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Kjelle E, Andersen ER, Brandsæter IØ, Hofmann BM. Norwegian general practitioners' and radiologists' perspectives on the referral, justification, and unnecessary imaging-a survey. Scand J Prim Health Care 2024:1-8. [PMID: 38916978 DOI: 10.1080/02813432.2024.2366247] [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: 01/10/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
AIM This study aimed to survey general practitioners' (GPs) and radiologists' perspectives on referrals, imaging justification, and unnecessary imaging in Norway. MATERIALS AND METHODS The survey covered access to imaging, responsibilities, attitudes toward justification assessment, referral process, and demographics using multiple choice questions, statements to report agreement with using the Likert scale and one open question. RESULTS Forty radiologists and 58 GPs attending national conferences completed a web-based survey, with a 20/15% response rate, respectively. Both radiologists (97%) and GPs (100%) considered avoiding unnecessary examinations essential to their role in the healthcare service. Still, 91% of GPs admitted that they referred to imaging they thought was not helpful, while about 60% of the radiologists agreed that unnecessary imaging was conducted in their workplace. GPs reported pressure from patients and patients having private insurance as the most common reasons for doing unnecessary examinations. In contrast, radiologists reported a lack of clinical information and the inability to discuss patient cases with the GPs as the most common reasons. CONCLUSION This study adds to our understanding of radiologists' and GPs' perspectives on unnecessary imaging and referrals. Better guidelines and, even more importantly, better communication between the referrer and the radiologist are needed. Addressing these issues can reduce unnecessary imaging and improve the quality and safety of care.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Ingrid Øfsti Brandsæter
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Gjøvik, Norway
- Centre of Medical Ethics, Centre of Medical Ethics at the University of Oslo, Blindern, Norway
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Searant I, Brown BT, Jenkins HJ. Chiropractors' perceptions on the use of spinal radiographs in clinical practice: a qualitative study. Chiropr Man Therap 2024; 32:23. [PMID: 38909258 PMCID: PMC11193277 DOI: 10.1186/s12998-024-00547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors' perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management. METHODS Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis. RESULTS Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance. CONCLUSION Australian chiropractors' decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes.
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Affiliation(s)
- Isaac Searant
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Benjamin T Brown
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hazel J Jenkins
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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3
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Ampiah JA, Moffatt F, Diver CJ, Ampiah PK. 'Specialist before physiotherapist': physicians' and physiotherapists' beliefs and management of chronic low back pain in Ghana - A qualitative study. Disabil Rehabil 2024:1-11. [PMID: 38767467 DOI: 10.1080/09638288.2024.2356005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE This study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices. MATERIALS/METHODS Thirty-three individual semi-structured interviews, involving eighteen physio-therapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy. RESULTS Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs' knowledge) and sociocultural environment (sociocultural/patients' expectations of passive therapy and paternalism). CONCLUSION The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs' CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, Institute of Health and Social Care, London South Bank University, London, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire J Diver
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Health Sciences, Division of Physiotherapy, College of Health, Medicine and Life Sciences, Brunel University, London, UK
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Valentine MJ, Hayat F, Kayastha A, Newsome-Cuby TR, Nguyen ATN, AlDallal U, Ismail M. An Unidentified Infiltrative Etiology of Spinal Cord Compression: A Case Report and Literature Review. Cureus 2024; 16:e60141. [PMID: 38864071 PMCID: PMC11166180 DOI: 10.7759/cureus.60141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Spinal cord compression is a neurosurgical emergency. Symptoms of this disorder are highlighted as back pain, ambulatory difficulties, and bladder/bowel incontinence. Diagnostic imaging is not indicated in many circumstances of nonspecific back pain; however, the addition of neurologic deficits in the setting of back pain justifies radiologic imaging. Various pathologies can cause constriction of the spinal cord due to the delicate nature of spinal cord anatomy. Etiologies may include trauma, neoplasms, and infections. In this report, we present an unusual case of a 31-year-old male who presented to the emergency department with a history of chronic back pain accompanied by neurological deficits, ataxia, and bladder dysfunction. Contrast-enhanced MRI imaging heightened the suspicion of a neoplastic etiology; however, neuropathology revealed a non-neoplastic nature with abnormal lymphohistiocytic infiltrate suspicious for Langerhans cell histiocytosis or infectious etiology. A second opinion was provided by Mayo Clinic Laboratories, resulting in the definitive conclusion that the mass was non-neoplastic and tested negative for SD1a and Langerhin, biomarkers used to diagnose Langerhans cell histiocytosis. This unusual non-neoplastic lesion exemplifies one of many diverse and multifaceted pathologies that can precipitate spinal cord compression. Additionally, these findings underscore the importance of considering both neoplastic and non-neoplastic causes in the differential diagnosis of spinal cord compression, thereby enhancing clinical vigilance and improving patient outcomes for underlying spinal conditions.
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Affiliation(s)
| | - Fakhar Hayat
- Neurosurgery, King Hamad University Hospital, Al Sayh, BHR
| | - Ankur Kayastha
- Medical School, Kansas City University, Kansas City, USA
| | | | | | - Usama AlDallal
- School of Medicine, Royal College of Surgeons In Ireland - Medical University of Bahrain, Manama, BHR
| | - Mohamed Ismail
- Neurosurgery, King Hamad University Hospital, Al Sayh, BHR
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5
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Pita-Martínez C, Justo-Cousiño LA. [Does patient communication influence kinesiophobia? A systematic review]. Rehabilitacion (Madr) 2024; 58:100837. [PMID: 38316098 DOI: 10.1016/j.rh.2024.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it.
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Affiliation(s)
- C Pita-Martínez
- Unidad de Investigación en Cuidados (SERGAS Área Sanitaria de Vigo), Galicia, España; Grupo de Investigación Traslacional en Cuidados (INVESTIC), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España
| | - L A Justo-Cousiño
- Universidade de Vigo, Facultade de Fisioterapia, Campus A Xunqueira, Galicia, España; Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España.
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Altinger G, Sharma S, Maher CG, Cullen L, McCaffery K, Linder JA, Buchbinder R, Harris IA, Coiera E, Li Q, Howard K, Coggins A, Middleton PM, Gunja N, Ferguson I, Chan T, Tambree K, Varshney A, Traeger AC. Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial. BMJ Open 2024; 14:e079870. [PMID: 38548366 PMCID: PMC10982715 DOI: 10.1136/bmjopen-2023-079870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural 'nudge' interventions on low-value care for ED patients with low back pain. METHODS AND ANALYSIS NUDG-ED is a 2×2 factorial, open-label, before-after, cluster randomised controlled trial. The trial includes 8 ED sites in Sydney, Australia. Participants will be ED clinicians who manage back pain, and patients who are 18 years or over presenting to ED with musculoskeletal back pain. EDs will be randomly assigned to receive (i) patient nudges, (ii) clinician nudges, (iii) both interventions or (iv) no nudge control. The primary outcome will be the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge or both. We will require 2416 encounters over a 9-month study period (3-month before period and 6-month after period) to detect an absolute difference of 10% in use of low-value care due to either nudge, with 80% power, alpha set at 0.05 and assuming an intra-class correlation coefficient of 0.10, and an intraperiod correlation of 0.09. Patient-reported outcome measures will be collected in a subsample of patients (n≥456) 1 week after their initial ED visit. To estimate effects, we will use a multilevel regression model, with a random effect for cluster and patient, a fixed effect indicating the group assignment of each cluster and a fixed effect of time. ETHICS AND DISSEMINATION This study has ethical approval from Southwestern Sydney Local Health District Human Research Ethics Committee (2023/ETH00472). We will disseminate the results of this trial via media, presenting at conferences and scientific publications. TRIAL REGISTRATION NUMBER ACTRN12623001000695.
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Affiliation(s)
- Gemma Altinger
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sweekriti Sharma
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey A Linder
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Macquarie University, Sydney, New South Wales, Australia
| | - Qiang Li
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Coggins
- Discipline of Emergency Medicine, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales, Australia
- South West Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Naren Gunja
- Discipline of Emergency Medicine, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
- Digital Health Solutions, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Ferguson
- South West Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
- Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Trevor Chan
- Emergency Care Institute, The Agency for Clinical Innovation, St Leonards Sydney, City of Willoughby, Australia
| | - Karen Tambree
- Consumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Ajay Varshney
- Consumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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Lowry V, Lavigne P, Zidarov D, Matifat E, Cormier AA, Desmeules F. A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders. Arch Phys Med Rehabil 2024; 105:411-426. [PMID: 37832814 DOI: 10.1016/j.apmr.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders. DATA SOURCES A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases. STUDY SELECTION Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included. DATA EXTRACTION CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into "recommended," "may be recommended," or "not recommended." Disagreements were resolved by discussion until reviewers reached consensus. DATA SYNTHESIS Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it. CONCLUSIONS Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada; Surgery Department, Medicine Faculty, University of Montreal, Montreal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Interdisciplinary Rehabilitation Montreal Research Center (CRIR), Montreal, Canada; Montreal University Institute for Physical Impairment Rehabilitation (IURDPM), Montreal, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
| | | | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
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Burton W, Salsbury SA, Goertz CM. Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey. BMC Health Serv Res 2024; 24:125. [PMID: 38263013 PMCID: PMC10804504 DOI: 10.1186/s12913-024-10578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. METHODS Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. RESULTS A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. CONCLUSIONS Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.
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Affiliation(s)
- Wren Burton
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Christine M Goertz
- Implementation of Spine Health Innovations, Department of Orthopaedic Surgery, School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Musculoskeletal Research, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke-Margolis Center for Health Policy, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
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9
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Özcan-Ekşi EE, Berikol G, Ekşi MŞ. Potential blood markers as screening tools for subjects with low back pain: an age- and gender-matched cross-sectional analysis. Curr Med Res Opin 2024; 40:77-85. [PMID: 37943293 DOI: 10.1080/03007995.2023.2282646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Mechanical and inflammatory factors were suggested as the causes of spine degeneration and low back pain (LBP). Previous studies partly reported the association of LBP with inflammation. However, none of them compared patients with LBP and asymptomatic subjects in terms of complete blood count and inflammatory markers in detail. We aimed to analyze the association of serum white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with chronic LBP by comparing the patients with chronic LBP and age- and gender-matched asymptomatic subjects. METHODS Lumbar intervertebral disc degeneration and vertebral end-plates were evaluated using Pfirrmann grading and Modic classification on lumbar spine magnetic resonance images, respectively. Serum WBC counts, CRP levels, and ESRs were recorded from chart reviews. RESULTS We included 147 patients with chronic LBP and 101 asymptomatic subjects. Patients with chronic LBP had significantly higher serum neutrophil, monocyte, and basophil counts, higher neutrophil-to-lymphocyte ratio, higher ESR, and lower serum CRP levels compared to the asymptomatic subjects. Serum monocyte and basophil cell counts and ESR were the most remarkable predictive factors for chronic LBP, severe IVDD, and Modic changes. Higher serum monocyte and basophil cell counts and higher serum ESR above cut-off values of 0.42 × 103/μL, 0.025 × 103/μL, and 3.5 mm/hour could be used as screening tools for subjects with persistent LBP in primary care. DISCUSSION Higher serum monocyte and basophil counts and serum ESR above new cut-off values should highlight the need to obtain early spinal imaging to prevent chronicity in patients with LBP.
