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Vries TMBD, Deen WE, Lucas C. Does the Keele STarT MSK tool predict the risk of poor outcome in non-specific shoulder complaints in primary care in a Dutch population? Physiotherapy 2024; 123:38-46. [PMID: 38266396 DOI: 10.1016/j.physio.2023.10.008] [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: 11/10/2022] [Revised: 06/03/2023] [Accepted: 10/17/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The Keele STarT MSK tool is a questionnaire to identify the prognostic factors for musculoskeletal conditions, such as shoulder complaints, developed by Keele University, UK. This study assessed whether the Keele STarT MSK tool can predict the risk of poor outcome in non-specific shoulder complaints in a Dutch population. DESIGN Multicentre prospective cohort study. SETTING Fourteen primary care physiotherapy clinics in the Netherlands participated in this study. PARTICIPANTS In total, 180 patients with non-specific shoulder complaints with complete data from the Keele STarT MSK tool (baseline), Short-Form 12 Health Survey (SF-12), Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Score (NPRS) and Global Perceived Effect (GPE) scale at week 6, week 12 or endpoint were included. Data were collected from January 2019 to January 2020. Of these, 180 patients were eligible for the study. Of these, 139 completed the study and were included in the analysis. MAIN OUTCOME MEASURES Poor outcome was defined as: SF-12 score ≤33 (physical health), SPADI score ≥30% (disability in activity), NPRS score ≥3 (pain intensity) and GPE scale score ≥3 (patient-reported recovery). RESULTS The area under the receiver operating characteristic curves for prediction of outcome were excellent for the SF-12, acceptable for the SPADI and NPRS, and showed no discrimination for the GPE scale. The optimal cut-off value for the Keele STarT MSK score to discriminate between low and medium/high risk groups was ≥5. CONCLUSIONS The Keele STarT MSK tool is able to predict the risk of poor outcome in patients with non-specific shoulder complaints in primary care physiotherapy clinics. Further research is needed to establish whether stratified care (subgrouping and targeted treatment) is more efficient. CONTRIBUTION OF PAPER.
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Affiliation(s)
| | - W E Deen
- Zorgtopics, Baarn, the Netherlands
| | - C Lucas
- Department of Epidemiology and Data Science, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Silva S, Hayden JA, Mendes G, Verhagen AP, Pinto RZ, Silva A. Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials. Sleep 2024; 47:zsae023. [PMID: 38300526 DOI: 10.1093/sleep/zsae023] [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: 09/20/2023] [Revised: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration-PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as "overall LBP improvement" outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.
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Affiliation(s)
- Samuel Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Gabriel Mendes
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Arianne P Verhagen
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rafael Z Pinto
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Andressa Silva
- School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Granviken F, Vasseljen O, Bach K, Jaiswal A, Meisingset I. Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application. JMIR Form Res 2024; 8:e44805. [PMID: 38728686 PMCID: PMC11127158 DOI: 10.2196/44805] [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: 12/04/2022] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. OBJECTIVE This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. METHODS Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT's ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. RESULTS The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. CONCLUSIONS This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain.
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Affiliation(s)
- Fredrik Granviken
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St Olavs Hospital, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kerstin Bach
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Amar Jaiswal
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
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Jiménez-Sánchez C, la Cruz NBD, Lafuente-Ureta R, Francín-Gallego M, Calvo S, Fortún-Rabadán R, Pérez-Palomares S. Physical therapy interventions for people experiencing homelessness to improve pain and self-perceived health status. BMC Public Health 2024; 24:993. [PMID: 38594673 PMCID: PMC11003153 DOI: 10.1186/s12889-024-18453-6] [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: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Homeless shelters have emerged as components of the social services network, playing an important role in providing health care to the homeless population. The aim of this study was to evaluate an individualized physical therapy intervention for people experiencing homelessness and to determine the relationship between self-perceived variables. METHODS Pre and post study, setting at the "Santa y Real Hermandad de Nuestra Señora del Refugio y Piedad" homeless shelter in Zaragoza, Spain. Participants were people experiencing homelessness with musculoskeletal disorders who attended a physical therapy service at shelter facilities. A physical therapy program was implemented including health education, exercise and manual therapy, electrotherapy, thermotherapy and bandaging. Demographic variables (age and gender), nationality, employment situation, educational level, pain location, number of painful areas, feeling of loneliness (3-Item Loneliness Scale; values from 3 to 9), pain intensity (Numerical Pain Rating Scale [NPRS]; from 0 to 10) and self-perceived health (Clinical Global Impression [CGI]; from 1 to 7). RESULTS Sixty-four homeless people (age of 46.4 ± 10.9 years) participated in the study. Musculoskeletal pain was reported by 98.4% of subjects, with moderate pain intensities (6.1), and 48.4% presenting with pain at multiple sites. Perceptions of loneliness were low (3.7 ± 2.5) and self-perceived health status was moderately ill (3.5 ± 1.7). Positive significant correlations were identified between pain intensity and self-perceived health. The average number of sessions was 1.5 (± 0.8), with manual therapy (35.6%) followed by health education (23.5%) being the most frequently used techniques. Both pain and self-perceived health improved after treatment, even following a brief intervention. CONCLUSIONS This study demonstrates the potentially negative impact of untreated pain on the self-perceived health of homeless individuals with musculoskeletal disorders that should be targeted for consideration. The findings suggest that a paradigm shift in pain management, including a physical therapy service in shelters, is needed to address the rehabilitation demands of these individuals in a real-life context. This study was approved by the Aragon Ethics Committee (PI19/438) and performed according to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.
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Affiliation(s)
- Carolina Jiménez-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- IIS Aragón, Zaragoza, Spain
| | - Natalia Brandín-de la Cruz
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- IIS Aragón, Zaragoza, Spain
| | - Raquel Lafuente-Ureta
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Marina Francín-Gallego
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sandra Calvo
- IIS Aragón, Zaragoza, Spain.
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Rocío Fortún-Rabadán
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sara Pérez-Palomares
- IIS Aragón, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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Karimi M, Zahednejad S, Negahban H, Tajali S, Saki Malehi A, Yadollahpour N, Shaterzadeh-Yazdi MJ. Validity and reliability of the Persian version of the STarT musculoskeletal tool. Physiother Theory Pract 2024; 40:386-394. [PMID: 36369951 DOI: 10.1080/09593985.2022.2142875] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Subgrouping for Targeted Treatment (STarT) musculoskeletal (MSK) tool stratifies patients with MSK disorders (MSDs) into prognostic categories based on poor outcomes. PURPOSE This study aimed at investigating the validity and reliability of the Persian STarT MSK tool in people suffering from painful MSDs in Iran. METHODS A total of 593 subjects with painful MSDs including neck, shoulder, low back, knee, and multisite pain received and completed the STarT MSK tool, visual analog scale (VAS), EuroQol five-dimensions three-levels questionnaire (EQ-5D-3 L), short form-36 health survey questionnaire (SF-36), and Örebro musculoskeletal pain screening questionnaire (ÖMPSQ) in the first visit. To examine test-retest reliability, 234 patients completed the STarT MSK tool 2 days after the initial visit. RESULTS In this study, 139 (23.5%), 266 (44.9%), and 188 (31.7%) participants were classified as low-, medium-, and high-risk groupings for poor outcomes, respectively. Spearman's correlation coefficient showed a strong relationship among Persian STarT MSK tool and EQ-5D-3 L (-0.78), SF-36 (-0.76), and OMPSQ (0.70). The results of known-group validity indicated that this tool could distinguish among the participants in different risk subgroups based on the scores of the ÖMPSQ, VAS, SF36, and EQ-5D-5 L (p < .001). No ceiling and floor effects were observed. Cronbach's alpha and intra-class correlation coefficient (ICC2,1) were acceptable (0.71) and excellent (0.98), respectively. CONCLUSION The Persian version of STarT MSK tool has shown to be a valid and reliable instrument to stratify people with painful MSDs into low-, medium-, and high-risk subgroups based on persistent pain disability.
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Affiliation(s)
- Mehrnoosh Karimi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahla Zahednejad
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Tajali
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M4P 1E4, Canada
| | - Amal Saki Malehi
- Department of Biostatistics and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nava Yadollahpour
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Jafar Shaterzadeh-Yazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Harrisson SA, Ogollah R, Dunn KM, Foster NE, Konstantinou K. Prognosis of Patients With Neuropathic Low Back-Related Leg Pain: An Exploratory Study Using Prospective Data From UK Primary Care. THE JOURNAL OF PAIN 2024; 25:533-544. [PMID: 37778405 DOI: 10.1016/j.jpain.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
This prospective cohort study investigates the prognosis of patients with neuropathic low back-related leg pain consulting in UK primary care. Data from 511 patients were collected using standardised baseline clinical examinations (including magnetic resonance imaging scan findings), self-report questionnaires at baseline, 4 months, 12 months, and 3 years. Cases of possible neuropathic pain (NP) and persistent-NP were identified using either of 2 definitions: 1) clinical diagnosis of sciatica, 2) self-report version of leeds assessment for neurological symptoms and signs (s-LANSS). Mixed-effects models compared pain intensity (highest of mean leg or mean back pain [0-10 Numerical Rating Scale]) over 3-years between persistent-NP versus non-persistent-NP based on 1) clinical diagnosis, 2) s-LANSS. Logistic regression examined associations between potential prognostic factors and persistent-NP at 4 months based on the 2 NP definitions. At 4-months, using both definitions: 1) approximately 4 out of 10 patients had persistent-NP, 2) mean pain intensity was higher for patients with persistent-NP at all follow-up points compared to those without, 3) only pain self-efficacy was significantly associated with persistent-NP (s-LANSS: OR .98, sciatica: .98), but it did not predict cases of persistent-NP in either multivariable model. Based on factors routinely collected from self-report and clinical examination, it was not possible to predict persistent-NP in this population. PERSPECTIVE: This study provides evidence that neuropathic back-related leg pain in patients consulting in primary care is not always persistent. Patients with persistent neuropathic pain had worse outcomes than those without. Neither leg pain intensity, pain self-efficacy nor MRI scan findings predicted cases of persistent neuropathic pain in this patient population.
