1
|
Greenwell K, Becque T, Sivyer K, Steele M, Denison-Day J, Howells L, Ridd MJ, Roberts A, Lawton S, Langan SM, Hooper J, Wilczynska S, Griffiths G, Sach TH, Little P, Williams HC, Thomas KS, Yardley L, Muller I, Santer M, Stuart B. Online behavioural interventions for children and young people with eczema: a quantitative evaluation. Br J Gen Pract 2024:BJGP.2023.0411. [PMID: 38316467 DOI: 10.3399/bjgp.2023.0411] [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: 08/11/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Two online behavioural interventions (one website for parents/carers of children with eczema; and one for young people with eczema) have been shown in randomised controlled trials to facilitate a sustained improvement in eczema severity. AIM To describe intervention use and examine potential mediators of intervention outcomes and contextual factors that may influence intervention delivery and outcomes. DESIGN AND SETTING Quantitative process evaluation in UK primary care. METHOD Parents/carers and young people were recruited through primary care. Intervention use was recorded and summarised descriptively. Logistic regression explored sociodemographic and other factors associated with intervention engagement. Mediation analysis investigated whether patient enablement (ability to understand and cope with health issues), treatment use, and barriers to adherence were mediators of intervention effect. Subgroup analysis compared intervention effects among pre-specified participant subsets. RESULTS A total of 340 parents/carers and 337 young people were recruited. Most parents/carers (87%, n = 148/171) and young people (91%, n = 153/168) in the intervention group viewed the core introduction by 24 weeks. At 24 weeks, users had spent approximately 20 minutes on average on the interventions. Among parents/carers, greater intervention engagement was associated with higher education levels, uncertainty about carrying out treatments, and doubts about treatment efficacy at baseline. Among young people, higher intervention use was associated with higher baseline eczema severity. Patient enablement (the ability to understand and cope with health issues) accounted for approximately 30% of the intervention effect among parents/carers and 50% among young people. CONCLUSION This study demonstrated that positive intervention outcomes depended on a modest time commitment from users. This provides further support that the wider implementation of Eczema Care Online is justified.
Collapse
Affiliation(s)
- Kate Greenwell
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine; Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Taeko Becque
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Mary Steele
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Laura Howells
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Sandra Lawton
- Queen's Nurse, Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Julie Hooper
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton
| | - Tracey H Sach
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Paul Little
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton; School of Psychological Science, University of Bristol, Bristol
| | - Ingrid Muller
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Miriam Santer
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London
| |
Collapse
|
2
|
Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [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] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
Collapse
Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| |
Collapse
|
3
|
Alzouhayli K, Schilaty ND, Nagai T, Rigamonti L, McPherson AL, Holmes B, Bates NA. The effectiveness of clinic versus home-based, artificial intelligence-guided therapy in patients with low back pain: Non-randomized clinical trial. Clin Biomech (Bristol, Avon) 2023; 109:106069. [PMID: 37717557 DOI: 10.1016/j.clinbiomech.2023.106069] [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: 02/12/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Low back pain is a common cause of disability in the US with increasing financial burden on healthcare. A variety of treatment options exist to combat LBP. Home-based therapy is a low-cost option, but there is a lack of data on how it compares to therapy in clinical settings. It was hypothesized that when using artificial intelligence-guided therapy, supervised in-clinic interventions would have a greater influence on patient-reported outcomes and strength than unsupervised, home interventions. METHODS This is a non-randomized controlled trial of 51 patients (28 female, 23 male). The investigation compared an 8-week, core-focused exercise intervention in a Clinic (supervised) versus Home (unsupervised) setting. Outcome variables included measures of strength, performance, and patient-reported outcomes related to function. Generalized linear regression (p < 0.05) was used to evaluate outcomes were evaluated with respect to sex, intervention setting, and time. FINDINGS Male subjects exhibited greater strength (p ≤ 0.02) but not greater patient-reported outcomes (p ≥ 0.30) than females. The Clinic group exhibited slightly greater lateral pull-down strength (p = 0.002), greater eccentric phase range of motion during overhead press (p < 0.01), and shorter concentric phase duration during bench press (p < 0.01) than the Home group. Significance between groups was not observed in any other strength, performance, or patient-reported outcome (p ≥ 0.11). INTERPRETATION A lack of consistent significance indicated that the hypothesis was not supported. AI-guided, telehealth exercise produced comparable outcomes in both home and clinical settings. Telehealth options may offer a lower-cost alternative to clinic-based exercise therapy for patients with nonspecific lower back pain.
Collapse
Affiliation(s)
- Kenan Alzouhayli
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA
| | - Takashi Nagai
- United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Piertro, Italy
| | - April L McPherson
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Sports Performance and Research Center, Emory University, Atlanta, GA, USA
| | | | - Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Sports Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
4
|
Johnson MB, Cohen RG. Altered coordination strategies during upright stance and gait in teachers of the Alexander Technique. Front Aging 2023; 4:1090087. [PMID: 37214774 PMCID: PMC10192613 DOI: 10.3389/fragi.2023.1090087] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
Deterioration in movement and posture often occurs with aging. Yet there may be approaches to movement training that can maintain posture and movement coordination patterns as we age. The Alexander Technique is a non-exercise-based approach that aims to improve everyday movement and posture by increasing awareness and modulating whole-body postural muscle activity. This study assessed whether nineteen 55-72-year-old Alexander Technique teachers showed different posture and movement coordination patterns than twenty age-matched controls during a standing and walking protocol using 3D inertial sensors. During upright stance, Alexander Technique teachers showed lower centroidal sway frequency at the ankle (p = .04) and lower normalized jerk at the sternum (p = .05) than controls. During gait, Alexander Technique teachers had more symmetrical gait cycles (p = .04), more symmetrical arm swing velocity (p = .01), greater arm swing velocity (p < .01), greater arm swing range of motion (p = .02), and lower range of acceleration of the torso in the frontal plane (p = .03) than controls. Smoother control of upright posture, more stable torso motion, and less restrained arm mobility suggest that Alexander Technique training may counter movement degradation that is found with aging. Results highlight the important balance between mobility and stability within the torso and limbs.
Collapse
Affiliation(s)
- Molly B. Johnson
- Trauma and Injury Research Center, Dell Children’s Medical Center, Austin, TX, United States
- Kinesiology Department, University of the Incarnate Word, San Antonio, TX, United States
| | - Rajal G. Cohen
- Mind in Movement Laboratory, Department of Psychology and Communication, University of Idaho, Moscow, ID, United States
| |
Collapse
|
5
|
Cohen RG, Hocketstaller J. Postural instructions affect postural sway in young adults. Gait Posture 2023; 100:193-5. [PMID: 36584422 DOI: 10.1016/j.gaitpost.2022.12.016] [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: 09/08/2022] [Revised: 11/12/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Instructions to exert effort to correct one's posture are ubiquitous, but previous work indicates that effort-based postural instructions can impair balance control in older adults with and without neurodegenerative disease. Although less-studied, young adults are at high risk of injurious falls. RESEARCH QUESTION How do different postural instructions influence static balance in young adults? METHODS Single-session, counterbalanced, within-subjects design. Twenty young adults briefly practiced three different ways of thinking about their posture, then attempted to employ each way of thinking while standing on springy foam for 30 s with eyes open. Relax instructions were used as a baseline between experimental conditions. Effort-based instructions emulated popular concepts of posture correction using muscular exertion. Light instructions aimed at encouraging length and width while reducing excess tension. Postural sway was assessed with an inertial sensor at the low back. RESULTS Effort-based postural instructions increased path length and jerk of postural sway during quiet stance, relative to Light and Relaxed instructions. SIGNIFICANCE These results are consistent with previous work in older adults indicating that thinking of upright posture as inherently effortful impairs balance. Therefore, the common practice of instructing young adults to use effortful posture may impair their balance performance.
