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Shaw E, Nunns M, Spicer SG, Lawal H, Briscoe S, Melendez‐Torres GJ, Garside R, Liabo K, Coon JT. What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1412. [PMID: 38751859 PMCID: PMC11094349 DOI: 10.1002/cl2.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes. Objectives The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes. Search Methods In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. Selection Criteria Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. Data Collection and Analysis Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM. Stakeholder Involvement We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. Main Results We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. Authors’ Conclusions This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.
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Affiliation(s)
- Elizabeth Shaw
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Michael Nunns
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Stuart G. Spicer
- NIHR Applied Research CollaborationUniversity of PlymouthPlymouthUK
| | - Hassanat Lawal
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Simon Briscoe
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - G. J. Melendez‐Torres
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Ruth Garside
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Kristin Liabo
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
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Tehrany R, Maki D, Teixeira MJC, Chumak T, Hoerz C. Allied health professionals' experiences and views towards improving musculoskeletal services in the UK for patients with musculoskeletal and co-existing mental health conditions: a qualitative study. BMC Musculoskelet Disord 2024; 25:207. [PMID: 38454371 PMCID: PMC10918939 DOI: 10.1186/s12891-023-06878-w] [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: 12/29/2022] [Accepted: 09/12/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Interplay between physical and mental health (MH) is widely recognised amongst patients with Musculoskeletal and co-existing MH conditions. Evidence suggests that psychological interventions improve outcomes and satisfaction in patients with physical conditions, however current healthcare models continue to separate physical and mental health care, as health services are fragmented. If the delivery of MH support could be facilitated by Allied Health Professionals (AHPs), such as physiotherapists and occupational therapists (OTs), this could be an effective, low-cost way to achieve routine integration. This study aimed to explore the experiences of UK physiotherapists and OTs working with patients with MSK and co-existing MH conditions and to understand views on improving MSK services. METHODS This was an exploratory-descriptive qualitative study using semi-structured interviews. Participants were recruited via social media and professional organisations using convenience sampling. Participants included registered UK physiotherapists or OTs within MSK settings who managed patients with MH conditions. Inductive thematic analysis was used, where single and double-level coding, single counting and inclusion of divergent cases were conducted to enhance methodological rigour. RESULTS Three overarching themes were identified. Overarching theme one referred to openness to provide MH support, with scope of practice and lack of confidence as themes. Overarching theme two described challenges, incorporating mental health stigma, the clinical environment, and limited experience. The overarching theme referring to training, identified the need for further training and strategies to implement as themes. CONCLUSION Many challenges to achieving optimal integration of physical and mental health care exist within MSK services. These challenges go beyond the need for additional training and knowledge acquisition and include departmental readiness such as funding, diary management, and supervision by senior colleagues/or psychologists. These need consideration in parallel to match the evolving needs of the MSK population.
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Affiliation(s)
- Rokhsaneh Tehrany
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, London, UK.
- Department of Orthopaedic and Musculoskeletal Science, University College London, London, UK.
| | - Dana Maki
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
- Alanzoor Physiotherapy & Rehabilitation Complex, Manama, Kingdom of Bahrain
| | - Maria J C Teixeira
- Nursing Research Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
- London South Bank University, London, UK
- Nuffield Health Oxford, The Manor Hospital, Oxford, UK
| | - Tanya Chumak
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Christine Hoerz
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
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Boylan P, Knisley J, Wiskur B, Nguyen J, Lam K, Hong J, Caballero J. Pharmacist-social worker interprofessional relations and education in mental health: a scoping review. PeerJ 2024; 12:e16977. [PMID: 38410797 PMCID: PMC10896088 DOI: 10.7717/peerj.16977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Background One in eight patients is affected by a mental health condition, and interprofessional mental health teams collaborate to improve patient care. While pharmacists and social workers are recognized as mental health team members, there is a lack of literature describing interprofessional relations and education between these professions, especially as it pertains to mental health. The purpose of this review was to identify and characterize reports describing pharmacist-social worker interprofessional relations and education within mental health. Methodology To address this knowledge gap, this scoping review was conducted to collect and characterize reports published between January 1, 1960 and August 18, 2023 describing pharmacist-social worker interprofessional relations and education within the field of mental health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Ovid MEDLINE, CINAHL, and Social Work Abstracts were searched using keywords "pharmacy student," "pharmacist," "social work student," "social worker," and "social work." Reports were included if they were published in English and interprofessional relations or education occurred directly between (student) pharmacists and social workers. Results Three hundred twenty records were identified and three records were included: one cross sectional study, one qualitative educational project, and one case report. Each record suggested positive patient and/or educational outcomes developing from pharmacist-social worker interprofessional relations and education. In clinical practice, pharmacist-social work teams identified mental health risk factors, reduced 30-day readmissions, and improved post-discharge telehealth care. In the classroom, a social worker improved pharmacy students' confidence assessing patient suicidal ideations. Conclusions This scoping review identified needs and areas for future research: pharmacist interprofessional education with Master of Social Work and Doctor of Social Work degree students, transitional care and mental health outcome measure reporting using evidence-based outcomes, and development of scholarly teaching projects utilizing higher-level educational frameworks beyond learner reactions.
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Affiliation(s)
- Paul Boylan
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | | | - Brandt Wiskur
- Office of the Vice Provost for Academic Affairs and Faculty Development, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jessica Nguyen
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Kristine Lam
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jisoo Hong
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Joshua Caballero
- College of Pharmacy, University of Georgia, Athens, Georgia, United States
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Mauck MC, Aylward AF, Barton CE, Birckhead B, Carey T, Dalton DM, Fields AJ, Fritz J, Hassett AL, Hoffmeyer A, Jones SB, McLean SA, Mehling WE, O'Neill CW, Schneider MJ, Williams DA, Zheng P, Wasan AD. [Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. Schmerz 2024:10.1007/s00482-024-00798-x. [PMID: 38381187 DOI: 10.1007/s00482-024-00798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Affiliation(s)
- Matthew C Mauck
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA.
| | - Aileen F Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chloe E Barton
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Brandon Birckhead
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane M Dalton
- Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Hoffmeyer
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Conor W O'Neill
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Michael J Schneider
- Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Zheng
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Ajay D Wasan
- Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Ceulemans D, Moens M, Reneman M, Callens J, De Smedt A, Godderis L, Goudman L, Lavreysen O, Putman K, Van de Velde D. Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis. J Rehabil Med 2024; 56:jrm13454. [PMID: 38226563 PMCID: PMC10802789 DOI: 10.2340/jrm.v56.13454] [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: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. DESIGN A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. METHODS Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. RESULTS Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. CONCLUSION This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.
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Affiliation(s)
- Dries Ceulemans
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium; STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Michiel Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jonas Callens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium; IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Olivia Lavreysen
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
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Schepens C, BOUCHE K, BRAECKMAN L, ROMBAUTS P, LINDEN P, PARLEVLIET T. THE MULTIDISCIPLINARY BIOPSYCHOSOCIAL REHABILITATION PROGRAMME FOR PATIENTS WITH CHRONIC SPINAL PAIN: OUTCOMES WITH WORK STATUS AS THE PRIMARY FOCUS. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2024; 7:5250. [PMID: 38264066 PMCID: PMC10802782 DOI: 10.2340/jrmcc.v7.5250] [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: 10/27/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Objective To assess the efficacy of the multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients as to work status, physical functioning, pain intensity, health-related quality of life and the psychosocial domain. Design This is a retrospective, single-centre, observational cohort study. Subjects/Patients A total of 209 subjects (mean age 41.5 ± 11.4 years) with chronic spinal pain participated in the rehabilitation programme. Methods Evaluations were conducted through standardized questionnaires at baseline and at the end of the rehabilitation programme. Results Patients were more likely to be at work. Sick leave and work VAS changed significantly. Patients in blue-collar jobs are less likely to return to work. Pain intensity, physical functioning, health-related quality of life and lumbar and cervical range of motion improved significantly. Conclusion The multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients improved the rate of return to work. In daily clinical practice, attention must be given to reducing mobility issues in daily life in order to get patients back to work. The occupational therapist should give patients with blue-collar jobs sufficient attention early in the programme in order to achieve a higher rate of return to work.