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Affiliation(s)
- Sarah A Harrisson
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; North Staffordshire and Stoke-on-Trent Integrated Musculoskeletal Service (NIMS), Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, UK
| | - Kate M Dunn
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; Surgical, Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Australia
| | - Kika Konstantinou
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; North Staffordshire and Stoke-on-Trent Integrated Musculoskeletal Service (NIMS), Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
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Beneciuk JM, Michener LA, Sigman E, Harrison T, Buzzanca-Fried KE, Lu X, Shan G, Hill JC. Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings. THE JOURNAL OF PAIN 2024:104475. [PMID: 38242334 DOI: 10.1016/j.jpain.2024.01.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida; Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erica Sigman
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Trent Harrison
- Brooks Institute of Higher Learning, Brooks Rehabilitation, Jacksonville, Florida
| | - Katherine E Buzzanca-Fried
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida; Rehabilitation Science Doctoral Program, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Xinlin Lu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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Larsen JB, Borregaard P, Thomsen JL, Rathleff MS, Johansen SK. Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns. Scand J Pain 2024; 24:sjpain-2023-0070. [PMID: 38451744 DOI: 10.1515/sjpain-2023-0070] [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: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the current setup for the management of patients with CMP. The objective was to explore GP's perspectives on the challenges, needs, and visions for improving the management of patients with CMP. METHODS A qualitative study with co-design using the future workshop approach. Eight GPs participated in the future workshop (five females). Insights and visions emerged from the GP's discussions and sharing of their experiences in managing patients with CMP. The audio-recorded data were subjected to thematic text analysis. RESULTS The thematic analysis revealed four main themes, including (1) challenges with current pain management, (2) barriers to pain management, (3) the need for a biopsychosocial perspective, and (4) solutions and visions. All challenges are related to the complexity and diagnostic uncertainty for this patient population. GPs experienced that the patients' biomedical understanding of their pain was a barrier for management and underlined the need for a biopsychosocial approach when managing the patients. The GPs described taking on the role of coordinators for their patients with CMP but could feel ill-equipped to handle diagnostic uncertainty. An interdisciplinary unit was recommended as a possible solution to introduce a biopsychosocial approach for the examination, diagnosis, and management of the patient's CMP. CONCLUSIONS The complexity and diagnostic uncertainty of patients with CMP warrants a revision of the current setup. Establishing an interdisciplinary unit using a biopsychosocial approach was recommended as an option to improve the current management for patients with CMP.
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Affiliation(s)
- Jesper Bie Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Aalborg, Denmark
| | | | | | - Michael Skovdal Rathleff
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Aalborg, Denmark
- Center for General Practice at Aalborg University, Aalborg, Denmark
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Agger N, Desmeules F, Christiansen DH. Predicting outcomes across treatment settings in patients with shoulder pain referred to physiotherapy: a secondary analysis of two comparable prospective cohort studies. BMJ Open Sport Exerc Med 2023; 9:e001770. [PMID: 38156241 PMCID: PMC10753741 DOI: 10.1136/bmjsem-2023-001770] [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] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Previous studies have examined factors that may contribute to predicting outcomes for patients with shoulder pain. However, there is still a lack of consensus on which factors predict the results and whether there are differences based on the treatment setting. Thus, this study aimed to analyse and compare how baseline variables are associated with future outcomes in patients with shoulder pain in primary and secondary care settings. Methods This study conducted a secondary analysis of two observational prospective cohort studies involving patients with shoulder pain in primary care (n=150) and secondary care (n=183). Multiple regression analyses were employed, with one interaction term at a time, to examine potential differences in association with baseline characteristics and future outcomes between the two settings. Results Changes in pain and function were statistically significant at 6 months for patients in primary care and secondary care. However, associations for most baseline variables and outcomes did not differ significantly across these two treatment settings. The only statistically significant interactions observed were for the associations between baseline level of pain, function and fear avoidance beliefs and change in pain scores at 6 months, with lower change scores observed among patients in the secondary care. Conclusion This study revealed that the association with outcomes did not differ across settings for most baseline characteristics. These findings suggest that it could be feasible to generalise the prognostic value of most baseline variables for patients with shoulder, irrespective of the treatment setting.
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Affiliation(s)
- Nikolaj Agger
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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10
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Callan F, Keating L, Casserley-Feeney S, French HP. ADvAnced PhysioTherapy in MuSculosKeletal Triage: Investigating prognostic factors, healthcare utilisation and clinical outcomes (ADAPT MSK) - a cohort study protocol. HRB Open Res 2023; 6:73. [PMID: 38384973 PMCID: PMC10879754 DOI: 10.12688/hrbopenres.13769.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Clinical specialist physiotherapist-led musculoskeletal triage clinics were introduced nationally in Ireland in 2011 to improve patient care and reduce waiting times for secondary care orthopaedics and rheumatology. Evidence has shown them to be effective in reducing waiting lists, however there are currently no data on longitudinal patient outcomes following clinic attendance. The primary aim of this cohort study is to identify predictors of pain and function outcomes up to one year following musculoskeletal triage review. Secondary aims include measuring self-reported use of healthcare resources over the 12-month follow-up period and to explore musculoskeletal phenotypes based on established prognostic factors for musculoskeletal pain. This is a prospective cohort study. METHODS ADvAnced PhysioTherapy in MuSculosKeletal Triage (ADAPT MSK) will recruit a cohort of 252 adults through musculoskeletal triage clinics across five secondary care sites in Ireland. The STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines will be adhered to for future reporting. Adults (≥ 18 years old) attending physiotherapist-led musculoskeletal triage clinics with musculoskeletal pain, who do not require surgical or consultant-led medical care will be considered for participation. Participant demographics, health literacy, healthcare utilisation, and self-report questionnaires on pain, function, musculoskeletal health, musculoskeletal risk stratification, fear of movement, and psychological distress will be obtained at baseline, with follow-ups at three, six, and 12 months. Primary outcomes are pain intensity and function. Secondary outcomes include musculoskeletal risk stratification status, musculoskeletal health, healthcare utilisation, and work-related factors. Descriptive statistics will be used to profile the participants and predictors of outcome will be assessed using multivariable linear regression. Musculoskeletal phenotypes will be explored using latent class analysis. RESULTS Results will be disseminated via peer-reviewed journal publication and presentation at national and international conferences. Engagement with a public patient involvement (PPI) panel will explore dissemination strategies for public and service user engagement.
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Affiliation(s)
- Fiona Callan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Keating
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Casserley-Feeney
- National Musculoskeletal Triage Initiative, National Clinical Programme for Trauma & Orthopaedic Surgery (NCPTOS), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Øverås CK, Nilsen TIL, Søgaard K, Mork PJ, Hartvigsen J. Temporal stability in the prevalence and pattern of co-occurring musculoskeletal pain among people with persistent low back pain: population-based data from the Norwegian HUNT Study, 1995 to 2019. Pain 2023; 164:2812-2821. [PMID: 37433178 PMCID: PMC10652714 DOI: 10.1097/j.pain.0000000000002981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 07/13/2023]
Abstract
ABSTRACT People with persistent low back pain (LBP) often report co-occurring persistent musculoskeletal (MSK) pain in other body regions that may influence prognosis as well as treatment approaches and outcomes. This study describes the prevalence and patterns of co-occurring persistent MSK pain among people with persistent LBP based on consecutive cross-sectional studies over 3 decades in the population-based HUNT Study, Norway. The analyses comprised 15,375 participants in HUNT2 (1995-1997), 10,024 in HUNT3 (2006-2008), and 10,647 in HUNT4 (2017-2019) who reported persistent LBP. Overall, ∼90% of participants in each of the HUNT surveys with persistent LBP reported persistent co-occurring MSK pain in other body sites. The age-standardized prevalence of the most common co-occurring MSK pain sites was consistent across the 3 surveys: 64% to 65% report co-occurring neck pain, 62% to 67% report shoulder pain, and 53% to 57% report hip or thigh pain. Using latent class analysis (LCA), we identified 4 distinct patterns of persistent LBP phenotypes that were consistent across the 3 surveys: (1) "LBP only," (2) "LBP with neck or shoulder pain," (3) "LBP with lower extremity or wrist or hand pain," and (4) "LBP with multisite pain," with conditional item response probabilities of 34% to 36%, 30% to 34%, 13% to 17%, and 16% to 20%, respectively. In conclusion, 9 of 10 adults in this Norwegian population with persistent LBP report co-occurring persistent MSK pain, most commonly in the neck, shoulders, and hips or thighs. We identified 4 LCA-derived LBP phenotypes of distinct MSK pain site patterns. In the population, both the prevalence and pattern of co-occurring MSK pain and the distinct phenotypic MSK pain patterns seem stable over decades.
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Affiliation(s)
- Cecilie K. Øverås
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tom I. L. Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Paul J. Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
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Collier TS, Hughes T, Chester R, Callaghan MJ, Selfe J. Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review. Ann Med 2023; 55:401-418. [PMID: 36705623 PMCID: PMC9888457 DOI: 10.1080/07853890.2023.2165706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Data collected during initial primary care consultations could be a source of baseline prognostic factors associated with changes in outcome measures for patients with knee pain. OBJECTIVES To identify, appraise and synthesize studies investigating prognostic factors associated with changes in outcome for people presenting with knee pain in primary care. METHODS EMBASE, CINAHL, AMED, MEDLINE and MedRxiv electronic databases were searched from inception to March 2021 and repeated in August 2022. Prospective cohort studies of adult participants with musculoskeletal knee pain assessing the association between putative prognostic factors and outcomes in primary care were included. The Quality in Prognostic Studies (QUIPS) tool and The Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, specific to prognostic reviews were used to appraise and synthesize the evidence respectively. RESULTS Eight studies were included. Eight knee pain outcomes were identified. Methodological and statistical heterogeneity resulted in qualitative analysis. All evidence was judged to be of low to very low quality. Bilateral knee pain (multivariable odds ratio (OR) range 2.60-2.74; 95%CI range 0.90-8.10, p value = 0.09) and a lower educational level (multivariable (OR) range 1.74-5.6; 95%CI range 1.16-16.20, p value = <0.001) were synonymously associated with persisting knee pain at 12-month follow up. A total of 37 univariable and 63 multivariable prognostic factors were statistically associated with outcomes (p ≤ 0.05) in single studies. CONCLUSIONS There was consensus from two independent studies that bilateral knee pain and lower educational level were associated with persistent knee pain. Many baseline factors were associated with outcome in individual studies but not consistently between studies. The current understanding, accuracy and reliability of the prognostic value of initial primary care consultation data for knee pain outcomes are limited. This review will provide an essential guide for candidate variable selection in future primary care prognostic confirmatory studies.Key messagesBilateral knee pain and lower educational level were associated with persistent knee pain.Many baseline factors were associated with outcome in individual studies but not consistently between studies.The current understanding, accuracy and reliability of the prognostic value of initial primary care consultation data for knee pain outcomes are limited.
