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Buhler M, Shah T, Perry M, Tennant M, Kruger E, Milosavljevic S. Geographic accessibility to physiotherapy care in Aotearoa New Zealand. Spat Spatiotemporal Epidemiol 2024; 49:100656. [PMID: 38876567 DOI: 10.1016/j.sste.2024.100656] [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: 01/22/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 06/16/2024]
Abstract
Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate 'accessibility scores' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low.
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Affiliation(s)
- Miranda Buhler
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand.
| | - Tayyab Shah
- Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Dr Room 260, Saskatoon, SK S7N 5A5, Canada
| | - Meredith Perry
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand
| | - Marc Tennant
- The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Estie Kruger
- School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Stephan Milosavljevic
- School of Rehabilitation Science, University of Saskatchewan, 104 Clinic Pl, Saskatoon, SK S7N 2Z4, Canada
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DeSouza A, Wang D, Wong JJ, Furlan AD, Hogg-Johnson S, Macedo L, Mior S, Côté P. Characteristics of Canadians Living With Long-Term Health Conditions or Disabilities Who Had Unmet Rehabilitation Needs During the First Wave of the COVID-19 Pandemic: A Cross-sectional Study. Am J Phys Med Rehabil 2024; 103:488-493. [PMID: 38112669 DOI: 10.1097/phm.0000000000002388] [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: 12/21/2023]
Abstract
OBJECTIVE This study aimed to describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN We used data from the Impacts of COVID-19 on Canadians Living With Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (ie, physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counseling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics and unmet rehabilitation needs. RESULTS More than half of the sample were 50 years and older (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socioeconomic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. CONCLUSIONS Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.
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Affiliation(s)
- Astrid DeSouza
- From the Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada (AD, DW, JJW, SH-J, PC); Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada (AS, DW, JJW, SH-J, SM, PC); Department of Medicine, University of Toronto, Toronto, Canada (ADF); Toronto Rehabilitation Institute, University Health Network, Toronto, Canada (ADF); Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada (SH-J, SM); Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (SH-J); and School of Rehabilitation Science, McMaster University, Hamilton, Canada (LM)
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Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P. Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems: A population-based study. BRAIN & SPINE 2024; 4:102812. [PMID: 38698804 PMCID: PMC11063586 DOI: 10.1016/j.bas.2024.102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024]
Abstract
Introduction Understanding healthcare utilization by Canadians with back problems informs healthcare planning nationally. Research question What is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001-2016)? Material and methods This population-based study used Canadian Community Health Survey data (2001-2016) restricted to respondents with chronic back problems (aged ≥12 years). We used self-reported consultation with healthcare providers (medical doctors, chiropractors, physiotherapists, nurses) from 2001-2010, and self-reported regular healthcare provider from 2015-2016. We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess sociodemographic, health-related and behavioural factors associated with utilization of different providers. Results From 2001 to 2010 and 2015/2016, respectively, prevalence of utilization of medical doctors was 87.9% (95% CI 87.6-88.2) and 86.7% (95% CI 85.9-87.5); chiropractors 24.0% (95% CI 23.6-24.4) and 14.5% (95% CI 13.8-15.3); physiotherapists 17.2% (95% CI 16.9-17.6) and 10.7% (95% CI 10.0-11.4); nurses 14.0% (95% CI 13.7-14.2) and 6.6% (95% CI 6.1-7.0). Females were more likely to see any provider than males. Persons of lower socioeconomic status were less likely to consult chiropractors or physiotherapists (2001-2016), or nurses (2001-2010). Immigrants were less likely to consult chiropractors or nurses. Persons aged >65 years were less likely to consult chiropractors or physiotherapists, and those with fair/poor general health were less likely to consult chiropractors, but more likely to consult other providers. Discussion and conclusion Medical doctors were most commonly consulted by Canadians with back problems, then chiropractors and physiotherapists. Characteristics of healthcare utilization varied by provider. Findings inform the need to strengthen healthcare delivery for Canadians with back problems.
