Recommandations européenes (COST B 13) en matiè de prévention et de prise en charge de la lombalgie non spécifique

Validation of the General Health Questionnaire 12 for assessing psychological distress in patients with chronic low back pain

BACKGROUND

The General Health Questionnaire 12 (GHQ-12) is a short easy-to-use scale to assess psychological distress. The GHQ-12 has not been validated for assessing psychological distress in patients with chronic low back pain (LBP).

OBJECTIVE

To investigate the psychometric properties of the GHQ-12 in patients with chronic LBP.

METHODS

The study involved a population of patients undergoing functional restoration for chronic LBP. The intraclass coefficient correlation was used for test-retest reliability (good if > 0.7) and the standard error measurement for absolute reliability. Construct validity was assessed with the Spearman correlation coefficient (moderate and high if r⩾ 0.35 and 0.5, respectively) and internal consistency with Cronbach's alpha (suitable if > 0.7). Responsiveness was assessed by the Wilcoxon test and effect size.

RESULTS

Four hundred and five patients were included. The intraclass coefficient correlation was 0.73 and standard error measurement 2.49. The GHQ-12 showed high convergence with the Beck Depression Inventory and subscales of the Dallas Pain Questionnaire for anxiety and depression and for sociability. It showed moderate convergence with the Quebec Back Pain Disability Scale and subscales of the Dallas Pain Questionnaire for daily activities and for leisure and occupation. Cronbach's alpha was 0.89. The GHQ-12 score changed after functional restoration. It was lower (better) with than without improvement.

CONCLUSIONS

We provide validation of the GHQ-12 for assessing psychological distress in patients with chronic LBP.

Volition and low back pain: When patients talk

OBJECTIVE

Our objective was to explore, describe and understand volition of chronic low back pain (LBP) patients, highlighting barriers and facilitators to practicing regular physical activity in order to develop a questionnaire assessing those volitional competencies.

METHODS

A content analysis of semi-structured interviews with 30 chronic LBP patients was performed. Participants were asked about their pain, motivation, physical abilities, barriers and facilitators to regular exercises and finally strategies implemented to achieve the exercise program.

RESULTS

Patients often reported that they were motivated and that exercises had no negative effects on LBP. Many patients recognized having difficulties performing all their exercises regularly. The main barriers were: lack of time, fatigue, lack of visible results, pain and other daily priorities. The main facilitators were: group exercise, help from the therapist, strategic planning, favorable environment, pleasure associated with exercises, fear of pain recurrence and pain itself.

CONCLUSION

Content analysis showed that sharing stories allowed patients to express their experience of LBP in their own words. It provides a solid ground to develop a questionnaire assessing volitional competencies in chronic LBP patients in order to identify patients who will not realize their exercises and help them be (more) active and avoid chronicity.

Is volition the missing link in the management of low back pain?

Patients with nonspecific chronic low back pain are typically prescribed a regimen of regular physical exercises to improve pain and function, increase workability, and prevent pain recurrence. However, adherence to home exercise programs is often partial at best. Patients often fail to translate their intention to exercise (motivation) into action (implementation). Volition is the mental activity by which intentions are implemented. In this review, we argue that volition may be crucial to the successful rehabilitation of patients with low back pain. Obstacles to the implementation of intentions are described, as well as factors that promote implementation, most notably the conscious formation of implementation intentions.

Effects of a five-week intensive and multidisciplinary spine-specific functional restoration program in chronic low back pain patients with or without surgery

OBJECTIVE

Evaluating the efficacy of an intensive, dynamic and multidisciplinary spine-specific functional restoration program in patients with chronic low back pain with or without surgery.

METHODS

One hundred and forty-four subjects with chronic low back pain included in the retrospective study and divided into two groups: patients who had spine surgery (GI, n=81) and patients who did not have surgery (GC, n=37). The two groups followed the same functional restoration program (175 hours). All the subjects were evaluated before (T0) and after (T5wks) rehabilitation care based on physical, functional, psychological and professional parameters.

RESULTS

All outcome measures were significantly improved for all subjects at the end of the study, regardless of the group. Eighty-one percent of patients returned to work. The surgery group obtained better results at the end of the program for pain and back muscle isometric endurance measures.

CONCLUSIONS

The effects of the intensive program were validated; nevertheless, spine surgery seems to have a positive impact on some physical parameters of this spine-specific functional restoration program.

Frequency and interrelations of risk factors for chronic low back pain in a primary care setting

Introduction

Many risk factors have been identified for chronic low back pain (cLBP), but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs) for cLBP.

Methods

A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA) was performed to study their interrelations.

Results

A total of 2068 GPs (68.9%) included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1%) and initial limitation of activities of daily living (66.4%). For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0%) and frequent heavy lifting at work (65.5%). On MCA, we identified 3 risk-factor dimensions (axes) for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension.

Discussion

Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a “work-related” dimension are the most important cLBP risk factors in the working population.