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Browne S, Schofield P, Ryan CG. The experiences of physiotherapists delivering pain science education via an interpreter: a mixed-methods online survey. Physiother Theory Pract 2024:1-10. [PMID: 39267266 DOI: 10.1080/09593985.2024.2396553] [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: 03/22/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To explore physiotherapist's experiences of delivering Pain Science Education (PSE) via an interpreter to people with persistent pain. METHOD A cross-sectional online survey study of UK Physiotherapists. The study protocol was registered on the Open Science Framework Registry. Seventy-seven physiotherapists with experience of delivering PSE via an interpreter completed the survey between January 16, 2023 and May 24, 2023. Feelings of stress and confidence the messages of PSE had been understood when delivering PSE with and without an interpreter were assessed on an 11-point Likert scale. In addition, drop-down, multi-selection lists were presented with barriers and facilitators to delivering PSE via an interpreter. Thematic analysis was undertaken of open text fields which allowed participants to elaborate on their responses. RESULTS Physiotherapists were less confident the information had been understood -2.3 (-2.8 to -1.8) mean difference (95% Confidence Interval) and more stressed 2.3 (1.7 to 2.9) when delivering PSE via an interpreter compared to doing so without an interpreter (p < .001). From the open-text data, the overarching theme was Trust in the Interpretation with three sub-themes: 1) Family vs Professional Interpreter, 2) Therapist and Interpreter Relationship, and 3) Strong Preference for Face-Face Interpretation. CONCLUSIONS UK Physiotherapists are less confident that patients understand the messages of PSE when delivered via an interpreter and they find it significantly more stressful than delivering PSE in English. Almost all participants encountered barriers to delivering PSE via an interpreter. Future research needs to explore the experience of patients and interpreters within this clinical context.
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Affiliation(s)
- Samuel Browne
- National Institute of Health and Social Care Research Pre-Doctoral Clinical Academic Fellow and Advanced Practitioner Physiotherapist at the Tyneside Integrated Musculoskeletal Service, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Pain Education Team to Advance Learning (PETAL) Collaboration
| | - Patricia Schofield
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Cormac G Ryan
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Pain Education Team to Advance Learning (PETAL) Collaboration
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Campbell I, Fary R, Hopper L, Hendry D. An Exploration of Low Back Beliefs of Male Pre-Professional and Professional Dancers. J Dance Med Sci 2024; 28:152-162. [PMID: 38476056 DOI: 10.1177/1089313x241237846] [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] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers' beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers' beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered. METHODS 40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were recruited to complete a cross-sectional survey comprising a beliefs questionnaire considering dance-specific movement and lifting tasks, the Back Pain Attitudes Questionnaire (Back-PAQ) and the Athletic Fear Avoidance Questionnaire (AFAQ). Primary analysis included initial descriptives, a repeated measures ANOVA for movement-specific beliefs and visual thematic analysis for written responses within the belief's questionnaire. Secondary subgroup analysis included independent T-tests for those with/without current LBP and those with/without a history of DLBP. RESULTS Fourteen dancers reported current LBP and 30 reported a history of DLBP. Dancers held generally negative beliefs toward the low back (Back-PAQ mean 123.1 ± 9.7) with neither subgroup demonstrating significant between-group difference (P < .05). Dance-specific flexion movements were seen as safer than extension movements (P < .05), and more extended-spine lifting was seen as safer than more flexed-spine lifting (P < .05). Dancers experiencing current LBP held less positive beliefs surrounding some dance-specific movements. CONCLUSIONS Dancers hold negative general beliefs toward the low back irrespective of current or historical DLBP, however their beliefs surrounding dance-specific movements were relatively positive. Dancers' beliefs surrounding some movements were affected by the presence of current LBP, in particular an arabesque and a fish dive.
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Affiliation(s)
| | - Robyn Fary
- Curtin University, Perth, WA, Australia
- The enAble Institute, Curtin University, Perth, WA, Australia
| | - Luke Hopper
- Edith Cowan University, Mount Lawley, WA, Australia
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Scott KM, Kreisel BR, Florkiewicz EM, Crowell MS, Morris JB, McHenry PA, Benedict TM. The Effect of Cautionary Versus Resiliency Spine Education on Maximum Deadlift Performance and Back Beliefs: A Randomized Control Trial. J Strength Cond Res 2024; 38:e341-e348. [PMID: 38900182 DOI: 10.1519/jsc.0000000000004783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT Scott, KM, Kreisel, BR, Florkiewicz, EM, Crowell, MS, Morris, JB, McHenry, PA, and Benedict, TM. The effect of cautionary versus resiliency spine education on maximum deadlift performance and back beliefs: A randomized control trial. J Strength Cond Res 38(7): e341-e348, 2024-The purpose of this study was to determine the effect of cautionary information about the spine vs. a message of spine resiliency on maximum deadlift (MDL) performance and beliefs regarding the vulnerability of the spine. This cluster randomized control trial involved 903 military new cadets (n = 903) during their mandatory fitness test in cadet basic training (mean age 18.3 years, body mass index 23.8 kg·m-2, 22% female). Subjects were cluster randomized to 3 groups. The cautionary group received a message warning them to protect their backs while deadlifting, the resiliency group received a message encouraging confidence while deadlifting, and the control group received the standardized Army deadlift education only. The outcome measures were MDL weight lifted and perceived spine vulnerability. Significance was set at alpha ≤0.05. There were no between-group differences in weight lifted (p=0.40). Most subjects believed that the spine is vulnerable to injury. Three times as many subjects who received the resiliency education improved their beliefs about the vulnerability of their spines compared with those receiving the cautionary education (p<0.001). This study demonstrated the potential for brief resiliency education to positively influence beliefs about spine vulnerability, whereas cautionary education did not impair performance.
