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Gregersen MHM, Nielsen KR, Lynge NH, Heiberg BD, Hartvigsen J, Kawchuk G, Kongsted A. Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors. BMC Musculoskelet Disord 2024; 25:339. [PMID: 38678259 PMCID: PMC11055288 DOI: 10.1186/s12891-024-07450-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Individual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups. METHODS In a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups. RESULTS Goals most often related to the ICF component of 'Activity and Participation'. The most prevalent goals were "Walking" (DK: 20%; CA: 15%) and "Maintaining a body position" (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants. CONCLUSIONS People with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.
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Affiliation(s)
- Mette H M Gregersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Kristine R Nielsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Nana H Lynge
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Bibi D Heiberg
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, Odense, Denmark
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 St NW, Edmonton, AB, Canada
| | - Alice Kongsted
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
- Chiropractic Knowledge Hub, Campusvej 55, Odense, Denmark.
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Bastiaens F, Wegener JT, Ostelo RWJG, van Roosendaal BKWP, Vissers KCP, van Hooff ML. Clinical Patient-Relevant Outcome Domains for Persistent Spinal Pain Syndrome-A Scoping Review and Expert Panels. J Clin Med 2024; 13:1975. [PMID: 38610739 PMCID: PMC11012536 DOI: 10.3390/jcm13071975] [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] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient's perspective. The study objectives were to identify patient-relevant outcome domains for PSPS and to establish a PSPS outcomes framework. PubMed, CINAHL, Cochrane, and EMBASE were searched to identify studies reporting views or preferences of PSPS patients on outcome domains. The Arksey and O'Malley framework was followed to identify outcome domains. An expert panel rated the domains based on the importance for PSPS patients they have treated. A framework of relevant outcome domains was established using the selected outcome domains by the expert panel. No studies were found for PSPS type 1. Five studies with 77 PSPS type 2 patients were included for further analysis. Fourteen outcome domains were identified. An expert panel, including 27 clinical experts, reached consensus on the domains pain, daily activities, perspective of life, social participation, mobility, mood, self-reliance, and sleep. Eleven domains were included in the PSPS type 2 outcomes framework. This framework is illustrative of a more holistic perspective and should be used to improve the evaluation of care for PSPS type 2 patients. Further research is needed on the prioritization of relevant outcome domains.
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Affiliation(s)
- Ferdinand Bastiaens
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Jessica T. Wegener
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Kristian W. P. van Roosendaal
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Miranda L. van Hooff
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain 2024; 28:181-198. [PMID: 37874300 DOI: 10.1002/ejp.2190] [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: 05/15/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Low back pain (LBP), and in particular non-specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into 'specific' versus 'non-specific' and 'acute' versus 'chronic' pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients. DATABASES AND DATA TREATMENT Narrative review. RESULTS NSLBP is a multi-dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive-behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re-assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively. CONCLUSIONS The identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient. SIGNIFICANCE STATEMENT Here, a comprehensive review of the challenges associated with the diagnostic label 'non-specific low back pain' is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.
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Affiliation(s)
- Brigitte Wirth
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Gayton J, Monga A. Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review. Musculoskeletal Care 2023; 21:1315-1340. [PMID: 37641529 DOI: 10.1002/msc.1803] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. OBJECTIVES This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? INCLUSION CRITERIA The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. METHODS This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. RESULTS 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. CONCLUSIONS Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.
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Affiliation(s)
- Jonathan Gayton
- Advanced Physiotherapy Practitioner, Musculoskeletal Service, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Aastha Monga
- School of Allied Health Professions, Keele University, Keele, UK
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Wilson L, Denham A, Ionova Y, O'Neill C, Greco CM, Hassett AL, Hanmer J, Shaikh S, Wolf M, Berven S, Williams D, Ma Y, Lotz J, Zheng P. Preferences for risks and benefits of treatment outcomes for chronic low back pain: Choice-based conjoint measure development and discrete choice experiment. PM R 2023. [PMID: 38040670 DOI: 10.1002/pmrj.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/10/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited. OBJECTIVE To develop and test a choice-based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid. DESIGN We developed a survey-based CBC measure to allow patients to make risk/benefit trade-off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Random-parameters logit models were used to estimate strength of preferences, and latent class analysis was used to identify patient characteristics associated with distinct preference. SETTING Online study using the Sawtooth web-based platform. PARTICIPANTS Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions. INTERVENTIONS Not applicable. RESULTS The most valued outcome was the highest level of physical activity (β = 1.6-1.98; p < .001), followed by avoiding cognitive difficulties (β = -1.48; p < .001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β = -0.99, -1.02); p < .001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability have stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk-seeking and willing to accept worse outcomes (56%); and (2) more risk-averse with a stronger preference for achieving maximum benefits (44%). CONCLUSIONS Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences to aid informed, shared decisions.
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Affiliation(s)
- Leslie Wilson
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Alina Denham
- Department of Family, Population and Preventive Medicine, Program in Public Health, Stony Brook University, San Francisco, Stony Brook, USA
| | - Yelena Ionova
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Conor O'Neill
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Carol M Greco
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Janel Hanmer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sana Shaikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Mehling Wolf
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Sigurd Berven
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - David Williams
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanlei Ma
- Department of Medicine, Cornell University, Ithaca, New York, USA
| | - Jeffrey Lotz
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Patricia Zheng
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
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Sullivan N, Schorpp H, Crosky S, Thien S, Helmer DA, Litke DR, Pigeon WR, Quigley KS, McAndrew LM. Treatment and life goals among veterans with Gulf War illness. PLoS One 2023; 18:e0295168. [PMID: 38033143 PMCID: PMC10688846 DOI: 10.1371/journal.pone.0295168] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Medically unexplained syndromes (MUS), also termed persistent physical symptoms, are both prevalent and disabling. Yet treatments for MUS are marked by high rates of patient dissatisfaction, as well as disagreement between patients and providers on the management of persistent physical symptoms. A better understanding of patient-generated goals could increase collaborative goal setting and promote person-centered care, a critical component of MUS treatment; yet research in this area is lacking. This paper aimed to develop a typology of treatment and life goals among Gulf War veterans with a medically unexplained syndrome (Gulf War Illness). We examined participants' responses to open-ended questions about treatment and life goals using Braun and Clarke's thematic analysis methodology. Results showed that treatment goals could be categorized into four overarching themes: 1) Get better/healthier, 2) Improve quality of life, 3) Improve or seek additional treatment, and 4) Don't know/Don't have any. Life goals were categorized into six overarching themes: 1) Live a fulfilling life, 2) Live a happy life, 3) Live a healthy life, 4) Be productive/financially successful, 5) Manage GWI, and 6) Don't know/Don't have any. Treatment goals were largely focused on getting better/healthier (e.g., improving symptoms), whereas life goals focused on living a fulfilling life. Implications for the treatment of Gulf War Illness and patient-provider communication are discussed. ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Hannah Schorpp
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America
| | - Sarah Crosky
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
| | - Scott Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - David R. Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States of America
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States of America
| | - Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
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Rasmussen-Barr E, Halvorsen M, Bohman T, Boström C, Dedering Å, Kuster RP, Olsson CB, Rovner G, Tseli E, Nilsson-Wikmar L, Grooten WJA. Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord 2023; 24:806. [PMID: 37828488 PMCID: PMC10568903 DOI: 10.1186/s12891-023-06930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence. METHODS We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible. RESULTS Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available. CONCLUSION Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality. TRIAL REGISTRATION Prospero CRD42022336014.
