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Riley SP, Flowers DW, Swanson BT, Shaffer SM, Cook CE, Brismée JM. 'Trustworthy' systematic reviews can only result in meaningful conclusions if the quality of randomized clinical trials and the certainty of evidence improves: an update on the 'trustworthy' living systematic review project. J Man Manip Ther 2024; 32:363-367. [PMID: 38990056 PMCID: PMC11257005 DOI: 10.1080/10669817.2024.2377490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Affiliation(s)
- Sean P. Riley
- Hartford Healthcare Rehabilitation Network, Glastonbury, CT, USA
| | - Daniel W. Flowers
- Doctor of Physical Therapy Program, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Brian T. Swanson
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Stephen M. Shaffer
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Chad E. Cook
- Doctor of Physical Therapy (DPT) Division, Duke University, Durham, NC, USA
- Duke Center for Excellence in Manual and Manipulative Therapy, Durham, NC, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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2
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IJzelenberg W, Oosterhuis T, Hayden JA, Koes BW, van Tulder MW, Rubinstein SM, de Zoete A. Exercise Therapy for Treatment of Acute Non-specific Low Back Pain: A Cochrane Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2024; 105:1571-1584. [PMID: 38513994 DOI: 10.1016/j.apmr.2024.02.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To assess the effectiveness of exercise for acute non-specific low back pain (LBP) vs our main comparisons: (1) sham treatment and (2) no treatment at short term (main follow-up time). DATA SOURCES AND STUDY SELECTION A comprehensive search up till November 2021 was conducted in numerous databases for randomized controlled trials on the effectiveness of exercise in adults with acute LBP (<6 weeks). Studies examining LBP with a specific etiology were excluded. The primary outcomes were back pain, back-specific functional status, and recovery. DATA EXTRACTION Two review authors independently conducted the study selection, risk of bias assessment, and data extraction. GRADE was used to assess the certainty of the evidence. DATA SYNTHESIS We identified 23 randomized controlled trials (2674 participants). There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain (mean difference [MD] -0.80, 95% confidence interval [CI] -5.79 to 4.19; 1 study, 299 participants) and on functional status (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants) in the short term. There is very low-quality evidence which suggests no difference in effect on pain and functional status for exercise vs no treatment (2 studies; n=157, not pooled due to heterogeneity) at short-term follow-up. Similar results were found for the other follow-up moments. The certainty of the evidence was downgraded because many randomized controlled trials had a high risk of bias, were small in size, and/or there was substantial heterogeneity. CONCLUSION Exercise therapy compared with sham/placebo and no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy.
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Affiliation(s)
- Wilhelmina IJzelenberg
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Teddy Oosterhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, Netherlands; Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Maurits W van Tulder
- Department Human Movement Sciences, Faculty Behavioural & Movement Sciences, Vrije Universiteit Amsterdam
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Novert P, Pelletier-Visa M, Pereira B, Lanhers C, Coudeyre E. A critical appraisal of "effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomised controlled trials". J Orthop Surg Res 2024; 19:427. [PMID: 39061047 PMCID: PMC11274749 DOI: 10.1186/s13018-024-04766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 07/28/2024] Open
Affiliation(s)
- Pierre Novert
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France.
| | - Mathilde Pelletier-Visa
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, secteur Biométrie-Economie, CHU de Clermont-Ferrand, 5 place Henri Dunant, Clermont-Ferrand, France
| | - Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
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4
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Wu Y, Lin Y, Zhang M, He K, Tian G. Causal association between circulating inflammatory markers and sciatica development: a Mendelian randomization study. Front Neurol 2024; 15:1380719. [PMID: 39015317 PMCID: PMC11250389 DOI: 10.3389/fneur.2024.1380719] [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: 02/13/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Background This research explores the causal association between circulating inflammatory markers and the development of sciatica, a common and debilitating condition. While previous studies have indicated that inflammation may be a factor in sciatica, but a thorough genetic investigation to determine a cause-and-effect relationship has not yet been carried out. Gaining insight into these interactions may uncover novel treatment targets. Methods We utilized data from the OpenGWAS database, incorporating a large European cohort of 484,598 individuals, including 4,549 sciatica patients. Our study focused on 91 distinct circulating inflammatory markers. Genetic variations were employed as instrumental variables (IVs) for these markers. The analysis was conducted using inverse variance weighting (IVW) as the primary method, supplemented by weighted median-based estimation. Validation of the findings was conducted by sensitivity studies, utilizing the R software for statistical computations. Results The analysis revealed that 52 out of the 91 inflammatory markers studied showed a significant causal association with the risk of developing sciatica. Key markers like CCL2, monocyte chemotactic protein-4, and protein S100-A12 demonstrated a positive correlation. In addition, there was no heterogeneity or horizontal pleiotropy in these results. Interestingly, a reverse Mendelian randomization analysis also indicated potential causative effects of sciatica on certain inflammatory markers, notably Fms-related tyrosine kinase 3 ligands. Discussion The study provides robust evidence linking specific circulating inflammatory markers with the risk of sciatica, highlighting the role of inflammation in its pathogenesis. These findings could inform future research into targeted treatments and enhance our understanding of the biological mechanisms underlying sciatica.
