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Selb M, Nicol R, Hartvigsen J, Segerer W, Côté P. An ICF-based assessment schedule to facilitate the assessment and reporting of functioning in manual medicine - low back pain as a case in point. Disabil Rehabil 2022; 44:8339-8348. [PMID: 34919452 DOI: 10.1080/09638288.2021.2012842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This paper outlines the first steps toward developing the ICF-based assessment schedule for manual medicine with a focus on low back pain (LBP). It reports on the results of a consensus process to develop the default and optional versions of the set of ICF categories (ManMed Set) the assessment schedule should cover, and gives insight in expert input toward building a toolbox of instruments for assessing the ManMed Set categories. METHODS A scoping review and qualitative study were conducted, each resulting in a list of ICF categories. These categories, along with the categories of the ICF Generic-30 Set, Comprehensive ICF Core Set for LBP, and from an existing Delphi study, served as the starting point for an established consensus process to decide on the ManMed Set. RESULTS After alternating plenary and working group sessions, an iterative ranking process and cut-off calculation, the multi-professional and international group of 20 experts in manual medicine included 23 categories in the default ManMed version (16 + the ICF Generic-7 Set categories) and 25 in the optional version. CONCLUSIONS Their development is a major step toward developing an assessment schedule that can be employed in standardizing the assessment and reporting of functioning in manual medicine, initially of LBP patients.Implications for rehabilitationThe ICF assessment schedule for manual medicine has potential use in supporting rehabilitation practice, such as for planning interventions, defining rehabilitation goals, and measuring and documenting functioning outcomes.It can be used to promote interdisciplinary coordination of care and facilitate communication between members of a multidisciplinary rehabilitation team within manual medicine and beyond.The ICF assessment schedule for manual medicine can facilitate rehabilitation and manual medicine research by providing evidence for optimizing rehabilitation practice.
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Affiliation(s)
- Melissa Selb
- ICF Research Branch, Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | | | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and CMCC, Oshawa, Ontario, Canada
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Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep 2022; 71:1-95. [PMID: 36327391 PMCID: PMC9639433 DOI: 10.15585/mmwr.rr7103a1] [Citation(s) in RCA: 457] [Impact Index Per Article: 228.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.
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Ebenbichler G, Bochdansky T, Ammer K, Lechner A. Commentary on an article entitled "an ICF-based assessment schedule to facilitate the assessment and reporting of functioning in manual medicine - low back pain as a case in point" by Selb M, Nicol R, Hartvigsen J, Segerer W, Côté P; ICF manual medicine expert group. Published in Disabil Rehabil. 2021 Dec 17:1-10. Disabil Rehabil 2022:1-3. [PMID: 35993420 DOI: 10.1080/09638288.2022.2112983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gerold Ebenbichler
- Department of Physical Medicine, Rehabilitation & Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Kurt Ammer
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, UK
| | - Alexander Lechner
- Österreichische Ärztegesellschaft für Manuelle Medizin, Vienna, Austria
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Park SY, Hwang EH, Cho JH, Kim KW, Ha IH, Kim MR, Nam K, Lee MH, Lee JH, Kim N, Shin BC. Comparative Effectiveness of Chuna Manipulative Therapy for Non-Acute Lower Back Pain: A Multi-Center, Pragmatic, Randomized Controlled Trial. J Clin Med 2020; 9:E144. [PMID: 31948083 PMCID: PMC7019562 DOI: 10.3390/jcm9010144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022] Open
Abstract
Current evidence on the effectiveness and safety of Chuna manipulative therapy (CMT) for managing non-acute lower back pain (LBP) is insufficient. We investigated the comparative effectiveness and safety of CMT, a Korean style of manipulation, plus usual care (UC) compared to UC alone for non-acute LBP. We conducted a parallel, two-armed, multi-centered, assessor blinded, pragmatic, randomized controlled trial at four major Korean medical hospitals. Overall, 194 patients were randomly allocated to either CMT plus UC (n = 97) or UC alone (n = 97), for six weeks of treatment and six months follow-up. The primary outcome was measured using the numerical rating scale (NRS) of LBP intensity at 7 weeks. Secondary outcomes included NRS of leg pain, Oswestry Disability Index (ODI) for functional disability, patient global impression of change (PGIC) scale, and safety. A total of 194 patients were included in the intention-to-treat analysis, and 174 patients provided complete data for the primary outcome. At 7 weeks, clinically significant differences between groups were observed in the NRS of LBP (CMT + UC: -3.02 ± 1.72, UC: -1.36 ± 1.75, p < 0.001), ODI scores (CMT + UC: -5.65 ± 4.29, UC: -3.72 ± 4.63, p = 0.003), NRS of leg pain (CMT + UC: -2.00 ± 2.33, UC: -0.44 ± 1.86, p < 0.0001), and PGIC (CMT + UC: -0.28 ± 0.85, UC: 0.01 ± 0.66, p = 0.0119). Mild to moderate safety concerns were reported in 21 subjects. CMT plus UC showed higher effectiveness compared to UC alone in patients with non-acute LBP in reducing LBP and leg pain and in improving function with good safety results using a powered sample size and including mid-term follow-up.