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Affiliation(s)
- Emel Ece Özcan-Ekşi
- School of Medicine, Department of Physical Medicine and Rehabilitation, Bahçeşehir University, Istanbul, Turkey
| | - Gürkan Berikol
- Taksim Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- School of Medicine, Department of Neurosurgery, Health Sciences University, Istanbul, Turkey
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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10
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Malliaras P, O'Keeffe M, Ridgway J, Whale R, Vasan V, L'Huillier P, Towers M, Farlie MK. Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study. Disabil Rehabil 2023:1-8. [PMID: 38153258 DOI: 10.1080/09638288.2023.2296986] [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: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging. MATERIALS AND METHODS Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset. RESULTS Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making. CONCLUSION Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.IMPLICATIONS FOR REHABILITATIONPatients with shoulder pain may believe imaging is necessary for diagnosis and defining treatment yet do not consider potential indirect harms (e.g., unnecessary treatment for findings that are not relevant).Health professionals should ensure patients are aware of imaging limitations and harms and facilitate shared decision-making about whether to have imaging.Health professionals also have an important role in the appropriate contextualisation of imaging findings (i.e., they do not necessarily relate to pain nor guide treatment).
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Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jacqueline Ridgway
- Physiotherapy Department, Frankston Hospital, Peninsula Health, Victoria, Australia
| | - Rhiannon Whale
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Vasish Vasan
- Physiotherapy Department, Monash University, Melbourne, Australia
| | | | - Mitch Towers
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Melanie K Farlie
- Physiotherapy Department, Monash University, Melbourne, Australia
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11
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Kirby E, MacMillan A, Liew BXW, Brinkley A, Bateman A. Characterising the interventions designed to affect the reporting of musculoskeletal imaging: a scoping review protocol using the COM-B model. BMJ Open 2023; 13:e072150. [PMID: 38011964 PMCID: PMC10685969 DOI: 10.1136/bmjopen-2023-072150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Attributing musculoskeletal (MSK) pain to normal and commonly occurring imaging findings, such as tendon, cartilage and spinal disc degeneration, has been shown to increase people's fear of movement, reduce their optimism about recovery and increase healthcare costs. Interventions seeking to reduce the negative effects of MSK imaging reporting have had little effect. To understand the ineffectiveness of these interventions, this study seeks to scope their behavioural targets, intended mechanisms of action and theoretical underpinnings. This information alongside known barriers to helpful reporting can enable researchers to refine or create new more targeted interventions. METHODS AND ANALYSIS The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Search terms will be devised by the research team. Searches of MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to current day will be performed. The review will include studies, which have developed or evaluated interventions targeting the reporting of MSK imaging. Studies targeting the diagnosis of serious causes of MSK pain will be excluded. Two independent authors will extract study participant data using predefined extraction templates and intervention details using the Template for Intervention Description and Replication checklist. Interventions will be coded and mapped to the technique, mechanism of action and behavioural target according to the Capability, Opportunity, Motivation-Behaviour (COM-B) model categories. Any explicit models or theories used to inform the selection of interventions will be extracted and coded. The study characteristics, behaviour change techniques identified, behavioural targets according to the COM-B and context specific theories within the studies will be presented in narrative and table form. ETHICS AND DISSEMINATION The information from this review will be used to inform an intervention design process seeking to improve the communication of imaging results. The results will also be disseminated through a peer-reviewed publication, conference presentations and stakeholder events.
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Affiliation(s)
- Edward Kirby
- MSK Physiotherapy Dept, Essex Partnership University NHS Foundation Trust, Wickford, UK
| | - Andrew MacMillan
- Research department, University College of Osteopathy, London, UK
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Andrew Brinkley
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
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Tait RC, Chibnall JT. The Healthcare Provider Burden Scale: Short Form. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1207-1208. [PMID: 37154685 DOI: 10.1093/pm/pnad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Raymond C Tait
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO 63105, United States
| | - John T Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO 63105, United States
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Costa N, Blyth FM, Parambath S, Huckel Schneider C. What's the low back pain problem represented to be? An analysis of discourse of the Australian policy directives. Disabil Rehabil 2023; 45:3312-3322. [PMID: 36150033 DOI: 10.1080/09638288.2022.2125085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Low back pain (LBP) directives provide information about how LBP should be managed, communicated and navigated in complex health systems, making them an important form of policy. This study aimed to examine how LBP is problematised (represented) in Australian directives. MATERIALS AND METHODS We employed an analysis of discourse of LBP directives drawing on Bacchi's "What's the problem represented to be?" policy problematisation approach. RESULTS Our analysis suggests that LBP is problematised as a symptom that tends to improve when individuals take responsibility for themselves, but may require care at times. The way in which LBP is represented in the directives excludes important aspects, such as the uncertainties of scientific knowledge, paradigms other than (post)positivist, multimorbidity, social and structural determinants of health. CONCLUSION LBP directives may benefit from problematisations of LBP that consider the ongoing nature of LBP and broader contextual factors that impact on both LBP outcomes and care, beyond individual responsibility. Consideration of a wider range of paradigms and expanded evidence base may also be beneficial, as these are likely to enable individuals, clinicians and the Australian healthcare system to address LBP while dealing with its complexities, enabling real-world changes to lessen the LBP burden.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who work with people who experience low back pain (LBP) may benefit from critically reflecting about discourses embedded in policy directives.Healthcare professionals may consider engaging in policy changes processes to expand the discourses on which LBP policy directives rely.Healthcare professionals' ability to enact policy recommendations may be enhanced by consideration of the fluctuating nature of LBP, uncertainties, multimorbidity and determinants of health.
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Affiliation(s)
- Nathalia Costa
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona M Blyth
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Sarika Parambath
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Panchal S, Hendrick P. The lived experiences of musculoskeletal physiotherapists managing patient expectations for diagnostic imaging: A qualitative study using a phenomenological analysis. Musculoskelet Sci Pract 2023; 67:102833. [PMID: 37672861 DOI: 10.1016/j.msksp.2023.102833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Unnecessary diagnostic imaging for musculoskeletal presentations is a pervasive phenomenon, placing a substantial weight on healthcare resources. Their overuse can lead to iatrogenic consequences associated with overdiagnosis and overtreatment. Factors which contribute to inappropriate imaging are multifactorial. Clinician-patient beliefs, behaviours, and expectations have been identified as central drivers. Physiotherapists play an important role in the utilisation of diagnostic imaging for musculoskeletal presentations throughout healthcare settings. This study aims to explore the lived experiences of physiotherapists managing patient expectations for diagnostic imaging. DESIGN A qualitative study using an interpretative phenomenological analysis. Five participants were purposefully recruited and took part in semi-structured individual interviews. RESULTS The central themes identified were expectations for diagnostic imaging, managing expectations, communicating imaging findings, imaging as a therapeutic tool, and risk and uncertainty. CONCLUSION The findings from this study gives new insights into how musculoskeletal physiotherapists manage expectations for diagnostic imaging, the associated complexities, and the challenges encountered.
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15
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Lowry V, Desmeules F, Zidarov D, Lavigne P, Roy JS, Cormier AA, Tousignant-Laflamme Y, Perreault K, Lefèbvre MC, Décary S, Hudon A. "I wanted to know what was hurting so much": a qualitative study exploring patients' expectations and experiences with primary care management. BMC Musculoskelet Disord 2023; 24:755. [PMID: 37749557 PMCID: PMC10521438 DOI: 10.1186/s12891-023-06885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The management of shoulder pain is challenging for primary care clinicians considering that 40% of affected individuals remain symptomatic one year after initial consultation. Developing tailored knowledge mobilization interventions founded on evidence-based recommendations while also considering patients' expectations could improve primary care for shoulder pain. The aim of this qualitative study is to explore patients' expectations and experiences of their primary care consultation for shoulder pain. METHODS In this qualitative study, participants with shoulder pain and having consulted a primary care clinician in the past year were interviewed. All the semi-structured interviews were transcribed verbatim, and inductive thematic analysis was performed to identify themes related to the participants' expectations and experiences of primary care consultations for shoulder pain. RESULTS Thirteen participants with shoulder pain were interviewed (8 women, 5 men; mean age 50 ± 12 years). Eleven of them initially consulted a family physician or an emergency physician, and two participants initially consulted a physiotherapist. Four overarching themes related to patients' expectations and experiences were identified from our thematic analysis: 1) I can't sleep because of my shoulder; 2) I need to know what is happening with my shoulder; 3) But… we need to really see what is going on to help me!; and 4) Please take some time with me so I can understand what to do!. Several participants waited until they experienced a high level of shoulder pain before making an appointment since they were not confident about what their family physician could do to manage their condition. Although some participants felt that their physician took the time to listen to their concerns, many were dissatisfied with the limited assessment and education provided by the clinician. CONCLUSIONS Implementing evidence-based recommendations while considering patients' expectations is important as it may improve patients' satisfaction with healthcare. Several participants reported that their expectations were not met, especially when it came to the explanations provided. One unexpected finding that emerged from this study was the waiting period between the onset of shoulder pain and when patients decided to consult their primary care clinician.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4.
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada.
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Institut Universitaire Sur La Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Québec, Canada
| | - Patrick Lavigne
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Audrey-Anne Cormier
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Marie-Claude Lefèbvre
- Groupe de Médecine Familiale Universitaire (GMF-U) Maisonneuve-Rosemont, Montréal, Canada
| | - Simon Décary
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne Hudon
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada
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16
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Oliveira CB, Coombs D, Machado GC, McCaffery K, Richards B, Pinto RZ, O'Keeffe M, Maher CG, Christofaro DGD. Process evaluation of the implementation of an evidence-based model of care for low back pain in Australian emergency departments. Musculoskelet Sci Pract 2023; 66:102814. [PMID: 37421758 DOI: 10.1016/j.msksp.2023.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The Sydney Health Partners Emergency Department (SHaPED) trial targeted ED clinicians and evaluated a multifaceted strategy to implement a new model of care. The objective of this study was to investigate attitudes and experiences of ED clinicians as well as barriers and facilitators for implementation of the model of care. DESIGN A qualitative study. METHODS The EDs of three urban and one rural hospital in New South Wales, Australia participated in the trial between August and November 2018. A sample of clinicians was invited to participate in qualitative interviews via telephone and face-to-face. The data collected from the interviews were coded and grouped in themes using thematic analysis methods. RESULTS Non-opioid pain management strategies (i.e., patient education, simple analgesics, and heat wraps) were perceived to be the most helpful strategy for reducing opioid use by ED clinicians. However, time constraints and rotation of junior medical staff were seen as the main barriers for uptake of the model of care. Fear of missing a serious pathology and the clinicians' conviction of a need to provide something for the patient were seen as barriers to reducing lumbar imaging referrals. Other barriers to guideline endorsed care included patient's expectations and characteristics (e.g., older age and symptoms severity). CONCLUSIONS Improving knowledge of non-opioid pain management strategies was seen as a helpful strategy for reducing opioid use. However, clinicians also raised barriers related to the ED environment, clinicians' behaviour, and cultural aspects, which should be addressed in future implementation efforts.