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Affiliation(s)
| | - Katie BOUCHE
- Physical and Rehabilitation Medicine, Ghent University, Ghent
| | - Lutgart BRAECKMAN
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Patrick LINDEN
- Physical and Rehabilitation Medicine, AZ Delta, Roeselare
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Nøst TH, Dahl-Michelsen T, Aandahl H, Steinsbekk A. Healthcare professionals' experiences of interdisciplinary collaboration in pain centres - A qualitative study. Scand J Pain 2024; 24:sjpain-2023-0132. [PMID: 38469660 DOI: 10.1515/sjpain-2023-0132] [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: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES The complexity of chronic pain requires interdisciplinary collaboration. Although this is recognisable in the framework for pain centres, few studies have investigated how interdisciplinary collaboration in pain centres is experienced by healthcare professionals, including the facilitators and barriers to interdisciplinary collaboration. The aim of the current study was therefore to investigate experiences of interdisciplinary collaboration in the treatment of patients with chronic pain among healthcare professionals in tertiary care pain centres. METHODS Eleven healthcare professionals, representing different healthcare disciplines from the four regional pain centres in Norway, participated in semi-structured individual interviews. The data were analysed thematically. RESULTS The results were categorised into three themes 'The best approach for chronic pain treatment', 'Collegial collaboration', and 'Challenges with interdisciplinary teamwork'. The informants valued the interdisciplinary work at the pain centre. They perceived it as the best approach for their patients and appreciated the support the collegial collaboration gave them as professionals. Although working together was rewarding and provided new insights, the informants also experienced the interdisciplinary teamwork as challenging, e.g., when the different professions disagreed on recommendations for further treatment or did not manage to work together as a team. CONCLUSION The informants found the interdisciplinary collaboration at the pain centre to provide the best treatment approach for their patients. It should be acknowledged that interdisciplinary teamwork can be challenging, and efforts should be put into establishing a good climate for collaboration and gaining knowledge about each profession's unique character and how they contribute to pain centre treatments.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tone Dahl-Michelsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health, VID Specialized University, Oslo, Norway
| | - Hanne Aandahl
- Department for Pain and Complex Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Digital Health Care Unit, Norwegian Centre for E-Health Research, Tromsø, Norway
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Lindenberg N, Bundscherer A, Wiese C, Lassen C. [Do pain therapy patients benefit from their fellow patients? : A retrospective observational study on the influence of the stage of pain management and therapy experience of fellow patients on the individual therapy success in an inpatient interdisciplinary multimodal pain therapy (IMPT)]. Schmerz 2023:10.1007/s00482-023-00774-x. [PMID: 38108893 DOI: 10.1007/s00482-023-00774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Interdisciplinary multimodal pain therapy (IMPT) is mostly run in a group setting to encourage the exchange of experiences between patients and thus facilitate the change of pain-related attitudes and behavior. As is known from psychotherapy research, the fellow patients in a therapy group have a relevant influence on the success of the therapy for the individual patient. OBJECTIVE We examined the extent to which therapy success in an IMST group is influenced by individual co-patient characteristics, such as cognitive behavioral pain management, the difference to their own pain management and the proportion of co-patients who repeat therapy. METHOD In a retrospectively planned investigation of the psychometric tests of all patients in an inpatient IMST between January 2013 and February 2020, the influence of fellow patient characteristics on clinically relevant changes with respect to various parameters of the severity of chronic pain disorders was analyzed using binary logistic regression analyses. RESULTS We examined 636 treatment cases of which 540 were first-time stays. On each day of treatment, 5 fellow patients were present, 15% of whom had repeated the therapy. We were able to show that the proportion of fellow patients who repeat the therapy (p < 0.001; odds ratio, OR = 1.032) and the cognitive behavioral pain management of the fellow patients (p < 0.001; OR = 2.885) significantly increase the probability of achieving success in at least one of the parameters examined. An influence of a specific parameter on the success of therapy could not be proven. CONCLUSION Despite methodological limitations our results suggest that in patient groups of an IMST, patients with therapy experience and those with advanced cognitive behavioral methods for pain management should be combined with novices and patients who are still at the beginning of coping with the chronic pain disorder.
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Affiliation(s)
- Nicole Lindenberg
- Zentrum für interdisziplinäre Schmerztherapie, Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Anika Bundscherer
- Zentrum für interdisziplinäre Schmerztherapie, Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Christoph Wiese
- Klinik für Anästhesiologie und Intensivmedizin, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124, Braunschweig, Deutschland
| | - Christoph Lassen
- Zentrum für interdisziplinäre Schmerztherapie, Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Areias AC, Molinos M, Moulder RG, Janela D, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management. NPJ Digit Med 2023; 6:188. [PMID: 37816899 PMCID: PMC10564877 DOI: 10.1038/s41746-023-00936-2] [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: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from -2.0 95%CI -2.1, -1.9 to -2.1 95%CI -2.3, -1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.
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Affiliation(s)
| | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | | | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Steven P Cohen
- Department of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Yang Y, Lai X, Li C, Yang Y, Gu S, Hou W, Zhai L, Zhu Y. Focus on the impact of social factors and lifestyle on the disease burden of low back pain: findings from the global burden of disease study 2019. BMC Musculoskelet Disord 2023; 24:679. [PMID: 37633880 PMCID: PMC10464198 DOI: 10.1186/s12891-023-06772-5] [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: 03/23/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the leading causes of disability worldwide. Differences in social backgrounds and lifestyles in various regions and countries may contribute to the discrepancies in the disease burden of LBP. METHODS Based on the GBD 2019, we collected and analyzed numbers and age-standardized rates (ASR) of LBP disability-adjusted life years (DALYs). Temporal trends in ASR were also analyzed using estimated annual percentage change (EAPC). The Age-period-cohort (APC) model was used to estimate age, period and cohort trends in DALYs of LBP. An autoregressive integrated moving average (ARIMA) model was used to forecast DALYs of LBP trends from 2020 to 2035. RESULTS The DALYs due to LBP increased from 1990 to 2019. The APC model showed that the risk of DALYs for global LBP increased with age and year and that the risk of DALYs was lower in the later-born cohort than in the earlier-born cohort. The main risk factors which GBD estimates were available for DALYs of LBP include smoking, occupational ergonomic factors and high BMI. It is expected that DALYs of LBP will continue to rise until 2035. CONCLUSION From 1990 to 2019, the global disease burden of LBP remained high. It is necessary to pay attention to the influence of social factors and lifestyle on LBP. Focusing on the impact of social factors as well as lifestyle on the prognosis of LBP and targeting interventions may further reduce the disease burden of LBP.
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Affiliation(s)
- Yao Yang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, 450000, China
| | - Xigui Lai
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, China
| | - Conghui Li
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, 450000, China
| | - Yujie Yang
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong, China
| | - Shanshan Gu
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Weiqian Hou
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, 450000, China
| | - Liwen Zhai
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, 450000, China
| | - Yi Zhu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450000, China.
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11
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Wami SD, Fasika S, Donnelly C, Gelaye KA, Pullatayil A, Miller J. Characteristics of interprofessional rehabilitation programs for patients with chronic low back pain evaluated in the literature: a scoping review protocol. Syst Rev 2023; 12:105. [PMID: 37386618 PMCID: PMC10308723 DOI: 10.1186/s13643-023-02275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Interprofessional rehabilitation programs have demonstrated effectiveness at improving health-related quality of life, function, work abilities, and reducing pain, for patients with chronic low back pain (CLBP). However, the characteristics of interprofessional rehabilitation programs vary widely across studies. Therefore, clarifying and describing key characteristics of interprofessional rehabilitation programs for patients with CLBP will be valuable for future intervention design and implementation. This scoping review aims to identify and describe the key characteristics of interprofessional rehabilitation programs for patients with CLBP. METHODS Our scoping review will follow the framework developed by Arksey and O'Malley, further enhanced by Levac et al. and the Joanna Briggs Institute (JBI). Electronic databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, PubMed, Web of Science, and Cochrane Library, will be searched to identify relevant published studies. Our scoping review will consider all primary source peer-reviewed published articles that evaluated interprofessional rehabilitation programs for adults with CLBP from all countries and any therapeutic settings. The Covidence software will be used to remove duplicates, article screening, record the step-by-step selection process, and data extraction. The analysis will involve a descriptive numerical summary and narrative analysis. Data will be presented in graphical and tabular format based on the nature of the data. DISCUSSION This scoping review is expected to provide a source of evidence for developing and implementing interprofessional rehabilitation programs in new settings or contexts. As such, this review will guide future research and provide key information to health professionals, researchers and policymakers interested in designing and implementing evidence and theory-informed interprofessional rehabilitation programs for patients with CLBP. TRIAL REGISTRATION https://osf.io/rquxv .
