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Lalji R, Muñoz Laguna J, Kauth J, Hofstetter L, Kurmann A, Adams J, Kongsted A, von Wyl V, Puhan MA, Hincapié CA. What Gets Measured Gets Managed: A Scoping Review of Musculoskeletal Research Conducted Within Practice-Based Research Networks. Am J Phys Med Rehabil 2024; 103:e113-e121. [PMID: 38682899 DOI: 10.1097/phm.0000000000002485] [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: 05/01/2024]
Abstract
ABSTRACT Musculoskeletal conditions are often managed in primary care settings. To facilitate research and healthcare quality, practice-based research networks offer sustained collaborations between clinicians and researchers. A scoping review was conducted to describe characteristics of practice-based research networks used for musculoskeletal research and musculoskeletal research conducted through practice-based research networks. Practice-based research networks were identified from 1) musculoskeletal-studies identified in OVID Medline, CINAHL, and Embase databases from inception to 5 February 2023 and in ClinicalTrials.gov and 2) from practice-based research network registries and websites. Among active musculoskeletal-focused practice-based research networks (i.e., currently recruiting and conducting research), an assessment of practice-based research network research good practices was performed. After screening 3025 records, 85 studies from 46 unique practice-based research networks met our eligibility criteria. Common conditions studied were low back pain (28%), musculoskeletal conditions not otherwise specified (25%), and osteoarthritis (19%). Thirty-two practice-based research networks (70%) were deemed to be active. Among active musculoskeletal-focused practice-based research networks, best practice data management information was retrievable for most (53%). Because of the scarcity of publicly available information, a large proportion of practice-based research network research good practice items was not assessable. Practice-based research networks have provided an avenue to assess clinical practice and patient outcomes related to musculoskeletal conditions. Further work to increase the transparency of musculoskeletal practice-based research network research practices is warranted.
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Affiliation(s)
- Rahim Lalji
- From the EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland (RL, JML, LH, AK, CAH); Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland (RL, JML, LH, VvW, MAP, CAH); University Spine Centre Zurich (UWZH), Balgrist University Hospital, Zurich, Switzerland (RL, JML, LH, CAH); Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland (JK); Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia (JA); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (AK); Chiropractic Knowledge Hub, Odense, Denmark (AK); and Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland (VvW)
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Hassan S, Nesovic K, Babineau J, Furlan AD, Kumbhare D, Carlesso LC. Identifying chronic low back pain phenotypic domains and characteristics accounting for individual variation: a systematic review. Pain 2023; 164:2148-2190. [PMID: 37027149 DOI: 10.1097/j.pain.0000000000002911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023]
Abstract
ABSTRACT Interpatient variability is frequently observed among individuals with chronic low back pain (cLBP). This review aimed at identifying phenotypic domains and characteristics that account for interpatient variability in cLBP. We searched MEDLINE ALL (through Ovid), Embase Classic and EMBASE (through Ovid), Scopus, and CINAHL Complete (through EBSCOhost) databases. Studies that aimed to identify or predict cLBP different phenotypes were included. We excluded studies that focused on specific treatments. The methodological quality was assessed using an adaptation of the Downs and Black tool. Forty-three studies were included. Although the patient and pain-related characteristics used to identify phenotypes varied considerably across studies, the following were among the most identified phenotypic domains and characteristics that account for interpatient variability in cLBP: pain-related characteristics (including location, severity, qualities, and duration) and pain impact (including disability, sleep, and fatigue), psychological domains (including anxiety and depression), behavioral domains (including coping, somatization, fear avoidance, and catastrophizing), social domains (including employment and social support), and sensory profiling (including pain sensitivity and sensitization). Despite these findings, our review showed that the evidence on pain phenotyping still requires further investigation. The assessment of the methodological quality revealed several limitations. We recommend adopting a standard methodology to enhance the generalizability of the results and the implementation of a comprehensive and feasible assessment framework to facilitate personalized treatments in clinical settings.