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Affiliation(s)
- Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (Unoeste), Presidente Prudente, Sao Paulo, Brazil; Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
| | - Danielle Coombs
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rafael Z Pinto
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Diego G D Christofaro
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana. BMJ Open 2023; 13:e073538. [PMID: 37474173 PMCID: PMC10360413 DOI: 10.1136/bmjopen-2023-073538] [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] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana. OBJECTIVES To explore the psychosocial impact of CLBP among patients with CLBP in Ghana. DESIGN Qualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP attending physiotherapy at two hospitals in Ghana. RESULTS Five categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived. CONCLUSION CLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients' psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Chiropractic and Sports Rehabilitation, London South Bank University, London, UK
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Claire Diver
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
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O'Leary H, Robinson K, Glynn L, Lenehan B, McCreesh K. "You're stuck in the middle here": a qualitative study of GPs' experiences of managing knee pain attributed to a degenerative meniscal tear. BMC PRIMARY CARE 2023; 24:127. [PMID: 37344762 DOI: 10.1186/s12875-023-02075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Exercise is the recommended first-line therapy for a degenerative meniscal tear (DMT). Despite this, knee pain attributed to DMTs are a common presentation to specialist orthopaedic clinics. In the primary care setting, the general practitioner (GP) plays a central role in managing patients with knee pain, but to date their perspective has not been explored in relation to DMTs. This study explored GPs' experiences of managing people with knee pain attributed to a DMT. METHODS A qualitative research design was adopted and practices in the South and Mid-West of Ireland were contacted via recruitment emails circulated through professional and research networks. Interested GPs contacted the researchers via email, and purposive and snowball sampling was used for recruitment. Semi-structured interviews were conducted online or over the telephone. Interviews were digitally recorded and transcribed. Data was analysed using an inductive approach to thematic analysis. Ethical approval was granted by the Irish College of General Practitioners (ICGP_REC_21_0031). RESULTS Seventeen semi-structured one-on-one interviews were conducted. Three main themes were identified with related subthemes: (1) GPs' experiences of relational aspects of care, (2) GP beliefs about what constitutes best care for patients with a DMT, and (3) how GP practice is enacted within the current healthcare setting. GPs described the challenge of maintaining a strong clinical alliance, while managing perceived patient expectations of a 'quick fix' and advanced imaging. They reported slowing down clinical decisions and feeling 'stuck' with limited options when conservative treatment had failed. GPs believed that exercise should be the core treatment for DMTs and emphasised engaging patients in an active approach to recovery. Some GPs believed arthroscopy had a role in circumstances where patients didn't improve with physiotherapy. Limited access to public physiotherapy and orthopaedic services hampered GPs' management plans and negatively impacted patient outcomes. CONCLUSIONS GP beliefs around what constitutes best care for a DMT generally aligned with the evidence base. Nonetheless, there was sometimes tension between these beliefs and the patient's own treatment expectations. The ability to enact their beliefs was hampered by limited access to conservative management options, sometimes leading to early escalation of care.
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Affiliation(s)
- Helen O'Leary
- School of Allied Health and Health Research Institute, Faculty of Education and Health Science, University of Limerick, Limerick, Ireland.
| | - Katie Robinson
- School of Allied Health and Ageing Research Centre, Health Research Institute, Faculty of Education and Health Science, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brian Lenehan
- Chief Clinical Director UL Hospitals Group and Consultant Orthopaedic Surgeon, Orthopaedics and Trauma Department, University Hospital Limerick, Limerick, Ireland
| | - Karen McCreesh
- School of Allied Health, and Ageing Research Centre, Health Research Institute, Faculty of Education and Health Science, University of Limerick, Limerick, Ireland
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Jensen RK, Lillesø S, Jensen JS, Stochkendahl MJ. Patient expectations and levels of satisfaction in chiropractic treatment for lumbar radiculopathy. A mixed methods study. Chiropr Man Therap 2023; 31:13. [PMID: 37208689 DOI: 10.1186/s12998-023-00486-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Chiropractic patients are generally satisfied with the care received. It is unclear if this also applies to Danish patients with lumbar radiculopathy included in a standardised chiropractic care package (SCCP). This study aimed to investigate patient satisfaction and explore perspectives on the SCCP for lumbar radiculopathy. METHODS An explanatory sequential mixed methods design with three separate phases was used. Phase one was a quantitative analysis based on a survey in a prospective cohort of patients with lumbar radiculopathy in an SCCP from 2018 to 2020. Patients rated their satisfaction with the examination, information, treatment effect, and overall management of their problem on a 0-10 scale. In phase two, six semi-structured interviews conducted in 2021 were used to gain further explanatory insights into the findings from phase one. Data were analysed using systematic text condensation. In phase three, the quantitative and qualitative data were merged in a narrative joint display to obtain a deeper understanding of the overall results. RESULTS Of 303 eligible patients, 238 responded to the survey. Of these, 80-90% were very satisfied (≥ 8) when asked about the examination, information, and overall management, whereas 50% were very satisfied with the treatment effect. The qualitative analysis led to the emergence of four themes: 'Understanding the standardised care packages', 'Expectations regarding consultation and treatment effect', 'Information about diagnosis and prognosis', and 'Interdisciplinary collaboration'. The joint display analysis showed that high patient satisfaction with the examination could be explained by the patients' feeling of being carefully and thoroughly examined by the chiropractor and by referrals to MRI. Advice and information given to patients on variations in symptoms and the expected prognosis were considered reassuring. Satisfaction with the chiropractor's coordination of care and with referral to other healthcare professionals was explained by the patients' positive experiences of coordinated care and their sense of alleviated responsibility. CONCLUSION Overall, patients were satisfied with the SCCP for lumbar radiculopathy. From a patient's perspective, the consultation should include a thorough examination and a focus on communication and information relating to symptoms and prognosis, while expectations regarding the content and efficacy of the treatment should be addressed and aligned.
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Affiliation(s)
- Rikke Krüger Jensen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
- Chiropractic Knowledge Hub, Campusvej 55, Odense M, 5230, Denmark.
| | - Sille Lillesø
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Jack Starche Jensen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Mette Jensen Stochkendahl
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
- Chiropractic Knowledge Hub, Campusvej 55, Odense M, 5230, Denmark.
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Dudli S, Heggli I, Laux CJ, Spirig JM, Wanivenhaus F, Betz M, Germann C, Farshad-Amacker NA, Herger N, Mengis T, Brunner F, Farshad M, Distler O. Role of C-reactive protein in the bone marrow of Modic type 1 changes. J Orthop Res 2023; 41:1115-1122. [PMID: 36062874 PMCID: PMC9985669 DOI: 10.1002/jor.25437] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
Modic type 1 changes (MC1) are vertebral bone marrow lesions and associate with low back pain. Increased serum C-reactive protein (CRP) has inconsistently been associated with MC1. We aimed to provide evidence for the role of CRP in the tissue pathophysiology of MC1 bone marrow. From 13 MC1 patients undergoing spinal fusion at MC1 levels, vertebral bone marrow aspirates from MC1 and intrapatient control bone marrow were taken. Bone marrow CRP, interleukin (IL)-1, and IL-6 were measured with enzyme-linked immunosorbent assays; lactate dehydrogenase (LDH) was measured with a colorimetric assay. CRP, IL-1, and IL-6 were compared between MC1 and control bone marrow. Bone marrow CRP was correlated with blood CRP and with bone marrow IL-1, IL-6, and LDH. CRP expression by marrow cells was measured with a polymerase chain reaction. Increased CRP in MC1 bone marrow (mean difference: +0.22 mg CRP/g, 95% confidence interval [CI] [-0.04, 0.47], p = 0.088) correlated with blood CRP (r = 0.69, p = 0.018), with bone marrow IL-1β (ρ = 0.52, p = 0.029) and IL-6 (ρ = 0.51, p = 0.031). Marrow cells did not express CRP. Increased LDH in MC1 bone marrow (143.1%, 95% CI [110.7%, 175.4%], p = 0.014) indicated necrosis. A blood CRP threshold of 3.2 mg/L detected with 100% accuracy increased CRP in MC1 bone marrow. In conclusion, the association of CRP with inflammatory and necrotic changes in MC1 bone marrow provides evidence for a pathophysiological role of CRP in MC1 bone marrow.
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Affiliation(s)
- Stefan Dudli
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Irina Heggli
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph J. Laux
- Department of Orthopeadics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José M. Spirig
- Department of Orthopeadics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopeadics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Betz
- Department of Orthopeadics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nadja A. Farshad-Amacker
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nick Herger
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tamara Mengis
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopeadics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Besor O, Brand R, Feldman R, Nudelman Y, Shahar Y, Finestone AS, Ben Ami N. Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4854. [PMID: 36981762 PMCID: PMC10049028 DOI: 10.3390/ijerph20064854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Low back pain (LBP) is a major cause of discomfort and disability. Physicians' attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians' attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.
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Affiliation(s)
- Omri Besor
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
| | - Ronen Brand
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
- Meuhedet Health Services, Haifa 3350127, Israel
| | - Ron Feldman
- Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel
- Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Yaniv Nudelman
- Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel
- Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Yair Shahar
- Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel
- Department of Physiotherapy, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Aharon S. Finestone
- Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel
- Department of Orthopaedic Surgery, Shamir Medical Centre (Assaf HaRofeh), Rhison Lezyon, Zerifin 7033001, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noa Ben Ami
- Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel
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Alqabbani S, Alsuwailem M, Alshammari M, Almutairi R, Alharthi G, Almuwais A. A preliminary exploration of attitudes, beliefs, and barriers to physical therapists' practices in ordering diagnostic imaging. J Back Musculoskelet Rehabil 2023; 36:609-618. [PMID: 36776037 DOI: 10.3233/bmr-220178] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND Diagnostic imaging (DI) studies are useful resources for examining musculoskeletal (MSK) conditions. When DI is used appropriately, it is an important tool for physical therapists (PTs). OBJECTIVE The purpose of this study was to explore the attitudes, beliefs, and barriers to PTs' practices in referring to DI in Saudi Arabia (SA). METHODS For this quantitative cross-sectional study, an online self-reported questionnaire was designed and distributed. A total of 138 PTs participated in the study. RESULTS Although most PTs had access to DI, few reported being able to order DI. The PTs demonstrated positive attitudes regarding their ability to refer patients for DI. Nevertheless, some PTs have adopted several beliefs and awareness of PTs regarding the clinical appropriateness of referring to DI, which may increase the unnecessary utilisation of DI requests. More than half of the PTs in this study reported that they were unfamiliar with the clinical rules used for prescribing imaging. CONCLUSION This study highlights recommendations to improve PTs' practices towards DI in SA, such as providing more DI courses targeting PTs and including clinical rules within DI education in undergraduate studies. Furthermore, a clear governmental policy is needed to permit PTs to refer to DI when specific criteria are met.
