detection bias due to lack of blinding, and four of the nine studies suffered from at least one additional source of possible bias.In MBR compared to usual care for subacute LBP, individuals receiving MBR had less pain (four studies with 336 participants; SMD -0.46, 95% CI -0.70 to -0.21, moderate-quality of evidence due to risk of bias) and less disability (three studies with 240 participants; SMD -0.44, 95% CI -0.87 to -0.01, low-quality of evidence due to risk of bias and inconsistency), as well as increased likelihood of return-to-work (three studies with 170 participants; OR 3.19, 95% CI 1.46 to 6.98, very low-quality of evidence due to serious risk of bias and imprecision) and fewer sick leave days (two studies with 210 participants; SMD -0.38 95% CI -0.66 to -0.10, low-quality of evidence due to risk of bias and imprecision) at 12-month follow-up. The effect sizes for pain and disability were low in terms of clinical meaningfulness, whereas effects for work-related outcomes were in the moderate range.However, when comparing MBR to other treatments (i.e. brief intervention with features from a light mobilization program and a graded activity program, functional restoration, brief clinical intervention including education and advice on exercise, and psychological counselling), we found no differences between the groups in terms of pain (two studies with 336 participants; SMD -0.14, 95% CI -0.36 to 0.07, low-quality evidence due to imprecision and risk of bias), functional disability (two studies with 345 participants; SMD -0.03, 95% CI -0.24 to 0.18, low-quality evidence due to imprecision and risk of bias), and time away from work (two studies with 158 participants; SMD -0.25 95% CI -0.98 to 0.47, very low-quality evidence due to serious imprecision, inconsistency and risk of bias). Return-to-work was not reported in any of the studies.Although we looked for adverse events in both comparisons, none of the included studies reported this outcome. AUTHORS' CONCLUSIONS On average, people with subacute LBP who receive MBR will do better than if they receive usual care, but it is not clear whether they do better than people who receive some other type of treatment. However, the available research provides mainly low to very low-quality evidence, thus additional high-quality trials are needed before we can describe the value of MBP for clinical practice.
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Affiliation(s)
- Teresa J Marin
- York UniversityDepartment of Psychology209 Behavioural Sciences Building4700 Keele StreetTorontoONCanadaM3J 1P3
| | - Dwayne Van Eerd
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Emma Irvin
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Rachel Couban
- McMaster UniversityDepartment of Anesthesiology1280 Main Street WestHamiltonONCanadaL8S 4K1
| | - Bart W Koes
- Erasmus Medical CenterDepartment of General PracticePO Box 2040RotterdamNetherlands3000 CA
| | - Antti Malmivaara
- National Institute for Health and Welfare (THL)Centre for Health and Social Economics (CHESS)PO Box 30Mannerheimintie 166HelsinkiFinlandFI‐00271
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Steven J Kamper
- The George Institute for Global HealthMusculoskeletal DivisionPO Box M201Missenden Road, CamperdownSydneyNSWAustralia2050
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Ciolac EG, Rodrigues-da-Silva JM. Resistance Training as a Tool for Preventing and Treating Musculoskeletal Disorders. Sports Med 2017; 46:1239-48. [PMID: 26914266 DOI: 10.1007/s40279-016-0507-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aging process is characterized by several physiological, morphological, and psychological alterations that result in a decreased functional and health status throughout the life span. Among these alterations, the loss of muscle mass and strength (sarcopenia) is receiving increased attention because of its association with innumerous age-related disorders, including (but not limited to) osteoporosis, osteoarthritis, low back pain, risk of fall, and disability. Regular participation in resistance training programs can minimize the musculoskeletal alterations that occur during aging, and may contribute to the health and well-being of the older population. Compelling evidence suggest that regular practice of resistance exercise may prevent and control the development of several musculoskeletal chronic diseases. Moreover, resistance training may also improve physical fitness, function, and independence in older people with musculoskeletal disorders, which may result in improved quality of the years lived. In summary, regular participation in resistance training programs plays an important role in aging and may be a preventive and therapeutic tool for several musculoskeletal disorders.
