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Struyf N, Vanwing T, Jacquet W, Ho-A-Tham N, Dankaerts W. What do we know about Indigenous Peoples with low back pain around the world? A topical review. Scand J Pain 2024; 24:sjpain-2023-0114. [PMID: 38497253 DOI: 10.1515/sjpain-2023-0114] [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: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. METHODS A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. RESULTS LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. CONCLUSION Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.
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Affiliation(s)
- Niels Struyf
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Onderzoeksgroep Musculoskeletale Revalidatie, Tervuursevest 101 - Bus 1501, 3001 Leuven Belgium
| | - Tom Vanwing
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nancy Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. Understanding how patients' pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach. BMJ Open 2022; 12:e061062. [PMID: 36581439 PMCID: PMC9806037 DOI: 10.1136/bmjopen-2022-061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear. OBJECTIVES To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them. DESIGN Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana. RESULTS Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients' themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana. CONCLUSION Participants' narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, London South Bank University Faculty of Health and Social Care, London, UK
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Claire Diver
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Hayashi K, Ikemoto T, Shiro Y, Arai YC, Marcuzzi A, Costa D, Wrigley PJ. A Systematic Review of the Variation in Pain Catastrophizing Scale Reference Scores Based on Language Version and Country in Patients with Chronic Primary (Non-specific) Pain. Pain Ther 2022; 11:753-769. [PMID: 35567720 PMCID: PMC9314526 DOI: 10.1007/s40122-022-00390-0] [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: 03/21/2022] [Accepted: 04/20/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This systematic review aimed to investigate variations of reference scores for the Pain Catastrophizing Scale (PCS) between language versions and between countries in patients with chronic primary pain (CPP) or chronic primary pain, not otherwise specified (CPP-NOS). METHODS Electronic searches of the Ovid/Embase, Ovid/MEDLINE, and Ovid/PsycINFO databases were conducted to retrieve studies assessing PCS scores in adults with CPP or CPP-NOS proposed by the International Classification of Diseases, Eleventh Revision for any country where the translated PCS was available. The protocol for this systematic review was prospectively registered on the International Prospective Register of Systematic Reviews 2018 (registration number: CRD 42018086719). RESULTS A total of 3634 articles were screened after removal of duplicates. From these, 241 articles reporting on 32,282 patients with chronic pain were included in the review. The mean (± standard deviation) weighted PCS score across all articles was 25.04 ± 12.87. Of the 12 language versions and 21 countries included in the review, the weighted mean PCS score in Asian languages or Asian countries was significantly higher than that in English, European, and other languages or Western and other countries. The highest mean score of the weighted PCS based on language was in Japanese (mean 33.55), and the lowest was in Russian (mean 20.32). The highest mean score of the weighted PCS based on country was from Japan (mean 33.55), and the lowest was from Australia (mean 19.80). CONCLUSION The weighted PCS scores for people with CPP or CPP-NOS were significantly higher in Asian language versions/Asian countries than in English, European and other language versions or Western and other countries.
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Affiliation(s)
- Kazuhiro Hayashi
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA, USA
| | - Tatsunori Ikemoto
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan.
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Yukiko Shiro
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
| | - Young-Chang Arai
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
| | - Anna Marcuzzi
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Costa
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Paul J Wrigley
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
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VanEvery R, Latimer M, Naveau A. Clinical Strategies to Develop Connections, Promote Health and Address Pain From the Perspectives of Indigenous Youth, Elders, and Clinicians. FRONTIERS IN PAIN RESEARCH 2022; 3:857624. [PMID: 35634453 PMCID: PMC9137308 DOI: 10.3389/fpain.2022.857624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
In this article we discuss findings from a community based, participatory action research study. The aim was to understand how Indigenous youth describe, experience, manage pain and hurt and how they seek care. A critical analysis guided by Two-Eyed Seeing and Medicine Wheel frameworks highlighted important clinical strategies for Indigenous youth to balance their health and reduce pain. This study is a partnership project with an Aboriginal Health Centre in Southern Ontario and the Canadian Institute of Health Research funded Aboriginal Children's Hurt and Healing Initiative (ACHH). The study gathered perspectives of Indigenous youth, Elders, and health clinicians using conversation sessions guided by a First Nations doctoral student and nurse researcher. Using the medicine wheel framework three main thematic areas emerged across the three groups and include (1) Predictors of Imbalance; (2) Indicators of Imbalance; and (3) Strategies to re-establish balance health in relation to pain. The main strategy includes considerations for clinicians using the acronym LISTEN (Language, Individual, Share, Teachable moments, Engage, and Navigate) approach that outlines strategies for clinicians that will be a safe guide to manage pain and hurt.
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Affiliation(s)
- Rachel VanEvery
- Department of Health, Aging, and Society, McMaster University, Hamilton, ON, Canada
- *Correspondence: Rachel VanEvery
| | - Margot Latimer
- Faculties of Health and Medicine, Dalhousie University, Centre for Pediatric Pain, IWK Health, Halifax, NS, Canada
- Margot Latimer
| | - Angela Naveau
- De dwa da dehs nye>s Aboriginal Health Centre, Hamilton, ON, Canada
- Angela Naveau
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Clinician Perspectives of Communication with Aboriginal and Torres Strait Islanders Managing Pain: Needs and Preferences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031572. [PMID: 35162593 PMCID: PMC8835490 DOI: 10.3390/ijerph19031572] [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: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/03/2022]
Abstract
Poor communication is an important factor contributing to health disparity. This study sought to investigate clinicians’ perspectives about communicating with Aboriginal and Torres Strait Islander patients with pain. This multi-site and mixed-methods study involved clinicians from three pain management services in Queensland, Australia. Clinicians completed a survey and participated in focus groups. Clinicians rated the importance of communication training, their knowledge, ability, and confidence in communicating with Aboriginal and Torres Strait Islander patients using a 5-point Likert scale. Rating scores were combined into low (scores 1–2); moderate (score 3) and high (scores 4–5). Informed by an interpretive description methodology, thematic analysis of focus group data was used to identify the communication needs and training preferences of clinicians. Overall (N = 64), 88% of clinicians rated the importance of communication training when supporting Aboriginal and Torres Strait Islander patients as “high”. In contrast, far fewer clinicians rated as “high” their knowledge (28%), ability (25%) and confidence (28%) in effectively communicating with Aboriginal and Torres Strait Islander patients. Thematic analysis identified three areas of need: knowledge of Aboriginal and Torres Strait Islander cultures, health beliefs, and understanding cross-cultural cues. Communication skills can be learned and training, in the form of a tailored intervention to support quality engagement with Aboriginal and Torres Strait Islander patients, should combine cultural and communication aspects with biomedical knowledge.