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23
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Areias AC, Costa F, Janela D, Molinos M, Moulder RG, Lains J, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD. Impact on productivity impairment of a digital care program for chronic low back pain: A prospective longitudinal cohort study. Musculoskelet Sci Pract 2023; 63:102709. [PMID: 36543719 DOI: 10.1016/j.msksp.2022.102709] [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: 08/24/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability in the United States and the main reason for absenteeism. Successful management of chronic LBP (CLBP) is dependent on multimodal evidence-based interventions. Digital interventions (DI) may ease accessibility to such treatments, increasing adherence, while reducing healthcare-related costs. OBJECTIVES Assess the impact of a completely remote multimodal DI on productivity impairment in a real-work context cohort of patients with CLBP. DESIGN Longitudinal study. METHODS Ad-hoc analysis of an interventional, single-arm study of individuals with CLBP undergoing a DI for 12 weeks. Outcomes included the mean change in work productivity and activity impairment (including overall and non-work related activities), pain, depression, anxiety, fear-avoidance beliefs, analgesic usage, and engagement. Minimal clinically important change (MCIC) was calculated for productivity using anchor- and distribution-based methods. RESULTS From 560 patients at program start, 78.4% completed the DI. A significant improvement in overall productivity (20.21, 95%CI: 16.48-23.94) and in non-work related activities (21.36, 95%CI: 17.49-25.22) was observed, corresponding to a responder rate of 57.1-83.3% and 60.5-79.8%, respectively, and depending on the MCIC method. Significant improvements were reported for pain (2.32 points, 95%CI: 2.02-2.61), anxiety (5.24, 95%CI: 4.18-6.29), depression (6.38, 95%CI: 4.78-7.98) and fear-avoidance beliefs (8.11, 95%CI: 6.20-10.02). Both engagement (sessions per week) and patient satisfaction scores were high, 2.9 (SD 1.0) and 8.8/10 (SD 1.6), respectively. CONCLUSIONS This study demonstrated the utility of a multimodal DI to address productivity impairment. DIs have great potential to ease the burden of CLBP, providing an accessible and cost-effective modality of care. TRIAL REGISTRATION The study was approved by the New England IRB (protocol number 120190313) and prospectively registered in ClinicalTrials.gov, NCT04092946, on September 17th, 2019.
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Affiliation(s)
| | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, 80309, USA.
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, 3064-908, Tocha, Portugal; Faculty of Medicine, Coimbra University, 3004-504, Coimbra, Portugal.
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA.
| | | | - Vijay Yanamadala
- Sword Health, Inc, UT, 84043, USA; Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, 06473, USA; Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, 06103, USA.
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA; Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, 20814, MD, USA.
| | - Fernando Dias Correia
- Sword Health, Inc, UT, 84043, USA; Neurology Department, Centro Hospitalar e Universitário do Porto, 4099-001, Porto, Portugal.
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Taimeh D, Leeson R, Fedele S, Riordain RN. A Meta-Synthesis of the Experience of Chronic Temporomandibular Disorder Patients Within Health Care Services. J Oral Facial Pain Headache 2023; 37:55-73. [PMID: 36917237 PMCID: PMC10586569 DOI: 10.11607/ofph.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/16/2022] [Indexed: 03/16/2023]
Abstract
Aims: To systematically review the qualitative evidence related to experiences of patients with temporomandibular disorders (TMD) and to explore their journeys within health care services. Methods: A systematic search of the following databases was conducted: MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Complete, and the Cochrane database. Thematic synthesis was used to analyze and synthesize the data from qualitative studies that explored the journeys of TMD patients within health care services. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the quality of the included studies. Results: The search strategies yielded 4,563 articles across all databases, and 18 articles were eventually included. Six themes were derived: care-seeking attitudes; expectations and health care experience; the patient-clinician interaction; diagnosis as a stepping stone for improvement; management; and social support. Conclusion: The journey within health care services may play a valuable role in the ability to cope with chronic TMDs. Receiving a diagnosis, being listened to, and being believed are among the most important elements making for a positive clinical experience.
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O'Keeffe M, Michaleff ZA, Harris IA, Buchbinder R, Ferreira GE, Zadro JR, Traeger AC, Thomas R, Belton J, Darlow B, Maher CG. Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3627-3639. [PMID: 36198841 DOI: 10.1007/s00586-022-07365-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/19/2022] [Accepted: 08/21/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. METHODS In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. RESULTS Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain. CONCLUSION Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia.
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | | | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
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Dreger M. Exploring determinants and regional variation of diagnostic imaging utilization rates in German inpatient care. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 175:76-80. [PMID: 36335010 DOI: 10.1016/j.zefq.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Germany ranks high concerning the per capita supply of computer tomographs (CT) and positron emission tomographs (PET) which may incentivize supply-induced use. Beyond that, international comparison shows high per capita examinations. However, misuse of diagnostic imaging may cause harm to patients and the health care system. The use of diagnostic imaging in Germany has been insufficiently studied so far. Therefore, the study aimed to determine the extent of regional differences as well as supply and demand side factors of per capita CT and PET examinations in German inpatient care. METHODS Cartographic visualizations and a random intercept model controlling for the regional disease burden, ambulatory provided supply and demand, and population deprivation between 2010 and 2017 for CT and between 2016 and 2017 for PET were applied. For this purpose, the Nationwide hospital discharge data (DRG statistics), hospital structured quality reports, the National Association of Statutory Health Insurance Physicians, the Central Research Institute of Ambulatory Health Care in Germany, and the German Index of Socioeconomic Deprivation were used. RESULTS We found a substantial regional variation of examination rates (-63 to +108% for CT and from -94 up to +847% for PET). Regarding PET, the supply structures have a significant impact on examinations per 1,000 inhabitants (28.46, p < .000). Both devices were used in correlation with the regional disease burden. Ambulatory and inpatient CT examination rates were positively associated. DISCUSSION The regional differences identified are to some extent attributable to the regional burden of disease and thus warranted. Although the inpatient PET supply influences utilization rates, the direction of the effect should be investigated more closely for valid statements. The findings in terms of CT should be treated with caution. The cartographic distribution and examination rates indicate global overuse. The clear separation of inpatient and ambulatory sectors leads to misallocation of scarce resources, medically unnecessary multiple examinations, and capacity utilization problems. CONCLUSION The results obtained have great potential for assessing and analyzing the adoption and rapid expansion of imaging technologies. Capacity utilization figures should be the focus of further research to assess utilization rates both economically and medically. Policy makers should address ongoing issues of operational and organizational separation of inpatient and ambulatory sectors in the German health care system.
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Affiliation(s)
- Marie Dreger
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany.
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27
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Kühn L, Lindert L, Choi KE. Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review protocol. Syst Rev 2022; 11:212. [PMID: 36199151 PMCID: PMC9536019 DOI: 10.1186/s13643-022-02083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The provision of low-value care services in low back pain management is a problem of global scope. Inappropriate imaging, overmedication, and overused invasive therapies are prevalent in physician services. Yet, little is known about overused low-value physiotherapy services. Most studies addressing physiotherapy overuse in low back pain management arose from countries in which physiotherapy is established in primary care. However, measures and instruments addressing physiotherapy overuse limitedly fit legislative conditions of health systems in which physiotherapy is a service of secondary care. Thus, this scoping review's purpose is to map existing research designs and instruments aiming to detect overused low-value physiotherapy services taking specific healthcare settings and aspects of medical overuse into account. METHODS The development of this scoping review is guided by the Arksey and O'Malley framework. A two-step, peer-reviewed search strategy in accordance with the PRESS checklist will be conducted on MEDLINE (PubMed), Web of Science, and CINHAL. Additionally, gray literature will be searched on Google Scholar. Preprints of empirical studies will be included. Initially, two reviewers will independently screen articles for eligibility by title and abstract. A third reviewer will mediate discrepancies. Uncertainties will be eliminated by a full-text analysis or by contacting the corresponding authors. A four-step analytical process will guide result reporting focusing on major research questions outlined in this protocol. Numerical and narrative tables, graphics, and narrative summaries will be the methods to summarize and collate results. In the final step, the German health system will serve as an exemplary setting and frame to practically apply results. DISCUSSION Results of this scoping review will help researchers to systematically select overuse measures referring to aspects of the overuse typology, specific healthcare settings, and physiotherapy services. It will further provide information on the limitations of present studies and will give advice on how to address them. Moreover, this review will illustrate to what degree existing studies succeed to comprehensively cover the concept of the overuse typology. SYSTEMATIC REVIEW REGISTRATION This protocol has been registered on the open science framework ( https://doi.org/10.17605/OSF.IO/PMF2G ).
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Affiliation(s)
- Lukas Kühn
- Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf bei Berlin, Neuruppin, Germany.
| | - Lara Lindert
- Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf bei Berlin, Neuruppin, Germany
| | - Kyung-Eun Choi
- Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf bei Berlin, Neuruppin, Germany
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Panigrahi S, Parveen S, Kshatri JS, Pati S, Bhaumik S. Facilitators and barriers to bicycle helmet use: A qualitative evidence synthesis. J Family Med Prim Care 2022; 11:5211-5225. [PMID: 36505541 PMCID: PMC9731013 DOI: 10.4103/jfmpc.jfmpc_2464_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Bicycles are environment-friendly and is an effective physical activity intervention to decrease risk of non-communicable diseases. Family physicians and primary care workers play a key role in promoting its usage, including addressing safety concerns through the use of bicycle helmet use. The uptake of bicycle helmets is low in many settings. We aimed to understand facilitators and barriers to bicycle helmet use. Method We searched five major electronic databases, screened references and manually searched conference abstracts for qualitative studies that focused on facilitators and barriers to bicycle helmet use. We critically appraised the studies using the Critical Appraisal Skills Programme (CASP) checklist and used PROGRESS-Plus tool for an equity-focused analysis. We conducted a thematic synthesis for analysis and used GRADE-CERQual to report confidence in findings. Results We included 15 studies from high-income countries. We identified 4 themes: 1. Perceptions on helmet design, it's quality and cost together with experiences influencing helmet use (10 studies, low confidence); 2. Perceived risk and benefits of helmet use through a gender lens (10 studies, moderate confidence); 3. Parental strategies influencing children's behavior regarding helmet use (6 studies, moderate confidence); 4. Adoption and enforcement of laws that shape perception and usage of bicycle helmets (8 studies, very low confidence). Conclusion Our study identified facilitators and barriers and can be considered for developing programs and strategies to influence bicycle helmet use, but the confidence in findings is not high. Family physicians and primary care workers should consider these factors when promoting bicycle helmet for injury prevention. There is a need for more qualitative studies in different contexts to develop more robust evidence.
