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Julsvoll EH, Myhrvold BL, Waagan K, Vøllestad NK, Robinson HS. Identifying phenotypes in persons with temporomandibular disorders, using latent class analyses: Temporomandibular disorders and phenotypes. J Oral Rehabil 2024. [PMID: 39175126 DOI: 10.1111/joor.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/20/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The heterogeneity of persons with temporomandibular disorders (TMD) and the lack of effective treatments have called for a biopsychosocial model and the development of a more personalised treatment approach. Emphasis on phenotypes might be a beneficial approach. OBJECTIVE Identifying phenotypes among persons with TMD using potential prognostic factors, including personal characteristics and responses to clinical tests. Additionally, examining the distribution of TMD diagnoses within the identified phenotypes. METHODS A cross-sectional study including 208 persons (85% females) seeking physiotherapy for problems in the temporomandibular area. All participants were examined clinically and answered questionnaires electronically. The phenotypes were identified using latent class analysis based on seven potential prognostic factors selected within pain, function and psychological domains. Table analysis was used to explore the distribution of TMD diagnoses within the identified phenotypes. RESULTS Most participants fit into one of three identified phenotypes. Phenotype 1 (32%) was characterised by functional disability, low psychosocial scores and low risk for developing chronicity and future work disability; Phenotype 2 (29%) by parafunctional habits, low psychosocial score and seeking treatment to reduce pain; and Phenotype 3 (39%) by high levels of mental distress, fear avoidance and a large risk of future work disability. Intra-articular disorders dominated Phenotype 1, myalgia and TMD-related headache Phenotype 2, while Phenotype 3 included all the different TMD diagnoses. CONCLUSION The knowledge about the three identified phenotypes might be useful for clinicians treating persons with TMD and for the development of preventive strategies and more personalised treatment.
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Affiliation(s)
- Elisabeth Heggem Julsvoll
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
- Hans & Olaf Outpatient Physiotherapy Clinic, Oslo, Norway
| | - Birgitte Lawaetz Myhrvold
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Waagan
- IT Department, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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2
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Cimerman M, Kacin A. Reproducibility and content validity of the Slovenian version of the STarT Back Screening Tool for chronicity risk assessment in patients with low back pain. Int J Rehabil Res 2023; 46:350-354. [PMID: 37906074 DOI: 10.1097/mrr.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Chronic pain is the most common cause of impaired work ability and thus represents a significant social and economic burden. STarT Back Screening Tool (SBT) is the most often used screening tool for rapid identification and classification of patients for their risk of development of chronic low back pain, which is valid and reliable in the original English version and translation into other languages. The aim of the present study was to translate the SBT into Slovenian and to evaluate its content validity and reliability. We translated the SBT from English into Slovenian and back according to the standard protocol. We tested its metric properties on a group of patients with low back pain aged 18 to 65 years. The reliability of the reassessment was calculated using the ICC and specific agreement, while the content validity of the questionnaire was determined using the ceiling and floor effect. Of the 42 patients who participated in the study, 42.9% were at low risk, 33.3% were at moderate risk, and 23.8% were at high risk of developing chronic pain, according to the SBT. The ICC for the entire sample was 0.96 (95% CI 0.92-0.98). The Slovenian translation of the SBT showed excellent specific agreement between the initial and repeat assessments: 91.4% for the low-risk group, 85.7% for the moderate-risk group, and 95.2% for the high-risk group. In addition, it showed good content validity, as no ceiling or floor effects were detected. The Slovenian translation of the questionnaire is suitable for clinical use.
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Affiliation(s)
- Marinka Cimerman
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
| | - Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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3
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Robarts S, Razmjou H, Yee A, Finkelstein J. Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools. Physiother Can 2023; 75:158-166. [PMID: 37736380 PMCID: PMC10510560 DOI: 10.3138/ptc-2021-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 09/23/2023]
Abstract
Purpose STarT Back Screening Tool and OSPRO-YF scales have been reported to be accurate tools for estimating risk for the development of persistent pain or prolonged disability in primary care settings. We performed a comparison of construct convergent and known-group validity and ceiling floor effect (CFE) of these tools using a common sample of patients seen at a tertiary care spine centre. Methods This was a cross-sectional study of patients with and without a work-related back injury. The Hospital Anxiety and Depression Scale (HADS) was used as the reference outcome measure for convergent validity. For known-group validity, we examined the ability of the scales to differentiate between different levels of compensation, presence of non-organic signs, and work status. The CFE values were calculated. Results Fifty consecutive injured workers were included along with 50 patients without an active compensation claim related to their low back pain. STarTBack and OSPRO-YF had moderate to high associations with the depression component of the HADS (0.69 to 0.77 respectively) with a statistically significant difference in favour of the OSPRO-YF. STarTBack's risk stratification categories were able to differentiate patients with a compensable injury, non-organic signs, and inability to work (p values ranging from 0.002 to < 0.001). The physical activity and work fear-avoidance beliefs constructs of the OSPRO-YF consistently outperformed other yellow flag constructs (p values ranging from 0.008 to < 0.001). The psychological sub-score of STarTBack showed a ceiling effect. There was a floor effect for the negative affect domain of OSPRO-YF. Neither total score had a floor or ceiling effect. Conclusions STarTBack and OSPRO-YF are short screening tools with acceptable convergent and known-group construct validity and no floor or ceiling effect of their total score. Both tools could assist with the identification, evaluation, and management of psychological distress in patients presenting to tertiary care spine centres.