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Affiliation(s)
- Jessica J. Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada
| | - Silvano A. Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Martinez-Rueda R, Aiyer H, Carnegie B, Custer M, McIntosh S, Bath B. "Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain. Can J Pain 2024; 8:2318706. [PMID: 38616950 PMCID: PMC11008541 DOI: 10.1080/24740527.2024.2318706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
Background Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terrence McDonald
- Department of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Calgary, Alberta, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rosmary Martinez-Rueda
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Lu M, Wong JJ, Côté P, Watson T, Rosella LC. Association between physiotherapy utilization and medical healthcare utilization and costs in adults with back pain from Ontario, Canada: a population-based cohort study. Pain 2023; 164:2572-2580. [PMID: 37310500 DOI: 10.1097/j.pain.0000000000002957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/30/2023] [Indexed: 06/14/2023]
Abstract
ABSTRACT This study examined the association between physiotherapy utilization and subsequent medical healthcare utilization and costs in a population-based sample of adults with back pain in Ontario. We conducted a population-based cohort study of Ontario respondents with back pain (≥18 years) of the Canadian Community Health Survey 2003 to 2010 cycles, linked to health administrative data up to 2018. Physiotherapy utilization was defined as self-reported consultation with a physiotherapist in the past 12 months. A propensity score-matched cohort was conducted to match adults with and without physiotherapy utilization, accounting for potential confounders. We assessed associations using negative-binomial and linear (log-transformed) regression to evaluate outcomes of healthcare utilization (back pain-specific and all-cause) and costs, respectively, at 1- and 5-year follow-up. There were 4343 pairs of matched respondents. Compared with those who did not receive physiotherapy, adults who received physiotherapy were more likely to have back pain-specific physician visits (RR women (5years) = 1.48, 95% CI 1.24-1.75; RR men (5years) = 1.42, 95% CI 1.10-1.84). Women who received physiotherapy had 1.11 times the rate of all-cause physician visits (RR 1year = 1.11, 95% CI 1.02-1.20), and men who received physiotherapy had 0.84 times the rate of all-cause hospitalizations (RR 5years = 0.84, 95% CI 0.71-0.99) than those who did not. There was no association between physiotherapy utilization and healthcare costs. Adults with back pain who received physiotherapy are more likely to have back pain-specific physician visits up to 5-year follow-up than those who did not. Physiotherapy utilization is linked to some sex-based differences in all-cause healthcare utilization but not differences in costs. Findings inform interprofessional collaboration and allied healthcare delivery for back pain in Ontario.
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Affiliation(s)
- Mindy Lu
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Jessica J Wong
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Pierre Côté
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kaseweter K, Nazemi M, Gregoire N, Louw WF, Walsh Z, Holtzman S. Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era. BMC Health Serv Res 2023; 23:1131. [PMID: 37864210 PMCID: PMC10588239 DOI: 10.1186/s12913-023-10157-8] [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: 08/16/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.
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Affiliation(s)
- Kimberley Kaseweter
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Mark Nazemi
- Clinical and Wellbeing Solutions, Thrive Health Inc, 200 - 116 West Hastings Street, Vancouver, BC, V6B 1G8, Canada
| | - Nina Gregoire
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - W Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Bill Nelems Pain and Research Centre, 309-2755 Tutt St, Kelowna, BC, V1Y 0G1, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
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Tesch F, Schmitt J, Dröge P, Günster C, Seidler A, Flechtenmacher J, Lembeck B, Kladny B, Wirtz DC, Niethard FU, Lange T. Socioeconomic differences in the utilization of diagnostic imaging and non-pharmaceutical conservative therapies for spinal diseases. BMC Musculoskelet Disord 2023; 24:774. [PMID: 37784063 PMCID: PMC10544477 DOI: 10.1186/s12891-023-06909-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND A different utilization of health care services due to socioeconomic status on the same health plan contradicts the principle of equal treatment. We investigated the presence and magnitude of socioeconomic differences in utilization of diagnostic imaging and non-pharmaceutical conservative therapies for patients with spinal diseases. METHODS The cohort study based on routine healthcare data from Germany with 11.7 million patient-years between 2012 and 2016 for patients with physician-confirmed spinal diseases (ICD-10: M40-M54), occupation and age 20 to 64 years. A Poisson model estimated the effects of the socioeconomic status (school education, professional education and occupational position) for the risk ratio of receiving diagnostic imaging (radiography, computed tomography, magnetic resonance imaging) and non-pharmaceutical conservative therapies (physical therapy including exercise therapy, manual therapy and massage, spinal manipulative therapy, acupuncture). RESULTS Patients received diagnostic imaging in 26%, physical therapy in 32%, spinal manipulative therapy in 25%, and acupuncture in 4% of all patient-years. Similar to previous survey-based studies higher rates of utilization were associated with higher socioeconomic status. These differences were most pronounced for manual therapy, exercise therapy, and magnetic resonance imaging. CONCLUSIONS The observed differences in health care utilization were highly related to socioeconomic status. Socioeconomic differences were higher for more expensive health services. Further research is necessary to identify barriers to equitable access to health services and to take appropriate action to decrease existing social disparities.
