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Zimmer JM, Fauser D, Golla A, Bethge M, Mau W. Contextual factors in persistent severe back pain: A longitudinal analysis among German employees. Eur J Pain 2024; 28:649-658. [PMID: 37994204 DOI: 10.1002/ejp.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Chronic back pain in employees compromises participation in social and daily activities, as well as work. OBJECTIVES To examine the severity of back pain after 2 years and identify factors predicting stagnation at this level of pain. METHODS Data were derived from a prospective cohort study with randomized sampling of insurants in the German Pension Insurance using a questionnaire at baseline and follow-up after 2 years. The sample consisted of middle-aged employees (45-59 years) with strong limitations due to back pain (Chronic Pain Grade III or IV), who had not applied for disability pension and did not use medical rehabilitation in the previous 4 years before baseline. Stepwise multivariable logistic regression models with backwards selection were used to identify relevant contextual factors in the stagnation of severe back pain. RESULTS Of 1208 persons with severe back pain at baseline, 48% had stagnated at that pain level after 2 years. Predictors of persistent severe back pain were older age, poorer general health, more additional disabling conditions, more depressive symptoms, caregiving burden, less pain-related self-efficacy and more fear avoidance beliefs. CONCLUSIONS In a high-risk subgroup with several co-existing conditions, this analysis highlights (mental) health, social and personal (contextual) factors associated with long-term unfavourable back pain progression. SIGNIFICANCE Back pain is a condition that often has a chronic or recurrent course, threatening participation in many areas of life. In this study it was found that the unfavourable condition of severe back pain can remain stable for long periods of time in a significant proportion of sufferers. Contextual factors (self-efficacy, fear-avoidance beliefs, caregiving burden) as well as additional health problems should be considered when identifying persons with stagnating pain courses.
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Affiliation(s)
- Julia-Marie Zimmer
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - David Fauser
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - André Golla
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Kjærgaard C, Schmidt AM, Larsen JB, Laurberg TB, Mechlenburg I. Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial. Scand J Pain 2024; 24:sjpain-2023-0139. [PMID: 38733320 DOI: 10.1515/sjpain-2023-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES The aim of this study was to identify prognostic variables at baseline associated with being responding favorably to multidisciplinary rehabilitation in patients with chronic low back pain (CLBP). METHODS A responder analysis was conducted based on data from a randomized controlled trial with 26-week follow-up including 165 patients with CLBP treated at a Danish multidisciplinary rehabilitation center. Patients were dichotomized into responders and non-responders based on the outcome of a minimal clinically important difference of six points on the Oswestry Disability Index. The associations between prognostic variables and responders were analyzed using logistic regression. RESULTS A total of 139 patients completed the study, of which 42% were classified as responders. Sex and employment status were statistically significant, with a decreased odds ratio (OR) of being a responder found for males compared to females (OR = 0.09, 95% CI = 0.02-0.48) and for being on temporary or permanent social benefits (OR = 0.28, 95% CI = 0.10-0.75) compared to being self-supporting or receiving retirement benefits. Statistically significant interaction (OR = 8.84, 95% CI = 1.11-70.12) was found between males and being on temporary or permanent social benefits. CONCLUSIONS In patients with CLBP, female patients as well as patients who were self-supporting or receiving retirement benefits were significantly more likely than male patients or patients on temporary or permanent social benefits to be a responder to multidisciplinary rehabilitation.
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Affiliation(s)
- Claus Kjærgaard
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Anne Mette Schmidt
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Josefine Beck Larsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Trine Bay Laurberg
- Department of Rheumatology, Aarhus University Hospital, Sano Aarhus, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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van Benten E, Coppieters MW, Pool JJM, Pool-Goudzwaard AL. Differences in balance control despite self-reported resolution of pregnancy-related pelvic girdle pain. A cross-sectional study. Musculoskelet Sci Pract 2022; 62:102620. [PMID: 35839702 DOI: 10.1016/j.msksp.2022.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Motor control patterns are altered when women with pregnancy-related pelvic girdle pain (PGP) experience pain. In low back pain, these adaptations can persist after recovery. OBJECTIVES This study aimed to assess balance control in postpartum women with and without a history of PGP during pregnancy. DESIGN Cross-sectional study. METHOD Eighteen postpartum women who reported to be recovered from PGP, and twelve postpartum women without a history of PGP during pregnancy performed two clinical tests: the single leg stance and active straight leg raise test. Primary outcomes were ground reaction forces measured with a force platform. RESULTS Multiple linear regression analyses showed smaller lateral displacement (β = -11cm; 95%CI: 19 to -3; p = 0.008) and lower displacement velocity of the Centre of Pressure (COP) (Ratio of Geometric Means (RGM) 0.76; 95%CI: 0.59 to 0.99; p = 0.043) during single leg stance in the participants with a history of PGP compared to participants without a history of PGP. Push-off force (β = -4.8 N; 95%CI: 22.0 to 12.5; p = 0.57) and asymmetry of push-off force (RGM 1.77; 95%CI: 0.62 to 5.04; p = 0.27) did not differ between groups. During the active straight leg raise test, no differences in lateral displacement (β = 3 cm; 95%CI: 3 to 8; p = 0.30) and COP displacement velocity (RGM 1.03; 95%CI: 0.70 to 1.52; p = 0.87) were observed. CONCLUSIONS Although the women with a history of PGP considered themselves recovered, their balance control during single leg stance was poorer compared to those without a history of PGP. No differences were found during the active straight leg raise test.