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Culture and musculoskeletal pain: strategies, challenges, and future directions to develop culturally sensitive physical therapy care. Braz J Phys Ther 2022; 26:100442. [PMID: 36209626 PMCID: PMC9550611 DOI: 10.1016/j.bjpt.2022.100442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/13/2022] [Accepted: 08/25/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural factors are often ignored. OBJECTIVE The aims of this Masterclass is threefold: (1) to discuss cultural influences on pain, (2) to provide strategies for delivering appropriate pain education and exercises in culturally diverse people with chronic pain, and (3) to present challenges and future directions to clinicians and researchers. DISCUSSION Cultural factors have a relevant influence on the way individuals experience and manage health and illness. Thus, people with different cultural experience perceive, respond, communicate and manage their pain in different ways. In this aspect, the contents of pain education should be presented using different culturally appropriate examples, metaphors, images, and delivery methods that may enhance the impact of the message. Efforts should be made to produce and spread culturally adapted evidence-based materials and resources. In addition, a culturally sensitive approach may help to introduce patients to graded activities, so that they can apply these strategies in culturally acceptable and meaningful ways. Future studies should investigate the effectiveness of culturally-adapted interventions in pain-related outcomes in different pain conditions in patients with different cultural backgrounds.
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Ho-A-Tham N, Ting-A-Kee B, Struyf N, Vanlandewijck Y, Dankaerts W. Low back pain prevalence, beliefs and treatment-seeking behaviour in multi-ethnic Suriname. Rheumatol Adv Pract 2021; 5:rkab074. [PMID: 34778699 PMCID: PMC8578690 DOI: 10.1093/rap/rkab074] [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: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives The aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community. Methods A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool). Results A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00-22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00-31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking. Conclusion Low back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.
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Affiliation(s)
- Nancy Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.,Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Beverly Ting-A-Kee
- Department of Pathology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Niels Struyf
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.,Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Yves Vanlandewijck
- Research Group of Adapted Physical Activity and Psychomotor Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Wim Dankaerts
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Bautista C, Amatangelo MP, Baby P, Cassier-Woidasky AK, Dycus K, Edoh EI, Green T, Ilano KCS, Kemboi M, Littlejohns L, Martinez RCKP, Mastamet G, Perera A, Ramazanu S, Ribeiro RM, Serondo DJF, Sila F, Strayer A, Soriano GP, Wessol JL. Cultural Perspectives on Pain Assessment and Opioid Use: International Neuroscience Nursing Research Symposium Conference Proceedings. J Neurosci Nurs 2021; 53:149-156. [PMID: 33935264 DOI: 10.1097/jnn.0000000000000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT INTRODUCTION: In August of 2020, the 4th International Neuroscience Nursing Research Symposium was held. The purpose of the symposium was to share neuroscience nursing research from around the world. One of the topics thought most notable that stimulated a crucial conversation was how different countries assessed pain and their use of opioids for pain management. BACKGROUND: Neuroscience nurses are global. What is not known is their experience with and what challenges exist with pain management for human beings in their country. Crossing geographic and cultural boundaries, pain affects all human beings. Each culture has unique values and beliefs regarding pain. Patient barriers, pivotal in this article, included poverty, poor health literacy, opioid phobia, and cultural as well as social beliefs. RESULTS: Neuroscience nurses from Australia, Brazil, Germany, Singapore, India, Ghana, Kenya, Philippines, South Africa, and the United States each collaborated to provide a short summary of assessing pain and use of opioids for pain management for the neuroscience patient. CONCLUSION: Neuroscience patients have varying degrees of pain based on many factors. Various countries have religious, spiritual, and cultural traditions that influence the reporting and management of pain. Pain assessment and management can be challenging, especially for the neuroscience nurses around the world.
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Feasibility of Imported Self-Management Program for Elderly People with Chronic Pain: A Single-Arm Confirmatory Trial. Pain Ther 2020; 9:583-599. [PMID: 32844366 PMCID: PMC7648817 DOI: 10.1007/s40122-020-00192-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Multidisciplinary pain management programs incorporating a cognitive-behavioral therapy (CBT) approach have been reported to be helpful for elderly people with chronic pain. However, it is unclear whether the same program for elderly people with chronic pain would translate to different cultures. This study investigated whether a multidisciplinary program based on that of Nicholas et al. (Pain 154(6):824–835, 2013) in Australia would be effective for elderly people with chronic pain in Japan. Methods Twenty-seven community-dwelling elderly people with chronic pain were enrolled to confirm changes (effect size d = 0.5) in pain disability, which were previously reported by Nicholas et al. The multidisciplinary program consisted of eight sessions (2 sessions a week for 4 weeks). Pain disability was assessed using the Pain Disability Assessment Scale (PDAS) as the primary outcome at the baseline, the beginning and the end of the program, and the 1- and 3-month (final) follow-up. We also assessed the pain severity, catastrophizing, pain self-efficacy, and physical function with the Timed Up and Go test (TUG) and the two-step test as secondary outcomes. Results PDAS, pain catastrophizing, and pain self-efficacy were significantly improved immediately after the program compared with baseline, and these effects were maintained at 3-month follow-up. The effect size (d) for the PDAS score was a medium size (0.54) from baseline to 3-month follow-up. Those who showed improvements in TUG immediately after the program tended to report improved psychometric measures at 3-month follow-up. Conclusion These results suggest that the Japanese multidisciplinary program has a similar effect on pain disability as that reported by Nicholas et al. This finding has important implications for the development of pain services in community-dwelling elderly Japanese.