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Affiliation(s)
- Falko Tesch
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany
| | - Patrik Dröge
- Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany
| | - Christian Günster
- Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Burkhard Lembeck
- German Professional Association for Orthopedics and Trauma Surgery, Berlin, Germany
| | - Bernd Kladny
- Department of Orthopedics and Trauma Surgery, m&i Fachklinik Herzogenaurach, Herzogenaurach, Germany
| | | | - Fritz-Uwe Niethard
- German Professional Association for Orthopedics and Trauma Surgery, Berlin, Germany
| | - Toni Lange
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Carnegie B, Custer M, McIntosh S, Bath B. Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey. Health Serv Insights 2023; 16:11786329231193794. [PMID: 37641592 PMCID: PMC10460467 DOI: 10.1177/11786329231193794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
Background Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽ .001). Not knowing where to go to access care or what would help their low back pain (P = .03), lack of cultural sensitivity (P = .007), and comfort discussing problems with health care professionals (P = .26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P = .013) and having healthcare options nearby in their community (P = .045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Terrence McDonald
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada
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Wong JJ, Lu M, Côté P, Watson T, Rosella LC. Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study. BMC Health Serv Res 2023; 23:793. [PMID: 37491238 PMCID: PMC10367314 DOI: 10.1186/s12913-023-09690-3] [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: 11/07/2022] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Adults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain. METHODS We conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association. RESULTS There were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73-1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57-0.97). CONCLUSIONS Among adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada.
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada.
| | - Mindy Lu
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON, M5T 3M7, Canada
| | - Tristan Watson
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- ICES, 155 College Street, Toronto, ON, M5B 1T8, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- ICES, 155 College Street, Toronto, ON, M5B 1T8, Canada
- Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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10
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Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:159-167. [PMID: 36841750 DOI: 10.1016/j.joim.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/14/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles. OBJECTIVE There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level. SEARCH STRATEGY Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021. INCLUSION CRITERIA Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review. DATA EXTRACTION AND ANALYSIS Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status. RESULTS A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%). CONCLUSION This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: a scoping review of the literature. J Integr Med. 2023; Epub ahead of print.
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Affiliation(s)
- Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Antoinette L Spector
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joni Williams
- Department of Medicine, Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Staci Young
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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11
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Leung T, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Carnegie B, Custer M, McIntosh S, Bath B. Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research. JMIR Res Protoc 2022; 11:e42484. [PMID: 36534454 PMCID: PMC9808614 DOI: 10.2196/42484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/01/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. METHODS In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. RESULTS Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. CONCLUSIONS This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42484.
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Affiliation(s)
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems (Medicinteknik och Hälsosystem), School of Engineering Sciences in Chemistry, Biotechnology, & Health (Kemi, Bioteknologi och Hälsa), Kungliga Tekniska Högskolan Royal Institute of Technology, Stockholm, Sweden.,Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Terrence McDonald
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.,Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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12
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Anderson BR, McClellan SW. Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims. J Manipulative Physiol Ther 2022; 44:683-689. [PMID: 35753873 DOI: 10.1016/j.jmpt.2022.03.010] [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: 06/22/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims. METHODS We performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. The 3 care patterns we analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. We considered "escalated care" to be any claims with diagnostic imaging, injection procedures, or back surgery. Modified-Poisson regression modeling was used to determine relative risk of escalated care. RESULTS There were 83 025 claims that were categorized into 10 372 unique patient first episodes. Spinal manipulative therapy was present in 2943 episodes (28%). Initial spinal manipulation was present in 2519 episodes (24%), delayed spinal manipulation was present in 424 episodes (4%), and 7429 (72%) had no evidence of spinal manipulative therapy. The estimated relative risk, adjusted for age, sex, and risk score, for care escalation (eg, imaging, injections, or surgery) was 0.70 (95% confidence interval 0.65-0.75, P < .001) for initial spinal manipulation and 1.22 (95% confidence interval 1.10-1.35, P < .001) for delayed spinal manipulation with no spinal manipulation used as the reference group. CONCLUSION For claims associated with initial episodes of back pain, initial spinal manipulative therapy was associated with an approximately 30% decrease in the risk of imaging studies, injection procedures, or back surgery compared with no spinal manipulative therapy. The risk of imaging studies, injection procedures, or back surgery in episodes in the delayed spinal manipulative therapy group was higher than those without spinal manipulative therapy.
