1
|
Mitchaï PM, Mapinduzi J, Verbrugghe J, Michiels S, Janssens L, Kossi O, Bonnechère B, Timmermans A. Mobile technologies for rehabilitation in non-specific spinal disorders: a systematic review of the efficacy and potential for implementation in low- and middle-income countries. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4077-4100. [PMID: 37794182 DOI: 10.1007/s00586-023-07964-2] [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: 05/22/2023] [Revised: 05/22/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this systematic review was primarily to identify the types of mHealth technologies for the rehabilitation of non-specific spinal disorders, second to evaluate their efficacy, and finally to determine their applicability in LMICs. METHODS Three databases (Scopus, PubMed, and Web of Science) were searched for randomized controlled trials and clinical trials from January 2012 until December 2022. Studies were found eligible when using mHealth technologies for the rehabilitation of non-specific spinal disorders. To evaluate efficacy, the primary outcome was pain intensity, and the secondary outcomes were disability and quality of life. To evaluate the applicability in LMICs, information about financial and geographical accessibility, offline usability, and languages was extracted. RESULTS Fifteen studies were included comprising 1828 participants who suffer from non-specific low back pain (86.05%) and non-specific neck pain (13.95%). Fourteen distinct smartphone-based interventions and two sensor system interventions were found, with a duration ranging from four weeks to six months. All mHealth interventions demonstrated efficacy for the improvement of pain, disability and quality of life in non-specific spinal disorders, particularly low back pain. Five of the evaluated smartphone applications were free of charge accessible and had language features that could be adapted for use in LMICs. CONCLUSION mHealth interventions can be used and integrated into the conventional treatment of non-specific spinal disorders in rehabilitation. They have demonstrated efficacy and could be implemented in LMICs with minor adaptations to overcome language barriers and the absolute necessity of the internet.
Collapse
Affiliation(s)
- Pénielle Mahutchegnon Mitchaï
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, 03 BP 10, Parakou, Benin
| | - Jean Mapinduzi
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- Department of Physiotherapy, National Institute of Public Health, University of Bujumbura, Bujumbura, Burundi
| | - Jonas Verbrugghe
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Sarah Michiels
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Lotte Janssens
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Oyéné Kossi
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium.
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, 03 BP 10, Parakou, Benin.
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin.
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
2
|
Abuijlan IAM, Muthu P, Avinash MN. Nurses Experience and Perceived Challenges of Using Nonpharmacological Pain Interventions for Musculoskeletal Pain: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231215600. [PMID: 38020316 PMCID: PMC10658770 DOI: 10.1177/23779608231215600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Current musculoskeletal pain management guidelines encourage utilizing nonpharmacological pain measures. Despite their positive effect in alleviating musculoskeletal pain, nurses reported negative attitudes toward utilizing nonpharmacological pain measures. Therefore, assessing nurses' perception of nonpharmacological pain measures is essential to promote patient comfort. Objective The aim of the study was to explore the nurses' experience and perceived challenges in using nonpharmacological pain measures in caring for patients with musculoskeletal pain. Materials & Methods A descriptive qualitative design was carried out. Face-to-face semistructured interviews were conducted among 11 nurses. Colaizzi's method was employed in analyzing the data. Results Four themes emerged, namely, constant monitoring and observation, selection of nonpharmacological pain measures, and various barriers related to patients and nurses. One of the ways to overcome these barriers or challenges, we should promote interprofessional teams in planning patient-centered pain management care. Also, defining the role of the pain management nurse would be pivotal to ensuring effective pain management measures. Conclusion The nursing workforce needs to initiate and utilize these measures as a common practice in managing musculoskeletal pain and in turn create a culture that strongly supports the utilization of nonpharmacological pain measures.