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Affiliation(s)
- Samah Hassan
- Institute of Education Research (TIER), University Health Network, Toronto, ON, Canada
| | - Karlo Nesovic
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Institute of Education Research (TIER), University Health Network, Toronto, ON, Canada
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dinesh Kumbhare
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Potter RS, Tang SY. Can we run away from low back pain? Osteoarthritis Cartilage 2022; 30:6-8. [PMID: 34536527 DOI: 10.1016/j.joca.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 02/02/2023]
Affiliation(s)
- R S Potter
- Department of Orthopedic Surgery, Washington University in St Louis, 660 S. Euclid, Campus Box 8233, St Louis, MO, 63103, USA; Department of Mechanical Engineering and Materials Science, Washington University in St Louis, St Louis, MO, USA
| | - S Y Tang
- Department of Orthopedic Surgery, Washington University in St Louis, 660 S. Euclid, Campus Box 8233, St Louis, MO, 63103, USA; Department of Biomedical Engineering, Washington University in St Louis, One Brookings Drive, Whitaker Hall, Campus Box 1097, St Louis, MO, 63130, USA; Department of Mechanical Engineering and Materials Science, Washington University in St Louis, St Louis, MO, USA.
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Morsø L, Olsen Rose K, Schiøttz-Christensen B, Sowden G, Søndergaard J, Christiansen DH. Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial. Eur J Pain 2021; 25:2020-2038. [PMID: 34101953 PMCID: PMC8518659 DOI: 10.1002/ejp.1818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/30/2021] [Indexed: 11/08/2022]
Abstract
Background A randomized controlled trial (RCT) of stratified care demonstrated superior clinical outcomes and cost‐effectiveness for low back pain (LBP) patients in UK primary care. This is the first study in Europe, outside of the original UK study, to investigate the clinical efficacy and cost‐effectiveness of stratified care compared with current practice for patients with non‐specific LBP. Methods The study was a two‐armed RCT. Danish primary care patients with LBP were randomized to stratified care (n = 169) or current practice (n = 164). Primary outcomes at 3‐ and 12‐months' follow‐up were Roland Morris Disability Questionnaire (RDMQ), patient‐reported global change and time off work. Secondary outcomes included pain intensity, patient satisfaction, healthcare resource utilization and quality‐adjusted life years. Results Intention‐to‐treat analyses found no between‐group difference in RMDQ scores at 3 months (0.5, 95% CI −1.8 to 0.9) or 12 months (0.4, −2.1 to 1.3). No overall differences were found between the arms at 3 and 12 months with respect to time off work or secondary outcomes. Stratified care intervention resulted in significantly fewer treatment sessions (3.5 [SD 3.1] vs. 4.5 [3.5]) and significantly lower total healthcare costs (€) (13.4 [529] vs. 228 [830], p = .002). There was no difference in cost‐effectiveness (0.09, 0.05 to 0.13 vs. 0.10, 0.07–0.14, p = .70). Conclusions There was no significant difference in clinical outcomes between patients with non‐specific LBP receiving stratified care and those receiving current practice. However, stratified care may reduce total healthcare costs if implemented in Danish primary care. Significance Stratified care for low back pain based on risk profile is recommended by recent evidence based clinical guidelines. This study is the first broad replication of the STarT Back Trial in Europe. Therefore, the study adds to the body of knowledge evaluating the effectiveness of stratified care for low back pain in primary care, and provides insight into the effects of stratification on clinical practice.
