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Habibi S, Tavafian SS, Maghbouli R, Montazeri A. The effectiveness of multidisciplinary interventions based on health belief model on musculoskeletal pain in the elderly living in nursing homes: a study protocol for a randomized controlled trial. Trials 2024; 25:406. [PMID: 38907349 PMCID: PMC11191210 DOI: 10.1186/s13063-024-08243-1] [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: 08/12/2023] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Due to the burden of musculoskeletal diseases in the elderly and the multifactorial nature of such conditions, controlling the pain caused by these disorders requires multidisciplinary approach. This approach requires the participation of the elderly in applying effective prevention measures. This study aims to design a multidisciplinary educational intervention based on health belief model (HBM) for elderly residents of nursing homes. METHODS This is a parallel randomized clinical trial among elderly people aged 60 years and over living in a nursing home who suffer from musculoskeletal pain. Eligible participants will be divided into two groups including the intervention group who will receive a multidisciplinary intervention (vitamin D consumption, psycho-social stress management, and physiotherapy) and the control group who will receive usual care. Data collection instruments will include demographic data, the Depression, Anxiety, and Stress Scale (DASS), the visual analogue scale (VAS), and a self-designed questionnaire containing the HBM constructs. The interventions will be carried out by the educational team (general practitioner, psychologist, physiotherapist, and health education specialist). Interventions include changing the wrong beliefs of the elderly, taking 800 units of vitamin D daily, daily walking exercise by the elderly for at least 30 min and maintaining proper body posture during daily activities, muscle relaxation, relaxation techniques, regular exercise, examining their diet and eliminating stimulants (such as smoking and coffee), regular visits with friends and family, and deep breathing techniques. All questionnaires will be completed by the elderly before, after, 3, and 6 months after the intervention. DISCUSSION The present study will evaluate the effect of an educational intervention based on a multifaceted pain control approach for elderly people who reside in nursing homes in order to reduce musculoskeletal pain in the elderly living in nursing homes. One of the features of this study is its focus on improving the health of elderly residents in nursing homes. Given the increase in the elderly population worldwide, the findings from the current trial might benefit elderly populations. TRIAL REGISTRATION IRCT20220904055881N1 . Registered on 11 February 2023.
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Affiliation(s)
- Sogand Habibi
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sedigheh Sadat Tavafian
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Reza Maghbouli
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science and Culture, ACECR, Tehran, Iran.
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Shaw E, Nunns M, Spicer SG, Lawal H, Briscoe S, Melendez‐Torres GJ, Garside R, Liabo K, Coon JT. What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1412. [PMID: 38751859 PMCID: PMC11094349 DOI: 10.1002/cl2.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes. Objectives The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes. Search Methods In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. Selection Criteria Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. Data Collection and Analysis Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM. Stakeholder Involvement We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. Main Results We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. Authors’ Conclusions This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.
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Affiliation(s)
- Elizabeth Shaw
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Michael Nunns
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Stuart G. Spicer
- NIHR Applied Research CollaborationUniversity of PlymouthPlymouthUK
| | - Hassanat Lawal
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Simon Briscoe
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - G. J. Melendez‐Torres
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Ruth Garside
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Kristin Liabo
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
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Bemani S, Sarrafzadeh J, Dehkordi SN, Talebian S, Salehi R, Zarei J. Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial. Adv Rheumatol 2023; 63:57. [PMID: 38049905 DOI: 10.1186/s42358-023-00329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. METHODS 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. RESULTS There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. CONCLUSIONS In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Department of Physiotherapy, Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blvd., Tehran, Iran
- Department of Rehabilitation Management, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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LoMartire R, Johansson P, Frumento P. Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions. THE JOURNAL OF PAIN 2023; 24:2003-2013. [PMID: 37348775 DOI: 10.1016/j.jpain.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PERSPECTIVES: This study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.
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Affiliation(s)
- Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden
| | - Per Johansson
- Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Administrative Region of Tuscany, Italy
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Hochheim M, Ramm P, Amelung V. The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A systematic review with meta-analysis. Pain Pract 2023; 23:409-436. [PMID: 36565010 DOI: 10.1111/papr.13198] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus active physical interventions on pain intensity and disability in adults with nonspecific chronic low back pain. INTRODUCTION Research has shown that primary care biopsychosocial interventions (PCBI) can reduce pain intensity and disability. While scattered studies support low-dosed (≤ 15 treatment hours) PCBI, no systematic review exists comparing the effectiveness of low-dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). INCLUSION CRITERIA Randomized controlled trials that evaluate low-dosed PCBI compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older), who suffer from CLBP were included. Not recommended interventions that feature only passive therapies, spinal surgery or pharmacological treatment, and studies with inpatient multidisciplinary-based rehabilitation (MBR) were excluded. METHODS Databases were searched from inception to December 31, 2021. Language was restricted to English or German. Keywords and derivatives of "chronic back pain", "exercise intervention", "cognitive-behavioral therapy", "primary care" and "randomized controlled trials" were used. Sources were CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. Search was finished on March 08, 2022. Data appraisal, extraction and synthesis followed JBI guidance for systematic reviews of effectiveness. Risk of Bias was assessed using JBI 13-item checklist for randomized controlled trials. The GRADE approach for grading the certainty of evidence was followed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2022 CRD42022302771. RESULTS Eighteen RCTs were found eligible and 15 trials comprising a total of 1531 participants suffering from CLBP were entered in the meta-analyses. Risk of Bias was low. Overall evidence was moderate. Significant effects in favor of PCBI were found for pain intensity post-treatment (standardized mean difference (SMD) = -1.09, 95% confidence interval (CI) = -1.84 to -0.34, I2 = 97%, p = 0.004) as well as at short-term (SMD = -0.23, 95% CI = -0.39 to -0.08, I2 = 0%, p = 0.004), long term (SMD = -0.79, 95% CI = -1.42 to -0.17, I2 = 96%, p = 0.01) and very long-term (SMD = -1.13, 95% CI = -1.93 to -0.33, I2 = 94%, p = 0.005) follow-up. Significant effects in favor of PCBI for physical function were found post-treatment (SMD = -1.33, 95% CI = -2.17 to -0.49, I2 = 97%, p = 0.002) at short-term (SMD = -0.20, 95% CI = -0.36 to -0.04, I2 = 0%, p = 0.01) and at long-term follow-up (SMD = -1.17, 95% CI = -2.06 to -0.28, I2 = 98%, p = 0.01). The results were characterized by high heterogeneity due to different types (cognitive behavioral therapy, pain-neuroscience education, mindfulness, and motivation), delivery modes (individual and/or group), durations (3-12 weeks) and contact times (2-15 h) of PCBI. In sensitivity analysis outliers were removed to reduce heterogeneity. The results remained significant for pain intensity at short-term (SMD = -0.23, 95% CI = -0.39 to -0.08, I2 = 0%, p = 0.004) and long-term follow-up (SMD = -0.22, 95% CI = -0.41 to -0.03, I2 = 39%, p = 0.02). CONCLUSIONS This meta-analysis suggests that low-dosed PCBI has favorable effects in terms of disability and pain intensity compared to active physical treatments alone. All conducted meta-analyses indicate that biopsychosocial interventions produce better outcomes than active physical treatment alone. Therefore, we strongly recommend decision makers and clinical practitioners to analyze how psychosocial elements can be introduced into outpatient (low-dosed) CLBP interventions.