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Affiliation(s)
- Sintayehu Daba Wami
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Fasika
- Department of Physiotherapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | | | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
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12
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Cheung JPY, Cheung PWH, Wong CKH, Chung HY, Tsang HHL. Propensity-matched Comparison Between Chronic Nonspecific Low Back Pain and Axial Spondyloarthritis: Impact on patient-perceived Quality of Life. Spine (Phila Pa 1976) 2023; 48:577-589. [PMID: 36255382 PMCID: PMC10035658 DOI: 10.1097/brs.0000000000004514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/30/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA). SUMMARY OF BACKGROUND DATA Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects. MATERIALS AND METHODS Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions. RESULTS A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger ( P <0.001), with more males ( P <0.001), and better educated ( P =0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use ( P <0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341-20.671; P <0.001) of experiencing current back pain compared with SpA patients. CONCLUSIONS The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management. LEVEL OF EVIDENCE Type I prognostic study.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Ho Yin Chung
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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13
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Alshehre YM, Alkhathami K, Brizzolara K, Weber M, Wang-Price S. Effectiveness of Spinal Stabilization Exercises on Dynamic Balance in Adults with Chronic Low Back Pain. Int J Sports Phys Ther 2023; 18:173-187. [PMID: 36793561 PMCID: PMC9897002 DOI: 10.26603/001c.68075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance. Purpose To determine the effectiveness of SSEs on dynamic balance in adults with CLBP. Study Design A double-blind randomized clinical trial. Methods Forty participants with CLBP were assigned randomly into either an SSE group or a general exercise (GE) group, which consisted of flexibility and range-of-motion exercises. Participants attended a total of four to eight supervised physical therapy (PT) sessions and performed their assigned exercises at home in the first four weeks of the eight-week intervention. In the last four weeks, the participants performed their exercises at home with no supervised PT sessions. Participants' dynamic balance was measured using the Y-Balance Test (YBT) and the normalized composite scores, Numeric Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire scores were collected at baseline, two weeks, four weeks, and eight weeks. Results A significant difference between groups from two weeks to four weeks (p = 0.002) was found, with the SSE group demonstrating higher YBT composite scores than the GE group. However, there were no significant between-group differences from baseline to two weeks (p =0.098), and from four weeks to eight weeks (p = 0.413). Conclusions Supervised SSEs were superior to GEs in improving dynamic balance for the first four weeks after initiating intervention in adults with CLBP. However, GEs appeared to have an effect equivalent to that of SSEs after 8-week intervention. Levels of Evidence 1b.
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Affiliation(s)
- Yousef M Alshehre
- Physical Therapy Department, Faculty of Applied Medical Sciences University of Tabuk, Saudi Arabia
| | | | - Kelli Brizzolara
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
| | - Mark Weber
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
| | - Sharon Wang-Price
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
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14
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Alkhathami K, Alshehre Y, Brizzolara K, Weber M, Wang-Price S. Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain. Int J Sports Phys Ther 2023; 18:169-172. [PMID: 36793568 PMCID: PMC9897033 DOI: 10.26603/001c.68024] [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: 06/03/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.
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Affiliation(s)
| | | | | | - Mark Weber
- School of Physical Therapy Texas Woman's University
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15
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Manigold T, Gantschnig BE, Streitberger K. [Multiprofessional treatment approach in chronic back pain]. Z Rheumatol 2023; 82:31-37. [PMID: 36053333 PMCID: PMC9894955 DOI: 10.1007/s00393-022-01258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 02/06/2023]
Abstract
International guidelines recommend involving various professions and disciplines at an early stage in the event of chronic back pain. In connection with this, terms such as multiprofessional or interprofessional interventions are often mentioned without a uniform idea of what they mean. This article is intended to provide an overview of multiprofessional interventions for patients with chronic back pain and the integration into a meaningful interdisciplinary and interprofessional multimodal treatment concept. This is illustrated in a biopsychosocial pillar model, which should be pursued for each patient individually.
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Affiliation(s)
- Tobias Manigold
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstr. 16p, 3010, Bern, Schweiz.
| | - Brigitte E Gantschnig
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstr. 16p, 3010, Bern, Schweiz
- Institut für Ergotherapie, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Zürich, Schweiz
| | - Konrad Streitberger
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
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Pedersen KKW, Langagergaard V, Jensen OK, Nielsen CV, Sørensen VN, Pedersen P. Two-Year Follow-Up on Return to Work in a Randomised Controlled Trial Comparing Brief and Multidisciplinary Intervention in Employees on Sick Leave Due to Low Back Pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:697-704. [PMID: 35147899 DOI: 10.1007/s10926-022-10030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To study return to work (RTW) at 2-year follow-up in a randomised controlled trial comparing brief intervention (BI) and multidisciplinary intervention (MDI) in employees on sick leave due to low back pain (LBP) stratified for job relations. METHODS In total 476 employees on sick leave for 4-12 weeks due to LBP were divided into strata with weak or strong job relations, based on perceived risk of losing job and influence on job planning. In each stratum participants were allocated to BI or MDI. All participants received BI, i.e. a clinical examination by a rheumatologist and physiotherapist. In addition, MDI involved a case manager who made a rehabilitation plan in collaboration with the participant. The primary outcome was time to RTW. Secondary outcomes were median weeks in different employment status and selfreported pain, disability and psychological health. Sustained RTW was estimated by work status the last 4 weeks before the 2-year date. RESULTS Participants with strong job relations who received BI had a higher RTW rate (hazard ratio = 0.74 (95% CI 0.57; 0.96)) and spent more weeks working than participants who received MDI. In the stratum of weak job relations, no difference was seen regarding RTW and weeks working. For health-related outcomes and sustained RTW no significant results were found in neither stratum. CONCLUSIONS Employees with strong job relations achieved higher RTW rates when receiving BI compared to MDI, while no difference was found between intervention groups for employees with weak job relations. TRIAL REGISTRATION Current Controlled Trials ISRCTN14136384. Registered 4 August.
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Affiliation(s)
| | - Vivian Langagergaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Ole K Jensen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus V Nielsen
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Vibeke N Sørensen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Pernille Pedersen
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
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17
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Talbot LA, Ramirez VJ, Webb L, Morrell C, Metter EJ. Home therapies to improve disability, activity, and quality of life in military personnel with subacute low back pain: Secondary outcome analysis of a randomized controlled trial. Nurs Outlook 2022; 70:S136-S145. [PMID: 36585060 DOI: 10.1016/j.outlook.2022.08.007] [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: 03/31/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Low back pain (LBP) is an urgent military health concern with implications for fitness, quality of life (QoL) and disability. PURPOSE This secondary outcome analysis from a randomized controlled trial (RCT) was to determine if the addition of neuromuscular electrical stimulation core strength training (NMES) or progressive exercise (PEP)in conjunction with primary care management (PCM) was more effective than PCM alone. METHODS This randomized controlled trial (RCT assigned 128 service members to the three intervention groups. The outcomes included changes in perceived disability (Oswestry Disability Index), health-related quality of life (SF-12v2), pain during activity (Clinical Back Pain Questionnaire), and daily steps walked in service members with subacute LBP. FINDINGS Over a 9-week intervention, perceived disability, SF-12v2 physical component summary, and activity associated with pain improved in all groups. Home therapies were helpful to reduce perceived disability, QoL and pain during activity in service members with subacute LBP. DISCUSSION These non-pharmacological options provide other home-managed approaches for those in the subacute LBP phase.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | | | - Lee Webb
- La Pointe Health Clinic, Physical Therapy, Fort Campbell, KY
| | - Christopher Morrell
- Department of Mathematics and Statistics, Loyola University Maryland, Baltimore, MD
| | - Earl J Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
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18
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Luites JWH, Kuijer PPFM, Hulshof CTJ, Kok R, Langendam MW, Oosterhuis T, Anema JR, Lapré-Utama VP, Everaert CPJ, Wind H, Smeets RJEM, van Zaanen Y, Hoebink EA, Voogt L, de Hoop W, Boerman DH, Hoving JL. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:337-352. [PMID: 34313903 PMCID: PMC9576671 DOI: 10.1007/s10926-021-09993-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 05/06/2023]
Abstract
Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.
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Affiliation(s)
- J W H Luites
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands.
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - C T J Hulshof
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - R Kok
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - M W Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Institute of Public Health, Amsterdam, The Netherlands
| | - T Oosterhuis
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - V P Lapré-Utama
- Dutch Association of Medical Officers in Private Insurances (GAV), Utrecht, The Netherlands
| | - C P J Everaert
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
- Arbo Unie, Arnhem, The Netherlands
| | - H Wind
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Society of Insurance Medicine (NVVG), Amsterdam, The Netherlands
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
- Netherlands Society of Physical and Rehabilitation Medicine (VRA), Utrecht, The Netherlands
| | - Y van Zaanen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Dutch Association of Physiotherapists Working in Occupational Health and Ergonomics (NVBF-KNGF), Amersfoort, The Netherlands
| | - E A Hoebink
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education (FORCE), Amphia Hospital, Breda, The Netherlands
| | - L Voogt
- Dutch Association for Patients With Back Problems (NVvR), Rotterdam, The Netherlands
| | - W de Hoop
- Dutch Association for Labour Experts (NVvA), Nijkerk, The Netherlands
| | - D H Boerman
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Netherlands Society for Neurology (NVN), Utrecht, The Netherlands
| | - J L Hoving
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
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19
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Costa F, Janela D, Molinos M, Moulder RG, Lains J, Bento V, Scheer J, Yanamadala V, Correia FD, Cohen SP. Digital Rehabilitation for Acute Low Back Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:1873-1887. [PMID: 35813029 PMCID: PMC9261956 DOI: 10.2147/jpr.s369926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) has a lifetime prevalence of 70–80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs. Purpose We aim to report the results of a fully remote digital care program (DCP) for acute LBP. Patients and Methods This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4). Conclusion This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.