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Affiliation(s)
- Lars Morsø
- Clinical Department, University of Southern Denmark, Odense, Denmark
| | - Kim Olsen Rose
- Department of Business and Economics, DaCHE, University of Southern Denmark, Odense, Denmark
| | | | | | - Jens Søndergaard
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - David H Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
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Kongsted A, Nielsen OL, Christensen HW, Hartvigsen J, Doktor K, Kent P, Jensen TS. The Danish Chiropractic Low Back Pain Cohort (ChiCo): Description and Summary of an Available Data Source for Research Collaborations. Clin Epidemiol 2020; 12:1015-1027. [PMID: 33061649 PMCID: PMC7537847 DOI: 10.2147/clep.s266220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Back pain is among the most frequent reasons for care seeking globally. Observational clinical cohorts are useful for understanding why people seek care, the content of that care, and factors related to prognosis. This paper describes the Danish Chiropractic low back pain Cohort (ChiCo) and summarizes the primary characteristics of the population to inform the scientific community of the availability of these data as a resource for collaborative research projects. METHODS Adults seeking chiropractic care for a new episode of non-specific back pain were enrolled at the initial visit and followed up after 2, 13, and 52 weeks, with a subpopulation having weekly follow-ups for 1 year. Patient-reported and clinical-reported data were collected in an electronic database using the REDCap software (REDCap Consortium, projectredcap.org). Variables were chosen to measure pre-defined research domains and questions and to capture information across health constructs deemed relevant for additional research. Non-responders at 13 and 52 weeks were contacted by phone to maximize follow-up data and explore differences on core outcomes between responders and non-responders. RESULTS A total of 2848 patients (mean age 45 years, 59% men) were included from 10 clinics with 71%, 68% and 64% responding to follow-ups at 2, 13 and 52 weeks, respectively. Most participants (82%) were employed, nearly half reported current LBP for 1-7 days, and 83% had experienced LBP episodes previously. We did not identify indications of serious attrition bias. CONCLUSION We have described the aims and procedures for establishing the ChiCo cohort, characteristics of the cohort, and available information about attrition bias. These data have the potential to be linked, at an individual participant level, to the extensive Danish population-based registries that measure diverse health and social characteristics.
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Affiliation(s)
- Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M 5230, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Orla Lund Nielsen
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M 5230, Denmark
| | | | - Jan Hartvigsen
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M 5230, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Klaus Doktor
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M 5230, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Tue Secher Jensen
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M 5230, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Axén I, Jensen I, Butler Forslund E, Grahn B, Jørgensen V, Opava CH, Bodin L. Frequently repeated measurements -our experience of collecting data with SMS. BMC Med Res Methodol 2020; 20:124. [PMID: 32429834 PMCID: PMC7236444 DOI: 10.1186/s12874-020-01013-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background As technology is advancing, so are the possibilities for new data collection methods in research, potentially improving data quality and validity of the results. In Sweden, a system using frequent repeated data collection using text messages, SMS Track, has been used in clinical research for more than a decade. In this paper, compliance with repeated text message questions was examined across five different studies, i.e. if compliance was 1: associated with study-specific factors (age or gender of the subjects, the condition, its’ severity or course, i.e. improvement, relapse or steady state) and/or. 2: associated with the methodology itself (the question being asked, the frequency and number of questions, duration of data collection, initial compliance or the management of the system). Methods Descriptive comparisons were done across five studies. Three studies were collecting weekly responses over at least 52 weeks (“Weekly studies”) and were used to investigate the effect of age, sex and pain severity on compliance, the effect of early compliance for late compliance, and finally the early occurrence of two successive weeks with non-compliance. Result Compliance was excellent across all five studies, and only influenced somewhat by age, sex and pain-level. The factor “study” remained significant in the final model thus the observed differences may be a result of the conditions studied but does not seem to be attributable to severity or development of these conditions. Number and frequency of questions did not influence compliance, nor did study duration. Conclusions Compliance was excellent in the included studies and was not affected by population factors. However, differences in compliance were observed that cannot be easily explained and warrant further investigation. In particular, the nature of the variables or the management of the study are potential areas for further investigations.
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Affiliation(s)
- I Axén
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden.
