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Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [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: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
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Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
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Zouch J, Comachio J, Bussières A, Ashton-James CE, dos Reis AHS, Chen Y, Ferreira M, Ferreira P. Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review. Phys Ther 2022; 102:pzac150. [PMID: 36317766 PMCID: PMC10071499 DOI: 10.1093/ptj/pzac150] [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: 11/29/2021] [Revised: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this research was to examine the scope of evidence for the influence of a nonmedical initial provider on health care utilization and outcomes in people with low back pain (LBP). METHODS Using scoping review methodology, we conducted an electronic search of 4 databases from inception to June 2021. Studies investigating the management of patients with a new onset of LBP by a nonmedical initial health care provider were identified. Pairs of reviewers screened titles, abstracts, and eligible full-text studies. We extracted health care utilization and patient outcomes and assessed the methodological quality of the included studies using the Joanna Briggs Institute checklist. Two reviewers descriptively analyzed the data and categorized findings by outcome measure. RESULTS A total of 26,462 citations were screened, and 11 studies were eligible. Studies were primarily retrospective cohort designs using claims-based data. Four studies had a low risk of bias. Five health care outcomes were identified: medication, imaging, care seeking, cost of care, and health care procedures. Patient outcomes included patient satisfaction and functional recovery. Compared with patients initiating care with medical providers, those initiating care with a nonmedical provider showed associations with reduced opioid prescribing and imaging ordering rates but increased rates of care seeking. Results for cost of care, health care procedures, and patient outcomes were inconsistent. CONCLUSIONS Prioritizing nonmedical providers at the first point of care may decrease the use of low-value care, such as opioid prescribing and imaging referral, but may lead to an increased number of health care visits in the care of people with LBP. High-quality randomized controlled trials are needed to confirm our findings. IMPACT This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, may help reduce opioid prescription and selective imaging in people with LBP. The trend observed in this scoping review has important implications for pathways of care and the role of nonmedical providers, such as physical therapists, within primary health care systems. LAY SUMMARY This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, might help reduce opioid prescription and selective imaging in people with LBP. High-quality randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- James Zouch
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Josielli Comachio
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - André Bussières
- Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Claire E Ashton-James
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Yanyu Chen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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3
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Sharpe JA, Thackeray A, Fritz JM, Martin BI, Magel J, Vanneman ME. Patients' use of physical therapy for lower back pain: A qualitative study. Musculoskelet Sci Pract 2021; 56:102468. [PMID: 34688104 PMCID: PMC8629949 DOI: 10.1016/j.msksp.2021.102468] [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: 03/17/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors that influence a patient's decision to use physical therapy (PT) services for a low back pain (LBP) complaint. METHODS Semi-structured qualitative phone interviews were conducted with patients who were offered an early outpatient PT visit secondary to patients' primary appointment for LBP with a non-operative sports medicine specialist physician. Interviews were recorded, transcribed, and analyzed to identify themes using an iterative process. RESULTS Forty participants were interviewed; 20 accepted early PT services, and 20 did not. Patients' decisions were influenced by perceived provider training, costs, doctor recommendations, wait times, symptoms, and a desire for a diagnosis. Patients preferred the care of non-operative sports medicine doctors over physical therapists for LBP due to their beliefs that favored doctors' diagnosis and management of LBP. Patients perceived exercise as an effective treatment for back pain. Physical therapists were viewed as an adjunct service, despite positive comments about PT and the belief that exercise is one of the most effective treatments for LBP. CONCLUSION Barriers including costs, patient preferences, and knowledge about physical therapists limited patients' use of PT. Value-based care strategies aimed at improving the management of LBP increasingly promote the early use of PT. For these strategies to be effective, it is critical that patient perceptions and the influence of barriers on PT use are further understood. This study highlights the need to promote confidence in physical therapists' expertise in the management and diagnosis of lower back pain.