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Affiliation(s)
- Fabíola Costa
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Dora Janela
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Maria Molinos
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Vijay Yanamadala
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Correspondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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20
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Costa F, Janela D, Molinos M, Moulder R, Bento V, Lains J, Scheer J, Yanamadala V, Cohen S, Dias Correia F. Depression and work productivity: insights from a longitudinal cohort study on digital care programs for Musculoskeletal conditions. J Med Internet Res 2022; 24:e38942. [PMID: 35714099 PMCID: PMC9361146 DOI: 10.2196/38942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity between musculoskeletal (MSK) pain and depression is highly common and associated with greater symptom burden and greater loss of work productivity. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. OBJECTIVE Assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. METHODS The present study is an ad-hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP. Three subgroups with different baseline depression severity levels were created based on the Patient Health Questionnaire (PHQ-9): cluster 1 (<5: minimal depression); cluster 2 (5-10: mild depression) and cluster 3 (≥10: moderate depression). The mean change between baseline and end-of-program (8-12 weeks) on depression, anxiety, fear-avoidance beliefs, work productivity and activity impairment and adherence was assessed across subgroups. Outcome changes were analyzed by latent growth curve analysis. RESULTS From a total of 7785 eligible participants, 6137 (78.8%) were included in Cluster 1, 1158 (14.9%) in cluster 2 and 490 (6.3%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (5 and 10 for clusters 2 and 3, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95%CI -20.32 to -13.42 in cluster 1 to -20.10, 95%CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). CONCLUSIONS A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. CLINICALTRIAL ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Fabíola Costa
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Dora Janela
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Maria Molinos
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Robert Moulder
- Institute for Cognitive Science, University of Colorado, Boulder, US
| | - Vírgilio Bento
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, PT.,Faculty of Medicine, Coimbra University, Coimbra, PT
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, US
| | - Vijay Yanamadala
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, US.,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, US.,SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Steven Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, US.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Maryland, USA, Bethesda, US
| | - Fernando Dias Correia
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PT
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21
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Circadian Rhythm Modulates the Therapeutic Activity of Pulsed Electromagnetic Fields on Intervertebral Disc Degeneration in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9067611. [PMID: 35368872 PMCID: PMC8975688 DOI: 10.1155/2022/9067611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
Circadian rhythm (CR) imparts significant benefits in treating multiple diseases, such as heart diseases and arthritis. But the CR effect on intervertebral disc degeneration (IVDD) therapy remains unclear. Recent studies revealed that pulsed electromagnetic fields (PEMF) are capable of alleviating IVDD. In this study, we evaluated the CR-mediated regulation of PEMF therapeutic effect on IVDD induced by rat tail disc needle puncture. Our results demonstrated that the daytime PEMF stimulation (DPEMF) is more effective than the nighttime PEMF (NPEMF) in delaying IVDD. Moreover, the rats treated with DPEMF maintained better disc stability and histology after 8 weeks, relative to NPEMF. CR and PEMF cotherapies were also examined in cellular models, whereby serum shock was used to induce different levels of clock gene expression in the nucleus pulposus (NP), thus imitating CR in vitro. PEMF at ZT8 (higher level of clock gene expression) correlated with a higher extracellular matrix (ECM) component expression, compared to ZT20 (lower level of clock gene expression). Taken together, these data suggest a strong role of CR in regulating the beneficial effect of PEMF on IVDD. Our findings provide a potential clinical significance of CR in optimizing PEMF positive effects on IVDD.
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22
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Sarma K, Kohns DJ, Berri MA, Joyce E, Smith SR. Interventional and Non-interventional Medical Rehabilitation Approaches to Axial Spine Pain in Vertebral Metastatic Disease. FRONTIERS IN PAIN RESEARCH 2022; 2:675787. [PMID: 35295460 PMCID: PMC8915636 DOI: 10.3389/fpain.2021.675787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
Abstract
As targeted therapies help patients with advanced cancer live longer, interventions for management of axial spine pain will become more common. Unfortunately, the indications for and safety of these procedures have been relatively unexplored compared with non-cancer adults. This review focuses on the following aspects of axial spine pain management in patients with vertebral metastatic disease: (1) pathophysiology and symptoms of cancer- and non-cancer-related spine pain; (2) safety and efficacy of non-interventional rehabilitation approaches to treat this pain; (3) considerations for interventional pain approaches to acute and chronic pain in patients with vertebral metastatic disease. This review also summarizes gaps in the literature and describes specific cases in which the described interventions have been applied.
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Affiliation(s)
- Krishna Sarma
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, United States
| | - David J Kohns
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Maryam A Berri
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Elizabeth Joyce
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, United States
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Puerto Valencia L, Arampatzis D, Beck H, Dreinhöfer K, Drießlein D, Mau W, Zimmer JM, Schäfer M, Steinfeldt F, Wippert PM. RENaBack: low back pain patients in rehabilitation-study protocol for a multicenter, randomized controlled trial. Trials 2021; 22:932. [PMID: 34922613 PMCID: PMC8684145 DOI: 10.1186/s13063-021-05823-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 11/12/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. METHODS The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). DISCUSSION An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. TRIAL REGISTRATION DRKS, DRKS00020373 . Registered on 15 April 2020.
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Affiliation(s)
| | - Diamantes Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heidrun Beck
- University Center for Orthopaedics and Trauma Surgery, Hospital Carl Gustav Carus at Technical University Dresden, Dresden, Germany
| | - Karsten Dreinhöfer
- Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, Munich, Germany
| | - David Drießlein
- Department of Orthopaedics and Trauma Surgery, Medical Park Berlin Humboldtmühle, Charité Berlin, Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin-Luther-University (MLU) Halle-Wittenberg, Halle, Germany
| | - Julia-Marie Zimmer
- Institute for Rehabilitation Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin-Luther-University (MLU) Halle-Wittenberg, Halle, Germany
| | - Michael Schäfer
- Department of Orthopedics, German Pension Insurance Berlin-Brandenburg, Rehabilitation Clinic Hohenelse, Rheinsberg, Germany
| | - Friedemann Steinfeldt
- Johannesbad Specialist Clinic & Health Center Raupennest, Orthopedic Clinic in Altenberg, Altenberg, Germany
| | - Pia-Maria Wippert
- Medical Sociology and Psychobiology, University of Potsdam, Potsdam, Germany.
- Faculty of Health Sciences Brandenburg, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany.
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Jain D, Norman K, Werner Z, Makovoz B, Baker T, Huber S. Using Postmarket Surveillance to Assess Safety-Related Events in a Digital Rehabilitation App (Kaia App): Observational Study. JMIR Hum Factors 2021; 8:e25453. [PMID: 34751664 PMCID: PMC8663617 DOI: 10.2196/25453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022] Open
Abstract
Background Low back pain (LBP) affects nearly 4 out of 5 individuals during their lifetime and is the leading cause of disability globally. Digital therapeutics are emerging as effective treatment options for individuals experiencing LBP. Despite the growth of evidence demonstrating the benefits of these therapeutics in reducing LBP and improving functional outcomes, little data has been systematically collected on their safety profiles. Objective This study aims to evaluate the safety profile of a multidisciplinary digital therapeutic for LBP, the Kaia App, by performing a comprehensive assessment of reported adverse events (AEs) by users as captured by a standardized process for postmarket surveillance. Methods All users of a multidisciplinary digital app that includes physiotherapy, mindfulness techniques, and education for LBP (Kaia App) from 2018 to 2019 were included. Relevant messages sent by users via the app were collected according to a standard operating procedure regulating postmarket surveillance of the device. These messages were then analyzed to determine if they described an adverse event (AE). Messages describing an AE were then categorized based on the type of AE, its seriousness, and its relatedness to the app, and they were described by numerical counts. User demographics, including age and gender, and data on app use were collected and evaluated to determine if they were risk factors for increased AE reporting. Results Of the 138,337 active users of the Kaia App, 125 (0.09%) reported at least one AE. Users reported 0.00014 AEs per active day on the app. The most common nonserious AE reported was increased pain. Other nonserious AEs reported included muscle issues, unpleasant sensations, headache, dizziness, and sleep disturbances. One serious AE, a surgery, was reported. Details of the event and its connection to the intervention were not obtainable, as the user did not provide more information when asked to do so; therefore, it was considered to be possibly related to the intervention. There was no relationship between gender and AE reporting (P>.99). Users aged 25 to 34 years had reduced odds (odds ratio [OR] 0.31, 95% CI 0.08-0.95; P=.03) of reporting AEs, while users aged 55 to 65 years (OR 2.53, 95% CI 1.36-4.84, P=.002) and ≥75 years (OR 4.36, 95% CI 1.07-13.26; P=.02) had increased odds. AEs were most frequently reported by users who had 0 to 99 active days on the app, and less frequently reported by users with more active days on the app. Conclusions This study on the Kaia App provides the first comprehensive assessment of reported AEs associated with real-world use of digital therapeutics for lower back pain. The overall rate of reported AEs was very low, but significant reporting bias is likely to be present. The AEs reported were generally consistent with those described for in-person therapies for LBP.