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Affiliation(s)
- Susan Robarts
- From the:
Bone and Joint Program, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Razmjou
- From the:
Bone and Joint Program, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Finkelstein
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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4
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Alshami AM. A single session of education for a patient with negative beliefs about low back pain: A case report of 16-month follow-up. J Med Life 2023; 16:325-328. [PMID: 36937477 PMCID: PMC10015564 DOI: 10.25122/jml-2022-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/22/2023] [Indexed: 03/21/2023] Open
Abstract
The effectiveness of education in patients with low back pain (LBP) remains controversial and inconclusive. This case report describes the long-term effects of a single educational session on the rehabilitation of a patient with chronic LBP (CLBP). A 57-year-old woman presented with the main complaint of LBP and inability to prostrate for several years. The intervention consisted of a single session of patient-specific education that targeted negative cognitive beliefs. This education included instructions about the obtained findings, spinal anatomy, patient reassurance, the relationship between imaging findings and patient symptoms, proposed treatment, and a home exercise program. The patient was able to independently complete the prostration task immediately after the session without pain. This improvement was maintained for at least 16 months, as demonstrated by the Numeric Pain Rate Scale, Patient-Specific Functional Scale, Fear Avoidance Belief Questionnaire, and the Keele STarT Back Screening Tool. In conclusion, a single session of patient-specific education was effective, both immediately and over the long term, in addressing pain and function in patients with CLBP.
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Affiliation(s)
- Ali Muteb Alshami
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Corresponding Author: Ali Muteb Alshami, Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. E-mail:
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Herman PM, Coulter ID, Hays RD, Rodriguez A, Edelen MO. A Scoping Review of Chronic Low Back Pain Classification Schemes Based on Patient-Reported Outcomes. Pain Physician 2022; 25:471-482. [PMID: 36122256 PMCID: PMC10543950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In 2014, the National Institutes of Health Pain Consortium Research Task Force recommended that patients with chronic low back pain (CLBP) be stratified by its impact on their lives. They proposed the Impact Stratification Score (ISS) to help guide therapy and facilitate study comparability. The ISS has been evaluated as a continuous measure, but not for use as a stratification or classification scheme. OBJECTIVES Identify the characteristics of successful schemes to inform the use of the ISS for stratification or classification. STUDY DESIGN Scoping review of the peer-reviewed literature. METHODS Search of PubMed, CINAHL, and APA PsycInfo to identify patient self-report-based classification schemes applicable to CLBP. Data were captured on the methods used for each scheme's development, the domains covered, their scoring criteria and what the classification has successfully measured. The study was reviewed and approved by the RAND Human Subjects Protection Committee (2019-0651-AM02). RESULTS The search identified 87 published articles about the development and testing of 5 classification schemes: 1) The Subgroups for Targeted Treatment (STarT) Back Screening Tool, 2) Multiaxial Assessment of Pain, 3) Graded Chronic Pain Scale, 4) Back Pain Classification Scale, and 5) Chronic Pain Risk Score. All have been shown to be predictive of future outcomes and the STarT Back has been found useful in identifying effective classification-specific treatment. Each scheme had a different classification scoring structure, was developed using different methods, and 3 included domains not found in the ISS. LIMITATIONS Expanding the search to other databases may have identified more classification schemes. Our minimum number of publications inclusion criterion eliminated dozens of cluster analyses, some of which may have eventually been replicated. CONCLUSIONS The methods used to develop these successful classification schemes, especially those that use straightforward scoring schemes, should be considered for use in the development of a scheme based on the ISS.