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Affiliation(s)
- Yang Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Lin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mengpei Zhang
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China
| | - Ke He
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guihua Tian
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Siviter LM, Morretta M, Petosky T, Klopper M, Rhon DI, Young JL. Self-acknowledged limitations in exercise therapy trials for low back pain. J Eval Clin Pract 2024. [PMID: 38837313 DOI: 10.1111/jep.14033] [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: 02/28/2024] [Revised: 04/09/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
RATIONALE Despite the widespread recommendation to engage in therapeutic exercise for the treatment of low back pain (LBP), there is conflicting evidence regarding clinical outcomes and effectiveness. Poor methodological quality may be to blame for reducing the overall strength of evidence for this intervention, yet little is known about the difficulties researchers encounter when designing and implementing their study methods. AIMS AND OBJECTIVES The aim of this study was to characterize the extent and type of self-acknowledged limitations (SALs) in exercise therapy trials for LBP to gain a better understanding of challenges encountered when conducting this research. METHODS This is a methodological review of clinical trials in which SALs were extracted, categorized by theme and subcategorized within each theme. Counts and prevalence rates were tabulated for the number of SALs in each category and subcategory. RESULTS There were 914 SALs among the 312 included trials, with a mean of 2.93 (95% confidence interval [CI], 2.77-3.09) per trial. Analysis of the data resulted in the development of 13 distinct categories of limitations, among which were 37 subcategories. The top three categories pertained to statistical power (14.3% of total SALs), study length and/or follow-up (14.3%) and inclusion criteria (14.2%). The top three subcategories were lack of long-term follow-up (13.8% of total SALs), inadequate sample size (13.3%) and inclusion of specific populations (12.3%). CONCLUSION Statistical power, study length and/or follow-up, and inclusion criteria were the three most commonly reported categories of SALs in exercise trials for LBP. Lack of long-term follow-up, inadequate sample size and inclusion of specific populations were the most common subcategories. Research protocols recognizing and avoiding these limitations will enhance the overall quality of evidence of exercise therapy trials for LBP.
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Affiliation(s)
- Laura M Siviter
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- University of St. Augustine for Health Sciences, Physical Therapy Department, San Marcos, California, USA
| | - Matthew Morretta
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- University of St. Augustine for Health Sciences, Physical Therapy Department, San Marcos, California, USA
| | - Teressa Petosky
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- Faulkner University, Physical Therapy Department, Montgomery, Alabama, USA
| | - Mareli Klopper
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
- Graceland University, Physical Therapy Department, Lamoni, Iowa, USA
| | - Daniel I Rhon
- Uniformed Services University, Rehabilitation Medicine Department, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy Department, Green Bay, Wisconsin, USA
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6
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Ferreira LF, Roda Cardoso J, Telles da Rosa LH. Effects of different nutrition interventions on sarcopenia criteria in older people: A study protocol for a systematic review of systematic reviews with meta-analysis. PLoS One 2024; 19:e0302843. [PMID: 38728270 PMCID: PMC11086819 DOI: 10.1371/journal.pone.0302843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Sarcopenia, a subject of extensive research, has led to numerous clinical trials and systematic reviews (SR). These reviews aid healthcare professionals by summarizing results and conducting meta-analyses, enhancing reliability. However, the abundance of reviews complicates decision-making on sarcopenia management. To address this, SR of SR have emerged, consolidating data from various sources into comprehensive documents. OBJECTIVE To assess the isolated impact of dietary interventions on sarcopenia's diagnostic criteria for older individuals. METHODS A study protocol for a SR of SR, following Cochrane and PRISMA recommendations. The search strategy includes the MeSH 'sarcopenia' and its subheadings; 'aged' and its subheadings; 'nutrition' and its subheadings; and filter 'systematic review', performed at main databases. Selected studies must include older adults, submitted to nutritional interventions compared to control groups. Quantitative analyses will use inverse variance statistic method (random effects); the effect measures mean difference. Heterogeneity measured with Q-Test. RESULTS The results of this SR of SR may provide valuable information about the sarcopenia treatment, deepening the knowledge about. CONCLUSION This protocol is reproducible, requires low cost and personnel, and may allow a higher understanding on sarcopenia treatment and management on older people.
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Affiliation(s)
- Luis Fernando Ferreira
- Queens University of Belfast (QUB), Belfast, Northern Ireland, United Kingdom
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jéssica Roda Cardoso
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Tracy BA, Soncrant J, Rhon DI, Young JL. Trials Investigating Exercise for Low Back Pain Lack Pragmatic Application: A Systematic Review. Arch Phys Med Rehabil 2024; 105:157-165. [PMID: 38042245 DOI: 10.1016/j.apmr.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To systematically review the orientation of trials analyzing exercise for low back pain (LBP) on the efficacy-effectiveness spectrum. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE were searched for trials published between January 1, 2010, and August 13, 2022. STUDY SELECTION Randomized controlled trials investigating exercise for adults with LBP. DATA EXTRACTION Two reviewers independently used the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool to determine the efficacy-effectiveness orientation. The same 2 reviewers assessed the risk of bias for all studies using the Cochrane Collaboration risk of bias 2.0 tool. DATA SYNTHESIS The search identified 2975 records. Full-text review was conducted on 674 studies, and 159 studies were included. The proportion of trials with a strong or rather strong efficacy orientation (RITES rating=1 or 2), balanced emphasis (RITES rating=3), or strong or rather strong effectiveness (RITES rating=4 or 5) orientation on the efficacy-effectiveness spectrum within each RITES domain were reported. A greater proportion of trials had an efficacy orientation when compared with effectiveness or a balanced emphasis within 4 domains: participant characteristics: efficacy 43.9%, 41.9% effectiveness, balanced 14.5%; trial setting: 69.0% efficacy, effectiveness 15.8% balanced 15.2%; flexibility of interventions: 74.2% efficacy, effectiveness 8.8%, balanced 17.0%; clinical relevance of experimental and comparison interventions: 50.3% efficacy, 33.3% effectiveness 33.3%, balanced 16.4%. A high risk of bias was found in 42.1% (n=67) of trials. CONCLUSION Trials investigating the effect of exercise for LBP have a greater orientation toward efficacy across multiple trial design domains. Researchers should consider pragmatic designs in future trials to improve generalizability. Clinicians should consider the efficacy-effectiveness orientation when translating evidence into clinical practice.