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Affiliation(s)
- Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University-UNESP, Av. Engenheiro Luiz Edmundo Carrijo Coube 14-06, Bauru, 17033-360, Brazil.
| | - José Messias Rodrigues-da-Silva
- Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University-UNESP, Av. Engenheiro Luiz Edmundo Carrijo Coube 14-06, Bauru, 17033-360, Brazil
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Madera M, Brady J, Deily S, McGinty T, Moroz L, Singh D, Tipton G, Truumees E. The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review. J Neurosurg Spine 2017; 26:694-704. [PMID: 28291412 DOI: 10.3171/2016.10.spine16627] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an exhaustive review of multiple electronic databases. Potential articles were screened using inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data fields, including study quality indicators such as level of evidence and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. A third author resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation, the need for rehabilitation relative to surgery-related morbidity, rehabilitation's relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the 12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start. Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade evidence. In these cases, the authors used "best evidence available" to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion rehabilitation remains elusive but, using the data available, the authors have crafted recommendations and a model protocol, which is currently undergoing prospective study. CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for future postoperative lumbar fusion rehabilitation research.
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Affiliation(s)
- Marcella Madera
- Department of Surgery and Perioperative Care, The University of Texas Dell Medical School
| | | | | | | | - Lee Moroz
- Physical Medicine & Rehabilitation and
| | | | - George Tipton
- Orthopaedic Spine Surgery, Seton Spine & Rehabilitation; and
| | - Eeric Truumees
- Department of Surgery and Perioperative Care, The University of Texas Dell Medical School
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Ogston JB, Crowell RD, Konowalchuk BK. Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain. J Back Musculoskelet Rehabil 2016; 29:673-684. [PMID: 26922849 DOI: 10.3233/bmr-160669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy. OBJECTIVE To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning. METHODS Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks (n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises. RESULTS A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements. CONCLUSION CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design.
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Affiliation(s)
- Jena B Ogston
- Physical Therapy Program, College of St. Scholastica, Duluth, MN, USA
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Perigny-Lajoie S, Hebert JS. A scoping review on heterogeneity in rehabilitation research: implications for return to duty in a military population. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2016. [DOI: 10.3138/jmvfh.3972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Understanding population heterogeneity in rehabilitation research is important, since varying conditions can influence clinical outcomes. The objectives of this scoping review were to review rehabilitation studies that used a heterogeneous group in a civilian or military population, and to discuss the impact of heterogeneity on participation outcomes such as return to duty in the Canadian Armed Forces. Methods: Literature search resulted in extraction of 37 articles, which were sorted according to degree of heterogeneity and type of outcomes examined. Results: The largest number of studies pertained to civilians ( n=26), followed by military ( n=10), and Veterans ( n=1). We found various degrees of heterogeneity in population, setting, intervention, and outcome in these studies. Discussion: Studies extracted seemed to show a superior positive outcome in return to work/duty when the group was heterogeneous. Military rehabilitation studies examining return to duty tended to include a highly heterogeneous population. Future studies pertaining to return to work/duty and using a heterogeneous group should include a wide range of outcomes in the domains of the International Classification of Functioning, Health and Disease. Potential economic benefits in using a heterogeneous-based intervention are also discussed, along with implications for the Canadian Armed Forces.