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Affiliation(s)
- Martin Hochheim
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Philipp Ramm
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Volker Amelung
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
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Gershoni T, Pud D, Aviram J, Eisenberg E. Wellness of patients with chronic pain is not only about pain intensity. Pain Pract 2023; 23:145-154. [PMID: 36181347 PMCID: PMC10092262 DOI: 10.1111/papr.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients. DESIGN A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T0 ), six (T6 ), and twelve (T12 ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively. RESULTS Participants included 510 patients. All variables were significantly improved from T0 to T6 and T12 . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T0 , T6 , and T12 (related conditions: β0 = 0.55, p < 0.001; β6 = 0.54, p < 0.001; and β12 = 0.51, p < 0.001; pain: β0 = 0.42, p < 0.001; β6 = 0.18, p < 0.001; and β12 = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness. CONCLUSION Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.
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Affiliation(s)
- Tamar Gershoni
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Joshua Aviram
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Lee SP, Farrokhi S, Kent JA, Ciccotelli J, Chien LC, Smith JA. Comparison of clinical and biomechanical characteristics between individuals with lower limb amputation with and without lower back pain: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 101:105860. [PMID: 36549051 PMCID: PMC9892268 DOI: 10.1016/j.clinbiomech.2022.105860] [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: 09/28/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower back pain is a debilitating condition common to individuals with lower limb amputation. It is unclear what risk factors contribute to the development of back pain. This study systematically reviewed and analyzed the available evidence regarding the clinical and biomechanical differences between individuals with amputation, with and without lower back pain. METHODS A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL databases in November 2020 and repeated in June 2021 and June 2022. Studies were included if they reported comparisons of demographic, anthropometric, biomechanical, and other clinical variables between participants with and without LBP. Study quality and potential for reporting bias were assessed. Meta-analyses were conducted to compare the two groups. FINDINGS Thirteen studies were included, with aggregated data from 436 participants (239 with LBP; 197 pain free). The median reporting quality score was 37.5%. The included studies enrolled participants who were predominantly male (mean = 91.4%, range = 77.8-100%) and with trauma-related amputation. Meta-analyses showed that individuals with LBP exhibited moderate (3.4 out of 10) but significantly greater pain than those without LBP. We found no between-group differences in age, height, weight, BMI, and time since amputation (p = 0.121-0.682). No significant differences in trunk/pelvic kinematics during gait were detected (p = 0.07-0.446) between the groups. INTERPRETATION Demographic, anthropometric, biomechanical, and simple clinical outcome variables may be insufficient for differentiating the risk of developing back pain after amputation. Investigators should be aware of the existing gender bias in sampling and methodological limitations, as well as to consider incorporating psychosocial measures when studying LBP in this clinical population.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
| | - Shawn Farrokhi
- Research and Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), San Antonio, TX, USA; Department of Physical and Occupational Therapy, Chiropractic Services and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA
| | - Jenny A Kent
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Jason Ciccotelli
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, NV, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Chapman University, Irvine, CA, USA
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S. Battin G, Romsland GI, Christiansen B. Diminishing pain stigma: patient perceptions of encounters with interprofessional teams in biopsychosocial pain rehabilitation. Ann Med 2022; 54:2562-2573. [PMID: 36128674 PMCID: PMC9518607 DOI: 10.1080/07853890.2022.2124447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To explore how patients in biopsychosocial pain rehabilitation perceive encounters with interprofessional teams. The focus of this article is to explore how interactions can perpetuate or diminish chronic pain stigma. MATERIAL AND METHODS An ethnographic approach was applied to the study. Participant observation of interprofessional encounters and clinical encounters in a pain rehabilitation ward was undertaken in 2016 (19 weeks). Interviews with 12 professionals and seven patients were conducted. Data were analysed in an abductive process using thematic analysis. RESULTS The patients perceived their encounters with interprofessional teams as supportive, with implications for pain stigma. This is presented as two themes: (1) being seen as credible, involving patients being believed in and a concept of being overactive at the expense of their own health, and (2) being helped to see their situation in a new light, which involves enthusiasm about changing and challenging views in a process with professionals who were supportive and united across professions. CONCLUSION Interprofessional biopsychosocial pain rehabilitation may be an intervention that can diminish internalised stigma in patients suffering from chronic pain. The study contributes to increased understanding of patient perceptions of positive encounters with professionals during a learning process in rehabilitation and of the imbued influence on power relations. This appears to be fundamental to diminishing pain stigma, as the occurrence of stigma is dependent on differences in power.KEY MESSAGESInterprofessional biopsychosocial pain rehabilitation can be an intervention for diminishing internalised pain stigma in patients.Knowledge on how encounters with professionals induce personal learning processes among people with chronic pain.