Collapse
Affiliation(s)
- Israa A. M. Abuijlan
- College of Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Priyalatha Muthu
- RAK College of Nursing, Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Manju Nair Avinash
- RAK College of Nursing, Medical and Health Sciences University, Ras Al Khaimah, UAE
| |
Collapse
|
3
|
Sarvilina IV, Danilov AB. [Comparative analysis of the use of symptomatic slow acting drugs for osteoarthritis containing chondroitin sulfate or affecting its biosynthesis in patients with non-specific low back pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:81-96. [PMID: 36719123 DOI: 10.17116/jnevro202312301181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Retrospective comparative analysis of the use of SYSADOA preparations containing chondroitin sulfate (Chondroguard, 2 ml, 25 amp., glycosaminoglycan-peptide complex, 1 ml 25 amp., bioactive concentrate of small marine fish, 2 ml, 10 amp.) in patients with chronic non-specific low back pain (LBP) of lumbar and sacral localization caused by spondylosis and osteochondrosis of the lumbar spine, at the stage of outpatient care. MATERIAL AND METHODS Data of medical records of patients (n=120; men - 32, women - 88, age - 54.1±7.6 years, duration of disease exacerbation 4.0±1.7 months) with nonspecific LBP were systematized according to the inclusion/exclusion criteria. All patients were divided into 4 groups: Group 1 (n=30) received Chondroguard im., 2 ml every other day, the course of treatment was 25 injections, 25 days; Group 2 (n=30) received glycosaminoglycan-peptide complex on the 1st day - 0.3 ml, on the 2nd day - 0.5 ml, and then 3 times a week for 1 ml, course of treatment - 25 injections, 25 days; Group 3 (n=30) received bioactive concentrate of small marine fish, 2 ml im., every other day, the course of treatment was 10 injections; repeated courses of treatment - after 6 months; Group 4 (n=30) received Amelotex (meloxicam) at a dose of 15 mg once a day for 15 days. All patients of the first 3 groups received Amelotex at a dose of 15 mg with the possibility of reducing the dose to 7.5 mg or completely discontinuing the drug if necessary. Retrospectively, dynamic monitoring was performed in the medical records of outpatients after 50 days and 6 months from the start of therapy according to the following parameters: intensity of pain according to VAS, short form of the McGill pain questionnaire, vital signs of patients (Oswestry Disability Index, version 2.1a [Oswestry Disability Index], and Roland-Morris questionnaire), propensity to chronic pain syndrome according to the STarT Back Screening Tool questionnaire, the presence and severity of comorbid fibromyalgia according to the Fibromyalgia Rapid Screening Tool questionnaire, the level of pain catastrophization according to the Pain Catastrophizing Scale, the severity of comorbid anxiety and depression according to the Hospital Anxiety and Depression Scale, the severity comorbid insomnia (Insomnia Severity Index), quality of life according to the SF-36 scale, the effectiveness of drugs according to the patient on a 5-point scale, the need to take NSAIDs and analgesics, tolerability on a 4-point system. The safety of therapy was monitored using the WHO and Naranjo scales. RESULTS In patients with nonspecific LBP, a greater degree of reduction in the intensity of the pain syndrome, a smaller number of exacerbations of the pain syndrome over 6 months of observation, an improvement in the functional status and life activity, a tendency to a decrease in the severity of anxiety and depression, sleep disturbances and comorbid fibromyalgia, limiting the risk of chronicity and catastrophization of pain, the presence of a structure-modifying effect on IVD and degenerative changes in the facet joints, a significant improvement in the physical and mental components of health, high satisfaction and safety of therapy, which included taking Chondroguard with meloxicam, with a decrease in the need to take the latter by the 50th day observation period compared to other regimens. The effects of Chondroguard and meloxicam turned out to be long-term and were recorded by the 6th month in the absence of Chondroguard, which indicated the preservation of the influence of highly purified cholesterol on the pathogenetic mechanisms of the formation of LBP. CONCLUSION The study allows us to recommend the use of a parenteral form of cholesterol (Chondroguard, CJSC «PharmFirma «Sotex», Russia) for the treatment of nonspecific LBP with moderate or severe pain, chronic relapsing or persistent course, in combination with NSAIDs and their subsequent cancellation or administration on demand.
Collapse
Affiliation(s)
- I V Sarvilina
- LLC «Medical Center «Novomedicina», Rostov-on-Don, Russia
| | - A B Danilov
- First Moscow State Medical University named after I.M. Sechenov, Moscow, Russia
| |
Collapse
|
4
|
Park SC, Kang MS, Yang JH, Kim TH. Assessment and nonsurgical management of low back pain: a narrative review. Korean J Intern Med 2023; 38:16-26. [PMID: 36420562 PMCID: PMC9816685 DOI: 10.3904/kjim.2022.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.