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Affiliation(s)
| | - Jacqueline S. Hebert
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Walter SD, Turner R, Macaskill P, McCaffery KJ, Irwig L. Beyond the treatment effect: Evaluating the effects of patient preferences in randomised trials. Stat Methods Med Res 2016; 26:489-507. [DOI: 10.1177/0962280214550516] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatments under comparison in a randomised trial should ideally have equal value and acceptability – a position of equipoise – to study participants. However, it is unlikely that true equipoise exists in practice, because at least some participants may have preferences for one treatment or the other, for a variety of reasons. These preferences may be related to study outcomes, and hence affect the estimation of the treatment effect. Furthermore, the effects of preferences can sometimes be substantial, and may even be larger than the direct effect of treatment. Preference effects are of interest in their own right, but they cannot be assessed in the standard parallel group design for a randomised trial. In this paper, we describe a model to represent the impact of preferences on trial outcomes, in addition to the usual treatment effect. In particular, we describe how outcomes might differ between participants who would choose one treatment or the other, if they were free to do so. Additionally, we investigate the difference in outcomes depending on whether or not a participant receives his or her preferred treatment, which we characterise through a so-called preference effect. We then discuss several study designs that have been proposed to measure and exploit data on preferences, and which constitute alternatives to the conventional parallel group design. Based on the model framework, we determine which of the various preference effects can or cannot be estimated with each design. We also illustrate these ideas with some examples of preference designs from the literature.
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Affiliation(s)
- SD Walter
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - R Turner
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - P Macaskill
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - KJ McCaffery
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - L Irwig
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Patel S, Hee SW, Mistry D, Jordan J, Brown S, Dritsaki M, Ellard DR, Friede T, Lamb SE, Lord J, Madan J, Morris T, Stallard N, Tysall C, Willis A, Underwood M. Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThere is good evidence that therapist-delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority.Aim and objectivesTo improve the clinical effectiveness and cost-effectiveness of LBP treatment by providing patients, their clinical advisors and health-service purchasers with better information about which participants are most likely to benefit from which treatment choices. Our objectives were to synthesise what is already known about the validity, reliability and predictive value of possible treatment moderators (patient factors that predict response to treatment) for therapist-delivered interventions; develop a repository of individual participant data from randomised controlled trials (RCTs) testing therapist-delivered interventions for LBP; determine which participant characteristics, if any, predict clinical response to different treatments for LBP; and determine which participant characteristics, if any, predict the most cost-effective treatments for LBP. Achieving these objectives required substantial methodological work, including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse the main effect of interventions and no such interpretations should be made.MethodsFirst, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with > 179 participants to share their data with us; some further smaller trials that were offered to us were also included. Using these trials we developed a repository of individual participant data of therapist-delivered interventions for LBP. Using this data set we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical effectiveness and cost-effectiveness outcomes. We undertook an analysis of covariance to identify potential moderators to apply in our main analyses. Subsequently, we developed and applied three methods of subgroup identification: recursive partitioning (interaction trees and subgroup identification based on a differential effect search); adaptive risk group refinement; and an individual participant data indirect network meta-analysis (NWMA) to identify subgroups defined by multiple parameters.ResultsWe included data from 19 RCTs with 9328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of subgroup identification that we identified. Additionally, we explored the application of Bayesian indirect NWMA. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile.ConclusionsThese data lack clinical effectiveness or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas. The pooled repository database will serve as a valuable resource to the LBP research community.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands (AWM) and the Wolfson Foundation.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Jordan
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Surrey Health Economic Centre, School of Economics, University of Surrey, Guildford, UK
| | - Sally Brown
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David R Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah E Lamb
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joanne Lord
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Colin Tysall
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Adrian Willis
- Warwick Medical School, University of Warwick, Coventry, UK
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Cost-Effectiveness of Physical Therapy Only and of Usual Care for Various Health Conditions: Systematic Review. Phys Ther 2016; 96:774-86. [PMID: 26678447 DOI: 10.2522/ptj.20140333] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/06/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Given continually rising health care costs, interventions of health care providers should be cost-effective. PURPOSE This review aimed to summarize current cost-effectiveness of physical therapy. Specific aims were: (1) to analyze cost-effectiveness of physical therapy only compared with usual care only, (2) to analyze cost-effectiveness of physical therapy added to usual care compared with usual care only, and (3) to specify in which health conditions physical therapy only or physical therapy added to usual care was cost-effective. DATA SOURCES Topic-related systematic reviews were searched in MEDLINE, CINAHL, PEDro, and Cochrane Library and manually. STUDY SELECTION Studies published between 1998 and 2014 that investigated the cost-effectiveness of interventions carried out by physical therapists were reviewed. The methodological quality was assessed with the Cochrane risk of bias assessment for intervention studies and with the Quality of Health Economic Analyses Scale. DATA EXTRACTION Effectiveness and cost data for calculating incremental cost-effectiveness ratios (ICERs) and the original authors' conclusions were extracted. DATA SYNTHESIS The 18 included studies presented low risk of bias and contained 8 comparisons of physical therapy only with usual care only and 11 comparisons of physical therapy added to usual care with usual care only. Based on ICERs, physical therapy only or added to usual care was cost-effective in 9 out of the 19 comparisons and in 10 comparisons according to the original authors' conclusions. CONCLUSION Physical therapy only or added to usual care implies improved health in almost all studies. The cost-effectiveness of such interventions was demonstrated in half of the studies. This result might have been influenced by the fact that different definitions of the notion of "cost-effectiveness" exist.