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Affiliation(s)
- Esther van Benten
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3501 AA, Utrecht, the Netherlands.
| | - Michel W Coppieters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Brisbane and Gold Coast Campus, Griffith University, 170 Kessels Road, QLD 4111, Nathan, Australia
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3501 AA, Utrecht, the Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van den Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN, Amersfoort, the Netherlands
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Santos VS, Leite MN, Camargo BIA, Saragiotto BT, Kamper SJ, Yamato TP. Three in Every 10 School-aged Children in Brazil Report Back Pain in Any Given Year: 12-Month Prospective Cohort Study of Prevalence, Incidence, and Prognosis. J Orthop Sports Phys Ther 2022; 52:554-62. [PMID: 35722760 DOI: 10.2519/jospt.2022.10819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the prevalence, incidence, and prognosis of back pain in children and adolescents. DESIGN Prospective cohort study. METHODS We followed children and adolescents between the ages of 8 and 18 years with and without back pain over 12 months (3, 6, and 12 months) from public and private schools. At baseline, parents (or guardians) answered questionnaires including sociodemographic characteristics and perception of sleep quality of their children and adolescents. Children and adolescents answered questionnaires including sociodemographic characteristics, presence of back pain, pain intensity, quality of life, and psychosomatic symptoms. At follow-up, children and adolescents answered questions about the presence of back pain. RESULTS Six hundred fifteen children and adolescents were included, 163 of whom had back pain and 452 of whom had no back pain at baseline. The mean age of participants was 11.6 years (SD = 2.5), and the majority were female (n = 362; 59%). The 1-month prevalence of back pain was 26% (95% confidence interval: 23%-30%). The incidence rate of back pain was 35% (31%-40%) over 12 months. Of the 163 participants who had back pain at baseline, 83% had recovered by 12 months. Of those who recovered within 6 months, 31% had a recurrence of back pain at the 12-month follow-up. CONCLUSION Two to 3 in every 10 children and adolescents reported back pain in the last month. New cases of back pain were reported by 3-4 in every 10 children and adolescents for a period of 12 months. Nearly all children recover within 12 months, but recurrence seems to be common. J Orthop Sports Phys Ther 2022;52(8):554-562. Epub: 19 June 2022. doi:10.2519/jospt.2022.10819.
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Alhowimel AS, Alotaibi MA, Alenazi AM, Alqahtani BA, Alshehri MA, Alamam D, Alodaibi FA. Psychosocial Predictors of Pain and Disability Outcomes in People with Chronic Low Back Pain Treated Conservatively by Guideline-Based Intervention: A Systematic Review. J Multidiscip Healthc 2022; 14:3549-3559. [PMID: 35002245 PMCID: PMC8722685 DOI: 10.2147/jmdh.s343494] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Previous evidence has recommended conservative interventions as the best treatment in individuals with chronic low back pain (CLBP). However, the influence of psychosocial factors on the treatment outcomes is unclear. Therefore, this systematic review aimed to address the psychosocial factors that influence changes in pain and disability in patients with CLBP after a guideline-based conservative intervention. Methods Four electronic databases were systematically searched from inception until September 2020 for prospective studies examining the relationship between psychosocial factors and the outcomes of pain and disability after conservative intervention. All included studies were selected, extracted, and critically evaluated by two independent reviewers. Results In total, 15 studies were included in this systematic review. The results support the link between the baseline fear of movement, depression, self-efficacy, and catastrophizing with future functional disability outcomes after conservative interventions. However, these factors were less likely to predict changes in pain intensity outcomes after conservative interventions. Self-efficacy seems to mediate between some of the baseline psychosocial factors (eg, fear) and future pain and disability. Conclusion Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention. This highlights the importance of addressing these factors in conservative management of CLBP.
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Affiliation(s)
- Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mansour A Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.,NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Dalyah Alamam
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Mourits BMP, Meulekamp MZ, van der Wurff P, Lucas C. Identifying prognostic factors to determine the level of recovery in servicemembers with chronic low back pain: A prospective cohort study. J Back Musculoskelet Rehabil 2021; 34:697-705. [PMID: 33896807 DOI: 10.3233/bmr-200123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The main objective of this study was to identify general and military-related factors that are associated with the level of recovery in Dutch service members with chronic low back pain (CLBP) who followed a rehabilitation program. MATERIAL AND METHOD One hundred five consecutive service members with CLBP were included in this study. The level of disability, was used to distinguish a recovered and non-recovered group. Level of pain and self-perceived recovery were used as secondary outcome measurements. Differences were evaluated within and between the groups using the Student's t-test Bivariate logistic regression analyses were used for identifying the prognostic factors related to various outcomes of recoveryRESULTS: After following the rehabilitation program, 64.8% of the service members recovered from CLBP. The recovered group, demonstrated significant effect sizes in disability and in pain The non-recovered group showed on disability a non-significant effect and in pain a significant effect. The self-perceived recovery in the recovered group was "much improved" and the non-recovered group "slightly improved". The results of the bivariate regression analyses showed no significant independent prognostic factors related to recovery. CONCLUSIONS In this study, no significant independent prognostic factors could be identified that were associated to the various outcomes of recovery in service members with CLBP who followed a rehabilitation program.
