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Wallwork SB, Nichols S, Jordan A, Noel M, Madden VJ, Lorimer Moseley G. Harnessing Children's Picture Books to Socialize Children About Pain and Injury: A Qualitative Study. THE JOURNAL OF PAIN 2024; 25:104520. [PMID: 38580100 DOI: 10.1016/j.jpain.2024.03.016] [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: 10/16/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Pain experiences are common during childhood (eg, "everyday" pain, vaccine injections) and are powerful opportunities for children to learn about pain and injury. These experiences likely inform fundamental and life-long beliefs about pain. There is scant research investigating the sociocultural contexts in which children learn about pain and injury. One unexplored context is the shared reading of picture books (eg, between parents/caregivers and children). In this study, we investigated whether shared reading of picture books that included depictions of pain and/or injury prompted parent/caregiver-child interactions. If interactions were observed, we explored what those interactions entailed. Twenty parents/caregivers (8 men, 12 women) and their children (n = 27; 10 boys, 17 girls) were recruited from libraries in South Australia. Parent/caregiver-child families chose from 8 books (7 fiction, 1 nonfiction) with varying amounts of pain/injury-related content. Shared reading interactions were video recorded, transcribed, and analyzed alongside analysis of the picture books using reflexive thematic analysis. Pain/injury-related interactions were observed between parents/caregivers and children during shared reading of picture books. Qualitative analyses generated 1 main theme and 3 subthemes. Findings identified that shared reading presented an opportunity for children's understanding of pain and injury to be socialized through discussion of characters' experiences. This included teaching children about pain and injury, as well as promoting empathy and emotional attunement toward characters who were depicted as being in pain. Finally, parents/caregivers often responded with observable/expressed amusement if pain/injury was depicted in a light-hearted or unrealistic way. Overall, shared reading of picture books presents an untapped opportunity to socialize children about pain and injury. PERSPECTIVE: Shared reading of picture books that have depictions of pain and/or injury can prompt parent/caregiver-child interactions about pain and injury. These interactions present critical opportunities that can be harnessed to promote children's learning of adaptive pain-related concepts and behaviors during a critical developmental period.
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Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Sue Nichols
- Education Futures, University of South Australia, Adelaide, South Australia, Australia
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Victoria J Madden
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Pain Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Augustine L, Zadro J, Maher C, Traeger AC, Jones C, West CA, Yang J, O'Keeffe M, Jenkins H, McAuley JH, Ferreira GE. Perceptions of advice for acute low back pain: a content analysis of qualitative data collected in a randomised experiment. BMJ Open 2024; 14:e079070. [PMID: 39043591 PMCID: PMC11268038 DOI: 10.1136/bmjopen-2023-079070] [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: 08/23/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES To explore how people perceive three different forms of advice for acute low back pain (LBP). DESIGN Content analysis of qualitative data collected in a three-arm randomised experiment. PARTICIPANTS 2200 participants with acute LBP (ie, pain duration for ≤6 weeks) were randomly assigned to receive three types of advice: guideline advice and guideline advice with the addition of either brief pain science or ergonomics messages. PRIMARY AND SECONDARY OUTCOMES After receiving the advice, participants answered two questions: 'If your health professional gave you this advice, how would it make you feel?' and 'If your health professional gave you this advice, what treatments (if any) do you think you would need?' Two researchers coded responses using deductive content analysis. RESULTS We analysed 4400 free-text responses from 2200 participants. There were little to no differences in participants' feelings, thoughts and expectations after receiving three types of advice for acute LBP. Participants most commonly expressed feeling positive about the advice (38%-35%), reassured (23%-22%) and empowered (10%-8%). Some expressed being unhappy or being frustrated with the advice (4%-3%). Participants most commonly thought they needed no treatment apart from staying active, followed by exercise and medication. CONCLUSIONS Guideline advice with or without the addition of brief pain science or ergonomics messages generated positive feelings, reassurance or a sense of empowerment in many people with acute LBP, with no difference between types of advice. TRIAL REGISTRATION NUMBER ACTRN12623000364673.
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Affiliation(s)
- Lidiya Augustine
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher Maher
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Caitlin Jones
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Courtney A West
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Jingjing Yang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- National University of Ireland Galway, Galway, Ireland
| | - Hazel Jenkins
- Macquarie University, Sydney, New South Wales, Australia
| | - James H McAuley
- University of New South Wales, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Burton W, Salsbury SA, Goertz CM. Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey. BMC Health Serv Res 2024; 24:125. [PMID: 38263013 PMCID: PMC10804504 DOI: 10.1186/s12913-024-10578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. METHODS Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. RESULTS A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. CONCLUSIONS Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.