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Affiliation(s)
- Brad A Tracy
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI.
| | - Jason Soncrant
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI; South College, Doctor of Physical Therapy Program, Knoxville, TN
| | - Daniel I Rhon
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI; Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jodi L Young
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI
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Furtado GE, Reis ASLDS, Braga-Pereira R, Caldo-Silva A, Teques P, Sampaio AR, dos Santos CAF, Bachi ALL, Campos F, Borges GF, Brito-Costa S. Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews. Healthcare (Basel) 2023; 11:3160. [PMID: 38132050 PMCID: PMC10742503 DOI: 10.3390/healthcare11243160] [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: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Centre for Natural Resources Environment and Society (CERNAS), Polytechnic Institute of Coimbra, Bencanta, 3045-601 Coimbra, Portugal
| | - Anne Sulivan Lopes da Silva Reis
- Postgraduate Program in Physical Education, University of Southwest Bahia and the State University of Santa Cruz (PPGEF/UESB/UESC), Ilhéus 45650-000, Brazil;
| | - Ricardo Braga-Pereira
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Adriana Caldo-Silva
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, 3040-248 Coimbra, Portugal;
| | - Pedro Teques
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
- CIPER, Interdisciplinary Center for the Study of Human Performance, 1499-002 Lisbon, Portugal
| | - António Rodrigues Sampaio
- N2i, Research Centre of the Polytechnic Institute of Maia, 4475-690 Maia, Portugal; (R.B.-P.); (P.T.); (A.R.S.)
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo 04020-050, Brazil;
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - André Luís Lacerda Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Francisco Campos
- Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal;
| | - Grasiely Faccin Borges
- Center for Public Policies and Social Technologies, Federal University of Southern Bahia, Praça José Bastos, s/n, Centro, Itabuna 45600-923, Brazil;
| | - Sónia Brito-Costa
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal;
- Research Group in Social and Human Sciences (NICSH), Coimbra Education School, Polytechnic of Coimbra, 3045-043 Coimbra, Portugal
- Human Potential Development Center (CDPH), Polytechnic of Coimbra, 3030-329 Coimbra, Portugal
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Rasmussen-Barr E, Halvorsen M, Bohman T, Boström C, Dedering Å, Kuster RP, Olsson CB, Rovner G, Tseli E, Nilsson-Wikmar L, Grooten WJA. Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord 2023; 24:806. [PMID: 37828488 PMCID: PMC10568903 DOI: 10.1186/s12891-023-06930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence. METHODS We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible. RESULTS Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available. CONCLUSION Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality. TRIAL REGISTRATION Prospero CRD42022336014.
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Affiliation(s)
- Eva Rasmussen-Barr
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden.
| | - Marie Halvorsen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Tony Bohman
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Roman P Kuster
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Christina B Olsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- ACT Institutet Sweden, Research and Education, Gothenburg, Sweden
| | - Elena Tseli
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lena Nilsson-Wikmar
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
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Ulrich L, Thies P, Schwarz A. Availability, Quality, and Evidence-Based Content of mHealth Apps for the Treatment of Nonspecific Low Back Pain in the German Language: Systematic Assessment. JMIR Mhealth Uhealth 2023; 11:e47502. [PMID: 37703072 PMCID: PMC10534285 DOI: 10.2196/47502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. OBJECTIVE We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. METHODS A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. RESULTS In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence-based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as "Yes" was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of "Yes" for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in "Section B-Functionality" (mean 3.81, SD 0.54). CONCLUSIONS Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. TRIAL REGISTRATION Open Science Framework Registries sq435; https://osf.io/sq435.
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Affiliation(s)
- Lauro Ulrich
- Faculty of Social Sciences, City University of Applied Sciences Bremen, Bremen, Germany
| | - Phillip Thies
- Faculty of Social Sciences, City University of Applied Sciences Bremen, Bremen, Germany
| | - Annika Schwarz
- Faculty of Social Sciences, City University of Applied Sciences Bremen, Bremen, Germany
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IJzelenberg W, Oosterhuis T, Hayden JA, Koes BW, van Tulder MW, Rubinstein SM, de Zoete A. Exercise therapy for treatment of acute non-specific low back pain. Cochrane Database Syst Rev 2023; 8:CD009365. [PMID: 37646368 PMCID: PMC10467021 DOI: 10.1002/14651858.cd009365.pub2] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability globally. It generates considerable direct costs (healthcare) and indirect costs (lost productivity). The many available treatments for LBP include exercise therapy, which is practised extensively worldwide. OBJECTIVES To evaluate the benefits and harms of exercise therapy for acute non-specific low back pain in adults compared to sham/placebo treatment or no treatment at short-term, intermediate-term, and long-term follow-up. SEARCH METHODS This is an update of a Cochrane Review first published in 2005. We conducted an updated search for randomised controlled trials (RCTs) in CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We screened the reference lists of all included studies and relevant systematic reviews published since 2004. SELECTION CRITERIA We included RCTs that examined the effects of exercise therapy on non-specific LBP lasting six weeks or less in adults. Major outcomes for this review were pain, functional status, and perceived recovery. Minor outcomes were return to work, health-related quality of life, and adverse events. Our main comparisons were exercise therapy versus sham/placebo treatment and exercise therapy versus no treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We evaluated outcomes at short-term follow-up (time point within three months and closest to six weeks after randomisation; main follow-up), intermediate-term follow-up (between nine months and closest to six months), and long-term follow-up (after nine months and closest to 12 months); and we used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 23 studies (13 from the previous review, 10 new studies) that involved 2674 participants and provided data for 2637 participants. Three small studies are awaiting classification, and four eligible studies are ongoing. Included studies were conducted in Europe (N = 9), the Asia-Pacific region (N = 9), and North America (N = 5); and most took place in a primary care setting (N = 12), secondary care setting (N = 6), or both (N = 1). In most studies, the population was middle-aged and included men and women. We judged 10 studies (43%) at low risk of bias with regard to sequence generation and allocation concealment. Blinding is not feasible in exercise therapy, introducing performance and detection bias. There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain scores in the short term (mean difference (MD) -0.80, 95% confidence interval (CI) -5.79 to 4.19; 1 study, 299 participants). The absolute difference was 1% less pain (95% CI 4% more to 6% less), and the relative difference was 4% less pain (95% CI 20% more to 28% less). The mean pain score was 20.1 (standard deviation (SD) 21) for the intervention group and 20.9 (SD 23) for the control group. There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on functional status scores in the short term (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants). The absolute difference was 2% worse functional status (95% CI 2% better to 6% worse), and the relative difference was 15% worse (95% CI 17% better to 47% worse). The mean functional status score was 15.3 (SD 19) for the intervention group and 13.3 (SD 18) for the control group. We downgraded the certainty of the evidence for pain and functional status by one level for risk of bias and by two levels for imprecision (only one study with fewer than 400 participants). There is very low-certainty evidence that exercise therapy compared with no treatment has no clinically relevant effect on pain or functional status in the short term (2 studies, 157 participants). We downgraded the certainty of the evidence by two levels for imprecision and by one level for inconsistency. One study associated exercise with small benefits and the other found no differences. The first study was conducted in an occupational healthcare centre, where participants received one exercise therapy session. The other study was conducted in secondary and tertiary care settings, where participants received treatment three times per week for six weeks. We did not pool data from these studies owing to considerable clinical heterogeneity. In two studies, there were no reported adverse events. One study reported adverse events unrelated to exercise therapy. The remaining studies did not report whether any adverse events had occurred. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy. AUTHORS' CONCLUSIONS Exercise therapy compared to sham/placebo treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Exercise therapy compared to no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. We downgraded the certainty of the evidence to very low for inconsistency, risk of bias concerns, and imprecision (few participants).
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Affiliation(s)
- Wilhelmina IJzelenberg
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teddy Oosterhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Ramond-Roquin A, Bègue C, Vizzini J, Chhor S, Bouchez T, Parot-Schinkel E, Loiez A, Petit A, Ghali M, Peurois M, Bouton C. Effectiveness of coordinated care to reduce the risk of prolonged disability among patients suffering from subacute or recurrent acute low back pain in primary care: protocol of the CO.LOMB cluster-randomized, controlled study. Front Med (Lausanne) 2023; 10:1156482. [PMID: 37409270 PMCID: PMC10318135 DOI: 10.3389/fmed.2023.1156482] [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: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
Background Low back pain (LBP) is a common musculoskeletal condition and, globally, a leading cause of years lived with disability. It leads to reduced social participation, impaired quality of life, and direct and indirect costs due to work incapacity. A coordinated approach focusing on psychosocial risk factors, active reeducation, and the early use of tools to maintain employment, may be effective for improving prognosis of patients with LBP. Primary care professionals and multidisciplinary teams, who see patients in the early stages of LBP may be in the best position to implement such a coordinated approach. We designed this study to assess a coordinated multi-faceted strategy in primary care for patients with subacute or recurrent acute LBP. Methods The CO.LOMB study was designed as a multicentric, cluster-randomized, controlled study. Patients aged 18-60 years, with subacute or recurrent acute LBP are eligible. Patients also need to be employed (but can be on sick leave) with access to occupational health services. The clusters of GPs will be randomized (1:1) to either the Coordinated-care group or the Usual-care group. Patients will be assigned the group allocated to their GP. The healthcare professionals (GPs and associated physiotherapists) allocated to the Coordinated-care group will perform a 2-session study training. The following interventions are planned in the Coordinated-care group: exploration and management of psychosocial factors, active reeducation with a physiotherapist, the implementing of tools to maintain employment, and a reinforced cooperation between primary healthcare professionals. The primary objective is to assess the benefit of coordinated primary care to reduce disability in LBP patients at 12 months after enrollment: measure using the validated French version of the Roland Morris Disability Questionnaire. Secondary objectives include the evaluation of pain, work status, and quality of life at various time points. The study plans to enroll 500 patients in 20 GP clusters. Patients will be followed up for 12months. Discussion This study will evaluate the benefit of a coordinated multi-faceted strategy in primary care for patients with LBP. Notably whether this approach will alleviate the associated disability, attenuate pain, and promote the maintenance or return to work. Clinical Trial Registration NCT04826757.