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Affiliation(s)
- Kelly M Scott
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Brian R Kreisel
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Erin M Florkiewicz
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
- Doctor of Philosophy in Health Sciences Program, Rocky Mountain University of Health Professions, Provo, Utah
| | - Michael S Crowell
- Department of Physical Therapy, University of Scranton, Scranton, Pennsylvania
| | - Jamie B Morris
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Paige A McHenry
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
| | - Timothy M Benedict
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York
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Larson DJ, Brown SHM. Effects of trunk extensor muscle fatigue on repetitive lift (re)training using an augmented tactile feedback approach. ERGONOMICS 2023; 66:1919-1934. [PMID: 36636970 DOI: 10.1080/00140139.2023.2168769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
Augmented tactile and performance feedback has been used to (re)train a modified lifting technique to reduce lumbar spine flexion, which has been associated with low back disorder development during occupational repetitive lifting tasks. However, it remains unknown if the presence of trunk extensor neuromuscular fatigue influences learning of this modified lifting technique. Therefore, we compared the effectiveness of using augmented tactile and performance feedback to reduce lumbar spine flexion during a repetitive lifting task, in both unfatigued and fatigued states. Participants completed repetitive lifting tests immediately before and after training, and 1-week later, with half of the participants completing training after fatiguing their trunk extensor muscles. Both groups demonstrated learning of the modified lifting technique as demonstrated by increased thorax-pelvis coordination variability and reduced lumbar range of motion variability; however, experiencing trunk extensor neuromuscular fatigue during lift (re)training may have slight negative influences on learning the modified lifting technique. Practitioner summary: An augmented lift (re)training paradigm using tactile cueing and performance feedback regarding key movement features (i.e. lumbar spine flexion) can effectively (re)train a modified lifting technique to reduce lumbar flexion and redistribute motion to the hips and knees. However, performing (re)training while fatigued could slightly hinder learning this lifting technique.
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Affiliation(s)
- Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
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Saraceni N, Campbell A, Kent P, Ng L, Straker L, O’Sullivan P. An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1903. [PMID: 36767270 PMCID: PMC9914774 DOI: 10.3390/ijerph20031903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.
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Affiliation(s)
- Nic Saraceni
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Campusvej 55, 5230 Odense, Denmark
| | - Leo Ng
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
| | - Peter O’Sullivan
- Curtin School of Allied Health, Curtin University, Bentley 6845, Western Australia, Australia
- Body Logic Physiotherapy, Shenton Park 6008, Western Australia, Australia
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Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. An Investigation of the Nature of Fear within ACL-Injured Subjects When Exposed to Provocative Videos: A Concurrent Qualitative and Quantitative Study. Sports (Basel) 2022; 10:sports10110183. [PMID: 36422952 PMCID: PMC9692454 DOI: 10.3390/sports10110183] [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: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Fear is a factor contributing to poor return to sport after an anterior cruciate (ACL) injury, however the identification and assessment of fear is challenging. To improve understanding of fear, this study qualitatively and quantitatively assessed responses to videos depicting threat to knee stability in people who had experienced an ACL injury. ACL-injured participants who had above average fear on the Tampa Scale of Kinesiophobia and were at least 1-year post-injury/surgery were eligible. Participants were shown four videos depicting sequentially increasing threat to their knee stability (running, cut-and-pivot, feigned knee injury during cut-and-pivot, series of traumatic knee injuries). Qualitative interviews explored participants feeling related to viewing the videos. Participants quantitatively self-rated fear and distress in response to each video. Seventeen participants were included in this study (71% female, with an average time since last ACL injury of 5 ½ years). Five themes were identified: (1) Evoked physiological responses, (2) Deeper contextualisation of the meaning of an ACL injury influencing bodily confidence, (3) Recall of psychological difficulties, (4) Negative implications of a re-injury, and (5) Change to athletic identity. Quantitatively, direct proportionality was noticed between threat level and reported fear and distress. Specifically, participants reported increasing levels of fear and distress as the videos progressed in threat level, with the largest increase seen between a cut-and-pivot movement to a feigned injury during a cut and pivot. The results support the notion that in addition to being a physical injury, an ACL injury has more complex neurophysiological, psychological, and social characteristics which should be considered in management. Using video exposure in the clinic may assist identification of underlying psychological barriers to recovery following an ACL injury, facilitating person-centred care.
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Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Correspondence:
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health & Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
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Liew BXW, Syrett J, Freeman P, Evans DW. Pain-related fear of movement dynamics in individuals with and without low back pain participating in weightlifting and/or powerlifting training. PLoS One 2022; 17:e0276983. [PMID: 36302048 PMCID: PMC9612576 DOI: 10.1371/journal.pone.0276983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Pain-free adults in the general population have been shown to possess unhelpful beliefs that certain movements and postures are harmful to the spine, potentially reinforcing fear-avoidance behaviour. Whether such beliefs occur in individuals undertaking regular powerlifting (PL) and Olympic weightlifting (OWL) training is unclear. METHODS In a cross-sectional study design, 67 individuals who participate in OWL and PL training completed an online survey. Demographic characteristics, training history, and self-reported perceptions of harm, on the 40-item Photograph Series of Daily Activities shortened electronic version (PHODA-SeV), were collected. After removing collinear variables, 13 items were entered into a network analysis, in which the adjusted correlations between items, and the centrality indices of each item (i.e., the degree of connection with other symptoms in the network) were quantified. RESULTS Twenty-one (31.3%) participants had LBP symptoms. The pairwise correlations with the greatest magnitudes were between images of 'leg stretch' and 'jumping' (0.32 [95%CI 0.08 to 0.45]) and two images depicting ironing (0.32 [95%CI 0.05 to 0.54]) respectively. The three most Central (connected) items were 'stair ascend', 'walking with groceries', and 'mopping with spine flexion'. CONCLUSIONS For individuals training in OWL and PL, images reflecting walking, rather than those depicting high spinal flexion angle, had greater connectivity to other activity items. In addition, the strongest correlations were not between items reflecting high spinal flexion angle. Future studies that investigate the relationship between different intensities of OWL and PL training and the dynamics of pain-related fear are warranted.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Josce Syrett
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Paul Freeman
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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de Oliveira EL, Coutinho PFF, Braga UM, Barsante LD. Hipervigilância postural e percepção da postura correta sentada em indivíduos com e sem dor lombar. Rev Bras Ortop 2022; 57:947-952. [DOI: 10.1055/s-0042-1756154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/14/2022] [Indexed: 11/06/2022] Open
Abstract
Resumo
Objetivos Verificar se há diferença na hipervigilância postural sentada em indivíduos com e sem dor lombar. Além disso, observar se há diferença na percepção da postura correta sentada entre indivíduos com dor lombar e sem dor lombar.
Métodos O presente estudo possui delineamento observacional transversal, como tamanho amostral de 92 indivíduos, posteriormente divididos igualmente em dois grupos (com dor lombar e sem dor lombar). Foram utilizados dois instrumentos: a escala de hipervigilância para analisar a frequência que voluntários corrigem a postura sentada no dia; e o quadro de posturas para investigar a percepção dos voluntários sobre a postura correta sentada. Os dados foram submetidos ao teste de Normalidade de Shapiro-Wilk. Para comparar os valores da Escala de Hipervigilância foi utilizado o teste de Mann-Whitney e o teste Qui-quadrado e exato de Fisher para avaliação da postura correta sentada.