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Affiliation(s)
- Wren Burton
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Christine M Goertz
- Implementation of Spine Health Innovations, Department of Orthopaedic Surgery, School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Musculoskeletal Research, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke-Margolis Center for Health Policy, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
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Zaworski K, Latosiewicz R. Are there any correlations among the number of discopathy levels and pain intensity or disability in patients with symptomatic low back pain? Arch Orthop Trauma Surg 2023; 143:6077-6085. [PMID: 37127817 DOI: 10.1007/s00402-023-04881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Low back pain (LBP) is considered a civilization disease that affects people in an increasing number. Discopathy (degeneration of intervertebral discs) is recognised as one of LBP causes. Still, the relationship between the number of discopathy levels and LBP remains unclear. The aim of this study was to evaluate the correlation between the number of discopathy levels with intensity of LBP, functional level and the degree of disability. MATERIALS AND METHODS The prospective, cohort study involved 200 patients aged 27 to 55 years (44.9 ± 9.2 years) with single- or multilevel lumbar discopathy confirmed by imaging examinations. Functional examination included NRSscale, goniometric measurements, Modified Laitinen Pain Questionnaire, Oswestry Disability Index and Back Pain Function Scale. RESULTS There were statistically significant positive correlations between the number of discopathy levels and the age of the subjects (r = 0.266; p = 0.000), BMI (r = 0.158; p = 0.029) and ODI (r = 0.157; p = 0.026). Positive correlation (r = 0.142; p = 0.044) was also observed between the results of Fingertip-to-floortest and the number of levels of discopathy. CONCLUSIONS The number of levels of discopathy was depended on the age and BMI of the patients. It had no effect on pain intensity, range of rotational motion of the lumbar spine and functional status of patients. As the number of levels of discopathy increased, a higher degree of everyday disability was observed.
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Affiliation(s)
- Kamil Zaworski
- Department of Physiotherapy, John Paul II University of Applied Sciences in Biała Podlaska, ul. Sidorska 95/97, 21-500, Biała Podlaska, Poland.
| | - Robert Latosiewicz
- Chair of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. Understanding how patients' pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach. BMJ Open 2022; 12:e061062. [PMID: 36581439 PMCID: PMC9806037 DOI: 10.1136/bmjopen-2022-061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 10/11/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear. OBJECTIVES To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them. DESIGN Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana. RESULTS Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients' themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana. CONCLUSION Participants' narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, London South Bank University Faculty of Health and Social Care, London, UK
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Claire Diver
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Alrushud AS, Alamam DM, Almurdi MM, Almutairi SK, Alzahrani RO, Alanazi MS, Dhahi WM, Alshaiqy DM. Primary Investigation of Low Back Pain among Saudi Arabians: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12854. [PMID: 36232153 PMCID: PMC9565200 DOI: 10.3390/ijerph191912854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Low back pain (LBP) is a prevalent disease that affects all ages and is a symptom that induces immobility. Patients' beliefs may influence LBP management, and adjusting detrimental beliefs is required to improve treatment outcomes. Our aim was to evaluate the prevalence of LBP within the Saudi population and beliefs regarding LBP, physical activity, rest, imaging, and medication. People with LBP were targeted with a questionnaire containing sections on demographic information and the validated Back Beliefs Questionnaire (BBQ), in addition to questions regarding imaging, physical activity, rest and medication. A total of 651 responses were received, 559 of them (86%) experienced LBP. The most common age group was those aged 18-21 (n = 221), 80% from females. The average BBQ score was 27.8 (SD = 5.58). The majority of the respondents held the following beliefs, which are contrary to the best available evidence: back pain must be rested (77.1%) and X-rays or scans are required to gain the best medical care for LBP (73.2%). The Saudi population holds unhelpful beliefs that may affect their quality of life. Healthcare professionals working with patients with LBP have an important role in changing detrimental beliefs and behaviors about the condition.
