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Agius Anastasi A, Zammit S. Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [PMCID: PMC9006098 DOI: 10.1177/22104917221092162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To analyse data related to the referral, selection and admission processes for inpatient rehabilitation at Karin Grech Hospital, Malta. Examining pre-pandemic challenges faced can guide reform towards a more sustainable use of inpatient rehabilitation services. Methods: Referrals and outcomes of all patients referred for inpatient rehabilitation between April and August, 2018 were analysed. Results: 47% of patients referred for inpatient rehabilitation were accepted, with an average time to transfer of 4.84 days. Of the 53% deemed unsuitable, the commonest reasons were: excessively high level of independence (22%), non-weight-bearing restriction (12%) and patient refusal (12%). 90% of inpatients in rehabilitation were discharged home, 7% were transferred back due to acute complications and 1 patient was transferred to a residential home. Out of all referrals, 14 passed away within 1 year, two of these within 8 days of referral. Conclusions: Identifying unsuitable referrals for inpatient rehabilitation can avoid inappropriate admissions that would otherwise decrease bed availability and increase waiting times. Basing patient selection on key principles can thence ensure efficient and sustainable rehabilitation services moving forward.
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Ozer AF, Oktenoglu T, Egemen E, Sasani M, Yilmaz A, Erbulut DU, Yaman O, Suzer T. Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients. Clin Orthop Surg 2017; 9:310-316. [PMID: 28861198 PMCID: PMC5567026 DOI: 10.4055/cios.2017.9.3.310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/12/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery. METHODS A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up. RESULTS Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery. CONCLUSIONS Each procedure offered satisfactory outcome regardless of which system was applied.
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Emrah Egemen
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Atilla Yilmaz
- Department of Neurosurgery, Mustafa Kemal University, Hatay, Turkey
| | - Deniz Ufuk Erbulut
- Department of Biomedical Engineering, Medipol University, Istanbul, Turkey
| | - Onur Yaman
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tuncer Suzer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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Salisbury C, O’Cathain A, Thomas C, Edwards L, Montgomery AA, Hollinghurst S, Large S, Nicholl J, Pope C, Rogers A, Lewis G, Fahey T, Yardley L, Brownsell S, Dixon P, Drabble S, Esmonde L, Foster A, Garner K, Gaunt D, Horspool K, Man MS, Rowsell A, Segar J. An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Thomas
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simon Brownsell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lisa Esmonde
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mei-See Man
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Rowsell
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
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McCluskey A, Lovarini M, Bennett S, McKenna K, Tooth L, Hoffmann T. What Evidence Exists for Work-Related Injury Prevention and Management? Analysis of an Occupational Therapy Evidence Database (OTseeker). Br J Occup Ther 2016. [DOI: 10.1177/030802260506801003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to summarise the quantity and quality of research contained in an online evidence database (OTseeker) in one practice area, work-related injury prevention and management, to highlight the available evidence. In May 2004, the systematic reviews and randomised controlled trials (RCTs) contained in OTseeker were analysed. The number and proportion of systematic reviews and RCTs and the number and proportion of RCTs meeting each of the 10 criteria on the PEDro scale (partitioned) were calculated and the topics and conclusions of the systematic reviews were summarised. Of the 2330 records contained in OTseeker, 346 (14.8%) related to work-related injury prevention and management (86 systematic reviews and 260 RCTs). Of the 260 RCTs, the majority (n = 140, 53.8%) scored between 3/8 and 5/8 for internal validity on the PEDro scale (partitioned); a few scored 6/8 or more (n = 13, 5.0%). The majority of the RCTs scored 2/2 for the reporting of results (n = 217, 83.5%). Evidence was identified, mostly for the treatment of low back pain, to support the use of multidisciplinary biopsychosocial rehabilitation including workplace visits, back schools, workplace exercise, and advice to stay active and/or return to normal activities. OTseeker contains a substantial body of research on the effectiveness of work-related injury prevention and management, although this research is of varying methodological quality.