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A systematic review of western medicine's understanding of pain experience, expression, assessment, and management for Australian Aboriginal and Torres Strait Islander Peoples. Pain Rep 2019; 4:e764. [PMID: 31984288 PMCID: PMC6903352 DOI: 10.1097/pr9.0000000000000764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022] Open
Abstract
Although pain is a near-universal experience, pain expression and beliefs are highly variable and can affect assessment and management of pain. This systematic review seeks to synthesize the research findings regarding pain management for Australian Aboriginal and Torres Strait Islander peoples addressing variation as voiced by patients, clinicians, and researchers alike. A systematic review was performed across 7 research databases for all articles related to pain within Indigenous Australian peoples. Additional literature was identified by hand-searching reference lists. Articles were restricted to literature which addressed pain within Indigenous Australians as the primary focus of the article. Thematic analysis was performed to group articles according to those which focussed on the experience, expression, assessment, or management of pain. A total of 294 articles were identified on initial search of literature, of which 20 met inclusion criteria for this study. This review captured gross heterogeneity in cohorts, research methodologies, and conditions studied, making generalized assumptions impossible and inappropriate. Studies suggest that the beliefs of both patients and practitioners are important considerations in approaching effective assessment and management of pain. Health practitioners should appreciate how our own beliefs influence the management of patients and must ensure community consultation is undertaken in order to improve pain assessment and management.
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Lin IB, Bunzli S, Mak DB, Green C, Goucke R, Coffin J, O'Sullivan PB. Unmet Needs of Aboriginal Australians With Musculoskeletal Pain: A Mixed-Method Systematic Review. Arthritis Care Res (Hoboken) 2019; 70:1335-1347. [PMID: 29245188 DOI: 10.1002/acr.23493] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Musculoskeletal pain (MSP) conditions are the biggest cause of disability, and internationally, indigenous peoples experience a higher burden. There are conflicting reports about Aboriginal Australians and MSP. We conducted a systematic review to describe the prevalence, associated factors, impacts, care access, health care experiences, and factors associated with MSP among Aboriginal Australians. METHODS We used a systematic search of quantitative and qualitative scientific and grey literature (PROSPERO# CRD42016038342). Articles were appraised using the Mixed Methods Appraisal Tool. Due to study heterogeneity, a narrative synthesis was conducted. RESULTS Of 536 articles identified, 18 were included (14 quantitative, 4 qualitative), of high (n = 11), medium (n = 2), and low (n = 5) quality. Prevalence of MSP in Aboriginal populations was similar to or slightly higher than the non-Aboriginal population (prevalence rate ratio 1.1 for back pain, 1.2-1.5 for osteoarthritis [OA], and 1.0-2.0 for rheumatoid arthritis). Aboriginal people accessed primary care for knee or hip OA at approximately half the rate of non-Aboriginal people, and were less than half as likely to have knee or hip replacement surgery. Communication difficulties with health practitioners were the main reason why Aboriginal people with MSP choose not to access care. No articles reported interventions. CONCLUSION Findings provide preliminary evidence of an increased MSP burden among Aboriginal Australians, and particularly for OA, a mismatch between the disease burden and access to health care. To increase accessibility, health services should initially focus on improving Aboriginal patients' experiences of care, in particular by improving patient-practitioner communication. Implications for care and research are outlined.
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Affiliation(s)
- Ivan B Lin
- University of Western Australia, Geraldton, Western Australia, Australia
| | | | - Donna B Mak
- University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
| | - Charmaine Green
- University of Western Australia, Geraldton, Western Australia, Australia
| | - Roger Goucke
- Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - Juli Coffin
- University of Notre Dame Australia, Broome, Western Australia, Australia
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Abd-Elsayed A, Grandhi R, Lawrence JP. Expectations, Coping, Cultural and Environmental Factors. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Introduction: Indigenous children and youth may be quiet about the way they express their pain and hurt which is in contrast to how health professionals are trained to assess it. Objectives: The aim was to understand how youth from 4 First Nation communities express pain using narratives and art-based methods to inform culturally appropriate assessment and treatment. Methods: This qualitative investigation used a community-based participatory action methodology to recruit 42 youth between 8 and 17 years of age to share their perspectives of pain using ethnographic techniques including a Talking Circle followed by a painting workshop. Physical pain perspectives were prominent in circle conversations, but emotional pain, overlapping with physical, mental, and spiritual pain perspectives, was more evident through paintings. Art themes include causes of pain and coping strategies, providing a view into the pain and hurt youth may experience. Youth were more comfortable expressing emotional and mental pain through their artwork, not sharing verbally in conversation. Results: Circle sessions and artwork data were themed using the Indigenous Medicine Wheel. Content of the circle conversations centered on physical pain, whereas paintings depicted mainly emotional pain (eg, crying or loneliness; 74% n = 31) with some overlap with physical pain (eg, injuries; 54%), mental pain (eg, coping strategies; 31%), and spiritual pain (eg, cultural symbols; 30%). Common threads included hiding pain, resilience, tribal consciousness, persistent pain, and loneliness. Conclusion: Once a safe space was created for First Nation youth, they provided a complex, culturally based understanding of the pain and coping experience from both an individual and community perspective. These engaging, culturally sensitive research methods provide direction for health providers regarding the importance of creating a safe space for young people to share their perspectives.
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Lin IB, Ryder K, Coffin J, Green C, Dalgety E, Scott B, Straker LM, Smith AJ, O'Sullivan PB. Addressing Disparities in Low Back Pain Care by Developing Culturally Appropriate Information for Aboriginal Australians: "My Back on Track, My Future". PAIN MEDICINE 2018; 18:2070-2080. [PMID: 28087847 DOI: 10.1093/pm/pnw314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives Addressing disparities in low back pain care (LBP) is an important yet largely unaddressed issue. One avenue to addressing disparities, recommended by clinical guidelines, is to ensure that LBP information is culturally appropriate. Our objectives were, first, to develop LBP information that was culturally appropriate for Aboriginal Australians living in a rural area and, second, to compare this to traditional information. Methods The overall information development process was guided by a "cultural security" framework and included partnerships between Aboriginal/non-Aboriginal investigators, a synthesis of research evidence, and participation of a project steering group consisting of local Aboriginal people. LBP information (entitled My Back on Track, My Future [MBOT]) was developed as five short audio-visual scenarios, filmed using Aboriginal community actors. A qualitative randomized crossover design compared MBOT with an evidence-based standard (the Back Book [BB]). Twenty Aboriginal adults participated. Qualitatively we ascertained which information participants' preferred and why, perceptions about each resource, and LBP management. Results Thirteen participants preferred MBOT, four the BB, two both, and one neither. Participants valued seeing "Aboriginal faces," language that was understandable, the visual format, and seeing Aboriginal people undertaking positive changes in MBOT. In contrast, many participants found the language and format of the BB a barrier. Participants who preferred the BB were more comfortable with written information and appreciated the detailed content. Conclusions The MBOT information was more preferred and addressed important barriers to care, providing support for use in practice. Similar processes are needed to develop pain information for other cultural groups, particularly those underserved by existing approaches to care.