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Affiliation(s)
| | | | - Ron D Hays
- RAND Corporation, Santa Monica, CA; UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, Los Angeles, CA
| | | | - Maria O Edelen
- RAND Corporation, Boston, MA; Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston
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6
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Moen VP, Tvedter AT, Herbert RD, Hagen KB. Development and external validation of a prediction model for patient-relevant outcomes in patients with chronic widespread pain and fibromyalgia. Eur J Pain 2022; 26:1123-1134. [PMID: 35263480 PMCID: PMC9311427 DOI: 10.1002/ejp.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to develop prediction models and explore the external validity of the models in a large sample of patients with chronic widespread pain (CWP) and fibromyalgia (FM). METHODS Patients with CWP and FM referred to rehabilitation services in Norway (n=986) self-reported data on potential predictors prior to entering rehabilitation, and self-reported outcomes at one-year follow-up. Logistic regression models of improvement, worsening and work status, and a linear regression model of health-related quality of life (HRQoL), were developed using lasso regression. Externally validated estimates of model performance were obtained from the validation set. RESULTS The number of participants in the development and the validation sets was 771 and 215 respectively; only participants with outcome data (n = 519-532 and 185, respectively) were included in the analyses. On average, HRQoL and work status changed little over one year. The prediction models included 10-11 predictors. Discrimination (AUC statistic) for prediction of outcome at follow-up was 0.71 for improvement, 0.67 for worsening, and 0.87 for working. The median absolute error of predictions of HRQoL was 0.36 (0.22-0.51). Reasonably good predictions of working at follow-up and HRQoL could be obtained using only the baseline scores as predictors. CONCLUSIONS Moderately complex predictions models (10-11 predictors) generated poor to excellent predictions of patient-relevant outcomes. Simple prediction models of working and HRQoL at follow-up may be nearly as accurate and more practical.
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Affiliation(s)
- V P Moen
- Centre for Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - A T Tvedter
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Physiotherapy, OsloMetropolitan University, Oslo, Norway
| | - R D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - K B Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
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7
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Giusti EM, Varallo G, Abenavoli A, Manzoni GM, Aletti L, Capodaglio P, Castelnuovo G, Maggiani A. Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain. Front Psychol 2021; 12:740851. [PMID: 34744912 PMCID: PMC8563832 DOI: 10.3389/fpsyg.2021.740851] [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: 07/13/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The STarT Back Screening Tool (SBST) is a self-report questionnaire developed for prognostic purposes which evaluates risk factors for disability outcomes in patients with chronic low back pain. Previous studies found that its use enables to provide a cost-effective stratified care. However, its dimensionality has been assessed only using exploratory approaches, and reports on its psychometric properties are conflicting. Objective: The objective of this study was to assess the factorial structure and the psychometric properties of the Italian version of the STarT Back Screening Tool (SBST). Materials and Methods: Patients with medical diagnosis of low back pain were enrolled from a rehabilitation unit of a tertiary care hospital specialized in obesity care (Sample 1) and from a clinical internship center of an osteopathic training institute (Sample 2). At baseline and after 7 days patients were asked to fill a battery of self-report questionnaires. The factorial structure, internal consistency, test-retest reliability, and construct validity of the SBST were assessed. Results: One hundred forty-six patients were enrolled (62 from Sample 1 and 84 from Sample 2). The confirmatory factor analysis showed that the fit of the original two-correlated factors model was adequate (CFI = 0.98, TLI = 0.99, RMSEA = 0.03). Cronbach's α of the total scale (α = 0.64) and of the subscales (physical subscale α = 0.55; psychological subscale α = 0.61) was below the cutoffs, partly because of the low correlation of item 2 with the other items. Test-retest reliability was adequate (ICC = 0.84). The SBST had moderate correlations with comparisons questionnaires, except for the Roland-Morris Disability Questionnaire, which had a high correlation (r = 0.65). Discussion: The SBST has adequate psychometric properties and can be used to assess prognostic factors for disability in low back pain patients.
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Affiliation(s)
- Emanuele Maria Giusti
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Giorgia Varallo
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Alessandra Abenavoli
- Research Department, Accademia Italiana di Medicina Osteopatica (AIMO), Saronno, Italy
| | - Gian Mauro Manzoni
- Faculty of Psychology, eCampus University, Novedrate, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Luca Aletti
- Research Department, Accademia Italiana di Medicina Osteopatica (AIMO), Saronno, Italy
| | - Paolo Capodaglio
- Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy.,Department Surgical Sciences, Physical Medicine and Rehabilitation, University of Turin, Turin, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Alberto Maggiani
- Research Department, Accademia Italiana di Medicina Osteopatica (AIMO), Saronno, Italy
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8
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Farmer C, O'Connor DA, Lee H, McCaffery K, Maher C, Newell D, Cashin A, Byfield D, Jarvik J, Buchbinder R. Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey. BMJ Open 2021; 11:e049938. [PMID: 34518265 PMCID: PMC8438839 DOI: 10.1136/bmjopen-2021-049938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP. DESIGN Cross-sectional online survey of the general public. SETTING Five English-speaking countries: UK, USA, Canada, New Zealand and Australia. PARTICIPANTS Adults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement. RESULTS From 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term 'disc degeneration', while only 71 (10.5%) reported understanding the term 'Modic changes'. For all terms, a moderate to large proportion of participants (range 59%-71%), considered they indicated a serious back problem, that pain might persist (range 52%-71%) and they would be fearful of movement (range 42%-57%). CONCLUSION Common and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP. TRIAL REGISTRATION NUMBER ACTRN12619000545167.