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Bernhardsson S, Öberg B, Johansson K, Nilsen P, Larsson MEH. Clinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden. J Eval Clin Pract 2015; 21:1169-77. [PMID: 25988993 DOI: 10.1111/jep.12380] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables. METHODS 419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire. RESULTS The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1-16). The most common treatment interventions across the three conditions were advice on posture (reported by 82-94%), advice to stay active (86-92%), and different types of exercise (65-92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29-96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience. CONCLUSIONS Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.
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Affiliation(s)
- Susanne Bernhardsson
- Närhälsan Rehabilitation, Region Västra Götaland, Hönö, Sweden.,Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Kajsa Johansson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Social Medicine, Linköping University, Linköping, Sweden
| | - Maria E H Larsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Avery S, O'Driscoll ML. Randomised Controlled Trials on the Efficacy Of Spinal Manipulation Therapy in The Treatment of Low Back Pain. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331904225006286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cohen SP, Gallagher RM, Davis SA, Griffith SR, Carragee EJ. Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment. Spine J 2012; 12:833-42. [PMID: 22100208 DOI: 10.1016/j.spinee.2011.10.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 09/25/2011] [Accepted: 10/21/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Nonbattle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate. PURPOSE To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation. STUDY DESIGN Literature review. METHODS Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts. RESULTS Spine-area pain is the most common injury or complaint "in garrison" and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates. CONCLUSIONS Spine-area pain syndromes comprise a major source of unit attrition and are often the result of duty-related burdens incurred during combat operations. Current strategies in theaters of operation that may improve the low RTD rates include individual and unit level psychological support, early resumption of at least some forward-area duties, multimodal treatments, and ergonomic modifications.
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Affiliation(s)
- Steven P Cohen
- Pain Management Division, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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Turner-Stokes L, Williams H, Sephton K, Rose H, Harris S, Thu A. Engaging the hearts and minds of clinicians in outcome measurement - the UK Rehabilitation Outcomes Collaborative approach. Disabil Rehabil 2012; 34:1871-9. [PMID: 22506959 PMCID: PMC3477889 DOI: 10.3109/09638288.2012.670033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article explores the rationale for choosing the instruments included within the UK Rehabilitation Outcomes Collaborative (UKROC) data set. Using one specialist neuro-rehabilitation unit as an exemplar service, it describes an approach to engaging the hearts and minds of clinicians in recording the data. KEY MESSAGES AND IMPLICATIONS Measures included within a national data set for rehabilitation should be psychometrically robust and feasible to use in routine clinical practice; they should also support clinical decision-making so that clinicians actually want to use them. Learning from other international casemix models and benchmarking data sets, the UKROC team has developed a cluster of measures to inform the development of effective and cost-efficient rehabilitation services. These include measures of (1) "needs" for rehabilitation (complexity), (2) inputs provided to meet those needs (nursing and therapy intervention), and (3) outcome, including the attainment of personal goals as well as gains in functional independence. CONCLUSIONS By integrating the use of the data set measures in everyday clinical practice, we have achieved a very high rate of compliance with data collection. However, staff training and ongoing commitment from senior staff and managers are critical to the maintenance of effort required to provide assurance of data quality in the longer term.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK.
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Snodgrass J. Effective occupational therapy interventions in the rehabilitation of individuals with work-related low back injuries and illnesses: a systematic review. Am J Occup Ther 2011; 65:37-43. [PMID: 21309370 DOI: 10.5014/ajot.2011.09187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A systematic review of the literature related to effective occupational therapy interventions in rehabilitation of individuals with work-related low back injuries and illnesses was carried out as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review evaluated research on a broad range of occupational therapy-related intervention procedures and approaches. Findings from the review indicate that the evidence is insufficient to support or refute the effectiveness of exercise therapy and other conservative treatments for subacute and chronic low back injuries. The research reviewed strongly suggests that for interventions to be effective, occupational therapy practitioners should use a holistic, client-centered approach. The research supports the need for occupational therapy practitioners to consider multiple strategies for addressing clients' needs. Specifically, interventions for individuals with low back injuries and illnesses should incorporate a biopsychosocial, client-centered approach that includes actively involving the client in the rehabilitation process at the beginning of the intervention process and addressing the client's psychosocial needs in addition to his or her physical impairments. The implications for occupational therapy practice, research, and education are also discussed.