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Affiliation(s)
- Ivan B Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia
| | - Kim Ryder
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia
| | - Juli Coffin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia.,Notre Dame University, Broome, Western Australia
| | - Charmaine Green
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia.,Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Eric Dalgety
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Brian Scott
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
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Cheng CY, Cheng YC, Wang TC, Yang WH. Fusion Techniques Are Related to a Lower Risk of Reoperation in Lumbar Disc Herniation: A 5-Year Observation Study of a Nationwide Cohort in Taiwan. World Neurosurg 2018; 117:e660-e668. [PMID: 29945009 DOI: 10.1016/j.wneu.2018.06.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common spinal problem, with reoperation rates of 6%-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in patients with LDH. METHODS This retrospective study used a 5-year nationwide database to analyze reoperation rates in Taiwan. Patient age groups (≥20 and <90 years) treated by index surgery and reoperation for LDH were identified. Four surgical procedures were included in the analysis: discectomy (DC), anterior lumbar fusion with DC (FA + DC), posterior lumbar fusion (FP), and posterior lumbar fusion with DC (FP + DC). RESULTS There were 1743 index surgeries between 2008 and 2012, with 184 (10.56%) reoperations. Index surgery DC had the highest reoperation rate (n = 121, 20%). The reoperation risk was significantly lower for patients undergoing fusion procedures (FA + DC vs. DC [hazard ratio (HR), 0.24; 95% confidence interval (CI), 0.12-0.47; P < 0.01], FP versus DC [HR, 0.17; 95% C, 0.09-0.33; P <0.01], FP + DC versus DC [HR, 0.31; 95% CI, 0.22-0.44; P < 0.01]). Fusion procedures had significantly higher treatment costs compared with DC (FA + DC vs. FP vs. FP + DC vs. DC: 5851.74 ± 4808.94 vs. 5116.88 ± 3428.97 vs. 4782.16 ± 2902.19 vs. 3846.79 ± 3584.45 U.S. dollars/patient, respectively; P < 0.0001). CONCLUSIONS Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared with discectomy, but at the expense of higher medical costs.
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Affiliation(s)
- Chun-Yu Cheng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ya-Chung Cheng
- Department of Internal medicine, College of Medicine, Nation Taiwan University, Taiwan
| | - Ting-Chung Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsun Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Coltman CE, Steele JR, McGhee DE. Can breast characteristics predict upper torso musculoskeletal pain? Clin Biomech (Bristol, Avon) 2018; 53:46-53. [PMID: 29448080 DOI: 10.1016/j.clinbiomech.2018.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/05/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain. METHODS A backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes. FINDINGS The model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants. INTERPRETATION Women with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.
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Affiliation(s)
- Celeste E Coltman
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| | - Julie R Steele
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| | - Deirdre E McGhee
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
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Guillén DA, Peterson CK, Humphreys BK. Comparison of Chiropractic Treatment Outcomes Depending on the Language Region in Switzerland: A Prospective Outcomes Study. JOURNAL OF CHIROPRACTIC HUMANITIES 2017; 24:1-8. [PMID: 29463961 PMCID: PMC5812905 DOI: 10.1016/j.echu.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/03/2017] [Accepted: 05/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Switzerland has optimal conditions for research of language-based cultural influences on low back pain (LBP). The aim of this study was to compare LBP treatment outcomes after chiropractic care between patients from the German- and French-speaking regions of Switzerland. METHODS Baseline Numeric Rating Scale for pain (NRS), demographic, and Oswestry Disability Index (ODI) data were collected from patients presenting to 51 Swiss-German and 12 Swiss-French chiropractors. Prospective outcome data included the proportion reporting clinically relevant improvement on the Patient Global Impression of Change scale and the NRS change scores collected at 1 week; 1, 3, and 6 months; and 1 year. ODI change scores were collected until 3 months. The proportion improved between the 2 groups was compared using the χ2 test. NRS and ODI change scores were compared using the unpaired t test. RESULTS At baseline, only patient age comparing 853 Swiss-German and 215 Swiss-French patients revealed a significant difference. The Patient Global Impression of Change, NRS, and ODI had no significant differences between both patient groups up to 6 months. Between 6 months and 1 year the proportion reporting improvement continued to increase to 83.5% for German-speaking Swiss but reduced to 73.1% for French-speaking Swiss (P = .01). The NRS change scores were also higher for German speaking Swiss at 1 year compared with Swiss-French citizens (P = .01). CONCLUSION Treatment outcome data for LBP are comparable in the German and French parts of Switzerland until the 1-year time point, when people located in the French-speaking regions are more likely to have an increase in pain levels.
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Affiliation(s)
- David A. Guillén
- Corresponding author: David A. Guillén, BMed, MChiroMed, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. Tel.: +41 (0)44 386 5701.Chiropractic Medicine DepartmentOrthopaedic University Hospital BalgristForchstrasse 340Zürich8008Switzerland
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Abstract
The relationship between pain and ethnicity is shaped by experience, learning and culture.Mistaken beliefs about the nature of pain and disability, resistance to treatment seeking, reluctance to comply with treatment and failure to accept responsibility of the treatment outcome are not culturally or sub-culturally specific obstacles to pain management.A cultural group's expectations and acceptance of pain as a normal part of life will determine whether pain is seen as a clinical problem that requires a clinical solution.The reviewed literature shows disparities in pain treatment based on ethnic background.Multidisciplinary research needs to investigate the models of pain and treatment in different cultural groups to allow us to understand how pain is presented and how beliefs and expectations about treatment can be married with practical solutions and effective evidence-based pain management.