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Affiliation(s)
- Aline Ramond-Roquin
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
- Département de Médecine de Famille et de Médecine d’Urgence, Université de Sherbrooke, Québec, QC, Canada
| | - Cyril Bègue
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Jonathan Vizzini
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Sidonie Chhor
- Département de Médecine Générale, Univ Rennes, Rennes, France
| | - Tiphanie Bouchez
- Département d'Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d'Azur, Nice, France
| | - Elsa Parot-Schinkel
- Biostatistics and Methodology Department, University Hospital of Angers, Angers, France
| | - Anthéa Loiez
- Département de Médecine Générale, Univ Angers, Angers, France
- Delegation for Clinical Research and Innovation, University Hospital of Angers, Angers, France
| | - Audrey Petit
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Maria Ghali
- Département de Médecine Générale, Univ Angers, Angers, France
| | - Matthieu Peurois
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Céline Bouton
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
- Département de Médecine Générale, Univ Nantes, Nantes, France
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13
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Rossettini G, Campaci F, Bialosky J, Huysmans E, Vase L, Carlino E. The Biology of Placebo and Nocebo Effects on Experimental and Chronic Pain: State of the Art. J Clin Med 2023; 12:4113. [PMID: 37373806 DOI: 10.3390/jcm12124113] [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: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: In recent years, placebo and nocebo effects have been extensively documented in different medical conditions, including pain. The scientific literature has provided strong evidence of how the psychosocial context accompanying the treatment administration can influence the therapeutic outcome positively (placebo effects) or negatively (nocebo effects). (2) Methods: This state-of-the-art paper aims to provide an updated overview of placebo and nocebo effects on pain. (3) Results: The most common study designs, the psychological mechanisms, and neurobiological/genetic determinants of these phenomena are discussed, focusing on the differences between positive and negative context effects on pain in experimental settings on healthy volunteers and in clinical settings on chronic pain patients. Finally, the last section describes the implications for clinical and research practice to maximize the medical and scientific routine and correctly interpret the results of research studies on placebo and nocebo effects. (4) Conclusions: While studies on healthy participants seem consistent and provide a clear picture of how the brain reacts to the context, there are no unique results of the occurrence and magnitude of placebo and nocebo effects in chronic pain patients, mainly due to the heterogeneity of pain. This opens up the need for future studies on the topic.
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Affiliation(s)
| | - Francesco Campaci
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL 32211, USA
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Elisa Carlino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
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14
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Kühn L, Lindert L, Kuper P, Prill R, Choi KE(A. Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review. BMC Health Serv Res 2023; 23:193. [PMID: 36823581 PMCID: PMC9949696 DOI: 10.1186/s12913-023-09166-4] [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: 10/21/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The provision of low-value physiotherapy services in low back pain management is a known but complex phenomenon. Thus, this scoping review aims to systematically map existing research designs and instruments of the field in order to discuss the current state of research methodologies and contextualize results to domains and perspectives of a referred low-value care typology. Ultimately, results will be illustrated and transferred to conditions of the German health care setting as care delivery conditions of physiotherapy in Germany face unique particularities. METHODS The development of this review is guided by the analysis framework of Arksey and O'Malley. A two-stage, audited search strategy was performed in Medline (PubMed), Web of Science, and google scholar. All types of observational studies were included. Identified articles needed to address a pre-determined population, concept, and context framework and had to be published in English or German language. The publication date of included articles was not subject to any limitation. The applied framework to assess the phenomenon of low-value physiotherapy services incorporated three domains (care effectiveness; care efficiency; patient alignment of care) and perspectives (provider; patient; society) of care. RESULTS Thirty-three articles met the inclusion criteria. Seventy-nine percent of articles focused on the appropriateness of physiotherapeutic treatments, followed by education and information (30%), the diagnostic process (15%), and goal-setting practice (12%). Study designs were predominantly cross-sectional (58%). Data sources were mainly survey instruments (67%) of which 50% were self-developed. Most studies addressed the effectiveness domain of care (73%) and the provider perspective (88%). The perspective of patient alignment was assessed by 6% of included articles. None of included articles assessed the society perspective. Four methodical approaches of included articles were rated to be transferrable to Germany. CONCLUSION Identified research on low-value physiotherapy care in low back pain management was widely unidimensional. Most articles focused on the effectiveness domain of care and investigated the provider perspective. Most measures were indirectly and did not monitor low-value care trends over a set period of time. Research on low-value physiotherapy care in secondary care conditions, such as Germany, was scarce. REGISTRATION This review has been registered on open science framework ( https://osf.io/vzq7k https://doi.org/10.17605/OSF.IO/PMF2G ).
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Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany. .,Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Lara Lindert
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Paulina Kuper
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany
| | - Robert Prill
- grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.473452.3Center of Orthopaedics and Traumatology, Universtiy Hospital Brandenburg/Havel, Brandenburg Medical School, Neuruppin, Germany
| | - Kyung-Eun (Anna) Choi
- grid.473452.3Center for Health Services Research, Seebad 82/83, 15562 Rüdersdorf Bei Berlin, Brandenburg Medical School, Neuruppin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816 Neuruppin, Germany ,grid.465811.f0000 0004 4904 7440Health Services Research, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, 3500 Krems-Stein, Austria
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Syroyid Syroyid I, Cavero-Redondo I, Syroyid Syroyid B. Effects of Resistance Training on Pain Control and Physical Function in Older Adults With Low Back Pain: A Systematic Review With Meta-analysis. J Geriatr Phys Ther 2023:00139143-990000000-00023. [PMID: 36805624 DOI: 10.1519/jpt.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP. METHODS A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z-test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications. RESULTS AND DISCUSSION Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies. CONCLUSIONS The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.
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Affiliation(s)
- Ivan Syroyid Syroyid
- Servicio de Salud de Castilla-La Mancha, Castilla-La Mancha, Spain.,Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Ivan Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Bohdan Syroyid Syroyid
- Universidad de Castilla-La Mancha, Ciudad Real, Spain.,Universidad de Salamanca, Salamanca, Spain
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Louw A, Farrell K, Nielsen A, O’Malley M, Cox T, Puentedura EJ. Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series. J Man Manip Ther 2023; 31:46-52. [PMID: 35739614 PMCID: PMC9848382 DOI: 10.1080/10669817.2022.2092822] [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: 01/21/2023] Open
Abstract
INTRODUCTION Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach. OBJECTIVES To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain. METHODS A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise. RESULTS Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID). CONCLUSIONS A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.