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Affiliation(s)
- Jason A. Sharpe
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA,Corresponding author. VA Medical Center (152), HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC, 27701, USA. (J.A. Sharpe)
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Julie M. Fritz
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Brook I. Martin
- University of Utah School of Medicine, Department of Orthopaedics, Salt Lake City, UT, USA,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Megan E. Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology Salt Lake City, UT, USA,Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
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Vigdal ØN, Storheim K, Munk Killingmo R, Småstuen MC, Grotle M. Characteristics of older adults with back pain associated with choice of first primary care provider: a cross-sectional analysis from the BACE-N cohort study. BMJ Open 2021; 11:e053229. [PMID: 34535487 PMCID: PMC8451307 DOI: 10.1136/bmjopen-2021-053229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist (PT) or chiropractor). DESIGN Cross-sectional analysis from the Back Complaints in the Elders-Norway cohort study. SETTING Norwegian GP, PT and chiropractic primary care centres. PARTICIPANTS Patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain were invited to participate. Between April 2015 and February 2020, we included 452 patients: 127 first visited a GP, 130 first visited a PT and 195 first visited a chiropractor. PRIMARY AND SECONDARY OUTCOME MEASURES For the first objective, the outcome measure was descriptive statistics of patient characteristics, covering the following domains: sociodemographic, general health, current and previous back pain, psychological and clinical factors. For the second objective, first primary care provider was the outcome measure. Associations between patient characteristics and visiting a GP or PT compared with a chiropractor were assessed with multiple multinomial regression analyses. RESULTS Median (IQR) age was 66 (59-72) years. Levels of back-related disability was moderate to severe, with a median (IQR) Roland-Morris Disability Questionnaire (range 0-24) score of 9 (5-13). Recurring episodes were common, 301 (67%) patients had monthly or yearly recurrences. Patients with worse back-related disability, longer duration of symptoms, lower expectations for full recovery and worse physical performance measured with the Back Performance Scale had higher odds of visiting a GP or PT compared with a chiropractor (p<0.05). CONCLUSION Older back pain patients in primary care had moderate to severe levels of back-related disability, and most had recurring episodes. Our results suggest that older adult's choice of first primary care provider was associated with important patient characteristics, which highlights the need for caution with generalisations of study results across primary care populations. TRIAL REGISTRATION NUMBER NCT04261309.
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Affiliation(s)
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | | | | | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
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Sharpe JA, Martin BI, Fritz JM, Newman MG, Magel J, Vanneman ME, Thackeray A. Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis. Fam Pract 2021; 38:203-209. [PMID: 33043360 PMCID: PMC8679185 DOI: 10.1093/fampra/cmaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged. OBJECTIVE Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral. METHODS The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression. RESULTS 15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample. CONCLUSIONS We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.
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Affiliation(s)
- Jason A Sharpe
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Brook I Martin
- University of Utah School of Medicine, Department of Orthopaedics.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
| | - Julie M Fritz
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Michael G Newman
- Data Science Services, University of Utah, Data Science Services
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Megan E Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology.,Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
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Svensson HK, Karlsson J, Sterner TR, Ahlner F, Skoog I, Erhag HF. Self-perceived functional ability and performance-based testing of physical function in older women with or without long-term back pain - results of the H70 study. BMC Geriatr 2021; 21:229. [PMID: 33827441 PMCID: PMC8028168 DOI: 10.1186/s12877-021-02177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background The proportion of older adults is increasing rapidly, and the majority are female. In 2050, the number of persons aged 60 years and over is estimated to reach 2.1 billion worldwide, constituting one-third of the total population of Europe. Long-term back pain is a disabling and common condition, primarily affecting older women. Although standardized functional evaluations are essential in the screening of older adults, self-rated activities of daily living capture a different aspect of the person’s ability in the context of his or her environment and social support system. This study aimed to describe how older women with or without long-term back pain self-rate their activities of daily living (ADL) and instrumental activities of daily living (IADL) in relation to their performance-based testing of physical function, including walking test, leg muscle strength, balance, and endurance. Method This study is part of the Gothenburg H70 Birth Cohort Studies in Sweden (H70 studies) and uses data from the 1944 birth cohort examined in 2015–16 at age 70. In the present study, only female participants were included in the analysis, and all cases of dementia (n = 17) and cases of acute and sub-acute back pain excluded (n = 181), leaving an effective sample of 446 female participants. Results Women with long-term back pain self-perceived their ADL and IADL as being as good as those without back pain, although they performed poorer in all performance-based tests and perceived themselves as less physically fit. Conclusion The discrepancy between self-perceived functional ability (ADL/IADL) and performance-based testing of functioning based on clinical tests calls for further investigation to incentivize person-centered care in older women with long-term back pain in municipal or emergency health-care settings.