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McGrath P, Rawson N, Adidi L. Diagnosis and treatment for vulvar cancer for indigenous women from East Arnhem Land, Northern Territory: bioethical reflections. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:343-352. [PMID: 24996629 DOI: 10.1007/s11673-014-9549-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and bioethics and bring to light areas of further research.
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Affiliation(s)
- Pam McGrath
- Centre for Community Science Population & Social Health Program Griffith Health Institute, LO5, Level 1 Logan Campus Griffith University, Meadowbrook Qld 4131, Queensland Australia, PO Box 1307, Kenmore, Qld 4069, Australia,
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Rahimi A, Vazini H, Alhani F, Anoosheh M. Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians. Trauma Mon 2015; 20:e18686. [PMID: 26290857 PMCID: PMC4538730 DOI: 10.5812/traumamon.18686] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/04/2014] [Accepted: 05/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses. Objectives: The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress. Materials and Methods: One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements. Results: Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024). Conclusions: A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.
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Affiliation(s)
- Abolfazl Rahimi
- Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hossein Vazini
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
| | - Fatemeh Alhani
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
- Corresponding author: Fatemeh Alhani, Department of Nursing, Medical Science Faculty, Tarbiat Modares University, Tehran, IR Iran. Tel/ Fax: +98-2182883898, E-mail:
| | - Monireh Anoosheh
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
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Strong J, Nielsen M, Williams M, Huggins J, Sussex R. Quiet about pain: Experiences of Aboriginal people in two rural communities. Aust J Rural Health 2015; 23:181-4. [DOI: 10.1111/ajr.12185] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jenny Strong
- Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Mandy Nielsen
- Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Michael Williams
- The University of Queensland Aboriginal and Torres Strait Islander Studies Unit; The University of Queensland; Brisbane Queensland Australia
| | - Jackie Huggins
- The University of Queensland Aboriginal and Torres Strait Islander Studies Unit; The University of Queensland; Brisbane Queensland Australia
| | - Roland Sussex
- Languages and Comparative Cultural Communication; The University of Queensland; Brisbane Queensland Australia
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Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open 2013; 3:e002654. [PMID: 23575999 PMCID: PMC3641505 DOI: 10.1136/bmjopen-2013-002654] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To determine the low back pain beliefs of Aboriginal Australians; a population previously identified as protected against the disabling effects of low back pain due to cultural beliefs. DESIGN Qualitative study employing culturally appropriate methods within a clinical ethnographic framework. SETTING One rural and two remote towns in Western Australia. PARTICIPANTS Thirty-two Aboriginal people with chronic low-back pain (CLBP; 21 men, 11 women). Participants included those who were highly, moderately and mildly disabled. RESULTS Most participants held biomedical beliefs about the cause of CLBP, attributing pain to structural/anatomical vulnerability of their spine. This belief was attributed to the advice from healthcare practitioners and the results of spinal radiological imaging. Negative causal beliefs and a pessimistic future outlook were more common among those who were more disabled. Conversely, those who were less disabled held more positive beliefs that did not originate from interactions with healthcare practitioners. CONCLUSIONS Findings are consistent with research in other populations and support that disabling CLBP may be at least partly iatrogenic. This raises concerns for all populations exposed to Western biomedical approaches to examination and management of low back pain. The challenge for healthcare practitioners dealing with people with low back pain from any culture is to communicate in a way that builds positive beliefs about low back pain and its future consequences, enhancing resilience to disability.
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Affiliation(s)
- Ivan B Lin
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | | | - Juli A Coffin
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia and Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Donna B Mak
- School of Medicine, The University of Notre Dame Australia, Perth, Australia
| | - Sandy Toussaint
- Anthropology and Sociology, The University of Western Australia, Perth, Australia
| | - Leon M Straker
- School of Physiotherapy, Curtin University, Perth, Australia
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Lin I, O'Sullivan P, Coffin J, Mak D, Toussaint S, Straker L. ‘I am absolutely shattered’: The impact of chronic low back pain on Australian Aboriginal people. Eur J Pain 2012; 16:1331-41. [DOI: 10.1002/j.1532-2149.2012.00128.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - J.A. Coffin
- Combined Universities Centre for Rural Health; University of Western Australia; Geraldton; Western Australia
| | - D.B. Mak
- University of Notre Dame; Perth; Western Australia
| | - S. Toussaint
- The University of Western Australia; Perth; Western Australia
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Wu JC, Liu L, Huang WC, Chen YC, Ko CC, Wu CL, Chen TJ, Cheng H, Su TP. The Incidence of Adjacent Segment Disease Requiring Surgery After Anterior Cervical Diskectomy and Fusion: Estimation Using an 11-Year Comprehensive Nationwide Database in Taiwan. Neurosurgery 2011; 70:594-601. [PMID: 22343790 DOI: 10.1227/neu.0b013e318232d4f2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
The incidence of symptomatic adjacent segment disease (ASD) after anterior cervical diskectomy and fusion (ACDF) was reported as 2.9%/y in a previous cohort of 374 patients. Few other data corroborate the incidence and natural history of ASD.
Objective:
To calculate the incidence of ASD after ACDF that required secondary fusion surgery.
Methods:
The retrospective study used an 11-year nationwide database to analyze the incidences. All patients who underwent ACDF for cervical disk diseases were identified through diagnostic and procedure codes. Kaplan-Meier and Cox regression analyses were performed.
Results:
From 1997 to 2007, covering 241 800 725.8 person-years, 19 385 patients received ACDF and 568 had ≥ 2 ACDF operations. The incidence of secondary ACDF operations was 7.6 per 1000 person-years. At the end of the 10-year cohort, 94.4% of patients who had received 1 ACDF remained free from secondary ACDF. The average time interval between the first and second ACDF was 23.3 months. After adjustment for comorbidities and socioeconomic status, secondary ACDF operations were more likely performed on male patients (hazard ratio = 1.27; P = .008) 15 to 39 years of age (hazard ratio = 1.45; P = .009) and 40 to 59 years of age (hazard ratio = 1.41, P = .002, respectively).
Conclusion:
Repeat ACDF surgery for ASD cumulated steadily in an annual incidence of approximately 0.8%, much lower than the reported incidence of symptomatic ASD. However, at the end of this 10-year cohort, a considerable portion of patients (5.6%) received a second operation. Younger and male patients are more likely to receive such second operations.