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Affiliation(s)
- Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Anthony Nielsen
- Department of Physical Therapy, Rock Valley Physical Therapy, Bettendorf, IA, USA
| | - Max O’Malley
- Department of Physical Therapy, AMN Healthcare, Lincolnwood, IL, USA
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, MO, USA
| | - Emilio J. Puentedura
- Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, Waco, TX, USA,CONTACT Emilio J. Puentedura Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, One Bear Place, Waco, TX97303, USA
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Raizah A, Alzahrani F, Albarqi B, Abusaq I, Alqarni H, Alyami I, Ahmad I, Reddy RS. Treatment Beliefs and Practices towards Low Back Pain among Teachers in Asir Region, Saudi Arabia-A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11030383. [PMID: 36766958 PMCID: PMC9914584 DOI: 10.3390/healthcare11030383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The prevalence of low back pain (LBP) is increasing exponentially, with this public health issue affecting over 70% of the population. However, sedentary careers exacerbate the problem further, with professions such as teaching disproportionately affected. In addition, the general population does not seek interventions from medical professionals for LBP; instead, they opt to manage their pain with over-the-counter medications, such as sedatives. The purpose of this study was to explore practices and beliefs related to back pain treatment among schoolteachers in the Asir region. This cross-sectional study included a sample of 312 teachers from the Asir region, with data collected regarding the prevalence of back pain, management approaches, and beliefs surrounding medical interventions. Chi-square or exact tests defined the association between variables, with significance determined at p < 0.05. Our results revealed that 67.3% of Saudi Arabian teachers experienced LBP within the last two months, with a continuous condition representing 36.7% of cases. This study identified several different treatment modalities the participants use to manage their pain, including sedatives, best rest, kaiy (traditional cautery), and local adhesives, with sedatives being the most employed method. It also highlighted that increased daily working hours and total days worked significantly increased the prevalence of LBP (p < 0.05). Although a considerable number of the included teachers were highly educated, with some teaching experience, they had a poor level of awareness and an incorrect attitude towards pain management. Enhanced efforts should be made to improve teachers' awareness regarding back pain causes and management methods.
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Affiliation(s)
- Abdullah Raizah
- Department of Orthopaedic Surgery, King Khalid University, Abha 61413, Saudi Arabia
| | - Faris Alzahrani
- The Joint Program of Public Health and Preventive Medicine, Abha 62527, Saudi Arabia
| | - Bandar Albarqi
- The Joint Program of Public Health and Preventive Medicine, Abha 62527, Saudi Arabia
| | - Ibrahim Abusaq
- Department of Pediatric Surgery, University Hospital Estaing, 63000 Clermont Ferrand, France
| | | | | | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
- Correspondence:
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
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Vervullens S, Meert L, Baert I, Smeets RJEM, Verdonk P, Rahusen F, Meeus M. Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care. Ann Phys Rehabil Med 2022; 66:101705. [PMID: 36115573 DOI: 10.1016/j.rehab.2022.101705] [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: 09/29/2021] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA). PURPOSE We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life. METHODS A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included. RESULTS After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies). CONCLUSION More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA. REGISTRATION NUMBER This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).
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Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; CIR Revalidatie, location Eindhoven, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium and ASTARC department, Antwerp University, Belgium
| | - Frank Rahusen
- Department of Orthopaedics, St Jans Gasthuis Weert, the Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands.
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Olowe O, Sokunbi O, Salisu A, Okafor A. The effect of treadmill walk with abdominal bracing versus usual care on functional limitation and fear-avoidance behaviours in the management of non-specific low back pain—a randomized control study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of a combined abdominal bracing technique concurrently with treadmill walking exercise seems not to have been widely investigated, The use of either abdominal bracing and treadmill walk as a single individual method of treatment has proven to be of immense benefit in athletic training and amelioration of pain and functional limitation among different age groups suffering from chronic low back pain. Thus, the need to investigate whether the combination of abdominal bracing and treadmill walking would produce greater benefits than when the exercises are carried out in isolation in the management of chronic low back pain patients.
Study design
The study was a randomized control.
Participants
Thirty-three participants who met the inclusion criteria with age from 18 to 65 participated in the study.
Aim
This study aimed to compare the effects of treadmill walk with and without abdominal bracing versus usual care on pain, functional limitation and fear-avoidance behaviours among patients with non-specific chronic low back pain.
Methods
Thirty-three non-specific chronic low back pain (NSCLBP) patients were randomized into three groups treadmill walk without abdominal bracing (TWW), treadmill walk with abdominal bracing (TWAB) and usual care (UC). Interventions were carried out for 6 weeks.
Outcome measure
Pre and post-intervention scores of pain intensity, functional limitation, and fear-avoidance belief were assessed with box numerical pain rating scales, Oswestry disability index and Fear-Avoidance Belief Questionnaire, respectively.
Results
Pre-intervention scores of pain intensity functional disability and fear-avoidance belief did not show significant differences among the groups (P >0.05). Within-group analysis with paired t-test showed that pain intensity and functional limitation were significantly reduced after 6 weeks of intervention among the 3 groups. Fear-avoidance belief recorded statistical reduction among the 2 treadmill procedures (TWAB and TWW) groups (P<0.05) but not in the usual care groups (P>0.05). Participants in the TWW group showed greater improvement than those in TWAB in terms of reduction in pain intensity (24.17±16.49), functional limitation (7.00±5.97, P = 0.001) and fear- avoidance (30.83±17.90, P = 0.003)
Conclusion
Treadmill walk with and without abdominal bracing as well as usual care could be effective in reducing pain. However, treadmill walk without abdominal bracing was more effective in improving back function in terms of reduction in pain intensity, functional limitation (as reported by the Oswestry scale) and reducing fear-avoidance behaviour (as reported by fear-avoidance belief scores).