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Affiliation(s)
- Sucharita Panigrahi
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India,Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Samina Parveen
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Jaya Singh Kshatri
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India,Injury Division, The George Institute for Global Health, New Delhi, India,Address for correspondence: Dr. Soumyadeep Bhaumik, Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, India, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi - 110 025, India. E-mail:
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Inman JGK, Ellard DR. What influences graduate medical students' beliefs of lower back pain? A mixed methods cross sectional study. BMC MEDICAL EDUCATION 2022; 22:633. [PMID: 35987611 PMCID: PMC9392230 DOI: 10.1186/s12909-022-03692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Low back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner's management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student's beliefs of LBP and what influences them. METHOD A cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis. RESULTS Fifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements. CONCLUSIONS The HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex.
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Affiliation(s)
- John G. K. Inman
- Warwick Medical School, Medical School Building, University of Warwick, Coventry, CV4 7HL UK
| | - David R. Ellard
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7HL UK
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Shin Y, Lee JS, Do YK. Increase in Potential Low-value Magnetic Resonance Imaging Utilization due to Out-of-pocket Payment Reduction Across Income Groups: An Experimental Vignette Study. J Prev Med Public Health 2022; 55:389-397. [PMID: 35940194 PMCID: PMC9371780 DOI: 10.3961/jpmph.22.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yukyung Shin
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul,
Korea
| | - Ji-Su Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Kyung Do
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul,
Korea
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31
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Costa F, Janela D, Molinos M, Moulder RG, Lains J, Bento V, Scheer J, Yanamadala V, Correia FD, Cohen SP. Digital Rehabilitation for Acute Low Back Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:1873-1887. [PMID: 35813029 PMCID: PMC9261956 DOI: 10.2147/jpr.s369926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) has a lifetime prevalence of 70–80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs. Purpose We aim to report the results of a fully remote digital care program (DCP) for acute LBP. Patients and Methods This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4). Conclusion This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.
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Affiliation(s)
- Fabíola Costa
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Dora Janela
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Maria Molinos
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Vijay Yanamadala
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Correspondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Pike A, Patey A, Lawrence R, Aubrey-Bassler K, Grimshaw J, Mortazhejri S, Dowling S, Jasaui Y, Hall A. Barriers to following imaging guidelines for the treatment and management of patients with low-back pain in primary care: a qualitative assessment guided by the Theoretical Domains Framework. BMC PRIMARY CARE 2022; 23:143. [PMID: 35659251 PMCID: PMC9164352 DOI: 10.1186/s12875-022-01751-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2022] [Indexed: 12/28/2022]
Abstract
Background Low back pain (LBP) is a leading cause of disability and is among the top five reasons that patients visit their family doctors. Over-imaging for non-specific low back pain remains a problem in primary care. To inform a larger study to develop and evaluate a theory-based intervention to reduce inappropriate imaging, we completed an assessment of the barriers and facilitators to reducing unnecessary imaging for NSLBP among family doctors in Newfoundland and Labrador (NL). Methods This was an exploratory, qualitative study describing family doctors’ experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging. Results Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation. Conclusions Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don’t have enough time to counsel patients about why they don’t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process – identifying the contextual barriers and the domains to which they are related. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01751-6.
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Affiliation(s)
- Andrea Pike
- Primary Healthcare Research Unit, Faculty of Medicine, Health Sciences Centre, Memorial University, Rm 421, Janeway Hostel, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Andrea Patey
- Centre for Implementation Research, Ontario Health Research Institute, Ottawa, ON, Canada
| | - Rebecca Lawrence
- Primary Healthcare Research Unit, Faculty of Medicine, Health Sciences Centre, Memorial University, Rm 421, Janeway Hostel, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Health Sciences Centre, Memorial University, Rm 421, Janeway Hostel, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Jeremy Grimshaw
- Centre for Implementation Research, Ontario Health Research Institute, Ottawa, ON, Canada
| | - Sameh Mortazhejri
- Centre for Implementation Research, Ontario Health Research Institute, Ottawa, ON, Canada
| | | | | | | | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Health Sciences Centre, Memorial University, Rm 421, Janeway Hostel, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
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Babateen EM, Alharbi ZM, Alnejadi WK, Fallatah MA, Bukhari OR, Lary A. The Utilization of Lumbar MRI for Lower Back Pain at National Guard Hospital, Jeddah: A Retrospective Cohort Study. Cureus 2022; 14:e25468. [PMID: 35783878 PMCID: PMC9240909 DOI: 10.7759/cureus.25468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Magnetic reasoning imaging (MRI) is the imaging modality of choice for detecting spinal pathologies. The study of the appropriateness of MRI utilization in Saudi Arabia is lacking. As a result, this research aims to assess the use and misuse of lumbar MRI in lower back pain (LBP) at the National Guard Hospital (NGH) in Jeddah city. Methods This is a retrospective cohort study that included all adult patients who had lumbar MRI for LBP at NGH in 2019. A total of 1,225 patients were included. Patients with extreme ages, trauma, recent lumbar spine surgery, spine or spinal canal tumors, and infection were excluded, leaving a number of 805 patients. Specific MRI findings were obtained and assessed in association with history and physical examination. Results LBP with radiculopathy was the most common complaint (82.9%) followed by LBP without radiculopathy (12.8%), with the lowest being limb pain alone (2.6%). Overall, 72% of patients had negative MRI findings, which did not explain their symptoms, and 28% had positive MRI findings that were not associated with their symptoms (p < 0.001). A complete physical examination was performed on 27.5% of patients, of which only 12% had positive findings. MRI was ordered for 72.5% of patients without a complete physical examination. Finally, 88.2% of patients who had MRI were managed conservatively, while only 6.7% were managed with surgery (p < 0.04). Conclusion The number of patients who had proper assessment prior to the ordering of MRI was significantly low. The decision to request MRI was not based on any scientific basis. This study has demonstrated that without proper and strict guidelines, MRIs will continue to be overutilized, which, in turn, will have negative consequences on the waiting time for an MRI and the cost of all the unnecessary MRIs. Furthermore, a good number of patients nowadays who do not have any indications for an MRI keep asking their physicians for it, and if the physician refuses, they transfer to another physician who will order the MRI.
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O'Keeffe M, Ferreira GE, Harris IA, Darlow B, Buchbinder R, Traeger AC, Zadro JR, Herbert RD, Thomas R, Belton J, Maher CG. Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment. Eur J Pain 2022; 26:1532-1545. [PMID: 35616226 PMCID: PMC9545091 DOI: 10.1002/ejp.1981] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
Background Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities. Methods Six‐arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels: ‘disc bulge’,‘degeneration’,‘arthritis’,‘lumbar sprain’,‘non‐specific LBP’, ‘episode of back pain’. The primary outcome was the belief about the need for imaging. Results A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. The need for imaging was rated lower with the labels ‘episode of back pain’ (4.2 [2.9]), ‘lumbar sprain’ (4.2 [2.9]) and ‘non‐specific LBP’ (4.4 [3.0]) compared to the labels ‘arthritis’ (6.0 [2.9]), ‘degeneration’ (5.7 [3.2]) and ‘disc bulge’ (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to ‘disc bulge’,‘degeneration’ and ‘arthritis’. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. Conclusions ‘Episode of back pain’,‘lumbar sprain’ and ‘non‐specific LBP’ reduced need for imaging, surgery and second opinion compared to ‘arthritis’,‘degeneration’ and ‘disc bulge’ amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care).
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia.,University of New South Wales, Randwick, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Joletta Belton
- Endless Possibilities Initiative, Fraser, Colorado, United States
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
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Witherow J, Jenkins H, Elliott J, Ip G, Maher C, Magnussen J, Hancock M. Characteristics and Effectiveness of Interventions That Target the Reporting, Communication, or Clinical Interpretation of Lumbar Imaging Findings: A Systematic Review. AJNR Am J Neuroradiol 2022; 43:493-500. [PMID: 35210277 PMCID: PMC8910802 DOI: 10.3174/ajnr.a7432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis. PURPOSE Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of lumbar imaging findings and determine whether interventions are effective in improving low back pain-related health outcomes, health care use, or health care costs. DATA SOURCES PubMed, MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library were searched from inception to October 20, 2021. STUDY SELECTION The search retrieved 4394 articles, nine articles (seven studies) met the inclusion criteria to summarize intervention characteristics. Five of these studies had an adequate design for evaluating intervention effectiveness. DATA ANALYSES Intervention characteristics were summarized using the Template for Intervention Description and Replication checklist. Effectiveness data were extracted from short, intermediate, and long-term follow-up points. Studies were assessed for risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology was used to determine the certainty of the evidence. DATA SYNTHESIS Four studies investigated the insertion of prevalence information into imaging reports. Single studies investigated withholding diagnostic information, education, and reassurance. Moderate-quality evidence (from 1 study) suggests that inserting prevalence information into imaging reports probably does not change the overall health care use in the long-term but may reduce opioid prescribing. LIMITATIONS The available evidence is limited, and a meta-analysis was not possible. CONCLUSIONS Further work is required to develop and test interventions that target the reporting, communication, and clinical interpretation of lumbar imaging findings that may reduce overdiagnosis and improve the management of low back pain.