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Van Dillen LR, Norton BJ, Sahrmann SA, Evanoff BA, Harris-Hayes M, Holtzman GW, Earley J, Chou I, Strube MJ. Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. ACTA ACUST UNITED AC 2016; 24:52-64. [PMID: 27317505 DOI: 10.1016/j.math.2016.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown. OBJECTIVES Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes. DESIGN 2 center, 2 parallel group, prospective, randomized, clinical trial. METHOD Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used. RESULTS 47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05). CONCLUSIONS There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.
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Affiliation(s)
- Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Barbara J Norton
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Shirley A Sahrmann
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, Campus Box 8228, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Bradley A Evanoff
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Gregory W Holtzman
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jeanne Earley
- Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA
| | - Irene Chou
- Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA
| | - Michael J Strube
- Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Psychology, Washington University, Campus Box 1125, One Brookings Drive, St. Louis, MO, 63130, USA
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Ojoawo AO, Odewole O, Odejide SA, Arilewola BO, Badru AG. Therapeutic efficacy of Lofnac Gel via phonophoresis in the management of chronic nonspecific low back pain: A randomised controlled trial. Hong Kong Physiother J 2015; 33:89-94. [PMID: 30930573 PMCID: PMC6385132 DOI: 10.1016/j.hkpj.2014.12.004] [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: 10/23/2022] Open
Abstract
BACKGROUND The prevalence of nonspecific low back pain is very high among Nigerians and in Africa. Lofnac Gel is a nonsteroidal anti-inflammatory gel that has been used to treat musculoskeletal pain, but its efficacy on nonspecific low back pain is inconclusive. OBJECTIVE The objective of this study was to examine the therapeutic efficacy of Lofnac Gel in the management of nonspecific low back pain. METHODS Seventy patients diagnosed with mechanical low back pain of 3 months' duration were divided into two groups: experimental group (n = 35) and control group (n = 35). Participants in both groups were placed on supervised strengthening exercises for multifidus muscles of the low back. The experimental group was placed on ultrasound phonophoresis therapy with Lofnac Gel (with diclofenac and methyl salicylate as active ingredients), whereas the control group was placed on ultrasound with water as coupling medium. The treatment was applied twice per week for 6 weeks. Present pain intensity and disability were measured before treatment, and in the 3rd week and 6th week of treatment. Data were analysed using descriptive and inferential statistics, and post hoc analysis was carried out when necessary. RESULTS There was a significant difference between the pre- and posttreatment pain intensity and disability index for both the experimental (F = 17.947, p < 0.001; F = 20.712, p < 0.001) and control (F = 14.791, p < 0.001; F = 10.418, p < 0.001) groups. There was also a significant difference between the experimental and control group data in terms of pain intensity (F = 28.76, p < 0.001) and disability index (F = 39.817, p < 0.001) in the 6th week. CONCLUSION Exercise combined with Lofnac phonophoresis was more effective in the management of patients with chronic low back pain than exercise and ultrasound alone.
