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Almeida VC, Pereira LCD, Machado SDC, Maciel LYDS, de Farias Neto JP, de Santana Filho VJ. The use of a biopsychosocial model in the treatment of patients with chronic. PATIENT EDUCATION AND COUNSELING 2024; 121:108117. [PMID: 38183922 DOI: 10.1016/j.pec.2023.108117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). METHODS A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. RESULTS According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. CONCLUSION BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. PRACTICE IMPLICATION Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research.
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Affiliation(s)
- Verena Calmon Almeida
- Graduate Program in Health Science, Federal University of Sergipe, Aracaju 49100-000, Sergipe, Brazil; Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), 4200-450 Porto, Portugal.
| | | | - Saulo da Cunha Machado
- Graduate Program in Health Science, Federal University of Sergipe, Aracaju 49100-000, Sergipe, Brazil
| | - Leonardo Yung Dos Santos Maciel
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), 4200-450 Porto, Portugal; Physiotherapy Department, Federal University of Sergipe, 49100-000 Lagarto, Sergipe, Brazil
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Buzasi E, Kurakata H, Gandhi A, Birch HL, Zarnegar R, Best L. Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:214-257. [PMID: 33863859 DOI: 10.1097/j.pain.0000000000002302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Our objective was to investigate the effectiveness of booster sessions after self-management interventions as a means of maintaining self-management behaviours in the treatment of chronic musculoskeletal pain. We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, and PsychINFO. Two authors independently identified eligible trials and collected data. We calculated the odds ratio for the analyses of dichotomous data and standardised mean differences (SMDs) with 95% confidence interval (CI) for continuous variables. Our search identified 14 studies with a total of 1695 patients. All studies were at high risk of bias and provided very low quality evidence. For the primary outcomes, booster sessions had no evidence of an effect on improving patient-reported outcomes on physical function (SMD -0.13, 95% CI -0.32 to -0.06; P = 0.18), pain-related disability (SMD -0.16, 95% CI -0.36 to 0.03; P = 0.11), and pain self-efficacy (SMD 0.15, 95% CI -0.07 to 0.36; P = 0.18). For the secondary outcomes, booster sessions caused a significant reduction in patient-reported pain catastrophising (SMD -0.42, 95% CI -0.64 to -0.19; P = 0.0004) and no evidence of an effect on patient-reported pain intensity, depression, coping, or treatment adherence. There is currently little evidence that booster sessions are an effective way to prolong positive treatment effects or improve symptoms of long-term musculoskeletal conditions after self-management interventions. However, the studies were few with high heterogeneity, high risk of bias, and overall low quality of evidence. Our review argues against including booster sessions routinely to self-management interventions for the purpose of behaviour maintenance.
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Affiliation(s)
- Eva Buzasi
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Hiroshi Kurakata
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Akash Gandhi
- Division of Medicine, Northwick Park Hospital, London, United Kingdom
| | - Helen L Birch
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Roxaneh Zarnegar
- Royal National Orthopaedic Hospital, University College London, Stanmore, United Kingdom
| | - Lawrence Best
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Hoben M, Ginsburg LR, Norton PG, Doupe MB, Berta WB, Dearing JW, Keefe JM, Estabrooks CA. Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study. Implement Sci 2021; 16:83. [PMID: 34425875 PMCID: PMC8381143 DOI: 10.1186/s13012-021-01151-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015-2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides' involvement in formal communications about resident care. METHODS Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019-03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention. RESULTS We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3. CONCLUSIONS Theory-informed feedback provides long-lasting improvement in care aides' involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study-as does possible post-intervention spread of our intervention to simple feedback homes.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Whitney B Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - James W Dearing
- Department of Communication, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, 48824, USA
| | - Janice M Keefe
- Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, B3M 2J6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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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] [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. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04353-y.