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Affiliation(s)
- B M P Mourits
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands
| | - M Z Meulekamp
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands
| | - P van der Wurff
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands.,Institute for Human Movement Studies HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - C Lucas
- Department of Clinical Epidemiology, Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam-Zuidoost, The Netherlands
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Abstract
This review aimed to present the current evidence-based answers to a questionnaire which was developed to evaluate the beliefs and knowledge of dental professionals concerning temporomandibular disorder (TMD). A literature review was conducted using the PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane, Google Scholar, and Scopus search engines from January 1980 to June 2020 corresponding to TMD diagnosis, causes, management, and consequences. A total of 50 articles were considered relevant and selected for full review. The etiology of TMD is multifactorial and complicated and involves several direct and indirect factors. Orthodontic treatment does not appear to either prevent or relieve TMD to a great degree. Nevertheless, condylar and occlusal stability reduces the risk of TMD development. As a result, an assessment of the function of masticatory system prior to beginning orthodontic therapy is fundamental. If signs and symptoms of TMD are significantly present, they should be managed before any orthodontic intervention. Moreover, psychological disorders are strongly associated with joint and facial pain. Thus, professionals who work with chronic TMD patients need to be aware of the psychological aspects of chronic pain and refer the patient for psychological evaluation when warranted. Future research elucidating a cause-effect relationship and neurobehavioral processes underlining chronic pain should be performed.
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Affiliation(s)
| | - Fulya Özdemir
- Department of Orthodontics, Marmara University, Istanbul, Turkey
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Galve Villa M, S Palsson T, Cid Royo A, R Bjarkam C, Boudreau SA. Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study. J Med Internet Res 2020; 22:e21475. [PMID: 33104012 PMCID: PMC7652695 DOI: 10.2196/21475] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Background Digital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient’s pain. Objective The primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance. Methods Patients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo–three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients’ characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care–related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance. Results Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001). Conclusions This is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance.
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Affiliation(s)
- Maria Galve Villa
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thorvaldur S Palsson
- Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Albert Cid Royo
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Carsten R Bjarkam
- Department of Neurosurgery, Institute of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Shellie A Boudreau
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Van Wilder L, Clays E, Devleesschauwer B, Pype P, Boeckxstaens P, Schrans D, De Smedt D. Health-related quality of life in patients with non-communicable disease: study protocol of a cross-sectional survey. BMJ Open 2020; 10:e037131. [PMID: 32912984 PMCID: PMC7485234 DOI: 10.1136/bmjopen-2020-037131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) are associated with lower health-related quality of life (HRQoL). However, knowledge about those diseases and predictors with a greater impact on patients' HRQoL as well as knowledge on the complex relationship between HRQoL and comorbidities is lacking. The aim of this study is to assess the impact of NCDs on patients' HRQoL, with a focus on multimorbidity and socioeconomic status. METHODS AND ANALYSIS A primary care-based cross-sectional study is conducted in Flanders (Belgium). Study participants (≥18 years) are medically diagnosed with at least one of the following diseases: cardiometabolic disorders, mental disorders and musculoskeletal disorders. A minimum of 50 general practitioners will participate to recruit participants (convenient sample) and a total of 531 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using multiple linear regression models with HRQoL as main outcome parameter, adjusted for possible confounders. This study will generate new evidence on the key predictors of HRQoL in patients with NCDs, and particularly provide new insights in multimorbidity to improve the quality of care in primary care, to support patients' self-management and to allocate resources more effectively. ETHICS AND DISSEMINATION The study has been approved by the Ethical Committee of Ghent University Hospital, Ghent, Belgium (reference number: B670201939629) prior to the beginning of the recruitment. Study results will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Diego Schrans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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11
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Innes S, Beynon A, Hodgetts C, Manassah R, Lim D, Walker BF. Predictors of instanteous relief from spinal manipulation for non-specific low back pain: a delphi study. Chiropr Man Therap 2020; 28:39. [PMID: 32611351 PMCID: PMC7331174 DOI: 10.1186/s12998-020-00324-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background There is some evidence and anecdotal reports that high-velocity low-amplitude (HVLA) spinal manipulation therapy (SMT) for non-specific low back pain (NSLBP) may immediately reduce pain in some patients. The mechanism for such a change remains unclear and the evidence is conflicting. The aim of this study was to seek consensus among a sample of expert manual therapists as to the possible clinical predictors that could help identify patients who are most likely to receive instant relief from NSLBP with SMT intervention. Methods Thirty-seven expert chiropractors and manipulative physiotherapists from around the world were invited to participate in a three round online Delphi questionnaire during the second half of 2018. Participants were provided with a list of 55 potential signs and symptoms as well as offering them the option of suggesting other factors in the first round. The variables were rated using a 4-point Likert likelihood scale and a threshold of 75% agreement was required for any item to progress to the next round. Results Of these 37 experts, 19 agreed to participate. Agreement as to the proportion of patients who receive instantaneous relief was minimal (range 10–80%). A total of 62 items were ranked over the 3 rounds, with 18 of these retained following the third round. The highest rated of the 18 was ‘A history including a good response to previous spinal manipulation’. Discussion/conclusion Five categories; patient factors, practitioner factors, signs and symptoms of NSLBP presentation, an instrument of measurement (FABQ), and the presence of cavitation following SMT best describe the overall characteristics of the factors. The 18 factors identified in this study can potentially be used to create an instrument of measurement for further study to predict those patients with NSLBP who will receive instantaneous relief post-SMT.