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Affiliation(s)
- Caitlin Farmer
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Maher
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | | | - Aidan Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - David Byfield
- University of South Wales Faculty of Life Sciences and Education, Treforest, UK
| | - Jeffrey Jarvik
- Departments of Radiology, Neurological Surgery and Health Services, School of Medicine, University of Washington, Seattle, Washington, USA
- UW Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders, University of Washington, Seattle, Washington, USA
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
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9
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Alzahrani H, Mackey M, Stamatakis E, Shirley D. Wearables-based walking program in addition to usual physiotherapy care for the management of patients with low back pain at medium or high risk of chronicity: A pilot randomized controlled trial. PLoS One 2021; 16:e0256459. [PMID: 34437607 PMCID: PMC8389429 DOI: 10.1371/journal.pone.0256459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/31/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although chronic low back pain (LBP) is a leading cause of disability and accounts for large costs, none of the available conventional treatments are clearly more favourable in treating people at increased risk of chronicity. OBJECTIVES To examine the feasibility and initial efficacy of a wearables-based walking intervention in addition to usual physiotherapy care in people with LBP at risk of chronicity. METHODS Twenty-six adult participants, diagnosed with non-specific LBP with medium or high risk of chronicity, were recruited from physiotherapy private practices. Participants were randomized into usual physiotherapy care (control, n = 14) and usual physiotherapy care plus a wearables-based walking intervention (experimental, n = 12). The intervention duration was 8 weeks. Feasibility outcomes included recruitment rate, adherence to the intervention, dropout rate, and serious adverse events reporting rate. Other outcomes included disability and pain (primary); and physical activity level, daily walking steps, depression, pain catastrophizing and fear of movement (secondary). The outcomes were assessed at baseline, post-intervention and 26 weeks post-randomization follow-up. RESULTS Adherence of experimental participants with the prescribed walking program was moderate. Four participants dropped out during the intervention, and no serious adverse events were reported. Participants in the experimental group showed significant improvement in pain at 26 weeks (β = -0.38; 95% confidence interval (CI) -0.66, -0.10; P = .013), compared with the control group. No between-group differences were found for disability at any time point and pain immediately post-intervention. Experimental participants demonstrated post-intervention improvement in light-intensity (β = 156.71; 95% CI 86.79, 226.64; P < .001), moderate-intensity physical activity (β = 0.46; 95% CI 0.12, 0.80; P = .012), and daily walking steps (β = 7099.13; 95% CI 4522.93, 9675.32; P < .001). Experimental participants demonstrated post-intervention increase in pain catastrophizing (β = 0.52, 95% CI 0.18, 0.86; P = .006). No between-group differences were found for pain catastrophizing at 26 weeks and other secondary outcomes. CONCLUSION Usual physiotherapy care plus a wearables-based walking intervention program was safe and moderately feasible, and provided significant reduction in pain at 26 weeks as well as increasing the total volume of light- and moderate-intensity physical activity, and daily walking steps immediately post-intervention.
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Affiliation(s)
- Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Martin Mackey
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Debra Shirley
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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10
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Poon CLL, Cheong P, Tan JWM, Thumboo J, Woon EL, Clark RA, Cheok G, Pua YH. Associations of the modified STarT back tool and Hospital Anxiety and Depression Scale (HADS) with gait speed and knee pain in knee osteoarthritis: a retrospective cohort study. Disabil Rehabil 2021; 44:4452-4458. [PMID: 33577352 DOI: 10.1080/09638288.2021.1883750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The association of the modified STarT Back Tool (mSBT) psychosocial measure with gait speed and knee pain in knee osteoarthritis is not well defined. This study aimed to, in patients with knee osteoarthritis, (i) examine the convergent validity of mSBT with the Hospital Anxiety and Depression Scale (HADS) and (ii) compare the predictive validity of mSBT and HADS with gait speed and knee pain. METHODS We performed a retrospective cohort analysis of mSBT, HADS, gait speed, and knee pain outcomes data collected from 119 patients who received outpatient physical therapy. Of these patients who were evaluated at their first (baseline) physical therapy visit, 55 had available data at the Week-16 follow-up visit. RESULTS mSBT and HADS showed moderately strong pairwise correlations (Spearman correlation > 0.57; p < 0.001). After adjusting for age, sex, body weight, and knee impairment variables in multivariable linear mixed-effects analyses, mSBT was associated with gait speed (p < 0.001) and knee pain intensity (p < 0.001) and it had comparable strength of association as HADS. In within-patient regression analyses, change in mSBT was associated with changes in gait speed (p = 0.04) and knee pain (p = 0.01) over 16 weeks. CONCLUSION The mSBT had convergent validity with HADS and it showed predictive validity with gait speed and knee pain in knee osteoarthritis. Although broader validation is required, the 5-item mSBT psychosocial measure may be applied as part of routine clinical care to assess psychological distress in patients with knee osteoarthritis. IMPLICATIONS FOR REHABILITATION The 5-item psychosocial subscale of the modified STarT Back tool (mSBT) showed good convergent validity with the 14-item Hospital Anxiety and Depression Scale in patients with knee osteoarthritis. The mSBT psychosocial subscale showed predictive validity, at both cross-sectional and longitudinal levels, with gait speed and knee pain in patients with knee osteoarthritis. The mSBT can potentially be used in the busy clinical setting to assess psychological distress in patients with knee osteoarthritis.