Collapse
|
6
|
Chen PC, Wei L, Huang CY, Chang FH, Lin YN. The Effect of Massage Force on Relieving Nonspecific Low Back Pain: A Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:ijerph192013191. [PMID: 36293771 PMCID: PMC9602448 DOI: 10.3390/ijerph192013191] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effect of force applied during massage on relieving nonspecific low back pain (LBP). METHODS This single-blinded, randomized controlled trial enrolled 56 female patients with nonspecific LBP at a single medical center. For each participant, the therapist performed a 30 min massage session (20 min general massage and 10 min focal massage) using a special instrument with a force sensor inserted, for a total of six sessions in 3 weeks. During the 10 min focal massage, HF and LF groups received high force (HF, ≥2 kg) and low force (LF, ≤1 kg) massage, respectively. The primary outcome was pain intensity (i.e., visual analog scale (VAS), 0-10), and secondary outcomes comprised pain pressure threshold, trunk mobility, LBP-associated disability, and quality of life. RESULTS No significant between-group differences were observed in baseline characteristics. The HF group exhibited significantly lower VAS than did the LF group, with a mean difference of -1.33 points (95% CI: -2.17 to -0.5) at the end of the intervention, but no significant difference was noted at the end of the follow-up. A significant time effect (p < 0.05) was detected in all secondary outcomes except the pain pressure threshold and trunk mobility. A significant time × group interaction (p < 0.05) was found only for the VAS and pain pressure threshold. CONCLUSIONS Compared with LF massage, HF massage exerted superior effects on pain relief in female patients with nonspecific LBP at the end of intervention. Applying different levels of force showed no effects on LBP-associated disabilities and quality of life.
Collapse
Affiliation(s)
- Pei-Chun Chen
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
| | - Li Wei
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 235, Taiwan
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Chung-Yu Huang
- Department of Traditional Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Feng-Hang Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
| |
Collapse
|
7
|
Butler M, D'Angelo S, Kaplan M, Tashnim Z, Miller D, Ahn H, Falzon L, Dominello AJ, Foroughi C, Chandereng T, Cheung K, Davidson K. A Series of Virtual Interventions for Chronic Lower Back Pain: A Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials. Harv Data Sci Rev 2022; 4:10.1162/99608f92.72cd8432. [PMID: 37609556 PMCID: PMC10443938 DOI: 10.1162/99608f92.72cd8432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Chronic lower back pain (CLBP) affects 25% of U.S. adults and is associated with high costs due to physician visits and reduced productivity. Research shows that massage and yoga can be effective nonpharmacological treatments for CLBP, but the feasibility, scalability, individual treatment, and adverse-event heterogeneity of these treatments are unknown. The current study evaluated the feasibility and acceptability of a series of personalized (N-of-1) interventions for virtual delivery of massage and yoga or usual-care treatment for CLBP in 57 participants. We hypothesized that this study would provide valuable information about implementing a virtual, personalized platform for randomized controlled trials of personalized (N-of-1) interventions among individuals with CLBP. The study will do so by determining participants' ratings of usability and satisfaction with the virtual, personalized intervention delivery system and, in the long term, identifying ways to integrate these personalized trials into patient care. Of the 57 participants enrolled, two withdrew from the study and were not eligible to receive the primary outcome assessment. Thirty-seven of the remaining 55 participants (67.3%) completed satisfaction surveys comprising the System Usability Scale (SUS) and items assessing satisfaction with the components of the personalized trial. Participants rated the usability of the personalized trial as excellent (average SUS score = 85.8), 95% were satisfied with the personalized trial overall, and 100% stated they would recommend the trial to others. These results suggest that personalized trials of massage and yoga are highly feasible and acceptable to participants with CLBP.
Collapse
Affiliation(s)
- Mark Butler
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Stefani D'Angelo
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Melissa Kaplan
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Zarrin Tashnim
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Danielle Miller
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Heejoon Ahn
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Louise Falzon
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Andrew J Dominello
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Cirrus Foroughi
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
| | - Thevaa Chandereng
- Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Karina Davidson
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States of America
| |
Collapse
|
8
|
Locher H, Bernardotto M, Beyer L, Acarkan T, Barth F, Borgstrøm H, Bultman H, Buzhov B, Çağlar Okur S, Caporale M, Di Segni F, Faldborg L, Firdin F, Genov D, Goss K, Habring M, Holck P, Jensen N, Jorritsma W, Kamping R, Klimczyk G, Larosa F, Lechner A, Liefring V, Linz W, Martin S, Meissner J, Mengemann H, Nazlıkul H, Satran R, Straiton N, Todorov I, Wittich P, Bernardotto M, Beyer L, Habring M, v. Heymann W, Karadjova M, Locher H, Sotos Borrás MV, Terrier B, Vinzelberg S, Bernardotto M, Beyer L, Habring M, v. Heymann W, Karadjova M, Locher H, Sotos Borrás MV, Terrier B, Vinzelberg S, Karadjova M, Vinzelberg S; ESSOMM Rome Consensus Group, Editorial Commission. ESSOMM European core curriculum and principles of manual medicine: Adopted by the ESSOMM General Assembly on September 18, 2021. Manuelle Medizin 2022; 60:3-40. [DOI: 10.1007/s00337-022-00886-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
9
|
Pocovi NC, de Campos TF, Christine Lin CW, Merom D, Tiedemann A, Hancock MJ. Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:85-99. [PMID: 34783263 DOI: 10.2519/jospt.2022.10612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effectiveness of walking/running, cycling, or swimming for treating or preventing nonspecific low back pain (LBP). DESIGN Intervention systematic review. LITERATURE SEARCH Five databases were searched to April 2021. STUDY SELECTION CRITERIA Randomized controlled trials evaluating walking/running, cycling, or swimming to treat or prevent LBP were included. DATA SYNTHESIS We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS No trials assessed LBP prevention or addressed acute LBP. Nineteen trials (2362 participants) assessed treatment of chronic/recurrent LBP. Low-certainty evidence suggests that walking/running was less effective than alternate interventions in reducing pain in the short term (8 trials; SMD, 0.81; 95% CI: 0.28, 1.34) and medium term (5 trials; SMD, 0.80; 95% CI: 0.10, 1.49). High-certainty evidence suggests that walking/running was less effective than alternate interventions at reducing disability in the short term (8 trials; SMD, 0.22; 95% CI: 0.06, 0.38) and medium term (4 trials; SMD, 0.28; 95% CI: 0.05, 0.51). There was high-certainty evidence of a small effect in favor of walking/running compared to minimal/no intervention for reducing pain in the short term (10 trials; SMD, -0.23; 95% CI: -0.35, -0.10) and medium term (6 trials; SMD, -0.26; 95% CI: -0.40, -0.13) and disability in the short term (7 trials; SMD, -0.19; 95% CI: -0.33, -0.06). Scarcity of trials meant few conclusions could be drawn regarding cycling and swimming. CONCLUSION Although less effective than alternate interventions, walking/running was slightly more effective than minimal/no intervention for treating chronic/recurrent LBP. J Orthop Sports Phys Ther 2022;52(2):85-99. Epub 16 Nov 2021. doi:10.2519/jospt.2022.10612.