Collapse
Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Min-Seok Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| |
Collapse
|
5
|
Hong JY, Song KS, Cho JH, Lee JH, Kim NH. An Updated Overview of Low Back Pain Management. Asian Spine J 2022; 16:968-982. [PMID: 34963043 PMCID: PMC9827206 DOI: 10.31616/asj.2021.0371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/12/2021] [Indexed: 01/11/2023] Open
Abstract
We aimed to determine the recommendation level for the treatment of acute and chronic low back pain (LBP). A systematic review (SR) of the literature was performed and all English-language articles that discuss acute and chronic LBP, including MEDLINE and the Cochrane Database of Systematic Reviews, were searched. Of the 873 searched literature reports, 259 articles, including 131 clinical trials, 115 SRs, nine meta-analyses, and four clinical guidelines were analyzed. In these articles, high-quality randomized controlled trials, SRs, and used well-written clinical guidelines were reviewed. The results indicated multiple acute and chronic LBP treatment methods in the literature, and these reports when reviewed included general behavior, pharmacological therapy, psychological therapy, specific exercise, active rehabilitation and educational interventions, manual therapy, physical modalities, and invasive procedures. The Trial conclusions and SRs were classified into four categories of A, B, C, and D. If there were not enough high-quality articles, it was designated as "I" (insufficient). This review and summary of guidelines may be beneficial for physicians to better understand and make recommendations in primary care.
Collapse
Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan,
Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul,
Korea
| | - Nack Hwan Kim
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan,
Korea
| |
Collapse
|
6
|
Das BM, Conerly J. Effectiveness of an 8-week hatha yoga intervention to improve lower back pain in university office workers: A mixed-methods pilot exploratory study. Work 2022; 73:569-577. [DOI: 10.3233/wor-205156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Hatha yoga programs have been shown to be effective at improving low back pain among a variety of populations; however, methods to decrease low back pain of university office employees have not been studied. OBJECTIVE: To examine the impact of an 8-week hatha yoga intervention on measures of health among university office employees. METHOD: Seven participants completed the 8-week yoga intervention. All measures, including anthropometric measures and online questionnaires, were completed at baseline and post-intervention. RESULTS: Baseline pain intensity (6.6±3.1) and pain interference (15.6±4.7) reflected a moderate level of back pain and moderate to severe interference. Pain intensity showed a non-significant improvement with medium-to-large effect size [p = 0.07, (d = 0.7)]. There was a significant improvement with a large effect size [p = 0.002, (d = 2.4)] in pain interference. Baseline anxiety (7.4±3.6) reflected a borderline abnormal symptom level, but anxiety significantly reduced to normal levels at post-intervention with a medium effect size [p = 0.002 (d = 0.5)]. Focus group themes were improvements in health and development of a sense of community. CONCLUSIONS: Hatha yoga may be an effective mode of low-impact physical activity to decrease pain and improve mental health while facilitating a sense of community for office workers employed by a university. This study demonstrates promising results with large effect sizes; however, more research with larger sample size and randomized treatment and control groups are needed for future study efforts.
Collapse
|
7
|
Price MR, Cupler Z, Hawk C, Bednarz EM, Walters SA, Daniels CJ. Systematic review of guideline-recommended medications prescribed for treatment of low back pain. Chiropr Man Therap 2022; 30:26. [PMID: 35562756 PMCID: PMC9101938 DOI: 10.1186/s12998-022-00435-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To identify and descriptively compare medication recommendations among low back pain (LBP) clinical practice guidelines (CPG). METHODS We searched PubMed, Cochrane Database of Systematic Review, Index to Chiropractic Literature, AMED, CINAHL, and PEDro to identify CPGs that described the management of mechanical LBP in the prior five years. Two investigators independently screened titles and abstracts and potentially relevant full text were considered for eligibility. Four investigators independently applied the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument for critical appraisal. Data were extracted for pharmaceutical intervention, the strength of recommendation, and appropriateness for the duration of LBP. RESULTS 316 citations were identified, 50 full-text articles were assessed, and nine guidelines with global representation met the eligibility criteria. These CPGs addressed pharmacological treatments with or without non-pharmacological treatments. All CPGS focused on the management of acute, chronic, or unspecified duration of LBP. The mean overall AGREE II score was 89.3% (SD 3.5%). The lowest domain mean score was for applicability, 80.4% (SD 5.2%), and the highest was Scope and Purpose, 94.0% (SD 2.4%). There were ten classifications of medications described in the included CPGs: acetaminophen, antibiotics, anticonvulsants, antidepressants, benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, oral corticosteroids, skeletal muscle relaxants (SMRs), and atypical opioids. CONCLUSIONS Nine CPGs, included ten medication classes for the management of LBP. NSAIDs were the most frequently recommended medication for the treatment of both acute and chronic LBP as a first line pharmacological therapy. Acetaminophen and SMRs were inconsistently recommended for acute LBP. Meanwhile, with less consensus among CPGs, acetaminophen and antidepressants were proposed as second-choice therapies for chronic LBP. There was significant heterogeneity of recommendations within many medication classes, although oral corticosteroids, benzodiazepines, anticonvulsants, and antibiotics were not recommended by any CPGs for acute or chronic LBP.