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Affiliation(s)
- Gudrun S. Battin
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | | | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Ghafouri B, Ernberg M, Andréll P, Bäckryd E, Fisher MR, Freund-Levi Y, Grelz H, Gräbel O, Karlsten R, Kosek E, Löfgren M, Ringqvist Å, Rudling K, Stålnacke BM, Sörlén N, Uhlin K, Westergren H, Gerdle B. Swedish Chronic Pain Biobank: protocol for a multicentre registry and biomarker project. BMJ Open 2022; 12:e066834. [PMID: 36450421 PMCID: PMC9717004 DOI: 10.1136/bmjopen-2022-066834] [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] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes. METHODS AND ANALYSIS Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
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Affiliation(s)
- Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Karolinska Institute, Stockholm, Sweden
| | - Paulin Andréll
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcelo Rivano Fisher
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Yvonne Freund-Levi
- School of Medical Sciences, Örebro University and department of Geriatrics, University Hospital Örebro, Örebro, Sweden
- Department of geriatrics, Södertälje Hospital, Södertälje, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grelz
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Olaf Gräbel
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rolf Karlsten
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Kosek
- Department Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Rudling
- Department of rehabilitation medicine, University hospital Örebro, Örebro, Sweden
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Niklas Sörlén
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Karin Uhlin
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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10
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Hochheim M, Ramm P, Amelung V. The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A protocol for a systematic review with meta-analysis. PLoS One 2022; 17:e0273983. [PMID: 36048791 PMCID: PMC9436074 DOI: 10.1371/journal.pone.0273983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Best outpatient treatment of nonspecific chronic low back pain is high-dosed exercise that is maintained after therapy. Primary care biopsychosocial intervention (PCBI) is an outpatient multicomponent intervention that includes an active component (exercise, physical activity, or physiotherapy) and at least one psychological, social, or occupational component. Research has shown that PCBI can reduce pain intensity and disability. While scattered studies support low-dosed (<15 treatment hours) PCBI, there is no systematic review comparing the effectiveness of low-dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). INCLUSION CRITERIA Randomised controlled trials that evaluate low-dosed outpatient biopsychosocial interventions compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older) who suffer from nonspecific CLBP will be included. METHODS A comprehensive search of multiple databases will be used to find relevant studies. The databases will be searched from inception to December 2021, with English or German language restrictions imposed. Keywords and derivatives of "chronic back pain", "exercise intervention", "cognitive-behavioral therapy", "primary care" and "randomized controlled trials" will be used. Sources will include CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. DISCUSSION To our knowledge, this will be the first systematic review and meta-analysis of narrowly defined low- dosed PCBI across populations with nonspecific chronic low back pain. The objective of this review is to evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus physical active interventions on pain intensity and disability in adults with CLBP. This study will provide evidence that could improve treatment options for patients with nonspecific CLBP. TRAIL REGISTRATION Systematic review registration number: PROSPERO 2022 CRD42022302771. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302771.
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Affiliation(s)
- Martin Hochheim
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Philipp Ramm
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Volker Amelung
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
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11
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Huijnen IPJ, Köke AJA, Lamper C, Verbunt JA. The organisation of biopsychosocial pain rehabilitation treatment; who should deliver? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2092963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ivan P. J. Huijnen
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
| | - Albère J. A. Köke
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
| | - Cynthia Lamper
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A. Verbunt
- Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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12
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Sarria-Santamera A, Kuntuganova A, Alonso M. Economic Costs of Pain in the Spanish Working Population. J Occup Environ Med 2022; 64:e261-e266. [DOI: 10.1097/jom.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Lewkowicz D, Wohlbrandt AM, Bottinger E. Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis. JMIR Mhealth Uhealth 2022; 10:e35042. [PMID: 35129454 PMCID: PMC8861873 DOI: 10.2196/35042] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Digital therapeutic care apps provide a new effective and scalable approach for people with nonspecific low back pain (LBP). Digital therapeutic care apps are also driven by personalized decision-support interventions that support the user in self-managing LBP, and may induce prolonged behavior change to reduce the frequency and intensity of pain episodes. However, these therapeutic apps are associated with high attrition rates, and the initial prescription cost is higher than that of face-to-face physiotherapy. In Germany, digital therapeutic care apps are now being reimbursed by statutory health insurance; however, price targets and cost-driving factors for the formation of the reimbursement rate remain unexplored. OBJECTIVE The aim of this study was to evaluate the cost-effectiveness of a digital therapeutic care app compared to treatment as usual (TAU) in Germany. We further aimed to explore under which circumstances the reimbursement rate could be modified to consider value-based pricing. METHODS We developed a state-transition Markov model based on a best-practice analysis of prior LBP-related decision-analytic models, and evaluated the cost utility of a digital therapeutic care app compared to TAU in Germany. Based on a 3-year time horizon, we simulated the incremental cost and quality-adjusted life years (QALYs) for people with nonacute LBP from the societal perspective. In the deterministic sensitivity and scenario analyses, we focused on diverging attrition rates and app cost to assess our model's robustness and conditions for changing the reimbursement rate. All costs are reported in Euro (€1=US $1.12). RESULTS Our base case results indicated that the digital therapeutic care strategy led to an incremental cost of €121.59, but also generated 0.0221 additional QALYs compared to the TAU strategy, with an estimated incremental cost-effectiveness ratio (ICER) of €5486 per QALY. The sensitivity analysis revealed that the reimbursement rate and the capability of digital therapeutic care to prevent reoccurring LBP episodes have a significant impact on the ICER. At the same time, the other parameters remained unaffected and thus supported the robustness of our model. In the scenario analysis, the different model time horizons and attrition rates strongly influenced the economic outcome. Reducing the cost of the app to €99 per 3 months or decreasing the app's attrition rate resulted in digital therapeutic care being significantly less costly with more generated QALYs, and is thus considered to be the dominant strategy over TAU. CONCLUSIONS The current reimbursement rate for a digital therapeutic care app in the statutory health insurance can be considered a cost-effective measure compared to TAU. The app's attrition rate and effect on the patient's prolonged behavior change essentially influence the settlement of an appropriate reimbursement rate. Future value-based pricing targets should focus on additional outcome parameters besides pain intensity and functional disability by including attrition rates and the app's long-term effect on quality of life.