Collapse
|
10
|
Wolverson E, Glover L, Clappison D. Self-care for family carers: Can the Alexander Technique help? Complement Ther Clin Pract 2022. [DOI: 10.1016/j.ctcp.2022.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
|
11
|
Little J, Geraghty AWA, Nicholls C, Little P. Findings from the development and implementation of a novel course consisting of both group and individual Alexander Technique lessons for low back pain. BMJ Open 2022; 12:e039399. [PMID: 35058254 PMCID: PMC8783812 DOI: 10.1136/bmjopen-2020-039399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) To develop a mixed course of individual and group lessons in the Alexander Technique (AT) for low back pain, and (2) to explore its: (a) effectiveness and (b) acceptability to both participant AT teachers and patients. DESIGN Single-centre study, mixed methods. SETTING Members of the public in the Brighton area (community recruitment), and patients from six Hampshire General Practices (GP) (National Health Service (NHS) recruitment). PARTICIPANTS People with chronic or recurrent low back pain; AT teachers. INTERVENTIONS Iterative development and implementation of a 10-lesson (6 group, 4 individual) AT course. OUTCOME MEASURES Perceptions from semistructured interviews analysed using inductive thematic analysis. Descriptive analysis of RMDQ (Roland-Morris Disability Questionnaire) over 12 weeks. RESULTS Thirty-nine participants with low back pain were included and 32 AT teachers were interviewed, 7 of whom taught on the course. Some participants had reservations, preferring only individual lessons, but the majority found the sharing of experience and learning in groups helpful. There was also concern regarding group teaching among some AT teachers, but most also found it acceptable. By 12 weeks, RMDQ score among participants fell from 10.38 to 4.39, a change of -5.99. 29 of 39 (74%) participants had a clinically important reduction in RMDQ score of 2.5 or more. CONCLUSION Some patients and practitioners had reservations about group AT lessons, but most found groups helpful. Further development is needed, but the course of individual and group lessons has the potential to cost-effectively deliver clinically important benefits to patients with back pain, who are known to improve little and slowly.
Collapse
Affiliation(s)
- Joseph Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Adam W A Geraghty
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| |
Collapse
|
12
|
Huang Q, Babgi A. Effect of hanna somatic education on low back and neck pain levels. Saudi J Med Med Sci 2022; 10:266-271. [PMID: 36247048 PMCID: PMC9555036 DOI: 10.4103/sjmms.sjmms_580_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/04/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Neck and low back pain are very common worldwide. Hanna somatic education (HSE) is a method of neuromuscular (mind–body) movement retraining that helps in managing pain, but its efficacy has not yet been studied. Objective: To evaluate the clinical effect of HSE on low back and neck pain and determine differences in pain, use of pain medication, and number of doctor visits before and after 6 months of HSE sessions. Methodology: This retrospective study included patients with neck and/or low back pain of >2-month duration who underwent HSE sessions between January 2016 and January 2018 and completed a minimum one follow-up session. Two to five one-to-one sessions of 40–60 min once every 1–2 weeks for 2–8 weeks were provided for each patient. Pain levels were recorded at each visit using the Wong-Baker FACES Pain Rating Scale. Data regarding medication use and number of doctor visits for pain management were also recorded. Results: A total of 103 patients were included, of which 81 (78.6%) were female. Completing a mean 2.8 HSE sessions resulted in a significant pain level reduction. There were significant reductions in the mean low back, neck, and low back + neck pain values between the first and the last visits (P < 0.001). In the 6 months before and after the HSE intervention, the number of patients using pain medication decreased from 53 (53.5%) to 14 (13.6%), respectively, and the mean number of doctor visits reduced significantly from 2 (±1.6) to 0.5 (±1.16) (P < 0.001), respectively. Conclusion: Clinical sessions of HSE were found to significantly reduce chronic spinal pain. Further investigations are recommended regarding evidence-based treatment of HSE in patients with muscles pain.
Collapse
|
13
|
Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
Collapse
Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
14
|
Kinsey D, Glover L, Wadephul F. How does the Alexander Technique lead to psychological and non-physical outcomes? A realist review. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101371] [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: 10/20/2022]
|
15
|
McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J 2021; 21:1286-1296. [PMID: 33676018 DOI: 10.1016/j.spinee.2021.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 02/03/2023]
Abstract
Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process(es), with potential pseudoarticulation or fusion with the sacrum. The Castellvi classification system is commonly utilized to grade LSTVs based on the degree of contact between the L5 transverse process(es) and the sacrum. LSTVs present a diagnostic dilemma to the treating clinician, as they may remain unidentified on plain x-rays and even advanced imaging; additionally, even if the malformation is identified, patients with a LSTV may be asymptomatic or have nonspecific symptoms, such as low back pain with or without radicular symptoms. With low back pain being extremely prevalent in the general population; it can be difficult to implicate the LSTV as the source of this pain. Care should be taken however, to exclude Bertolotti Syndrome in patients under 30 years old presenting with persisting low back pain given its congenital origin. If a LSTV is identified, typically with acquisition of a MRI or CT scan of the lumbosacral spine, and there is an absence of a more compelling or obvious source for the patient's symptoms, a conservative, step-wise management plan is recommended. This may include assessing for improvement in symptoms with injections prior to proceeding with surgical intervention. Additional concerns arise from the biomechanical alterations that a LSTV induces in adjacent spinal levels, predisposing this patient population to a more rapid-onset of adjacent segment disease, raising the question as to the most appropriate surgery (resection of LSTV pseudoarticulation with or without fusion). Postoperative outcome data for patients undergoing surgical treatment is limited in the literature with promising, but variable, results. More large-scale, controlled studies must be performed to gain further insight into the ideal work-up and management of this pathology.
Collapse
Affiliation(s)
- Kyle McGrath
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Eric Schmidt
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Rabah
- Case Western Reserve College of Medicine, Cleveland, OH, USA
| | | | - Michael Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
16
|
Meehan E, Carter B. Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain. Front Psychol 2021; 11:620381. [PMID: 33569028 PMCID: PMC7868595 DOI: 10.3389/fpsyg.2020.620381] [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] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
This article brings together research from the fields of chronic pain management and somatic practices to develop a novel framework of principles to support people living with persistent pain. These include movement-based approaches to awareness of the internal body (interoception), the external environment (exteroception) and movement in space (proprioception). These significantly work with the lived subjective experiences of people living with pain, to become aware of body signals and self-management of symptoms, explore fear and pleasure of movement, and understand how social environments impact on pain. This analysis has potential to create new ways of supporting, understanding and articulating pain experiences, as well as shaping the future of somatic practices for chronic pain.
Collapse
Affiliation(s)
- Emma Meehan
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| |
Collapse
|
17
|
McManus RJ, Little P, Stuart B, Morton K, Raftery J, Kelly J, Bradbury K, Zhang J, Zhu S, Murray E, May CR, Mair FS, Michie S, Smith P, Band R, Ogburn E, Allen J, Rice C, Nuttall J, Williams B, Yardley L. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ 2021; 372:m4858. [PMID: 33468518 PMCID: PMC7814507 DOI: 10.1136/bmj.m4858] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING 76 general practices in the United Kingdom. PARTICIPANTS 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION ISRCTN13790648.