Collapse
Affiliation(s)
| | | | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX USA
| | | | | | | |
Collapse
|
8
|
Exercise Interventions for Persistent Non-Specific Low Back Pain – Does Matching Outcomes to Treatment Targets Make a Difference? A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 22:107-126. [DOI: 10.1016/j.jpain.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/18/2020] [Accepted: 04/08/2020] [Indexed: 01/10/2023]
|
9
|
Urits I, Wang JK, Yancey K, Mousa M, Jung JW, Berger AA, Shehata IM, Elhassan A, Kaye AD, Viswanath O. Acupuncture for the Management of Low Back Pain. Curr Pain Headache Rep 2021; 25:2. [PMID: 33443607 DOI: 10.1007/s11916-020-00919-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW This evidence-based systematic review will focus on the use of acupuncture and its role in the treatment of low back pain to help better guide physicians in their practice. It will cover the background and the burden of low back pain and present the current options for treatment and weigh the evidence that is available to support acupuncture as a treatment modality for low back pain. RECENT FINDINGS Low back pain (LBP), defined as a disorder of the lumbosacral spine and categorized as acute, subacute, or chronic, can be a debilitating condition for many patients. Chronic LBP is more typically defined by its chronicity with pain persisting > 12 weeks in duration. Conventional treatment for chronic LBP includes both pharmacologic and non-pharmacologic options. First-line pharmacologic therapy involves the use of NSAIDs, then SNRI/TCA/skeletal muscle relaxants, and antiepileptics. Surgery is usually not recommended for chronic non-specific LBP patients. According to the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain and the 2017 American College of Physicians (ACP) clinical practice guidelines for chronic pain, non-pharmacologic interventions, acupuncture can be a first-line treatment for patients suffering from chronic low back pain. Many studies have been done, and most show promising results for acupuncture as an alternative treatment for low back pain. Due to non-standardized methods for acupuncture with many variations, standardization remains a challenge.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, LA, USA
| | - Jeffrey Kway Wang
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Kristina Yancey
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Mohammad Mousa
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Jai Won Jung
- MedStar Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Amir Elhassan
- Department of Anesthesiology, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, LA, USA. .,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. .,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. .,Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.
| |
Collapse
|
10
|
Castellini G, Iannicelli V, Briguglio M, Corbetta D, Sconfienza LM, Banfi G, Gianola S. Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument. BMC Health Serv Res 2020; 20:970. [PMID: 33092579 PMCID: PMC7583191 DOI: 10.1186/s12913-020-05827-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31-84%), Scope and Purpose (median 64%, IQR 22-83%), Rigour of Development (median 50%, IQR 21-72%), Clarity and Presentation (median 50%, IQR 28-79%), Stakeholder Involvement (median 36%, IQR 10-74%), and Applicability (median 11%, IQR 0-46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88-0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE 1 TRIAL REGISTRATION: REGISTRATION PROSPERO DETAILS: CRD42019127619 .