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Affiliation(s)
- Adesola O. Ojoawo
- Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University (OAU), Ile Ife, Nigeria
| | - Olamide Odewole
- Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University (OAU), Ile Ife, Nigeria
| | - Sunday A. Odejide
- Department of Medical Rehabilitation, OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Bosede O. Arilewola
- Department of Medical Rehabilitation, OAU Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Abiodun G. Badru
- Department of Medical Rehabilitation, OAU Teaching Hospitals Complex, Ile Ife, Nigeria
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Rundell SD, Gellhorn AC, Comstock BA, Heagerty PJ, Friedly JL, Jarvik JG. Clinical outcomes of early and later physical therapist services for older adults with back pain. Spine J 2015; 15:1744-55. [PMID: 25849809 DOI: 10.1016/j.spinee.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/05/2015] [Accepted: 04/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The timing of physical therapy (PT) services and its association with later function and pain are not clear, especially in older adults. PURPOSE The purpose of this study was to compare clinical outcomes of patients receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back pain. STUDY DESIGN/SETTING Prospective cohort study using the Back Pain Outcomes Using Longitudinal Data registry. PATIENT SAMPLE A total of 3,705 adults 65 years and older with a new visit for back pain were included. OUTCOME MEASURES The outcome measures were Roland-Morris Disability Questionnaire (RMDQ), Pain Numerical Rating Scales, and EuroQol-5D. METHODS We studied two phases of PT utilization: early (0-28 days) and later (3-6 months). At baseline, we selected the participants with complete 12 months of patient-reported outcomes and electronic medical record data. Early PT was defined as initiating PT less than or equal to 28 days from the index visit for back pain. The no early PT group consisted of patients with no PT, no injections, no surgery, and no chiropractic within 28 days. We restricted the later phase analysis to patients with pain greater than 2 of 10 and an RMDQ score greater than 4 to create a subsample of patients with continuing clinically important back pain. We defined later PT as initiating PT between 3 and 6 months after the index visit. The no later PT group consisted of patients without any PT during this time. We used propensity score matching followed by multiple linear regression to estimate the mean difference in outcome. Sensitivity analysis examined clinically important change and dose of PT use among the early PT group. RESULTS The early PT group had better functional status with an adjusted mean RMDQ of 1.1 points less than the no early PT group (95% confidence interval: -2.2, -0.1) and less back pain of -0.5 (-0.9, -0.1) at 12 months. There was no difference between early PT groups at 3 and 6 months. The odds of a 30% improvement in function or pain were not different between these matched groups at 12 months, but the early PT group had increased odds of a 50% improvement in function at 12 months (odds ratio: 1.58, 95% confidence interval: 1.04, 2.40). There was no difference between later groups at 12 months. Greater dose of PT use within the early PT group was associated with better functional status (p= .01). CONCLUSIONS We found that among older adults presenting to their primary care providers for a new episode of back pain, early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT. Secondary analysis show that patients initiating early PT may be somewhat more likely to experience 50% improvement in function at 12 months.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA.
| | - Alfred C Gellhorn
- Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10021, USA
| | - Bryan A Comstock
- Center for Biomedical Statistics, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA
| | - Patrick J Heagerty
- Center for Biomedical Statistics, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA; Department of Biostatistics, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98105, USA; Department of Radiology, Neurological Surgery, Health Services, Orthopedics and Sports Medicine and Pharmacy, University of Washington, 325 9(th) Ave, Seattle, WA 98104, USA
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O'Keeffe M, Purtill H, Kennedy N, O'Sullivan P, Dankaerts W, Tighe A, Allworthy L, Dolan L, Bargary N, O'Sullivan K. Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e007156. [PMID: 26033941 PMCID: PMC4458611 DOI: 10.1136/bmjopen-2014-007156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Non-specific chronic low back pain (NSCLBP) is a very common and costly musculoskeletal disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) represents a novel, patient-centred intervention which directly challenges pain-related behaviours in a cognitively integrated, functionally specific and graduated manner. CFT aims to target all biopsychosocial factors that are deemed to be barriers to recovery for an individual patient with NSCLBP. A recent randomised controlled trial (RCT) demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy combined with exercise. However, several previous RCTs have suggested that class-based interventions are as effective as individualised interventions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to a relatively cheaper exercise and education class. The current study will compare the clinical effectiveness of individualised CFT with a combined exercise and pain education class in people with NSCLBP. METHODS AND ANALYSIS This study is a multicentre RCT. 214 participants, aged 18-75 years, with NSCLBP for at least 6 months will be randomised to one of two interventions across three sites. The experimental group will receive individualised CFT and the length of the intervention will be varied in a pragmatic manner based on the clinical progression of participants. The control group will attend six classes which will be provided over a period of 6-8 weeks. Participants will be assessed preintervention, postintervention and after 6 and 12 months. The primary outcomes will be functional disability and pain intensity. Non-specific predictors, moderators and mediators of outcome will also be analysed. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Mayo General Hospital Research Ethics Committee (MGH-14-UL). Outcomes will be disseminated through publication according to the SPIRIT statement and will be presented at scientific conferences. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov NCT02145728).