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Affiliation(s)
- Cheryl Lian-Li Poon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Philip Cheong
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - John Wei-Ming Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Health Services Research and Evaluation, Singhealth Office of Regional Health, Singapore, Singapore
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Gary Cheok
- Department of Physiotherapy, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.,Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
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11
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Toomey D, Reid D, White S. How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report. J Man Manip Ther 2020; 29:107-132. [PMID: 32930642 DOI: 10.1080/10669817.2020.1813472] [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: 10/23/2022] Open
Abstract
BACKGROUND The management of patients with chronic post-surgical low back pain can be very challenging to surgeons, physiotherapists, and patients alike. Subsequent surgery is often associated with post-operative complications and even lower levels of success than the initial spinal surgery. Physiotherapy is often recommended as the first-line management, however, debate exists amongst physiotherapists regarding the optimal treatment strategy. A key focus of this debate has been the use of manual therapy in chronic pain populations, leading clinicians to reevaluate its use. CASE DESCRIPTION A 44-year-old female presented to physiotherapy with a 13-year history of persistent pain, having had a spinal fusion 12 years prior, following a skiing accident. Her primary complaints were pain and decreased self-efficacy. The patient was treated with a 12-week multimodal approach consisting of manual therapy, exercise rehabilitation, and pain neuroscience education. OUTCOMES The patient had a significant reduction in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI) and the Fear Avoidance Belief Questionnaire Physical Activity Subscale (FABQ-PA) scores following the intervention. She returned to running and cycling, reporting that pain was something she would 'work with instead of against'. DISCUSSION This case study suggests that manual therapy can enhance an individualized biopsychosocial approach in the physiotherapy management of a patient with chronic post-surgical low back pain. Further research is needed to evaluate optimal intervention dosages and effective strategies in the management of patients with chronic low back pain following spinal surgery.
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Affiliation(s)
- David Toomey
- Auckland University of Technology, Auckland, New Zealand.,Waiheke Physiotherapy and Pilates, Auckland, New Zealand
| | - Duncan Reid
- Auckland University of Technology, Auckland, New Zealand
| | - Steven White
- Auckland University of Technology, Auckland, New Zealand
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12
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Szita J, Kiss L, Biczo A, Feher K, Varga PP, Lazary A. Outcome of group physical therapy treatment for non-specific low back pain patients can be predicted with the cross-culturally adapted and validated Hungarian version STarT back screening tool. Disabil Rehabil 2020; 44:1427-1435. [PMID: 32735178 DOI: 10.1080/09638288.2020.1799248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The STarT Back Tool was developed to identify the specific modifiable prognostic factors for non-specific low back pain and to classify the patients into risk groups; low, medium and high risk of chronicity. Applied therapeutic approaches often involve group physical therapy. The aim of this study was the cross-cultural adaptation and validation of the Hungarian version of the STarT Back Tool and to investigate the predictive ability for global treatment outcome. MATERIALS AND METHODS A prospective cohort study (N = 133) was carried out involving non-specific low back pain patients. Internal consistency, construct validity, reliability and prognostic discriminative ability have been investigated. After 3 months of treatment global outcome was evaluated. RESULTS A 2-factor structure was found, with moderate internal consistency (Cronbach α = 0.89 for the total and psychosocial subscale 0.62). Between the Hungarian STarT Back Tool, the Oswestry Disability Index, leg pain, low back pain, Tampa Scale for Kinesiophobia, Fear Avoidance Beliefs Questionnaire and the physical subscale of the quality of life questionnaire, significant good to excellent- correlation was found (r > 0.41). The test-retest analysis showed excellent reliability (Intraclass Correlation Coefficient = 0.93) with standard error measurement being 0.49 (minimal detectable change = 1.37). The Area Under the Curve for baseline STarT Back Tool scores was 0.7 and 0.8 for global treatment outcome and distress, respectively. The Area Under the Curve for global treatment outcome versus STarT risk groups proved to be 0.76 representing adequate discriminative ability. CONCLUSION The successful cross-cultural adaptation was followed by the validity analysis and as a result the Hungarian version of the STarT Back Tool proved to be a reliable and valid tool in the identification of risk groups of chronicity for patients with low back pain. Patients allocated to the high-risk group were more likely experiencing poor outcome at 3 months follow up, thus it can be used to predict outcome if treated with group physical therapy.Implication for rehabilitationLow back pain is a multifactorial disease where physical and psychosocial risk factors play a role in the development and prognosis of the disease.The STarT-H can be considered as a reliable, valid measurement tool in the identification of risk groups of chronicity for patients with low back pain.Clinical relevance of the STarT-H is that it can be used to stratify patients into risk groups of chronicity in different Hungarian speaking healthcare settings.According to our findings the STarT-H can also be applied to predict global treatment outcome in low back pain patients if treated with group physical therapy.