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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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Hofmann J, Peters S, Geidl W, Hentschke C, Pfeifer K. Effects of behavioural exercise therapy on the effectiveness of a multidisciplinary rehabilitation for chronic non-specific low back pain: study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2013; 14:89. [PMID: 23496822 PMCID: PMC3610103 DOI: 10.1186/1471-2474-14-89] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/28/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In Germany, a multidisciplinary rehabilitation named "behavioural medical rehabilitation" (BMR) is available for treatment of chronic low back pain (clbp). A central component of BMR is standard exercise therapy (SET), which is directed mainly to improve physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with clbp. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is unclear. METHODS/DESIGN To compare the effectiveness of two exercise programs with different approaches within BMR on the effects of BMR a prospective randomized controlled trial (RCT) in two rehabilitation centres will be performed. 214 patients aged 18-65 with clbp will be, based on an "urn randomisation"-algorithm, randomly assigned to a BMR with SET (function-oriented, n=107) and BMR with BET (behaviour-oriented, n=107). Both exercise programs have a mean duration of 26 hours in three weeks and are delivered by a limited number of not-blinded study therapists in closed groups with six to twelve patients who will be masked regarding study group. The main differences of BET lie in its detailed manualised program with a theory-based, goal-orientated combination of exercise, education and behavioural elements, active participation of patients and consideration of their individual preferences and previous experiences with exercise. The primary outcome is functional ability assessed with the Hannover Functional Ability Questionnaire directly before and after the rehabilitation program, as well as a six and twelve-month follow-up. DISCUSSION This RCT is designed to explore the effects of BET on the effectiveness of a BMR compared to a BMR with SET in the management of patients with clbp. Methodological challenges arise from conducting a RCT within routine health care as well as from ensuring high treatment integrity. Findings of this study might contribute to a better understanding of the mechanism of action of BMR and the special effects of BET and may be used to improve the quality of these interventions in routine care, therefore reducing the burden to patients with disabling clbp. TRIAL REGISTRATION Current controlled trials NCT01666639.
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Affiliation(s)
- Jana Hofmann
- Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Gebbertstr. 123b, D-91058 Erlangen, Germany
| | - Stefan Peters
- Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Gebbertstr. 123b, D-91058 Erlangen, Germany
| | - Wolfgang Geidl
- Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Gebbertstr. 123b, D-91058 Erlangen, Germany
| | - Christian Hentschke
- Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Gebbertstr. 123b, D-91058 Erlangen, Germany
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg, Gebbertstr. 123b, D-91058 Erlangen, Germany
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Morone G, Iosa M, Paolucci T, Fusco A, Alcuri R, Spadini E, Saraceni VM, Paolucci S. Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study. Clin Rehabil 2011; 26:339-50. [PMID: 21965520 DOI: 10.1177/0269215511414443] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a perceptive rehabilitative approach, based on a new device, with regard to pain and disability in patients with chronic nonspecific low back pain. DESIGN Single blind, randomized, controlled trial. SETTING An outpatient academic hospital. PATIENTS Seventy-five patients with chronic low back pain. INTERVENTIONS Patients were randomized into three groups. Twenty-five subjects received 10 sessions in one month, based on specific perceptive exercises that were performed on a suitably developed device. Twenty-five patients entered a Back School programme. Twenty-five patients comprised a control group that received the same medical and pharmacological assistance as the other groups. MAIN OUTCOME MEASURES Pain was assessed using the Visual Analogue Scale and McGill Pain Questionnaire. Disability was evaluated using the Oswestry Disability Index and Waddell Disability Index. All measurements were recorded before treatment, at the end of the study, and at 12 and 24 weeks. RESULTS General pain relief was recorded in all the groups, which was elicited more quickly in the perceptive treatment group; significant differences in pain scores were observed at the end of treatment (P < 0.001 for visual analogue scale and P = 0.001 for Questionnaire) versus the other groups. Disability scores in the perceptive group did not differ significantly from those in the other group, whereas these scores significantly differed between Back School and control groups at the follow-ups (P < 0.01 for both scales). CONCLUSION Perceptive rehabilitation has immediate positive effects on pain. Back School reduces disabilities at follow-up.
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Affiliation(s)
- Giovanni Morone
- Movement and Brain Laboratory, Santa Lucia foundation, Rome, Italy.
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