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Affiliation(s)
- Mary O'Keeffe
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Munster, Ireland
| | - Norelee Kennedy
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences and Physiotherapy, University of Leuven, Leuven, Belgium
| | - Aidan Tighe
- Ballina Primary Care Centre, Ballina, Mayo, Ireland
| | - Lars Allworthy
- Physiotherapy Department, Mayo General Hospital, Castlebar, Mayo, Ireland
| | - Louise Dolan
- Claremorris Primary Care Centre, Claremorris, Mayo, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, University of Limerick, Limerick, Munster, Ireland
| | - Kieran O'Sullivan
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
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Supervised walking in comparison with fitness training for chronic back pain in physiotherapy. Pain 2015; 156:131-147. [DOI: 10.1016/j.pain.0000000000000013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ko YJ, Ha HG, Jeong J, Lee WH. Variations in lateral abdominal muscle thickness during abdominal drawing-in maneuver in three positions in a young healthy population. ACTA ACUST UNITED AC 2014. [DOI: 10.14474/ptrs.2014.3.2.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Young Jun Ko
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Geun Ha
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Seoul, Republic of Korea
| | - Juri Jeong
- Korea National Rehabilitation Research Institute, Department of Clinical Rehabilitation, Seoul, Republic of Korea
| | - Wan Hee Lee
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
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Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Abstract
Chronic pain is a complex phenomenon that does not fit well within the normal conceptions of health and illness. Pain Management Programs are commonly used to train and support people to self-manage, however, the long-term impact of this biopsychosocial approach remains poorly understood. The social domain can impact on patients' quality of life more than any other aspect of chronic pain; however, it is rarely addressed by health services. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
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Harman K, MacRae M, Vallis M. The Development and Testing of a Checklist to Study Behaviour Change Techniques used in a Treatment Programme for Canadian Armed Forces Members with Chronic Non-specific Low Back Pain. Physiother Can 2014; 66:313-21. [PMID: 25125787 DOI: 10.3138/ptc.2013-55bc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE There are reports of increased use of a variety of behaviour change techniques (BCT) by physiotherapists and findings of beneficial effects of use. However, there is a lack of physiotherapy-specific definitions of these techniques, as well as a sense of how physiotherapists use them in practice. Through this study, the authors created and field tested a preliminary nomenclature and description for BCT in patients with chronic non-specific low back pain (CNSLBP). METHODS Items for the Physiotherapy Behaviour Change Technique (PT-BCT) checklist were derived from a nomenclature created for use in psychology and also from publications of studies using cognitive behaviour therapy-based approaches in physiotherapy. Content validity was tested via survey of clinical and research experts. Videotapes of a 6-week patient self-management rehabilitation programme were used for training, reliability testing, and field testing of the PT-BCT checklist. RESULTS Checklist items were endorsed by the majority of experts surveyed; intra- and inter-rater reliability were moderate to high. In the field study, a broad range of BCT types (behavioural, cognitive, and motivational) were observed in both classroom and gym settings. CONCLUSIONS The BCT nomenclature arising from this study and the PT-BCT checklist will be useful to further explore behaviour change in physiotherapy practice. The observation in this study that BCT were integrated into physiotherapists' practice illustrates how physiotherapists can play a role in changing behaviour, specifically in the presence of CNSLBP.