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Affiliation(s)
- Daniel Lewkowicz
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Attila M Wohlbrandt
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Erwin Bottinger
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany.,Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
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14
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Rolving N, Agerbo K, Aalkjær Clausen S, Denby KAR, Jacobsen AP, Langagergaard V. Does group-based cognitive therapy improve functional ability, pain, catastrophic thoughts and quality of life in patients with persistent low back pain and psychological risk factors? A randomised controlled trial in a secondary care setting. Clin Rehabil 2021; 36:317-330. [PMID: 34967224 DOI: 10.1177/02692155211056202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effects of a group-based cognitive behavioural intervention for patients with persistent low back pain (LBP) and psychological risk factors referred to secondary care. DESIGN A randomised controlled trial. SETTING Silkeborg Regional Hospital, Denmark. SUBJECTS A total of 136 participants with chronic LBP and psychological risk factors. INTERVENTIONS Participants were randomised to the standard care group, including examination by a rheumatologist and/or a physiotherapist, or the intervention group, including standard care plus a multidisciplinary group-based pain management programme. MAIN MEASURES Patient-reported outcomes were collected at baseline and after 6 and 12 months. The primary outcome was disability (Roland Morris Disability Questionnaire). Secondary outcomes included low back pain intensity, pain catastrophising, health-related quality of life, and sick leave. RESULTS Among 136 participants, 68 (mean age: 41.7 years (SD 11.8)) were randomised to standard care and 68 (mean age: 46.0 years (SD 10.8)) were randomised to the intervention group. Except for age, baseline characteristics were comparable between groups. 12-month follow-up was completed by 92.6% in the intervention group and 80.9% in the standard care group. Both groups achieved significant improvements on disability, with a reduction of -4.8 points (SD 6.1) in the intervention group compared to -3.7 points (SD 5.2), resulting in an insignificant difference between groups. No significant differences were found in the secondary outcomes. CONCLUSION A group-based pain management programme was no more effective than standard care for patients with persistent LBP and psychological risk factors.
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Affiliation(s)
- Nanna Rolving
- 224712DEFACTUM, Corporate Quality, Central Denmark Region, Aarhus, Denmark.,Spine Center, Diagnostic Center, 53179Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Public Health, 1006Aarhus University, Aarhus, Denmark
| | - Karina Agerbo
- Spine Center, Diagnostic Center, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Stine Aalkjær Clausen
- Spine Center, Diagnostic Center, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kate Ane Rauff Denby
- Spine Center, Diagnostic Center, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Anna Puk Jacobsen
- Department of Social Affairs and Employment, Aarhus Municipality, Aarhus, Denmark.,Department of Clinical Social Medicine & Rehabilitation, Gødstrup Hospital, Aarhus, Denmark
| | - Vivian Langagergaard
- Spine Center, Diagnostic Center, 53179Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Social Medicine & Rehabilitation, Gødstrup Hospital, Aarhus, Denmark
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15
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Chowdhury AR, Graham PL, Schofield D, Cunich M, Nicholas M. Cost-effectiveness of Multidisciplinary Interventions for Chronic Low Back Pain: A Narrative Review. Clin J Pain 2021; 38:197-207. [PMID: 34812772 PMCID: PMC8823904 DOI: 10.1097/ajp.0000000000001009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic musculoskeletal pain in adults is a global health and economic problem. The aim of this paper was to systematically review and determine what proportion of multidisciplinary approaches to managing chronic musculoskeletal pain are cost-effective. MATERIALS AND METHODS The EconLit, Embase, and PubMed electronic databases were searched for randomized and nonrandomized economic evaluation studies of nonpharmaceutical multidisciplinary chronic pain management interventions published from inception through to August 2019. RESULTS Seven studies comprising 2095 patients were included. All studies involved diverse multidisciplinary teams in one or more of the study arms. All studies involved chronic (both chronic and subacute) low back pain and were economic evaluations from either a societal or health care perspective. Two of the 3 studies that reported on a multidisciplinary pain intervention compared with nonmultidisciplinary intervention concluded favorable cost-effectiveness based on cost per quality adjusted life years gained, 1 study was not found to be cost-effective. Cost-effectiveness of the multidisciplinary intervention of interest was also not established by another 3-arm study. Two studies compared 2 multidisciplinary interventions; neither of these could definitively declare cost-effectiveness. The remaining study indicated the intervention by a multidisciplinary team was more effective but at a higher cost. None of the included studies used decision models to estimate long-term health outcomes and cost-effectiveness of multidisciplinary programs. DISCUSSION There are few studies on the cost-effectiveness of multidisciplinary chronic pain management interventions. This study encourages additional rigorous economic evaluations of multidisciplinary models for chronic pain management. Economic evaluations that enable extrapolating costs and effects of multidisciplinary programs beyond the time horizon of clinical trials may be more informative for clinicians and health administrators.