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Affiliation(s)
- Eva Rasmussen-Barr
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden.
| | - Marie Halvorsen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Tony Bohman
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Roman P Kuster
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Christina B Olsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- ACT Institutet Sweden, Research and Education, Gothenburg, Sweden
| | - Elena Tseli
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lena Nilsson-Wikmar
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
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8
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van Slingerland K, de Jong PHP, Dolhain RJEM, Pasma A. The effect of a goal-setting strategy with integrated feedback on goal attainment in inflammatory arthritis patients: a mixed method study. Rheumatol Int 2023; 43:1897-1904. [PMID: 37481593 PMCID: PMC10435644 DOI: 10.1007/s00296-023-05394-3] [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: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
Patients with Inflammatory Arthritis (IA) often experience difficulties in daily life as a result of their disease. Unfortunately, outpatient consultations in daily practice tend to focus on medical topics, thereby ignoring the impact of the disease on patients' daily lives. Patient-Reported Outcomes (PROs) can be used to understand this impact, but they are not enough for offering person-centered care. Because the patient's true values and goals can only be ascertained during a proper conversation, which should include both medical as well as patient goals. Therefore, the aim of the study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in IA patients. IA patients with an active disease were given the opportunity to set and follow-up goals. In addition to goal setting, patients were asked to complete online questionnaires on various PROs, including HRQoL. Ninety-two IA patients participated in the study. The mean age was 51 years and most of them had rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. In the entire population, HRQoL did not change over time, but patients who did not meet their goals tended to report a lower HRQoL. Incorporating a feedback mechanism in a goal-setting strategy has a positive effect on goal attainment. Yet no effect was seen on HRQoL, but this may due to the fact that general HRQoL measurement are not sensitive or specific enough to detect changes that are accompanied with goal setting and attainment.
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Affiliation(s)
| | - P H P de Jong
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - A Pasma
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Quality and Patient Care, Erasmus MC, Rotterdam, The Netherlands
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9
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Rogers CJ, Elchert CR, Hackney ME. Chiropractic Management of a 67-Year-Old Veteran With Chronic Low Back Pain Utilizing Low-Velocity Flexion-Distraction: A Case Report. J Chiropr Med 2023; 22:157-163. [PMID: 37346235 PMCID: PMC10280086 DOI: 10.1016/j.jcm.2023.03.002] [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] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The purpose of this case report was to describe the treatment of an older veteran with chronic low back pain, utilizing flexion-distraction as a primary intervention for management. Clinical Features A 67-year-old man with chronic low back pain for several decades presented to the chiropractic clinic for evaluation. He reported low back pain that extended into the right lower extremity intermittently. The patient's imaging demonstrated significant degenerative changes in the lumber spinal anatomy. He had never experienced chiropractic interventions or management for his condition. Intervention and Outcome A trial of conservative care with flexion-distraction was applied as a primary intervention for the management of chronic low back pain. Instrument-assisted soft-tissue mobilization and moist heat were also applied for interventions. Despite having no changes in outcome assessments, the patient reported an improvement in his condition, reduced use of pain medication, and increased mobility after 4 sessions over a 4-week period. Conclusion Flexion-distraction was a beneficial chiropractic approach to the management of an older veteran with chronic low back pain and intermittent lower extremity pain for several decades.
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Affiliation(s)
- Casey J. Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Health Care System, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Madeleine E. Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, Georgia
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, Georgia
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10
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Naylor J, Killingback C, Green A. What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies. Disabil Rehabil 2023; 45:950-961. [PMID: 35348410 DOI: 10.1080/09638288.2022.2055165] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE There is a growing expectation of physiotherapists to adopt a person-centred approach to their practice. Person-centredness for musculoskeletal physiotherapy, however, remains an under-researched area. A synthesis of the findings from qualitative studies exploring perceptions of person-centredness in musculoskeletal physiotherapy was conducted to inform future clinical practice. METHODS ENTREQ and PRISMA guidelines were used to develop a protocol for a qualitative systematic review registered with PROSPERO (registration number: CRD42020170762). Five electronic databases were searched to identify relevant primary studies. Studies were assessed for quality and data extracted. Data were analysed using thematic synthesis. RESULTS A total of 3250 studies were identified and screened. Nine studies met the inclusion criteria. Four main themes emerged from the data: treating each patient as a unique person, the importance of communication for achieving a therapeutic alliance, necessary physiotherapist traits for person-centredness, and supporting patient empowerment. CONCLUSION Empowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment, with clinical bravery recognised as a specific person-centred physiotherapy trait able to facilitate this. Physiotherapists should also consider the meaningfulness of any treatment activities they provide to maximise the person-centredness of their approach.IMPLICATIONS FOR REHABILITATIONEmpowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment.Clinical bravery is a person-centred physiotherapy trait that facilitates certain conversational freedom to elicit the true patient narrative.Person-centred physiotherapists should reflect on how meaningful their treatment activities are for individual MSK outpatients.
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Affiliation(s)
- John Naylor
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Angela Green
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, UK
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11
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. Understanding how patients' pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach. BMJ Open 2022; 12:e061062. [PMID: 36581439 PMCID: PMC9806037 DOI: 10.1136/bmjopen-2022-061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear. OBJECTIVES To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them. DESIGN Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana. RESULTS Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients' themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana. CONCLUSION Participants' narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, London South Bank University Faculty of Health and Social Care, London, UK
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Claire Diver
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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12
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Alan Fontana M, Islam W, Richardson MA, Parks ML, Mayman DJ, MacLean CH. Eliciting Activity Goals With a Self-Administered Survey Among Patients With Hip or Knee Osteoarthritis. HSS J 2022; 18:490-497. [PMID: 36263283 PMCID: PMC9527544 DOI: 10.1177/15563316221085568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023]
Abstract
Background: Success of treatment for hip or knee osteoarthritis (OA) should be evaluated relative to patients' personal activity goals. Questions/Purposes: We sought to ascertain important principles for collecting such goals and developed a survey informed by those principles to facilitate better shared decision-making. Methods: From a series of 100 patient interviews inquiring about specific activity goals, we identified 6 principles for goal collection that are important to patients and physicians and could practically facilitate better shared decision-making (phase 1). Incorporating these principles, we designed a self-administered survey to measure specific pretreatment activity goals, piloting in 1 surgeon's office (phase 2). During office visits, the feasibility of achieving stated goals was discussed between the surgeon and the patient, and goal modifications were recorded. Results: The phase 2 survey was administered to 252 patients, among whom 130 were women (51.6%); 215 (85.3%), white; mean age, 58.5 years; mean body mass index, 30.2 kg/m2; and 92.9% had 1 or more goals, totaling 106 unique goals. Patient demographics were associated with having goals for walking, running, exercising, golfing, tennis, and stairs. Hip and knee patients could last perform their goal on average 21.7 and 38.6 months prior (P = .002). Patient and surgeon agreed to modify goals 19% of the time, more often among younger patients (P = .001) and for running (64% modified, P < .0001) and skiing (42%, P = .0026), but less often for walking (14%, P = .0430) and golf (0%, P = .0204). Conclusions: Patients' activity goals can be captured by a self-administered survey, collected before an office visit, and used to facilitate shared decision-making.
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Affiliation(s)
- Mark Alan Fontana
- Center for Analytics, Modeling, and Performance, Hospital for Special Surgery, New York, NY, USA
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Wasif Islam
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michelle A. Richardson
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michael L. Parks
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - David J. Mayman
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Catherine H. MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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13
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Coronado RA, Master H, Bley JA, Robinette PE, Sterling EK, O'Brien MT, Henry AL, Pennings JS, Vanston SW, Myczkowski B, Skolasky RL, Wegener ST, Archer KR. Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial. Phys Ther 2022; 102:6623302. [PMID: 35778941 PMCID: PMC10071580 DOI: 10.1093/ptj/pzac091] [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: 09/30/2021] [Revised: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery. METHODS In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score ≥ 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. RESULTS Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. CONCLUSIONS Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. IMPACT This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopedic Surgery, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Bley
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Payton E Robinette
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emma K Sterling
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael T O'Brien
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Abigail L Henry
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan W Vanston
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brittany Myczkowski
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard L Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin R Archer
- Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Fidler SK. Comprehensive Evaluation for Chronic Pain. Prim Care 2022; 49:375-385. [DOI: 10.1016/j.pop.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E. Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews. BMC Musculoskelet Disord 2022; 23:801. [PMID: 35996124 PMCID: PMC9394044 DOI: 10.1186/s12891-022-05722-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability. Methods We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE. Results Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention. Conclusions Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources. Trial registration PROSPERO: Reg no 190409 Registration date 01AUG 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05722-x.