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Affiliation(s)
- J.L. Witherow
- From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
| | - H.J. Jenkins
- From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
| | - J.M. Elliott
- Faculty of Medicine and Health (J.M.E.),The Kolling Institute of Medical Research (J.M.E.), Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - G.H. Ip
- From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
| | - C.G. Maher
- Sydney School of Public Health (C.G.M.), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,Institute for Musculoskeletal Health (C.G.M.), Sydney, New South Wales, Australia
| | - J.S. Magnussen
- From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
| | - M.J. Hancock
- From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
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Di Donato M, Iles R, Buchbinder R, Xia T, Collie A. Prevalence, Predictors and Wage Replacement Duration Associated with Diagnostic Imaging in Australian Workers with Accepted Claims for Low Back Pain: A Retrospective Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:55-63. [PMID: 33913056 DOI: 10.1007/s10926-021-09981-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
Objectives To determine in Australian workers with an accepted workers' compensation claim for low back pain (LBP) (1) the prevalence of diagnostic imaging of the spine and factors associated with its use, and (2) the association between spinal diagnostic imaging events and wage replacement duration. Methods Workers with accepted workers' compensation claims for LBP longer than 2 weeks were grouped by whether workers' compensation funded no, single, or multiple diagnostic spinal imaging in the 2 years since reported LBP onset. Ordinal logistic regression was used to define the demographic, occupational and social factors associated with each group. Time-to-event analysis was used to determine the association between spinal imaging and wage replacement duration. Results In the sample of 30,530 workers, 9267 (30.4%) received single spinal imaging and 6202 (20.3%) received multiple spinal imaging. Male workers and workers from the state of Victoria had significantly higher odds of multiple imaging. Socioeconomically advantaged workers and workers from remote Australia had significantly lower odds of multiple imaging. Magnetic Resonance Imaging was the most common imaging modality. Workers with single spinal imaging (median duration 17.0 weeks; HR 2.0, 95% CI 1.9, 2.1) and multiple spinal imaging (median duration 49.0 weeks; HR 4.0, 95% CI 3.9, 4.1) had significantly longer wage replacement duration than those with no imaging (median duration 6.1 weeks). Conclusions Over half of Australian workers with an accepted workers' compensation claim for LBP longer than 2 weeks received diagnostic spinal imaging. Receipt of diagnostic imaging, particularly multiple imaging, was associated with longer wage replacement duration.
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Affiliation(s)
- Michael Di Donato
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Ross Iles
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 4 Drysdale St, Malvern, VIC, 3144, Australia
| | - Ting Xia
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Barber P, Lack SD, Bartholomew C, Curran AJ, Lowe CM, Morrissey D, Neal BS. Patient experience of the diagnosis and management of patellofemoral pain: A qualitative exploration. Musculoskelet Sci Pract 2022; 57:102473. [PMID: 34740149 DOI: 10.1016/j.msksp.2021.102473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is common and long-term treatment outcomes are unsatisfactory. Qualitative exploration of diagnosis and management from the perspective of people with PFP is lacking. OBJECTIVES To inform care and improve intervention delivery by exploring the experience of people with PFP regarding diagnosis and management. DESIGN Qualitative study with semi-structured interviews. METHOD Online recruiting yielded a convenience sample of participants with PFP for semi-structured interview. Interviews were recorded, transcribed verbatim, and analysed using thematic analysis until theoretical saturation by multiple investigators to determine themes and sub-themes. RESULTS 12 participants were interviewed, with three themes identified; the value of diagnosis, the need for tailored (individualised) care, and the role of education. Participants viewed receiving a diagnosis as essential to guide management, yet one was rarely provided, causing uncertainty about pain mechanisms; "it's nice to be told what it is that's wrong". Interventions needed to be tailored to the individual as not all participants responded in the same way to treatment(s) or had the same needs; "everyone copes and reacts differently". Finally, participants viewed education as essential to empower them to understand and manage the condition; "if I'd have been given more information, I think I'd know how to deal with it more". CONCLUSIONS The overarching narrative from three themes was a desire for clearly communicated personalised care that meets individual needs. People with PFP desire a diagnosis to explain their pain, tailored interventions, and appropriate education to optimise their experience and outcomes.
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Affiliation(s)
- Philip Barber
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK; Connect Health, The Light Box, Quorum Park, Benton Lane, Newcastle Upon Tyne, Tyne and Wear, NE12 8EU, UK
| | - Simon David Lack
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Pure Sports Medicine, Point West Building, 116 Cromwell Road, London, SW7 4XR, UK
| | - Clare Bartholomew
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Amy Jessica Curran
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Catherine Minns Lowe
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Physiotherapy Department, Barts Health NHS Trust, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3WA, UK.
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Reducing the Weight of Spinal Pain in Children and Adolescents. CHILDREN 2021; 8:children8121139. [PMID: 34943335 PMCID: PMC8700484 DOI: 10.3390/children8121139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Spinal pain in adults is a significant burden, from an individual and societal perspective. According to epidemiologic data, spinal pain is commonly found in children and adolescents, where evidence emerging over the past decade has demonstrated that spinal pain in adults can, in many cases, be traced back to childhood or adolescence. Nevertheless, very little focus has been on how to best manage spinal pain in younger age groups. The purpose of this article is to put the focus on spinal pain in children and adolescents and highlight how and where these problems emerge and how they are commonly dealt with. We will draw on findings from the relevant literature from adults to highlight potential common pathways that can be used in the management of spinal pain in children and adolescents. The overall focus is on how healthcare professionals can best support children and adolescents and their caregivers in making sense of spinal pain (when present) and support them in the self-management of the condition.
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Beales D, Kent P, Birkrem MB, Man Chow C, Li LK, Tan RLJ, Kendell M, Straker L, O'Sullivan P, Smith A. Only one fifth of young Australian adults have beliefs about medical imaging for low back pain that align with current evidence: A cross-sectional study. Musculoskelet Sci Pract 2021; 56:102460. [PMID: 34547611 DOI: 10.1016/j.msksp.2021.102460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/31/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients' perceptions/expectations may be a factor behind medical imaging referral rates. Few studies have investigated the beliefs that might drive expectations of medical imaging. OBJECTIVES This study examined whether beliefs of young Australian adults with and without impactful low back pain (LBP) concerning medical scans for LBP align with current evidence. It also investigated if these beliefs were associated with clinical factors (history of impactful LBP, history of previous medical scans, LBP-related disability and the presence of leg pain) or sociodemographic factors (sex, education, income). DESIGN Cross-sectional observational study. METHODS 78 participants from the Raine Study with a history of impactful LBP and 85 participants with no history of impactful LBP completed a study-specific questionnaire with five statements concerning beliefs about medical imaging for LBP. All statements were not aligned with current evidence about the use of medical imaging in LBP management. RESULTS Only 15-21% (n = 24-34) of the participants held beliefs that were aligned with current evidence. Participants with a university education had slightly more aligned beliefs compared to those whose highest education was completing secondary school. There was no difference in the beliefs of participants based on their history of impactful LBP, or other clinical or sociodemographic factors. CONCLUSION As beliefs are likely to drive care-seeking behavior, it is notable that most participants' views about the role of medical imaging for LBP were not aligned with current evidence. Therefore, this suggests a need for community education, especially for those with lower education.
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Affiliation(s)
- Darren Beales
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Peter Kent
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
| | - Magnus B Birkrem
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Cheuk Man Chow
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Lap Kiu Li
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Rui Ling Joleen Tan
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Michelle Kendell
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Leon Straker
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Peter O'Sullivan
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
| | - Anne Smith
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, Perth, Australia.
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40
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Sharma S, Traeger AC, Tcharkhedian E, Middleton PM, Cullen L, Maher CG. Effect of a waiting room communication strategy on imaging rates and awareness of public health messages for low back pain. Int J Qual Health Care 2021; 33:6384520. [PMID: 34623440 DOI: 10.1093/intqhc/mzab129] [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: 05/17/2021] [Revised: 07/22/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few studies have investigated the effects of waiting room communication strategies on health-care behavior. OBJECTIVE We aimed to determine the effect of a waiting room communication strategy, designed to raise awareness of potential harms of unnecessary imaging, on lumbar imaging rates in the emergency department (ED). METHODS We conducted a controlled experimental study with a replicated time series design. The design included a 6-week run-in time. Following this there were alternating 1-week intervention and control periods. The intervention group received a communication strategy describing the potential harms of unnecessary imaging for low back pain, shown on a 55" LCD screen positioned in the ED waiting room. The communication strategy was designed by a creative innovation agency and included five digital posters and a patient leaflet. The control group received standard messaging for the waiting room at the time, shown on the same 55" LCD screen, and access to the patient leaflet. The primary outcome was the number and proportion of people presenting to ED with low back pain who received at least one lumbar imaging test, measured using routinely collected ED data. Secondary patient-reported outcomes (patient satisfaction and awareness of campaign messages) were collected from a sample of people presenting for any condition who responded to a text-message-based survey. RESULTS For the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n = 99; control n = 238). All had available data on lumbar imaging. Use of lumbar imaging was 25% in those exposed to the communication strategy [95% confidence interval (CI) = 18% to 35%] compared with 29% in those exposed to the standard waiting room messaging [95% CI = 23% to 35%; odds ratio (OR) = 0.83, 95% CI = 0.49 to 1.41]. For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n = 170; control n = 179; response rate = 33%). There was uncertain evidence that the intervention increased awareness of the communication strategy leaflet (OR = 2.00, 95% CI = 0.90 to 4.47). Other measures did not suggest between-group differences in patient satisfaction or awareness of the campaign messages. CONCLUSION A communication strategy displayed in the ED waiting room may slightly reduce the proportion of patients with low back pain who receive lumbar imaging, although there is uncertainty due to imprecision. The campaign did not appear to increase awareness of campaign messages or affect patient satisfaction in a sample of patients presenting to the ED for any reason. Larger studies should investigate whether simple, low-cost waiting room communication strategies can raise awareness of unnecessary healthcare and influence health-care quality. TRIAL REGISTRATION ACTRN12620000300976, 05/03/2020.