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Affiliation(s)
| | - Petra L. Graham
- Department of Mathematics and Statistics, Macquarie University
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney
| | - Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney
- Sydney Institute for Women, Children and their Families, Sydney Local Health District
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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16
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Pain, Sleep, and Health-Related Quality of Life after Multidisciplinary Intervention for Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910233. [PMID: 34639534 PMCID: PMC8508437 DOI: 10.3390/ijerph181910233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022]
Abstract
Multidisciplinary pain-management programs have the potential to decrease pain intensity, improve health-related quality of life (HRQOL), and increase sleep quality. In this longitudinal prospective cohort study, the aim was to investigate the long-term effects of multidisciplinary pain rehabilitation interventions in Iceland. More precisely, we (a) explored and described how individuals with chronic pain evaluated their pain severity, sleep, and HRQOL at pre-treatment and at one-year follow-up and (b) examined what predicted the participants' one-year follow-up HRQOL. Seventy-nine patients aged 20-68 years, most of whom were women (85%), responded. The participants scored their pain lower at one-year follow-up (p < 0.001). According to their response, most of them had disrupted sleep, mainly because of pain. One year after the treatment, more participants slept through the night (p = 0.004), and their HRQOL increased. Higher pre-treatment mental component summary (MCS) scores and having pursued higher education predicted higher MCS scores at one-year follow-up, and higher pre-treatment physical component summary (PCS) scores predicted higher PCS scores at one-year follow-up. Sleep problems, being a woman, and having children younger than 18 years of age predicted lower MCS scores at one-year follow-up. These findings are suggestive that patients should be examined with respect to their mental status, and it could be beneficial if they received some professional support after completing the intervention.
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17
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Kadowaki Å, Alvunger AK, Larsen HI, Persdotter A, Zak MS, Johansson P, Nystrom FH. Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial. BMC FAMILY PRACTICE 2021; 22:179. [PMID: 34496751 PMCID: PMC8428055 DOI: 10.1186/s12875-021-01526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Abstract
Background The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas. Results The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24). Conclusions Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality. Trial registration Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01526-5.
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Affiliation(s)
- Åsa Kadowaki
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna-Karin Alvunger
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Hanna Israelsson Larsen
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Persdotter
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Marta Stelmach Zak
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nystrom
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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LoMartire R, Björk M, Dahlström Ö, Constan L, Frumento P, Vixner L, Gerdle B, Äng BO. The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register-based cohort study. Eur J Pain 2021; 25:2190-2201. [PMID: 34189810 DOI: 10.1002/ejp.1832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. METHODS With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. RESULTS IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). CONCLUSION Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. SIGNIFICANCE In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.
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Affiliation(s)
- Riccardo LoMartire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural, Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lea Constan
- Department of Arts and Crafts, Konstfack: University of Arts, Crafts and Design, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn O Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
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19
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Proetzel S, Weigl MB. Is multidisciplinary rehabilitation for low back pain effective in patients above 65 years? An observational cohort study with 12-month follow-up. Eur J Phys Rehabil Med 2021; 57:783-792. [PMID: 34128604 DOI: 10.23736/s1973-9087.21.06553-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In contrast to the broad evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain (CLBP) patients of working age, little is known about the benefit in patients aged ≥ 65 years. AIM To quantify the short-term and 12-month effects of a 3-week CLBP specific MBR program in patients ≥ 65 years of age; to compare the effects in patients ≥ 65 years of age to the effects in younger patients. DESIGN Observational prospective cohort study. SETTING Outpatient clinic at a tertiary physical medicine and rehabilitation centre. POPULATION Consecutive patients with CLBP who participated in a CLBP a specific MBR program. METHODS The 3-week MBR program included 44 hours of treatment. The primary outcomes pain and disability were measured by the North American Spine Society Questionnaire (NASS). Secondary outcome measures were the Short-Form 36 (SF-36) and the numerical rating scale for pain. Effects were quantified using effect sizes (ES). RESULTS From 203 included patients, 104 patients older than 65 years (mean: 70.7; SD: 4.0) were compared to 99 patients younger than 65 years (mean: 56.4; SD: 6.7). The older patients had more comorbidities (two or more comorbidities: 49.5% versus 23.5%; p < 0.001). Both groups showed significant improvements in pain and disability at discharge (both groups: p<0.001) and at the 12 months' follow-up (old: p < 0.001; young: 0.039) with slightly higher effects for the older patients compared to the younger patients (discharge: ES = 0.67 versus ES = 0.53; 12 months: ES = 0.42 versus ES = 0.29). Both groups also improved in the SF-36 Physical Component Summary with slightly lower effects for the older patients (discharge: ES =0.31, p<0.001 versus ES=0.43, p<0.001; 12 months: ES=0.27, p=0.025 versus ES=0.39, p=0.001). The group differences of the change scores were not significant in any of the outcome measures. CONCLUSIONS MBR shows similar improvements in pain and disability in patients aged ≥ 65 compared to younger patients for at least 12 months. CLINICAL REHABILITATION IMPACT The findings support the concept of MBR in the growing population of CLBP patients older than 65 years of age.
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Affiliation(s)
- Stephan Proetzel
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany.,Department of Orthopaedics and Trauma Surgery, Wertachklinik Bobingen, Germany
| | - Martin B Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany -
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Mantilla Toloza SC, Jaimes Guerrero CA, Lerma Castaño PR. Knowledge and Practices of Back Care, Experience in Colombian Children. Glob Pediatr Health 2021; 8:2333794X211023460. [PMID: 34179301 PMCID: PMC8193660 DOI: 10.1177/2333794x211023460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Early back care has become the preventive strategy to mitigate bad postural habits and musculoskeletal alterations that trigger inadequate postural patterns in the body schema. The objective was to determine the knowledge and practice of back care in first-grade school children after applying an educational intervention for back care. Quasi-experimental study with pre-test and post-tests in a sample of 71 first grade school students. Knowledge and practices for back care were evaluated before and after of the intervention. During 5 weeks, a program of education for back care was developed in the intervention group, formed by concepts about anatomy, physiology, alterations of the spine, adoption of appropriate postures and movements in school life and the execution of adequate movements learned. Simultaneously, physical exercises based on aerobic work, strengthening and stretching the back muscles were carried out with the children in the control group. A linear regression model and a two-level hierarchical model were applied to estimate the effect of the intervention. After the execution of the back care education program, a better score was found in the knowledge and practice questionnaire, which was different between the intervention group and the control group (1.72 95% CI 1.21-2.24). The development of an education program generated a change in the score of the questionnaire on knowledge of back care in the intervnetion group, which suggests the implementation of these strategies in the school context during early childhood, contributing to the prevention of back disorders and deficiencies.