Collapse
Affiliation(s)
- Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Paul Little
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Katherine Morton
- School of Psychology, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | | | - Jin Zhang
- School of Psychology, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health Sciences, University College London, London, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Peter Smith
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Rebecca Band
- School of Psychology, University of Southampton, Southampton, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cathy Rice
- Patient and Public Contributor, Bristol, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Bryan Williams
- Institute of Cardiovascular Sciences, NIHR UCL Hospitals Biomedical Research Centre, University College London, London, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, UK
| |
Collapse
|
18
|
Alhowimel A, Alotiabi M, Coulson N, Radford K. Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia. Pilot Feasibility Stud 2020; 6:188. [PMID: 33292710 PMCID: PMC7702682 DOI: 10.1186/s40814-020-00731-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/12/2022] Open
Abstract
Aim To determine the feasibility of conducting a definitive randomised control trial (RCT) to answer the following questions: (1) Is early physiotherapy treatment acceptable and feasible for patients and direct healthcare providers? and (2) Is early physiotherapy intervention associated with better disability and psychosocial outcomes compared with the practice of routine MRIs? Methods In a feasibility RCT in Riyadh City from 01 March 2018 until 29 July 2018, chronic low back pain (CLBP) patients presenting to spine clinics were randomised to receive an MRI (intervention) plus physiotherapy rehabilitation or physiotherapy alone (control group). The acceptability of randomisation to the control group (non-MRI) was tested during the recruitment by qualitatively interviewing study participants and referring physicians. Moreover, interviews with study participants explored the broader social, political, economic, and environmental (context) aspects that may influence trial delivery and intervention implementation. Results The recruitment target was not met: 16/24 (66%) participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified numerous factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, the lack of research infrastructure to support recruitment to trials, limited research capacity in terms of knowledge and skills of the healthcare team, and limited funding. Conclusion A definitive RCT to test the influence of MRI diagnosis on the psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia is feasible. However, the lack of research infrastructure, research capacity, the impact of MRI on patient outcomes, and a lack of clinical equipoise in the treatment and management of CLBP in Saudi Arabia pose major barriers to clinical trials.
Collapse
Affiliation(s)
- Ahmed Alhowimel
- Physical Therapy and Rehabilitation Science Department, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia.
| | - Mazyad Alotiabi
- Physical Therapy and Rehabilitation Science Department, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia
| | - Neil Coulson
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
19
|
Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
Collapse
Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
20
|
Geraghty AWA, Roberts L, Hill J, Foster NE, Yardley L, Hay E, Stuart B, Turner D, Griffiths G, Webley F, Durcan L, Morgan A, Hughes S, Bathers S, Butler-Walley S, Wathall S, Mansell G, Leigh L, Little P. Supporting self-management of low back pain with an internet intervention in primary care: a protocol for a randomised controlled trial of clinical and cost-effectiveness (SupportBack 2). BMJ Open 2020; 10:e040543. [PMID: 32819960 PMCID: PMC7440707 DOI: 10.1136/bmjopen-2020-040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Self-management and remaining physically active are first-line recommendations for the care of patients with low back pain (LBP). With a lifetime prevalence of up to 85%, novel approaches to support behavioural self-management are needed. Internet interventions may provide accessible support for self-management of LBP in primary care. The aim of this randomised controlled trial is to determine the clinical and cost-effectiveness of the 'SupportBack' internet intervention, with or without physiotherapist telephone support in reducing LBP-related disability in primary care patients. METHODS AND ANALYSIS A three-parallel arm, multicentre randomised controlled trial will compare three arms: (1) usual primary care for LBP; (2) usual primary care for LBP and an internet intervention; (3) usual primary care for LBP and an internet intervention with additional physiotherapist telephone support. Patients with current LBP and no indicators of serious spinal pathology are identified and invited via general practice list searches and mailouts or opportunistic recruitment following LBP consultations. Participants undergo a secondary screen for possible serious spinal pathology and are then asked to complete baseline measures online after which they are randomised to an intervention arm. Follow-ups occur at 6 weeks, 3, 6 and 12 months. The primary outcome is physical function (using the Roland and Morris Disability Questionnaire) over 12 months (repeated measures design). Secondary outcomes include pain intensity, troublesome days in pain over the last month, pain self-efficacy, catastrophising, kinesophobia, health-related quality of life and cost-related measures for a full health economic analysis. A full mixed-methods process evaluation will be conducted. ETHICS AND DISSEMINATION This trial has been approved by a National Health Service Research Ethics Committee (REC Ref: 18/SC/0388). Results will be disseminated through peer-reviewed journals, conferences, communication with practices and patient groups. Patient representatives will support the implementation of our full dissemination strategy. TRIAL REGISTRATION NUMBER ISRCTN14736486.
Collapse
Affiliation(s)
- Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Jonathan Hill
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
- School of Psychological Science, University of Bristol, Bristol, Bristol, UK
| | - Elaine Hay
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - David Turner
- Keele Clinical Trials Unit, School of Primary, Community and Social Care, Keele University, Keele, Newcastle, UK
| | - Gareth Griffiths
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Frances Webley
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Lorraine Durcan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Alannah Morgan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Sarah Bathers
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | | | - Simon Wathall
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Gemma Mansell
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Linda Leigh
- Patient and Public Involvement Representative, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| |
Collapse
|
21
|
Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J 2020; 20:998-1024. [PMID: 32333996 DOI: 10.1016/j.spinee.2020.04.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN This is a guideline summary review. METHODS This guideline is the product of the Low Back Pain Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. RESULTS Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
Collapse
Affiliation(s)
- D Scott Kreiner
- Barrow Neurological Institute, 4530 E. Muirwood Dr. Ste. 110, Phoenix, AZ 85048-7693, USA.