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Affiliation(s)
- Thomas S Collier
- Pure Physiotherapy Specialist Clinics, Norwich, UK.,School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norwich, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Tom Hughes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.,Football Medicine and Science Department, Manchester United Football Club, Manchester United Training Centre, Manchester, UK
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Michael J Callaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Olbort C, Pfanne F, Schwahn C, Bernhardt O. Training of the lateral pterygoid muscle in the treatment of temporomandibular joint disc displacement with reduction: A randomised clinical trial. J Oral Rehabil 2023; 50:921-930. [PMID: 37226632 DOI: 10.1111/joor.13517] [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: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Disc displacement with reduction (DDwR) therapy should be performed only when pain or discomfort is presented. Data on treatment options for painful DDwR are very limited. OBJECTIVE The aim was to investigate whether isometric training of the lateral pterygoid muscle (LPM) is equivalent to stabilisation appliance therapy with regard to the treatment of painful DDwR. The training program is based on the science of Janda. METHODS This was a prospective, randomised study with a comparative treatment group. Sixty patients (≥18 years) with DDwR and pain were randomly assigned to two groups: (1) muscle training and (2) stabilisation appliance. The following variables were recorded at baseline examination and after 2, 4 and 6 months: changes in orofacial pain, clicking sounds of the temporomandibular joint (TMJ), force degrees for the lateral movement of the mandible and interincisal opening distance. p values of <.05 were considered statistically significant but 95% confidence intervals were also presented. RESULTS A decrease in orofacial pain intensity was seen in both groups (p < .0001). Registered TMJ clicking disappeared after 6 months of treatment in 37% (n = 11) of the patients in the training group and in 27% (n = 8) of the appliance group (p = .0009 and p = .0047). Muscle training showed 27 improvements in Janda force degrees at the end of the study (p < .0001). CONCLUSION Muscle training and appliance therapy improved mouth opening and reduced pain intensity in both patient groups. Muscle training might be a promising option in the treatment of patients suffering from painful DDwR.
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Affiliation(s)
- Christin Olbort
- Dental Practice, with Focus on Temporomandibular Disorders, Competence Centre, Steina, Germany
| | - Falk Pfanne
- Dental Practice, with Focus on Temporomandibular Disorders, Competence Centre, Steina, Germany
| | - Christian Schwahn
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Olaf Bernhardt
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Fu Y, Chiarotto A, Enthoven W, Skou ST, Koes B. The influence of comorbidities on outcomes for older people with back pain: BACE-D cohort study. Ann Phys Rehabil Med 2023; 66:101754. [PMID: 37276834 DOI: 10.1016/j.rehab.2023.101754] [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: 08/09/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. OBJECTIVES To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. METHODS We analyzed data from the 'Back Complaints in the Elders' Dutch study cohort (BACE-D) and included participants aged >55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. RESULTS Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14-0.39; 12-month β = 0.31, 95% CI 0.17-0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31-0.77; 12-month β = 0.64, 95% CI 0.37-0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41-1.37; 12-month β = 1.17, 95% CI 0.65-1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71-2.52; 12-month β = 1.85, 95% CI 0.82-2.89, P-value < 0.001) compared to participants without musculoskeletal comorbidities. CONCLUSIONS More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.
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Affiliation(s)
- Yanyan Fu
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Søren Thorgaard Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Myhrvold BL, Vøllestad NK, Irgens P, Robinson HS, Axén I. Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study. Chiropr Man Therap 2023; 31:33. [PMID: 37653398 PMCID: PMC10472687 DOI: 10.1186/s12998-023-00507-y] [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: 12/20/2022] [Accepted: 08/05/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Chiropractors' clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated with being recommended continued care beyond 4 weeks, and if so whether this recommendation was dependent of chiropractor characteristics, as well as if the number of clinical indicators influenced this recommendation. METHODS In this multi-center observational study, 172 patients seeking care for a new episode of neck pain in chiropractic practice in Norway were included between September 2015 and May 2016. The chiropractors treated their patients as per usual, and for this study, baseline data and 4-week follow-up data were used. Patient data included the clinical indicators (1) previous episodes of neck pain, (2) a history of long duration neck pain and (3) improvement four weeks after initial treatment. The recruiting chiropractors were asked at 4-week follow-up if each patient was recommended continued care, defined as care planned beyond the first 4 weeks. Univariate and multivariable logistic regression models investigated the association between clinical indicators and the continued care recommendation, as well as the influence of chiropractor characteristics on this recommendation. Cross tabulations investigated the relationship between the number of indicators present and recommendation of continued care. RESULTS Long duration of neck pain was the strongest clinical indicator for being recommended continued care 4 weeks after the initial treatment. Chiropractor characteristics were not associated with this recommendation. In patients with all three clinical indicators present, 39% were recommended continued care. When two and one indicators were present, the percentages of those recommended continued care were 25% and 10%, respectively. CONCLUSION Chiropractors recommended continued care for patients experiencing neck pain based on their history of long pain duration, and this was not influenced by characteristics of the chiropractor. This differs from previous studies of indicators for maintenance care in patients with low back pain.
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Affiliation(s)
- Birgitte Lawaetz Myhrvold
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway.
- Et Liv I Bevegelse (ELiB), The Norwegian Chiropractic Research Foundation, Oslo, Norway.
| | - Nina K Vøllestad
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
| | - Pernille Irgens
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
| | - Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
| | - Iben Axén
- Et Liv I Bevegelse (ELiB), The Norwegian Chiropractic Research Foundation, Oslo, Norway
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden
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Areias AC, Janela D, Molinos M, Moulder RG, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study. JMIR Rehabil Assist Technol 2023; 10:e49673. [PMID: 37465960 PMCID: PMC10466151 DOI: 10.2196/49673] [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: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). OBJECTIVE This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. METHODS We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non-work-related activity impairment. RESULTS Of 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P<.001 and OR 2.40, 95% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95% CI 1.03-1.45; P=.03 and OR 1.38, 95% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6%; middle-aged adults: 1848/2834, 65.2%; and older adults: 241/387, 62.3%; P=.17). CONCLUSIONS Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population.
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Affiliation(s)
| | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | | | - Robert G Moulder
- Sword Health, Inc, Draper, UT, United States
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - 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, United States
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Amundsen O, Moger TA, Holte JH, Haavaag SB, Bragstad LK, Hellesø R, Tjerbo T, Vøllestad NK. Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Serv Res 2023; 23:858. [PMID: 37580723 PMCID: PMC10426198 DOI: 10.1186/s12913-023-09852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. METHODS The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013-2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1-5 above 95th percentile (≥ 3 744€). RESULTS We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1-30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. CONCLUSION There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.
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Affiliation(s)
- Olav Amundsen
- Dept. for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Tron Anders Moger
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jon Helgheim Holte
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Silje Bjørnsen Haavaag
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Kildal Bragstad
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ragnhild Hellesø
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Tjerbo
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Dept. for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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Rasmussen-Barr E, Sövelid M, Krantz R, Hill JC. The Swedish version of the STarT MSK Tool: cross-cultural adaption, test-retest reliability, and aspects of validity. BMC Musculoskelet Disord 2023; 24:644. [PMID: 37563613 PMCID: PMC10413630 DOI: 10.1186/s12891-023-06771-6] [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: 05/06/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are a common reason for seeking primary health care. The STarT Musculoskeletal (MSK) tool is designed to stratify patients suffering from MSDs to risk groups, based on prognostic factors. AIM The aim was to translate and cross-culturally adapt the STarT MSK tool in a Swedish primary health care context through testing of reliability and construct validity. METHODS We included consecutive patients with MSDs seeking primary care (n = 99). The STarT MSK was translated using international recommendations. Construct validity was investigated by correlation analysis (Spearmans Rho) with the following reference instruments: the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), the EuroQol 5-dimension (EQ-5D) and the Musculoskeletal Health Questionnaire (MSKHQ). Reliability was tested using test-retest (Intra Class Correlation, ICC2.1) (n = 31). Known-groups validity was calculated with a difference of 10% between risk groups based on how the participants had answered. RESULTS The STarT MSK was successfully translated into Swedish. The participants were grouped into low risk (n = 28), medium risk (n = 60) and high risk (n = 11). The construct validity showed a moderate to high correlation with the ÖMPQ (r = .61), EQ-5D (r = .59) and MSK-HQ (r = .56). All separate items except item 2 and 9 correlated according to predefined hypotheses. Test-retest demonstrated an excellent reliability for the total score (ICC2.1 0.85) (n = 31). The STarT MSK tool was able to differentiate by 10% between the risk groups, based on how the participants had answered. CONCLUSION The STarT MSK has been successfully translated and adapted into Swedish and shows acceptable measurement properties regarding test-retest reliability and aspects of validity and seems to be able to discriminate between the proposed risk groups. The tool can therefore be useful in a Swedish primary health care context. A future study needs to determine the tools predictive validity and to investigate if stratification to risk groups leads to a faster recovery and to lower health care costs.