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Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute
- School of Medicine
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linko, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute
- School of Medicine
| | - Yu-Chun Chen
- School of Medicine
- Department of Medical Informatics, Institute for Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute
- School of Medicine
| | | | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute
- School of Medicine
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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LoGiudice DC, Smith K, Atkinson D, Dwyer A, Lautenschlager N, Almeida OA, Flicker L. Preliminary evaluation of the prevalence of falls, pain and urinary incontinence in remote living Indigenous Australians over the age of 45 years. Intern Med J 2010; 42:e102-7. [DOI: 10.1111/j.1445-5994.2010.02332.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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M. Peolsson, R. Saljo, U. Satterlun, LARSSON, SATTERLUND. Experiencing and Knowing Pain - Patients' Perspectives. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/140381900750063409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Vindigni D, Perkins J. IDENTIFYING MUSCULOSKELETAL CONDITIONS AMONG RURAL INDIGENOUS PEOPLES. Aust J Rural Health 2008. [DOI: 10.1111/j.1440-1584.2003.tb00534.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Patients and health professionals bring their own cultural attitudes to the communication and interpretation of the patient's pain experience. In this interaction, it is the health professional's knowledge and attitudes that dominate the response to the patient's experience of pain. In Saudi Arabia, a multicultural foreign and local health care team is challenged to understand the cultural beliefs and attitudes toward pain of both patients and team members. To increase cultural understanding and knowledge, a collaborative inquiry project using a culturally diverse group was conducted to learn about cultural attitudes and beliefs on the causes, treatment, and experience of pain. This article presents the knowledge gained from the collaborative inquiry journey of action and reflection.
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Affiliation(s)
- Sandy Lovering
- King Faisal Specialist Hospital and Research Center-Jeddah, Saudi Arabia
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Vindigni D, Walker BF, Jamison JR, Da Costa C, Parkinson L, Blunden S. Low back pain risk factors in a large rural Australian Aboriginal community. An opportunity for managing co-morbidities? CHIROPRACTIC & OSTEOPATHY 2005; 13:21. [PMID: 16197555 PMCID: PMC1277832 DOI: 10.1186/1746-1340-13-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 09/30/2005] [Indexed: 01/04/2023]
Abstract
BACKGROUND Low back pain (LBP) is the most prevalent musculo-skeletal condition in rural and remote Australian Aboriginal communities. Smoking, physical inactivity and obesity are also prevalent amongst Indigenous people contributing to lifestyle diseases and concurrently to the high burden of low back pain. OBJECTIVES This paper aims to examine the association between LBP and modifiable risk factors in a large rural Indigenous community as a basis for informing a musculo-skeletal and related health promotion program. METHODS A community Advisory Group (CAG) comprising Elders, Aboriginal Health Workers, academics, nurses, a general practitioner and chiropractors assisted in the development of measures to assess self-reported musculo-skeletal conditions including LBP risk factors. The Kempsey survey included a community-based survey administered by Aboriginal Health Workers followed by a clinical assessment conducted by chiropractors. RESULTS Age and gender characteristics of this Indigenous sample (n = 189) were comparable to those reported in previous Australian Bureau of Statistics (ABS) studies of the broader Indigenous population. A history of traumatic events was highly prevalent in the community, as were occupational risk factors. Thirty-four percent of participants reported a previous history of LBP. Sporting injuries were associated with multiple musculo-skeletal conditions, including LBP. Those reporting high levels of pain were often overweight or obese and obesity was associated with self-reported low back strain. Common barriers to medical management of LBP included an attitude of being able to cope with pain, poor health, and the lack of affordable and appropriate health care services. Though many of the modifiable risk factors known to be associated with LBP were highly prevalent in this study, none of these were statistically associated with LBP. CONCLUSION Addressing particular modifiable risk factors associated with LBP such as smoking, physical inactivity and obesity may also present a wider opportunity to prevent and manage the high burden of illness imposed by co-morbidities such as heart disease and type-2 diabetes.
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Affiliation(s)
- Dein Vindigni
- Private practice of chiropractic, 12 David Street, Lalor, Victoria, 3075, Australia
| | - Bruce F Walker
- School of Medicine, James Cook University, Townsville, Queensland, Australia
| | | | - Cliff Da Costa
- School of Mathematical & Geospatial Sciences, RMIT University, Melbourne, Australia
| | - Lynne Parkinson
- Centre for Research and Education in Ageing, Faculty of Health, The University of Newcastle, New South Wales, Australia
| | - Steve Blunden
- Chief Executive Officer, Durri Aboriginal Corporation Medical Service, Kempsey, New South Wales, Australia
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Prista A, Balagué F, Nordin M, Skovron ML. Low back pain in Mozambican adolescents. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13:341-5. [PMID: 15034774 PMCID: PMC3468049 DOI: 10.1007/s00586-004-0683-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Revised: 11/05/2003] [Accepted: 01/17/2004] [Indexed: 10/26/2022]
Abstract
Recent literature shows that the prevalence of low back pain (LBP) in adolescents living in Western countries approaches that of adults 18-55 years of age. Moreover, epidemiological studies have also shown that the frequency of different rheumatic disorders in developing countries is similar to that found in Western industrialized regions. The purpose of this study was to ascertain the prevalence of LBP and to explore some risk factors among adolescents living in different zones of Mozambique. A previously validated questionnaire was distributed to schoolchildren of grades 6 and 7 living in three different residential/social regions of the country. Two hundred four (204) children participated in the survey. Median age was 13 years (age range 11-16 years) and 46% were boys. Several episodes of LBP interfering with usual activities during the previous year were reported by 13.5% of the sample. Living in the wealthier urban center (as compared with the peripheral regions) and walking >30 min per day to and from school were associated with an increased risk of LBP (OR 3.1, 95% CI 0.99-9.48, and OR 4.8, 95% CI 1.61-14.28, respectively).