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Affiliation(s)
- Brian R Anderson
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
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13
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Huang H, Huo Z, Jiao J, Ji W, Huang J, Bian Z, Xu B, Shao J, Sun J. HOXC6 impacts epithelial-mesenchymal transition and the immune microenvironment through gene transcription in gliomas. Cancer Cell Int 2022; 22:170. [PMID: 35488304 PMCID: PMC9052479 DOI: 10.1186/s12935-022-02589-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gliomas are the most common primary malignant tumours of the central nervous system (CNS). To improve the prognosis of glioma, it is necessary to identify molecular markers that may be useful for glioma therapy. HOXC6, an important transcription factor, is involved in multiple cancers. However, the role of HOXC6 in gliomas is not clear. METHODS Bioinformatic and IHC analyses of collected samples (n = 299) were performed to detect HOXC6 expression and the correlation between HOXC6 expression and clinicopathological features of gliomas. We collected clinical information from 177 to 299 patient samples and estimated the prognostic value of HOXC6. Moreover, cell proliferation assays were performed. We performed Gene Ontology (GO) analysis and gene set enrichment analysis (GSEA) based on ChIP-seq and public datasets to explore the biological characteristics of HOXC6 in gliomas. RNA-seq was conducted to verify the relationship between HOXC6 expression levels and epithelial-mesenchymal transition (EMT) biomarkers. Furthermore, the tumour purity, stromal and immune scores were evaluated. The relationship between HOXC6 expression and infiltrating immune cell populations and immune checkpoint proteins was also researched. RESULTS HOXC6 was overexpressed and related to the clinicopathological features of gliomas. In addition, knockdown of HOXC6 inhibited the proliferation of glioma cells. Furthermore, increased HOXC6 expression was associated with clinical progression. The biological role of HOXC6 in gliomas was primarily associated with EMT and the immune microenvironment in gliomas. High HOXC6 expression was related to high infiltration by immune cells, a low tumour purity score, a high stromal score, a high immune score and the expression of a variety of immune checkpoint genes, including PD-L1, B7-H3 and CLTA-4. CONCLUSIONS These results indicated that HOXC6 might be a key factor in promoting tumorigenesis and glioma progression by regulating the EMT signalling pathway and might represent a novel immune therapeutic target in gliomas.
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Affiliation(s)
- Hui Huang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Zhengyuan Huo
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Jiantong Jiao
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Wei Ji
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Jin Huang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Zheng Bian
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Bin Xu
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China
| | - Junfei Shao
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China.
| | - Jun Sun
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qing Yang Road, 214023, Wuxi, Jiangsu, China.
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14
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Effect of Patient Use of Physical Therapy After Referral for Musculoskeletal Conditions on Future Medical Utilization: A Retrospective Cohort Analysis. J Manipulative Physiol Ther 2022; 44:621-636. [DOI: 10.1016/j.jmpt.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
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15
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Sharpe JA, Thackeray A, Fritz JM, Martin BI, Magel J, Vanneman ME. Patients' use of physical therapy for lower back pain: A qualitative study. Musculoskelet Sci Pract 2021; 56:102468. [PMID: 34688104 PMCID: PMC8629949 DOI: 10.1016/j.msksp.2021.102468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors that influence a patient's decision to use physical therapy (PT) services for a low back pain (LBP) complaint. METHODS Semi-structured qualitative phone interviews were conducted with patients who were offered an early outpatient PT visit secondary to patients' primary appointment for LBP with a non-operative sports medicine specialist physician. Interviews were recorded, transcribed, and analyzed to identify themes using an iterative process. RESULTS Forty participants were interviewed; 20 accepted early PT services, and 20 did not. Patients' decisions were influenced by perceived provider training, costs, doctor recommendations, wait times, symptoms, and a desire for a diagnosis. Patients preferred the care of non-operative sports medicine doctors over physical therapists for LBP due to their beliefs that favored doctors' diagnosis and management of LBP. Patients perceived exercise as an effective treatment for back pain. Physical therapists were viewed as an adjunct service, despite positive comments about PT and the belief that exercise is one of the most effective treatments for LBP. CONCLUSION Barriers including costs, patient preferences, and knowledge about physical therapists limited patients' use of PT. Value-based care strategies aimed at improving the management of LBP increasingly promote the early use of PT. For these strategies to be effective, it is critical that patient perceptions and the influence of barriers on PT use are further understood. This study highlights the need to promote confidence in physical therapists' expertise in the management and diagnosis of lower back pain.