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Affiliation(s)
- Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
| | - Maria Sövelid
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Rasmus Krantz
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
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Tousignant-Laflamme Y, Houle C, Longtin C, Gérard T, Lagueux E, Perreault K, Beaudry H, Tétreault P, Blanchette MA, Décary S. Prognostic factors specific to work-related musculoskeletal disorders: An overview of recent systematic reviews. Musculoskelet Sci Pract 2023; 66:102825. [PMID: 37463542 DOI: 10.1016/j.msksp.2023.102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Work-related injuries affect a considerable number of people each year and represent a significant burden for society. To reduce this burden, optimizing rehabilitation care by integrating prognostic factors (PF) into the clinical decision-making process is a promising way to improve clinical outcomes. The aim of this study was to identify PF specific to work-related musculoskeletal disorders. METHODS We performed an overview of systematic reviews reporting on PF that had the following outcomes of interest: Return to work, pain, disability, functional status, or poor outcomes. Each extracted PF was categorized according to its level of evidence (grade A or B) and whether it was modifiable or not. The risk of bias of each study was assessed with the ROBIS tool. RESULTS We retrieved 757 citations from 3 databases. After removing 307 duplicates, 450 records were screened, and 20 studies were retained. We extracted a total of 20 PF with a Grade A recommendation, where 7 were deemed modifiable, 11 non-modifiable and 2 were index test. For example, return to work expectations, previous sick leave, delay in referral and pain intensity were found to be predictors of return-to-work outcomes. We also identified 17 PF with a Grade B recommendation, where 11 were deemed modifiable. For example, poor general health, negative recovery expectations, coping and fear-avoidance beliefs, pain severity, and particularly physical work were found to predict return to work outcomes. CONCLUSION We found numerous modifiable PFs that can help clinicians personalize their treatment plan beyond diagnostic-related information for work-related musculoskeletal disorders.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Christian Longtin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Thomas Gérard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Emilie Lagueux
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Kadija Perreault
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Pascal Tétreault
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada; Departments of Anesthesiology and Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marc-André Blanchette
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
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Bondesson E, Jöud A, Rivano Fischer M, Trulsson Schouenborg A. Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain? Pain Res Manag 2023; 2023:5182996. [PMID: 37360748 PMCID: PMC10289872 DOI: 10.1155/2023/5182996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Background No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions. Methods In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating. Results Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes. Conclusions Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health.
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Affiliation(s)
- Elisabeth Bondesson
- Lund University, Department of Clinical Sciences Lund, Lund, Sweden
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
| | - Anna Jöud
- Lund University, Department of Clinical Sciences Lund, Lund, Sweden
- Lund University, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund, Sweden
- Skåne University Hospital, Department of Research and Education, Lund, Sweden
| | - Marcelo Rivano Fischer
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
- Lund University, Department of Health Sciences, Research Group Rehabilitation Medicine, Lund, Sweden
| | - Anna Trulsson Schouenborg
- Skåne University Hospital, Department of Neurosurgery and Pain Rehabilitation, Lund, Sweden
- Lund University, Department of Health Sciences, Research Group Human Movement-Health and Rehabilitation, Lund, Sweden
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Rysstad T, Grotle M, Aasdahl L, Dunn KM, Tveter AT. Identification and Characterisation of Trajectories of Sickness Absence Due to Musculoskeletal Pain: A 1-Year Population-based Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:277-287. [PMID: 36103063 PMCID: PMC10172278 DOI: 10.1007/s10926-022-10070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 05/12/2023]
Abstract
Purpose This study aimed to identify trajectories of sickness absence in workers on sick leave due to musculoskeletal disorders and explore the association between these trajectories and established prognostic factors for sickness absence. Methods We conducted a prospective cohort study of 549 workers (56% women, aged 18-67 years) on sick leave due to musculoskeletal disorders in Norway in 2018-2019. Sickness absence data were collected from the Norwegian sick leave registry and prognostic factors via self-reported baseline questionnaires. We used group-based trajectory modelling to define the different trajectories of sickness absence spanning a 1-year period. Multivariable multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for prognostic factors associated with the identified trajectory groups. Results We identified six distinct trajectories of sickness absence over 1 year: 'fast decrease' (27% of the cohort): 'moderate decrease' (22%); 'slow decrease' (12%); 'u-shape' (7%); 'persistent moderate' (13%); and 'persistent high' (18%). Prognostic factors, such as previous sickness absence days, return-to-work expectancy, workability, multisite pain, and health scores, differentiated between the sickness absence trajectories (all P < 0.05). Negative return-to-work expectancy was associated with the three trajectory groups with the highest number of sickness absence days ('slow decrease', 'persistent moderate', and 'persistent high'). Conclusions This is the first study to explore the association of return-to-work expectancy with trajectories of sickness absence. Our findings highlight different patterns of sickness absence and the complex range of prognostic factors. These findings have implications for secondary and tertiary prevention strategies for work absence in workers with musculoskeletal disorders.
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Affiliation(s)
- Tarjei Rysstad
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, 0130, Oslo, Norway.
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, 0130, Oslo, Norway
- Research- and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, 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
| | - Kate M Dunn
- School of Medicine, Keele University, Staffordshire, UK
| | - Anne Therese Tveter
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, 0130, Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Gulle H, Morrissey D, Tan XL, Cotchett M, Miller SC, Jeffrey AB, Prior T. Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors. J Foot Ankle Res 2023; 16:28. [PMID: 37173686 PMCID: PMC10176769 DOI: 10.1186/s13047-023-00626-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Plantar Heel Pain (PHP) is a common disorder with many treatment pathways and is not self-limiting, hence prognostic information concerning recovery or recalcitrance is needed to guide practice. In this systematic review, we investigate which prognostic factors are associated with favourable or unfavourable PHP outcomes. METHODS MEDLINE, Web of Science, EMBASE, Scopus and PubMed electronic bibliographic databases were searched for studies evaluating baseline patient characteristics associated with outcomes in prospective longitudinal cohorts or after specific interventions. Cohort, clinical prediction rule derivation and single arms of randomised controlled trials were included. Risk of bias was evaluated with method-specific tools and evidence certainty with GRADE. RESULTS The review included five studies which evaluated 98 variables in 811 participants. Prognostic factors could be categorised as demographics, pain, physical and activity-related. Three factors including sex and bilateral symptoms (HR: 0.49[0.30-0.80], 0.33[0.15-0.72], respectively) were associated with a poor outcome in a single cohort study. The remaining four studies reported twenty factors associated with a favourable outcome following shockwave therapy, anti-pronation taping and orthoses. Heel spur (AUC = 0.88[0.82-0.93]), ankle plantar-flexor strength (Likelihood ratio (LR): 2.17[1.20-3.95]) and response to taping (LR = 2.17[1.19-3.90]) were the strongest factors predicting medium-term improvement. Overall, the study quality was low. A gap map analysis revealed an absence of research that included psychosocial factors. CONCLUSIONS A limited number of biomedical factors predict favourable or unfavourable PHP outcomes. High quality, adequately powered, prospective studies are required to better understand PHP recovery and should evaluate the prognostic value of a wide range of variables, including psychosocial factors.
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Affiliation(s)
- Halime Gulle
- Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Xiang Li Tan
- Department of Rheumatology, Medicine, Ashford and St Peter's Hospital, Guildford St, Lyne, KT16 0PZ, Chertsey, UK
| | - Matthew Cotchett
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
| | - Stuart Charles Miller
- Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Aleksandra Birn Jeffrey
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University London, Mile End, Bancroft Road, London, E1 4DG, UK
| | - Trevor Prior
- Consultant Podiatric Surgeon Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Abstract
Musculoskeletal pain treatments are widespread in the clinical practice of physiotherapists. A multifaceted biopsychosocial approach should guide modern pain therapy. The study aimed to investigate the association of musculoskeletal problems with lifestyle behaviors. The study adopted a qualitative literature review methodology. About 200 papers have been reviewed for this study. The categories of the study had been classified according to the factors that are interconnected to the life intervention. The inclusion criteria of the selected literature depend upon the data received. This is a review-based study. The results of cross-sectional and correlational analysis dominated the literature on lifestyle implications on musculoskeletal health, which included pain and its correlated inflammation. Long-term prospective studies, however, are difficult to enroll in due to ethical concerns about denying patients' therapies shown to benefit them, notably lifestyle behavior modification. By conducting intervention studies, it determines lifestyle modifications that determine the beneficial aspects. These aspects are avoiding and reducing pain by increasing exercise capacity. The study concluded that the quantity of beneficial health practices boosted the health-related quality of life. To achieve long-term health, the complexity of the behaviour change needs to be supported by the individual's lifestyle pattern and the support of the data. Therefore, in this century characterized by chronic lifestyle-related illnesses, various health behavior modifications may be claimed to be a primary therapeutic skill of health professionals (individually and collectively).
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Affiliation(s)
- H Ahmed
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
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Dupuis F, Cherif A, Batcho C, Massé-Alarie H, Roy JS. The Tampa Scale of Kinesiophobia: A Systematic Review of Its Psychometric Properties in People With Musculoskeletal Pain. Clin J Pain 2023; 39:236-247. [PMID: 36917768 DOI: 10.1097/ajp.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The aims of this systematic review were to identify the different versions of the Tampa Scale of kinesiophobia (TSK) and to report on the psychometric evidence relating to these different versions for people experiencing musculoskeletal pain. METHODS Medline [Ovid] CINAHL and Embase databases were searched for publications reporting on the psychometric properties of the TSK in populations with musculoskeletal pain. Risks of bias were evaluated using the COSMIN risk of the bias assessment tool. RESULTS Forty-one studies were included, mainly with a low risk of bias. Five versions of the TSK were identified: TSK-17, TSK-13, TSK-11, TSK-4, and TSK-TMD (for temporomandibular disorders). Most TSK versions showed good to excellent test-retest reliability (intraclass coefficient correlation 0.77 to 0.99) and good internal consistency (ɑ=0.68 to 0.91), except for the TSK-4 as its reliability has yet to be defined. The minimal detectable change was lower for the TSK-17 (11% to 13% of total score) and the TSK-13 (8% of total score) compared with the TSK-11 (16% of total score). Most TSK versions showed good construct validity, although TSK-11 validity was inconsistent between studies. Finally, the TSK-17, -13, and -11 were highly responsive to change, while responsiveness has yet to be defined for the TSK-4 and TSK-TMD. DISCUSSION Clinical guidelines now recommend that clinicians identify the presence of kinesiophobia among patients as it may contribute to persistent pain and disability. The TSK is a self-report questionnaire widely used, but 5 different versions exist. Based on these results, the use of TSK-13 and TSK-17 is encouraged as they are valid, reliable, and responsive.