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Affiliation(s)
- Hilda Kristin Svensson
- Academy of Health and Welfare and Centre of Research on Welfare, Health and Sport (CVHI), Halmstad University, Box 823, SE-301 18, Halmstad, Sweden. .,Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Jon Karlsson
- Institute of Clinical Sciences and Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, Box 426, SE-405 30, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Felicia Ahlner
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Hanna Falk Erhag
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
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Giannakou I, Gaskell L. A qualitative systematic review of the views, experiences and perceptions of Pilates-trained physiotherapists and their patients. Musculoskeletal Care 2021; 19:67-83. [PMID: 32929888 DOI: 10.1002/msc.1511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A review of qualitative studies exploring Pilates-trained physiotherapists and their patients' perspectives and experiences of Pilates, aiming to improve practice and provide a deeper insight into the way this method is being utilized along with its effects on participants. DESIGN Qualitative evidence synthesis using meta-ethnography. DATA SOURCES A comprehensive search strategy, limited to English language articles, was conducted to MEDLINE (PubMed), EMBASE, CINAHL, PEDro and Cochrane Central for the period of January 2000 (inception) to June 2020. This was supplemented by identification of Grey literature through Google Scholar, website searching and reference lists. STUDY SELECTION Qualitative studies reporting experiences and perceptions of patients' or Pilates-trained physiotherapists' regarding the efficacy of Pilates for the management of chronic musculoskeletal conditions. After a process of exclusion, eight studies were included in the synthesis. DATA EXTRACTION The textual data were analysed by a qualitative software program. Studies were critically appraised independently by two reviewers. DATA SYNTHESIS Articles were synthesized using a technique of meta-ethnography. Three themes emerged from the process of reciprocal translation: (1) Benefits of the Pilates approach; (2) most effective ways to utilize and most beneficial parameters and (3) risks, precautions, contraindications and indications. CONCLUSION This is the first qualitative evidence synthesis of practitioners' and patients' perspectives of Pilates. Findings support evidence for the various benefits of this approach and provide fresh insight into the way this method can be practiced to maximize efficiency and focus on the patients' needs. KEY RECOMMENDATIONS Pilates-trained physiotherapists identified that Pilates can be tailored to individual requirements, preferences and needs, to promote self-management to facilitate clinical and cost-effective care.
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Affiliation(s)
- Ioanna Giannakou
- School of Health and Society, University of Salford, Manchester, UK
| | - Lynne Gaskell
- School of Health and Society, University of Salford, Manchester, UK
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Talty FT, Roberts ME, Dang C, Clewley DJ, Horn ME. Using a behavioral model to identify factors associated with choice of provider for neck and low back pain: A systematic review. Musculoskelet Sci Pract 2020; 49:102223. [PMID: 32763791 DOI: 10.1016/j.msksp.2020.102223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND It remains unclear as to what factors influence a patient's choice to seek care from a specific healthcare provider for low back and neck pain. OBJECTIVE Utilize Andersen's Behavioral Model of Health Service Utilization as a conceptual framework to identify the predisposing, enabling and need factors associated with choice of healthcare provider for back and/or neck pain. METHODS PubMed, CINAHL, EMBASE, and SCOPUS databases were searched for studies that included 1) patients seeking care for acute or chronic low back or neck pain; 2) patients at least 18 years of age; 3) reported any healthcare provider type chosen to be seen. Significant factors addressing a patient's choice of provider seen for back pain, neck pain, or both were extracted from studies and analyzed under the Behavioral Model of Health Service Utilization. RESULTS 20 studies were included in this review: 17 quantitative studies and 3 qualitative studies. Provider types identified were medical physicians, chiropractors, physical therapists, acupuncturists and CAM providers. Age and sex were the most commonly reported predisposing factors; financial and personal factors were the most common enabling factors; patients' duration of pain and self-reported level of functioning were the most commonly reported need factors. CONCLUSIONS While predisposing and need factors are important, enabling factors also have an influence in choice of healthcare provider for back and/or neck pain.