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Affiliation(s)
- Jason A. Sharpe
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA,Corresponding author. VA Medical Center (152), HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC, 27701, USA. (J.A. Sharpe)
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Julie M. Fritz
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Brook I. Martin
- University of Utah School of Medicine, Department of Orthopaedics, Salt Lake City, UT, USA,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Megan E. Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology Salt Lake City, UT, USA,Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
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16
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Knudsen RH, Thomsen JL, Andersen CA, Afzali T, Riis A. Involving practice nurse and other assistant clinical staff members in the management of low back pain: A qualitative interview study from Danish general practice. SAGE Open Med 2021; 9:20503121211039660. [PMID: 34777804 PMCID: PMC8580501 DOI: 10.1177/20503121211039660] [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: 03/26/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Involving practice nurse and other assistant clinical staff members in providing information and education to patients with low back pain at follow-up appointments may release more time and improve care in general practice. However, this requires a shift in the division of tasks, and general practitioners' barriers and facilitators for this are currently unknown. The objectives were to explore general practitioners' experiences and perceptions of including assistant clinical staff members in the management of low back pain. Methods This is a semi-structured interview study in Danish general practice. General practitioners with a variation in demographics and experience with task-delegation to clinical staff were recruited for in-depth interviews. We used a phenomenological approach to guide the data collection and the analysis in order to gain insight into the subjective experiences of the general practitioners and to understand the phenomenon of 'delegating tasks to practice staff' from the perspective of the general practitioners' lifeworld. Analysis was conducted using an inductive descriptive method. The sample size was guided by information power. Results We conducted five interviews with general practitioners. All general practitioners had experience with task delegation, but there was a variation in which tasks the general practitioners delegated and to which types of clinical staff members. The following themes were derived from the analysis: general practice organisation, delegating to clinical staff members, doctor-patient relationship, exercise instruction, clinical pathway for patients and external support. Conclusion General practitioners consider patients with low back pain to be a heterogeneous group with a variety of treatment needs and a patient group without any predetermined content or frequency of consultations; this can be a barrier for delegating these patients to clinical staff members.
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Affiliation(s)
- Randi H Knudsen
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Janus L Thomsen
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | | | - Tamana Afzali
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Allan Riis
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
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17
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Busse JW, Pallapothu S, Vinh B, Lee V, Abril L, Canga A, Riva JJ, Viggiani D, Dilauro M, Harvey MP, Pagé I, Bhela AK, Sandhu S, Makanjuola O, Hassan MT, Moore A, Gauthier CA, Price DJ. Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians. BMC FAMILY PRACTICE 2021; 22:188. [PMID: 34525953 PMCID: PMC8442384 DOI: 10.1186/s12875-021-01535-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes. METHODS A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores. RESULTS Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI - 2.67 to - 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI - 2.59 to - 0.23) and reported use of the research literature (- 6.04 points; 95% CI - 8.47 to - 3.61) or medical school (- 5.03 points; 95% CI - 7.89 to - 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic. CONCLUSIONS Although generally positive, Canadian family physicians' attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.