Resultados Não houve diferença significativa entre a hipervigilância postural sentada entre indivíduos com dor lombar e sem dor lombar. Não houve diferença significativa entre a escolha da postura correta sentada entre o grupo de indivíduos com e sem dor lombar.
Conclusão Não há diferença entre a escolha da postura correta sentada e quantidade de hipervigilância postural em indivíduos com ou sem dor lombar.
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Affiliation(s)
- Eduardo Lima de Oliveira
- Departamento de Fisioterapia, Faculdade Ciências Médicas de Minas Gerais (FCM-MG), Belo Horizonte, Minas Gerais, Brasil
| | | | - Uiara Martins Braga
- Faculdade Ciências Médicas de Minas Gerais (FCM-MG), Belo Horizonte, Minas Gerais, Brasil
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Ray BM, Kovaleski A, Kelleran KJ, Stilwell P, Baraki A, Coninx S, Eubanks JE. An exploration of low back pain beliefs in a Northern America based general population. Musculoskelet Sci Pract 2022; 61:102591. [PMID: 35777261 DOI: 10.1016/j.msksp.2022.102591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prior research has demonstrated that people across different populations hold beliefs about low back pain (LBP) that are inconsistent with current evidence. Qualitative research is needed to explore current LBP beliefs in Northern America (NA). OBJECTIVES We conducted a primarily qualitative cross-sectional online survey to assess LBP beliefs in a NA population (USA and Canada). METHODS Participants were recruited online using social media advertisements targeting individuals in NA over the age of 18 with English speaking and reading comprehension. Participants answered questions regarding the cause of LBP, reasons for reoccurrence or persistence of LBP, and sources of these beliefs. Responses were analyzed using conventional (inductive) content analysis. RESULTS/FINDINGS 62 participants were included with a mean age of 47.6 years. Most participants reported multiple causes for LBP as well as its persistence and reoccurrence, however, these were biomedically focused with minimal to no regard for psychological or environmental influences. The primary cited source of participants' beliefs was healthcare professionals. CONCLUSIONS Our findings align with prior research from other regions, demonstrating a need for updating clinical education and public messaging about the biopsychosocial nature of LBP.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, VA, USA.
| | | | - Kyle J Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY, USA
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, USA
| | - Austin Baraki
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, DE, Germany
| | - James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Saraceni N, Campbell A, Kent P, Ng L, Straker L, O'Sullivan P. Does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A cross-sectional laboratory study. ERGONOMICS 2022; 65:1380-1396. [PMID: 35098885 DOI: 10.1080/00140139.2022.2036819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Advice to limit or avoid a flexed lumbar curvature during lifting is widely promoted to reduce the risk of low back pain (LBP), yet there is very limited evidence to support this relationship. To provide higher quality evidence this study compared intra-lumbar flexion in manual workers with (n = 21) and without a history of LBP (n = 21) during a repeated lifting task. In contrast to common expectations, the LBP group demonstrated less peak absolute intra-lumbar flexion during lifting than the noLBP group [adjusted difference -3.7° (95%CI -6.9 to -0.6)]. The LBP group was also further from the end of range intra-lumbar flexion and did not use more intra-lumbar range of motion during any lift condition (both symmetrical and asymmetrical lifts and different box loads). Peak absolute intra-lumbar flexion was more variable in the LBP group during lifting and both groups increased their peak absolute intra-lumbar flexion over the lift repetitions. This high-quality capture of intra-lumbar spine flexion during repeated lifting in a clinically relevant cohort questions dominant safe lifting advice.Practitioner summary: Lifting remains a common trigger for low back pain (LBP). This study demonstrated that people with LBP, lift with less intra-lumbar flexion than those without LBP. Providing the best quality in-vivo laboratory evidence, that greater intra-lumbar flexion is not associated with LBP in manual workers, raising questions about lifting advice.
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Affiliation(s)
- Nic Saraceni
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Leo Ng
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
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Tagliaferri SD, Wilkin T, Angelova M, Fitzgibbon BM, Owen PJ, Miller CT, Belavy DL. Chronic back pain sub-grouped via psychosocial, brain and physical factors using machine learning. Sci Rep 2022; 12:15194. [PMID: 36071092 PMCID: PMC9452567 DOI: 10.1038/s41598-022-19542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic back pain (CBP) is heterogenous and identifying sub-groups could improve clinical decision making. Machine learning can build upon prior sub-grouping approaches by using a data-driven approach to overcome clinician subjectivity, however, only binary classification of pain versus no-pain has been attempted to date. In our cross-sectional study, age- and sex-matched participants with CBP (n = 4156) and pain-free controls (n = 14,927) from the UkBioBank were included. We included variables of body mass index, depression, loneliness/social isolation, grip strength, brain grey matter volumes and functional connectivity. We used fuzzy c-means clustering to derive CBP sub-groups and Support Vector Machine (SVM), Naïve Bayes, k-Nearest Neighbour (kNN) and Random Forest classifiers to determine classification accuracy. We showed that two variables (loneliness/social isolation and depression) and five clusters were optimal for creating sub-groups of CBP individuals. Classification accuracy was greater than 95% for when CBP sub-groups were assessed only, while misclassification in CBP sub-groups increased to 35-53% across classifiers when pain-free controls were added. We showed that individuals with CBP could sub-grouped and accurately classified. Future research should optimise variables by including specific spinal, psychosocial and nervous system measures associated with CBP to create more robust sub-groups that are discernible from pain-free controls.
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Affiliation(s)
- Scott D Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia.
| | - Tim Wilkin
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Maia Angelova
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Bernadette M Fitzgibbon
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monarch Research Group, Monarch Mental Health Group, Sydney, NSW, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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12
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Liechti M, von Arx M, Eichelberger P, Bangerter C, Meier ML, Schmid S. Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task. J Electromyogr Kinesiol 2022; 65:102678. [DOI: 10.1016/j.jelekin.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
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13
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Krug RC, Silva MF, Lipp OV, O'Sullivan PB, Almeida R, Peroni IS, Caneiro JP. An investigation of implicit bias about bending and lifting. Scand J Pain 2022; 22:336-347. [PMID: 34821139 DOI: 10.1515/sjpain-2021-0145] [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: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups. METHODS Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire). RESULTS Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups. CONCLUSIONS In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.