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Affiliation(s)
- Julia Szita
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Laszlo Kiss
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Adam Biczo
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Katalin Feher
- Department of Spinal Surgery, National Center for Spinal Disorders, Budapest, Hungary
| | - Peter P Varga
- Department of Spinal Surgery, National Center for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Department of Spine Surgery, Semmelweis University, Budapest, Hungary
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Use of the STarT Back Screening Tool in patients with chronic low back pain receiving physical therapy interventions. Braz J Phys Ther 2020; 25:286-295. [PMID: 32773289 DOI: 10.1016/j.bjpt.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The STarT Back Screening Tool (SBST) is used to stratify care. It is unclear if the SBST approach works as well for patients in low- and medium-income countries as for patients from high-income countries. OBJECTIVES (1) To investigate whether patients with chronic low back pain (LBP) stratified by the SBST are different at baseline; (2) to describe the clinical course for each SBST subgroup; (3) to investigate the SBST utility to predict clinical outcomes; and (4) to determine which SBST subgroup show greater clinical improvement. DESIGN This is a secondary analysis of data derived from a previously published clinical trial. METHODS 148 patients with chronic nonspecific LBP were included. Pain intensity, disability, global perceived effect, and the SBST were assessed at baseline and at 5, 12, and 24 weeks after baseline. Descriptive data were provided and ANOVA, unadjusted and adjusted regression models, and linear mixed models were used for data analysis. RESULTS Duration of symptoms, use of medication, pain, disability, and global perceived effect were different between SBST subgroups. Clinical improvements over a 6-month period were consistently greater in patients classified as high risk. The SBST was able to predict disability but this predictability decreased when the analysis was adjusted for possible confounders. CONCLUSION Clinical outcomes were different between SBST subgroups over 6 months. Adjusting for confounders influenced the predictability of SBST. Patients classified as high risk presented higher improvements in terms of disability.
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Tagliaferri SD, Angelova M, Zhao X, Owen PJ, Miller CT, Wilkin T, Belavy DL. Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews. NPJ Digit Med 2020; 3:93. [PMID: 32665978 PMCID: PMC7347608 DOI: 10.1038/s41746-020-0303-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022] Open
Abstract
Artificial intelligence and machine learning (AI/ML) could enhance the ability to detect patterns of clinical characteristics in low-back pain (LBP) and guide treatment. We conducted three systematic reviews to address the following aims: (a) review the status of AI/ML research in LBP, (b) compare its status to that of two established LBP classification systems (STarT Back, McKenzie). AI/ML in LBP is in its infancy: 45 of 48 studies assessed sample sizes <1000 people, 19 of 48 studies used ≤5 parameters in models, 13 of 48 studies applied multiple models and attained high accuracy, 25 of 48 studies assessed the binary classification of LBP versus no-LBP only. Beyond the 48 studies using AI/ML for LBP classification, no studies examined use of AI/ML in prognosis prediction of specific sub-groups, and AI/ML techniques are yet to be implemented in guiding LBP treatment. In contrast, the STarT Back tool has been assessed for internal consistency, test-retest reliability, validity, pain and disability prognosis, and influence on pain and disability treatment outcomes. McKenzie has been assessed for inter- and intra-tester reliability, prognosis, and impact on pain and disability outcomes relative to other treatments. For AI/ML methods to contribute to the refinement of LBP (sub-)classification and guide treatment allocation, large data sets containing known and exploratory clinical features should be examined. There is also a need to establish reliability, validity, and prognostic capacity of AI/ML techniques in LBP as well as its ability to inform treatment allocation for improved patient outcomes and/or reduced healthcare costs.