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Affiliation(s)
- Stanley Innes
- Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia.
| | - Amber Beynon
- Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia
| | - Christopher Hodgetts
- Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia
| | - Rachel Manassah
- 5th Year student, Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia
| | - Denyse Lim
- 5th Year student, Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia
| | - Bruce F Walker
- Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Murdoch, Australia
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Herman PM, Edgington SE, Hurwitz EL, Coulter ID. Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data. BMC Musculoskelet Disord 2020; 21:298. [PMID: 32404152 PMCID: PMC7222295 DOI: 10.1186/s12891-020-03330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic spinal pain is prevalent, expensive and long-lasting. Several provider-based nonpharmacologic therapies have now been recommended for chronic low-back pain (CLBP) and chronic neck pain (CNP). However, healthcare and coverage policies provide little guidance or evidence regarding the long-term use of this care. To provide one glimpse into the long-term use of nonpharmacologic provider-based care, this study examines the predictors of visit frequency in a large sample of patients with CLBP and CNP using ongoing chiropractic care. METHODS Observational data were collected from a large national sample of chiropractic patients in the US with non-specific CLBP and CNP. Visit frequency was defined as average number of chiropractic visits per month over the 3-month study period. Potential baseline predictor variables were entered into two sets of multi-level models according to a defined causal theory-in this case, Anderson's Behavioral Model of Health Services Use. RESULTS Our sample included 852 patients with CLBP and 705 with CNP. Visit frequency varied significantly by chiropractor/clinic, so our models controlled for this clustering. Patients with either condition used an average of 2.3 visits per month. In the final models visit frequency increased (0.44 visits per month, p = .008) for those with CLBP and some coverage for chiropractic, but coverage had little effect on visits for patients with CNP. Patients with worse function or just starting care also had more visits and those near to ending care had fewer visits. However, visit frequency was also determined by the chiropractor/clinic where treatment was received. Chiropractors who reported seeing more patients per day also had patients with higher visit frequency, and the patients of chiropractors with 20 to 30 years of experience had fewer visits per month. In addition, after controlling for both patient and chiropractor characteristics, the state in which care was received made a difference, likely through state-level policies and regulations. CONCLUSIONS Chiropractic patients with CLBP and CNP use a range of visit frequencies for their ongoing care. The predictors of these frequencies could be useful for understanding and developing policies for ongoing provider-based care.
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Affiliation(s)
| | | | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
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13
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Herman PM, Edgington SE, Ryan GW, Coulter ID. Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care. J Altern Complement Med 2019; 25:1015-1025. [PMID: 31453711 DOI: 10.1089/acm.2019.0247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain can help inform health policy related to this care. Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with different treatment goals for their ongoing care. Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions. Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP). Interventions: All were receiving ongoing chiropractic care. Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables. Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer. Conclusions: Although much of health policy follows a curative model, the majority of these CLBP and CNP patients have goals of pain management (using ongoing care) rather than "cure" (care with a specific end) for their chiropractic care. This information could be useful in crafting policy for patients facing provider-based nonpharmacologic care for chronic pain.
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14
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Haj A, Weisman A, Masharawi Y. Lumbar axial rotation kinematics in men with non-specific chronic low back pain. Clin Biomech (Bristol, Avon) 2019; 61:192-198. [PMID: 30594767 DOI: 10.1016/j.clinbiomech.2018.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar flexion, coupled with rotation, is a dominant factor in the etiology and exacerbation of low back pain. Yet, no study has examined its kinematics in patients with non-specific chronic low back pain (NSCLBP). The aim of the study was to evaluate the lumbar rotation kinematics in neutral standing and with full flexion in men with NSCLBP. METHODS ROM, average velocity, maximum velocity and maximal acceleration of lumbar rotation in neutral standing and with full flexion were measured using an industrial lumbar motion monitor in 50 men (25 with NSCLBP and 25 controls). VAS and Rolland Morris questionnaire were also included. FINDINGS All examined kinematical parameters were significantly lower in men with NSCLBP compared with controls (↓ROM = 29%-45%; ↓AV = 40%-68%; ↓MV = 25%-50%; ↓MA = 20%-37%). Left rotation manifested smaller kinematic values (except for MA) than right rotation (Δ ROM = 35%; Δ AV = 66%; Δ MV = 19%) in NSCLBP. Most kinematical parameters significantly decreased from neutral standing to standing with flexion (right rotation: ↓ROM = 43%-45%, ↓AV = 38%-45%, ↓MV = 24%-27%, ↓MA for the NSCLBP group = 21%; left rotation: ↓ROM = 25%-38%, ↓AV in the control group: =34%, ↓MV in the control group: =23%, ↓MA in the control group = 25%). No correlations were found between all measured kinematical parameters, VAS and RMQ total score in the NSCLBP group. INTERPRETATION The kinematic parameters of lumbar rotation were reduced in men with NSCLBP compared with controls both in neutral standing and with fully forward bending. Most lumbar rotation kinematics decreased from neutral standing to standing with flexion.