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Affiliation(s)
- Roberto Costa Krug
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Marcelo Faria Silva
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy, Shenton Park, Perth, Australia
| | - Rosicler Almeida
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ian Sulzbacher Peroni
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - J P Caneiro
- School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy, Shenton Park, Perth, Australia
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14
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Caneiro JP, Smith A, Bunzli S, Linton S, Moseley GL, O'Sullivan P. From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. Phys Ther 2022; 102:6480889. [PMID: 34971393 DOI: 10.1093/ptj/pzab271] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
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Affiliation(s)
- J P Caneiro
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
| | - Anne Smith
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Samantha Bunzli
- University of Melbourne Department Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Steven Linton
- Örebro University, Center for Health and Medical Psychology (CHAMP), Örebro, Sweden
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Peter O'Sullivan
- Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.,Body Logic Physiotherapy Perth, Western Australia, Australia
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15
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Chan VCH, Welsh TN, Tremblay L, Frost DM, Beach TAC. A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks. APPLIED ERGONOMICS 2022; 99:103612. [PMID: 34743974 DOI: 10.1016/j.apergo.2021.103612] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.
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Affiliation(s)
- Victor C H Chan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Timothy N Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - David M Frost
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Tyson A C Beach
- Centre for Motor Control, University of Toronto, Toronto, ON, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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16
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Ippersiel P, Teoli A, Wideman TH, Preuss RA, Robbins SM. The Relationship Between Pain-Related Threat and Motor Behavior in Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6478879. [PMID: 34939120 DOI: 10.1093/ptj/pzab274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although pain-related fear and catastrophizing are predictors of disability in low back pain (LBP), their relationship with guarded motor behavior is unclear. The aim of this meta-analysis was to determine the relationship between pain-related threat (via pain-related fear and catastrophizing) and motor behavior during functional tasks in adults with LBP. METHODS This review followed PRISMA guidelines. MEDLINE, Embase, PsychINFO, and CINAHL databases were searched to April 2021. Included studies measured the association between pain-related fear or pain catastrophizing and motor behavior (spinal range of motion, trunk coordination and variability, muscle activity) during movement in adults with nonspecific LBP. Studies were excluded if participants were postsurgery or diagnosed with specific LBP. Two independent reviewers extracted all data. The Newcastle-Ottawa Scale was used to assess for risk of bias. Correlation coefficients were pooled using the random-effects model. RESULTS Reduced spinal range of motion during flexion tasks was weakly related to pain-related fear (15 studies, r = -0.21, 95% CI = -0.31 to -0.11) and pain catastrophizing (7 studies, r = -0.24, 95% CI = -0.38 to -0.087). Pain-related fear was unrelated to spinal extension (3 studies, r = -0.16, 95% CI = -0.33 to 0.026). Greater trunk extensor muscle activity during bending was moderately related to pain-related fear (2 studies, r = -0.40, 95% CI = -0.55 to -0.23). Pain catastrophizing, but not fear, was related to higher trunk activity during gait (2 studies, r = 0.25, 95% CI = 0.063 to 0.42). Methodological differences and missing data limited robust syntheses of studies examining muscle activity, so these findings should be interpreted carefully. CONCLUSION This study found a weak to moderate relationship between pain-related threat and guarded motor behavior during flexion-based tasks, but not consistently during other movements. IMPACT These findings provide a jumping-off point for future clinical research to explore the advantages of integrated treatment strategies that target both psychological and motor behavior processes compared with traditional approaches.
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Affiliation(s)
- Patrick Ippersiel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Richard A Preuss
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - Shawn M Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
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17
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Rialet-Micoulau J, Lucas V, Demoulin C, Pitance L. Misconceptions of physical therapists and medical doctors regarding the impact of lifting a light load on low back pain. Braz J Phys Ther 2022; 26:100385. [PMID: 35063698 PMCID: PMC8784290 DOI: 10.1016/j.bjpt.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND A common misconception about low back pain (LBP) is that the spine is weak and that lumbar flexion should be avoided. Because the beliefs of health-care professionals (HCPs) influence patients, it is important to understand the attitudes of health care professionals towards LBP and lifting. OBJECTIVES To assess and compare the perceptions of different categories of HCPs regarding the safety of specific movement strategies used to lift a light load, and their beliefs regarding back pain. The secondary aim was to determine whether certain factors influenced the beliefs of HCPs. METHODS Data were collected via an electronic survey. Student and qualified physical therapists (PTs), medical students, and general practitioner (GP) trainees were included. The questionnaire included eight photographs, depicting eight different strategies to lift a light load. Respondents were requested to select the strategy(s) they considered as "unsafe" to use for asymptomatic people with a previous history of LBP and people with chronic LBP. Beliefs and attitudes towards LBP were evaluated using the Back Pain Attitudes Questionnaire (Back-PAQ). RESULTS Questionnaires from 1005 participants were included. Seventy percent of qualified PTs considered none of the strategies as harmful (versus 32% of PT students, 9% of GP trainees and 1% of medical students). Qualified PTs had higher Back-PAQ scores (mean ± SD: 13.6 ± 5.5) than PT students (8.7 ± 5.7), GP trainees (5.9 ± 5.9) and medical students (4.1 ± 5.2), indicating less misconceptions regarding LBP. Having LBP negatively influenced beliefs while taking a pain education course positively influenced beliefs. CONCLUSION Misconceptions regarding LBP and the harmfulness of lifting a light load with a rounded back remain common among HCPs, particularly medical doctors.