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Affiliation(s)
- Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Marie Halvorsen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Roman P Kuster
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Christina B Olsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,ACT Institutet Sweden, Gothenburg, Sweden
| | - Elena Tseli
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
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16
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Larsson A, Barenfeld E, Fors A, Gjertsson I, Bergenheim A, Mannerkorpi K. Person-centred health plans for physical activity in persons with chronic widespread pain (CWP) - a retrospective descriptive review. Disabil Rehabil 2022; 45:1857-1864. [PMID: 35658763 DOI: 10.1080/09638288.2022.2077992] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Physical activity is recommended as first-choice treatment in chronic pain conditions. The aim was to describe the content and perceptions of person-centred health plans, and to evaluate patients' implementation of the health plan in their everyday life. MATERIALS AND METHODS A descriptive retrospective review was conducted of person-centred health plans to support physical activity in 133 participants. Quantitative content analysis was used to analyse the content of the health plans. Questionnaires on physical activity and on implementation and perception of the health plans, and a test of physical capacity were administered. RESULTS Participants' goals were found to be related to physical function (n = 118), general health (n = 90), activity and participation (n = 80) and symptoms (n = 35). Participants identified personal (n = 174), social (n = 69) and material resources (n = 36). They identified fears and obstacles related to health issues (n = 95), difficulties getting it done (n = 41), competing priorities (n = 19) and contextual factors (n = 12). Participants identified need for external support (n = 110). Participants' level of physical activity and physical capacity increased significantly during the first 6 months of the study. CONCLUSION The person-centred approach seems helpful in enhancing motivation to achieve set goals and strengthen self-efficacy in physical activity also supported by increased physical activity and physical capacity. Implications for rehabilitationA person-centred approach can be helpful to enhance motivation to achieve set goals and self-efficacy to manage symptoms when engaging in physical activity.Shared documentation of a personal health plan helps to visualize resources to promote regular physical activity as well as alternative ways to reach set goals.The co-created health-plan captures the participant's goals, resources, fears and need of support, helps the participant to overcome challenges, and supports the participant to be physically active.
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Affiliation(s)
- Anette Larsson
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.,General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Fors
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Lukacs MJ, Kowalski KL, Peters N, Stanley M, Rushton AB. How is recovery defined and measured in patients with low back pain? Protocol for a mixed study systematic review. BMJ Open 2022; 12:e061475. [PMID: 35537787 PMCID: PMC9092166 DOI: 10.1136/bmjopen-2022-061475] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This protocol describes the methods for a mixed study systematic review aiming to explore the definitions and measurements of recovery in patients with low back pain, and how perspectives of recovery differ between patients and providers. This review will be the first to review the concept of recovery in patients with low back pain across both quantitative and qualitative literature. METHODS AND ANALYSIS This protocol has been designed and reported in line with Preferred Reporting Items of Systematic Reviews and Meta-Analyses Protocols. The following databases will be electronically searched from database inception until 30 November 2021: Medline, EMBASE, CINAHL, Cochrane, PEDro. Grey literature will be searched for through targeted searching of ProQuest Dissertations and Theses and handsearching of the references of all included studies. Studies will be included if they include a patient population of >50% with low back pain (with or without leg pain), and mention the concept of recovery within the abstract, methods or results. The Mixed Methods Appraisal Tool will be used for quality assessment of both quantitative and qualitative included studies. Two independent reviewers will conduct the search, screen titles/abstracts and extract relevant data from full texts. Discrepancies between reviewers will be settled by a third reviewer with spinal pain expertise. For syntheses, thematic analysis will be used to analyse both qualitative and quantitative investigations to explore meanings, measurement and perspectives of recovery from a diverse evidence base. There is no clinical trial associated with this protocol. ETHICS AND DISSEMINATION There are no ethical issues associated with this systematic review, and ethics approval was not required. Once completed, the results of this review will be published in a peer-reviewed journal within the realm of spinal pain to help guide future research inquiries. PROSPERO REGISTRATION NUMBER CRD42022295804.
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Affiliation(s)
- Michael J Lukacs
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Katie L Kowalski
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Nicole Peters
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Meagan Stanley
- Western University Allyn and Betty Taylor Library, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
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18
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Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag 2022; 12:653-664. [PMID: 35350847 DOI: 10.2217/pmt-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/28/2022] Open
Abstract
Chronic low back pain (cLBP) impacts millions of adults annually. Several nonsurgical interventions are recommended for treating this condition, however, limited literature exists regarding the impact patient-led goals may have on outcomes in the treatment of cLBP. The purpose of this narrative review is to identify gaps and synthesize literature examining the associations of patient-led goals combined with care for cLBP. A total of 12 studies were reviewed and findings were synthesized. Patient-led goal setting may serve as an effective intervention for adults with cLBP. Current outcome measures may not align with patient-led goals. Further investigation is required to understand patient-led goals with ancillary treatments and specific age groups, such as adults over age 65.
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Affiliation(s)
- Casey J Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA
| | - Madeleine E Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Katharina V Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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19
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Salsbury SA, Twist E, Wallace RB, Vining RD, Goertz CM, Long CR. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a qualitative study with veteran stakeholders from a pilot trial of multimodal chiropractic care. Pilot Feasibility Stud 2022; 8:6. [PMID: 35031072 PMCID: PMC8759237 DOI: 10.1186/s40814-021-00962-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP. METHODS The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10-week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services. RESULTS Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers). CONCLUSIONS This qualitative study highlighted veteran stakeholders' perceptions of VA-based chiropractic services and offered important suggestions for conducting a full-scale, veteran-focused, randomized trial of multimodal chiropractic care for chronic LBP in this clinical setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03254719.
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Affiliation(s)
- Stacie A. Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Elissa Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Robert B. Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, S422 CPHB, 145 N. Riverside Drive, Iowa City, Iowa 52242 USA
| | - Robert D. Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Christine M. Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, 200 Morris Street, Durham, North Carolina 27701 USA
| | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
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Spink A, Wagner I, Orrock P. Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies. Musculoskelet Sci Pract 2021; 56:102433. [PMID: 34416557 DOI: 10.1016/j.msksp.2021.102433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 03/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors. OBJECTIVES The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective. METHODS An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research). RESULTS Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors. CONCLUSION Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.
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21
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Flynn SB, Gordee A, Kuchibhatla M, George SZ, Eucker SA. Moving toward patient-centered care in the emergency department: Patient-reported expectations, definitions of success, and importance of improvement in pain-related outcomes. Acad Emerg Med 2021; 28:1286-1298. [PMID: 34358379 DOI: 10.1111/acem.14328] [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] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/05/2021] [Accepted: 06/23/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. METHODS We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). RESULTS Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. DISCUSSION ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain. CONCLUSIONS Our findings indicate that: (1) patient subgroups by outcome priorities may exist that could inform multimodal, personalized approaches from the ED and (2) patients are flexible in which treatments they are willing to try to meet their individual goals.