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Affiliation(s)
- Deeptee Jain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Kevin Norman
- Neoteric Consulting, New York, NY, United States
| | | | - Bar Makovoz
- Neoteric Consulting, New York, NY, United States
| | - Turner Baker
- Neoteric Consulting, New York, NY, United States
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25
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Grote V, Böttcher E, Unger A, Hofmann P, Moser M, Fischer MJ. Observational study of an inpatient program for musculoskeletal disorders: The effects of gender and physical activity. Medicine (Baltimore) 2021; 100:e27594. [PMID: 34713836 PMCID: PMC8556041 DOI: 10.1097/md.0000000000027594] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/08/2021] [Indexed: 01/05/2023] Open
Abstract
A new inpatient secondary preventive program for patients with musculoskeletal health problems was introduced throughout Austria. The aim of the current work was to evaluate this "Health Prevention Active" program and its possible influences on the quality of medical results upon hospital discharge.This observational study presents monocentric data for 7448 patients (48.99 ± 6.15 years; 53.7% women) with chronic musculoskeletal disorders who completed a 3-week health program. The focus was placed on measuring medical quality outcomes such as BMI, blood pressure, heart rate, pain, subjective ratings, and achieved power output in cycle ergometer exercise testing. We describe pre-post changes before and after the inpatient program and the results of a follow-up survey conducted after 1 year to identify moderating factors related to health outcomes.The medical baseline showed obvious deficits regarding obesity, hypertension, and subjective symptoms. Of all patients, 36.5% were completely inactive. The patient's gender and physical activity had a high impact on the medical baseline status. In total, the majority of patients (86.2%; SMD = -0.78 ± 0.59) responded well to the health prevention program, independent of their ages and lifestyles.Requirements for secondary prevention programs are high. The results of the study reflect the general problems presented by inactivity, obesity, and subjective symptoms like pain. Physical activity was specifically identified as a major factor for the observed medical baseline status.
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Affiliation(s)
- Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | | | - Alexandra Unger
- University College of Teacher Education Carinthia, Viktor Frankl University College, Klagenfurt, Austria
| | - Peter Hofmann
- Institute of Human Movement Science, Sport & Health, Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Maximilian Moser
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
- Human Research Institute, Weiz, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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26
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Falla D, Devecchi V, Jiménez-Grande D, Rügamer D, Liew BXW. Machine learning approaches applied in spinal pain research. J Electromyogr Kinesiol 2021; 61:102599. [PMID: 34624604 DOI: 10.1016/j.jelekin.2021.102599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this narrative review is to provide a critical reflection of how analytical machine learning approaches could provide the platform to harness variability of patient presentation to enhance clinical prediction. The review includes a summary of current knowledge on the physiological adaptations present in people with spinal pain. We discuss how contemporary evidence highlights the importance of not relying on single features when characterizing patients given the variability of physiological adaptations present in people with spinal pain. The advantages and disadvantages of current analytical strategies in contemporary basic science and epidemiological research are reviewed and we consider how analytical machine learning approaches could provide the platform to harness the variability of patient presentations to enhance clinical prediction of pain persistence or recurrence. We propose that machine learning techniques can be leveraged to translate a potentially heterogeneous set of variables into clinically useful information with the potential to enhance patient management.
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Affiliation(s)
- Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK.
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - David Jiménez-Grande
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - David Rügamer
- Department of Statistics, Ludwig-Maximilians-Universität München, Germany
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
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Miki T, Kondo Y, Kurakata H, Takebayashi T, Samukawa M. Effects of a physiotherapist-led approach based on a biopsychosocial model for spinal disorders: protocol for a systematic review. BMJ Open 2021; 11:e055144. [PMID: 34588269 PMCID: PMC8479989 DOI: 10.1136/bmjopen-2021-055144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Low back pain and neck pain are among the most common musculoskeletal disorders, and their related medical costs are rising every year. Many interventions are based on the biopsychosocial (BPS) model since the cause of pain is more multifaceted. Physiotherapists have increased opportunities to perform multidisciplinary interventions alone in clinical practice due to a lack of understanding of the model and its cost. Therefore, physiotherapist-led interventions using the BPS model are important and require an updated report summarising their effectiveness. Thus, the purpose of this study will be to summarise and synthesise the effects of physiotherapist-led interventions using the BPS model for spinal disorders. METHODS AND ANALYSIS We will search the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL and PEDro electronic databases, using a date range from inception to September 2021. We will include only randomised controlled trials for patients diagnosed with spinal disorders who received physiotherapist-led interventions based on the BPS model. The search will be limited to English-language publications. Pain intensity and disability are the primary outcomes. Secondary outcomes are any psychological factors. We will examine the short-term, medium-term and long-term effects, and a subgroup analysis will be conducted, if possible, to investigate the role of additional physiotherapist training. ETHICS AND DISSEMINATION This study is exempt from ethical approval because it involves publicly available documents. The findings will be submitted for publication in a relevant peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021258071.
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Affiliation(s)
- Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkaido, Japan
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Kurakata
- Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkido, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Sommers E, Vinjamury SP, Noborikawa J. Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning. Glob Adv Health Med 2021; 10:21649561211042571. [PMID: 34458014 PMCID: PMC8392795 DOI: 10.1177/21649561211042571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
The epidemics of pain and opioid use pose unique challenges. Comprehensive approaches are required to address minds, bodies and spirits of individuals who live with pain and/or opioid use. The lack of an effective “quick fix” for either condition necessitates developing effective, innovative and multi-disciplinary avenues for treatment. This analytic article reviews epidemiological and demographic factors associated with pain and with opioid use and additional challenges posed by the Covid-19 epidemic. Several large-scale studies and meta-analyses have examined the role of acupuncture as a nonpharmacological approach to pain management as well as a component of comprehensive strategies to address opioid use disorder. We review and describe these in the context of safety, effectiveness, access and cost-related factors. With one in four U.S. hospitals as well as 88% of Veterans Health Administration facilities incorporating acupuncture, the feasibility of mobilizing and scaling up these treatment resources is being developed and demonstrated. We also identify potential facilitators and barriers to implementing acupuncture treatment. As part of a multi-disciplinary approach to pain management and/or opioid use disorder, we suggest that integrating acupuncture into treatment protocols may represent a viable strategy that is based on and consistent with public health principles.
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Affiliation(s)
- Elizabeth Sommers
- Integrative Medicine and Health Disparities Program, Family Medicine Department, Boston Medical Center, Boston, Massachusetts.,Family Medicine Department, Boston University School of Medicine, Boston, Massachusetts
| | - Sivarama Prasad Vinjamury
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Jennifer Noborikawa
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
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See YKC, Smith HE, Car LT, Protheroe J, Wong WC, Bartlam B. Health literacy and health outcomes in patients with low back pain: a scoping review. BMC Med Inform Decis Mak 2021; 21:215. [PMID: 34256742 PMCID: PMC8276540 DOI: 10.1186/s12911-021-01572-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed. OBJECTIVES The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. METHODS The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis. RESULTS The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. CONCLUSIONS To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.
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Affiliation(s)
- Ye King Clarence See
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Helen Elizabeth Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Joanne Protheroe
- School of Primary, Community and Social Care, Keele University, Newcastle, UK
| | - Wei Cong Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bernadette Bartlam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Primary, Community and Social Care, Keele University, Newcastle, UK
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Standal MI, Aasdahl L, Jensen C, Foldal VS, Hagen R, Fors EA, Solbjør M, Hjemdal O, Grotle M, Meisingset I. Subgroups of Long-Term Sick-Listed Based on Prognostic Return to Work Factors Across Diagnoses: A Cross-Sectional Latent Class Analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:383-392. [PMID: 33052511 PMCID: PMC8172395 DOI: 10.1007/s10926-020-09928-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.