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Affiliation(s)
- Joséphine Rialet-Micoulau
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium
| | - Valoris Lucas
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Demoulin
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium; Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Laurent Pitance
- Clinical Research Institute, Neuro-musculo-skeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium; Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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18
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Themelis K, Ratcliffe N, Nishigami T, Wand BM, Newport R, Stanton TR. The effect of visually manipulating back size and morphology on back perception, body ownership, and attitudes towards self-capacity during a lifting task. PSYCHOLOGICAL RESEARCH 2021; 86:1816-1829. [PMID: 34727227 PMCID: PMC9363286 DOI: 10.1007/s00426-021-01609-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Abstract
Body re-sizing illusions can profoundly alter perception of our own body. We investigated whether creating the illusion of a muscled and fit-looking back (Strong) influenced perceived back size, body ownership, and attitudes towards self-capacity during a lifting task. Twenty-four healthy male volunteers performed a standardised lifting task while viewing real-time (delay < 20 ms) video of their own back through a head-mounted display under four different conditions (Normal size, Strong, Reshaped, Large; order randomised). The MIRAGE-mediated reality system was used to modify the shape, size, and morphology of the back. Participants were poor at recognizing the correct appearance of their back, for both implicit (perceived width of shoulders and hips) and explicit (questionnaire) measures of back size. Visual distortions of body shape (Reshaped condition) altered implicit back size measures. However, viewing a muscled back (Strong condition) did not result in a sense of agency or ownership and did not update implicit perception of the back. No conditions improved perceptions/attitudes of self-capacity (perceived back strength, perceived lifting confidence, and perceived back fitness). The results lend support for the importance of the embodiment of bodily changes to induce changes in perception. Further work is warranted to determine whether increased exposure to illusory changes would alter perceptions and attitudes towards self-capacity or whether different mechanisms are involved.
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Affiliation(s)
- Kristy Themelis
- School of Psychology, University of Nottingham, Nottingham, UK. .,Department of Psychology, University of Warwick, Coventry, UK.
| | | | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Benedict M Wand
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Roger Newport
- School of Psychology, University of Nottingham, Nottingham, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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19
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Kamachi M, Owlia M, Dutta T. Evaluating a wearable biofeedback device for reducing end-range sagittal lumbar spine flexion among home caregivers. APPLIED ERGONOMICS 2021; 97:103547. [PMID: 34365286 DOI: 10.1016/j.apergo.2021.103547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/12/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
Caregivers who work in the home environment are at risk of back injury due to the awkward postures they have to adopt while providing care. Real-time biofeedback provided by a recently developed wearable device (PostureCoach) may be able to reduce this risk. The effectiveness of a two-day training intervention (including PostureCoach and an educational video) was evaluated for its ability to decrease the amount of time spent in end-range spine flexion. Twenty novice caregivers repeated a series of simulated care tasks. Real-time auditory biofeedback was provided to the intervention group (n = 10) when participants' sagittal lumbar spine flexion exceeded a preset threshold during training trials. Participants in the control group (n = 10) received no feedback. Participants repeated the tasks again two weeks and two months post-intervention. The intervention group maintained decreased end-range (80th and 95th percentile) spine flexion compared to controls at both post-intervention time points.
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Affiliation(s)
- Megan Kamachi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada; Institute of Biomedical Engineering, University of Toronto, Rosebrugh Building, 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada
| | - Mohammadhasan Owlia
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | - Tilak Dutta
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada; Institute of Biomedical Engineering, University of Toronto, Rosebrugh Building, 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada.
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20
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Osborn-Jenkins L, Roberts L. The advice given by physiotherapists to people with back pain in primary care. Musculoskelet Sci Pract 2021; 55:102403. [PMID: 34130069 DOI: 10.1016/j.msksp.2021.102403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Back pain guidelines endorse giving advice to enable people to self-manage and continue normal activities. Little is known however, about the content of advice that clinicians give and this project aimed to identify the advice given by clinicians to patients with back pain at their initial consultation. METHODS A secondary analysis was conducted with 25 audio-recordings and transcriptions of consultations between patients with back pain and physiotherapists in a primary care outpatients department. Using a Framework approach, the data were coded and analysed to identify the content of advice given and mode of delivery. RESULTS The mean duration of consultation was 38 min 59 s (range 26:21-53:16). Advice was given in 88% (n = 22/25) of consultations and 96% included additional exercise instruction. Cognitive reassurance was evident, focussing on getting people confident to 'move your back' despite pain and encouraging active lifestyle changes. Beyond reassurance and discussion to enhance confidence, the key topics of advice given were: activity promotion; postural changes; practical self-help advice regarding ways to sit; pain-management advice including medication and using heat. Gaps were identified in the advice given, most notably there was a lack of specificity relating to the frequency and duration of recommended tasks and activities. CONCLUSIONS Advice and reassurance are integral to enabling people to self-manage their back pain. It is important to avoid contradictory and unhelpful messages. Despite its importance, little is known about the advice offered by clinicians during initial back pain consultations highlighting the need for guidance to be patient-centred and tailored.
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Affiliation(s)
- Lisa Osborn-Jenkins
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK; School of Health Sciences, University of Southampton, Highfield, Southampton, UK.
| | - Lisa Roberts
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK; School of Health Sciences, University of Southampton, Highfield, Southampton, UK.
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21
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Hand grip strength as a predictor of recovery from low back pain in the pregnant women-a prospective study. J Orthop Sci 2021; 26:566-571. [PMID: 32807585 DOI: 10.1016/j.jos.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common musculoskeletal problem during pregnancy with an estimated prevalence ranging from 30% to 78%. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. The definite mechanism behind LBP during pregnancy remains unknown. Therefore, the purpose of this study was to investigate whether hand grip strength (HGS), which is a straightforward and reliable indicator of overall muscle strength, is associated with unrecovered LBP after delivery. METHODS 257 pregnant women who registered at obstetrics units in two tertiary hospitals from January 2016 to June 2017 and meanwhile suffered the LBP during pregnancy were included. They were grouped based on whether they recovered from LBP after delivery (recovery was defined as a pain rating of ≤3). The variables such as age, HGS, and education level were recorded and examined for the risk analysis of unrecovered LBP. Also, the Pearson correlation between HGS levels and pain intensities was investigated. RESULTS LBP without recovery at two years after delivery was reported among 22.7% of the subjects. Women with increasing age, low HGS (<25 kg), LBP in a previous pregnancy, back pain, sick leave, and a large amount of physical demand (all p < 0.05), were more likely to report LBP without recovery. Besides, there was a significant correlation between HGS values and the intensities of LBP (r = -0.525; p = 0.003). CONCLUSIONS Low HGS has the highest OR value (adjusted OR = 9.12, P < 0.001) among these factors. The present findings may be used to design and encourage a specific stabilization exercise regime to build well stability of the lumbar spinal column and thus alleviating the LBP.
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22
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Knechtle D, Schmid S, Suter M, Riner F, Moschini G, Senteler M, Schweinhardt P, Meier ML. Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults. Pain 2021; 162:1621-1631. [PMID: 33323888 PMCID: PMC8120682 DOI: 10.1097/j.pain.0000000000002170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects.