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Affiliation(s)
- Francis T Talty
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.
| | | | - Christine Dang
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Derek J Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Maggie E Horn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies. Rheumatol Int 2019; 39:1663-1679. [DOI: 10.1007/s00296-019-04430-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/20/2019] [Indexed: 01/07/2023]
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Challenges and opportunities for Australian osteopathy: A qualitative study of the perceptions of registered osteopaths. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Igwesi-Chidobe CN, Sorinola IO, Kitchen S, Godfrey EL. Unconventional Practitioners' Causal Beliefs and Treatment Strategies for Chronic Low Back Pain in Rural Nigeria. Health Serv Insights 2018; 11:1178632918808783. [PMID: 30397385 PMCID: PMC6207981 DOI: 10.1177/1178632918808783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 12/29/2022] Open
Abstract
Chronic low back pain (CLBP) is highly prevalent and CLBP disability reinforces poverty and Nigerian rural-urban inequality. Most rural Nigerian dwellers with CLBP consult unconventional practitioners due to difficulty in accessing conventional health care. This interaction may influence back pain beliefs and behaviours, and health outcomes including disability. In line with the recent Lancet Low Back Pain series call to address widespread misconceptions in the population and among health practitioners about low back pain, this study explored the beliefs and management strategies of unconventional practitioners consulted by people living with CLBP in rural Nigeria. Qualitative semi-structured face-to-face individual interviews. Thematic analysis of transcripts was performed using the Framework approach. Nine unconventional practitioners consented to participate in this study. Patent medicine sellers and herbalists had biomedical beliefs about CLBP and encouraged passivity and drug dependence in patients. Pastors adopted spiritual or biopsychosocial-spiritual management models and either encouraged spiritual CLBP causal beliefs and spiritual healing expectations; or patients' resilience and acceptance, respectively. Unconventional practitioners' CLBP beliefs and management strategies aligned with the beliefs and coping strategies of patients who consulted them. Unconventional practitioners' beliefs and management strategies may therefore contribute to the adverse impact of CLBP in rural Nigeria.
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Affiliation(s)
- Chinonso N Igwesi-Chidobe
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Enugu, Nigeria.,Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Isaac O Sorinola
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sheila Kitchen
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Emma L Godfrey
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study. Support Care Cancer 2018; 26:3627-3633. [PMID: 29728845 DOI: 10.1007/s00520-018-4233-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 04/26/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain. METHODS This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods. RESULTS We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy. CONCLUSIONS The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.
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Sibbritt D, Lauche R, Sundberg T, Peng W, Moore C, Broom A, Kirby E, Adams J. Severity of back pain may influence choice and order of practitioner consultations across conventional, allied and complementary health care: a cross-sectional study of 1851 mid-age Australian women. BMC Musculoskelet Disord 2016; 17:393. [PMID: 27639556 PMCID: PMC5026776 DOI: 10.1186/s12891-016-1251-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Back pain is a common, disabling and costly disorder for which patients often consult with a wide range of health practitioners. Unfortunately, no research to date has directly examined the association between the severity of back pain and back pain sufferers' choice of whom and in what order to consult different health practitioners. METHODS This is a sub-study of the large nationally representative Australian Longitudinal Study on Women's Health (ALSWH). The mid-age cohort women (born 1946-51, n = 13,715) of the ALSWH were recruited from the Australian national Medicare database in 1996. These women have been surveyed six time, with survey 6 being conducted in 2010 (n = 10,011). Mid-age women (n = 1851) who in 2010 had sought help from a health care practitioner for their back pain were mailed a self-report questionnaire targeting their previous 12 months of health services utilisation, health status and their levels of back pain intensity. RESULTS A total of 1620 women were deemed eligible and 1310 (80.9 %) returned completed questionnaires. Mid-age women with back pain visited various conventional, allied health and CAM practitioners for care: 75.6 % consulted a CAM practitioner; 58.4 % consulted a medical doctor; and 54.2 % consulted an allied health practitioner. Women with the most severe back pain sought conventional care from a general practitioner, and those who consulted a general practitioner first had more severe back pain than those who consulted another practitioner first. Following the general practitioner visit, the women with more severe back pain were more likely to be referred to a conventional specialist, and those with less severe back pain were more likely to be referred to a physiotherapist. CONCLUSIONS Our findings suggest that women with more severe back pain are likely to visit a conventional practitioner first, whereas women with less severe back pain are likely to explore a range of treatment options including CAM practitioners. The improvement of back pain over time following the various possible sequencing of consultations with different types of health practitioners is a topic with implications for ensuring safe and effective back pain care and worthy of further detailed investigation.