| | - Paul Matz
- Advantage Orthopedics and Neurosurgery, Casper, WY, USA
| | | | - Charles H Cho
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Zoher Ghogawala
- Lahey Hospital and Medical Center, Burlington, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | | | | | - William C Watters
- Institute of Academic Medicine Houston Methodist Hospital, Houston, TX, USA
| | - Thiru M Annaswamy
- VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Randall P Brewer
- River Cities Interventional Pain Specialists, Shreveport, LA, USA
| | | | - David S Cheng
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Park
- University Of Michigan, Ann Arbor, MI, USA
| | | | | | - Ravi Prasad
- University of California, Davis, Sacramento, CA, USA
| | | | - Kris E Radcliff
- Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA
| | | | | | | | | | | | | | | | | | | | - Ryan A Tauzell
- Choice Physical Therapy & Wellness, Christiansburg, VA, USA
| | | | - Yakov Vorobeychik
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Amy M Yahiro
- North American Spine Society, Burr Ridge, IL, USA
| |
Collapse
|
22
|
Kendrick T, Geraghty AWA, Bowers H, Stuart B, Leydon G, May C, Yao G, O'Brien W, Glowacka M, Holley S, Williams S, Zhu S, Dewar-Haggart R, Palmer B, Bell M, Collinson S, Fry I, Lewis G, Griffiths G, Gilbody S, Moncrieff J, Moore M, Macleod U, Little P, Dowrick C. REDUCE (Reviewing long-term antidepressant use by careful monitoring in everyday practice) internet and telephone support to people coming off long-term antidepressants: protocol for a randomised controlled trial. Trials 2020; 21:419. [PMID: 32448374 PMCID: PMC7245840 DOI: 10.1186/s13063-020-04338-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around one in ten adults take antidepressants for depression in England, and their long-term use is increasing. Some need them to prevent relapse, but 30-50% could possibly stop them without relapsing and avoid adverse effects and complications of long-term use. However, stopping is not always easy due to withdrawal symptoms and a fear of relapse of depression. When general practitioners review patients on long-term antidepressants and recommend to those who are suitable to stop the medication, only 6-8% are able to stop. The Reviewing long-term antidepressant use by careful monitoring in everyday practice (REDUCE) research programme aims to identify safe and cost-effective ways of helping patients taking long-term antidepressants taper off treatment when appropriate. METHODS Design: REDUCE is a two-arm, 1:1 parallel group randomised controlled trial, with randomisation clustered by participating family practices. SETTING England and north Wales. POPULATION patients taking antidepressants for longer than 1 year for a first episode of depression or longer than 2 years for repeated episodes of depression who are no longer depressed and want to try to taper off their antidepressant use. INTERVENTION provision of 'ADvisor' internet programmes to general practitioners or nurse practitioners and to patients designed to support antidepressant withdrawal, plus three patient telephone calls from a psychological wellbeing practitioner. The control arm receives usual care. Blinding of patients, practitioners and researchers is not possible in an open pragmatic trial, but statistical and health economic data analysts will remain blind to allocation. OUTCOME MEASURES the primary outcome is self-reported nine-item Patient Health Questionnaire at 6 months for depressive symptoms. SECONDARY OUTCOMES depressive symptoms at other follow-up time points, anxiety, discontinuation of antidepressants, social functioning, wellbeing, enablement, quality of life, satisfaction, and use of health services for costs. SAMPLE SIZE 402 patients (201 intervention and 201 controls) from 134 general practices recruited over 15-18 months, and followed-up at 3, 6, 9 and 12 months. A qualitative process evaluation will be conducted through interviews with 15-20 patients and 15-20 practitioners in each arm to explore why the interventions were effective or not, depending on the results. DISCUSSION Helping patients reduce and stop antidepressants is often challenging for practitioners and time-consuming for very busy primary care practices. If REDUCE provides evidence showing that access to internet and telephone support enables more patients to stop treatment without increasing depression we will try to implement the intervention throughout the National Health Service, publishing practical guidance for professionals and advice for patients to follow, publicised through patient support groups. TRIAL REGISTRATION ISRCTN:12417565. Registered on 7 October 2019.
Collapse
Affiliation(s)
- Tony Kendrick
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK.
| | - Adam W A Geraghty
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Hannah Bowers
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Beth Stuart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Carl May
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - Wendy O'Brien
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Marta Glowacka
- Department for Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Simone Holley
- School of Psychology, Building 44 Highfield Campus, University of Southampton, Southampton, UK
| | - Samantha Williams
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Shihua Zhu
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Rachel Dewar-Haggart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Bryan Palmer
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Margaret Bell
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Sue Collinson
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Imogen Fry
- School of Psychology, Building 44 Highfield Campus, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Joanna Moncrieff
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Michael Moore
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Una Macleod
- Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
| | - Paul Little
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| |
Collapse
|
23
|
Stuart B, Becque T, Moore M, Little P. Clustering of continuous and binary outcomes at the general practice level in individually randomised studies in primary care - a review of 10 years of primary care trials. BMC Med Res Methodol 2020; 20:83. [PMID: 32293280 PMCID: PMC7158044 DOI: 10.1186/s12874-020-00971-7] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In randomised controlled trials, the assumption of independence of individual observations is fundamental to the design, analysis and interpretation of studies. However, in individually randomised trials in primary care, this assumption may be violated because patients are naturally clustered within primary care practices. Ignoring clustering may lead to a loss of power or, in some cases, type I error. METHODS Clustering can be quantified by intra-cluster correlation (ICC), a measure of the similarity between individuals within a cluster with respect to a particular outcome. We reviewed 17 trials undertaken by the Department of Primary Care at the University of Southampton over the last ten years. We calculated the ICC for the primary and secondary outcomes in each trial at the practice level and determined whether ignoring practice-level clustering still gave valid inferences. Where multiple studies collected the same outcome measure, the median ICC was calculated for that outcome. RESULTS The median intra-cluster correlation (ICC) for all outcomes was 0.016, with interquartile range 0.00-0.03. The median ICC for symptom severity was 0.02 (interquartile range (IQR) 0.01 to 0.07) and for reconsultation with new or worsening symptoms was 0.01 (IQR 0.00, 0.07). For HADS anxiety the ICC was 0.04 (IQR 0.02, 0.05) and for HADS depression was 0.02 (IQR 0.00, 0.05). The median ICC for EQ. 5D-3 L was 0.01 (IQR 0.01, 0.04). CONCLUSIONS There is evidence of clustering in individually randomised trials primary care. The non-zero ICC suggests that, depending on study design, clustering may not be ignorable. It is important that this is fully considered at the study design phase.
Collapse
Affiliation(s)
- Beth Stuart
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK.
| | - Taeko Becque
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Michael Moore
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Paul Little
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| |
Collapse
|
24
|
Cohen RG, Baer JL, Ravichandra R, Kral D, McGowan C, Cacciatore TW. Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults. Innov Aging 2020; 4:igz056. [PMID: 32226825 PMCID: PMC7092748 DOI: 10.1093/geroni/igz056] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 02/01/2023] Open
Abstract
Background and Objectives Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson's disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults. Research Design and Methods Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. "Light" instructions relied on principles of reducing excess tension while encouraging length. "Effortful" instructions relied on popular concepts of effortful posture correction. "Relax" instructions encouraged minimization of effort. We measured kinematics and muscle activity. Results During quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles. Discussion and Implications Thinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.
Collapse
Affiliation(s)
- Rajal G Cohen
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho.,Department of Biological Sciences, University of Idaho, Moscow, Idaho
| | - Jason L Baer
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho.,Department of Biological Sciences, University of Idaho, Moscow, Idaho
| | - Ramyaa Ravichandra
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho
| | - Daniel Kral
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho
| | - Craig McGowan
- Department of Biological Sciences, University of Idaho, Moscow, Idaho.,WWAMI Medical Education Program, University of Idaho, Moscow, Idaho
| | - Timothy W Cacciatore
- Sobell Department of Motor Neuroscience, Institute of Neurology, University College London, London, UK
| |
Collapse
|
25
|
Hegmann KT, Travis R, Andersson GB, Belcourt RM, Carragee EJ, Donelson R, Eskay-auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Non-Invasive and Minimally Invasive Management of Low Back Disorders: . J Occup Environ Med 2020; 62:e111-38. [DOI: 10.1097/jom.0000000000001812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
26
|
Davies J. Alexander Technique classes improve pain and performance factors in tertiary music students. J Bodyw Mov Ther 2020; 24:1-7. [PMID: 31987527 DOI: 10.1016/j.jbmt.2019.04.006] [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] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Professional and student instrumental musicians experience high rates of playing-related pain (PR pain) and other playing-related musculoskeletal disorders (PRMDs). This significant occupational health risk signals an urgent need for preventive education at the college level. During tertiary studies however, music students may be more focused on musical skill development than health outcomes. Alexander Technique (AT) is reputed to be beneficial for factors relating to both PR pain and the improvement of performance quality in musicians, therefore AT training for music students could be relevant for prevention. OBJECTIVES To examine the effects of AT classes for tertiary music students on PR pain, associated risk factors for PR pain, and factors associated with improvements in music performance quality. METHODS Responses were collected from 23 volunteer music performance students at an Australian University who undertook weekly AT classes for one semester using a curriculum specifically designed for music students. RESULTS The majority of participants rated AT classes as beneficial for all factors, particularly reduction of PR pain, posture, ability to release excess muscle tension, improvements in instrumental technique, and improvements in performance level. Benefits to practice effectiveness and a reduction in non-playing-related pain, stress levels and performance anxiety were also reported. CONCLUSIONS Purpose-designed AT classes may contribute to the management of PR pain and pertinent risk factors in music students, thus further investigation of the potential role of AT classes in pain prevention programs is warranted. Reports of benefit across a range of performance-related skills strengthen relevance to music practice and performance.