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Affiliation(s)
- Deborah Knechtle
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Magdalena Suter
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Fabienne Riner
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Greta Moschini
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Marco Senteler
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
- Alan Edwards Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michael L. Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
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23
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Krug RC, Caneiro JP, Ribeiro DC, Darlow B, Silva MF, Loss JF. Back pain attitudes questionnaire: Cross-cultural adaptation to brazilian-portuguese and measurement properties. Braz J Phys Ther 2021; 25:271-280. [PMID: 32739110 PMCID: PMC8134768 DOI: 10.1016/j.bjpt.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 06/13/2020] [Accepted: 06/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to evaluate attitudes and beliefs of the general public, people with back pain, and healthcare professionals about the spine. OBJECTIVES To translate and cross-culturally adapt the Back-PAQ (34-item and 10-item versions) into Brazilian-Portuguese (Back-PAQ-Br) and test its measurement properties in a Brazilian sample. METHODS The cross-cultural adaptation and testing of the measurement properties followed the recommendations of international guidelines. Members of the general public, people with back pain, and healthcare professionals, for a total of 139 individuals, took part in the assessment of internal consistency, construct validity, and ceiling and floor effects. The Hospital Anxiety and Depression Scale (HADS) and the Brazilian-Portuguese version of the Tampa Scale of Kinesiophobia (TSK) were used to evaluate construct validity. Test-retest reproducibility was determined on 77 participants. Retest was performed a minimum of 1 week and a maximum of 2 weeks from the original test. RESULTS There was very high agreement between translators (88.2%). The Back-PAQ-Br showed excellent internal consistency (Cronbach's alpha 0.92) and excellent reproducibility (ICC 0.94; SEM 5.14 points on a 136 point scale), with a smallest detectable change (90% confidence level) of 11.93 points. There was strong correlation between Back-PAQ-Br and TSK (r = -0.72) and very weak correlation between Back-PAQ-Br and HADS (r = -0.23 for both depression and anxiety domains). No ceiling/floor effects were observed. CONCLUSION The translation process and cross-cultural adaptation had very high agreement between translators. The Back-PAQ-Br has excellent measurement properties that are similar to the properties of the original version.
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Affiliation(s)
- Roberto Costa Krug
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Centro Histórico, CEP: 90050-170, Porto Alegre, RS, Brazil.
| | - J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy, Shenton Park, Perth, Australia
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Marcelo Faria Silva
- Physical Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Centro Histórico, CEP: 90050-170, Porto Alegre, RS, Brazil
| | - Jefferson Fagundes Loss
- School of Physical Education, Physical Therapy and Dance (ESEFID), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Marquardt N, Hoebel M, Lud D. Safety culture transformation-The impact of training on explicit and implicit safety attitudes. HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING 2021; 31:191-207. [PMID: 33362405 PMCID: PMC7753658 DOI: 10.1002/hfm.20879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/28/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
The present paper investigates the changeability of safety culture elements such as explicit and implicit safety attitudes by training. Therefore, three studies with different time frames, training durations, and settings will be presented. In the first study, the short-term attitude change of students from an international environmental sciences study program was measured after safety training in a chemical laboratory. In the second study, the medium-term attitude change was assessed after a Crew Resource Management training for German production workers in the automotive industry. In the third study, the long-term attitude changes were measured after safety ethics training in a sample of German occupational psychology and business students. Different self-report measures were used to evaluate the training effectiveness of explicit safety attitudes. The change of implicit safety attitudes was assessed by Implicit Association Tests. The results of all three studies revealed a significant training effect on the explicit safety attitudes, but not on the implicit ones. Besides the training effect on the explicit attitudes, there was no effect of time frame (short-, medium-, long-term), training duration (2 h, 2 days, 12 weeks), and setting (chemical laboratory, automotive industry, safety ethics study program) on the attitude change. Based on the results, conceptual, methodological, and practical implications for training effectiveness and safety culture transformation are discussed.
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Affiliation(s)
- Nicki Marquardt
- Faculty of Communication and EnvironmentRhine‐Waal University of Applied SciencesKamp‐LintfortGermany
| | - Merle Hoebel
- Faculty of Communication and EnvironmentRhine‐Waal University of Applied SciencesKamp‐LintfortGermany
| | - Daniela Lud
- Faculty of Communication and EnvironmentRhine‐Waal University of Applied SciencesKamp‐LintfortGermany
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25
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van Lankveld W, Pat-El RJ, van Melick N, van Cingel R, Staal JB. Is Fear of Harm (FoH) in Sports-Related Activities a Latent Trait? The Item Response Model Applied to the Photographic Series of Sports Activities for Anterior Cruciate Ligament Rupture (PHOSA-ACLR). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186764. [PMID: 32948087 PMCID: PMC7557538 DOI: 10.3390/ijerph17186764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022]
Abstract
Background: Fear of Harm (FoH) predicts return to sports in Anterior Cruciate Ligament Reconstruction (ACLR) and can be assessed using the Photographic Sports Activities for ACLR (PHOSA-ACLR). This study was conducted to determine whether FoH assessed using the PHOSA-ACLR is a latent trait, and to analyze differences in PHOSA-ACLR in athletes with or without an ACL rupture. Methods: Three convenience samples completed the PHOSA-ACLR: (1) ACLR patients (n = 58; mean age 25.9 years; range 17–56; SD = 8.2; 43% male); (2) first year Physical Therapy (PT) students (n = 169; mean age = 19.2; SD = 2.0; 48% male), and (3) junior football players (n = 30; mean age = 18.3; range 17–20; SD = 3.2; 94% males). ACLR patients additionally reported functioning and Fear of Movement. PHOSA-ACLR items were analyzed with Item Response Theory using the Graded Response Model (GRM). Differences between three groups of participants were analyzed using Univariate Analysis of Variance. Results: Data fitted the two-parameter GRM, and therefore the items of the PHOSA-ACLR constitute a latent trait. There was a significant difference between the three groups in PHOSA-ACLR after controlling for age and gender (F (2, 255) = 17.1, p < 0.001). PT students reported higher levels of FoH compared to either ACLR patients or healthy soccer players. Conclusions: PHOSA-ACLR items constitute a latent trait of FoH for ACLR-specific movements. Contrary to expectations, PHOSA-ACLR is higher in first year physiotherapy students compared to patients rehabilitating from ACLR, and healthy junior soccer players.