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Affiliation(s)
- Frederique Dupuis
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, Canada
| | - Amira Cherif
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, Canada
| | - Charles Batcho
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, Canada
| | - Hugo Massé-Alarie
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, Canada
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Budtz CR, Rønnow MM, Stæhr TAB, Andersen NBDV, Christiansen DH. The usefulness of the STarT back screening tool and single-item general health measures when predicting future disability in patients with low back pain treated in Danish primary care physiotherapy. Musculoskelet Sci Pract 2023; 65:102767. [PMID: 37116370 DOI: 10.1016/j.msksp.2023.102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/13/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION The extent to which disease specific screening tools or other health measures add to the predictive value of common clinical factors (pain, disability and socio-demographics) has been sparsely investigated. The aim of this study was to investigate whether a disease specific screening tool and a single-item general health measure adds predictive value to basic information collected in primary physiotherapy care when predicting future disability in patients with low back pain. MATERIAL AND METHODS This longitudinal cohort study included 354 patients with low back pain from Danish primary care physiotherapy. Information was collected on socio-demographics, common clinical factors, The STarT Back Screening Tool (SBT) and general health perceptions measured as a single item from the SF-36 (GH-1). Disability at 6-month follow-up, measured by the Roland-Morris Disability Questionnaire, was predicted using multiple linear regression models. RESULTS Clinical factors and baseline disability level explained 28.3% of the variance in 6-month disability scores. With SBT and GH-1 added separately to the baseline model, the explained variance increased by 2.1% (p = 0.01) and 3.6% (p < 0.001), respectively. CONCLUSION The added value of the disease specific screening tools or the single-item general measure when predicting disability in patients with low back pain was generally small. Moreover, the predictive value of the single-item general measure seems comparable to and slightly better than the disease specific screening tool. Overall these findings may question the clinical utility of such measures.
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Affiliation(s)
- Cecilie Rud Budtz
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1, 8600, Silkeborg, Denmark.
| | - Mathias Moselund Rønnow
- Department of Occupational Medicine, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Thor Andre Brøndberg Stæhr
- Department of Occupational Medicine, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Nils-Bo de Vos Andersen
- Central Denmark Region, Primary Health Care and Quality Improvement, Skottenborg 26, 8800, Viborg, Denmark
| | - David Høyrup Christiansen
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1, 8600, Silkeborg, Denmark; Regional Hospital Central Jutland, Heibergs Allé 2K, 8000, Viborg, Denmark; Deartment of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
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Rambla C, Aragonès E, Pallejà-Millán M, Tomé-Pires C, López-Cortacans G, Sánchez-Rodríguez E, Miró J. Short and long-term predictors of pain severity and interference in primary care patients with chronic musculoskeletal pain and depression. BMC Musculoskelet Disord 2023; 24:270. [PMID: 37020278 PMCID: PMC10074832 DOI: 10.1186/s12891-023-06357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain. OBJECTIVE To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression. METHODS Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes. RESULTS 83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (β = 0.53; 95% CI = 0.37-0.68) and at 12 months (β = 0.48; 95% CI = 0.29-0.67). Also, pain > 2 years of evolution predicted long term pain severity (β = 0.91; CI95%=0.11-1.71). Baseline pain interference predicted interference at 3 and 12 months (β = 0.27; 95%CI = 0.11-0.43 and β = 0.21; 95%CI = 0.03-0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (β = 0.26; 95%CI = 0.10-0.42 and β = 0.20; 95%CI = 0.02-0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (β = 0.91; CI95%=0.11-1.71, and β = 1.23; CI95%=0.41-2.04). Depression severity predicted more interference at 12 months (β = 0.58; CI95%=0.04-1.11). Occupational status as active worker predicted less interference throughout the follow-up (β=-0.74; CI95%=-1.36 to -0.13 and β=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (β=-0.77; CI95%=1.52 - 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (β = 0.03; 95% CI = 0.00-0.05 and β = 0.03; 95% CI = 0.00-0.05), but not at long term. CONCLUSION In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions. TRIAL REGISTRATION ClinicalTrials.gov (NCT02605278), registered 16/11/2015.
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Affiliation(s)
- Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
- Centre d'Atenció Primària Constantí, Carrer dels Horts, 6, Constantí, 43120, Tarragona, Spain.
| | | | - Catarina Tomé-Pires
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Psychology Research Center (CIP), Autonomous University of Lisbon, Lisboa, Portugal
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
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Wingbermühle RW, Chiarotto A, van Trijffel E, Stenneberg MS, Kan R, Koes BW, Heymans MW. External validation and updating of prognostic models for predicting recovery of disability in people with (sub)acute neck pain was successful: broad external validation in a new prospective cohort. J Physiother 2023; 69:100-107. [PMID: 36958979 DOI: 10.1016/j.jphys.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/22/2022] [Accepted: 02/09/2023] [Indexed: 03/25/2023] Open
Abstract
QUESTION Can existing post-treatment prognostic models for predicting neck pain recovery (primarily in terms of disability and secondarily in terms of pain intensity and perceived improvement) be externally validated and updated at the end of the treatment period and at 6 and 12 weeks of follow-up in a new Dutch cohort of people with neck pain treated with guideline-based usual care physiotherapy? DESIGN External validation and model updating in a new prospective cohort of three previously developed prognostic models. PARTICIPANTS People with (sub)acute neck pain and registered for primary care physiotherapy treatment. OUTCOME MEASURES Recovery of disability, pain intensity, and perceived recovery at 6 and 12 weeks and at the end of the treatment period. RESULTS Discriminative performance (c-statistic) of the disability model at 6 weeks was 0.73 (95% CI 0.69 to 0.77) and reasonably well calibrated after intercept recalibration. The disability model at 12 weeks and at the end of the treatment period showed discriminative c-statistic performance values of 0.69 (95% CI 0.64 to 0.73) and 0.68 (95% CI 0.63 to 0.72), respectively, and was well calibrated. Pain models and perceived recovery models did not reach acceptable performance. Cervical mobility added value to the disability models and pain catastrophising to the disability and pain models at 6 weeks. DISCUSSION Broad external validation of the disability model was successful in people with (sub)acute neck pain and clinicians may use this model in clinical practice with reasonable accuracy. Further research is required to assess the disability model's clinical impact and generalisability, and to identify additional valuable model predictors. REGISTRATION https://osf.io/a6r3k/.
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Affiliation(s)
- Roel W Wingbermühle
- SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Martijn S Stenneberg
- SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of Physiotherapy, Human Physiology and Anatomy, Experimental Anatomy Research Department, Vrije Universiteit Brussel, Belgium
| | - Ronald Kan
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
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Bilika P, Paliouras A, Savvoulidou K, Arribas-Romano A, Dimitriadis Z, Billis E, Strimpakos N, Kapreli E. Psychometric properties of quantitative sensory testing in healthy and patients with shoulder pain: A systematic review. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:145-164. [PMID: 36856109 PMCID: PMC9976178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Quantitative Sensory Testing (QST) is a psychophysical battery of various tests developed to quantify the subjects' self-reported sensory experience. Although the use of QST is valuable for the clinical assessment of pain, standard evaluation protocols have not yet been established. This systematic review aimed to investigate the level of evidence for the psychometric properties of QST in healthy and patients with shoulder pain. Eight databases were searched for peer-reviewed studies published until August 2021. The methodological quality of studies was evaluated using the COSMIN checklist. Twelve studies were included for qualitative synthesis, which included three different tests (Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Temporal Summation (TS)). As the body of evidence consisted of studies of low methodological quality, the psychometric properties of PPT, CPM, and TS in healthy and patients with shoulder pain were classified as unknown. Although there is a risk that the conclusions may be 'superficial' in nature, the reliability seems to be nearly excellent for the PPT, however, the protocols' variation and the low methodological quality of the studies do not allow for clear conclusions. Further studies are required for the CPM and TS in patients with shoulder pain.
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Affiliation(s)
- Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Achilleas Paliouras
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Konstantina Savvoulidou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - Zacharias Dimitriadis
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Evdokia Billis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece.,Division of Musculoskeletal & Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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Chen JA, Anderson ML, Cherkin DC, Balderson BH, Cook AJ, Sherman KJ, Turner JA. Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:282-303. [PMID: 36180008 PMCID: PMC9898119 DOI: 10.1016/j.jpain.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0-10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. TRIAL REGISTRATION: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PERSPECTIVE: Although few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.
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Affiliation(s)
- Jessica A Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel C Cherkin
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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Şentürk İA, Şentürk E, Üstün I, Gökçedağ A, Yıldırım NP, İçen NK. High-impact chronic pain: evaluation of risk factors and predictors. Korean J Pain 2023; 36:84-97. [PMID: 36581599 PMCID: PMC9812691 DOI: 10.3344/kjp.22357] [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: 10/28/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
Background The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP. Methods Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores. Results One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01-1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001). Conclusions This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.