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Affiliation(s)
- Spencer B. Flynn
- David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute Duke University Durham North Carolina USA
| | - Stephanie A. Eucker
- Department of Surgery and Department of Orthopaedic Surgery Division of Emergency Medicine Duke University Durham North Carolina USA
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22
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Rasmussen-Barr E, Lindqvist C, Östhols S, Boström C. Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden. Musculoskelet Sci Pract 2021; 55:102414. [PMID: 34153691 DOI: 10.1016/j.msksp.2021.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/07/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physiotherapists in primary health care are required to use patient reported outcome measures (PROMs) to manage patients with low back pain (LBP). OBJECTIVE Our aim was to explore and describe how physiotherapists in primary care managing patients with LBP, experience the use of PROMs with a focus on facilitating and hindering factors. METHODS We undertook a qualitative study with semi-structured interviews. Fifteen physiotherapists (9 female and 6 male) were included. The interviews were audio-recorded and transcribed verbatim and analysed by inductive manifest content analysis. RESULTS Our findings resulted in eight main categories: PROMs give structure and increase patient involvement; Patients' motivations to use PROMs; Time and the physiotherapist's clinical priorities; Physiotherapists' routines steer their use of PROMs; Physiotherapists' competences in using PROMs; Organizations and managers steer the use of PROMs; Prerequisites for future use of PROMs; Using PROMs develops the physiotherapy profession. CONCLUSION Our findings show that using PROMs gives structure and increases patient involvement, but the patient's motivation to use PROMs needs to be taken into consideration. Time and routines influence the use of PROMs and these factors depend on organizational and managerial levels. Using PROMs is believed to help develop the physiotherapy profession. Prerequisites for future use, such as digitalization and increased competence, need to be fulfilled. Future studies should focus on increasing physiotherapists' knowledge about relevant PROMs, and study implementation in clinical practice, thereby improving the physiotherapy profession's quality of care.
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23
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Dorich JM, Cornwall R. A psychometric comparison of patient-reported outcome measures used in pediatric hand therapy. J Hand Ther 2021; 33:477-483. [PMID: 31477330 DOI: 10.1016/j.jht.2019.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective case series. INTRODUCTION Patient-reported outcome measures are important for research and also for informing clinical practice. The Pediatric Outcomes Data Collection Instrument (PODCI) and the Canadian Occupational Performance Measure (COPM) are commonly used in pediatric hand therapy. Both are validated in research, but no data exist regarding their relative merits for clinical practice. PURPOSE OF THE STUDY This study compares the psychometric properties of the PODCI and COPM in children receiving hand therapy to examine their relative utility in clinical practice. METHODS We assessed the psychometric properties of the PODCI and COPM in 75 children receiving hand therapy. Treatment outcomes were assessed simultaneously with the PODCI (Upper Extremity Function and Pain and Comfort scales), COPM (Performance and Satisfaction scales) at baseline and posttreatment time points. Interim scores were included for a subset of patients. Each scale was assessed for responsiveness, ceiling effect, and concurrent and discriminate validity. RESULTS All scales, except PODCI/Pain from interim to completion, were able to detect changes over the course of therapy. However, both COPM scales demonstrated greater responsiveness and less severe ceiling effects than both PODCI scales at all time points. All scales had weak concurrent validity and limited discriminate validity. CONCLUSIONS The COPM is more responsive to changes during treatment and less hindered by a ceiling effect than the PODCI. Weak concurrent validity between the PODCI and COPM suggests that they measure different things in this population.
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Affiliation(s)
- Jenny M Dorich
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Health Sciences, Cincinnati, OH, USA.
| | - Roger Cornwall
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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24
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Rhon DI, Fritz JM, Greenlee TA, Dry KE, Mayhew RJ, Laugesen MC, Dragusin E, Teyhen DS. Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial. J Transl Med 2021; 19:357. [PMID: 34407840 PMCID: PMC8371880 DOI: 10.1186/s12967-021-03013-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. METHODS The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. DISCUSSION Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. TRIAL REGISTRATION Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
| | | | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Katie E Dry
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Rachel J Mayhew
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Mary C Laugesen
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Edita Dragusin
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Deydre S Teyhen
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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25
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Colasanti JA, Vettese T, Samet JH. Improving Outpatient Management of Patients On Chronic Opioid Therapy. Infect Dis Clin North Am 2021; 34:621-635. [PMID: 32782105 DOI: 10.1016/j.idc.2020.06.014] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Managing patients with chronic pain on chronic opioid therapy (COT) can be challenging if done mainly by an individual clinician. A stepwise, systematic approach to managing patients on COT includes centering the discussion around safety for the patient. Treatment agreements and monitoring plans are important to safe prescribing. With a team-based care approach programs can be implemented, which optimize the benefits of opioid therapy and mitigate the risk. In these settings COT can be prescribed adhering to current guidelines in order to help achieve pain management, optimize function, and advance the patients' quality of life goals.
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Affiliation(s)
- Jonathan A Colasanti
- Department of Medicine, Division of Infectious Diseases, Emory University, 341 Ponce de Leon Avenue, Atlanta, GA 30308, USA.
| | - Theresa Vettese
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University, 49 Jesse Hill Drive SE #40, Atlanta, GA 30303, USA. https://twitter.com/tracyvettese
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center; 801 Massachusetts Avenue, CT 2, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, CT 2, Boston, MA 02118, USA
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26
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Poder TG, Beffarat M. Attributes Underlying Non-surgical Treatment Choice for People With Low Back Pain: A Systematic Mixed Studies Review. Int J Health Policy Manag 2021; 10:201-210. [PMID: 32610721 PMCID: PMC8167275 DOI: 10.34172/ijhpm.2020.49] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The knowledge of patients’ preferences in the medical decision-making process is gaining in importance. In this article we aimed to provide an overview on the importance of attributes underlying the choice of non-surgical treatments in people with low back pain (LBP).
Methods: A systematic mixed studies review was conducted. Articles were retrieved from the search engines PubMed, ScienceDirect, and Scopus through June 21, 2018. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study, and each step was performed by 2 reviewers.
Analysis: From a total of 390 articles, 13 were included in the systematic review, all of which were considered to be of good quality. Up to 40 attributes were found in studies using various methods. Effectiveness, ie, pain reduction, was the most important attribute considered by patients in their choice of treatment. This attribute was cited by 7 studies and was systematically ranked first or second in each. Other important attributes included the capacity to realize daily life activities, fit to patient’s life, and the credibility of the treatment, among others.
Discussion: Pain reduction was the most important attribute underlying patients’ choice for treatment. However, this was not the only trait, and future research is needed to determine the relative importance of the attributes.
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Affiliation(s)
- Thomas G Poder
- School of Public Health, University of Montreal, Montreal, QC, Canada.,Research Center of the IUSMM, CIUSSS de l'Est de l'Île de Montréal, Montreal, QC, Canada
| | - Marion Beffarat
- CERDI, Université Clermont Auvergne, ClermontFerrand, France
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Amundsen O, Vøllestad NK, Meisingset I, Robinson HS. Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskelet Disord 2021; 22:182. [PMID: 33583404 PMCID: PMC7882069 DOI: 10.1186/s12891-021-04048-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome. Methods Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x2 and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months. Results There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p < .001). Activity/participation goals were associated with better outcomes on GPE (OR 1.80, 95% CI 1.23–2.66). Non-classifiable goal was associated with poorer outcomes on pain intensity (B .87, 95% CI .32–1.43). Conclusion There is an association between goal classes and patient characteristics. Including activity/participation in the main goal was associated with better outcomes for GPE and having a non-classifiable goal was associated with poorer outcomes for pain intensity. Trial registration The project is approved by the Regional committee for Medical and Health Research Ethics in Norway (REC no. 2013/2030). https://clinicaltrials.gov/ct2/show/NCT03626389.