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Affiliation(s)
- Jeff Snodgrass
- Milligan College, P.O. Box 130, Milligan College, TN 37682, USA.
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Medication prescription: a pilot survey of Bernese doctors of chiropractic practicing in Switzerland. J Manipulative Physiol Ther 2010; 33:231-7. [PMID: 20350678 DOI: 10.1016/j.jmpt.2010.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/30/2009] [Accepted: 11/05/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this survey was to assess the use of and the attitude toward prescribing medication among doctors of chiropractic in 1 of 26 Swiss cantons. METHODS A Likert scale electronic questionnaire was sent to licensed doctors of chiropractic of the canton of Berne (n = 47). Percentages, mean values, and standard deviations were calculated. A follow-up survey was used to assess comments from the main survey. A probability value of P < .05 indicated a statistically significant difference. RESULTS The response rate was 77%. Forty-one percent of the respondents stated that medications are a necessary component of the chiropractic treatment. Although 92% actively prescribe medication at least once a week, this is significantly less than asked for by their patients (P < .01). Seventy-two percent of the doctors of chiropractic rated the present privilege to prescribe nonprescription medications as an advantage for chiropractic care. Fifty-eight percent thought that chiropractic should aim at expanding the options of nonsteroidal anti-inflammatory drugs, analgesics, and muscle relaxants that can be prescribed. Ninety-one percent agreed on continuing education in pharmacology. Despite prescribing medication at least once a week, less than half of Bernese doctors of chiropractic perceived medications as a necessary component of their treatment, mainly using them to help patients who cannot sleep because of pain and to speed up recovery. When asked if they would be allowed to prescribe medications of the "B-list," the majority would want structured continuing education. CONCLUSION Limited medication prescription was judged as an advantage for the chiropractic profession by this group of survey participants.
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Keleş G, Topçu I, Ekici Z, Yentür A. Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery. Braz J Med Biol Res 2010; 43:806-11. [DOI: 10.1590/s0100-879x2010007500063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 07/08/2010] [Indexed: 11/21/2022] Open
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Liddle SD, Baxter GD, Gracey JH. Chronic low back pain: Patients' experiences, opinions and expectations for clinical management. Disabil Rehabil 2009; 29:1899-909. [PMID: 17852259 DOI: 10.1080/09638280701189895] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore the experiences, opinions and treatment expectations of chronic low back pain (LBP) patients in order to identify what components of treatment they consider as being of most value. METHOD Three stand-alone focus groups were convened. All participants were experiencing chronic non-specific LBP (>3 months). Each group was facilitated by an independent moderator, and guided by a series of pre-determined questions. Participants were encouraged to freely air their personal opinions during the discussion. Transcribed data were organized into a series of 'categories' using the Qualitative Solutions for Researchers Nudist 6 package from which five common themes emerged. RESULTS Each participant had typically experienced a variety of failed treatment approaches. Whilst the value of advice and exercise was recognized, participants typically questioned the appropriateness of such treatment given the fact that a precise diagnosis was rarely given, and symptoms often recurred. As a result, poor adherence with advice and exercise appeared to be a key factor limiting the potential effectiveness of long-term self-management strategies. CONCLUSIONS Participants considered appropriate exercise (despite pain) and activity modification as important components for effective long-term self-management of symptoms. To enhance treatment effectiveness, participants welcomed the introduction of individually tailored advice and exercise programmes, with supervision and follow-up support, along with a better understanding of the physical and emotional impact of chronic LBP by practitioners.
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Affiliation(s)
- Sarah Dianne Liddle
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Northern Ireland, UK.