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Semrau J, Hentschke C, Peters S, Pfeifer K. Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:500. [PMID: 34051780 PMCID: PMC8164753 DOI: 10.1186/s12891-021-04353-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). METHODS A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an 'urn randomisation' algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. RESULTS There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI - 2.82 to 2.99; p = 0.955), at 6 months (mean difference, - 1.80; 95% CI; - 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, - 1.33; 95% CI - 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. CONCLUSION BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. TRIAL REGISTRATION Current controlled trials NCT01666639 , 16/08/2012.
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Affiliation(s)
- Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany.
| | | | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie (DVGS) e.V, Vogelsanger Weg 48, 50354, Hürth-Efferen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany
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Bérubé M, Martorella G, Côté C, Gélinas C, Feeley N, Choinière M, Parent S, Streiner DL. The Effect of Psychological Interventions on the Prevention of Chronic Pain in Adults: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:379-395. [PMID: 33577194 DOI: 10.1097/ajp.0000000000000922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset. METHODS We searched databases for articles published from databases inceptions until July 2019. We used standardized mean differences with 95% confidence intervals to assess treatment effect. RESULTS In all, 18 trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared with standard treatments was nonsignificant at 3, 6, and 12 months. We found a moderate significant effect size in favor of psychological interventions compared with standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared with information alone. Most of meta-analysis findings were associated with a low level of evidence. DISCUSSION This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared with standard treatment and information, respectively. However, these findings must be interpreted with caution considering the limited sample of trials. More rigorous randomized controlled trials performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.
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Affiliation(s)
- Mélanie Bérubé
- Faculty of Nursing, Laval University
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Research Center of the Quebec University Health Center (Enfant-Jesus Hospital), Quebec City
| | - Géraldine Martorella
- College of Nursing, Florida State University
- Tallahassee Memorial Hospital Center for Research and Evidence-Based Practice, Tallahassee, FL
| | | | - Céline Gélinas
- Ingram School of Nursing, McGill University
- Center for Nursing Research and Lady Davis Institute, Jewish General Hospital
| | - Nancy Feeley
- Ingram School of Nursing, McGill University
- Center for Nursing Research and Lady Davis Institute, Jewish General Hospital
| | - Manon Choinière
- Research Center of the Montreal University Health Center
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Montreal University
| | - Stefan Parent
- Orthopaedic Department, Montreal University Health Center (Ste-Justine Hospital)
- Surgery Department, University of Montreal, Montreal, QC
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Faes Y, Elfering A. When Unnecessary Tasks Weigh Heavily on the Back: A Diary Study on Musculoskeletal Pain. Workplace Health Saf 2021; 69:410-418. [PMID: 33825571 DOI: 10.1177/2165079921994830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Auxiliary tasks such as administrative work often include tasks that are unnecessary in the view of workers but still have to be done. These tasks can threaten a worker's self-esteem. The purpose of this study was to examine the effects of unnecessary and unreasonable tasks on musculoskeletal pain. METHODS Fifty-five office workers (29 male; mean age = 41.96, SD = 14.2 years) reported their unnecessary and unreasonable tasks at the beginning of the study and kept a diary of their daily musculoskeletal pain over 5 weeks, using a visual analogue scale. Other work-related risk factors (prolonged sitting), job resources (participation in decision-making), and individual risk factors (sex, smoking, exercise, body mass index, maladaptive back beliefs) were controlled for in multilevel regression analysis. FINDINGS Multilevel regression analysis with 742 reports showed unnecessary tasks (B = 4.27, p = .006)-but not unreasonable tasks (B = 3.05, p = .074)-to predict the daily intensity of musculoskeletal pain, beyond other significant risk factors, such as prolonged sitting (B = 2.06, p = .039), body mass index (B = 1.52, p < .001), and maladaptive back beliefs (B = 3.78, p = .003). Participation in decision-making was not a significant protective factor (B = -1.67, p = .176). CONCLUSIONS/APPLICATION TO PRACTICE The higher frequency of unnecessary tasks-compared with unreasonable tasks-could place workers at risk for musculoskeletal pain. Work redesign that reduces unnecessary and unreasonable tasks can make a valuable contribution to worker health and safety among office workers.