Collapse
Affiliation(s)
- Janet Davies
- Sydney Conservatorium, University of Sydney, Macquarie St, Sydney, NSW, 2000, Australia.
| |
Collapse
|
27
|
Ainsworth B, Greenwell K, Stuart B, Raftery J, Mair F, Bruton A, Yardley L, Thomas M. Feasibility trial of a digital self-management intervention 'My Breathing Matters' to improve asthma-related quality of life for UK primary care patients with asthma. BMJ Open 2019; 9:e032465. [PMID: 31722952 PMCID: PMC6858238 DOI: 10.1136/bmjopen-2019-032465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a randomised controlled trial (RCT) and acceptability of an asthma self-management digital intervention to improve asthma-specific quality of life in comparison with usual care. DESIGN AND SETTING A two-arm feasibility RCT conducted across seven general practices in Wessex, UK. PARTICIPANTS Primary care patients with asthma aged 18 years and over, with impaired asthma-specific quality of life and access to the internet. INTERVENTIONS 'My Breathing Matters' (MBM) is a digital asthma self-management intervention designed using theory, evidence and person-based approaches to provide tailored support for both pharmacological and non-pharmacological management of asthma symptoms. OUTCOMES The primary outcome was the feasibility of the trial design, including recruitment, adherence and retention at follow-up (3 and 12 months). Secondary outcomes were the feasibility and effect sizes of specific trial measures including asthma-specific quality of life and asthma control. RESULTS Primary outcomes: 88 patients were recruited (target 80). At 3-month follow-up, two patients withdrew and six did not complete outcome measures. At 12 months, two withdrew and four did not complete outcome measures. 36/44 patients in the intervention group engaged with MBM (median of 4 logins, range 0-25, IQR 8). Consistent trends were observed to improvements in asthma-related patient-reported outcome measures. CONCLUSIONS This study demonstrated the feasibility and acceptability of a definitive RCT that is required to determine the clinical and cost-effectiveness of a digital asthma self-management intervention. TRIAL REGISTRATION NUMBER ISRCTN15698435.
Collapse
Affiliation(s)
- Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kate Greenwell
- Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Frances Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anne Bruton
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Sciences, University of Bristol, Bristol, UK
| | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
28
|
Kamalikhah T, Rahmati-najarkolaei F, Rouhani-tonekaboni N, Sabzmakan L, Okati-aliabad H, Rezaei Moghadam F. Education of Teachers with Chronic Low Back Pain Based on Integrative Model of Behavioral Prediction. Health Scope 2019; 8. [DOI: 10.5812/jhealthscope.82753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
29
|
Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Schoeb V, Murtagh G. How do physiotherapists solicit and explore patients' concerns in back pain consultations: a conversation analytic approach. Physiother Theory Pract 2019; 37:693-709. [PMID: 31392911 DOI: 10.1080/09593985.2019.1641864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient's perspective as part of the treatment process. 'Agenda setting' has been introduced as the key to understanding patients' concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analyzed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients' concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions, patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
Collapse
Affiliation(s)
- Ian Cowell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alison McGregor
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley Perth, WA, Australia.,Bodylogic Physiotherapy, Shenton Park, Perth, WA, Australia
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Poyton
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Veronika Schoeb
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Ged Murtagh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
30
|
Krusche A, Bradbury K, Corbett T, Barnett J, Stuart B, Yao GL, Bacon R, Böhning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Müller A, Neal RD, Osborne R, Rathod S, Richardson A, Sharman G, Summers K, Watson E, Wilde L, Wilkinson C, Yardley L, Little P. Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors. BMJ Open 2019; 9:e024862. [PMID: 30826763 PMCID: PMC6429898 DOI: 10.1136/bmjopen-2018-024862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management. METHODS AND ANALYSIS A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support. ETHICS AND DISSEMINATION The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN96374224; Pre-results.
Collapse
Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, Southampton, UK
| | | | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Biostatistics Research Group, University of Leicester, Leicester, UK
| | - Roger Bacon
- Patient and Public Involvement team for the CLASP project
| | - Dankmar Böhning
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Diana Eccles
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Andre Müller
- Saw Swee Hock Public School of Health, National University of Singapore, Singapore
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Kevin Summers
- Patient and Public Involvement team for the CLASP project
| | - Eila Watson
- School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Laura Wilde
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| |
Collapse
|
31
|
Gillman T, Schmidtke KA, Manning V, Vlaev I. General Practitioners' recommendations of self-directed-exercises for musculoskeletal problems and perceived barriers and facilitators to doing so: a mixed methods study. BMC Health Serv Res 2018; 18:998. [PMID: 30587183 PMCID: PMC6307153 DOI: 10.1186/s12913-018-3799-x] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal problems substantially impact the demand for and the finances of the United Kingdom's National Health Service. Some of this demand and cost could be alleviated if patients use self-directed-exercises. The present study aims first to establish whether general practitioners already recommend self-directed-exercises and second to describe barriers and facilitators to making such recommendations. METHOD The design of the current study included surveys and interviews. The surveys were designed to draw out participants' tendency to recommend self-directed-exercises and their behavioral drivers to do so. The drivers investigated include 14 domains described by the Theoretical Domains Framework. The surveys were completed online and the responses were analyzed using descriptive reports and regression analyses. The interviews were designed to more fully understand participants' experiences recommending self-directed-exercises according to the same framework. The interviews were audio-taped, transcribed, and thematically analyzed. RESULTS The survey found that the following domains significantly predicted participants' tendency to recommend self-directed-exercises: Environmental contexts and resources, Goals, Intentions, Knowledge, Memory attention and decision processes, and Social/professional role. The interviews brought out four themes that could be leveraged to increase general practitioners' tendency to recommend self-directed-exercises: (1) Practitioners' beliefs about self-directed-exercises being effective, (2) Patients' motivations to engage in self-directed-exercises, (3) Time constraints, and (4) The ease with which practitioners can recommend self-directed-exercises. CONCLUSIONS Most general practitioners already recommend self-directed-exercises, though they note significant barriers that may prevent them from doing so. General practitioners' tendency to recommend self-directed-exercises would be bolstered by creating a respected central resource of exercise pamphlets. These pamphlets should clearly describe how different self-directed-exercises should be performed and evidence supporting their effectiveness.