| | - I Jensen
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden
| | - E Butler Forslund
- Rehab Station Stockholm, Research and Development Unit, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - B Grahn
- Department of Clinical Sciences Lund, Orthopedics, Faculty of medicine, Lund University, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - V Jørgensen
- Research Departement, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, N-1453, Bjørnemyr, Norway
| | - C H Opava
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - L Bodin
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden
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Hayden JA, Wilson MN, Riley RD, Iles R, Pincus T, Ogilvie R. Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor review. Cochrane Database Syst Rev 2019; 2019:CD011284. [PMID: 31765487 PMCID: PMC6877336 DOI: 10.1002/14651858.cd011284.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low back pain is costly and disabling. Prognostic factor evidence can help healthcare providers and patients understand likely prognosis, inform the development of prediction models to identify subgroups, and may inform new treatment strategies. Recent studies have suggested that people who have poor expectations for recovery experience more back pain disability, but study results have differed. OBJECTIVES To synthesise evidence on the association between recovery expectations and disability outcomes in adults with low back pain, and explore sources of heterogeneity. SEARCH METHODS The search strategy included broad and focused electronic searches of MEDLINE, Embase, CINAHL, and PsycINFO to 12 March 2019, reference list searches of relevant reviews and included studies, and citation searches of relevant expectation measurement tools. SELECTION CRITERIA We included low back pain prognosis studies from any setting assessing general, self-efficacy, and treatment expectations (measured dichotomously and continuously on a 0 - 10 scale), and their association with work participation, clinically important recovery, functional limitations, or pain intensity outcomes at short (3 months), medium (6 months), long (12 months), and very long (> 16 months) follow-up. DATA COLLECTION AND ANALYSIS We extracted study characteristics and all reported estimates of unadjusted and adjusted associations between expectations and related outcomes. Two review authors independently assessed risks of bias using the Quality in Prognosis Studies (QUIPS) tool. We conducted narrative syntheses and meta-analyses when appropriate unadjusted or adjusted estimates were available. Two review authors independently graded and reported the overall quality of evidence. MAIN RESULTS We screened 4635 unique citations to include 60 studies (30,530 participants). Thirty-five studies were conducted in Europe, 21 in North America, and four in Australia. Study populations were mostly chronic (37%), from healthcare (62%) or occupational settings (26%). General expectation was the most common type of recovery expectation measured (70%); 16 studies measured more than one type of expectation. Usable data for syntheses were available for 52 studies (87% of studies; 28,885 participants). We found moderate-quality evidence that positive recovery expectations are strongly associated with better work participation (narrative synthesis: 21 studies; meta-analysis: 12 studies, 4777 participants: odds ratio (OR) 2.43, 95% confidence interval (CI) 1.64 to 3.62), and low-quality evidence for clinically important recovery outcomes (narrative synthesis: 12 studies; meta-analysis: 5 studies, 1820 participants: OR 1.89, 95% CI 1.49 to 2.41), both at follow-up times closest to 12 months, using adjusted data. The association of recovery expectations with other outcomes of interest, including functional limitations (narrative synthesis: 10 studies; meta-analysis: 3 studies, 1435 participants: OR 1.40, 95% CI 0.85 to 2.31) and pain intensity (narrative synthesis: 9 studies; meta-analysis: 3 studies, 1555 participants: OR 1.15, 95% CI 1.08 to 1.23) outcomes at follow-up times closest to 12 months using adjusted data, is less certain, achieving very low- and low-quality evidence, respectively. No studies reported statistically significant or clinically important negative associations between recovery expectations and any low back pain outcome. AUTHORS' CONCLUSIONS We found that individual recovery expectations are probably strongly associated with future work participation (moderate-quality evidence) and may be associated with clinically important recovery outcomes (low-quality evidence). The association of recovery expectations with other outcomes of interest is less certain. Our findings suggest that recovery expectations should be considered in future studies, to improve prognosis and management of low back pain.
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Affiliation(s)
- Jill A Hayden
- Dalhousie UniversityDepartment of Community Health & Epidemiology5790 University AvenueRoom 403HalifaxNSCanadaB3H 1V7
| | - Maria N Wilson
- Dalhousie UniversityDepartment of Community Health and EpidemiologyHalifaxNova ScotiaCanada
| | - Richard D Riley
- Keele UniversitySchool of Primary, Community and Social CareDavid Weatherall Building, Keele University CampusKeeleStaffordshireUKST5 5BG
| | - Ross Iles
- Monash UniversityDepartment of Physiotherapy, Faculty of Medicine, Nursing and Health SciencesPeninsula CampusFrankstonVictoriaAustralia3199
| | - Tamar Pincus
- Royal Holloway University of LondonDepartment of PsychologyEghamSurreyUKTW20 0EX
| | - Rachel Ogilvie
- Dalhousie UniversityCommunity Health & Epidemiology5760 University AvenueHalifaxCanadaB3H 1V7
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