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Affiliation(s)
- Scott D. Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Maia Angelova
- School of Information Technology, Deakin University, Geelong, VIC Australia
| | - Xiaohui Zhao
- Xi’an University of Architecture & Technology, Beilin, Xi’an China
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Clint T. Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Tim Wilkin
- School of Information Technology, Deakin University, Geelong, VIC Australia
| | - Daniel L. Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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15
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Schmidt PA, Naidoo V. Cross-cultural adaptation and validation of the STarT back screening tool in isiZulu. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1402. [PMID: 32537525 PMCID: PMC7276483 DOI: 10.4102/sajp.v76i1.1402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-specific low back pain (NSLBP) is one of the most prevalent conditions in the world. Identifying patients at risk for developing chronic NSLBP is key to effective treatment. The STarT back screening tool is a validated, prognostic screening tool identifying subgroups of NSLBP patients, and the risk factors associated with each subgroup, guiding treatment in the primary care of NSLBP. OBJECTIVES To translate the English version of the STarT back screening tool into isiZulu and determine the content validity and reliability of the translated tool. METHOD Translation was completed in four phases - forward translation and synthesis, backward translation and expert review. Validation included expert review for content validity and testing of the translated tool on 30 patients, determining test-retest reliability, internal consistency and usability. RESULTS Minor linguistic differences were addressed during the translation phase. Item content validity was excellent for relevance (1.00), satisfactory (0.94) for clarity, simplicity and ambiguity, with scale-content validity acceptable (0.955). Spearman's correlation coefficient for test-retest reliability was acceptable (0.73). Cronbach's alpha for internal consistency for the total score for test 1 and test 2 was 0.68 and 0.77, and for the psychosocial scale 0.62 and 0.77 respectively. Overall, 33% found the tool very easy to understand and 40% found it very easy to complete. CONCLUSION The isiZulu STarT back screening tool showed excellent content validity, acceptable reliability and acceptable internal consistency. CLINICAL IMPLICATIONS Use of the isiZulu tool in local clinics and private practices can improve clinical decision-making and treatment outcomes for isiZulu-speaking patients with NSLBP.
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Affiliation(s)
- Peta-Ann Schmidt
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vaneshveri Naidoo
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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van Tilburg ML, Kloek CJJ, Staal JB, Bossen D, Veenhof C. Feasibility of a stratified blended physiotherapy intervention for patients with non-specific low back pain: a mixed methods study. Physiother Theory Pract 2020; 38:286-298. [PMID: 32431201 DOI: 10.1080/09593985.2020.1756015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Integrating web-based or mobile components and face-to-face components within a treatment process is called blended care. As part of the participatory development of a blended physiotherapeutic intervention for patients with low back pain (e-Exercise LBP), a proof of concept study was carried out and showed promising results. OBJECTIVE To investigate the feasibility of the e-Exercise LBP prototype for patients and physiotherapists to improve the intervention. METHODS A mixed methods study was executed, embedded in the development phase of e-Exercise LBP. 21 physiotherapists treated 41 patients with e-Exercise LBP. Quantitative data consisted of: patients' satisfaction on a five-point Likert Scale; patients' and physiotherapists' experienced usability of the web-based application (System Usability Scale) and; patients' experiences with e-Exercise LBP (closed-ended questions and statements related to the elements and goals of e-Exercise LBP). Semi-structured interviews about experiences with e-Exercise LBP were conducted with seven patients and seven physiotherapists. Qualitative data were analyzed by a phenomenological approach. Quantitative data were analyzed with descriptive statistics. RESULTS Patients were satisfied with e-Exercise LBP (mean: 4.0; SD:0.8; range: extreme dissatisfaction (1)-extreme satisfaction (5)). Usability of the web-based application was acceptable (patients: mean: 73.2 (SD:16.3); physiotherapists: mean: 63.3 (SD:12.0); range: 0-100). Interviews revealed that physiotherapists' training is essential to successfully integrate the web-based application and face-to-face sessions within physiotherapy treatment. Also, patients addressed the need of reminder messages to support long-term (exercise) adherence. CONCLUSION e-Exercise LBP appeared to be feasible. However, various prerequisites and points of improvement were mentioned to improve physiotherapists' training and the prototype.
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Affiliation(s)
- Mark L van Tilburg
- Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corelien J J Kloek
- Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - J Bart Staal
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, The Netherlands
| | - Daniël Bossen
- Achieve Center of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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17
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Haglund E, Bremander A, Bergman S. The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - a population based cohort study. BMC Musculoskelet Disord 2019; 20:460. [PMID: 31638972 PMCID: PMC6805365 DOI: 10.1186/s12891-019-2836-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods One hundred and nineteen individuals (aged 40–71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin – as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0–18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Results Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - < 0.001). Conclusions Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT.