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Affiliation(s)
- İlteriş Ahmet Şentürk
- Department of Pain Medicine, Bagcilar Education and Research Hospital, Istanbul, Turkiye
| | - Erman Şentürk
- Department of Psychiatry, Üsküdar University NP Feneryolu Medical Center, Istanbul, Turkiye,Correspondence: Erman Şentürk Department of Psychiatry, Üsküdar University NP Feneryolu Medical Center, Ahmet Mithat Efendi Cad. No:17 (Bağdat Cad. Sahil Yolu Kalamış Mevkii) - 34726 Fenerbahçe – Kadıköy, Istanbul, Turkiye, Tel: +902164181500, Fax: +902164181530, E-mail:
| | - Işıl Üstün
- Department of Physical Medicine and Rehabilitation, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkiye
| | - Akın Gökçedağ
- Department of Neurosurgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkiye
| | - Nilgün Pulur Yıldırım
- Department of Neurology, Bagcilar Education and Research Hospital, Istanbul, Turkiye
| | - Nilüfer Kale İçen
- Department of Neurology, Bagcilar Education and Research Hospital, Istanbul, Turkiye
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Steyaert A, Bischoff R, Feron JM, Berquin A. The High Burden of Acute and Chronic Pain in General Practice in French-Speaking Belgium. J Pain Res 2023; 16:1441-1451. [PMID: 37151810 PMCID: PMC10162396 DOI: 10.2147/jpr.s399037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/23/2023] [Indexed: 05/09/2023] Open
Abstract
Background Chronic pain prevalence is very high in the general population, much higher than can be managed by chronic pain centers. Therefore, most pain patients are cared for by first-line professionals. However, general practitioners often feel ill at ease with these patients, and only a few studies assess the burden of chronic pain in general practice. To better estimate the resources needed to support these professionals, a good knowledge of (sub)acute and chronic pain prevalence and prognosis in general practices is needed. Methods We report cross-sectional data from a larger longitudinal study performed in French-speaking general practices in Belgium in November 2018. Fifth-year medical students performing a one-month internship collected data for every third patient they saw each day: demographic information, pain characteristics, lifestyle, general health perception and the short Örebro Musculoskeletal Pain Screening Questionnaire in the French language. Results 3882 patients (participation rate 66%) accepted to take part in the study. 22 and 50% of these suffered from (sub)acute and chronic pain, respectively. Pain was more often the motive of the consultation for (sub)acute than for chronic pain patients. Pain intensity and functional impact were moderate, irrespective of pain duration. 70% of (sub)acute and 31% of chronic pain patients were at low risk of chronicity. Conclusion In our sample, chronic pain patients constituted 33-50% of patient contacts in general practice, indicating the high importance of providing adequate support to general practitioners and other first-line professionals, ie, by reinforcing collaboration with chronic pain centers.
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Affiliation(s)
- Arnaud Steyaert
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Romain Bischoff
- General Practice Medecine Internship, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Marc Feron
- Centre Académique de médecine générale, Université Catholique de Louvain, Brussels, Belgium
| | - Anne Berquin
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Correspondence: Anne Berquin, Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium, Email
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Garnæs KK, Mørkved S, Tønne T, Furan L, Vasseljen O, Johannessen HH. Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients. BMC Musculoskelet Disord 2022; 23:1115. [PMID: 36544130 PMCID: PMC9773452 DOI: 10.1186/s12891-022-06051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (CMP) is characterised by pain related to the muscles or the joints with a duration of three months or more and is associated with high symptomatic burden in patients in primary health care. CMP is commonly associated with impaired mental health, which may affect the rehabilitation process. The primary aim of this study was to compare symptoms of anxiety, depression, fatigue, and insomnia in patients in primary health care with and without CMP. The secondary aim was to assess difference in mental health symptoms related to number of pain sites and pain intensity. METHODS This cross-sectional study was conducted in Trondheim, Norway. All patients aged 21-58 from randomly selected general practitioners (GPs) were invited to participate. Participants were classified into two groups according to presence of CMP. Symptoms of anxiety, depression, fatigue, and insomnia were assessed by the Hospital Anxiety and Depression Scale (HADS), Chalder Fatigue Questionnaire (CFQ), and Insomnia Severity Index (ISI), respectively, using an online survey system. RESULTS From the patient lists of six GPs, we included 969 patients. Mean age 46 years (SD: 10.1), and 517 reported CMP. CMP patients reported higher mean symptom score for anxiety (5.4 vs 3.7), depression (3.4 vs 2.0), fatigue (14.2 vs 11.2), and insomnia (8.1 vs 4.4), all p < 0.01 compared to no-CMP patients. Symptoms of impaired mental health increased with increasing number of pain sites and pain intensity (p < 0.001). CONCLUSIONS Primary health care patients with CMP reported significantly more symptoms of anxiety, depression, fatigue, and insomnia than patients without CMP. The higher number of pain sites and pain intensity, the more mental health symptoms, especially of anxiety. Primary health care personnel have to address mental health issues when treating patients with CMP. TRIAL REGISTRATION Clinicaltrials.gov (NCT02020772, 25/12/2013).
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Affiliation(s)
- Kirsti Krohn Garnæs
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, P.O Box 3250, Trondheim, Norway
| | - Siv Mørkved
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway ,grid.453770.20000 0004 0467 8898Central Norway Regional Health Authority, P.O Box 464, Stjørdal, Norway
| | - Torgrim Tønne
- Tiller Physiotherapy and Manual Therapy. Ivar Lykkes Veg 9, 7075 Tiller, Norway
| | - Lars Furan
- Stokmoen Physiotherapy, Wergelandsveien 27, 7504 Stjørdal, Norway
| | - Ottar Vasseljen
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, N-7491 Trondheim, Norway
| | - Hege Hølmo Johannessen
- grid.446040.20000 0001 1940 9648Department of Health and Welfare, Østfold University College, Kobberslagerstredet 5, Fredrikstad, Norway
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Willems SJ, Coppieters MW, Rooker S, Ostelo R, Hoekstra T, Scholten-Peeters GGM. Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis. Clin Neurol Neurosurg 2022; 224:107551. [PMID: 36563569 DOI: 10.1016/j.clineuro.2022.107551] [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: 10/02/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The clinical course of lumbar radiculopathy following microdiscectomy and post-operative physiotherapy varies substantially. No prior studies assessed this variability by deriving outcome trajectories. The primary aims of this study were to evaluate the variability in long-term recovery after lumbar microdiscectomy followed by post-operative physiotherapy and to identify outcome trajectories. The secondary aim was to assess whether demographic, clinical characteristics and patient-reported outcome measures routinely collected at baseline could predict poor outcome trajectories. METHODS We conducted a prospective cohort study with a 24-month follow-up. We included 479 patients with clinical signs and symptoms of lumbar radiculopathy confirmed by Magnetic Resonance Imaging findings, who underwent microdiscectomy and post-operative physiotherapy. Outcomes were leg pain and back pain measured with Visual Analogue Scales, and disability measured with the Roland-Morris Disability Questionnaire. Descriptive statistics were performed to present the average and the individual clinical course. A latent class trajectory analysis was conducted to identify leg pain, back pain, and disability outcome trajectories. The best number of clusters was determined using the Bayesian Information Criterion, Akaike's information criteria, entropy, and overall interpretability. Prediction models for poor outcome trajectories were assessed using multivariable logistic regression analyses. RESULTS Several outcome trajectories were identified. Most patients were assigned to the 'large improvement' trajectory (leg pain: 79.3%; back pain: 70.2%; disability: 59.5% of patients). Smaller proportions of patients were assigned to the 'moderate improvement' trajectory (leg pain: 7.9%; back pain: 10.6%; disability: 20.7% of patients), the 'minimal improvement' trajectory (leg pain: 4.9%, back pain: 6.7%, disability: 16.3% of patients) and the 'relapse' trajectory (leg pain: 7.9%; back pain: 12.5%; disability: 3.5%). Approximately one-third of patients (32.6%) belonged to one or more than one poor outcome trajectory. Patients with previous treatment (prior back surgery, injection therapy, and medication use) and those who had higher baseline pain and disability scores were more likely to belong to the poor outcome trajectories in comparison to the large improvement trajectories in back pain, leg pain and disability, and the moderate improvement trajectory in disability. The explained variance (Nagelkerke R2) of the prediction models ranged from 0.06 to 0.13 and the discriminative ability (Area Under the Curve) from 0.66 to 0.73. CONCLUSION The clinical course of lumbar radiculopathy varied following microdiscectomy and post-operative physiotherapy, and several outcome trajectories could be identified. Although most patients were allocated to favorable trajectories, one in three patients was assigned to one or more poor outcome trajectories following microdiscectomy and post-operative physiotherapy for lumbar radiculopathy. Routinely gathered data were unable to predict the poor outcome trajectories accurately. Prior to surgery, clinicians should discuss the high variability and the distinctive subgroups that are present in the clinical course with their patients.
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Affiliation(s)
- Stijn J Willems
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane, Gold Coast, Australia.
| | - Servan Rooker
- Department of Neurosurgery Kliniek ViaSana, Mill, the Netherlands; Department of Family medicine and population health (FAMPOP), University of Antwerp, Antwerp, Belgium.
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute,Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands.
| | - Trynke Hoekstra
- Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands.
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Shaygan M, Hosseini FA. Comparison of the effect of psychosocial skills training on acute and chronic musculoskeletal pain intensity: The effectiveness of early intervention in the reduction of acute musculoskeletal pain. Musculoskeletal Care 2022; 20:839-847. [PMID: 35332994 DOI: 10.1002/msc.1635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pain, as a psychological experience, is caused by complex interactions among sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. METHODS In this quasi-experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8-10 people over six 1-h sessions. The data were collected at baseline, after the intervention, and 3 months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. RESULTS In this study, the mean age of the participants was 50.10 ± 10.63 years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p < 0.001), but the effect of group on pain intensity was not statistically significant (p = 0.07). The group × time effect on pain intensity was also statistically significant (p < 0.001). CONCLUSION Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh A Hosseini
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Asquini G, Devecchi V, Borromeo G, Viscuso D, Morato F, Locatelli M, Falla D. Predictors of pain reduction following a program of manual therapies for patients with temporomandibular disorders: A prospective observational study. Musculoskelet Sci Pract 2022; 62:102634. [PMID: 35939919 DOI: 10.1016/j.msksp.2022.102634] [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: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function. OBJECTIVES To identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making. DESIGN A cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped samples. RESULTS Patients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram. CONCLUSIONS The high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research. TRIAL REGISTRATION NUMBER NCT03990662.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK; Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK
| | - Giulia Borromeo
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Domenico Viscuso
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy; University of Cagliari, Department of Surgical Sciences, Dental Service, Via Università 40 Cagliari, Italy
| | - Federico Morato
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Matteo Locatelli
- IRCCS San Raffaele Scientific Institute, Via Olgettina Milano 60, 20132, Milano, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK.