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Affiliation(s)
- Alaa Haj
- The Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel; Clalit Health Services, Department of Physical Therapy, Haifa and Western Galilee District, 104 Sderot HaMeginim, Haifa, Israel
| | - Asaf Weisman
- The Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel; Clalit Health Services, Department of Physical Therapy, Tel Aviv-Jaffa District, 16 Naomi Shemer Street, Holon, Israel
| | - Youssef Masharawi
- The Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
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15
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Kim JH, Koes BW, Enthoven WTM, Bierma-Zeinstra SMA, Luijsterburg PAJ. No association between low bone quality and back pain in older adults: A cohort study. J Back Musculoskelet Rehabil 2018; 31:541-547. [PMID: 29562490 DOI: 10.3233/bmr-170961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is unclear whether bone quality associates with severity and prognosis of back pain. OBJECTIVES To investigate the association between bone quality and back pain severity at baseline, and whether low bone quality is a prognostic factor for persistent back pain in patients aged over 55 years at 1-year follow-up. METHODS In this prospective cohort study persistent back pain was defined as a decrease in the back pain severity score of less than 30% at 1-year follow-up compared with baseline score or as a back pain severity score greater than 1 (0-10: 0 = no pain) Low bone quality was categorized as a T-score, calculated using a stiffness index by quantitative ultrasound of the heel, of 2.5 or below. Data were analyzed in multiple regression analyses. RESULTS Of all 513 patients, 68 (13%) showed low bone quality at baseline. Back pain severity showed no differences between patients with normal and with low bone quality. At 1-year follow-up, low bone quality was not associated with persistent back pain (defined as < 30%: OR 1.0; 95% CI: 0.40-2.30, p-value = 0.93; and defined as score > 1: OR 0.4; 95% CI: 0.17-1.15), p-value = 0.09), adjusted for all covariates. CONCLUSIONS In older adults with back pain presenting in general practice, low bone quality was not associated with severity of back pain at baseline nor with persistent back pain at 1-year follow-up.
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Affiliation(s)
- Jung-Ha Kim
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Family Medicine, Chung-ang University Medical Center, Seoul, Korea
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy T M Enthoven
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Heidari J, Belz J, Hasenbring MI, Kleinert J, Levenig C, Kellmann M. Evaluation of the short-term effects of recovery tools in the rehabilitation of chronic back pain: a feasibility study. European Journal of Physiotherapy 2018. [DOI: 10.1080/21679169.2018.1460397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jahan Heidari
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Germany
| | - Johanna Belz
- Department of Health & Social Psychology, German Sport University Cologne Germany
| | - Monika I. Hasenbring
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Germany
| | - Jens Kleinert
- Department of Health & Social Psychology, German Sport University Cologne Germany
| | - Claudia Levenig
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Germany
| | - Michael Kellmann
- Unit of Sport Psychology, Faculty of Sport Science, Ruhr University Bochum, Germany
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Australia
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17
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Herman PM, Kommareddi M, Sorbero ME, Rutter CM, Hays RD, Hilton LG, Ryan GW, Coulter ID. Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther 2018; 41:445-455. [PMID: 30121129 DOI: 10.1016/j.jmpt.2018.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/05/2018] [Accepted: 02/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Chronic low back pain (CLBP) and chronic neck pain (CNP) are the most common types of chronic pain, and chiropractic spinal manipulation is a common nonpharmacologic treatment. This study presents the characteristics of a large United States sample of chiropractic patients with CLBP and CNP. METHODS Data were collected from chiropractic patients using multistage systematic stratified sampling with 4 sampling levels: regions and states, sites (ie, metropolitan areas), providers and clinics, and patients. The sites and regions were San Diego, California; Tampa, Florida; Minneapolis, Minnesota; Seneca Falls and Upstate New York; Portland, Oregon; and Dallas, Texas. Data were collected from patients through an iPad-based prescreening questionnaire in the clinic and emailed links to full screening and baseline online questionnaires. The goal was 20 providers or clinics and 7 patients with CLBP and 7 with CNP from each clinic. RESULTS We had 6342 patients at 125 clinics complete the prescreening questionnaire, 3333 patients start the full screening questionnaire, and 2024 eligible patients completed the baseline questionnaire: 518 with CLBP only, 347 with CNP only, and 1159 with both. In general, most of this sample were highly-educated, non-Hispanic, white females with at least partial insurance coverage for chiropractic care who have been in pain and using chiropractic care for years. Over 90% reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care. CONCLUSIONS Given the prevalence of CLBP and CNP, the need to find effective nonpharmacologic alternatives for chronic pain, and the satisfaction these patients found with their care, further study of these patients is worthwhile.