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Affiliation(s)
- Olav Amundsen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway.
| | - Nina Køpke Vøllestad
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Stendal Robinson
- Institute of Health and Society, Faculty of Medicine, University of Oslo, P. O box 1130 Blindern, 0318, Oslo, Norway
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28
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Vader K, Patel R, Doulas T, Miller J. Promoting Participation in Physical Activity and Exercise Among People Living with Chronic Pain: A Qualitative Study of Strategies Used by People with Pain and Their Recommendations for Health Care Providers. Pain Med 2021; 21:625-635. [PMID: 31592526 DOI: 10.1093/pm/pnz246] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore strategies used by people living with chronic pain when participating in physical activity and exercise and their recommendations for health care providers when promoting participation in physical activity and exercise. DESIGN Interpretive description qualitative study. SETTING Participants were recruited from primary care sites and a hospital-based chronic pain clinic in Kingston, Ontario, Canada. SUBJECTS Adults (>18 years of age) who self-identified as experiencing chronic pain (three months' duration) were interviewed. METHODS In-depth semistructured interviews were conducted with participants. Interviews were audio-recorded, transcribed verbatim, and reviewed for accuracy by the interviewer. Transcripts were analyzed using thematic analysis. Peer debriefing, reflexivity, and multiple in-person meetings were used to establish trustworthiness. RESULTS Sixteen adults (five men, 11 women) with a median age of 53 years were interviewed. Strategies used by people living with chronic pain to participate in physical activity and exercise included 1) finding the motivation, 2) setting up for success, 3) leveraging social support, and 4) managing pain and discomfort during activity. Recommendations for health care providers when promoting participation in physical activity and exercise for people living with chronic pain included 1) the importance of listening, 2) providing tailored advice, 3) being supportive, and 4) making physical activity and exercise programming accessible. CONCLUSIONS People living with chronic pain reported using multiple strategies to participate in physical activity and exercise. Recommendations for health care providers centered on the importance of listening and taking a supportive approach when promoting engagement in physical activity and exercise for this population.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre-Hotel Dieu Hospital Site, Kingston, ON, Canada
| | - Rupa Patel
- Kingston Community Health Centre, Kingston, ON, Canada.,Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Tom Doulas
- Chronic Pain Clinic, Kingston Health Sciences Centre-Hotel Dieu Hospital Site, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Zhang X, Ren J, Liu C, He M, Ren L, Lv Z. Evaluating Traditional Chinese Medicine Interventions on Chronic Low Back Pain Using Goal Attainment Scaling. Evid Based Complement Alternat Med 2020; 2020:8854927. [PMID: 33354222 DOI: 10.1155/2020/8854927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Extensive studies have been conducted to evaluate the pain relief effect of traditional Chinese medicine (TCM) interventions on patients with low back pain, including in China. However, there is a dearth in the literature documenting the diverse goals of TCM interventions, let alone the overall effect of such interventions. In this study, the goal attainment scaling (GAS) method was adopted to evaluate individualised TCM interventions on chronic low back pain. METHODS A pre-post intervention study was conducted on patients with chronic low back pain who received individualised TCM interventions in community health services. The study was undertaken in three community health centres in Hangzhou of China. A total of 165 eligible patients were invited, and 150 participated in the study, including 136 who completed both pre- and postintervention surveys. Each participant was asked to identify three to five intended goals from a pool of 26 outcome indicators and their corresponding expectations of these goals prior to the TCM interventions. Their conditions were rated against the selected indicators on a self-report five-point Likert scale before and after the TCM interventions, respectively. Gaps between the actual conditions and the expected goals were summed up for each participant and converted into a standardised GAS score, with a higher score indicating higher achievements, and 50 indicting patient expectations were met. Linear regression models were established to determine the factors associated with the pre-post GAS changes after adjustment for variations in other variables. RESULTS On average, an increase of 14.99 (SD = 9.81) in the GAS scores was achieved. This resulted in a mean GAS score of 48.33 (SD = 9.74) after the TCM interventions, falling slightly short (<2) of patient expectations. The multivariate linear regression models revealed that local residents, the retired, and those who perceived lower professional competency of their attending doctors had a smaller increase in the GAS scores after adjustment for variations in other variables. CONCLUSION The individualised TCM interventions can help patients with low back pain to achieve their expected goals as measured by the GAS. Further studies are needed to better understand how patients set up their goals and the professional competency requirements to meet patient expectations.
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30
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Rosenberg E, Carver T, Mamishi N, Bartlett G. What Role Can Trained Volunteers Add to Chronic Disease Care of Immigrants? J Immigr Minor Health 2020; 22:1281-1286. [PMID: 32935254 PMCID: PMC7683475 DOI: 10.1007/s10903-020-01079-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 10/31/2022]
Abstract
To help primary care teams improve patient-centered care, we elicited health and life goals of immigrants with a chronic disease. We conducted an exploratory study of the (1) acceptability of home visits by volunteers to collect health information and (2) content of health and life goals within a primary care program for immigrants with chronic disease. Pairs of trained community volunteers visited 23 patients in their homes and asked them to identify three life goals and three health goals. We conducted content analyses of written notes. Health goals were related to disease prevention and symptom control, family well-being, own quality of life, own or family members' work and/or financial situation. Life goals concerned family well-being, their own quality of life, work/financial situation and health. Given the limited time health professionals have with their patients, trained community volunteers could be important members of primary care teams caring for immigrants.
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Affiliation(s)
- Ellen Rosenberg
- Department of Family Medicine, McGill University, Montreal, QC, Canada. .,, Westmount, Canada.
| | - Tamara Carver
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Nina Mamishi
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Hennessy RW, Rumble D, Christian M, Brown DA, Trost Z. A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design. JMIR Serious Games 2020; 8:e17799. [PMID: 32773381 PMCID: PMC7445609 DOI: 10.2196/17799] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/13/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. OBJECTIVE This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. METHODS We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. RESULTS The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions. CONCLUSIONS The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely.
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Affiliation(s)
- Rebecca White Hennessy
- PhD Program in Rehabilitation Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deanna Rumble
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - David A Brown
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, United States
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
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Mertz K, Shah RF, Eppler SL, Yao J, Safran M, Palanca A, Hu SS, Gardner M, Amanatullah DF, Kamal RN. A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial. Med Decis Making 2020; 40:766-773. [PMID: 32744134 DOI: 10.1177/0272989x20943520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.
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Affiliation(s)
- Kevin Mertz
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Romil F Shah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Sara L Eppler
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Jeffrey Yao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Marc Safran
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Ariel Palanca
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Serena S Hu
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Michael Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Derek F Amanatullah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
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Esteve R, López-Martínez AE, Ruíz-Párraga GT, Serrano-Ibáñez ER, Ramírez-Maestre C. Pain Acceptance and Pain-Related Disability Predict Healthcare Utilization and Medication Intake in Patients with Non-Specific Chronic Spinal Pain. Int J Environ Res Public Health 2020; 17:ijerph17155556. [PMID: 32752085 PMCID: PMC7432233 DOI: 10.3390/ijerph17155556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months’ duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability—understood as giving up normal activities—can lead to reductions in healthcare utilization and medication intake.
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Affiliation(s)
- Rosa Esteve
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Alicia Eva López-Martínez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Gema Teresa Ruíz-Párraga
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
| | - Elena Rocío Serrano-Ibáñez
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Facultad de Ciencias de la Salud, Área de Psicología, Universidad Isabel I, 09003 Burgos, Spain
| | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga, Facultad de Psicología, Andalucía Tech, Universidad de Málaga, 29071 Málaga, Spain; (R.E.); (A.E.L.-M.); (G.T.R.-P.); (E.R.S.-I.)