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Affiliation(s)
| | | | - Michael Vallis
- CFB Stadacona ; Behaviour Change Institute, Capital District Health Authority, Halifax, N.S
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Diaz-Mancha JA, Heredia-Rizo AM, Fernandez-Seguín LM, Albornoz-Cabello M. Visceral treatment and nutritional patterns in the management of low back pain: a case study. J Altern Complement Med 2014; 20:661-2. [PMID: 25046379 DOI: 10.1089/acm.2013.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Juan Antonio Diaz-Mancha
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
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Outcomes of a group education/exercise intervention in a population of patients with non-specific low back pain: a 3-year review. Ir J Med Sci 2013; 183:341-50. [DOI: 10.1007/s11845-013-1013-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
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Schaafsma FG, Whelan K, van der Beek AJ, van der Es‐Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013; 2013:CD001822. [PMID: 23990391 PMCID: PMC7074637 DOI: 10.1002/14651858.cd001822.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. OBJECTIVES To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. SEARCH METHODS We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. SELECTION CRITERIA Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies.Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment.For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers).For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18).For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03).Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. AUTHORS' CONCLUSIONS The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.
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Affiliation(s)
- Frederieke G Schaafsma
- VU University Medical Center, EMGO+ InstituteDepartment of Public and Occupational HealthVan der Boechorststraat 7 ‐ room A524Postbus 7057AmsterdamNetherlands1007 MB
| | - Karyn Whelan
- Australian Catholic UniversitySchool of Physiotherapy, Faculty of Health SciencesLevel 2, 173 Pacific HighwayNorth SydneyAustraliaNSW 2060
| | - Allard J van der Beek
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO InstituteVan der Boechorststraat 7AmsterdamNetherlandsNL‐1081 BT
| | | | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
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Hettinga DM, Jackson A, Moffett JK, May S, Mercer C, Woby SR. A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks' duration. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x222958] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Foster NE. Beliefs and preferences: do they help determine the outcome of musculoskeletal problems? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x222976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Levsen MJ, Hansen ML, Kent AD, Sieren JJ, Thoreson JP, Farrell KP. Effects of Physical Therapist Training on Outcomes of Patients With Chronic Low Back Pain or Chronic Shoulder Pain. J Man Manip Ther 2013. [DOI: 10.1179/jmt.2001.9.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Shete KM, Suryawanshi P, Gandhi N. Management of low back pain in computer users: A multidisciplinary approach. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2013; 3:7-10. [PMID: 23741122 PMCID: PMC3669474 DOI: 10.4103/0974-8237.110117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analyzed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired “t” test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings.