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Affiliation(s)
| | | | | | | | - Ron D Hays
- University of California Los Angeles, Los Angeles, California
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18
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Amundsen PA, Evans DW, Rajendran D, Bright P, Bjørkli T, Eldridge S, Buchbinder R, Underwood M, Froud R. Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012. BMC Musculoskelet Disord 2018; 19:113. [PMID: 29650015 PMCID: PMC5898037 DOI: 10.1186/s12891-018-2034-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain is a common health complaint resulting in substantial economic burden. Each year, upwards of 20 randomised controlled trials (RCTs) evaluating interventions for non-specific low back pain are published. Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes, challenging meta-analyses. We explored selection criteria used in trials of treatments for nsLBP. Methods A systematic review of English-language reports of RCTs in nsLBP population samples, published between 2006 and 2012, identified from MEDLINE, EMBASE, and the Cochrane Library databases, using a mixed-methods approach to analysis. Study inclusion and exclusion criteria were extracted, thematically categorised, and then descriptive statistics were used to summarise the prevalence by emerging category. Results We included 168 studies. Two inclusion themes (anatomical area, and symptoms and signs) were identified. Anatomical area was most reported as between costal margins and gluteal folds (n = 8, 5%), while low back pain (n = 150, 89%) with or without referred leg pain (n = 27, 16%) was the most reported symptom. Exclusion criteria comprised 21 themes. Previous or scheduled surgery (n = 84, 50%), pregnancy (n = 81, 48%), malignancy (n = 78, 46%), trauma (n = 63, 37%) and psychological conditions (n = 58, 34%) were the most common. Sub-themes of exclusion criteria mostly related to neurological signs and symptoms: nerve root compromise (n = 44, 26%), neurological signs (n = 34, 20%) or disc herniation (n = 30, 18%). Specific conditions that were most often exclusion criteria were spondylolisthesis (n = 35, 21%), spinal stenosis (n = 31, 18%) or osteoporosis (n = 27, 16%). Conclusion RCTs of interventions for non-specific low back pain have incorporated diverse inclusion and exclusion criteria. Guidance on standardisation of inclusion and exclusion criteria for nsLBP trials will increase clinical homogeneity, facilitating greater interpretation of between-trial comparisons and meta-analyses. We propose a template for reporting inclusion and exclusion criteria. Electronic supplementary material The online version of this article (10.1186/s12891-018-2034-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pål André Amundsen
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152, Oslo, Norway.
| | - David W Evans
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152, Oslo, Norway.,Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Dévan Rajendran
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152, Oslo, Norway.,European School of Osteopathy, The Street, Boxley, Maidstone, Kent, ME14 3DZ, UK
| | - Philip Bright
- European School of Osteopathy, The Street, Boxley, Maidstone, Kent, ME14 3DZ, UK
| | - Tom Bjørkli
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152, Oslo, Norway
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, Whitechapel, London, E1 2AB, UK
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, Monash University, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, Melbourne, Victoria, 3144, Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit. Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Robert Froud
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152, Oslo, Norway.,Warwick Clinical Trials Unit. Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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Adnan R, Van Oosterwijck J, Cagnie B, Dhondt E, Schouppe S, Van Akeleyen J, Logghe T, Danneels L. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study. J Manipulative Physiol Ther 2017; 40:659-667. [DOI: 10.1016/j.jmpt.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
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20
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Deer T, Slavin KV, Amirdelfan K, North RB, Burton AW, Yearwood TL, Tavel E, Staats P, Falowski S, Pope J, Justiz R, Fabi AY, Taghva A, Paicius R, Houden T, Wilson D. Success Using Neuromodulation With BURST (SUNBURST) Study: Results From a Prospective, Randomized Controlled Trial Using a Novel Burst Waveform. Neuromodulation 2017; 21:56-66. [DOI: 10.1111/ner.12698] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/10/2017] [Accepted: 08/21/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Timothy Deer
- The Spine and Nerve Center of the Virginias, Inc.; Charleston WV USA
| | | | | | | | | | | | - Ed Tavel
- Pain Specialists of Charleston; Charleston SC USA
| | | | | | | | - Rafael Justiz
- Department of Anesthesiology; Oklahoma Pain Physicians, University of Oklahoma; Oklahoma City OK USA
| | - Alain Y. Fabi
- Department of Neurosurgery; Bronson Neuroscience Center; Kalamazoo MI USA
| | | | | | | | - Derron Wilson
- Department of Neurological Surgery; Indiana University School of Medicine; Indianapolis IN USA
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21
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Knecht C, Humphreys BK, Wirth B. An Observational Study on Recurrences of Low Back Pain During the First 12 Months After Chiropractic Treatment. J Manipulative Physiol Ther 2017; 40:427-33. [PMID: 28822475 DOI: 10.1016/j.jmpt.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/03/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate recurrence rate and prognostic factors in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care using standardized definitions. METHODS In Switzerland, 722 patients with LBP (375 male; mean age = 44.5 ± 13.8 years) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Based on NRS values, patients were categorized as "fast recovery," "slow recovery," "recurrent," "chronic," and "others." In multivariable logistic regression models, age, sex, work status, duration of complaint (subacute: ≥14 days to <3 months; chronic: ≥3 months), previous episodes, baseline NRS, and baseline ODI were investigated as predictors. RESULTS Based on NRS values, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint (subacute: odds ratio [OR] = 3.3; chronic: OR = 10.1). The recurrent and chronic pattern significantly differed in duration of complaint (chronic: OR = 0.14) and baseline NRS (OR = 0.75). CONCLUSION Recurrence rate was low in this LBP patient population. The duration of complaint before treatment was the main predictor for recurrence. The fact that even subacute duration significantly increased the odds for an unfavorable course of LBP is of clinical relevance.