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Affiliation(s)
- Martin Inge Standal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Chris Jensen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Occupational Rehabilitation, Rauland, Norway
| | - Vegard Stolsmo Foldal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Egil Andreas Fors
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department for Research of Musculoskeletal Disorders (FORMI), Oslo University Hospital, Oslo, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Bethge M, Spanier K, Streibelt M. Using Administrative Data to Assess the Risk of Permanent Work Disability: A Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:376-382. [PMID: 32910345 PMCID: PMC8172482 DOI: 10.1007/s10926-020-09926-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Unmet rehabilitation needs are common. We therefore developed a risk score using administrative data to assess the risk of permanent work disability. Such a score may support the identification of individuals with a high likelihood of receiving a disability pension. Methods Our sample was a random and stratified 1% sample of individuals aged 18-65 years paying pension contributions. From administrative records, we extracted sociodemographic data and data about employment and welfare benefits covering 2010-2012. Our outcome was a pension due to work disability that was requested between January 2013 and December 2017. We developed a comprehensive logistic regression model and used the model estimates to determine the risk score. Results We included 352,140 individuals and counted 6,360 (1.8%) disability pensions during the 5-year follow-up. The area under the receiver operating curve was 0.839 (95% CI 0.834 to 0.844) for the continuous risk score. Using a threshold of ≥ 50 points (20.2% of all individuals), we correctly classified 80.6% of all individuals (sensitivity: 71.5%; specificity: 80.8%). Using ≥ 60 points (9.9% of all individuals), we correctly classified 90.3% (sensitivity: 54.9%; specificity: 91.0%). Individuals with 50 to < 60 points had a five times higher risk of a disability pension compared to individuals with low scores, individuals with ≥ 60 points a 17 times higher risk. Conclusions The risk score offers an opportunity to screen for people with a high risk of permanent work disability.
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Affiliation(s)
- Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Katja Spanier
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Monticone M, Ambrosini E, Portoghese I, Rocca B. Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up. Eur J Phys Rehabil Med 2021; 57:959-967. [PMID: 33947827 DOI: 10.23736/s1973-9087.21.06696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials. AIM To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent. DESIGN Randomised parallel-group superiority-controlled trial. SETTING Outpatient rehabilitation hospital. POPULATION 150 patients with subacute LBP. METHODS Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p<0.001), time (p=0.002), and time-by-group interaction (p<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up. CONCLUSIONS The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year. CLINICAL REHABILITATION IMPACT Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioural and motor lasting changes.
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Affiliation(s)
- Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy - .,Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy -
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research, Lissone, Monza Brianza, Italy
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Leung GCN, Cheung PWH, Lau G, Lau ST, Luk KDK, Wong YW, Cheung KMC, Koljonen PA, Cheung JPY. Multidisciplinary programme for rehabilitation of chronic low back pain - factors predicting successful return to work. BMC Musculoskelet Disord 2021; 22:251. [PMID: 33676471 PMCID: PMC7937227 DOI: 10.1186/s12891-021-04122-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are no clear indicators for predicting return to work for patients with chronic low back pain (LBP). We aim to report the outcomes of a 14-week multidisciplinary programme targeting patients with chronic LBP who failed conventional physiotherapy to provide functional rehabilitation. Also, this study will identify factors predicting successful return to work (RTW). Methods A collected cohort of patients with chronic LBP was consecutively enrolled into the programme from 1996 to 2014. All recruited patients failed to RTW despite at least 3 months of conservative treatment. Patient underwent weekly multidisciplinary sessions with physiotherapists, occupational therapists and clinical psychologists. Patient perceived function was considered the primary outcome of the programme. Patients were assessed for their sitting, standing and walking tolerance. Oswestry Disability Index (ODI) and Spinal Function Sort Score (SFSS) were used to assess patient perceived disability. Results One hundred and fifty-eight patients were recruited. After the programme, statistically significant improvement was found in ODI (47.5 to 45.0, p = 0.01) and SFSS (98.0 to 109.5, p < 0.001). There was statistically significant improvement (p < 0.01) in sitting, standing, walking tolerance and straight leg raise tests. 47.4% of the patients were able to meet their work demand. Multivariate logistic regression model (R2 = 59.5%, χ2 (9) = 85.640, p < 0.001) demonstrated that lower initial job demand level and higher patient-perceived back function correlated with greater likelihood of returning to work. Conclusion The results of this study may support the use of this multidisciplinary programme to improve patient function and return to work.
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Affiliation(s)
- Gabriel Ching Ngai Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Gareth Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Sin Ting Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Keith Dip Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
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Follow-Up of a Case of Dopamine-Mediated Yawning-Fatigue-Syndrome Responsive to Opioids, Successful Desensitization via Graded Activity Treatment. Neurol Int 2021; 13:79-84. [PMID: 33668800 PMCID: PMC7930949 DOI: 10.3390/neurolint13010008] [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: 01/10/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
A 60-year-old man suffering from recurrent attacks of yawning-fatigue-syndrome, triggered by mild exercise of his right leg since a temporary lumbar disc herniation 9 years ago, was initially treated with the oral µ-opioid-receptor agonist tilidine before each bout of exercise (see Dibaj et al. 2019 JAMA Neurology 2019;77:254). During the first few months, this treatment continuously prolonged the time without exercise-triggered yawning and fatigue. In the next few months of treatment, exercise was increased in a graded manner to alleviate the yawning-fatigue-syndrome. The number of repetitions of the physical exercises was gradually increased without taking the opioid beforehand. After several months, almost the same effort level without medication could be achieved by graded activity as before under the influence of opioid medication. Graded physical activity can thus disrupt complex pathophysiological mechanisms leading to yawning and fatigue.
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Abstract
Abstract
Objective
The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management.
Methods
A scoping review was guided by Arksey and O'Malley's (2005)1 five-stage framework, investigated contemporary patient education programs (2007–2018) for chronic pain management in education content, formats of delivery, and tools used for evaluation. Content analysis and description were used for the outcome report.
Results
Seven quantitative studies were included. Education content consisted of General information, Cognitive behavior therapy (CBT), Self-management, and Pain neurophysiology (PN). Education delivery formats varied from workbook to workbook, face-to-face, online, when given for a group or individual or in a combined way. In total, 19 tools were reported for the evaluation of the education programs.
Conclusions
There is a variety in the education content and the delivery formats. The majority of programs showed effectiveness in patients’ chronic pain management based on their selected evaluation tools. This review showed that patient education programs can be useful in chronic pain management. The effectiveness of patient education programs focuses on the improved patients’ physical function and quality of life rather than the cessation of pain only.
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Nicol AL, Adams MCB, Gordon DB, Mirza S, Dickerson D, Mackey S, Edwards D, Hurley RW. AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2661-2675. [PMID: 32914195 PMCID: PMC8453619 DOI: 10.1093/pm/pnaa239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy. METHODS A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain. RESULTS Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain. CONCLUSIONS The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.
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Affiliation(s)
- Andrea L Nicol
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Meredith C B Adams
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Debra B Gordon
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Sohail Mirza
- Department of Orthopedic Surgery, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - David Dickerson
- Department of Anesthesiology, NorthShore University Health System, Evanston, Illinois
| | - Sean Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - David Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert W Hurley
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston Salm, North Carolina, USA
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Kleinmann B, Wolter T, Weyerbrock A. Cooled radiofrequency for the treatment of sacroiliac joint pain - impact on pain and psychometrics: a retrospective cohort study. Scand J Pain 2020; 20:737-745. [PMID: 32841170 DOI: 10.1515/sjpain-2020-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/23/2020] [Indexed: 01/10/2023]
Abstract
Objectives Cooled radiofrequency (cRF) is an effective treatment for sacroiliac pain. In contrast to conventional radiofrequency denervation, this technique allows enlarging the area of denervation by cooling the radiofrequency probe. However, there is sparse knowledge about the impact of interventional procedures like cRF treatment of sacroiliac joint pain on psychological comorbidities. The aim of this retrospective study was to evaluate the outcome of cRF in chronic pain patients regarding the psychological outcomes anxiety, depression, sleep quality and pain related disability. Methods In this retrospective observational study 29 interventions were performed over a period of two years in 28 patients. Pre- and post-interventional pain levels, depression and anxiety scores, pain-related disability, treatment satisfaction and sleep quality were assessed by standardized and validated questionnaires. Pain medication was recorded prior to the intervention and at follow-up. Results Hospital Anxiety and Depression Scale (HADS-D) scores for depression showed a statistically significant reduction after therapy which did not remain significant after Bonferroni-Holm correction. Anxiety as measured by the HADS-A score did not show a statistically significant change. No statistically significant improvement was observed in the pain disability index. Patients reported fewer sleep disorders after treatment. Mean pain (NRS) was statistically significantly reduced 1 week post intervention and at time of follow-up. There was no clear reduction of analgesic medication. Conclusions Besides pain reduction, our data show a positive influence on sleep quality, possibly on depression, but not on anxiety and pain disability.