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Gerdle B, Cervin M, Rivano Fischer M, Ringqvist Å. Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory - A Study From the Swedish Quality Registry for Pain Rehabilitation. Pain Pract 2021; 21:662-679. [PMID: 33759355 DOI: 10.1111/papr.13007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. METHODS Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. RESULTS The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. CONCLUSION The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matti Cervin
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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25
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Gerdle B, Rivano Fischer M, Cervin M, Ringqvist Å. Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2021; 14:173-187. [PMID: 33542650 PMCID: PMC7850976 DOI: 10.2147/jpr.s288638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined. Methods Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1–6 regions with pain (20.6% of patients), 7–12 regions (26.8%), 13–18 regions (22.0%) and 19–36 regions (30.6%). Results More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both posttreatment and at a 12-month follow-up, but effect sizes were small. Discussion Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-58185, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund SE-22185, Sweden.,Research Group Rehabilitation Medicine,Dept of Health Sciences, Lund University, Lund, Sweden
| | - Matti Cervin
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund SE-22100, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund SE-22185, Sweden
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Höder J. [Results of Rehabilitation in Chronic Non-Specific Back Pain in Germany - Meta-Analyses of Change Scores of Pain Intensity and Functional Capacity]. REHABILITATION 2021; 60:177-184. [PMID: 33477191 DOI: 10.1055/a-1300-6669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE How do pain intensity and functional capacity improve after rehabilitating chronic non-specific back pain? Are the changes of practical relevance for quality of life and social participation? Are they stronger than placebo effects? METHODS Meta-analyses of short-, medium- and long-term outcomes from rehabilitation studies with standardized mean differences and MID-units were performed, as well as meta-analyses of outcomes of sham therapies. In addition, non-standardized effect measures and the amount of reliable change were determined. RESULTS for pain intensity short-term effects were moderate, long-term effects were small, for functional capacity short-term effects were small, and no effects occurred in the long term. The effects were at no time of practical relevance. Similar results could be achieved with sham treatments. CONCLUSION As far as pain intensity and functional capacity are concerned, the typical rehabilitee does not experience any significant improvements; a smaller proportion achieve results in the range of placebo effects.
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Investigation of Risk Factors for Pain Chronification in Patients Suffering from Infections of the Spine. J Clin Med 2020; 9:jcm9124056. [PMID: 33334043 PMCID: PMC7765470 DOI: 10.3390/jcm9124056] [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: 11/26/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Spinal infections represent a therapeutic challenge. The often protracted course of the disease is accompanied by pain, which can lead to a chronic pain experience even after the infectious disease has been treated successfully. The aim of this study was to investigate possible risk factors of pain chronification. Methods: In a prospective study, 14 patients with spinal infections were examined at admission (T1), at discharge from inpatient therapy (T2), and three to eight months postoperatively (T3) byquestionnaires on risk factors for pain chronification and by quantitative sensory testing (QST). Results: In-patient treatment lasted on average 45.3 days (±33.13). The patients complained of pain for 3.43 months (±2.77) prior to inpatient treatment. The visual analogue scale (VAS) for pain (0–10) and the Oswestry Disability Index detected significant improvement in the course of the study. However, patients also reported catastrophic thinking, as well as fear of movement and (re)-injury. Conclusion: In summary, our results demonstrate that patients with spinal infections did not suffer from pain chronification, but might benefit from an interdisciplinary therapeutic approach, which emphasizes promoting active pain-coping strategies, as well as addressing fear of movement and catastrophic thinking.
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van Erp RMA, Huijnen IPJ, Köke AJA, Verbunt JA, Smeets RJEM. Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1840627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Reni M. A. van Erp
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ivan P. J. Huijnen
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Albère J. A. Köke
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Faculty of Health, Department of Physiotherapy, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeanine A. Verbunt
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rob J. E. M. Smeets
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Revalidatie location Eindhoven, Eindhoven, The Netherlands
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The Economic and Social Burden of Low Back Pain in Spain: A National Assessment of the Economic and Social Impact of Low Back Pain in Spain. Spine (Phila Pa 1976) 2020; 45:E1026-E1032. [PMID: 32706566 DOI: 10.1097/brs.0000000000003476] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Economic evaluation of the costs of low back pain (LBP) in Spain from a societal perspective, including direct and indirect costs, based on a national representative sample of the general population, the National Health Survey of 2017 (NHS 2017). OBJECTIVE To estimate the costs attributable to LBP in Spain. SUMMARY OF BACKGROUND DATA LBP has a high prevalence and is associated with lower quality of life, functional status, and increased use of health services. Studies that assess the socio-economic burden of LBP from a general population perspective have not been published yet in Spain. METHODS Data from NHS 2017 were used. Direct costs (consultations-general practitioner, specialist and emergency departments-, diagnostic tests, hospitalizations, physiotherapy, psychologist, and medication consumption) and indirect costs (absenteeism and presenteeism) were assessed. Multivariate models were obtained to determine the independent attributable effect of LBP in each variable. Costs were determined through existing regional healthcare services public data. RESULTS Prevalence of LBP was 17.1% for men and 24.5% for women, and increased with age, low educational status, higher body mass index, and was associated with less physical activity, and lower self-perceived health. Multivariate analysis demonstrated that LBP was independently associated with a significant increase both in the utilization of all health services and on work day losses. Attributable costs of LBP were 8945.6 million euros, of which 74.5% implied indirect costs, representing overall 0.68% of Spanish Gross Domestic Product. CONCLUSION Spain is paying a heavy price for LBP, mostly associated with its significant impact on absenteeism and presenteeism, as well as a noteworthy effect on excess health services utilization. These findings underscore the need to address this considerable public health and social problem through interventions that address widely LBP and that have demonstrated to be cost-effective. LEVEL OF EVIDENCE 3.