Collapse
Affiliation(s)
- Toby Gillman
- Centre for Health Policy, Imperial College London, London, UK
| | | | - Victoria Manning
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| |
Collapse
|
32
|
Becker JJ, Copeland SL, Botterbusch EL, Cohen RG. Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain. Complement Ther Med 2018; 39:80-86. [PMID: 30012397 DOI: 10.1016/j.ctim.2018.05.012] [Citation(s) in RCA: 4] [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: 02/02/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To determine feasibility and potential of Alexander technique (AT) group classes for chronic neck pain and to assess changes in self-efficacy, posture, and neck muscle activity as potential mechanisms for pain reduction. DESIGN A single-group, multiple-baseline design, with two pre-tests to control for regression toward the mean, a post-test immediately after the intervention, and another post-test five weeks later to examine retention of benefits. Participants were predominately middle-aged; all had experienced neck pain for at least six months. INTERVENTION Participants attended ten one-hour group classes in AT, an embodied mindful approach that may reduce habitual overactivation of muscles, including superficial neck muscles, over five weeks. OUTCOME MEASURES (1) self-reports: Northwick Park Questionnaire (to assess neck pain and associated disability) and Pain Self-Efficacy Questionnaire; (2) superficial neck flexor activation and fatigue (assessed by electromyography and power spectral analysis) during the cranio-cervical flexion test; (3) posture during a video game task. RESULTS There were no significant changes in outcomes between pre-tests. All participants completed the intervention. After the intervention: (1) participants reported significantly reduced neck pain; (2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; (3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another. CONCLUSIONS Group AT classes may provide a cost-effective approach to reducing neck pain by teaching participants to decrease excessive habitual muscle contraction during everyday activity.
Collapse
Affiliation(s)
- Jordan J Becker
- Department of Psychology & Communication, University of Idaho, USA
| | | | | | - Rajal G Cohen
- Department of Psychology & Communication, University of Idaho, USA.
| |
Collapse
|
33
|
Cramer H, Mehling WE, Saha FJ, Dobos G, Lauche R. Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain. BMC Musculoskelet Disord 2018; 19:109. [PMID: 29625603 PMCID: PMC5889545 DOI: 10.1186/s12891-018-2031-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/08/2017] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background Habitual postural patterns are associated with musculoskeletal pain, and improving a maladaptive posture requires postural awareness in order to lead to clinical improvements. This study aimed to develop and evaluate the psychometric properties of an innovative postural awareness scale. Methods A 12-item Postural Awareness Scale (PAS) was developed and administered to 512 chronic pain patients (50.3 ± 11.4 years, 91.6% female, 37.1% spinal/shoulder pain) to assess its factor structure and reliability. To determine convergent validity, measures of body awareness, body responsiveness, body image, and mindfulness were correlated with the PAS, as were clinical measures of pain intensity, disability, and mental health. Sensitivity to change was assessed in 202 outpatients participating in a 10-week multimodal mind-body program. Results Factor analysis revealed two factors (Ease/Familiarity with Postural Awareness and Need for Attention Regulation with Postural Awareness) that explained 50.8% of the variance. Cronbach’s alpha for the complete scale was 0.80; Spearman-Brown coefficient of split-half reliability was 0.67; and intra-class correlation was ICC2,1 = 0.75 (95% confidence interval = 0.71, 0.78). Significant positive correlations were found for body awareness (r = 0.23), body responsiveness (r = 0.41), body image (r = 0.22–0.32), and mindfulness (r = 0.38); negative correlations for pain intensity (r = − 0.14), disability (r = − 0.12), depression (r = − 0.23), and stress (r = − 0.29). Postural awareness scores increased with a mind-body program (p < 0.001); changes in the PAS were negatively correlated with changes in pain intensity (r = − 0.35) in patients with spinal/shoulder pain. Conclusion Self-reported postural awareness is associated with clinical symptoms in chronic pain patients; improvements in postural awareness are longitudinally associated with reduced pain in patients with spinal/shoulder pain.
Collapse
Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. .,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia.
| | - Wolf E Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Felix J Saha
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia
| |
Collapse
|
34
|
Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complement Ther Clin Pract 2018; 31:308-314. [PMID: 29705473 PMCID: PMC5941320 DOI: 10.1016/j.ctcp.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
Background and purpose A large randomised controlled trial found that the provision of either Alexander Technique lessons or acupuncture, for those with chronic neck pain, resulted in significantly increased self-efficacy when compared with usual care alone. In turn, enhanced self-efficacy was associated with significant reductions in neck pain at 6 and 12 months. In this analysis we explore the perspectives of participants within the trial, with the aim of gaining a better understanding of how these interventions had an impact. Methods We used a longitudinal qualitative approach; in-depth interviews, informed by a topic guide, were conducted with a sample of the trial population. Participants were interviewed twice: at around six months (n = 30) and twelve months (n = 26) after trial entry. Analysis was guided by the principles of grounded theory, and key themes were developed. Results Five key themes emerged: pre-trial experiences of biomedical treatment against which subsequent interventions were compared; emergence of tangible benefits from the interventions; factors that contributed to the observed benefits, notably growing self-care and self-efficacy; a developing sense of embodiment as an integral part of the transformative process; and contribution of these factors to sustaining benefits over the longer term. Conclusions In-depth interviews revealed a rich array of experiences. They gave insight into the positive impact of the interventions on development of self-care, self-efficacy and embodiment. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain.
Collapse
Affiliation(s)
- Aniela Wenham
- Department of Social Policy & Social Work, University of York, York, YO10 5DD, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Julia Woodman
- Department of Health Sciences, University of York, York, YO10 5DD, UK; Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| |
Collapse
|
35
|
Geraghty AWA, Stanford R, Stuart B, Little P, Roberts LC, Foster NE, Hill JC, Hay EM, Turner D, Malakan W, Leigh L, Yardley L. Using an internet intervention to support self-management of low back pain in primary care: findings from a randomised controlled feasibility trial (SupportBack). BMJ Open 2018. [PMID: 29525768 PMCID: PMC5879455 DOI: 10.1136/bmjopen-2017-016768] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine the feasibility of a randomised controlled trial of an internet intervention for low back pain (LBP) using three arms: (1) usual care, (2) usual care plus an internet intervention or (3) usual care plus an internet intervention with additional physiotherapist telephone support. DESIGN AND SETTING A three-armed randomised controlled feasibility trial conducted in 12 general practices in England. PARTICIPANTS Primary care patients aged over 18 years, with current LBP, access to the internet and without indicators of serious spinal pathology or systemic illness. INTERVENTIONS The 'SupportBack' internet intervention delivers a 6-week, tailored programme, focused on graded goal setting, self-monitoring and provision of tailored feedback to encourage physical activity. Additional physiotherapist telephone support consisted of three brief telephone calls over a 4-week period, to address any concerns and provide reassurance. OUTCOMES The primary outcomes were the feasibility of the trial design including recruitment, adherence and retention at follow-up. Secondary descriptive and exploratory analyses were conducted on clinical outcomes including LBP-related disability at 3 months follow-up. RESULTS Primary outcomes: 87 patients with LBP were recruited (target 60-90) over 6 months, and there were 3 withdrawals. Adherence to the intervention was higher in the physiotherapist-supported arm, compared with the stand-alone internet intervention. Trial physiotherapists adhered to the support protocol. Overall follow-up rate on key clinical outcomes at 3 months follow-up was 84%. CONCLUSIONS This study demonstrated the feasibility of a future definitive randomised controlled trial to determine the clinical and cost-effectiveness of the SupportBack intervention in primary care patients with LBP. TRIAL REGISTRATION NUMBER ISRCTN31034004; Results.