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Affiliation(s)
- Sun-Young Park
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Department of Korean Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - Eui-Hyoung Hwang
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Korea; (J.-H.C.); (K.-W.K.)
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Korea; (J.-H.C.); (K.-W.K.)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Korea;
| | - Me-riong Kim
- Jaseng Hospital of Korean Medicine, Seoul 06110, Korea;
| | - Kibong Nam
- Mokhuri Neck & Back Hospital, Seoul 06272, Korea; (K.N.); (M.h.L.)
| | - Min ho Lee
- Mokhuri Neck & Back Hospital, Seoul 06272, Korea; (K.N.); (M.h.L.)
| | - Jun-Hwan Lee
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon 34054, Korea;
| | - Namkwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan 50612, Korea;
| | - Byung-Cheul Shin
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
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Lim KT, Hwang EH, Cho JH, Jung JY, Kim KW, Ha IH, Kim MR, Nam K, Lee A MH, Lee JH, Kim N, Shin BC. Comparative effectiveness of Chuna manual therapy versus conventional usual care for non-acute low back pain: a pilot randomized controlled trial. Trials 2019; 20:216. [PMID: 30987662 PMCID: PMC6466698 DOI: 10.1186/s13063-019-3302-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain (LBP) is common, with a lifetime prevalence of 80%, and as such it places substantial social and economic burden on individuals and society. Chuna manual therapy (CMT) combines aspects of physiology, biodynamics of spine and joint motion, and basic theory of movement dynamics. This study aimed to test the comparative effectiveness and safety of CMT for non-acute LBP. Methods A three-arm, multicenter, pragmatic, randomized controlled pilot trial was conducted from 28 March 2016 to 19 September 2016, at four medical institutions. A total of 60 patients were randomly allocated to the CMT group (n = 20), usual care (UC) group (n = 20), or combined treatment (CMT + UC) group (n = 20), and received the relevant treatments for 6 weeks. The primary outcome was a numeric rating scale (NRS) representation of LBP intensity, while secondary outcomes included NRS of leg pain, Oswestry disability index (ODI), Patient Global Impression of Change (PGIC), the EuroQol-5 dimensions (EQ-5D), lumbar range of motion, and safety. Results A total of 60 patients were included in the intention-to-treat analysis and 55 patients (CMT, 18; UC, 18; CMT + UC, 19) were included in the per-protocol analysis (drop-out rate 5.3%). Over the treatment period there were significant differences in the NRS score for LBP (CMT mean − 3.28 (95% CI − 4.08, − 2.47); UC − 1.95 (− 2.82, − 1.08); CMT + UC − 1.75 (− 2.70, − 0.80), P < 0.01) and the ODI scores in each group (CMT − 12.29 (− 16.86, − 7.72); UC − 10.34 (− 14.63, − 6.06); CMT + UC − 9.27 (− 14.28, − 4.26), P < 0.01). The changes in other secondary outcomes did not significantly differ among the three groups. Sixteen minor-to-moderate safety concerns were reported. Conclusions Our results suggest that CMT has comparative efficacy for non-acute LBP and is generally safe. As this was a preliminary study, a well-powered (over 192 participants) two-arm (CMT versus UC) verification trial will be performed to assess the generalizability of these results. Trial registration Clinical Research Information Service (CRIS), KCT0001850. Registered on 12 March 2016.
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Affiliation(s)
- Kyeong-Tae Lim
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea.,Department of Korean Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Eui-Hyoung Hwang
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea.,3rd Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jae-Heung Cho
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Jae-Young Jung
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Koh-Woon Kim
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06017, Republic of Korea
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06017, Republic of Korea
| | - Kibong Nam
- Mokhuri Neck & Back Hospital, Repulic of, Seoul, 06272, South Korea
| | - Min Ho Lee A
- Mokhuri Neck & Back Hospital, Repulic of, Seoul, 06272, South Korea
| | - Jun-Hwan Lee
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Namkwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Byung-Cheul Shin
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea. .,3rd Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
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Downie A, Hancock M, Jenkins H, Buchbinder R, Harris I, Underwood M, Goergen S, Maher CG. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med 2019; 54:642-651. [DOI: 10.1136/bjsports-2018-100087] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
ObjectivesTo (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.Data sourcesElectronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.Eligibility criteria for selecting studiesObservational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.Results45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.Summary/conclusionOne in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.Trial registration numberCRD42016041987.
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