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Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med 2020; 9:jcm9082374. [PMID: 32722367 PMCID: PMC7466148 DOI: 10.3390/jcm9082374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
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Grotle M, Bråten LC, Brox JI, Espeland A, Zolic-Karlsson Z, Munk Killingmo R, Tingulstad A, Grøvle L, Froholdt A, Kristoffersen PM, Wigemyr M, van Tulder MW, Storheim K, Zwart JA. Cost-utility analysis of antibiotic treatment in patients with chronic low back pain and Modic changes: results from a randomised, placebo-controlled trial in Norway (the AIM study). BMJ Open 2020; 10:e035461. [PMID: 32546490 PMCID: PMC7299049 DOI: 10.1136/bmjopen-2019-035461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/19/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the cost-utility of 100 days of antibiotics in patients with chronic low back pain (LBP) and type I or II Modic changes included in the Antibiotic treatment In patients with chronic low back pain and Modic changes (AIM) study. DESIGN A cost-utility analysis from a societal and healthcare perspective alongside a double-blinded, parallel group, placebo, multicentre trial. SETTING Hospital outpatient clinics at six hospitals in Norway. The main results from the AIM study showed a small effect in back-related disability in favour of the antibiotics group, and slightly larger in those with type I Modic changes, but this effect was below the pre-defined threshold for clinically relevant effect. PARTICIPANTS 180 patients with chronic LBP, previous disc herniation and Modic changes type I (n=118) or type II (n=62) were randomised to antibiotic treatment (n=89) or placebo-control (n=91). INTERVENTIONS Oral treatment with either 750 mg amoxicillin or placebo three times daily for 100 days. MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) by EuroQoL-5D over 12 months and costs for healthcare and productivity loss measured in Euro (€1=NOK 10), in the intention-to-treat population. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER). RESULTS Mean (SD) total cost was €21 046 (20 105) in the amoxicillin group and €19 076 (19 356) in the placebo group, mean difference €1970 (95% CI; -3835 to 7774). Cost per QALY gained was €24 625. In those with type I Modic changes, the amoxicillin group had higher healthcare consumption than the placebo group, resulting in €39 425 per QALY gained. Given these ICERs and a willingness-to-pay threshold of €27 500 (NOK 275 000), the probability of amoxicillin being cost-effective was 51%. Even when the willingness-to-pay threshold increased to €55 000, the probability of amoxicillin being cost-effective was never higher than 53%. CONCLUSIONS Amoxicillin treatment showed no evidence of being cost-effective for people with chronic LBP and Modic changes during 1-year follow-up. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02323412.
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Affiliation(s)
- Margreth Grotle
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway
| | | | - Jens Ivar Brox
- Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Rikke Munk Killingmo
- Department of Physiotherapy, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Oslo, Norway
| | - Alexander Tingulstad
- Department of Physiotherapy, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Oslo, Oslo, Norway
| | - Anne Froholdt
- Department of Physical Medicine and Rehabilitation, Vestre Viken Hospital Trust, Drammen, Norway
| | - Per Martin Kristoffersen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Hordaland, Norway
| | - Monica Wigemyr
- FORMI, Oslo University Hospital Ullevaal, Oslo, OSLO, Norway
| | | | | | - John-Anker Zwart
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Davergne T, Bailly F, Foltz V, Lambert A, Fautrel B, Gossec L. Effectiveness of a short functional restoration program for patients with chronic low back pain: A cohort study of 193 patients. Joint Bone Spine 2020; 87:640-646. [PMID: 32534196 DOI: 10.1016/j.jbspin.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Functional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity. METHODS Longitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi2 between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8). RESULTS In all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference -5.9, 95% confidence interval: -7.6, -4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1min: 0.54 [0.29,0.99]). CONCLUSION This CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de santé Publique, (IPLESP), (équipe PEPITES), 7-83, boulevard de l'Hôpital, 75013 Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France.
| | - Florian Bailly
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de santé Publique, (IPLESP), (équipe PEPITES), 7-83, boulevard de l'Hôpital, 75013 Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Violaine Foltz
- Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Anne Lambert
- Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de santé Publique, (IPLESP), (équipe PEPITES), 7-83, boulevard de l'Hôpital, 75013 Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
| | - Laure Gossec
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de santé Publique, (IPLESP), (équipe PEPITES), 7-83, boulevard de l'Hôpital, 75013 Paris, France; Pitié Salpêtrière hospital, AP-HP, Rheumatology department, Paris, France
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Affiliation(s)
- Frank Janssen
- Tagesklinik für Schmerztherapie, Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - Stefanie Füssel
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Nadja Hanisch
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
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Ibrahim ME, Weber K, Courvoisier DS, Genevay S. Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study. BMC Musculoskelet Disord 2019; 20:439. [PMID: 31597562 PMCID: PMC6785904 DOI: 10.1186/s12891-019-2831-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/12/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. METHODS This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. RESULTS Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. CONCLUSIONS This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.
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Affiliation(s)
- Maha E. Ibrahim
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14 Geneva, Switzerland
- Department of Physical Medicine, Rheumatology and Rehabilitation, Suez Canal University, Ismailia, Egypt
| | - Kerstin Weber
- Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S. Courvoisier
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14 Geneva, Switzerland
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14 Geneva, Switzerland
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Ringqvist Å, Dragioti E, Björk M, Larsson B, Gerdle B. Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med 2019; 8:jcm8060905. [PMID: 31238588 PMCID: PMC6617026 DOI: 10.3390/jcm8060905] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022] Open
Abstract
Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP.
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Affiliation(s)
- Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, SE-221 85 Lund, Sweden.
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Mathilda Björk
- Department of Social and Welfare Studies, Linköping University, SE-602 21 Norrköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Gerdle B, Åkerblom S, Stålnacke BM, Brodda Jansen G, Enthoven P, Ernberg M, Dong HJ, Äng BO, Boersma K. The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation – a SQRP study of more than 20,000 chronic pain patients. Scand J Pain 2019; 19:693-711. [DOI: 10.1515/sjpain-2019-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up.
Methods
Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods.
Results
The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements.
Conclusions
Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.
Implications
This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden , Phone: +46763927191
| | - Sophia Åkerblom
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Psychology , Lund University , Lund , Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine , Umeå University , Umeå , Sweden
| | - Gunilla Brodda Jansen
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine , Stockholm , Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Malin Ernberg
- Department of Dental Medicine , Karolinska Institutet , Stockholm , Sweden
- Scandinavian Center for Orofacial Neuroscience (SCON) , Huddinge , Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , 23100 Huddinge , Sweden
- Center for Clinical Research Dalarna – Uppsala University , Falun , Sweden
- School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work , Örebro University , Örebro , Sweden
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