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Ray BM, Kovaleski A, Kelleran KJ, Stilwell P, Baraki A, Coninx S, Eubanks JE. An exploration of low back pain beliefs in a Northern America based general population. Musculoskelet Sci Pract 2022; 61:102591. [PMID: 35777261 DOI: 10.1016/j.msksp.2022.102591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prior research has demonstrated that people across different populations hold beliefs about low back pain (LBP) that are inconsistent with current evidence. Qualitative research is needed to explore current LBP beliefs in Northern America (NA). OBJECTIVES We conducted a primarily qualitative cross-sectional online survey to assess LBP beliefs in a NA population (USA and Canada). METHODS Participants were recruited online using social media advertisements targeting individuals in NA over the age of 18 with English speaking and reading comprehension. Participants answered questions regarding the cause of LBP, reasons for reoccurrence or persistence of LBP, and sources of these beliefs. Responses were analyzed using conventional (inductive) content analysis. RESULTS/FINDINGS 62 participants were included with a mean age of 47.6 years. Most participants reported multiple causes for LBP as well as its persistence and reoccurrence, however, these were biomedically focused with minimal to no regard for psychological or environmental influences. The primary cited source of participants' beliefs was healthcare professionals. CONCLUSIONS Our findings align with prior research from other regions, demonstrating a need for updating clinical education and public messaging about the biopsychosocial nature of LBP.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, VA, USA.
| | | | - Kyle J Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY, USA
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, USA
| | - Austin Baraki
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, DE, Germany
| | - James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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O'Hagan E, Traeger AC, Schabrun SM, O'Neill S, Wand BM, Cashin A, Williams CM, Harris IA, McAuley JH. It's safe to move! A protocol for a randomised controlled trial investigating the effect of a video designed to increase people's confidence becoming more active despite back pain. BMJ Open 2022; 12:e063250. [PMID: 35840303 PMCID: PMC9295673 DOI: 10.1136/bmjopen-2022-063250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Social media provide promising contemporary platforms for sharing public health information with a broad audience. Before implementation, testing social media campaigns that are intended to engage audiences and initiate behaviour change is necessary. This trial aims to investigate the effectiveness of a public health campaign to increase people's confidence in becoming more active despite low back pain in comparison with no intervention. METHODS AND ANALYSIS This is an online randomised controlled trial with two intervention groups and one control group in a 1:1:1 allocation. People over 18 years of age and fluent in English will be recruited via social media advertising. We developed a social media-based public health campaign to support recommendations for managing low back pain. The interventions are two videos. Participants in the control group will be asked questions about low back pain but will not view either video intervention. The primary outcome will be item 10 of the Pain Self-Efficacy Questionnaire, which asks participants to rate how confident they would feel to gradually become more active despite pain ranging from 0 (not at all confident) to 6 (completely confident). This outcome will be measured immediately in all participant groups. We will compare group mean of the three arms of the trial using univariate analyses of variance. ETHICS AND DISSEMINATION This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry. We obtained ethical approval from our institutions Human Research Ethics Committee before data collection. We will publish the results in a peer-reviewed medical journal and on institution websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12622000466741).
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Affiliation(s)
- Edel O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
- Maridulu Budyari Gumal, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Maridulu Budyari Gumal, Sydney, New South Wales, Australia
| | - Sean O'Neill
- Maridulu Budyari Gumal, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Benedict Martin Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Aidan Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Michael Williams
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Ian A Harris
- Maridulu Budyari Gumal, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Maridulu Budyari Gumal, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Grøn S, Jensen RK, Kongsted A. Beliefs about back pain and associations with clinical outcomes: a primary care cohort study. BMJ Open 2022; 12:e060084. [PMID: 35545402 PMCID: PMC9096526 DOI: 10.1136/bmjopen-2021-060084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate associations between beliefs about low back pain (LBP) at baseline and pain intensity and disability at 2-week, 13-week and 52-week follow-up. DESIGN Observational cohort study. SETTING Primary care private chiropractic clinics in Denmark. PARTICIPANTS A total of 2734 adults consulting a chiropractor for a new episode of LBP, with follow-up data available from 71%, 61% and 52% of the participants at 2, 13 and 52 weeks, respectively. OUTCOME MEASURES Beliefs about LBP were measured by the Back Belief Questionnaire (BBQ) before consulting the chiropractor. Pain (Numerical Rating Scale 0-10) and disability (the Roland-Morris Disability Questionnaire) were measured at baseline and after 2, 13 and 52 weeks. Associations were explored using longitudinal linear mixed models estimating interactions between BBQ and time, and by estimating associations between single items of BBQ and 13-week outcomes. RESULTS More positive beliefs about LBP were weakly associated with a reduction in pain at 2 weeks (β interaction BBQ#Time=-0.02 (95% CI -0.04 to -0.001)), at 13 weeks (-0.03 (95% CI -0.05 to -0.01)) and at 52 weeks of follow-up (-0.03 (95% CI -0.05 to -0.01); p=0.003). For disability, the association was uncertain (p=0.7). The item 'Back trouble means periods of pain for the rest of one's life' had the strongest association with both reduction in pain (-0.29, 95% CI -0.4 to -0.19, p<0.001) and disability (-2.42, 95% CI -3.52 to -1.33, p<0.001) at 13-week follow-up. CONCLUSION Positive beliefs regarding LBP, measured by the BBQ, were associated with a reduction in pain intensity at both short-term and long-term follow-up. However, the association was weak, and the clinical relevance is therefore questionable. No clear association was demonstrated between beliefs and disability. This study did not show promise that back beliefs as measured by the BBQ were helpful for predicting or explaining the course of LBP in this setting.