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Affiliation(s)
- David Sibbritt
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
| | - Romy Lauche
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Tobias Sundberg
- Research Group for Studies of Integrative Health Care, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden
| | - Wenbo Peng
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Craig Moore
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Alex Broom
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Emma Kirby
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
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Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL. “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil 2016; 39:779-790. [DOI: 10.3109/09638288.2016.1161844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chinonso N. Igwesi-Chidobe
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria
| | - Sheila Kitchen
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Isaac O. Sorinola
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Emma L. Godfrey
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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15
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Frawley J, Sibbritt D, Broom A, Gallois C, Steel A, Adams J. Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy. Women Health 2016; 56:926-39. [DOI: 10.1080/03630242.2016.1145170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Murthy V, Sibbritt D, Broom A, Kirby E, Frawley J, Refshauge KM, Adams J. Back pain sufferers' attitudes toward consultations with CAM practitioners and self- prescribed CAM products: A study of a nationally representative sample of 1310 Australian women aged 60-65 years. Complement Ther Med 2015; 23:782-8. [PMID: 26645516 DOI: 10.1016/j.ctim.2015.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 07/22/2015] [Accepted: 09/07/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze back pain sufferers' attitudes toward consultations with complementary and alternative medicine (CAM) practitioners and self-prescribed CAM products. METHODS A cross-sectional survey of a nationally representative sample of Australian women aged 60-65 years. RESULTS A significant number of women with back pain consulted a massage therapist (41.4%, n=578), a chiropractor (37.3%, n=488), an acupuncturist (13.3%, n=174), used self-prescribed supplements (59.2%, n=776), vitamins/minerals (45.2%, n=592) and/or herbal medicines (13.1%, n=172). Women who perceived CAM as providing greater control over their body/health were more likely to have consulted a chiropractor (OR=4.21; 95% CI; 2.16, 8.19) and/or self- prescribed supplements (OR=2.38; 95% CI: 1.05, 3.49) than those who did not perceive CAM as providing greater control over their body/health. Women who perceived CAM as natural (OR=1.56; 95% CI: 1.02, 2.37) or promoting a holistic approach to health (OR=2.73; 95% CI: 1.60, 4.64) were more likely to have self-prescribed vitamins/minerals than those who did not perceive CAM as natural and promoting a holistic approach to health. Women who expressed that knowledge about evidence of CAM as important to them were more likely to have self-prescribed herbal medicines (OR=7.15; 95% CI: 1.72, 29.64) than those who did not express an interest in knowledge about evidence of CAM. CONCLUSION Certain key attitudes toward CAM influence back pain sufferers' choice of CAM use, highlighting the need for back pain care providers to ensure appropriate enquiry and discussion with their patients regarding consulting CAM practitioners and/or self-prescribing CAM products for back pain.
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Affiliation(s)
- Vijayendra Murthy
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Alex Broom
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Emma Kirby
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Kathryn M Refshauge
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia.
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An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication. Spine J 2015; 15:1870-83. [PMID: 25962340 DOI: 10.1016/j.spinee.2015.04.049] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/23/2015] [Accepted: 04/30/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (e.g., acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain. PURPOSE This study aims to conduct an integrative review on CAM use for back pain focusing on prevalence of use, commonly used CAM, characteristics of users, factors influencing decision making, self-perceived effectiveness, and communication with health-care providers. STUDY DESIGN/SETTING The study is based on an integrative literature review. METHODS A comprehensive search of international literature from 2000 to 2014 in MEDLINE, CINHAL, AMED, DARE, EMBASE, ExceptaMedica, psycINFO, and SCOPUS databases was conducted. The search was limited to peer-reviewed articles published in English language and reporting empirical research findings on CAM use for back pain. RESULTS The review reveals a considerable variation in prevalences of CAM use for back pain internationally. Acupuncture, chiropractic, osteopathy, and massage therapy are the commonly used CAM treatments besides a range of self-prescribed CAM, and back pain sufferers use CAM alongside conventional medical treatments. Female gender, chronicity of back pain, and previous exposure to CAM are key predictors of CAM use for back pain as highlighted from the reviewed literature. Family, friends, and recommendation by doctors appear to influence decision making on CAM use for back pain. The review reveals that users of CAM for back pain tend to report CAM as beneficial, but there is little knowledge on communication between CAM users with back pain and health-care providers about such use. Existing literature is largely based on the research investigating CAM use for back pain among a range of other health conditions. Further rigorous research is needed to investigate the use of a wider range of CAM treatments, particularly self-prescribed CAM for back pain. CONCLUSIONS The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers' decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain.