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Behrend CJ, Schönbach EM, Vaccaro AR, Coyne E, Prasarn ML, Rechtine GR. Maximum pain on visual analog scales in spinal disorders. Spine J 2017; 17:1061-1065. [PMID: 27939747 DOI: 10.1016/j.spinee.2016.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/28/2016] [Accepted: 11/28/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Determining pain intensity is largely dependent on the patient's report. PURPOSE The objective of this study was to test the hypothesis that patients initially reporting a pain score of 10 out of 10 on the visual analog scale (VAS) would experience symptom improvement to a degree similar to patients reporting milder pain. STUDY DESIGN This study is a retrospective chart review. PATIENT SAMPLE A total of 6,779 patients seeking care for spinal disorders were included in the study. OUTCOME MEASURES The outcome measures used in the study were pain scores on the VAS pain scale, smoking status, morbid depression, gender, and the presence of known secondary gain. MATERIALS AND METHODS Patients with lumbar degenerative disk disease with or without spinal stenosis who reported a VAS pain score of 10 out of 10 were identified. Changes in reported VAS pain, patient age, smoking status, morbid depression, gender, and the presence of known secondary gain were examined. RESULTS A total of 160 individuals (2.9%) reported a maximum pain score of 10 out of 10 on a VAS at their initial presentation. The patients had a median improvement of 3 points in reported VAS pain between the first visit and the last follow-up appointment. The odds to improve by at least 40% on the VAS were 1.500 (95% confidence interval 1.090-2.065) compared with patients reporting submaximal pain. The proportion of patients with identifiable secondary gain was higher (p=.001) than that of patients with submaximal pain. Patients whose pain scores improved dramatically (ie, at least 4 points on the VAS) tended to be older (p=.001), to less often have secondary gain from their disease (p=.007), and to have a negative current smoking status (p=.002). Patients whose pain remained 10 out of 10 during the course of treatment smoked more frequently (p=.016). CONCLUSIONS Our analysis supports the need to consider the influence of secondary gain on the patients' reported VAS pain scores. Maximum pain seems to be a more acute phenomenon with some likelihood to significantly improve.
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Affiliation(s)
- Caleb J Behrend
- Carilion Clinic Orthopaedics, Virginia Tech, 2331 Franklin Rd, Roanoke, VA 24014, USA
| | - Etienne M Schönbach
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA.
| | - Alexander R Vaccaro
- Rothman Institute, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107, USA
| | - Ellen Coyne
- Independent Statistical Support, Rochester, NY, USA
| | - Mark L Prasarn
- Department of Orthopaedics and Rehabilitation, University of Texas, 6431 Fannin St, Houston, TX 77030, USA
| | - Glenn R Rechtine
- Department of Orthopaedics, Veterans Affairs Medical Center, 1100 Tunnel Rd, Asheville, NC 28805, USA
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Saariaho AS, Saariaho TH, Mattila AK, Ohtonen P, Joukamaa MI, Karukivi M. Alexithymia and depression in the recovery of chronic pain patients: a follow-up study. Nord J Psychiatry 2017; 71:262-269. [PMID: 28413937 DOI: 10.1080/08039488.2016.1275782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare. AIMS The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied. METHODS The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided. RESULTS At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome. CONCLUSIONS Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.
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Affiliation(s)
| | - Tom H Saariaho
- b Pain Clinic , Oulu University Hospital , Oulu , Finland
| | - Aino K Mattila
- c Department of Psychiatry , Tampere University Hospital , Tampere , Finland
| | - Pasi Ohtonen
- d Department of Anesthesiology and Surgery , Oulu University Hospital , Oulu , Finland
| | - Matti I Joukamaa
- e School of Health Sciences, Tampere University , Tampere , Finland
| | - Max Karukivi
- f Department of Psychiatry , University of Turku and Turku University Hospital, Turku Unit of Adolescent Psychiatry, Satakunta Hospital District , Pori , Finland
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Jegan NRA, Brugger M, Viniol A, Strauch K, Barth J, Baum E, Leonhardt C, Becker A. Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care. BMC Musculoskelet Disord 2017; 18:114. [PMID: 28320375 PMCID: PMC5360090 DOI: 10.1186/s12891-017-1482-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial. Trial registration German Clinical Trial Register, DRKS00003123 (June 28th 2011). Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nikita Roman A Jegan
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany.
