Software-based interventions for low back pain management: A systematic review and meta-analysis

INTRODUCTION

Using software for self-management interventions can improve health outcomes for individuals with low back pain, but there is a dearth of research to confirm its effectiveness. Additionally, no known research has evaluated the effective elements of software-based interventions for low back pain self-management components. This study aimed to synthesize the effectiveness of software-based interventions to promote self-management health outcomes among individuals with low back pain.

DESIGN

A systematic review and meta-analysis was conducted.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, relevant studies up to July 2022 were searched via four electronic databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science.

RESULTS

4908 adults with low back pain who participated in 23 studies were included. Software-based interventions were effective in reducing fear avoidance (mean difference [MD] = -0.95, 95% CI: -1.45 to -0.44), pain catastrophizing (MD = -1.31, 95% CI: -1.84 to -0.78), disability (MD = -8.21, 95% CI: -13.02 to -3.39), and pain intensity (MD = -0.86, 95% CI: -1.17 to -0.55). Specifically, interventions that included an exercise component were more effective in reducing pain and disability. Additionally, cognitive behavioral therapy (CBT) intervention significantly reduced fear avoidance and pain catastrophizing but had no noticeable impact on disability and pain compared to standard treatment. The certainty of the evidence in this review varied from very low to high across outcomes. The heterogeneity of the study results was significant, suggesting that future studies in this area could optimize the design, time points, measures, and outcomes to strengthen the evidence.

CONCLUSIONS

Low back pain self-management interventions delivered through software-based programs effectively reduce pain intensity, disability, fear avoidance, and pain catastrophizing.

CLINICAL RELEVANCE

Low back pain is among the most common reasons for seeking healthcare visits. Combining exercise and counseling through soft-based programs may effectively address this issue and its associated suffering and disability.

Aflatoxin biocontrol effectiveness in the real world—Private sector-led efforts to manage aflatoxins in Nigeria through biocontrol-centered strategies

Aflatoxins are toxic compounds produced by several Aspergillus species that contaminate various crops. The impact of aflatoxin on the health of humans and livestock is a concern across the globe. Income, trade, and development sectors are affected as well. There are several technologies to prevent aflatoxin contamination but there are difficulties in having farmers use them. In Nigeria, an aflatoxin biocontrol product containing atoxigenic isolates of A. flavus has been registered with regulatory authorities and is now being produced at scale by the private company Harvestfield Industries Limited (HIL). The current study reports results of biocontrol effectiveness trials in maize conducted by HIL during 2020 in several locations across Nigeria and compared to untreated maize from nearby locations. Also, maize was collected from open markets to assess levels of contamination. All treated maize met tolerance thresholds (i.e., <4 ppb total aflatoxin). In contrast, most maize from untreated fields had a higher risk of aflatoxin contamination, with some areas averaging 38.5 ppb total aflatoxin. Maize from open markets had aflatoxin above tolerance thresholds with even an average of up to 90.3 ppb. Results from the trials were presented in a National Workshop attended by key officers of Government agencies, farmer organizations, the private sector, NGOs, and donors. Overall, we report (i) efforts spearheaded by the private sector to have aflatoxin management strategies used at scale in Nigeria, and (ii) deliberations of key stakeholders to ensure the safety of crops produced in Nigeria for the benefit of farmers, consumers, and industries.

Bias in Musculoskeletal Pain Management and Bias-Targeted Interventions to Improve Pain Outcomes: A Scoping Review

Bias in healthcare negatively impacts disparities in care, treatment, and outcomes, especially among minority populations. A scoping review of the literature was performed to provide a deeper understanding of how bias influences musculoskeletal pain and potential effects of bias-targeted interventions on reducing pain disparities, as well as identify gaps and make suggestions for further research in this area. Publications from peer-reviewed journals were searched using the databases PubMed/MEDLINE, PsycINFO, CINAHL, and Scopus, with 18 studies identified. The literature review revealed that clinician-based bias and discrimination worsen pain and disability by reducing access to treatment and increasing patient pain-related injustice, catastrophizing, depression, and perceived stress. In contrast, clinician education and perspective-taking, patient decision tools, and community outreach interventions can help reduce bias and disparities in musculoskeletal pain outcomes. Increasing the diversity of the healthcare workforce should also be a priority. Models of care focused on health equity may provide an ideal framework to reduce bias and provide sustainable improvement in musculoskeletal pain management.

Neurophysiological and transcriptomic predictors of chronic low back pain: Study protocol for a longitudinal inception cohort study

Chronic low back pain is one of the most common, costly, and debilitating pain conditions worldwide. Increased mechanistic understanding of the transition from acute to chronic low back and identification of predictive biomarkers could enhance the clinical assessment performed by healthcare providers and enable the development of targeted treatment to prevent and/or better manage chronic low back pain. This study protocol was designed to identify the neurological and transcriptomic biomarkers predictive of chronic low back pain at low back pain onset. This is a prospective descriptive longitudinal inception cohort study that will follow 340 individuals with acute low back pain and 40 healthy controls over 2 years. To analyze the neurophysiological and transcriptomic biomarkers of low back pain, the protocol includes psychological and pain-related survey data that will be collected beginning within 6 weeks of low back pain onset (baseline, 6, 12, 24, 52 weeks, and 2 years) and remotely at five additional time points (8, 10, 16, 20 weeks, and 18 months). Quantitative sensory testing and collection of blood samples for RNA sequencing will occur during the six in-person visits. The study results will describe variations in the neurophysiological and transcriptomic profiles of healthy pain-free controls and individuals with low back pain who either recover to pain-free status or develop chronic low back pain.