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Affiliation(s)
- Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | | | - Brian Vinh
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Vivienne Lee
- The School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | - Lina Abril
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Albana Canga
- Institute for Work & Health, Toronto, ON, Canada
| | - John J Riva
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel Viggiani
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Marc Dilauro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marie-Pierre Harvey
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada
| | - Isabelle Pagé
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC, Canada
| | - Avneet K Bhela
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Serena Sandhu
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | | | | | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David J Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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18
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Anderson BR, McClellan WS, Long CR. Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims. J Manipulative Physiol Ther 2021; 44:372-377. [PMID: 34366149 DOI: 10.1016/j.jmpt.2021.03.001] [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: 08/27/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine. METHODS We used retrospective analysis of insurance claims data (2012-2018) from a single Fortune 500 company. After isolating the first episode of care, we categorized 58 147 claims into 7951 unique patient episodes. Treatment escalation included claims where imaging, injection, emergency room, or surgery was present. Modified Poisson regression was used to determine the relative risk of treatment escalation comparing recipients vs nonrecipients of spinal manipulation, adjusted for age, sex, episode duration, and risk scores. RESULTS The sample was 55% women, with a mean age of 44 years (range, 18-103). Treatment escalation was present in 42% of episodes overall: 2448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation (95% confidence interval, 2.22-2.55, P = .001). CONCLUSION Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain.
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Affiliation(s)
- Brian R Anderson
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | | | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
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19
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Sharpe JA, Martin BI, Fritz JM, Newman MG, Magel J, Vanneman ME, Thackeray A. Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis. Fam Pract 2021; 38:203-209. [PMID: 33043360 PMCID: PMC8679185 DOI: 10.1093/fampra/cmaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged. OBJECTIVE Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral. METHODS The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression. RESULTS 15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample. CONCLUSIONS We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.
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Affiliation(s)
- Jason A Sharpe
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Brook I Martin
- University of Utah School of Medicine, Department of Orthopaedics.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
| | - Julie M Fritz
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Michael G Newman
- Data Science Services, University of Utah, Data Science Services
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Megan E Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology.,Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
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20
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Braaten AD, Hanebuth C, McPherson H, Smallwood D, Kaplan S, Basirico D, Clewley D, Rethorn Z. Social determinants of health are associated with physical therapy use: a systematic review. Br J Sports Med 2021; 55:1293-1300. [PMID: 34083223 DOI: 10.1136/bjsports-2020-103475] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services. DESIGN A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use. DATA SOURCES The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies. ELIGIBILITY CRITERIA Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations. RESULTS Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use. CONCLUSION This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.
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Affiliation(s)
- Amanda Day Braaten
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Cannon Hanebuth
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Holt McPherson
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Dashae Smallwood
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - David Basirico
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Derek Clewley
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Zachary Rethorn
- Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
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21
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Lang AE, Hendrick PA, Clay L, Mondal P, Trask CM, Bath B, Penz ED, Stewart SA, Baxter GD, Hurley DA, McDonough SM, Milosavljevic S. A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain. BMC Musculoskelet Disord 2021; 22:206. [PMID: 33607979 PMCID: PMC7896363 DOI: 10.1186/s12891-021-04060-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).
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Affiliation(s)
- Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Paul A Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Lynne Clay
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prosanta Mondal
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Brenna Bath
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erika D Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Samuel A Stewart
- Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, Nova Scotia, Canada
| | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Deidre A Hurley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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22
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Beyera GK, O'Brien J, Campbell S. Determinants of healthcare utilisation for low back pain: A population-based study in Ethiopia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1058-1070. [PMID: 31894620 DOI: 10.1111/hsc.12939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/19/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Low back pain (LBP) remains one of the major public health problems worldwide. However, in low-income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population-based cross-sectional study was conducted in South-West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log-binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9-38.1, while the annual prevalence rate was 30%, 95% CI: 27.9-32.2. Of those with a 1-year history of healthcare utilisation, while 7.4%, 95% CI: 4.9-10.3 rural and 36.6%, 95% CI: 29.5-44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3-2.7 rural and 6.8%, 95% CI: 3.1-10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.
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Affiliation(s)
- Getahun K Beyera
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jane O'Brien
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Steven Campbell
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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23
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Wong JJ, Côté P, Tricco AC, Rosella LC. Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study. BMJ Open 2019; 9:e031749. [PMID: 31562160 PMCID: PMC6773279 DOI: 10.1136/bmjopen-2019-031749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Low back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms. METHODS AND ANALYSIS We designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003-2004, 2005-2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding. ETHICS AND DISSEMINATION This study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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