Collapse
Affiliation(s)
- G Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - V Iannicelli
- Vita-Salute San Raffaele University, Milan, Italy
| | - M Briguglio
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - D Corbetta
- Vita-Salute San Raffaele University, Milan, Italy.,Rehabilitation and Functional Recovery Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - L M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - G Banfi
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| |
Collapse
|
11
|
Eklund A, Hagberg J, Jensen I, Leboeuf-Yde C, Kongsted A, Lövgren P, Jonsson M, Petersen-Klingberg J, Calvert C, Axén I. The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial. Chiropr Man Therap 2020; 28:19. [PMID: 32316995 PMCID: PMC7171853 DOI: 10.1186/s12998-020-00309-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background A recent study showed that chiropractic patients had fewer days with bothersome (activity-limiting) low back pain (LBP) when receiving care at regular pre-planned intervals regardless of symptoms (‘maintenance care’, MC) compared to receiving treatment only with a new episode of LBP. Benefit varied across psychological subgroups. The aims of this study were to investigate 1) pain trajectories around treatments, 2) recurrence of new episodes of LBP, and 3) length of consecutive pain-free periods and total number of pain-free weeks, for all study participants as well as for each psychological subgroup. Methods A secondary analysis of data from a randomized controlled trial of patients (n = 319) seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with bothersome (activity-limiting) LBP. First, a generalized estimating equations analysis was used to compare the pain trajectory before and after the initial treatment in every new treatment period. Thereafter, a time-to-event analysis (using Cox regression) estimated time to/risk of a new LBP episode. The analyses were performed on i) all study participants and ii) separately for each psychological sub-group (named adaptive copers, interpersonally distressed and dysfunctional) classified by the West Haven-Yale Multidimensional Pain Inventory. Results Patients receiving MC had flat pain trajectories around each new treatment period and reported fewer days with pain compared to patients receiving the control intervention. The entire effect was attributed to the dysfunctional subgroup who reported fewer days with activity limiting pain within each new LBP episode as well as longer total pain-free periods between episodes with a difference of 9.8 weeks (CI 95% 3.3, 16.3) compared to the control group. There were no differences in the time to/risk of a new episode of LBP in either of the subgroups. Conclusion Data support the use of MC in a stratified care model targeting dysfunctional patients for MC. For a carefully selected group of patients with recurrent and persistent LBP the clinical course becomes more stable and the number of pain-free weeks between episodes increases when receiving MC. Understanding how subgroups of patients are likely to be affected by MC may help align patients’ and clinicians’ expectations based on realistic outcomes. Trial registration Clinical trials.gov; NCT01539863; February 22, 2012.
Collapse
Affiliation(s)
- Andreas Eklund
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
| | - Jan Hagberg
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Irene Jensen
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Charlotte Leboeuf-Yde
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | - Iben Axén
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| |
Collapse
|
12
|
Parfenov VA, Golovacheva VA. [Diagnosis and treatment of acute low back pain]. TERAPEVT ARKH 2019; 91:155-159. [PMID: 32598768 DOI: 10.26442/00403660.2019.08.000315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 12/29/2022]
Abstract
Low back pain (LBP) is frequent cause for visit to the doctor and common cause of disability. Modern experts' recommendations for diagnostics and treatment of acute LBP are presented. Common mistakes, difficulties in diagnostics and treatment of acute LBP are discussed. Diagnosis of non - specific acute LBP is based on clinical examination and exclusion of specific causes of back pain. Instrumental studies are not needed in most cases of acute LBP. Key steps in the treatment of patients with acute non - specific LBP are to inform of patients about good prognosis of pain, to recommend daily activity and avoidance of bed rest, to prescribe nonsteroidal anti - inflammatory drug for pain reducing. Effectiveness of vitamins B in acute LBP is discussed.
Collapse
Affiliation(s)
- V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Neurology and Neurosurgery Department
| | - V A Golovacheva
- Sechenov First Moscow State Medical University (Sechenov University), Neurology and Neurosurgery Department
| |
Collapse
|
13
|
Parfenov VA, Yakhno NN, Davydov OS, Kukushkin ML, Churyukanov MV, Golovacheva VA, Isaikin AI, Achkasov EE, Evzikov GY, Karateev AE, Khabirov FA, Shirokov VA, Yakupov EZ. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2019. [DOI: 10.14412/2074-2711-2019-2s-7-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome.An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients.Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes.