Trial registration
PACTR, PACTR201910691645076. Registered on 22 October 2019.
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20
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Roren A, Daste C, Coleman M, Rannou F, Freyssenet D, Moro C, Lefèvre-Colau MM, Nguyen C. Physical activity and low back pain: A critical narrative review. Ann Phys Rehabil Med 2022; 66:101650. [PMID: 35240326 DOI: 10.1016/j.rehab.2022.101650] [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: 09/28/2021] [Revised: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Non-specific low back pain (LBP) is the leading cause of years lived with disability worldwide. Physical activity is an integral part of LBP treatment. OBJECTIVE To critically review available evidence regarding the efficacy of physical activity for people with LBP. METHODS Up to date critical narrative review of the efficacy of physical activity for the managment LBP. The process of article selection was unsystematic; articles were selected based on authors' expertise, self-knowledge and reflective practice. RESULTS Therapeutic physical activity for LBP includes a wide range of non-specific and specific activities. The efficacy of physical activity on pain and activity limitations has been widely assessed. In acute and subacute LBP, exercise did not reduce pain compared to no exercise. In chronic low back pain (CLBP), exercise reduced pain at the earliest follow-up compared with no exercise. In a recent systematic review, exercise improved function both at the end of treatment and in the long-term compared with usual care. Exercice also reduced work disability in the long-term. We were unable to establish a clear hierarchy between different exercise modalities. Multidisciplinary functional programs consistently improved pain and function in the short- and long-term compared with usual care and physiotherapy and improved the long-term likelihood of returning to work compared to non-multidisciplinary programs. CONCLUSION Physical activity of all types is an effective treatment for CLBP.
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Affiliation(s)
- Alexandra Roren
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Université Paris Cité, Faculté de Santé, UFR Médecine Paris Descartes, Paris 75006, France; INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, Paris 75004, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, Paris 75013, France.
| | - Camille Daste
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Université Paris Cité, Faculté de Santé, UFR Médecine Paris Descartes, Paris 75006, France
| | - Marvin Coleman
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Laboratoire de l'Institut des Sciences du Sport-Santé de Paris, URP 3625, Université Paris Cité, Paris, France
| | - François Rannou
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Université Paris Cité, Faculté de Santé, UFR Médecine Paris Descartes, Paris 75006, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, Paris 75013, France; INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Faculté des Sciences Fondamentales et Biomédicales, Université Paris Cité, Sorbonne Paris Cité, Paris 75006, France
| | - Damien Freyssenet
- Laboratoire Inter-universitaire de biologie de la motricité (LIBM), EA 7424, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
| | - Cedric Moro
- Inserm/UPS UMR1297, Université Paul Sabatier, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Equipe MetaDiab, Toulouse, France
| | - Marie-Martine Lefèvre-Colau
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Université Paris Cité, Faculté de Santé, UFR Médecine Paris Descartes, Paris 75006, France; INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, Paris 75004, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, Paris 75013, France
| | - Christelle Nguyen
- AP-HP, Groupe Hospitalier AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, Paris 75014, Ile de France, France; Université Paris Cité, Faculté de Santé, UFR Médecine Paris Descartes, Paris 75006, France; INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Faculté des Sciences Fondamentales et Biomédicales, Université Paris Cité, Sorbonne Paris Cité, Paris 75006, France
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21
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Knoop J, van Lankveld W, Beijer L, Geerdink FJB, Heymans MW, Hoogeboom TJ, Hoppenbrouwers S, van Overmeeren E, Soer R, Veenhof C, Vissers KCP, van der Wees PJ, Sappelli M, Staal JB. Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care. BMC Musculoskelet Disord 2022; 23:834. [PMID: 36057717 PMCID: PMC9440317 DOI: 10.1186/s12891-022-05718-7] [Citation(s) in RCA: 1] [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: 03/29/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling. Methods Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis. Results Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice. Conclusions We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05718-7.
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Affiliation(s)
- J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.
| | - W van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands
| | - L Beijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Research and Innovation Department, Sint Maartenskliniek, Nijmegen, Netherlands
| | - F J B Geerdink
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands
| | - M W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - S Hoppenbrouwers
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - E van Overmeeren
- Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands
| | - R Soer
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Pain Center, Groningen, Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, Netherlands
| | - K C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - P J van der Wees
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - M Sappelli
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - J B Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
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22
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Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E. Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews. BMC Musculoskelet Disord 2022; 23:801. [PMID: 35996124 PMCID: PMC9394044 DOI: 10.1186/s12891-022-05722-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability. Methods We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE. Results Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention. Conclusions Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources. Trial registration PROSPERO: Reg no 190409 Registration date 01AUG 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05722-x.