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Affiliation(s)
- Emma Haglund
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden. .,Spenshult Research and Development Center, Halmstad, Sweden.
| | - Ann Bremander
- Spenshult Research and Development Center, Halmstad, Sweden.,Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden.,Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.,Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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18
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Alzayed KA, Alsaadi SM. Efficacy of Pulsed Low-Frequency Magnetic Field Therapy on Patients with Chronic Low Back Pain: A Randomized Double-Blind Placebo-Controlled Trial. Asian Spine J 2019; 14:33-42. [PMID: 31575112 PMCID: PMC7010518 DOI: 10.31616/asj.2019.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 02/04/2023] Open
Abstract
Study Design A randomized double-blind placebo-controlled trial. Purpose To investigate the efficacy of pulsed electromagnetic field (PEMF) therapy combined with therapeutic exercises in the treatment of chronic low back pain (CLBP). Overview of Literature Low back pain (LBP) is the most common musculoskeletal pain disorder. Most available interventions for CLBP have modestly beneficial outcomes. Despite the potential effect of PEMF therapy on LBP, there have been few studies regarding its effectiveness. Methods Forty-two patients (22 males, 20 females), were randomized into either the treatment group (PEMF and therapeutic exercises) or placebo group (sham PEMF and exercises). Primary outcome measures were pain intensity on the 10-point Numeric PainRating Scale and disability measured by the Roland-Morris Disability Questionnaire. The patients were assessed at baseline, during the treatment period (weeks 3, 6, and 9), and after treatment (week 13). Results The treatment group experienced a more rapid improvement in both pain and disability compared with the placebo group. The analysis showed a significant improvement in the pain intensity and disability scores in the treatment group at week 3 (p<0.05), whereas an improvement in the placebo group was detected at week 6. The significant improvement in both groups was sustained for weeks 6, 9, and 13. There was no difference between the groups in scores of pain intensity and disability at weeks 6 and 13. Conclusions PEMF therapy improved pain and disability in patients with CLBP. However, it does not seem to be superior to other treatment options.
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Affiliation(s)
| | - Saad Mohammed Alsaadi
- Musculoskeletal Division, Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Khan Y, Lawrence D, Vining R, Derby D. Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey. Chiropr Man Therap 2019; 27:2. [PMID: 30675336 PMCID: PMC6332914 DOI: 10.1186/s12998-018-0228-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background The Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care. Methods The SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores). Results Of 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]). Conclusion The sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.
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Affiliation(s)
- Yasmeen Khan
- 1Parker University, 2500 Walnut Hill Lane, Dallas, TX 75229 USA
| | - Dana Lawrence
- 1Parker University, 2500 Walnut Hill Lane, Dallas, TX 75229 USA
| | - Robert Vining
- 2Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Dustin Derby
- 3Palmer College of Chiropractic, 1000 Brady Street, Davenport, IA 52803 USA
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Gabel CP, Mokhtarinia HR, Hoffman J, Osborne J, Laakso EL, Melloh M. Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers. BMJ Open 2018; 8:e020946. [PMID: 30093512 PMCID: PMC6089271 DOI: 10.1136/bmjopen-2017-020946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Investigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP). SETTING Regional Australian council training facility. PARTICIPANTS Consecutive participants recruited during 39 back education classes (8-26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18-64 years, 67.1% male. METHODS Cross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) 'toilet squat'; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times. INTERVENTIONS Nil. RESULTS For the group 'no-some', 94.3% completed 4-5 test exercises, while for group 'With', 95.7% completed 0-1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ2(10)=300.61, p<0.001). Furthermore, multinomial logistic regression predicting LBP (0=no, 1=some, 2=most) from the number of exercises completed, substantially improved the model fit (initial-2LL=348.246, final-2LL=73.620, χ2(2)=274.626, p<0.001). As the number of exercises performed increased, the odds of reporting 'some LBP' or 'most LBP' dropped substantially (ORs of 0.34 and 0.17, respectively). CONCLUSION The ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.
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Affiliation(s)
| | - Hamid Reza Mokhtarinia
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jonathan Hoffman
- Human Movement, Independent Private Researcher, Placencia Village, Belize
| | - Jason Osborne
- Department of Mathematical Sciences, Clemson University, Clemson, South Carolina, USA
- Department of Public Health Science, Clemson University, Clemson, South Carolina, USA
| | - E-Liisa Laakso
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Mater Research, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - Markus Melloh
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
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Unsgaard-Tøndel M, Kregnes IG, Nilsen TIL, Marchand GH, Askim T. Risk classification of patients referred to secondary care for low back pain. BMC Musculoskelet Disord 2018; 19:166. [PMID: 29793536 PMCID: PMC5968566 DOI: 10.1186/s12891-018-2082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/08/2018] [Indexed: 01/15/2023] Open
Abstract
Background Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. Methods An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen’s Kappa coefficient, Pearson’s r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. Results A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. Conclusion The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway. .,Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway.
| | - Ingunn Gunnes Kregnes
- Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom I L Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Hege Marchand
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway
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