Collapse
Affiliation(s)
- V. A. Parfenov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - N. N. Yakhno
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - O. S. Davydov
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
| | - M. L. Kukushkin
- Research Institute of General Pathology and Pathophysiology, Russian Academy of Sciences
| | - M. V. Churyukanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Acad. B.V. Petrovsky Russian Research Center of Surgery
| | - V. A. Golovacheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - A. I. Isaikin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. E. Achkasov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - G. Yu. Evzikov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | | | - F. A. Khabirov
- Kazan State Medical Academy, Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - V. A. Shirokov
- Ural State Medical University, Ministry of Health of Russia
| | - E. Z. Yakupov
- Kazan State Medical University, Ministry of Health of Russia
| |
Collapse
|
14
|
Walking more than 90minutes/week was associated with a lower risk of self-reported low back pain in persons over 50years of age: a cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J 2019; 19:846-852. [PMID: 30448632 DOI: 10.1016/j.spinee.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Physical activity, such as muscle strengthening and aerobic exercise, has been found to be effective for low back pain (LBP). However, the association between weekly walking duration and LBP in the general population remains poorly understood. OBJECT This study aimed (1) to analyze the association between walking and LBP and (2) to examine this association according to walking duration and overall walking days per week in a general population over 50years of age using a representative sample of Korean adults. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Data from the Korea National Health and Nutrition Examination Surveys V and VI, performed from 2010 to 2015. OUTCOME MEASURES Multiple logistic regression analysis was performed to determine the association between walking days and duration and LBP. Analysis was restricted to participants aged over 50years who responded to surveys on LBP and walking activity. METHODS National health and nutrition examination surveys were performed in the Korean general population (N=48,482) from 2010 to 2015. LBP status was surveyed using a self-reported questionnaire form ("Have you complained of LBP for more than 30days during the past 3 months?"). Daily walking activity (low-intensity activity) was evaluated using the following two questions: (1) "During the last 7days, on how many days did you walk for at least 10 minutes at a time? This includes at work and at home, walking to travel from place to place, and any other walking that you have done solely for recreation, sport, exercise, or leisure." (2) "How much time did you usually spend walking on each of those days?" Walking duration per day was classified into two categories: over 30min/day and over 1h/day. Overall walking days per week were categorized into <3, 3-4, and ≥5days/week. Basic characteristics, comorbidities, socioeconomic status, and other variables were used to create multiple logistic regression models. No sources of funding and no conflicts of interest were associated with this study. RESULTS Walking for more than 3days per week for over 30 minutes at a time was negatively associated with LBP in the unadjusted (adjusted odds ratio [aOR]: 0.65, p<.001) and fully adjusted logistic regression models (aOR: 0.79, p<.001). Similarly, walking for more than 5days per week for over 1 hour at a time was negatively associated with LBP in the unadjusted (aOR: 0.62, p<.001) and fully adjusted logistic regression models (aOR: 0.76, p<.001). The risk of LBP decreased with increasing walking days and duration. CONCLUSIONS Our study showed that longer walking duration was associated with a lower risk of LBP using a cross-sectional health survey in the Korean general population. Regular walking with a longer duration for more than 3days/week is significantly associated with a lower risk of LBP in the general population aged over 50years.
Collapse
|
15
|
Park SM, Kim GU, Kim HJ, Kim H, Chang BS, Lee CK, Yeom JS. Low handgrip strength is closely associated with chronic low back pain among women aged 50 years or older: A cross-sectional study using a national health survey. PLoS One 2018; 13:e0207759. [PMID: 30475880 PMCID: PMC6261108 DOI: 10.1371/journal.pone.0207759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/06/2018] [Indexed: 12/19/2022] Open
Abstract
Object This study aimed to analyze the association between low handgrip strength (HGS) and low back pain (LBP) according to physical activity (PA) in the general population aged over 50 years. Methods Nationwide health surveys and examinations were performed in a cross-sectional representative of the Korean general population (n = 7,550 in 2014, n = 7,380 in 2015). Chronic LBP status was determined by self-reported survey responses with respect to the occurrence of LBP for more than 30 days during the previous 3 months. Maximal HGS was determined as the maximal strength of the dominant hand, and low HGS was defined as measurement in the lower 20th percentile of HGS measurements for the general population. High PA was defined as muscle-strengthening exercise for at least 3 days within 1 week. Demographics, medical history, and other variables were used to analyze adjusted weighted logistic regression models with propensity score matching. After propensity score matching, 429 participants were included in each group. Results Analysis was confined to those aged 50–89 years who responded to the chronic LBP survey and had no missing data on HGS. Low HGS and LBP showed significant association in the crude logistic regression model. In the multiple logistic regression model, after adjusting for confounding factors, low HGS was significantly associated with LBP in women with low PA (adjusted odds ratio [aOR]: 1.75, p = 0.047). In the logistic regression model after propensity score matching, low HGS was also significantly related to LBP in women with low PA (aOR: 3.12, p = 0.004). Conclusions Our study showed the relationship between low HGS and LBP using a cross-sectional Korean population-based health survey. Low HGS in women aged over 50 years with low PA was significantly associated with the presence of LBP.