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Affiliation(s)
- Søren Grøn
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rikke K Jensen
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Masuy R, Bamelis L, Bogaerts K, Depreitere B, De Smedt K, Ceuppens J, Lenaert B, Lonneville S, Peuskens D, Van Lerbeirghe J, Van Schaeybroeck P, Vorlat P, Zijlstra S, Meulders A, Vlaeyen JWS. Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS). BMC Psychol 2022; 10:39. [PMID: 35193697 PMCID: PMC8862001 DOI: 10.1186/s40359-022-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors of work resumption after back surgery. Methods In this multisite, prospective, longitudinal study, 300 individuals with radicular pain undergoing a lumbar decompression will be followed until 1-year post-surgery. Prior to surgery, participants will perform a computer task to assess fear of movement-related pain, avoidance behavior, and their generalization to novel situations. Before and immediately after surgery, participants will additionally complete questionnaires to assess fear of movement-related pain, avoidance behavior, optimism, expectancies towards recovery and work resumption, and the duration and severity of the pain. Six weeks, 3 months, 6 months, and 12 months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. The primary hypothesis is that (generalization of) fear of movement-related pain and avoidance behavior will negatively affect sustainable work resumption after back surgery. Second, we hypothesize that (generalization of) fear of movement-related pain and avoidance behavior, negative expectancies towards recovery and work resumption, longer pain duration, and more severe pain before the surgery will negatively affect work resumption, pain severity, disability, and quality of life after back surgery. In contrast, optimism and positive expectancies towards recovery and work resumption are expected to predict more favorable work resumption, better quality of life, and lower levels of pain severity and disability after back surgery. Discussion With the results of this research, we hope to contribute to the development of strategies for early identification of risk factors and appropriate guidance and interventions before and after back surgery. Trial registration The study was preregistered on ClinicalTrials.gov: NCT04747860 on February 9, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00736-5.
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Affiliation(s)
- Rini Masuy
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.
| | - Lotte Bamelis
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Centre for Translational Psychological Research TRACE, Genk, Belgium.,Department of Psychology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Katleen Bogaerts
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Kris De Smedt
- Department of Neurosurgery, GasthuisZusters Antwerpen, Wilrijk, Belgium
| | | | - Bert Lenaert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Sarah Lonneville
- Department of Neurosurgery, Centre Hospitalier de Wallonie picarde, Tournai, Belgium
| | - Dieter Peuskens
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Neurosurgery, Noorderhart Mariaziekenhuis, Pelt, Belgium
| | | | - Patrick Van Schaeybroeck
- Department of Neurosurgery, Imeldaziekenhuis, Bonheiden, Belgium.,Department of Neurosurgery, Regional Hospital Sacred Heart Tienen, Tienen, Belgium
| | - Peter Vorlat
- Department of Orthopedics, Noorderhart Mariaziekenhuis, Pelt, Belgium
| | | | - Ann Meulders
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
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11
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Gorgon E, Maka K, Kam A, Nisbet G, Sullivan J, Regan G, Pourkazemi F, Lin J, Mohamed M, Leaver A. Needs assessment for health service design for people with back pain in a hospital setting: A qualitative study. Health Expect 2022; 25:721-731. [PMID: 35150036 PMCID: PMC8957737 DOI: 10.1111/hex.13419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is a need for effective health service solutions to provide greater structure and support for implementing evidence-based practice in back pain care. Patient involvement in developing these solutions is crucial to increase relevance, acceptability and uptake. OBJECTIVES To determine patients' perceived needs and barriers to best-practice back pain care, and potential solutions to better address care needs. The study is the third in a series of needs assessment studies feeding into the 'idea generation' for service design in a large teaching hospital in a culturally and linguistically diverse community in metropolitan Sydney, Australia. DESIGN We conducted a combination of focus groups and in-depth interviews using an interpretive description approach. We used inductive thematic analysis to identify the main themes. SETTING AND PARTICIPANTS We purposively sampled patients with diverse characteristics from the neurosurgery and physiotherapy outpatient clinics, in particular those