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Clark ME, Scholten JD, Walker RL, Gironda RJ. Assessment and Treatment of Pain Associated with Combat-Related Polytrauma. PAIN MEDICINE 2009; 10:456-69. [DOI: 10.1111/j.1526-4637.2009.00589.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lau PMY, Chow DHK, Pope MH. Early physiotherapy intervention in an Accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial. ACTA ACUST UNITED AC 2009; 54:243-9. [PMID: 19025504 DOI: 10.1016/s0004-9514(08)70003-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
QUESTION What is the effect of early physiotherapy intervention on pain and patient satisfaction in acute low back pain? DESIGN Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS 110 patients attending the Accident and Emergency Department of a local acute hospital. INTERVENTION The experimental group received early physiotherapy intervention which consisted of education, reassurance, pain management, mobility training, interferential therapy, walking training, and walking aids as indicated. The control group received only walking training and walking aids as indicated. All participants received conventional medical intervention and outpatient physiotherapy intervention. OUTCOME MEASURES Pain was measured using the Numeric Pain Rating Scale and satisfaction was measured using the Numeric Global Rating of Change Scale at baseline, discharge from the Accident and Emergency Department, admission to the Physiotherapy Outpatient Department, 1 month, 3 months, and 6 months. RESULTS Participants in the experimental group had 1.6 out of 10 points (97.5% CI 0.8 to 2.3) less pain than the control group on discharge from the Accident and Emergency Department and still had 0.9 points (97.5% CI 0.1 to 1.6) less pain on admission to the Physiotherapy Outpatient Department. Participants in the experimental group were 2.1 out of 20 points (97.5% CI 1.2 to 2.9) more satisfied than the control group on discharge from the Accident and Emergency Department. CONCLUSION Early physiotherapy intervention was effective in reducing pain and increasing satisfaction for patients with acute low back pain in an Accident and Emergency Department but the effect tailed off.
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Bellini CM, Galbusera F, Raimondi MT, Mineo GV, Brayda-Bruno M. Biomechanics of the lumbar spine after dynamic stabilization. ACTA ACUST UNITED AC 2007; 20:423-9. [PMID: 17970182 DOI: 10.1097/bsd.0b013e318031af6f] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Target of the study was to predict the biomechanics of the instrumented and adjacent levels due to the insertion of the DIAM spinal stabilization system (Medtronic Ltd). For this purpose, a 3-dimensional finite element model of the intact L3/S1 segment was developed and subjected to different loading conditions (flexion, extension, lateral bending, axial rotation). The model was then instrumented at the L4/L5 level and the same loading conditions were reapplied. Within the assumptions of our model, the simulation results suggested that the implant caused a reduction in range of motion of the instrumented level by 17% in flexion and by 43% in extension, whereas at the adjacent levels, no significant changes were predicted. Numerical results in terms of intradiscal pressure, relative to the intact condition, predicted that the intervertebral disc at the instrumented level was unloaded by 27% in flexion, by 51% in extension, and by 6% in axial rotation, while no variations in pressure were caused by the device in lateral bending. At the adjacent levels, a change of relative intradiscal pressure was predicted in extension, both at the L3/L4 level, which resulted unloaded by 26% and at the L5/S1 level, unloaded by 8%. Furthermore, a reduction in terms of principal compressive stress in the annulus fibrosus of the L4/L5 instrumented level was predicted, as compared with the intact condition. These numerical predictions have to be regarded as a theoretical representation of the behavior of the spine, because any finite element model represents only a simplification of the real structure.