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Affiliation(s)
- Barbara Kleinmann
- Interdisciplinary Pain Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tilman Wolter
- Interdisciplinary Pain Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
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[Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews]. Z Gerontol Geriatr 2020; 54:54-60. [PMID: 33044620 PMCID: PMC7835300 DOI: 10.1007/s00391-020-01796-1] [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: 05/11/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Abstract
Hintergrund Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor. Ziel der Arbeit Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland. Methoden Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein. Ergebnisse Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme. Schlussfolgerungen Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.
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Kahere M, Ginindza T. The burden of non-specific chronic low back pain among adults in KwaZulu-Natal, South Africa: a protocol for a mixed-methods study. BMJ Open 2020; 10:e039554. [PMID: 32873683 PMCID: PMC7467525 DOI: 10.1136/bmjopen-2020-039554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is a major public health concern, affecting individuals of all age groups across the world. In about 90% of LBP cases, there is no specific cause identified and is, therefore, referred to as non-specific LBP. Due to the non-specific nature of LBP, investigations such as radiological and laboratory investigations are unnecessary and results to delayed diagnosis and improper treatment culminating in LBP progressing into chronic LBP (CLBP). LBP is now the leading cause of disability with a significant socioeconomic burden. Despite all these challenges, CLBP is regarded as a trivial condition in low-and-middle-income countries and remains poorly investigated. The distribution of CLBP in Africa is unclear. METHODS AND ANALYSIS The research will be conducted in two phases. The initial phase will be an observational, cross-sectional hospital-based study that will be recruiting 650 participants, to determine the prevalence and risk factors of CLBP. A standardised questionnaire will be used to collect baseline data on the socio-demographic characteristics of participants and other variables of interest (exercise history, occupational posture, level of education and the income status). Disability will be assessed using the Oswestry Disability Questionnaire and the psychological risk factors will be assessed using the Illness-Behaviour Questionnaire (IBQ) and the Fear-Avoidance Belief Questionnaire (FABQ). The second phase will be a retrospective, top-down, prevalence-based cost-of-illness study of the 2018-2019 health records, to estimate the burden of CLBP from the healthcare system's perspective. The SPSS V.25.0 statistical package will be used for data entry and analysis. Statistical analysis will include descriptive statistics by means of graphs and cross tabulations, inferential statistics by means of logistic regression and χ2 test. A p value of 0.05 will be deemed statistically significant. ETHICS AND DISSEMINATION This protocol was approved by the University of KwaZulu-Natal's Biomedical Research Ethics Committee (Ref. No.: BREC/00000205/2019) and the KwaZulu-Natal Department of Health Research Ethics (Ref. No.: KZ_201909_002). This will be the first LBP cost-of-illness study in the sub-Saharan Africa, and, therefore, it will close these knowledge gaps and present important evidence on the estimated burden of CLBP in this context. The results of this study will be presented to the Department of Health and to the respective stakeholders and decision-makers to discuss the findings and draw their attention to the prioritisation of LBP research, its management, prevention programmes and implementation of educational programme and for the planning of cost-containment policies.
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Affiliation(s)
- Morris Kahere
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Themba Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Priebe JA, Haas KK, Moreno Sanchez LF, Schoefmann K, Utpadel-Fischler DA, Stockert P, Thoma R, Schiessl C, Kerkemeyer L, Amelung V, Jedamzik S, Reichmann J, Marschall U, Toelle TR. Digital Treatment of Back Pain versus Standard of Care: The Cluster-Randomized Controlled Trial, Rise-uP. J Pain Res 2020; 13:1823-1838. [PMID: 32765057 PMCID: PMC7381830 DOI: 10.2147/jpr.s260761] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Non-specific low back pain (NLBP) causes an enormous burden to patients and tremendous costs for health care systems worldwide. Frequently, treatments are not oriented to existing guidelines. In the future, digital elements may be promising tools to support guideline-oriented treatment in a broader range of patients. The cluster-randomized controlled “Rise-uP” trial aims to support a General Practitioner (GP)-centered back pain treatment (Registration No: DRKS00015048) and includes the following digital elements: 1) electronic case report form (eCRF), 2) a treatment algorithm for guideline-based clinical decision making of GPs, 3) teleconsultation between GPs and pain specialists for patients at risk for development of chronic back pain, and 4) a multidisciplinary mobile back pain app for all patients (Kaia App). Methods In the Rise-uP trial, 111 GPs throughout Bavaria (southern Germany) were randomized either to the Rise-uP intervention group (IG) or the control group (CG). Rise-uP patients were treated according to the guideline-oriented Rise-uP treatment algorithm. Standard of care was applied to the CG patients with consideration given to the “National guideline for the treatment of non-specific back pain”. Pain rating on the numeric rating scale was the primary outcome measure. Psychological measures (anxiety, depression, stress), functional ability, as well as physical and mental wellbeing, served as secondary outcomes. All values were assessed at the beginning of the treatment and at 3-month follow-ups. Results In total, 1245 patients (IG: 933; CG: 312) with NLBP were included in the study. The Rise-uP group showed a significantly stronger pain reduction compared to the control group after 3 months (IG: M=−33.3% vs CG: M=−14.3%). The Rise-uP group was also superior in secondary outcomes. Furthermore, high-risk patients who received a teleconsultation showed a larger decrease in pain intensity (−43.5%) than CG patients (−14.3%). ANCOVA analysis showed that the impact of teleconsultation was mediated by an increased training activity in the Kaia App. Conclusion Our results show the superiority of the innovative digital treatment algorithm realized in Rise-uP, even though the CG also received relevant active treatment by their GPs. This provides clear evidence that digital treatment may be a promising tool to improve the quality of treatment of non-specific back pain. In 2021, analyses of routine data from statutory health insurances will enable us to investigate the cost-effectiveness of digital treatment.
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Affiliation(s)
- Janosch A Priebe
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katharina K Haas
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leida F Moreno Sanchez
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Bayerische TelemedAllianz (BTA), Ingolstadt, Germany
| | - Karin Schoefmann
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel A Utpadel-Fischler
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul Stockert
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Reinhard Thoma
- Pain Clinic, Algesiologikum Pain Center, Munich, Germany
| | | | - Linda Kerkemeyer
- Institute for Applied Health Services Research, inav GmbH, Berlin, Germany
| | - Volker Amelung
- Institute for Applied Health Services Research, inav GmbH, Berlin, Germany
| | | | | | | | - Thomas R Toelle
- Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Reconnecting the Brain With the Rest of the Body in Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2020; 22:1-8. [PMID: 32553621 DOI: 10.1016/j.jpain.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/27/2019] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
A challenge in understanding chronic musculoskeletal pain is that research is often siloed between neuroscience, physical therapy/rehabilitation, orthopedics, and rheumatology which focus respectively on 1) neurally mediated effects on pain processes, 2) behavior and muscle activity, 3) tissue structure, and 4) inflammatory processes. Although these disciplines individually study important aspects of pain, there is a need for more cross-disciplinary research that can bridge between them. Identifying the gaps in knowledge is important to understand the whole body, especially at the interfaces between the silos-between brain function and behavior, between behavior and tissue structure, between musculoskeletal and immune systems, and between peripheral tissues and the nervous system. Research on "mind and body" practices can bridge across these silos and encourage a "whole person" approach to better understand musculoskeletal pain by bringing together the brain and the rest of the body. PERSPECTIVE: Research on chronic musculoskeletal pain is limited by significant knowledge gaps. To be fully integrated, musculoskeletal pain research will need to bridge across tissues, anatomical areas, and body systems. Research on mind and body approaches encourages a "whole person" approach to better understand musculoskeletal pain.
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Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil 2020; 34:571-583. [PMID: 32037876 PMCID: PMC7350200 DOI: 10.1177/0269215520905112] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. METHOD This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. FINDINGS The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. CONCLUSION Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient's needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.
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Affiliation(s)
- Derick T Wade
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR) and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Voss MR, Homa JK, Singh M, Seidl JA, Griffitt WE. Outcomes of an interdisciplinary work rehabilitation program. Work 2020; 64:507-514. [PMID: 31658084 PMCID: PMC7029322 DOI: 10.3233/wor-193012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient’s RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge. OBJECTIVE: To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes. METHODS: A retrospective database analysis was conducted with a sample of 495 participants (Mage = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010. RESULTS: A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = –3.152, p = 0.002). The type of injury was not related to strength at the time of discharge. CONCLUSIONS: Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.