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Affiliation(s)
- Kiran M Shete
- Spinalogy Clinic, Vidya building, Next to Hotel Sarja, ITI Road, Aundh, Pune, Maharashtra, India
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Franco MR, Ferreira ML, Ferreira PH, Maher CG, Pinto RZ, Cherkin DC. Methodological limitations prevent definitive conclusions on the effects of patients’ preferences in randomized clinical trials evaluating musculoskeletal conditions. J Clin Epidemiol 2013; 66:586-98. [DOI: 10.1016/j.jclinepi.2012.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE The aim of this systematic review was to assess the evidence for lumbopelvic neuromuscular training (LNMT) in individuals after musculoskeletal (MSK) injury. DATA SOURCES A literature search of PubMed and EMBASE databases was performed for English studies from January 1990 to March 2012. Search terms including and related to trunk, core, stability, injury, and LNMT were used. STUDY SELECTION All studies directly involving LNMT for MSK injuries were reviewed by 2 authors. These articles were assessed based on the inclusion criteria and if appropriate selected for further analysis. Expert opinion, review articles, and articles involving non-MSK injuries were excluded. Four authors then scored the selected articles for methodological quality. A total of 2312 articles were initially identified. Twenty-nine articles met the inclusion criteria for review and were divided into categories of lower extremity (LE), lumbar, and upper extremity (UE). No trials involving the UE met the inclusion criteria. DATA EXTRACTION Data including subject demographics (age, height, weight, gender, etc), injury type, intervention type, and outcome measurements were extracted from the relevant articles. A variety of baseline and follow-up scores were extracted including pain levels, patient satisfaction, disability questionnaires, and other functional outcomes. DATA SYNTHESIS Two out of 3 LE randomized controlled trials (RCTs) and 9/26 lumbar RCTs were rated with high methodological quality based on the scoring system described by van Tulder et al. The average quality score for the LE RCTs was 6.3 (range = 4-9) and for the lumbar RCTs was 5.1 (range = 2-9). The evidence for the effectiveness of the 3 LE studies was rated as conflicting, whereas 24 lumbar studies demonstrated moderate-to-strong evidence. Unfortunately, heterogeneity of populations, interventions, and outcomes precluded a quantitative meta-analysis and specific clinical recommendations. CONCLUSIONS High-quality evidence is lacking to make specific clinical recommendations for or against the use of LNMT in the rehabilitation of individuals after MSK injury. Based on this review, future research should focus on well-defined, homogeneous populations, interventions specifically addressing neuromuscular activation of the lumbopelvic musculature, patient-specific clinical outcomes, measures of motor control, biomechanics, and return to specific activities.
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van der Kooij SM, Hehenkamp WJK, Birnie E, Ankum WM, Mol BW, Scherjon S, Reekers JA. The effect of treatment preference and treatment allocation on patients' health-related quality of life in the randomized EMMY trial. Eur J Obstet Gynecol Reprod Biol 2013; 169:69-74. [PMID: 23474384 DOI: 10.1016/j.ejogrb.2013.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 12/29/2012] [Accepted: 01/23/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine the effect of preference and treatment allocation on health-related quality of life (HRQOL) in patients in the randomized EMMY trial of hysterectomy versus uterine artery embolization (UAE) for symptomatic uterine fibroids. STUDY DESIGN We invited 349 patients eligible for trial participation, of which 177 agreed to participate (the 'randomized group'). Within the randomized group, patients were allocated to. UAE (n=88) or hysterectomy (n=89). The remaining 172 patients refused randomization and received the treatment of their preference (varying from hysterectomy to no treatment at all), of which 103 patients agreed to fill in questionnaires (the 'preference group'). Patients' treatment preferences and HRQOL were assessed at baseline and the patients were prospectively followed to evaluate HRQOL at 12 months after treatment. RESULTS At baseline, most patients in the randomized group preferred UAE: 115/177 (65%). In the preference group most patients preferred hysterectomy: 100/172 (58%). At 12 months there was no effect of having had the preferred treatment on HRQOL, neither in the randomized nor in the preference group. The randomized group improved significantly in both mental and physical health, compared to baseline. In the preference group, only mental health improved compared to baseline, while physical health did not improve significantly. CONCLUSIONS In a randomized trial comparing UAE and hysterectomy for symptomatic fibroids, the pre-randomization preference for a specific treatment did not affect HRQOL. Trial participants improved better on physical HRQOL than women who refused to participate.
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Calvo-Muñoz I, Gómez-Conesa A, Sánchez-Meca J. Physical therapy treatments for low back pain in children and adolescents: a meta-analysis. BMC Musculoskelet Disord 2013; 14:55. [PMID: 23374375 PMCID: PMC3568715 DOI: 10.1186/1471-2474-14-55] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 01/30/2013] [Indexed: 11/26/2022] Open
Abstract
Background Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents. Methods Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments). Results Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant. Conclusions Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.
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Affiliation(s)
- Inmaculada Calvo-Muñoz
- Department of Physiotherapy, Faculty of Medicine, Espinardo Campus, University of Murcia, Murcia 30100, Spain.
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