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Peters R, van Trijffel E, van Rosmalen J, Mutsaers B, Pool-Goudzwaard A, Verhagen A, Koes B. Non-serious adverse events do not influence recovery in patients with neck pain treated with manual therapy; an observational study. Musculoskelet Sci Pract 2022; 61:102607. [PMID: 35772317 DOI: 10.1016/j.msksp.2022.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Renske Peters
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Experimental Anatomy Research Department, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
| | - Bert Mutsaers
- Avans University of Applied Sciences, Breda, the Netherlands.
| | - Annelies Pool-Goudzwaard
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; MOVE Research Institute, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Arianne Verhagen
- University of Technology Sydney, Discipline of Physiotherapy, Sydney, Australia.
| | - Bart Koes
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
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Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements. J Orthop Sports Phys Ther 2022; 52:685-693. [PMID: 35960508 DOI: 10.2519/jospt.2022.11018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To predict 30- and 180-day improvements in disability and pain for patients seeking physical therapy care for low back pain (LBP). DESIGN: Longitudinal cohort. METHODS: Baseline assessment was completed by 259 patients with chief complaint of LBP, and the assessment includes psychosocial measures (Keele STarT Back Screening [SBST] and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag [OSPRO-YF] tools), the Optimal Screening for Prediction of Referral and Outcome Review of Symptoms (OSPRO-ROS) and the Review of Symptoms Plus (OSPRO-ROS+) tools, the Charlson Comorbidity Index (CCI), the Area Deprivation Index (ADI), and the National Institute of Health Chronic Pain Criteria (NIH-CP). Using the Modified Low Back Disability Questionnaire (MDQ) and the Numeric Pain Rating Scale (NPRS) as primary outcomes, statistical analysis determined multiple sets of predictor variables with similar model performance. RESULTS: The parsimonious "best model" for prediction of the 180-day MDQ change included 3 predictors (Admit MDQ, NIH-CP, and OSPRO ROS+) because it had the lowest penalized goodness-of-fit statistic (BIC = -35.21) and the highest explained variance (R2 = 0.295). The parsimonious "best model" for 180-day NPRS change included 2 variables (Admit NPRS and OSPRO-ROS+) with the lowest penalized goodness-of-fit statistic (BIC = -18.2) and the highest explained variance (R2 = 0.190). CONCLUSION: There were many model options with similar statistical performance when using established measures to predict MDQ and NPRS outcomes. A potential variable set for a standard predictive model that balances statistical performance with pragmatic considerations included the OSPRO-ROS+, OSPRO-YF, NIH-CP definition, and admit MDQ and NPRS scores. J Orthop Sports Phys Ther 2022;52(10):685-693. Epub: 12 August 2022. doi:10.2519/jospt.2022.11018.
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Castellini G, Pillastrini P, Vanti C, Bargeri S, Giagio S, Bordignon E, Fasciani F, Marzioni F, Innocenti T, Chiarotto A, Gianola S, Bertozzi L. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother 2022; 68:244-254. [PMID: 36266185 DOI: 10.1016/j.jphys.2022.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/08/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023] Open
Abstract
QUESTION Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? DESIGN A systematic review and network meta-analysis of randomised clinical trials. PARTICIPANTS Adults with CNSNP of at least 3 months duration. INTERVENTIONS All available pharmacological and non-pharmacological interventions. OUTCOME MEASURES The primary outcomes were pain intensity and disability. The secondary outcome was adverse events. RESULTS Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty. CONCLUSIONS While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence. REGISTRATION PROSPERO CRD42019124501.
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Affiliation(s)
- Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Carla Vanti
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Giagio
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | | | - Francesco Fasciani
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Francesco Marzioni
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Tiziano Innocenti
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; GIMBE Foundation, Bologna, Italy
| | - Alessandro Chiarotto
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of General Practice - Erasmus MC - University Medical Center Rotterdam, The Netherlands
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Lucia Bertozzi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Tingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022; 11:192. [PMID: 36064472 PMCID: PMC9446672 DOI: 10.1186/s13643-022-02055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. METHODS We conducted a systematic review in accordance with international guidelines. Campbell Collaboration (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-analyses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. RESULTS We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically significant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months follow-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. CONCLUSION Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies.
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Affiliation(s)
| | - Jose Meneses-Echavez
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Facultad de Cultura Fisica, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia
| | - Line Holtet Evensen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Bjerk
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, University of Tromsø, Tromsø, Norway
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Otero-Ketterer E, Peñacoba-Puente C, Ferreira Pinheiro-Araujo C, Valera-Calero JA, Ortega-Santiago R. Biopsychosocial Factors for Chronicity in Individuals with Non-Specific Low Back Pain: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610145. [PMID: 36011780 PMCID: PMC9408093 DOI: 10.3390/ijerph191610145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 06/12/2023]
Abstract
Low back pain (LBP) is a global and disabling problem. A considerable number of systematic reviews published over the past decade have reported a range of factors that increase the risk of chronicity due to LBP. This study summarizes up-to-date and high-level research evidence on the biopsychosocial prognostic factors of outcomes in adults with non-specific low back pain at follow-up. An umbrella review was carried out. PubMed, the Cochrane Database of Systematic Reviews, Web of Science, PsycINFO, CINAHL Plus and PEDro were searched for studies published between 1 January 2008 and 20 March 2020. Two reviewers independently screened abstracts and full texts, extracted data and assessed review quality. Fifteen systematic reviews met the eligibility criteria; all were deemed reliable according to our criteria. There were five prognostic factors with consistent evidence of association with poor acute-subacute LBP outcomes in the long term (high levels of pain intensity and disability, high emotional distress, negative recovery expectations and high physical demands at work), as well as one factor with consistent evidence of no association (low education levels). For mixed-duration LBP, there was one predictor consistently associated with poor outcomes in the long term (high pain catastrophism). We observed insufficient evidence to synthesize social factors as well as to fully assess predictors in the chronic phase of LBP. This study provides consistent evidence of the predictive value of biological and psychological factors for LBP outcomes in the long term. The identified prognostic factors should be considered for inclusion into low back pain explanatory models.
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Affiliation(s)
- Emilia Otero-Ketterer
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Physiotherapy Department, Mutua Universal Mugenat, 28001 Alcalá de Henares, Spain
| | | | | | - Juan Antonio Valera-Calero
- Valtradofi Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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Godeau D, Fadel M, Descatha A. Factors associated with limitations in daily life and at work in a population with shoulder pain. BMC Musculoskelet Disord 2022; 23:777. [PMID: 35971096 PMCID: PMC9377064 DOI: 10.1186/s12891-022-05638-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain. Methods A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation. Results The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively). Conclusions The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.
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Affiliation(s)
- Diane Godeau
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France. .,AP-HP ("Assistance Publique-Hôpitaux de Paris"), Unité des pathologies professionnelles et environnementales, Hôpitaux universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, F-93009, Bobigny cedex, France. .,Université Sorbonne Paris Nord, F-93206, Saint-Denis, France. .,Godeau, Hôpital Avicenne, Unité fonctionnelle des pathologies professionnelles et environnementales, 125 rue de Stalingrad, 93009, Bobigny cedex, France.
| | - Marc Fadel
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France
| | - Alexis Descatha
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France.,CHU Angers, Poisoning Control Center- Clinical Data Center, F-49000, Angers, France
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Evans DW, Rushton A, Middlebrook N, Bishop J, Barbero M, Patel J, Falla D. Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom. JAMA Netw Open 2022; 5:e2228870. [PMID: 36018591 PMCID: PMC9419019 DOI: 10.1001/jamanetworkopen.2022.28870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain. OBJECTIVE To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021. EXPOSURE Acute musculoskeletal trauma requiring admittance to a major trauma center hospital. MAIN OUTCOMES AND MEASURES A poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results. RESULTS In total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92. CONCLUSIONS AND RELEVANCE A poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.
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Affiliation(s)
- David W. Evans
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Nicola Middlebrook
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jon Bishop
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Marco Barbero
- Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Jaimin Patel
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- University Hospitals Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Edgar N, Clifford C, O'Neill S, Pedret C, Kirwan P, Millar NL. Biopsychosocial approach to tendinopathy. BMJ Open Sport Exerc Med 2022; 8:e001326. [PMID: 35990762 PMCID: PMC9345071 DOI: 10.1136/bmjsem-2022-001326] [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] [Accepted: 06/15/2022] [Indexed: 12/15/2022] Open
Abstract
Tendinopathy describes a spectrum of changes that occur in damaged tendons, leading to pain and reduced function that remains extremely challenging for all clinicians. There is an increasing awareness of the influence that psychological and psychosocial components, such as self-efficacy and fear-avoidance, have on rehabilitation outcomes in musculoskeletal medicine. Although it is widely accepted that psychological/psychosocial factors exist in tendinopathy, there is currently a distinct lack of trials measuring how these factors affect clinical outcomes. Biopsychosocial treatments acknowledge and address the biological, psychological and social contributions to pain and disability are currently seen as the most efficacious approach to chronic pain. Addressing and modulating these factors are crucial in the pathway of personalised treatments in tendinopathy and offer a real opportunity to drive positive outcomes in patients. In this education review, we also provide the current evidence-based guidance on psychological and psychosocial developments in musculoskeletal medicine and how these may be translated to treating tendinopathy using a biopsychosocial model.
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Affiliation(s)
- Nathan Edgar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Clifford
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Seth O'Neill
- Department of Physiotherapy, School of Allied Health Professionals, University of Leicester, Leicester, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis C/Muntaner, Barcelona, Spain
| | - Paul Kirwan
- Discipline of Physiotherapy, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Risk Factors to Persistent Pain Following Musculoskeletal Injuries: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159318. [PMID: 35954679 PMCID: PMC9367909 DOI: 10.3390/ijerph19159318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
Background: Musculoskeletal (MSK) injury is one of the major causes of persistent pain. Objective: This systematic literature review explored the factors that lead to persistent pain following a MSK injury in the general population, including athletes. Methods: A primary literature search of five electronic databases was performed to identify cohort, prospective, and longitudinal trials. Studies of adults who diagnosed with a MSK injury, such as sprains, strains or trauma, were included. Results: Eighteen studies involving 5372 participants were included in this review. Participants’ ages ranged from 18–95 years. Most of the included studies were of prospective longitudinal design. Participants had a variety of MSK injuries (traumatic and non-traumatic) causing persistent pain. Multiple factors were identified as influencing the development of persistent pain following a MSK injury, including high pain intensity at baseline, post-traumatic stress syndrome, presence of medical comorbidities, and fear of movement. Scarcity of existing literature and the heterogeneity of the studies made meta-analysis not possible. Conclusions: This systematic review highlighted factors that might help predict persistent pain and disability following MSK injury in the general population, including athletes. Identification of these factors may help clinicians and other health care providers prevent the development of persistent pain following a MSK injury.