- Correspondence: ; Tel.: +34-952-132-389
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Pires D, Cruz EB, Costa D, Nunes C. Beyond pain and disability: an explanatory mixed methods study exploring outcomes after physiotherapy intervention in patients with chronic low back pain. Disabil Rehabil 2020; 44:882-891. [PMID: 32579037 DOI: 10.1080/09638288.2020.1781938] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: The primary aim of this study was to explore relevant outcome domains for patients with chronic low back pain (CLBP) undergoing physiotherapy. A secondary aim was to examine potential discrepancies between meaningful changes in pain and disability and the global perception of improvement.Methods: An explanatory mixed methods design was employed. Twenty-two patients with CLBP completed self-reported measures before and after a physiotherapy programme. After the intervention, three focus groups were conducted with patients who perceived an overall improvement. Discussions were recorded, transcribed and analysed using thematic analysis.Results: Quantitative analysis showed an inconsistent relationship between changes in pain and disability measures and global improvements as perceived by patients. Two main themes emerged from the thematic analysis: "pain relief" (subthemes: reducing pain intensity and other symptoms; reducing medication intake; improving sleep quality) and "gaining control over the LBP condition" (subthemes: ability to self-manage; return to function; and sense of well-being and normality).Conclusion: Patients with CLBP perceived multiple outcomes from physiotherapy treatment that cover the domains of global, physical, mental and social health. These study findings suggest that the targets of measurement for physiotherapy need to be expanded in order to reflect outcome domains valued by patients.Implications for rehabilitationMinimum important changes in pain intensity and disability were not valid indicators of global improvements as perceived by patients.Patients with chronic low back pain undergoing physiotherapy perceived gains in multiple health domains that ranged beyond pain and disability domains.Physiotherapy outcome assessment needs to integrate other patient-relevant outcomes such as medication intake, sleep quality, ability to self-manage and sense of well-being.
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Affiliation(s)
- Diogo Pires
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Eduardo Brazete Cruz
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal.,Department of Physiotherapy, School of Health Care, Polytechnic Institute of Setúbal, Lisbon, Portugal
| | - Daniela Costa
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Pires D, Cruz EB, Gomes LA, Nunes C. How Do Physical Therapists Measure Treatment Outcomes in Adults With Chronic Low Back Pain? A Systematic Review. Phys Ther 2020; 100:1020-1034. [PMID: 32115634 DOI: 10.1093/ptj/pzaa030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/23/2019] [Revised: 07/03/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is an increasing recognition of the importance of using a conceptual framework covering the full range of relevant health domains and outcome measures addressed by physical therapy modalities in patients with chronic low back pain (CLBP). However, little is known about what outcome domains have been measured and through what measures in physical therapy research. OBJECTIVE The purpose of this review was to synthesize outcome domains, instruments, and cutoff values reported in published randomized controlled trials and their compliance with the original Patient-Reported Outcomes Measurement Information System (PROMIS) framework. DATA SOURCES Embase, MEDLINE, Cochrane Library, and Physiotherapy Evidence Database electronic databases were systematically searched from January 2008 to April 2019. STUDY SELECTION Randomized controlled trials that compared physical therapy with any other intervention for adults with CLBP were included. DATA EXTRACTION Study characteristics, outcome domains, instruments, and cutoff values were extracted by 2 reviewers. The PROMIS framework was used for domain categorization. DATA SYNTHESIS One hundred ninety-five studies were included, with 52 outcome domains and 45 cutoff values identified from 182 instruments reported. Only 14 of 195 studies assessed all PROMIS health core areas, whereas the PROMIS physical health core area was assessed in all included studies. Pain intensity and disability were the most frequently used domains. LIMITATIONS Only studies for which full texts were available in English were included. CONCLUSIONS This review identified a poor overlap between the PROMIS framework and outcome domains used to define the effectiveness of physical therapy in adults with CLBP. This finding suggests that other potential benefits resulting from physical therapy modalities are not being measured. Furthermore, a large diversity in the outcome domains and instruments was found.
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Affiliation(s)
- Diogo Pires
- Public Health Research Center, National School of Public Health, Nova University of Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon, Lisbon, Portugal
| | - Eduardo Brazete Cruz
- Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon
| | - Luís A Gomes
- Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal
| | - Carla Nunes
- Public Health Research Center, National School of Public Health, Nova University of Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal; and Comprehensive Health Research Centre, Nova University of Lisbon, Lisbon, Portugal
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Pires DADF, Brazete Cruz EJC, Canhão HCDM, Nunes CDRD. The role of pain and disability changes after physiotherapy treatment on global perception of improvement in patients with chronic low back pain. Musculoskelet Sci Pract 2020; 47:102139. [PMID: 32148329 DOI: 10.1016/j.msksp.2020.102139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/25/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effectiveness of physiotherapy in patients with chronic low back pain is usually measured through changes in pain and disability domains. However, recent research has suggested that these two domains are not sufficient to capture all the physiotherapy benefits when patients' perspective is considered. OBJECTIVE The aim of this study was to investigate the role of pain and disability changes in explaining the global perception of improvement in patients with chronic low back pain undergoing physiotherapy. DESIGN Prospective cohort study. METHODS The study was conducted on183 patients who were referred to physiotherapy treatment due to low back pain lasting more than 12 weeks. Sociodemographic and clinical characteristics were measured at baseline, together with pain intensity and disability. Eight (post-intervention) and twelve weeks later, global perception of improvement was measured together with pain and disability. The Pearson correlation coefficient and linear regression models were used for analyses. RESULTS Of the 183 participants included, 144 completed the 12-weeks follow-up. Significant and moderate correlation was found between pain and disability changes and the global perception of improvement after intervention and at the 12-weeks follow-up. Pain and disability changes explained 20.7%-36.3% of the variance in the global perception of improvement. CONCLUSIONS Pain and disability changes are related and contributed to explaining a partial proportion of variance in the global perception of improvement. The findings suggest that these domains are not sufficient to explain and measure all of the benefits of physiotherapy when patients' global perception of improvement is considered.
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Affiliation(s)
- Diogo André da Fonseca Pires
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Eduardo José Carvalho Brazete Cruz
- Comprehensive Health Research Center (CHRC), Portugal; Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal, Portugal
| | - Helena Cristina de Matos Canhão
- Comprehensive Health Research Center (CHRC), Portugal; Cedoc, EpiDoC Unit, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal; Department of Rheumatology, CHULC-Hospital Curry Cabral, Lisbon, Portugal
| | - Carla do Rosário Delgado Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
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Zeppieri Jr G, Bialosky J, George SZ. Importance of Outcome Domain for Patients With Musculoskeletal Pain: Characterizing Subgroups and Their Response to Treatment. Phys Ther 2020; 100:829-845. [PMID: 31944245 PMCID: PMC7297504 DOI: 10.1093/ptj/pzaa009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/12/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patient-centered care models allow for the ability to tailor treatment to outcomes of importance to patients. OBJECTIVE The purposes of this study were to (1) define patient subgroups based on outcomes of importance; (2) determine whether patient subgroups based on outcomes of importance differed in demographic, clinical, and psychological measures; and (3) determine whether outcome domain subgroups differed in treatment responses. DESIGN This was a prospective, longitudinal observational study. METHODS This was a secondary analysis of the Optimal Screening for Prediction of Referral and Outcome study. Patients in the development phase completed the Patient Centered Outcome Questionnaire (PCOQ) and questionnaires related to negative mood, fear avoidance, and positive coping, as well as region-specific questionnaires. Patients in the validation cohort completed the PCOQ, measures of treatment satisfaction and region-specific questionnaires at 4 weeks, 6 months, and 1 year. A hierarchical agglomerative cluster analysis identified profiles based on importance outcomes as determined by the PCOQ. Analysis of variance and chi-squared assessed baseline subgroup differences in demographics, psychological factors, and clinical outcomes. Repeated-measure analysis of variance considered subgroup differences in outcomes longitudinally. RESULTS Cluster analysis identified 3 subgroups: (1) "Multiple Outcome Domains Important" subgroup characterized by high importance attached to improvement in all domains, (2) "Pain and Function Outcomes Important" subgroup characterized by high importance attached to improvement in pain and interference, and (3) "Pain Important" subgroup characterized by greatest importance attached to improvement in pain. LIMITATIONS Our sample included patients from outpatient physical therapy and may not be representative of patients in other settings. CONCLUSION Patients can be characterized by the importance attached to improvement in outcome domains. The identified subgroups differed in baseline measures as well as response to treatment.