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Affiliation(s)
- Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales 2050, Australia.,School of Public Health, The University of Sydney, New South Wales 2006, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales 2050, Australia.,School of Public Health, The University of Sydney, New South Wales 2006, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Liverpool Hospital, Liverpool, NSW 2170, Australia.,Discipline of Emergency Medicine, University of Sydney, Sydney, NSW 2006, Australia
| | - Louise Cullen
- Emergency and Trauma Center, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD 4029, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales 2050, Australia.,School of Public Health, The University of Sydney, New South Wales 2006, Australia
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Pesonen J, Shacklock M, Suomalainen JS, Karttunen L, Mäki J, Airaksinen O, Rade M. Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC Musculoskelet Disord 2021; 22:808. [PMID: 34548049 PMCID: PMC8456642 DOI: 10.1186/s12891-021-04649-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The straight leg raise test (SLR) is one of the most utilized and studied physical tests in patients with low back pain (LBP) for the detection of lumbar disc herniation (LDH), showing high sensitivity and heterogeneous or low specificity. The high incidence of asymptomatic 'pathologic' findings in the magnetic resonance imaging (MRI) scans may cause verification bias to these results. We studied an extended SLR (ESLR) by adding location-specific structural differentiation movements (hip internal rotation or ankle dorsiflexion) to the traditional SLR for it to better differentiate neural symptoms from musculoskeletal. Previously, the ESLR has shown almost perfect interrater reliability between examiners and ability to detect sciatic patients. In this study, we investigated whether a 'positive' ESLR finding is associated with pathology seen on MRI. METHODS Forty subjects comprised the study population, 20 in sciatic group and 20 in control group. The ESLR was performed 'blinded' to the subjects. After the ESLR, each subject's lumbar MRI was evaluated. The MRIs were analyzed independently by 2 senior radiologists and a spine specialist clinician. The ESLR and MRI results were cross-tabulated. To obtain the odds ratio (OR) with positive ESLR or SLR results for LDH or nerve root compression (NC), a binary logistic regression analysis with subjects' age, gender, height and weight was performed. ESLR's validity was assessed by combination of interrater agreement and percentage prevalence of both LDH and NC. RESULTS Of sciatic (ESLR+) patients, 85 % had LDH and 75 % NC in the MRI. Not surprisingly, MRI showed a very high incidence of 'false-positive' findings with the ESLR negative group. The ESLR showed 0.85 sensitivity and 0.45 specificity for LDH and 0.75 sensitivity and 0.50 specificity for NC. A positive result in the ESLR was found to be strongly associated with for both LDH and NC: the OR was 8.0 (p = 0.028) and 5.6 (p = 0.041), respectively. CONCLUSIONS The ESLR shows high validity in detecting neural symptoms and is strongly associated with pathology seen in the MRI when judged positive. We suggest the use of ESLR in clinical practice as a part of clinical examination, where it may prove to be a valuable tool in detecting patients with sciatic symptoms.
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Affiliation(s)
- Janne Pesonen
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
- Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland
| | - Michael Shacklock
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
- Neurodynamic Solutions, Adelaide, Australia
| | | | - Lauri Karttunen
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
- Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland
| | - Jussi Mäki
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
| | - Olavi Airaksinen
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
- Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland
| | - Marinko Rade
- Department of Rehabilitation, Kuopio University Hospital, PL 100, 70029 KYS / Kuopio, Finland
- Faculty of Medicine, University of Osijek, Orthopaedic and Rehabilitation Hospital “Martin Horvat”, Rovinj, Croatia
- Department of Natural and Health Studies, Juraj Dobrila University of Pula, Pula, Croatia
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Suhail A, Slathia S, Quais S, Poulter DC. Do “Myths” of low back pain exist among young Indian college-going adults with a history of low back pain? A cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00036-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
Background
Low back pain (LBP) is a prominent public health problem which causes disability around the globe. The prevalence of LBP is on the rise in lower to middle-income countries. India has a varied prevalence of LBP among the rural as well as urban population ranging from 6.2 to 92%. There has been a marked increase in young adults getting LBP with a proportion converting to chronic LBP later in life. Beliefs associated with any disorder affect the course, management, and need for imaging studies. Negative beliefs about LBP in any population may lead to unnecessary psychologic distress and an increase in disease burden. Focusing these negative beliefs on the younger population can help curb the chronicity and lessen the disability caused by it. This cross-sectional study explored the presence of myths in 516 college-going Indian young adults from Lovely Professional University.
Results
A total of 516 individuals participated in the study. The mean (SD) age of the participants was 22.69 years (2.417). Among them, 47.5% (245) were females and 52.5% (271) were males. The findings show that a high percentage of college-going young adults have false beliefs in most of the ten domains (myths) explored. The most prevalent myths were “LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP” (81.2%) and “LBP is caused by poor posture when sitting, standing, and lifting” with 80.6% agreeing to it.
Conclusion
Our study demonstrated that the myths of low back pain are widespread among the studied population. The findings suggest that community education programs must be developed to address these myths, hence reducing the disease burden associated with back pain.
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Simula AS, Jenkins HJ, Hancock MJ, Malmivaara A, Booth N, Karppinen J. Patient education booklet to support evidence-based low back pain care in primary care - a cluster randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:178. [PMID: 34493219 PMCID: PMC8422671 DOI: 10.1186/s12875-021-01529-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in comparison to usual care. METHODS A cluster-randomized trial was performed. The intervention involved providing practitioners with the new patient-education booklet and a 30-min training session on its use. The booklet was provided during the clinical consult to all consenting LBP patients in the intervention group. Primary outcomes were the proportion of patients presenting with LBP who underwent imaging examinations during the first three months of follow-up and PROMIS PF-20 (Patient-Reported Outcomes Measurement Information System, 20-item physical functioning short form) change between baseline and three-month follow-up. Secondary outcomes, including sick leave and imaging examinations at 12 months, were investigated. Logistic regression using GEE-estimation was used for dichotomous outcomes, Poisson regression using GEE-estimation for count outcomes, and linear mixed models for continuous outcomes. RESULTS Using the patient education booklet appeared to substantially reduce the proportion of LBP patients who underwent an imaging examination at three months, but the result was not statistically significant (OR 0.57, 95% confidence interval (Cl) 0.27 to 1.22). At 12 months, the effect was slightly larger and statistically significant (OR 0.50, 95%Cl 0.30 to 0.83, p = 0.008). No difference was observed in the PROMIS PF-20 T-score change between baseline and 3 months or 12 months (p = 0.365 and p = 0.923, respectively). The number of sick leave days in the intervention group was less than that in the control group at 3 months (RR 0.47, 95%Cl 0.26 to 0.83, p = 0.010) and at 12 months (RR 0.36, 95%Cl 0.18 to 0.72, p = 0.004). CONCLUSIONS The booklet appeared to be effective in reducing the proportion of LBP patients who underwent imaging examinations over 12 months. The intervention had no discernible effect on the PROMIS PF20 T-score change. The number of sick leave days was substantially lower in the intervention group. TRIAL REGISTRATION ISRCTN, ISRCTN14389368 , Registered 4 April 2019-Retrospectively registered.
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Affiliation(s)
- Anna S Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, 90014, Oulu, Finland. .,Department of General Medicine, the South Savo Social and Health Care Authority, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Hazel J Jenkins
- Department of Health Professions, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia.,Department of Chiropractic, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Balaclava Road, North Ryde, NSW, 2109, Australia
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Neill Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, 90014, Oulu, Finland.,Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
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Tait RC, Chibnall JT. Community Perspectives on Patient Credibility and Provider Burden in the Treatment of Chronic Pain. PAIN MEDICINE 2021; 23:1075-1083. [PMID: 34387353 DOI: 10.1093/pm/pnab256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examined factors influencing lay perceptions of a provider's clinical burden in providing care to a person with chronic pain. DESIGN In a between-subjects design that varied three levels of pain severity (4-6-8/10) with two levels of medical evidence (low/high), participants rated the credibility of pain reported by a hypothetical patient and psychosocial factors expected to mediate the effects of evidence and severity on a provider's burden of care. SETTING A randomized vignette study in which community participants were recruited via Amazon Mechanical Turk. SUBJECTS 337 community participants. METHODS Using a Qualtrics platform, participants read one of six vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity, and then rated perceived pain severity, pain credibility, psychosocial variables, and burden. RESULTS Serial mediation models accounted for all effects of medical evidence and pain severity on burden. Low medical evidence was associated with increased burden, as mediated through lower pain credibility and greater concerns about patient depression, opioid abuse, and learning pain management. Higher levels of reported pain severity were associated with increased burden, as mediated through greater pain discounting and concerns about opioid abuse. CONCLUSIONS The lay public is skeptical of chronic pain that is not supported by medical evidence or is reported at high levels of severity, raising concerns about psychosocial complications and drug seeking and expectations of higher burden of care. Such negative stereotypes can pose obstacles to people seeking necessary care if they or others develop a chronic pain condition.
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Affiliation(s)
- Raymond C Tait
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
| | - John T Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
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Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ Open Qual 2021; 10:e001287. [PMID: 34215659 PMCID: PMC8256731 DOI: 10.1136/bmjoq-2020-001287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The largest proportion of general practitioner (GP) magnetic resonance imaging (MRI) is musculoskeletal (MSK), with consistent annual growth. With limited supporting evidence and potential harms from early imaging overuse, we evaluated practice to improve pathways and patient safety. METHODS Cohort evaluation of routinely collected diagnostic and general practice data across a UK metropolitan primary care population. We reviewed patient characteristics, results and healthcare utilisation. RESULTS Of 306 MSK-MRIs requested by 107 clinicians across 29 practices, only 4.9% (95% CI ±2.4%) appeared clearly indicated and only 16.0% (95% CI ±4.1%) received appropriate prior therapy. 37.0% (95% CI ±5.5%) documented patient imaging request. Most had chronic symptoms and half had psychosocial flags. Mental health was addressed in only 11.8% (95% CI ±6.3%) of chronic sufferers with psychiatric illness, suggesting a solely pathoanatomical approach to MSK care. Only 7.8% (95% CI ±3.0%) of all patients were appropriately managed without additional referral. 1.3% (95% CI ±1.3%) of scans revealed diagnoses leading to change in treatment (therapeutic yield). Most imaged patients received pathoanatomical explanations to their symptoms, often based on expected age or activity-related changes. Only 16.7% (95% CI ±4.2%) of results appeared correctly interpreted by GPs, with spurious overperception of surgical targets in 65.4% (95% CI ±5.3%) who suffered 'low-value' (ineffective, harmful or wasteful) post-MRI referral cascades due to misdiagnosis and overdiagnosis. Typically, 20%-30% of GP specialist referrals convert to a procedure, whereas MRI-triggered referrals showed near-zero conversion rate. Imaged patients experienced considerable delay to appropriate care. Cascade costs exceeded direct-MRI costs and GP-MSK-MRI potentially more than doubles expenditure compared with physiotherapist-led assessment services, for little-to-no added therapeutic yield, unjustifiable by cost-consequence or cost-utility analysis. CONCLUSION Unfettered GP-MSK-MRI use has reached unaccceptable indication creep and disutility. Considerable avoidable harm occurs through ubiquitous misinterpretation and salient low-value referral cascades for two-thirds of imaged patients, for almost no change in treatment. Any marginally earlier procedural intervention for a tiny fraction of patients is eclipsed by negative consequences for the vast majority. Only 1-2 patients need to be scanned for one to suffer mismanagement. Direct-access imaging is neither clinically, nor cost-effective and deimplementation could be considered in this setting. GP-MSK-MRI fuels unnecessary healthcare utilisation, generating nocebic patient beliefs and expectations, whilst appropriate care is delayed and a high burden of psychosocial barriers to recovery appear neglected.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Anand Parkunan
- Healthshare Community NHS Musculoskeletal Services, London, UK
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
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Buchbinder R, Bourne A, Staples M, Lui C, Walker K, Ben-Meir M, Gorelik A, Blecher G. Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia. Emerg Med Australas 2021; 34:157-163. [PMID: 34164911 DOI: 10.1111/1742-6723.13814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Recent studies suggest many patients with non-specific low back pain presenting to public hospital EDs receive low-value care. The primary aim was to describe management of patients presenting with low back pain to the ED of a private hospital in Melbourne, Australia, and received a final ED diagnosis of non-specific low back pain. We also determined predictors of hospital admission. METHODS Retrospective review of patients who presented with low back pain and received a final ED diagnosis of non-specific low back pain to Cabrini Malvern ED in 2015. Demographics, lumbar spinal imaging, pathology tests and medications were extracted from hospital records. Multivariate logistic regression was used to determine independent predictors of hospital admission. RESULTS Four hundred and fifty presentations were included (60% female); 238 (52.9%) were admitted to hospital. One hundred and seventy-seven (39.3%) patients received lumbar spine imaging. Two hundred and eighty (62.2%) patients had pathology tests and 391 (86.9%) received medications, which included opioids (n = 298, 66.2%), paracetamol (n = 219, 48.7%), NSAIDs (n = 161, 35.8%), benzodiazepines (n = 118, 26.2%) and pregabalin (n = 26, 5.8%). Predictors of hospital admission included older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.05), arrival by ambulance (OR 2.03, 95% CI 1.06-3.90) and receipt of pathology tests (OR 3.32, 95% CI 2.01-5.49) or computed tomography scans (OR 1.86, 95% CI 1.12-3.11). CONCLUSION We observed high rates of imaging, pathology tests and hospital admissions compared with previous public hospital studies, while medication use was similar. Implementation of strategies to optimise evidence-based ED care is needed to reduce low-value care and improve patient outcomes.