Collapse
Affiliation(s)
- Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Gang-Un Kim
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Choon-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Jin S. Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
| |
Collapse
|
16
|
Park SM, Kim HJ, Jeong H, Kim H, Chang BS, Lee CK, Yeom JS. Longer sitting time and low physical activity are closely associated with chronic low back pain in population over 50 years of age: a cross-sectional study using the sixth Korea National Health and Nutrition Examination Survey. Spine J 2018; 18:2051-2058. [PMID: 29678404 DOI: 10.1016/j.spinee.2018.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/09/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT There is increasing evidence supporting an association between sitting time and low back pain (LBP). However, the degree of the association between the total daily sitting time and LBP in the general population is poorly understood. PURPOSE The present study aimed (1) to analyze the association between the duration of sitting time and LBP, and (2) to examine this association according to the degree of physical activity in population over 50 years of age with a nationally representative sample of Korean adults. STUDY DESIGN This is a cross-sectional study. PATIENT SAMPLE Data from version VI-2, 3 of the Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 and 2015 were analyzed. OUTCOME MEASURES Multiple logistic regression was performed to find the rates of association between chronic LBP, level of sitting time, and physical activity. METHODS Nationwide health surveys and examinations were conducted in general Korean representative populations (n=7,550 in 2014, n=7,380 in 2015). Chronic LBP was defined as self-reported LBP lasting for more than 30 days during the past 3 months in a health survey. Sitting time and daily physical activity were evaluated using the long version of the International Physical Activity Questionnaires (IPAQ). The duration of sitting time was divided into two categories according to the median value (7 hours) and further divided into four categories using quartiles. Physical activity was also divided into low and high physical activity according to duration of mid- to high-intensity activities. There were no sources of funding and no conflicts of interest associated with the present study. RESULTS On multiple logistic regression analysis, sitting time more than 7 hours/day was significantly associated with LBP (adjusted odds ratio 1.33, p<.001). The risk of LBP increased with increasing duration of sitting time. In participants with low levels of physical activity, the duration of sitting time showed more positive association with LBP than that in all the participants and participants with high levels of physical activity. CONCLUSIONS Longer duration of sitting time is a risk factor for LBP. Furthermore, long duration of sitting time with low physical activity further increases the risk of LBP.
Collapse
Affiliation(s)
- Sang-Min Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Hyunseok Jeong
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea.
| |
Collapse
|
17
|
Depression is Closely Associated With Chronic Low Back Pain in Patients Over 50 Years of Age: A Cross-sectional Study Using the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Spine (Phila Pa 1976) 2018; 43:1281-1288. [PMID: 29462063 DOI: 10.1097/brs.0000000000002595] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study was designed to analyze the relationship between the presence and severity of depression and low back pain (LBP) in a representative sample of the general population using a self-report screening questionnaire for depression. SUMMARY OF BACKGROUND DATA There is increasing evidence supporting an association between depression and LBP. However, the degree of the association between these two conditions in the general population is poorly understood. METHODS Health surveys and examinations were conducted on a nationally representative sample (n = 7550) of Koreans. LBP status was determined by a simple survey response concerning LBP >30 days during the past 3 months. Depression was defined as individuals with a total score >10 on the Patient Health Questionnaire (PHQ)-9 survey. The severity of depression was categorized as none (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27) according to PHQ-9 score. Data regarding demographics, socioeconomic history, and comorbid health conditions were used to analyze adjusted, weighted logistic regression models. RESULTS In the Korean population, the prevalence of depression was significantly greater in individuals with LBP (20.3%) than in those without LBP (4.5%). On multivariate logistic regression analysis, the presence of depression was significantly associated with LBP (adjusted odd ratio [aOR]: 3.93, P < 0.001). The risk of LBP increased with increasing severity of depression as follows: severe depression (aOR: 9.28, P < 0.001), moderately severe depression (aOR: 3.24, P = 0.001), moderate depression (aOR: 4.97, P < 0.001), and mild depression (aOR: 2.48, P < 0.001). CONCLUSION Depression is more common in patients with LBP among Koreans. The presence of depression was significantly associated with LBP, especially in severely depressed individuals. LEVEL OF EVIDENCE 3.
Collapse
|