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Affiliation(s)
- Giorgio Zeppieri Jr
- Department of Rehabilitation, University of Florida Health, 3450 Hull Rd, Gainesville, FL 32610 USA,Address all correspondence to Dr Zeppieri at:
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Khan JS, Shah R, Gilron I. Outcomes in Pain Clinical Research: What Really Matters for Patients? Curr Anesthesiol Rep 2019. [DOI: 10.1007/s40140-019-00361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Goudman L, Bruzzo A, Sande J, Moens M. Goal Identification Before Spinal Cord Stimulation: A Qualitative Exploration in Potential Candidates. Pain Pract 2019; 20:247-254. [DOI: 10.1111/papr.12845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery Universitair Ziekenhuis Brussel Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy Faculty of Physical Education & Physiotherapy Vrije Universiteit Brussel BrusselsBelgium
| | | | | | - Maarten Moens
- Department of Neurosurgery Universitair Ziekenhuis Brussel Brussels Belgium
- Department of Radiology Universitair Ziekenhuis Brussel BrusselsBelgium
- Center for Neurosciences Vrije Universiteit Brussel Brussels Belgium
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Abstract
Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.
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Affiliation(s)
- Jeanette Melin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,RISE, Research Institutes of Sweden, Gothenburg, Sweden
| | - Åsa Nordin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Danielsson
- Angered hospital, Research Unit, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. Br J Sports Med 2019; 53:1424-1431. [PMID: 30808666 DOI: 10.1136/bjsports-2018-100080] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND One model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of a patient-led goal setting approach (intervention) with simple advice to exercise (control) over 12 months. METHODS An assessor-blinded randomised controlled trial. Intervention was education combined with patient-led goal setting compared with a control group receiving a standardised exercise programme. The primary outcomes were back pain disability and pain intensity. Secondary outcomes were quality of life, kinesiophobia, self-efficacy, depression, anxiety and stress. Outcomes and healthcare use were assessed immediately post-treatment (2 months) and after 4 and 12 months. Analysis was by intention to treat. RESULTS Seventy-five patients were randomly assigned to either the intervention (n=37) or the control (n=38) group. Using linear mixed model analyses, adjusted mean changes in primary outcomes of disability and pain intensity were greater in the intervention group than in the control group (disability post-treatment: p<0.05). These differences were clinically meaningful. Mean differences in all secondary measures were greater in the intervention group than in the control group (p<0.05). There was no difference in healthcare use between groups over 12 months. CONCLUSION A patient-led goal setting intervention was significantly more effective than advice to exercise for improving outcomes in disability, pain intensity, quality of life, self-efficacy and kinesiophobia in chronic LBP. These improvements were maintained at 12 months. Smaller effects were seen in measures of depression, anxiety and stress. TRIAL REGISTRATION NUMBER ACTRN12614000830695.
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Affiliation(s)
- Tania Gardner
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Kathryn Refshauge
- Department of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - James McAuley
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research & Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Lorraine Smith
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
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Abstract
Background: Some individuals with chronic pain do not seek care. This decision may be due to characteristics of the individual, pain, and/or their health professional(s). Aims: This study aimed to identify and compare features of individuals with chronic pain, their pain and general health, and their health care professional between community-dwelling adults who did and did not seek care. Methods: Randomly selected adults were mailed a study questionnaire that screened for chronic pain (pain persisting ≥3 months) and asked about their general well-being (Short Form [SF]-36), pain location (body diagram), pain intensity and characteristics (Leeds Assessment of Neuropathic Symptoms and Signs), experiences with health care professionals (Chronic Illness Resources Survey), and visits made to health professionals over the past year. Respondents were categorized as help-seeking (≥1 visit in the past year) and non-help-seeking (zero visits in the past year). Results: Six percent of respondents (44/696) were non-help-seeking. These respondents differed in individual, pain, and health care professional characteristics when compared to those who did seek care. Specifically, when other variables were controlled, non-help-seeking individuals were less likely to be male (relative risk [RR] = 0.39, 95% confidence interval [CI], 0.18-0.86), report comorbid conditions (RR = 0.46, 95% CI, 0.22-0.98), report being treated as an equal partner in decision making (RR = 0.40, 95% CI, 0.18-0.93), and rate their health care professional as important to their pain management (RR = 0.39, 95% CI, 0.18-0.85). They were more likely to use over-the-counter medication to manage their pain (RR = 2.52, 95% CI, 1.14-5.58). Conclusions: Experiences with health professionals play a role in determining whether an individual manages his or her pain independently. Future research should explore the safety of those who do not seek care.
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Affiliation(s)
- Elizabeth G Mann
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth G VanDenKerkhof
- School of Nursing and Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ana Johnson
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Kingston General Hospital, Kingston, Ontario, Canada
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Kulis A, Misiorek A, Marchewka A. The influence of cryotherapy and kinesitherapy on lower back pain reduction and im-provement of quality of life in elderly women. Med Rehabil 2019. [DOI: 10.5604/01.3001.0013.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cryotherapy and kinesitherapy are commonly used methods in treating lower back pain
Aim: The main aim of the study is to compare the effects of whole-body cryotherapy, cryo-therapy combined with kinesitherapy, and kinesitherapy alone on pain and quality of life in older women with spinal arthritis.
Material and methods: The study group comprised 69 women between the age of 65 and 70 who were diagnosed with lumbar spine arthritis and were undergoing physical therapy due to back pain. The women were divided into 3 subgroups which participated in different rehabili-tation protocols (cryotherapy, cryotherapy with kinesitherapy and kinesitherapy alone). Physi-cal therapy lasted for 2 weeks, from Monday to Friday. Quality of life was investigated with the SF-36v2 questionnaire, completed on the first and last day of physical therapy.
Results: The study with the SF-36v2 questionnaire observed statistically significant improve-ment in quality of life among all groups.
Conclusions: Physical activity effectively reduces pain and improves quality of life among women with osteoarthritis, which casts doubt on the viability of using cryotherapy for this purpose.
Article received: 20.05.2018; Accepted: 23.01.2019
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Affiliation(s)
- Aleksandra Kulis
- Katedra Terapii Zajęciowej, Wydział Rehabilitacji Ruchowej, AWF im. Bronisława Czecha w Krakowie / Department of Occupational Therapy, Faculty of Motor Rehabilitation, University of Physical Education, Cracow, Poland
| | - Anna Misiorek
- Katedra Terapii Zajęciowej, Wydział Rehabilitacji Ruchowej, AWF im. Bronisława Czecha w Krakowie / Department of Occupational Therapy, Faculty of Motor Rehabilitation, University of Physical Education, Cracow, Poland
| | - Anna Marchewka
- Katedra Rehabilitacji Klinicznej, Wydział Rehabilitacji Ruchowej, AWF im. Bronisława Czecha w Krakowie / Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Cracow, Poland
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Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-940. [PMID: 31354247 PMCID: PMC6576121 DOI: 10.2147/ppa.s201401] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/13/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives: Hospital-based health technology assessment (HB-HTA) needs to consider all relevant data to help decision making, including patients' preferences. In this study, we comprehensively describe the process of identification, refinement and selection of attributes and levels for a discrete choice experiment (DCE). Methods: A mixed-methods design was used to identify attributes and levels explaining low back pain (LBP) patients' choice for a non-surgical treatment. This design combined a systematic literature review with a patients' focus group, one-on-one interactions with experts and patients, and discussions with stakeholder committee members. Following the patient's focus group, preference exercises were conducted. A consensus about the attributes and levels was researched during discussions with committee members. Results: The literature review yielded 40 attributes to consider in patients' treatment choice. During the focus group, one additional attribute emerged. The preference exercises allowed selecting eight attributes for the DCE. These eight attributes and their levels were discussed and validated by the committee members who helped reframe two levels in one of the attributes and delete one attribute. The final seven attributes were: treatment modality, pain reduction, onset of treatment efficacy, duration of efficacy, difficulty in daily living activities, sleep problem, and knowledge about their body and pain. Conclusion: This study is one of the few to comprehensively describe the selection process of attributes and levels for a DCE. This may help ensure transparency and judge the quality of the decision-making process. In the context of a HB-HTA unit, this strengthens the legitimacy to perform a DCE to better inform decision makers in a patient-centered care approach.