| | - Markus Brugger
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Annika Viniol
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Konstantin Strauch
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich und University Zurich, Zurich, Switzerland
| | - Erika Baum
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Corinna Leonhardt
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Annette Becker
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
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Wirth B, Ehrler M, Humphreys BK. First episode of acute low back pain - an exploratory cluster analysis approach for early detection of unfavorable recovery. Disabil Rehabil 2016; 39:2559-2565. [PMID: 27758141 DOI: 10.1080/09638288.2016.1239765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify recovery patterns in patients with a first episode of acute low back pain (LBP) and to define risk factors for unfavorable outcome. METHODS One hundred and eight patients (55 male, 53 female; mean age = 40.8, SD 14.2 years) rated pain (NRS) and disability [Oswestry Disability Index (ODI)] before the first treatment and 1 week, 1, 3, 6, and 12 months later. Hierarchical cluster analysis identified recovery patterns based on NRS data. Clusters were compared for age, NRS and ODI at baseline, pain reduction in the first week, gender, radicular signs and traumatic onset using one-way ANOVA (post hoc Bonferroni) and χ2 tests. RESULTS The cluster analysis revealed four clusters: moderate baseline pain/fast recovery; high baseline pain/fast recovery; high baseline pain/persistent mild pain; high baseline pain/persistent high pain. These clusters differed in baseline NRS [F(3,104) = 39.61, p < 0.001], baseline ODI [F(3,104) = 12.17, p < 0.001], pain reduction in the first week [F(3,104) = 11.51, p < 0.001] and in radicular signs [χ2(3) = 9.20, p = 0.027]. CONCLUSIONS These results suggest that an initial and regularly repeated assessment of pain intensity and functional disability is important. Initial pain intensity does not seem to be a prognostic factor per se, as it did not negatively affect recovery provided that it decreased early in treatment. Implications for Rehabilitation Prediction of outcome is particularly important in patients with a first episode of acute LBP as one third did not completely recover. Pain intensity and functional disability should be initially assessed and regularly repeated in the first phase of treatment. High initial pain intensity and disability combined with small pain reduction during the first week might predict unfavorable outcome and require adequate treatment.
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Affiliation(s)
- Brigitte Wirth
- a Department of Chiropractic Medicine , University of Zurich, Balgrist University Hospital , Zurich , Switzerland
| | - Marco Ehrler
- a Department of Chiropractic Medicine , University of Zurich, Balgrist University Hospital , Zurich , Switzerland
| | - Barry Kim Humphreys
- a Department of Chiropractic Medicine , University of Zurich, Balgrist University Hospital , Zurich , Switzerland
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Abstract
This review explores the principles and process associated with the diagnosis of temporomandibular disorders (TMDs). TMD diagnosis has evolved substantially over the past 25 y. Previously, diagnosis focused solely on aberrations in oral structures, largely without empirical evidence. The Research Diagnostic Criteria for TMD (RDC/TMD) were developed on core principles of 1) a dual-axis system reflecting the biopsychosocial model, 2) a clear operationalization for reliability, and 3) the allowance of multiple diagnoses. These principles were retained in the subsequent validation research of the RDC/TMD, and the current diagnostic system-the Diagnostic Criteria for TMD (DC/TMD)-has improved on those principles as well as on diagnostic validity and protocols for assessing the psychosocial domain. Further investigations into etiology and its potential contribution to taxonomy revision are described, particularly within the context of complex disease. The review concludes with an outline of major research areas already underway that will support future revisions of the DC/TMD.
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Affiliation(s)
- R Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, NY, USA
| | - S F Dworkin
- Schools of Medicine and Dentistry, University of Washington, Seattle, WA, USA
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Werner EL, Storheim K, Løchting I, Wisløff T, Grotle M. Cognitive Patient Education for Low Back Pain in Primary Care: A Cluster Randomized Controlled Trial and Cost-Effectiveness Analysis. Spine (Phila Pa 1976) 2016; 41:455-62. [PMID: 26966970 DOI: 10.1097/BRS.0000000000001268] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A pragmatic cluster randomized controlled trial in primary care. OBJECTIVE The aim of this study was to estimate the clinical effectiveness and cost-effectiveness of a cognitive-based education program on patients with subacute or chronic low back pain (LBP) in primary care, compared to usual treatment, provided by general practitioners (GP) and physiotherapists (PT). SUMMARY OF BACKGROUND DATA Patient education has been reported to have a favorable effect on patients with chronic musculoskeletal disorders. In this study, an "Explain Pain" model was adapted to fit into an ordinary clinical setting in Norwegian primary care. METHODS Sixteen GPs and 20 PTs participated in the study and a total of 216 patients were recruited. The GPs and PTs were randomly assigned to provide either a cognitive patient education or usual treatment. All patients in both groups were provided with four consultations of 30 min with their provider during the study. In the intervention group the patients were educated according to a specific manual written for the purpose of this study. RESULTS Eighty-one percent responded at 4-week, and 68% at the 12-month follow-up. There was a substantial improvement in function, pain, and sick leave in both groups. After 4 weeks the intervention group scored 0.51 RMDQ points lower than the control group (Beta -0.506 [95% CI -1.76-0.75]). After 12 months the intervention group scored 0.66 RMDQ points higher than the control group (Beta 0.66 [95% CI -0.56-1.88]). There was no significant difference in QALYs in the two treatment groups; the estimated difference was 0.005 (-0.016-0.027) in favor of the intervention. CONCLUSION This study showed no clinical or health economic benefits as a result of adding a cognitive education program to usual treatment for patients with subacute and chronic LBP. Potential weaknesses such as a long recruiting period and potentially low compliance with the cognitive intervention warrant a careful interpretation of the results.
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