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Mandigo CE, Sampath P, Kaiser MG. Posterior dynamic stabilization of the lumbar spine: pedicle based stabilization with the AccuFlex rod system. Neurosurg Focus 2007; 22:E9. [PMID: 17608343 DOI: 10.3171/foc.2007.22.1.9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Posterior dynamic stabilization in the lumbar spine is performed in an attempt to reduce loading across the intervertebral disc for the purpose of relieving pain and limiting degeneration while preserving motion. The AccuFlex rod system (Globus Medical, Inc.), a first-generation device, achieves this by changing the properties of the rod within the Protex pedicle screw-based rigid rod system. Helical cuts that have been created in the standard 6.5-mm rod allow for a limited range of motion while providing a posterior tension band that relieves a significant amount of disc loading. The AccuFlex rod system has been approved by the Food and Drug Administration for single-level fusion when used in conjunction with an interbody graft. In a study involving 170 patients who underwent fusion surgery for back pain, the 54 who received the AccuFlex construct had statistically similar fusion rates and outcomes (as assessed by visual analog scale and Short Form-16 scores) when compared with 116 patients treated with rigid rod fixation after 1 year of follow up. Future clinical studies will examine and provide information regarding the impact of AccuFlex on the incidence of adjacent-level disease. Information gained through the clinical experience with AccuFlex will serve as a foundation for the development of a stand-alone dynamic construct.
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Affiliation(s)
- Christopher E Mandigo
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Eley C. Magnetic resonance imaging for low back injuries: appropriate use in managing workers' compensation claims. ACTA ACUST UNITED AC 2006; 54:429-33. [PMID: 17059160 DOI: 10.1177/216507990605401002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Workers' compensation claims resulting from low back injuries are a major concern for U.S. employees and employers. Employees seek resolution of their injuries and related symptoms and rapid return to gainful employment. Employers are eager to help them, as they must absorb the health care and disability costs incurred. Health care providers involved with workers' compensation claims are charged with providing appropriate services to meet the needs of both employees and employers. Magnetic resonance imaging has become the gold standard for diagnosing low back injuries. This study provided data necessary for health care providers to design protocols using magnetic resonance imaging in managing workers' compensation claims for low back injuries.
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Pensri P, Foster NE, Srisuk S, Baxter GD, McDonough SM. Physiotherapy management of low back pain in Thailand: a study of practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2006; 10:201-12. [PMID: 16411615 DOI: 10.1002/pri.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP) is one of the most common musculoskeletal disorders in both developed and developing countries. Whilst there have been a number of studies investigating the current physiotherapy management of LBP in the former, little is known about such management in developing countries. The objectives of the present study were to investigate the physiotherapy management of LBP in Thailand and to compare the results with those of developed countries where applicable. METHOD A cross-sectional survey was undertaken to collect information on physiotherapists, LBP patients and treatment interventions used, using a Thai version of an available (English) questionnaire. Subsequent to a pilot study with 32 Thai therapists, minor revisions were made and the final questionnaires were mailed to all 776 physiotherapists currently working throughout Thailand. RESULTS Responses were received from 559 therapists (a 77.2% response rate), and 502 of these were currently involved in LBP management. Results indicated that LBP patients made up, on average, 37.5% of their patient caseloads. Electrophysical modalities, especially hot packs (64%), ultrasound (61%) and mechanical traction (61%), were reported to be the most commonly used treatments, particularly by hospital-based therapists, whereas those working in university-based hospitals and private clinics were more likely to use manual therapy. CONCLUSIONS This study provides descriptive data from the therapists' perspective about LBP management and shows that the treatments most commonly used are different from those treatments commonly used in developed countries. The potential reasons for this are explored in this paper and recommendations are made for further research.