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Affiliation(s)
- A. Prista
- Faculty of Medicine, Universidade Eduardo Mondlane, Faculty of Physical Education and Sports Science, Universidade Pedagógica, C.P. 2017 Maputo, Mozambique
| | - F. Balagué
- Service de Rhumatologie, Médecine Physique et Rééducation, Hôpital Cantonal, 1708 Fribourg, Switzerland
| | - M. Nordin
- Occupational Industrial and Orthopedic Center, 61 Downing Street, New York, NY USA
| | - M. L. Skovron
- Global Epidemiology and Outcomes Research, Bristol-Myers Squibb, Inc., 311 Pennington-Rocky Hill Road, Pennington, N.J. 08534 USA
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Fenwick C, Stevens J. Post operative pain experiences of central Australian aboriginal women. What do we understand? Aust J Rural Health 2004; 12:22-7. [PMID: 14723777 DOI: 10.1111/j.1440-1584.2004.00541.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the postoperative pain experiences of Central Australian Aboriginal women and the subsequent interpretation of that pain experience by non-Aboriginal female nurses. DESIGN Qualitative study using grounded theory methodology. SETTING Postoperative surgical setting of a Central Australian regional hospital. SUBJECTS Five Aboriginal female clients who had undergone a surgical procedure, eight non-Aboriginal female nurses and four Aboriginal female health workers employed by a Central Australian regional hospital. RESULTS Aboriginal women have culturally appropriate ways of expressing and managing pain that are not well understood by non-Aboriginal female nurses. In addition, the Aboriginal women inappropriately endow non-Aboriginal nurses with the same powers and skills expected of healers from their culture. This phenomenon resulted in the non-Aboriginal nurses lacking the cultural insight and the appropriate knowledge and tools required to assess and manage the postoperative pain of Central Australian Aboriginal women effectively or efficiently. CONCLUSIONS Non-Aboriginal nurses have a profound knowledge deficit about the postoperative pain experiences of Central Australian Aboriginal women. This deficit is evident through the use of culturally inappropriate and unreliable pain assessment strategies and tools and the misinterpretation of traditional pain relief strategies, such as the use of pituri, rubbing and centreing. The findings of this study suggested that nurse/client interactions related to language and role interpretation were in cultural conflict. The nurses expected the Aboriginal women to adopt pain behaviours as understood from the nurses' culture. The nurses anticipated that the client would contribute to their own care by communicating pain experiences in ways that are familiar and are believed to be universal. The Aboriginal women expected the nurses to conduct business similar to that of their own traditional tribal healers, 'to see within' and to 'just know'.
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Affiliation(s)
- Clare Fenwick
- Western Institute of Technology in Taranaki, New Plymouth, New Zealand.
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Vindigni D, Perkins J. IDENTIFYING MUSCULOSKELETAL CONDITIONS AMONG RURAL INDIGENOUS PEOPLES. Aust J Rural Health 2003. [DOI: 10.1046/j.1440-1584.2003.00503.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Honet JC, Ellenberg MR. What you always wanted to know about the history and physical examination of neck pain but were afraid to ask. Phys Med Rehabil Clin N Am 2003; 14:473-91. [PMID: 12948339 DOI: 10.1016/s1047-9651(03)00039-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diagnoses of most cases of neck pain can be made on the basis of a careful history and physical examination. Any tests must be interpreted only in the context of the clinical examination. The clinician must be cognizant of signs or symptoms that may indicate a more serious disorder by attending to the red flags and examining the lower extremities for spasticity that could indicate cervical myelopathy.
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Affiliation(s)
- Joseph C Honet
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA.
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Heistaro S, Jousilahti P, Lahelma E, Vartiainen E, Puska P. Self rated health and mortality: a long term prospective study in eastern Finland. J Epidemiol Community Health 2001; 55:227-32. [PMID: 11238576 PMCID: PMC1731868 DOI: 10.1136/jech.55.4.227] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To assess the relation between self rated health and mortality over a period of 23 years, taking into account medical history, cardiovascular risk factors, and education at the beginning of the follow up. DESIGN A cohort of random population samples. The baseline studies included a self administered questionnaire and a health examination. Mortality data were collected from the national mortality register using personal identification numbers. SETTING The provinces of North Karelia and Kuopio in eastern Finland. PARTICIPANTS Random samples of working age people (n=21 302) from the population register. MAIN RESULTS For self rated health, the age adjusted poor to good relative risk for all cause mortality was 2.36 (95% confidence intervals 2.10, 2.64) for men and 1.90 (1.63, 2.22) for women, and for cardiovascular mortality 2.29 (1.96, 2.68) for men and 2.34 (1.84, 2.96) for women. Adjusted for selected potentially fatal diseases from the subjects' medical histories, cardiovascular disease risk factors, and education, the corresponding relative risks for all cause mortality were 1.66 (1.47, 1.88) for men and 1.50 (1.26, 1.78) for women, and for cardiovascular mortality 1.54 (1.29, 1.82) for men and 1.63 (1.26, 2.10) for women. The association between self rated health and mortality attributable to external causes was fairly strong. CONCLUSIONS Poor self rated health is a strong predictor of mortality, and the association is only partly explained by medical history, cardiovascular disease risk factors, and education.
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Affiliation(s)
- S Heistaro
- National Public Health Institute, Helsinki, Finland.
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Abstract
Western health professionals often experience difficulties in service delivery to Aboriginal people because of the disparity between Aboriginal and Western health belief systems. This article reviews the literature which considers 'traditional' Aboriginal health beliefs and medical systems. The traditional Aboriginal model of illness causation emphasises social and spiritual dysfunction as a cause of illness. Supernatural intervention is regarded as the main cause of serious illness. There are gender divisions in Aboriginal society that impact on the delivery of Western healthcare. Management strategies such as preventative care, bush medicine, and the role of traditional healers are discussed. These belief systems are considered with particular reference to their interactions and implications with regard to the Western medical system. This information provides a framework to allow improved understanding by health professionals of the health-related decisions made by Aboriginal people.
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Affiliation(s)
- P Maher
- Northern Rehabilitation Network, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.