whose primary language was English, Arabic, Persian or Mandarin. Non-English audio recordings were translated and transcribed by bilingual researchers. RESULTS There were 24 participants (focus groups = 9; individual interviews = 15) when data saturation was reached. The analysis identified three key themes with several subthemes around what service designers needed to understand in helping people with back pain in this setting: (1) This is who I am; (2) It's not working for me; and (3) What I think I need. DISCUSSION AND CONCLUSION This study highlights that perceived unmet needs of patients are underpinned by unhelpful beliefs about the causes of and solutions for back pain, misaligned care expectations, unclear expectations of the hospital role and fragmentations in the health system. To design and implement a service that can deliver better back pain care, several solutions need to be integrated around: developing new resources that challenge unhelpful beliefs and set realistic expectations; improving access to education and self-management resources; focusing on individualized care; using a collaborative multidisciplinary approach within the hospital; and better connecting with and directing primary health care services. PATIENT OR PUBLIC CONTRIBUTION A consumer representative of the Western Sydney Local Health District provided input during study conceptualisation and is duly recognized in the Acknowledgements section.
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Affiliation(s)
- Edward Gorgon
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Physical Therapy, University of the Philippines Manila, Manila, Philippines
| | - Katherine Maka
- Western Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Andrew Kam
- Western Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Gillian Nisbet
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gerard Regan
- Western Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Fereshteh Pourkazemi
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jianhua Lin
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Mahmoud Mohamed
- Western Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Andrew Leaver
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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12
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Feldman R, Nudelman Y, Haleva-Amir S, Ben Ami N. Patients' prior perceptions and expectations of the Enhanced Transtheoretical Model Intervention for chronic low back pain: A qualitative study. Musculoskeletal Care 2021; 20:371-382. [PMID: 34726320 DOI: 10.1002/msc.1600] [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] [Received: 10/11/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Enhanced Transtheoretical Model Intervention (ETMI) is an approach for treating chronic low back pain (CLBP), which demonstrated clinical and cost-effectiveness outcomes. ETMI highlights reassurance, return to normal activities and encouragement of recreational physical activity. In order to optimally implement ETMI, it is important to gain an understanding of the expectations and perceptions of patients before they engage with the intervention. OBJECTIVES To explore CLBP patients' perceptions and expectations of the ETMI method prior to their first consultation with physiotherapist. METHODS Qualitative semi-structured interviews were conducted with 30 CLBP patients. The interviews were audio-recorded, transcribed, coded, and analysed thematically. Patients were first asked about their expectations of treatment, then they were asked to comment on the ETMI method. RESULTS Three main themes emerged from the interviews: (1) Patient's perceptions of LBP; (2) patient's expectations from current physiotherapy and (3) Patient's expectations from ETMI method. The patients' perceptions of back pain centred on biomechanical causal factors, a desire for diagnostic tests and beliefs that rest cures the pain. Their expectations from current physiotherapy included pain reduction, passive treatment, a structured exercise program and clear information about LBP. In reference to the ETMI method, patients expected pain reduction, practical tools to self-manage, and a combination of ETMI with passive treatment. CONCLUSION addressing issues around patient's perceptions and expectations of current physiotherapy and of the ETMI method, prior to their first consultation with physiotherapist, could be beneficial for understanding how to improve the ETMI implementation in the health care system.
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Affiliation(s)
- Ron Feldman
- Department of Physiotherapy, Ariel University, Ariel, Israel.,Department of Physiotherapy, 'Maccabi' Healthcare Services, Tel-Aviv, Israel
| | - Yaniv Nudelman
- Department of Physiotherapy, Ariel University, Ariel, Israel.,Department of Physiotherapy, 'Maccabi' Healthcare Services, Tel-Aviv, Israel
| | | | - Noa Ben Ami
- Department of Physiotherapy, Ariel University, Ariel, Israel
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