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Affiliation(s)
- Praneet Pensri
- Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Smidt N, de Vet HCW, Bouter LM, Dekker J, Arendzen JH, de Bie RA, Bierma-Zeinstra SMA, Helders PJM, Keus SHJ, Kwakkel G, Lenssen T, Oostendorp RAB, Ostelo RWJG, Reijman M, Terwee CB, Theunissen C, Thomas S, van Baar ME, van 't Hul A, van Peppen RPS, Verhagen A, van der Windt DAWM. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. ACTA ACUST UNITED AC 2005; 51:71-85. [PMID: 15924510 DOI: 10.1016/s0004-9514(05)70036-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy for patients with disorders of the musculoskeletal, nervous, respiratory, and cardiovascular systems. Systematic reviews were identified by means of a comprehensive search strategy in 11 bibliographic databases (08/2002), in combination with reference tracking. Reviews that included (i) at least one randomised controlled trial investigating the effectiveness of exercise therapy, (ii) clinically relevant outcome measures, and (iii) full text written in English, German or Dutch, were selected by two reviewers. Thirteen independent and blinded reviewers participated in the selection, quality assessment and data-extraction of the systematic reviews. Conclusions about the effectiveness of exercise therapy were based on the results presented in reasonable or good quality systematic reviews (quality score > or = 60 out of 100 points). A total of 104 systematic reviews were selected, 45 of which were of reasonable or good quality. Exercise therapy is effective for patients with knee osteoarthritis, sub-acute (6 to 12 weeks) and chronic (> or = 12 weeks) low back pain, cystic fibrosis, chronic obstructive pulmonary disease, and intermittent claudication. Furthermore, there are indications that exercise therapy is effective for patients with ankylosing spondylitis, hip osteoarthritis, Parkinson's disease, and for patients who have suffered a stroke. There is insufficient evidence to support or refute the effectiveness of exercise therapy for patients with neck pain, shoulder pain, repetitive strain injury, rheumatoid arthritis, asthma, and bronchiectasis. Exercise therapy is not effective for patients with acute low back pain. It is concluded that exercise therapy is effective for a wide range of chronic disorders.
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Abstract
STUDY DESIGN A literature review. OBJECTIVE To evaluate the mechanisms of action and effectiveness of posterior dynamic stabilization devices in the management of painful spinal disorders. SUMMARY OF BACKGROUND DATA Dynamic stabilization may provide pain relief by altering the transmission of abnormal loads across the degenerated disc space. METHODS A Medline search was conducted. RESULTS Articles supporting abnormal load transmission across the disc space and clinical reviews of currently available posterior dynamic systems were included. CONCLUSIONS Posterior dynamic stabilization systems may provide benefit comparable to fusion techniques, but without the elimination of movement. Further study is required to determine optimal design and clinical indications.
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Affiliation(s)
- Russ P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA.
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Affiliation(s)
- Anthony B Ward
- North Staffordshire Rehabilitation Centre, Stoke on Trent, UK
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Affiliation(s)
- Michael E Clark
- Chronic Pain Rehabilitation Program, Tampa VA Hospital, Tampa, FL, USA
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Heiss DG, Fitch DS, Fritz JM, Sanchez WJ, Roberts KE, Buford JA. The interrater reliability among physical therapists newly trained in a classification system for acute low back pain. J Orthop Sports Phys Ther 2004; 34:430-9. [PMID: 15373006 DOI: 10.2519/jospt.2004.34.8.430] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A prospective methodological interrater reliability study. OBJECTIVES To calculate the interrater reliability among clinicians newly trained in a classification system for acute low back pain and to determine the level of agreement at key junctures within the classification algorithm. BACKGROUND The utility of a classification system for patients with low back pain depends on its reliability and generalizability. To be practical, clinicians must be able to apply the system after a reasonable amount of training. Identifying key points in the classification algorithm where disagreement occurs can lead to better operational definitions. METHODS Four physical therapists read an article and attended a 1-day training session in the classification system. Randomly paired therapists classified patients referred for treatment of acute low back pain and noted decisions at key junctures in the system algorithm. RESULTS Forty-five patients were classified. Repeated examinations did not increase the patient's pain (P>.05). For 3 out of the 4 therapists, the interrater reliability showed a kappa value of 0.45. The fourth therapist, excluded from the overall analysis, exhibited a bias towards the immobilization classification. Among the 3 therapists, major disagreement occurred with the determination of symmetry with trunk side bending and the effects of repeated movements. CONCLUSIONS Three out of 4 clinicians newly trained in the system showed moderate reliability. The reliability was slight when the fourth therapist was included. Refinement of the operational definitions and criteria for determining lumbar capsular patterns are needed. One day of training is probably not adequate for all therapists, especially for those biased towards specific low back pain syndromes.
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Affiliation(s)
- Deborah Givens Heiss
- Physical Therapy Division, School of Allied Medical Professions, College of Medicine and Public Health, Ohio State University, Columbus, OH, USA.
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