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Affiliation(s)
- Wim van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
- Correspondence:
| | - Ron J. Pat-El
- Department of Methods and Statistics, Open University of The Netherlands, 6401 DL Heerlen, The Netherlands;
| | - Nicky van Melick
- Knee Expert Center Company Eindhoven, 5624 EB Eindhoven, The Netherlands;
| | - Robert van Cingel
- Radboud Institute for Health Sciences, IQ Healthcare, University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Sport Medisch Centrum Company Papendal, 6816 VD Arnhem, The Netherlands
| | - J. Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
- Radboud Institute for Health Sciences, IQ Healthcare, University Medical Center, 6500 HB Nijmegen, The Netherlands;
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What do UK osteopaths view as the safest lifting posture, and how are these views influenced by their back pain beliefs? INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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Meulders A. Fear in the context of pain: Lessons learned from 100 years of fear conditioning research. Behav Res Ther 2020; 131:103635. [DOI: 10.1016/j.brat.2020.103635] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
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Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J Phys Ther 2020; 25:17-29. [PMID: 32616375 DOI: 10.1016/j.bjpt.2020.06.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Beliefs about the body and pain play a powerful role in behavioural and emotional responses to musculoskeletal pain. What a person believes and how they respond to their musculoskeletal pain can influence how disabled they will be by pain. Importantly, beliefs are modifiable and are therefore considered an important target for the treatment of pain-related disability. Clinical guidelines recommend addressing unhelpful beliefs as the first line of treatment in all patients presenting with musculoskeletal pain. However, many clinicians hold unhelpful beliefs themselves; while others feel ill-equipped to explore and target the beliefs driving unhelpful responses to pain. As a result, clinicians may reinforce unhelpful beliefs, behaviours and resultant disability among the patients they treat. METHODS To assist clinicians, in Part 1 of this paper we discuss what beliefs are; how they are formed; the impact they can have on a person's behaviour, emotional responses and outcomes of musculoskeletal pain. In Part 2, we discuss how we can address beliefs in clinical practice. A clinical case is used to illustrate the critical role that beliefs can have on a person's journey from pain and disability to recovery. CONCLUSIONS We encourage clinicians to exercise self-reflection to explore their own beliefs and better understand their biases, which may influence their management of patients with musculoskeletal pain. We suggest actions that may benefit their practice, and we propose key principles to guide a process of behavioural change.
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Randomized Trial of General Strength and Conditioning Versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes. J Clin Med 2020; 9:jcm9061726. [PMID: 32503243 PMCID: PMC7355598 DOI: 10.3390/jcm9061726] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/29/2022] Open
Abstract
Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC; n = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; n = 20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; p < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; p = 0.001) and endurance (9.1 (1.7, 16.4) reps; p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts; p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; p < 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.
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30
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To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2020; 50:121-130. [PMID: 31775556 DOI: 10.2519/jospt.2020.9218] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether lumbar spine flexion during lifting is a risk factor for low back pain (LBP) onset/persistence or a differentiator of people with and without LBP. DESIGN Etiology systematic review with meta-analysis. LITERATURE SEARCH Database search of ProQuest, CINAHL, MEDLINE, and Embase up to August 21, 2018. STUDY SELECTION CRITERIA We included peer-reviewed articles that investigated whether lumbar spine position during lifting was a risk factor for LBP onset or persistence or a differentiator of people with and without LBP. DATA SYNTHESIS Lifting-task comparison data were tabulated and summarized. The meta-analysis calculated an n-weighted pooled mean ± SD of the results in the LBP and no-LBP groups. If a study contained multiple comparisons (ie, different lifting tasks that used various weights or directions), then only 1 result from that study was included in the meta-analysis. RESULTS Four studies (1 longitudinal study and 3 cross-sectional studies across 5 articles) included in meta-analysis measured lumbar flexion with intralumbar angles and found no difference in peak lumbar spine flexion when lifting (1.5°; 95% confidence interval [CI]: -0.7°, 3.7°; P = .19 for the longitudinal study and -0.9°; 95% CI: -2.5°, 0.7°; P = .29 for the cross-sectional studies). Seven cross-sectional studies measured lumbar flexion with thoracopelvic angles and found that people with LBP lifted with 6.0° less lumbar flexion than people without LBP (95% CI: -11.2°, -0.9°; P = .02). Most (9/11) studies reported no significant between-group differences in lumbar flexion during lifting. The included studies were of low quality. CONCLUSION There was low-quality evidence that greater lumbar spine flexion during lifting was not a risk factor for LBP onset/persistence or a differentiator of people with and without LBP. J Orthop Sports Phys Ther 2020;50(3):121-130. Epub 28 Nov 2019. doi:10.2519/jospt.2020.9218.
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31
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Khoddam-Khorasani P, Arjmand N, Shirazi-Adl A. Effect of changes in the lumbar posture in lifting on trunk muscle and spinal loads: A combined in vivo, musculoskeletal, and finite element model study. J Biomech 2020; 104:109728. [PMID: 32147242 DOI: 10.1016/j.jbiomech.2020.109728] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Irrespective of the lifting technique (squat or stoop), the lumbar spine posture (more kyphotic versus more lordotic) adopted during lifting activities is an important parameter affecting the active-passive spinal load distribution. The advantages in either posture while lifting remains, however, a matter of debate. To comprehensively investigate the role on the trunk biomechanics of changes in the lumbar posture (lordotic, free or kyphotic) during forward trunk flexion, validated musculoskeletal and finite element models, driven by in vivo kinematics data, were used to estimate detailed internal tissue stresses-forces in and load-sharing among various joint active-passive tissues. Findings indicated that the lordotic posture, as compared to the kyphotic one, resulted in marked increases in back global muscle activities (~14-19%), overall segmental compression (~7.5-46.1%) and shear (~5.4-47.5%) forces, and L5-S1 facet joint forces (by up to 80 N). At the L5-S1 level, the lordotic lumbar posture caused considerable decreases in the moment resisted by passive structures (spine and musculature, ~14-27%), negligible reductions in the maximum disc fiber strains (by ~0.4-4.7%) and small increases in intradiscal pressure (~1.8-3.4%). Collectively and with due consideration of the risk of fatigue and viscoelastic creep especially under repetitive lifts, current results support a free posture (in between the extreme kyphotic and lordotic postures) with moderate contributions from both active and passive structures during lifting activities involving trunk forward flexion.