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Affiliation(s)
- E N Hanley
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
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Abstract
OBJECTIVE To document the frequency and disease phenotype of various rheumatic diseases in the Australian Aborigine. METHODS A comprehensive review was performed of the archaeological, ethnohistorical, and contemporary literature relating to rheumatic diseases in these indigenous people. RESULTS No evidence was found to suggest that rheumatoid arthritis (RA), ankylosing spondylitis (AS), or gout occurred in Aborigines before or during the early stages of white settlement of Australia. Part of the explanation for the absence of these disorders in this indigenous group may relate to the scarcity of predisposing genetic elements, for example, shared rheumatoid epitope for RA, B27 antigen for AS. In contrast, osteoarthritis appeared to be common particularly involving the temporomandibular joint, right elbow and knees and, most probably, was related to excessive joint loading in their hunter gatherer lifestyle. Since white settlement, high frequency rates for rheumatic fever, systemic lupus erythematosus, and pyogenic arthritis have been observed and there are now scanty reports of the emergence of RA and gout in these original Australians. CONCLUSION The occurrence and phenotype of various rheumatic disorders in Australian Aborigines is distinctive but with recent changes in diet, lifestyle, and continuing genetic admixture may be undergoing change. An examination of rheumatic diseases in Australian Aborigines and its changing phenotype may lead to a greater understanding of the aetiopathogenesis of these disorders.
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Stiefel FC, de Jonge P, Huyse FJ, Slaets JP, Guex P, Lyons JS, Vannotti M, Fritsch C, Moeri R, Leyvraz PF, So A, Spagnoli J. INTERMED--an assessment and classification system for case complexity. Results in patients with low back pain. Spine (Phila Pa 1976) 1999; 24:378-84; discussion 385. [PMID: 10065523 DOI: 10.1097/00007632-199902150-00017] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional investigation and follow-up of patients with low back pain. OBJECTIVES To evaluate the capacity of the INTERMED--a biopsychosocial assessment and classification system for case complexity--to identify patients with a chronic, disabling course of low back pain and to predict treatment outcome. SUMMARY OF BACKGROUND DATA An impressive number of biologic and nonbiologic factors influencing the course of low back pain have been identified. However, the lack of a concise, comprehensive, reliable and validated classification system of this heterogeneous patient population hampers preventive and therapeutic progress. METHODS The INTERMED was used to assess patients with low back pain, who participated in a functional rehabilitation program (n = 50) and patients with low back pain who applied for disability compensation (n = 50). Patients of the rehabilitation program were observed to assess the effects of treatments. RESULTS The INTERMED distinguished between patients in different phases of disability and provided meaningful information about the biopsychosocial aspects of low back pain. In hierarchical cluster analysis two distinct clusters emerged that differed in the degree of case complexity and treatment outcomes. CONCLUSIONS This first application of the INTERMED indicates its potential utility as a classification system for patients with low back pain.
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Affiliation(s)
- F C Stiefel
- Department of Orthopedics, University Hospital, Lausanne, Switzerland
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Nordin M, Cedraschi C, Skovron ML. Patient-health care provider relationship in patients with non-specific low back pain: a review of some problem situations. BAILLIERE'S CLINICAL RHEUMATOLOGY 1998; 12:75-92. [PMID: 9668957 DOI: 10.1016/s0950-3579(98)80006-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Problem situations in the patient-health care relationship may relate to the patient or to the health care provider characteristics or to the way they interact; they may also relate to the general social context. Such situations force the clinician dealing with non-specific low back pain patients to look beyond the traditional biomedical model that assumes a linear connection between pathology and symptomatology. The introduction of the biopsychosocial model approximately 10 years ago has improved the understanding of common low back pain. This chapter gives some insight into areas relating to factors that may hamper the patient-therapist relationship and thus complicate treatment and recommendation outcomes. It emphasizes the necessity to involve the patient in the decision-making. Recognizing the patients' psychological, social and cultural background as well as the level of education and employability are important to make successful recommendations. This knowledge is not new but the difficulty is to implement it in today's cost effectiveness driven society. However the benefit at the end may be the decrease of chronicity and/or permanent disability, suffering for the patient and frustration for the clinician. Identifying the underlying cause of non-compliance or of unexpected delayed recovery is an exciting issue. The cause may or may not be biomedical. If a specific cause can be identified, it has to be diagnosed and evaluated. If the clinical examination has ruled out specific or emergency conditions, another perspective may be needed and the course of action could then be determined.
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Affiliation(s)
- M Nordin
- Occupational and Industrial Orthopedic Center, Hospital for Joint Diseases, New York University Medical Center, NY 10014, USA
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Volinn E. The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries. Spine (Phila Pa 1976) 1997; 22:1747-54. [PMID: 9259786 DOI: 10.1097/00007632-199708010-00013] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A criteria-based review of the literature. SUMMARY OF BACKGROUND DATA The literature on the epidemiology of low back pain is accumulating, but for the most part studies are restricted to high-income countries, which comprise less than 15% of the world's population. Little is known about the epidemiology of low back pain in the rest of the world. OBJECTIVES To address the imbalance in the literature and to review the relatively few studies on the epidemiology of low back pain in low- and middle-income countries. Rates from these studies are contrasted with rates from selected high-income countries. In reviewing the literature, a hypothesis is tested: low back pain rates are higher in low-income countries than in high-income countries, not only because hard physical labor is more prevalent in low-income countries, but also because, unlike high-income countries, hard physical labor for older workers in low-income countries often is unavoidable. METHODS Among other sources, articles for the review come from a search of the MEDLINE bibliographic database, with "back pain" and individual low- and middle-income countries entered as key words. To avoid recall biases, findings specifically on point prevalence are reviewed. RESULTS Within the categories of low-income and high-income countries, low back pain rates vary twofold or more. In comparisons between these categories of countries, rates on the whole are higher among the general populations of selected high-income countries than among rural low-income populations; specifically, rates are 2-4 times higher among Swedish, German, and Belgium general populations than among Nigerian, southern Chinese, Indonesian, and Filipino farmers. Within low income countries, rates are higher among urban populations than among rural populations and still higher among workers in particular worksites, referred to as "enclosed workshops." CONCLUSIONS The disparity in low back pain rates within categories of countries, high-income and low-income, calls attention to the high proportion of studies on the epidemiology of low back pain that are methodologically questionable. Recommendations are offered to improve the methodologic quality of this type of study. Conclusions may be drawn from comparisons between studies, although, in the absence of set methodologic standards, they are tentative. The considerably lower rates among populations of low-income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low-income populations as compared with rates in rural low-income populations and the sharply higher rates among workers in enclosed workshops of low-income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.
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Affiliation(s)
- E Volinn
- Liberty Mutual Research Center for Safety and Health, Hopkinton, Massachussetts, USA
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