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McClean S, Brilleman S, Wye L. What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander technique service for those with chronic back pain. BMC Health Serv Res 2015. [PMID: 26215122 PMCID: PMC4517566 DOI: 10.1186/s12913-015-0966-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Randomised controlled trial evidence indicates that Alexander Technique is clinically and cost effective for chronic back pain. The aim of this mixed methods evaluation was to explore the role and perceived impact of Alexander Technique lessons in the naturalistic setting of an acute hospital Pain Management Clinic in England. Methods To capture changes in health status and resource use amongst service users, 43 service users were administered three widely used questionnaires (Brief Pain Inventory, MYMOP and Client Service Resource Inventory) at three time points: baseline, six weeks and three months after baseline. We also carried out 27 telephone interviews with service users and seven face-to-face interviews with pain clinic staff and Alexander Technique teachers. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Results Those taking Alexander Technique lessons reported small improvements in health outcomes, and condition-related costs fell. However, due to the non-randomised, uncontrolled nature of the study design, changes cannot be attributed to the Alexander Technique lessons. Service users stated that their relationship to pain and pain management had changed, especially those who were more committed to practising the techniques regularly. These changes may explain the reported reduction in pain-related service use and the corresponding lower associated costs. Conclusions Alexander Technique lessons may be used as another approach to pain management. The findings suggests that Alexander Technique lessons can help improve self-efficacy for those who are sufficiently motivated, which in turn may have an impact on service utilisation levels.
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Affiliation(s)
- Stuart McClean
- Department of Health and Applied Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Sam Brilleman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Lesley Wye
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Peng W, Adams J, Hickman L, Sibbritt DW. Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study. Climacteric 2014; 18:551-8. [PMID: 25418796 DOI: 10.3109/13697137.2014.989828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the associations between consultations with complementary and alternative medicine (CAM) practitioners and menopause-related symptoms. METHODS A cross-sectional survey of a nationally representative sample of 10 011 women aged 59-64 years from the Australian Longitudinal Study on Women's Health, conducted in 2010. Women, including those with hysterectomy, oophorectomy and natural menopause, were asked about their consultations with a range of CAM practitioners and menopause-related symptoms experienced. RESULTS Acupuncturists were more likely to be consulted by women with hysterectomy experiencing night sweats (odds ratio, OR = 2.21), but were less likely to be consulted by those experiencing hot flushes (OR = 0.53). Acupuncturists were also more likely to be consulted by women with oophorectomy (OR = 3.11) and natural menopausal women (OR = 1.57) experiencing back pain. Massage therapists were more likely to be consulted by women with oophorectomy experiencing back pain (OR = 1.98), women with hysterectomy experiencing anxiety (OR = 1.52), and natural menopausal women experiencing back pain (OR = 1.54) and/or anxiety (OR = 1.29). Naturopaths/herbalists were more likely to be consulted by women with oophorectomy experiencing leaking urine (OR = 2.08). Chiropractors/osteopaths were more likely to be consulted by women across all menopausal status experiencing back pain (OR = 2.52, 2.31 and 2.25 for women with oophorectomy, hysterectomy and natural menopause, respectively). CONCLUSIONS There are substantial levels of CAM practitioners' consultations amongst menopausal women, with a range of menopause-related symptoms associated with the use of specific CAM practitioner modalities. It is important that health-care providers are mindful of CAM practitioner use in order to ensure safe, effective and coordinated treatment and support for menopausal women in their care.
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Affiliation(s)
- W Peng
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney , Sydney, NSW , Australia
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