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Affiliation(s)
- Rachelle Buchbinder
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Allison Bourne
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Staples
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Lui
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katie Walker
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gabriel Blecher
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
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Blokzijl J, Dodd RH, Copp T, Sharma S, Tcharkhedian E, Klinner C, Maher CG, Traeger AC. Understanding overuse of diagnostic imaging for patients with low back pain in the Emergency Department: a qualitative study. Emerg Med J 2021; 38:529-536. [PMID: 34045266 DOI: 10.1136/emermed-2020-210345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 04/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Overuse of lumbar imaging in the Emergency Department is a well-recognised healthcare challenge. Studies to date have not provided robust evidence that available interventions can reduce overuse. For an intervention aimed at reducing imaging to be effective, insight into how both patients and clinicians view lumbar imaging tests is essential. AIM To explore factors that might influence overuse of lumbar imaging in the Emergency Department. METHODS Participants were recruited from three hospitals in Sydney, Australia between April and August 2019. We conducted focus groups and/or interviews with 14 patients and 12 clinicians. Sessions were audio-recorded and transcribed verbatim. Data were analysed using framework analysis by a team of four researchers with diverse backgrounds. RESULTS Patients described feeling that the decision about lumbar imaging was made by their Emergency Department clinician and reported little involvement in the decision-making process. Other potential drivers of lumbar imaging overuse from the patients' perspective were strong expectations for lumbar imaging, a reluctance to delay receiving a diagnosis, and requirements from third parties (eg, insurance companies) to have imaging. Emergency Department clinicians suggested that the absence of an ongoing therapeutic relationship, and the inability to manage perceived patient pressure could drive overuse of lumbar imaging. Suggested protective factors included: involving patients in the decision, ensuring clinicians have the ability to explain the reasons to avoid imaging and collaborative approaches to care both within the Emergency Department and with primary care. CONCLUSION AND KEY FINDINGS We found several factors that could contribute to overuse of lumbar imaging in the Emergency Department. Solutions to overuse of lumbar imaging in the Emergency Department could include: (1) strategies to involve patients in decisions about imaging; (2) training and support to provide thorough and well explained clinical assessment for low back pain; and (3) systems that support collaborative approaches to care.
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Affiliation(s)
- Johan Blokzijl
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands.,Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | | | - Christiane Klinner
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia .,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Plinsinga ML, Mellor R, Setchell J, Ford K, Lynch L, Melrose J, Polansky C, Vicenzino B. Perspectives and experiences of people who were randomly assigned to wait-and-see approach in a gluteal tendinopathy trial: a qualitative follow-up study. BMJ Open 2021; 11:e044934. [PMID: 33883152 PMCID: PMC8061810 DOI: 10.1136/bmjopen-2020-044934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore participants' perspectives on, and experiences of, being assigned to a wait-and-see arm of a gluteal tendinopathy trial. DESIGN Descriptive qualitative. SETTING General community in Brisbane and Melbourne, Australia. PARTICIPANTS Fifteen participants who had been randomly allocated to the wait-and-see group in a recent parallel group superiority clinical trial. That trial compared the wait-and-see approach to a physiotherapist-led education plus exercise approach, and an ultrasound-guided corticosteroid injection. The wait-and-see approach involved one physiotherapy session in which participants received reassurance, general advice and encouragement to stay active for the management of gluteal tendinopathy. DATA COLLECTION AND ANALYSIS Semistructured interviews were conducted by four interviewers in person or over the internet, audio recorded and transcribed verbatim. Transcripts were coded and data analysed using an inductive thematic approach. RESULTS Five themes were extracted from the interview transcripts: (1) Feeling disenfranchised by being assigned to a wait-and-see approach; (2) the importance of having a clinical and imaging diagnosis during screening for inclusion into the clinical trial; (3) feelings regarding the effectiveness of the approach; (4) the convenient and easy to follow nature of the wait-and-see approach and (5) the connotation of wait-and-see not always being perceived as an intervention. CONCLUSIONS Participants found the wait-and-see approach convenient and easy to follow, yet almost always felt disenfranchised that nothing was being done. Participants highlighted the importance of a definite clinical and imaging diagnosis. TRIAL REGISTRATION NUMBER ACTRN12612001126808; Post-results.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Kelsie Ford
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Leonard Lynch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Joshua Melrose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Clare Polansky
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Sharma S, Traeger AC, Tcharkhedian E, Harrison J, Hersch JK, Pickles K, Harris IA, Maher CG. "I would not go to him": Focus groups exploring community responses to a public health campaign aimed at reducing unnecessary diagnostic imaging of low back pain. Health Expect 2021; 24:648-658. [PMID: 33599389 PMCID: PMC8077077 DOI: 10.1111/hex.13211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Community awareness of the harms of overdiagnosis remains low. OBJECTIVE To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain. METHODS We conducted two focus groups of 19 community members with or without low back pain in Sydney, Australia. This study formed the fourth and final stage of the development process of a public health campaign: (a) initial design, (b) expert review and revision, (c) online experiment and (d) community views & revision. We evaluated reactions to components of the campaign that included digital posters and an information leaflet using strong imagery and messaging about the risk of overdiagnosis. We conducted a qualitative thematic analysis to identify main themes. RESULTS Community members reacted with surprise, initial mistrust, and occasionally anger towards imagery and messaging that suggested diagnostic imaging tests could be unnecessary and harmful. With further reflection and discussion, and after reading longer format information about overdiagnosis, the participants found some of the messages informative and useful. Participants appeared to gain a better understanding of the concept of overdiagnosis and the importance of not rushing to imaging. CONCLUSIONS Public health campaigns including posters and leaflets displayed in waiting rooms could raise awareness about overuse of diagnostic imaging and the harms of overdiagnosis more broadly. However, negative reactions are possible and must be managed carefully. PATIENT OR PUBLIC CONTRIBUTION We involved a community participation manager who provided advice on the focus group discussion guide, participant recruitment and manuscript presentation.
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Affiliation(s)
- Sweekriti Sharma
- Faculty of Medicine and HealthInstitute for Musculoskeletal HealthSydney School of Public HealthThe University of Sydney and Sydney Local Health DistrictSydneyNSWAustralia
- Wiser HealthcareSydney School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Adrian C. Traeger
- Faculty of Medicine and HealthInstitute for Musculoskeletal HealthSydney School of Public HealthThe University of Sydney and Sydney Local Health DistrictSydneyNSWAustralia
- Wiser HealthcareSydney School of Public HealthThe University of SydneySydneyNSWAustralia
| | | | - Janet Harrison
- Clinical Governance DepartmentLiverpool HospitalSydneyNSWAustralia
| | - Jolyn K. Hersch
- Wiser HealthcareSydney School of Public HealthThe University of SydneySydneyNSWAustralia
- Faculty of Medicine and HealthSydney School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Kristen Pickles
- Wiser HealthcareSydney School of Public HealthThe University of SydneySydneyNSWAustralia
- Faculty of Medicine and HealthSydney School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Ian A. Harris
- Faculty of Medicine and HealthInstitute for Musculoskeletal HealthSydney School of Public HealthThe University of Sydney and Sydney Local Health DistrictSydneyNSWAustralia
- Ingham Institute for Applied Medical ResearchSouth Western Sydney Clinical SchoolUNSW SydneySydneyNSWAustralia
| | - Chris G. Maher
- Faculty of Medicine and HealthInstitute for Musculoskeletal HealthSydney School of Public HealthThe University of Sydney and Sydney Local Health DistrictSydneyNSWAustralia
- Wiser HealthcareSydney School of Public HealthThe University of SydneySydneyNSWAustralia
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AlAteeq M, Alseraihi AA, Alhussaini AA, Binhasan SA, Ahmari EA. Plain lumbosacral X-rays for low back pain: Findings correlate with clinical presentation in primary care settings. J Family Med Prim Care 2021; 9:6115-6120. [PMID: 33681049 PMCID: PMC7928145 DOI: 10.4103/jfmpc.jfmpc_1238_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/08/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Low back pain (LBP) is a common disabling condition frequently seen and managed in primary care. LBP is considered to be the most common health problem for which general practitioners order an imaging test. Objective: To correlate radiological findings of plain lumbosacral X-rays with the initial clinical presentation of patients with back pain. Materials and Methods: This is a descriptive cross-sectional retrospective chart review study, conducted for 384 adult patients, with back pain who had plain lumbosacral X-rays, at three primary healthcare centers at King Abdul-Aziz Medical City (KAMC) in Riyadh, Saudi Arabia, in the period from 1 Jan 2017 to 31 Dec 2018. Results: The majority of cases had either normal lumbosacral X-rays (32.8%) or incidental findings that were nonspecific. The most abnormal findings were degenerative changes such as spondylosis (osteophytosis) and narrowing of the intervertebral foraminal space (45.3%). The vast majority of cases of chronic back pain was associated with abnormal findings on a plain lumbosacral X-ray, which constituted most cases with abnormal findings among subjects. Conclusion: Lumbosacral X-ray findings in the vast majority of cases do not correlate with clinical presentation and do not justify routinely ordering imaging studies for nonspecific back pain in a primary care setting.
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Affiliation(s)
- Mohammed AlAteeq
- Family Medicine Department, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdelelah A Alseraihi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz A Alhussaini
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sultan A Binhasan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad A Ahmari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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