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Affiliation(s)
- Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Marie Halvorsen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Roman P Kuster
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Christina B Olsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,ACT Institutet Sweden, Gothenburg, Sweden
| | - Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
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23
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Orrillo E, Vidal Neira L, Piedimonte F, Plancarte Sanchez R, Astudilllo Mihovilovic S, Narvaez Tamayo MA, Rekatsina M, Varrassi G. What Is New in the Clinical Management of Low Back Pain: A Narrative Review. Cureus 2022; 14:e22992. [PMID: 35464575 PMCID: PMC8996822 DOI: 10.7759/cureus.22992] [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] [Received: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Low back pain (LBP) is a prevalent condition associated with disability. Treating patients with LBP becomes further complicated by the potential presence of underlying conditions, such as cancer or traumatic injury, or biopsychosocial aspects. LBP usually has a neuropathic component that must be assessed and treated appropriately. Pharmacological management of LBP requires a thorough knowledge of the available agents and the mechanisms of the LBP. Although there are effective pharmacological treatments for LBP, it is important to consider safety issues. Fixed-dose combination products may be helpful, as they can reduce opioid consumption without sacrificing analgesic benefits. Neuromodulation is an important and sometimes overlooked treatment option for LBP and may be appropriate for chronic LBP requiring long-term treatment. Imaging studies support neuroplastic changes in the brain as a result of neuromodulation. Interventional approaches to chronic LBP are numerous and must be appropriately selected based on the individual patient. Evidence in support of epidural injections for LBP is strong for short-term pain control but moderate to limited for long-term relief. Rehabilitation for LBP can be an important element of long-term care, and new forms of rehabilitation programs are being developed using telemedicine. A variety of new and established treatments are available for patients with LBP, and clinicians and patients may benefit from emerging new treatment modalities.
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24
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Tanveer F, Arslan SA, Darain H, Ahmad A, Gilani SA, Hanif A. Prevailing treatment methods for lumbar spondylolysis: A systematic review. Medicine (Baltimore) 2021; 100:e28319. [PMID: 34941130 PMCID: PMC8702222 DOI: 10.1097/md.0000000000028319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Aim of this study was to systematically review the prevailing treatment methods for lumbar spondylolysis. Methods: Manuscripts published between 1951 and 2020 were searched by using PubMed, Medline, Scopus, Springer, Web of Science databases. The study protocol was registered with PROSPERO (CRD42020218651). The inclusion criteria for all articles of prevailing treatment methods for spondylolysis were: Standards have been independently applied by using 2 reviewers and another author resolved disagreements. Results: Data extraction screened 12 full-length articles. Description, treatment, outcome, and findings were individually extracted and cross-referenced. Discussion: Current review has suggested that the noninvasive treatment method specifically low intensity pulsed ultrasound, electro acupuncture and pulsed electromagnetic filed is effective for bone union while operative treatment specifically pedicle screw fixation +/- interbody fusion depending the extent of disk degeneration and craniocaudal foraminal stenosis is effective for minimizing pain and functional disability in patients with spondylolysis. This review concluded that the noninvasive treatment method specifically low intensity pulsed ultrasound is effective for bone union. Review Registration: PROSPERO (CRD42020218651).
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Affiliation(s)
- Fahad Tanveer
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | | | - Haider Darain
- Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Public Health, University of Lahore, Lahore, Pakistan
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25
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Trulsson Schouenborg A, Rivano Fischer M, Bondesson E, Jöud A. Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain: interventions and promising long-term outcomes. BMC Musculoskelet Disord 2021; 22:910. [PMID: 34711194 PMCID: PMC8555237 DOI: 10.1186/s12891-021-04780-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed. AIM To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period. METHODS All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014-2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured 'clinical reasoning' using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients' medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge. RESULTS In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up. CONCLUSIONS A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.
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Affiliation(s)
- Anna Trulsson Schouenborg
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden. .,Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden.
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden
| | - Elisabeth Bondesson
- Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden
| | - Anna Jöud
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Research and Education, Skane University Hospital, Lund, Sweden
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Di Gangi S, Bagnoud C, Pichierri G, Rosemann T, Plate A. Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study. J Pain Res 2021; 14:3109-3120. [PMID: 34675640 PMCID: PMC8504656 DOI: 10.2147/jpr.s328033] [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: 07/06/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Low back pain (LBP) is one of the most frequent reasons for medical consultations. Literature suggests a large evidence-performance gap, especially regarding pain management. Therefore, the monitoring of treatment patterns is important to ensure high quality of treatment. This study aimed to describe treatment patterns specific to patients with diagnostic imaging of the spine for LBP. Patients and Methods The study was retrospective observational and based on health claims data from 2015 to 2019 provided by a Swiss health insurance company covering around 12% of the population. Patients, ≥18 years of age, with diagnostic imaging of the spine were included and observed 12 months before and after imaging. Patients with back surgery or comorbidities associated with the use of pain medications were excluded. Results In total, 60,822 patients (mean age: 53.5 y, 56.1% female) were included and 85% received at least one pain medication. Of these, non-steroidal anti-inflammatory drugs, paracetamol, or opioids were prescribed in 88.6%, 70.7%, and 40.3% of patients, respectively. Strong opioids were used in 17% of patients given opioids. Patients with combinations of diagnostic imaging methods had the highest odds of receiving pain medication prescriptions (1.81, 95% CI: 1.66, 1.96, P < 0.001). Prescribed defined daily doses corresponded to short-term therapies. Conclusion Although the majority of patients received non-opioid short-term therapies, we found a substantial use of opioids, and in particular, a relative high usage of strong opioids. Our results highlighted the importance of both patient and healthcare provider awareness regarding the prudent treatment of LBP.
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Affiliation(s)
- Stefania Di Gangi
- Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland
| | | | - Giuseppe Pichierri
- Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland
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Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168430. [PMID: 34444189 PMCID: PMC8391468 DOI: 10.3390/ijerph18168430] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. METHOD PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. RESULTS We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = -0.89. 95% CI -0.99 to -0.80) and in the group which conducted exercise both at-home and at another setting (-0.73. -0.86 to -0.59). Similarly, functional limitation also decreased in both groups (-0.75. -0.91 to -0.60, and -0.70, -0.92 to -0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. CONCLUSION Home-based exercise training improved pain intensity and functional limitation parameters in LBP.
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