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Sions JM, Beisheim-Ryan EH, Pohlig RT, Seth M. Adults with unilateral lower-limb amputation: greater spatial extent of pain is associated with worse adjustment, greater activity restrictions, and less prosthesis satisfaction. Scand J Pain 2022; 22:578-586. [PMID: 35107232 PMCID: PMC9262753 DOI: 10.1515/sjpain-2021-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation. METHODS Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability. RESULTS Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC)3,1 = 0.84]. CONCLUSIONS A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated- and secondary-site pain prevention. ETHICAL COMMITTEE NUMBER IRB #1611862.
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Affiliation(s)
- Jaclyn Megan Sions
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 210JJ, Newark, DE, 19713, USA
| | - Emma Haldane Beisheim-Ryan
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 144A, Newark, DE, 19713, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, 80045, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 102B STAR
Tower, Newark, DE, 19713, USA
| | - Mayank Seth
- University of Delaware, Department of Physical Therapy, 540
South College Avenue, Suite 144A, Newark, DE, 19713, USA
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Lalji R, Hofstetter L, Kongsted A, von Wyl V, Puhan MA, Hincapié CA. Swiss chiropractic practice-based research network and musculoskeletal pain cohort pilot study: protocol of a nationwide resource to advance musculoskeletal health services research. BMJ Open 2022; 12:e059380. [PMID: 35831057 PMCID: PMC9280900 DOI: 10.1136/bmjopen-2021-059380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) pain conditions, a leading cause of global disability, are usually first managed in primary care settings such as medical, physiotherapy, and chiropractic community-based practices. While chiropractors often treat MSK conditions, there is limited real-world evidence on the topic of health service outcomes among patients receiving this type of care. A nationwide Swiss chiropractic practice-based research network (PBRN) and MSK pain patient cohort study will have potential to monitor the epidemiological trends of MSK pain conditions and contribute to healthcare quality improvement. The primary aims of this protocol are to (1) describe the development of an MSK-focused PBRN within the Swiss chiropractic setting, and (2) describe the methodology of the first nested study to be conducted within the PBRN-an observational prospective patient cohort pilot study. METHODS AND ANALYSIS This initiative is conceptualised with two distinct phases. Phase I focuses on the development of the Swiss chiropractic PBRN, and will use a cross-sectional design to collect information from chiropractic clinicians nationwide. Phase II will recruit consecutive patients aged 18 years or older with MSK pain from community-based chiropractic practices participating in the PBRN into a prospective chiropractic cohort pilot study. All data collection will occur through electronic surveys offered in the three Swiss official languages (German, French, Italian) and English. Surveys will be provided to patients prior to their initial consultation in clinics, 1 hour after initial consultation, and at 2, 6 and 12 weeks after initial consultation. ETHICS AND DISSEMINATION Ethics approval has been obtained from the independent research ethics committee of Canton Zurich (BASEC-Nr: 2021-01479). Informed consent will be obtained electronically from all participants. Findings will be reported to stakeholders after each study phase, presented at local and international conferences, and disseminated through peer-reviewed publications. STUDY PRE-REGISTRATION Phase I-Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Phase 2-Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).
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Affiliation(s)
- Rahim Lalji
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials. J Orthop Sports Phys Ther 2022; 52:432-445. [PMID: 35584025 DOI: 10.2519/jospt.2022.10698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of individual patient education for managing acute and/or subacute low back pain (LBP), compared to no intervention/placebo education, noneducational interventions, or other type of education. DESIGN Systematic review with meta-analysis of randomized trials. LITERATURE SEARCH PubMed, CINAHL, PEDro, Embase, Scopus, and CENTRAL (up to September 30, 2020); reference lists of previous systematic reviews. STUDY SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP. DATA SYNTHESIS Random-effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We included 13 RCTs. There was moderate certainty evidence that individual patient education was more effective than placebo education for pain at medium term (mean difference [MD], -0.79; 95% confidence interval [CI]: -1.52, -0.07) and physical function at short term (standardized mean difference [SMD], -0.25; 95% CI: -0.47, -0.02) and medium term (SMD, -0.26; 95% CI: -0.48, -0.04), but with no clinically relevant effects. There was low-to-moderate certainty evidence that individual patient education was superior to noneducational interventions on short-term quality of life (MD, -12.00; 95% CI: -20.05, -3.95) and medium-term sick leave (odds ratio = 0.32; 95% CI: 0.11, 0.88). We found no clinically relevant between-group effects for any other comparison (low-to-high certainty of evidence) at any follow-up. CONCLUSION One or 2 hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute and/or subacute LBP. Considering its effects on other outcomes (eg, reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP. J Orthop Sports Phys Ther 2022;52(7):432-445. Epub: 18 May 2022. doi:10.2519/jospt.2022.10698.
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Liechti S, Tseli E, Taeymans J, Grooten W. Prognostic Factors for Quality of Life After Interdisciplinary Pain Rehabilitation in Patients with Chronic Pain-A Systematic Review. PAIN MEDICINE 2022; 24:52-70. [PMID: 35736398 PMCID: PMC9825145 DOI: 10.1093/pm/pnac098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Health-related quality of life (hrQoL) is a core outcome in evaluating interdisciplinary pain rehabilitation (IPR). This systematic review aimed to identify prognostic factors for hrQoL at least six months after IPR in chronic pain patients. METHODS A systematic search was conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science and Cochrane CENTRAL until September 2020. Included were prognostic studies on the outcome hrQoL in adults aged 18 to 67 years with chronic pain (excluding malignancies, systemic-, inflammatory or degenerative joint diseases) who had undergone IPR. Studies were assessed with The Quality in Prognostic Studies-tool. Potential prognostic factors at baseline for the domains pain, psychological and physical functioning were qualitatively synthesized for hrQoL. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the level of evidence. RESULTS Fourteen studies on 6,668 participants (mean age 37.4-52.8 y), with musculoskeletal pain/fibromyalgia and a pain duration ranging between 13.1 and 177.4 months were considered eligible. With a very low certainty of evidence, pain intensity, emotional distress, and physical functioning at baseline were inconsistent for prediction of hrQoL and pain duration was not predictive. With low certainty of evidence, fewer pain sites, lower levels of negative cognitive behavioral factors, and higher levels of positive cognitive behavioral factors predicted a better outcome. CONCLUSIONS The overall certainty of evidence was low to very low, making it difficult to reach definitive conclusions at present. Future studies with a predefined core set of predictors investigating hrQoL in patients with chronic pain after IPR are needed.
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Affiliation(s)
- Seraina Liechti
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Elena Tseli
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of physical therapy, Karolinska Institutet, Huddinge, Sweden
| | - Jan Taeymans
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
- Department of Movement and Sport Science & Rehabilitation, Vrije Universiteit Brussel
| | - Wilhelmus Grooten
- Correspondence to: Wilhelmus Grooten, PhD, Department of Neurobiology, Care Sciences and Society, Division of Physical Therapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83 Huddinge, Sweden. Tel: +46-8-524 888 61; E-mail:
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Kandakurti PK, Arulsingh W, S Patil S. Influence of kinesiophobia on pain intensity, disability, muscle endurance, and position sense in patients with chronic low back pain-a case-control study. Trials 2022; 23:469. [PMID: 35668498 PMCID: PMC9169280 DOI: 10.1186/s13063-022-06406-6] [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: 11/30/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with chronic low back pain (CLBP) frequently present with kinesiophobia. Though large body of evidence reported the impact of kinesiophobia in patients with CLBP, there are paucity of studies in associating kinesiophobia to muscle endurance and position sense in patients with CLBP. The primary aim of the study is to compare the impact of kinesiophobia on lumbar extensor endurance, position sense in patient with CLBP, and asymptomatic individuals. Secondarily, we aim to examine the association between kinesiophobia and lumbar extensor endurance, position sense, pain intensity, and functional ability in patients with CLBP. Thirdly, we aim to assess the degree of association of various factors on CLBP, lumbar endurance, and position sense. Material and methods This case-control study will have 200 patients with CLBP and 400 controls. Kinesiophobia, lumbar endurance, and lumbar position sense will be assessed with Tampa Scale, Soren’s lumbar extensor test, and lumbar repositioning test respectively. Secondarily, the pain intensity will be assessed with visual analog scale and functional ability with Patient-specific Functional Scale in patients with CLBP. Lumbar endurance and joint position sense will be compared between subjects with and without kinesiophobia. Kinesiophobia scores will be compared with lumbar extensor endurance and proprioception joint position errors, pain intensity, and functional ability. Simple and multiple binary logistic regression will be used to determine crude and adjusted odd’s ratio for kinesiophobia, lumbar position sense and kinesiophobia, and lumbar endurance. Discussion The finding from this study can be generalized as this study has adequate sample size and subgroup analysis by adjusting the variables to draw a valid conclusion. The finding of this study will help the working physician to include assessment of kinesiophobia as part of musculoskeletal evaluation for patient with CLBP in a prospective diagnostic intervention. Trial registration ClinicalTrials.gov NCT05079893. Registered on 14 October 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06406-6.
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Affiliation(s)
| | - Watson Arulsingh
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Sharad S Patil
- Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, United Arab Emirates
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Affiliation(s)
- Alessandro Chiarotto
- From the Department of General Practice, Erasmus University Medical Center, Rotterdam (A.C., B.W.K.), and the Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam (A.C.) - both in the Netherlands; and the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (B.W.K.)
| | - Bart W Koes
- From the Department of General Practice, Erasmus University Medical Center, Rotterdam (A.C., B.W.K.), and the Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam (A.C.) - both in the Netherlands; and the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (B.W.K.)
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