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Affiliation(s)
- P Khoddam-Khorasani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Québec, Canada
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32
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Owlia M, Kamachi M, Dutta T. Reducing lumbar spine flexion using real-time biofeedback during patient handling tasks. Work 2020; 66:41-51. [PMID: 32417812 PMCID: PMC7369082 DOI: 10.3233/wor-203149] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient handling activities require caregivers to adopt postures that increase the risk of back injury. Training programs relying primarily on didactic methods have been shown to be ineffective at reducing this risk. The use of real-time biofeedback has potential as an alternative training method. OBJECTIVE To investigate the effect of real-time biofeedback on time spent by caregivers in end-range lumbar spine flexion. METHODS Novice participants were divided into intervention (n = 10) and control (n = 10) groups and were asked to perform a set of simulated care activities eight times on two consecutive days. Individuals in the intervention group watched a training video on safer movement strategies and received real-time auditory feedback from a wearable device (PostureCoach) in four training trials whenever their lumbar spine flexion exceeded a threshold (70% of maximum flexion). Changes in end-range lumbar spine flexion were compared between groups and across trials. RESULTS Participants in the intervention group saw reductions in end-range lumbar spine flexion during the simulated patient handling tasks at the end of the training compared to their baseline trials while there was no change for the control group. CONCLUSIONS The training program including PostureCoach has the potential to help caregivers learn to use safer postures that reduce the risk of back injury.
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Affiliation(s)
- Mohammadhasan Owlia
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, ON, Canada
| | - Megan Kamachi
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, University Health Network, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Canada
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Nolan D, O’Sullivan K, Newton C, Singh G, Smith BE. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain 2019; 20:215-227. [DOI: 10.1515/sjpain-2019-0089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background and aims
To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).
Methods
Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.
Results
Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.
Conclusions
People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.
Implications
The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.
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Affiliation(s)
- David Nolan
- Sheffield Teaching Hospitals NHS Foundation Trust , PhysioWorks, Firth Park Clinic, North Quadrant , Sheffield , UK , Phone: 07725854140
| | - Kieran O’Sullivan
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
- School of Allied Health , University of Limerick , Limerick , Ireland
- Health Research Institute , University of Limerick , Limerick , Ireland
| | - Chris Newton
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
| | - Gurpreet Singh
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Benjamin E. Smith
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
- University Hospitals of Derby and Burton NHS Foundation Trust , Derby , UK
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Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B, Masse-Alarie H, Van Oosterwijck J, Belavy DL. Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective. Pain Pract 2019; 20:211-225. [PMID: 31610090 DOI: 10.1111/papr.12846] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Abstract
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.
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Affiliation(s)
- Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, U.S.A
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bernadette Fitzgibbon
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Hugo Masse-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Pain in Motion International Research Group
| | - Daniel L Belavy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Leahy A, O’Keeffe M, Robinson K, O’Sullivan K. The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aoife Leahy
- Barking Havering and Redbridge University Trust, Romford, England
| | - Mary O’Keeffe
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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36
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Matheve T, De Baets L, Bogaerts K, Timmermans A. Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain 2019; 23:1171-1184. [PMID: 30793429 DOI: 10.1002/ejp.1384] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most studies fail to show an association between higher levels of pain-related fear and protective movement behaviour in patients with chronic low back pain (CLBP). This may be explained by the fact that only general measures of pain-related fear have been used to examine the association with movement patterns. This study explored whether task-specific, instead of general measures of pain-related fear can predict movement behaviour. METHODS Fifty-five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia and its Activity Avoidance and Somatic Focus subscales were used as general measures of pain-related fear. The score on a picture of the PHODA-SeV, showing a person lifting a heavy object with a bent back, was used as task-specific measure of pain-related fear. RESULTS Lumbar ROM was predicted by task-specific, but not by general measures of pain-related fear. Only the scores on one other picture of the PHODA-SeV, similar to the task-specific picture regarding threat value and movement characteristics, predicted the lumbar ROM. Compared to healthy persons, patients with CLBP used significantly less ROM, except the subgroup with a low score on the task-specific measure of pain-related fear, who used a similar ROM. CONCLUSIONS Our results suggest to use task-specific measures of pain-related fear when assessing the relationship with movement. It would be of interest to investigate whether reducing task-specific fear changes protective movement behaviour. SIGNIFICANCE This study shows that lumbar range of motion in CLBP is predicted by task-specific, but not by general measures of pain-related fear. This suggests that both in clinical practice and for research purposes, it might be recommended to use task-specific measures of pain-related fear when assessing the relationship with movement behaviour. This may help to disentangle the complex interactions between pain-related fear, movement and disability in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Liesbet De Baets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Katleen Bogaerts
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Health Psychology, University of Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Physiotherapists implicitly evaluate bending and lifting with a round back as dangerous. Musculoskelet Sci Pract 2019; 39:107-114. [PMID: 30553986 DOI: 10.1016/j.msksp.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/21/2018] [Accepted: 12/05/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Beliefs can be assessed using explicit measures (e.g. questionnaires) that rely on information of which the person is 'aware' and willing to disclose. Conversely, implicit measures evaluate beliefs using computer-based tasks that allow reduced time for introspection thus reflecting 'automatic' associations. Thus far, physiotherapists' beliefs about back posture and safety have not been evaluated with implicit measures. OBJECTIVES (1) Evaluate implicit associations between bending lifting back posture (straight-back vs round-back) and safety (safe vs danger); (2) Explore correlations between implicit and explicit measures of beliefs towards vulnerability of the back. DESIGN Exploratory cross-sectional quantitative study. METHODS 47 musculoskeletal physiotherapists completed explicit measures of fear of movement (TSK-HC), back beliefs (BackPAQDanger) and beliefs related to bending and lifting back posture and safety (BSB). An Implicit Association Test (IAT) was used to assess implicit associations between (i) images of people bending/lifting with a 'round-back' or with a 'straight-back' posture, and (ii) words representing 'safety' and 'danger'. A one-sample t-test assessed the degree and direction of the sample's IAT score. Cohen's d provided an effect size of the estimated bias. Correlation between IAT and each explicit measure was assessed using Pearson's coefficient. RESULTS The sample displayed an implicit association between 'round-back' and 'danger' (μ = 0.213, 95% CI [0.075-0.350], p = .003), with an effect size magnitude of 0.45. There were fair to moderate correlations between IAT and BSB (r = 0.320, 95% CI [0.036-0.556], p = .029) and, IAT and BackPAQDanger (r = 0.413, 95%CI [0.143-0.626], p = .004). CONCLUSIONS Physiotherapists displayed an implicit bias towards bending and lifting with a round-back as dangerous.
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Affiliation(s)
- Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway
- Faculty of Medicine , University of Oslo , Oslo , Norway
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