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Affiliation(s)
- Thomas G Poder
- UETMISSS, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- CRCHUS, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Correspondence: Thomas G PoderCRCHUS and UETMISSS, CIUSSS de l’Estrie-CHUS, 1036 Belvédère Sud, SherbrookeJ1H 4C4, CanadaTel + 1 819 346 1110 ext 13496Email
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Abstract
Giving less importance to pain and focusing on achieving objectives in accordance with values can help people to live their lives in spite of the pain. We present a rationale for this orientation and several techniques that can help people achieve this. Specifically, we present the importance of starting the intervention by educating people about pain and setting objectives in line with each person's personal values. After that, we present some techniques that can help people deal with triggers and barriers that can make it difficult to stay on track when it comes to giving less importance to pain and more to achieving objectives.
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Affiliation(s)
- Rubén Nieto
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona 08018, Spain
| | - Beatriz Sora
- Faculty of Psychology & Education Sciences, Universitat Oberta de Catalunya
| | - Gemma Ruiz
- Faculty of Psychology & Education Sciences, Universitat Oberta de Catalunya
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Havas K, Douglas C, Bonner A. Meeting patients where they are: improving outcomes in early chronic kidney disease with tailored self-management support (the CKD-SMS study). BMC Nephrol 2018; 19:279. [PMID: 30342487 PMCID: PMC6195997 DOI: 10.1186/s12882-018-1075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/05/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To achieve optimal health outcomes, people with chronic kidney disease must make changes in their everyday lives to self-manage their condition. This can be challenging, and there is a need for self-management support interventions which assist people to become successful self-managers. While interventions have been developed, the literature in this area is sparse and limited by lack of both individualisation and sound theoretical basis. The aim of this study was to implement and evaluate the Chronic Kidney Disease-Self-Management Support intervention: a theory-based, person-centred self-management intervention for people with chronic kidney disease stages 1-4. METHODS A single-sample, pre-post study of an individualised, 12-week intervention based upon principles of social-cognitive theory and person-centred care was conducted with patients attending outpatient renal clinics in Queensland, Australia (N = 66). Data were collected at T0 (pre-intervention) and T1 (post-intervention). Primary outcomes were self-efficacy and self-management behaviour. RESULTS There were significant, small-to-medium improvements in primary outcomes (self-efficacy: mean difference + 0.8, 95% CI 0.3-1.2, d = 0.4; self-management behaviour: mean difference + 6.2, 95% CI 4.5-7.9, d = 0.8). There were further significant improvements in secondary outcomes (blood pressure, disease-specific knowledge, physical activity, fruit and vegetable consumption, alcohol consumption, health-related quality of life, psychological distress, and communication with healthcare providers), with effect sizes ranging from negligible to large (all ps < .05). CONCLUSIONS Social-cognitive theory shows promise as a framework for providing effective person-centred self-management support to patients within this population, and longer-term evaluation is needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000066280 . Retrospectively registered 17/01/2018.
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Affiliation(s)
- Kathryn Havas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
- Visiting Research Fellow, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia
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Cooke K, Millard SK. The Most Important Therapy Outcomes for School-Aged Children Who Stutter: An Exploratory Study. Am J Speech Lang Pathol 2018; 27:1152-1163. [PMID: 30347060 DOI: 10.1044/2018_ajslp-odc11-17-0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/21/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this article was to identify what school-aged children who stutter consider to be the most important outcomes from therapy. METHOD A Delphi approach was employed for the study. Eighteen participants aged 9-13 years completed a survey, generating 90 statements that would constitute successful therapy outcomes. After categorization and reduction, 79 statements were sent to participants in a second survey to seek consensus on their importance. Fifteen participants aged 8-14 years completed this second survey. Statements with the highest median ratings and smallest standard deviations were retained. RESULTS Twenty-one statements were retained after analysis. These reflected hopes for affective and behavioral change in the young person and in other people after therapy. Important outcomes included, but are not limited to, increased fluency, greater independence, increased confidence at school, others knowing how to support the individual, and communication situations feeling easier. CONCLUSIONS Participants identified a range of outcomes that were important to achieve as a result of speech and language therapy. The findings suggest a need for a more holistic view of what is meant by successful therapy, incorporating improvements in the ability to communicate and participate in daily situations. The findings suggest that an integrated or holistic approach to intervention would be required to achieve these goals and should include significant others from the child's environment. The important statements identified in this study could be used to inform the content of therapy and to evaluate change over time. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.7144205.
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Affiliation(s)
| | - Sharon K Millard
- City University London, United Kingdom
- The Michael Palin Centre for Stammering, London, United Kingdom
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Östhols S, Boström C, Rasmussen-Barr E. Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists. Disabil Rehabil 2018; 41:2459-2467. [DOI: 10.1080/09638288.2018.1467503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Sara Östhols
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Capio St Göran Hospital, Multidisciplinary Pain Unit, Stockholm, Sweden
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Karolinska University Hospital, Department of Allied Health Professionals, Stockholm, Sweden
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
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Makris UE, Higashi RT, Marks EG, Fraenkel L, Gill TM, Friedly JL, Reid MC. Physical, Emotional, and Social Impacts of Restricting Back Pain in Older Adults: A Qualitative Study. Pain Med 2018; 18:1225-1235. [PMID: 27516362 DOI: 10.1093/pm/pnw196] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Back pain is the most common type of pain reported by older adults, yet current management strategies often do not address the multi-dimensional impacts on older adults who face unique challenges as compared with younger populations. The objective of this qualitative study was to assess the physical, psychological, and social impacts of back pain (severe enough to restrict activity, hereafter referred to as restricting back pain) on older adults. Design This was a qualitative study using semi-structured interviews and focus groups. Setting and Patients This study was comprised of a diverse sample of 93 community-living older adults (median age 83) with restricting back pain. Methods We used a semi-structured guide in 23 interviews and 16 focus groups to discuss the various ways that restricting back pain impacted participants. Transcripts were analyzed in an iterative process to develop thematic categories. Results Restricting back pain affected participants physically (inability to execute routine tasks, disruption of sleep and exercise), psychologically (feelings of sadness and irritability, fears about worsening health, loss of hope towards recovery or pain relief), and socially (experiences of isolation, inability to pursue hobbies). Conclusions These data inform which outcomes should be measured in studies evaluating treatments for older adults with restricting back pain.
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Affiliation(s)
- Una E Makris
- Departments of Internal Medicine.,Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Department of Medicine, Division of Rheumatology, VA North Texas Health Care System, Dallas, Texas
| | - Robin T Higashi
- Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Emily G Marks
- Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Liana Fraenkel
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Medicine, VA Connecticut Health Care System, West Haven, Connecticut
| | - Thomas M Gill
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janna L Friedly
- Department of Rehabilitation Medicine.,Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes? Physiother Theory Pract 2018; 34:795-805. [DOI: 10.1080/09593985.2018.1425785] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tania Gardner
- Faculty of Pharmacy, Sydney University, Sydney, Australia
| | | | | | | | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Lorraine Smith
- Faculty of Pharmacy, Sydney University, Sydney, Australia
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