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Affiliation(s)
- Mitchell R Voss
- Physical Medicine and Rehabilitation, Aurora BayCare Medical Center, Green Bay, WI, USA
| | - Jennifer K Homa
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA
| | - Jennifer A Seidl
- Physical Medicine and Rehabilitation, Aurora Health Care, Milwaukee, WI, USA
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Granan LP, Reme SE, Jacobsen HB, Stubhaug A, Ljoså TM. The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scand J Pain 2020; 19:365-373. [PMID: 30699072 DOI: 10.1515/sjpain-2017-0160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/05/2019] [Indexed: 12/26/2022]
Abstract
Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0-10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient's perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients' self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.
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Affiliation(s)
- Lars-Petter Granan
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424 Oslo, Norway.,Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway, Phone: +47 91 85 95 05
| | - Silje Endresen Reme
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,National Advisory Unit for Neuropathic Pain, Oslo, Norway
| | - Audun Stubhaug
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Marte Ljoså
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Braun C, Voigt-Radloff S. [Treatment of non-specific low back pain: Evidence map of systematic reviews from 2015 to 2019]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:12-21. [PMID: 32151527 DOI: 10.1016/j.zefq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low back pain represents a major healthcare challenge in Germany and worldwide. The research field is highly dynamic. The aim of this evidence map was to create a compact overview of current systematic reviews on interventions for non-specific low back pain. METHODS Medline (PubMed), the Cochrane Database of Systematic Reviews and Epistemonikos were systematically searched from March 2015 to March 2019 for systematic reviews addressing any interventions for acute, subacute or chronic non-specific low back pain and reporting at least one patient-relevant outcome. Key information on the characteristics and conclusions of the included reviews were extracted and aspects of the methodological quality of the included reviews were assessed independently by two reviewers. The data were tabulated. RESULTS The search identified 1,436 records. 53 systematic reviews were included in the evidence map. The quality of the reviews and of the studies included therein varied. The reviews addressed a variety of different interventions, with considerable heterogeneity of their characteristics and methodological aspects. Many reviews found evidence for positive effects of the studied interventions, some found evidence for no effect, but the quantity and quality of the evidence were often judged as insufficient for formulating robust conclusions. Relatively few data were available on adverse events. CONCLUSION This evidence map provides a compact resource for the use of current systematic reviews on interventions for non-specific low back pain. The methodological deficits of many reviews require a careful approach towards their findings and conclusions and suggest a need for methodologically rigorous reviews.
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Affiliation(s)
- Cordula Braun
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland.
| | - Sebastian Voigt-Radloff
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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46
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Pfingsten M, Kaiser U, Sabatowski R. Qualität und Effektivität der interdisziplinären multimodalen Schmerztherapie. Schmerz 2019; 33:558-561. [DOI: 10.1007/s00482-019-00400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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47
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Verspannte Muskeln – angespannte Psyche: Behandlung von Patienten mit chronischer Schmerzstörung in der orthopädischen Rehabilitation. MANUELLE MEDIZIN 2019. [DOI: 10.1007/s00337-019-00609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Ibrahim ME, Weber K, Courvoisier DS, Genevay S. Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study. BMC Musculoskelet Disord 2019; 20:439. [PMID: 31597562 PMCID: PMC6785904 DOI: 10.1186/s12891-019-2831-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. Methods This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. Results Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. Conclusions This study extends previous results confirming the program’s contribution to recovering work capability among chronic LBP patients.
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Affiliation(s)
- Maha E Ibrahim
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland. .,Department of Physical Medicine, Rheumatology and Rehabilitation, Suez Canal University, Ismailia, Egypt.
| | - Kerstin Weber
- Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland.,Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland
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Vanti C, Banchelli F, Marino C, Puccetti A, Guccione AA, Pillastrini P. Effectiveness of a "Spring Pillow" Versus Education in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. Phys Ther 2019; 99:1177-1188. [PMID: 30939188 PMCID: PMC6736423 DOI: 10.1093/ptj/pzz056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Different types of pillows have been proposed for neck pain, but no previous randomized controlled trial has investigated the effectiveness of a "spring pillow" for adults with chronic nonspecific neck pain. OBJECTIVE We evaluated the effectiveness of using a pillow made from viscoelastic polyurethane and 60 independent springs compared with an educational intervention in individuals with chronic nonspecific neck pain. DESIGN This was a randomized controlled trial with crossover study design. SETTING The setting was the Occupational Medicine Unit, University Hospital, Bologna (Italy). PARTICIPANTS We recruited 70 adults with chronic nonspecific neck pain, of whom 64 completed the trial. INTERVENTION Participants were randomly assigned to 2 groups. One group used the spring pillow for 4 weeks, and the other group followed educational advice for 4 weeks while continuing to use their own pillows. After 4 weeks of treatment and 4 weeks of washout, groups were crossed over. Pain perceived in the neck, thoracic, and shoulder areas and headache were the primary outcome measures. In addition, disability, sleep quality, subjective improvement, and pillow comfort were assessed. Measures were captured at pretreatment, after 4 weeks, after the 4-week washout period, and 4 weeks after crossover. The mean differences (MD) in outcomes between groups were assessed. RESULTS Treatment with the spring pillow appeared to reduce neck pain (MD = -8.7; 95% confidence interval [CI] = -14.7 to -2.6), thoracic pain (MD = -8.4; 95% CI = -15.2 to -1.5), and headache (MD = -16.0; 95% CI = -23.2 to -8.7). Reductions in shoulder pain were not statistically significant between groups (MD = -6.9; 95% CI = -14.1-0.3). Neither the crossover sequence nor the period (first vs second intervention administration) significantly affected the results. LIMITATIONS Education may not have been the best comparator for the spring pillow; drug consumption, actual pillow use, and the implementation of the educational suggestions as prescribed were not controlled. CONCLUSIONS Use of the spring pillow in this study was more effective than an educational intervention for improving cervical, thoracic, and head pain. Whether a spring pillow is more effective than other ergonomic pillows remains to be tested.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neurological Sciences, Occupational Medicine Unit, University of Bologna, Bologna, Italy
| | - Federico Banchelli
- Department of Diagnostics, Clinical and Public Health Medicine, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Marino
- Department of Biomedical and Neurological Sciences, Occupational Medicine Unit, University of Bologna, Bologna, Italy
| | - Andrea Puccetti
- Department of Biomedical and Neurological Sciences, Occupational Medicine Unit, University of Bologna, Bologna, Italy
| | - Andrew A Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Paolo Pillastrini
- Department of Biomedical and Neurological Sciences, Occupational Medicine Unit, University of Bologna, via P. Palagi 9–40138, Bologna, Italy,Address all correspondence to Prof Pillastrini at:
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Gianola S, Castellini G, Andreano A, Corbetta D, Frigerio P, Pecoraro V, Redaelli V, Tettamanti A, Turolla A, Moja L, Valsecchi MG. Effectiveness of treatments for acute and sub-acute mechanical non-specific low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:196. [PMID: 31395091 PMCID: PMC6688358 DOI: 10.1186/s13643-019-1116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Non-specific low back pain (LBP) is the leading cause of disability worldwide. Acute LBP usually has a good prognosis, with rapid improvement within the first 6 weeks. However, the majority of patients develop chronic LBP and suffer from recurrences. For clinical management, a plethora of treatments is currently available but evidence of the most effective options is lacking. The objective of this study will be to identify the most effective interventions to relieve pain and reduce disability in acute and sub-acute non-specific LBP. METHODS/DESIGN We will search electronic databases (MEDLINE, Embase, CENTRAL) from inception onwards. The eligible population will be individuals with non-specific LBP older than 18 years, both males and females, who experience pain less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Eligible interventions and comparators will include all conservative rehabilitation or pharmacological treatments provided by any health professional; the only eligible study design will be a randomized controlled trial. The primary outcomes will be pain intensity and back-specific functional status. Secondary outcomes will be any adverse events. Studies published in languages other than English will also potentially be included. Two reviewers will independently screen the titles and abstracts retrieved from a literature search, as well as potentially relevant full-text articles. General characteristics, potential effect modifiers, and outcome data will be extracted from the included studies, and the risk of bias will be appraised. Conflicts at all levels of screening and abstraction will be resolved through team discussions. After describing the results of the review, if appropriate, a random effects meta-analysis and network meta-analysis will be conducted in a frequentist setting, assuming equal heterogeneity across all treatment comparisons and accounting for correlations induced by multi-arm studies using a multivariate normal model. DISCUSSION Our systematic review will address the uncertainties in the use of pharmacological or non-pharmacological treatments, and their relative efficacy, for acute and subacute LBP. These findings will be useful for patients, healthcare providers, and policymakers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018102527.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Davide Corbetta
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pamela Frigerio
- Child and Adolescent Neuropsychiatric Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valentina Pecoraro
- Department of Laboratory Medicine, OCSAE, Azienda USL of Modena, Modena, Italy
| | | | - Andrea Tettamanti
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Turolla
- Laboratory for Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Lorenzo Moja
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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