Collapse
Affiliation(s)
- Adam W A Geraghty
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rosie Stanford
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Lisa C Roberts
- Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nadine E Foster
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jonathan C Hill
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine M Hay
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Wansida Malakan
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Linda Leigh
- Patient and Public Involvement Representative, Southampton, UK
| | - Lucy Yardley
- School of Experimental Psychology, University of Bristol, Bristol, UK
- Department of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
36
|
Little P, Stuart B, Hobbs FR, Kelly J, Smith ER, Bradbury KJ, Hughes S, Smith PW, Moore MV, Lean ME, Margetts BM, Byrne CD, Griffin S, Davoudianfar M, Hooper J, Yao G, Zhu S, Raftery J, Yardley L. Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). Health Technol Assess 2018; 21:1-62. [PMID: 28122658 DOI: 10.3310/hta21040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice. DESIGN Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews. SETTING Primary care general practices in the UK. PARTICIPANTS Patients with a body mass index of ≥ 30 kg/m2 (or ≥ 28 kg/m2 with risk factors) identified from general practice records, recruited by postal invitation. INTERVENTIONS Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls). MAIN OUTCOME MEASURES The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months. RESULTS A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI -£129 to £195) for POWeR+F and -£25 (95% CI -£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+. STUDY LIMITATIONS Maintenance of weight loss after 1 year is unknown. FUTURE WORK Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity. CONCLUSION Clinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective. TRIAL REGISTRATION Current Controlled Trials ISRCTN21244703. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Paul Little
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emily R Smith
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Katherine J Bradbury
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Wf Smith
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike Ej Lean
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barrie M Margetts
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christopher D Byrne
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Simon Griffin
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Mina Davoudianfar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Hooper
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
37
|
Kabir RS, Haramaki Y, Ki H, Ohno H. Self-Active Relaxation Therapy (SART) and Self-Regulation: A Comprehensive Review and Comparison of the Japanese Body Movement Approach. Front Hum Neurosci 2018; 12:21. [PMID: 29472851 PMCID: PMC5809433 DOI: 10.3389/fnhum.2018.00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 06/30/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Relaxation programs are known for their versatility, cost-effectiveness, and ability to help people obtain skills to regulate their mental states and promote and maintain health. Self-Active Relaxation Therapy (SART) is a body-oriented approach to psychological rehabilitation that grew out of the suite of movement tasks developed in the Japanese psychotherapy known as Dohsa-hou, or the body movement method. The program for SART is designed to stretch, twist, and release areas of the upper, lower, and whole body through a set of movements which are guided by the practitioner and performed "self-actively" by the client to empower them to learn to recognize points of tension in the body and act on their own to achieve a relaxed state. Numerous studies have showed that SART is associated with reduced negative mood states and enhanced body awareness. A short version of SART has been investigated as a psychological support salon activity for the elderly, mothers raising children, special needs students, and children adapting to school. The full program has also been applied in clinical settings to address or supplement treatments for psychological and developmental conditions, and longitudinally employed in community contexts to assist residents facing long-term disaster recovery circumstances in Japan. This paper reviews the research and applications of SART as a bodymind approach by critically examining evidence and research gaps for future studies, comparing it with techniques established in the literature, and positing a self-regulatory framework for SART as a tool to become aware of bodily states, regulate mood, and manage stress through the deliberate practice of relaxation.
Collapse
Affiliation(s)
- Russell S Kabir
- Graduate School of Education, Hiroshima University, Higashihiroshima, Japan
| | - Yutaka Haramaki
- Department of Clinical Psychology, Hiroshima University, Higashihiroshima, Japan
| | - Hyeyoung Ki
- Department of Psychology, Fukuoka Jo Gakuin University, Fukuoka, Japan
| | - Hiroyuki Ohno
- Department of Clinical Psychology, Fukuoka Jo Gakuin University, Fukuoka, Japan
| |
Collapse
|
38
|
Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. Eur J Integr Med 2018. [PMID: 29527245 PMCID: PMC5842361 DOI: 10.1016/j.eujim.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/23/2023]
Abstract
Introduction ATLAS was a pragmatic randomised (1:1:1 ratio), controlled trial recruiting patients with chronic neck pain (N = 517) and evaluating one-to-one Alexander Technique lessons, or acupuncture, each plus usual care, compared with usual care alone. The primary outcome (12-month Northwick Park Neck Pain Questionnaire [NPQ]) demonstrated significant and clinically meaningful reductions in neck pain and associated disability for both interventions compared with usual care alone. Here we describe pre-specified, self-efficacy and other self-care-related outcomes for the Alexander group compared with usual care. Methods Participants reported on 11 self-efficacy/self-care-related outcome measures at 6 and 12 months. Linear or logistic regression models evaluated changes in parameters and impact on NPQ. Alexander teachers reported on lesson content. Results Lesson content reflected standard UK practice. The Alexander group (n = 172) reported significantly greater improvements, compared with usual care alone (n = 172), in most of the self-efficacy/self-care measures (9/11 measures at 6 months, and 8/11 at 12 months), including the ability to reduce pain in daily life. At 6 months, 81% (106/131) of Alexander participants reported significant improvement in the way they lived and cared for themselves (versus 23% for usual care), increasing to 87% (117/135) at 12 months (usual care: 25%). NPQ scores at both 6 and 12 months were related to improvement in self-efficacy and ability to reduce pain during daily life. Conclusions Alexander Technique lessons led to long-term improvements in the way participants lived their daily lives and managed their neck pain. Alexander lessons promote self-efficacy and self-care, with consequent reductions in chronic neck pain.
Collapse
Affiliation(s)
- Julia Woodman
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK.,Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| |
Collapse
|
39
|
Essex H, Parrott S, Atkin K, Ballard K, Bland M, Eldred J, Hewitt C, Hopton A, Keding A, Lansdown H, Richmond S, Tilbrook H, Torgerson D, Watt I, Wenham A, Woodman J, MacPherson H. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PLoS One 2017; 12:e0178918. [PMID: 29211741 PMCID: PMC5718562 DOI: 10.1371/journal.pone.0178918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 05/19/2017] [Indexed: 02/01/2023] Open
Abstract
Objectives To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. Methods An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure–the Northwick Park Neck Pain Questionnaire (NPQ). Results In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. Conclusions In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.
Collapse
Affiliation(s)
- Holly Essex
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, York, United Kingdom
| | - Janet Eldred
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ann Hopton
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ada Keding
- Department of Health Sciences, University of York, York, United Kingdom
| | - Harriet Lansdown
- Department of Health Sciences, University of York, York, United Kingdom
- British Acupuncture Council, London, United Kingdom
| | - Stewart Richmond
- Sydera Research Associates, Market Weighton, York, United Kingdom
| | - Helen Tilbrook
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Torgerson
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ian Watt
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Aniela Wenham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Julia Woodman
- Department of Health Sciences, University of York, York, United Kingdom
- Society of Teachers of the Alexander Technique, London, United Kingdom
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, United Kingdom
| |
Collapse
|
40
|
Tator CF, Truluck C. Musculoskeletal Pain Relief in Sonographers: A Systematic Review of the Effects of Therapeutic Techniques. Journal of Diagnostic Medical Sonography 2017. [DOI: 10.1177/8756479317721673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Musculoskeletal pain and resulting injury is a growing concern for sonographers. Statistics substantiate the rising trend of sonographers in pain, but prevention methods are not currently established as part of the education process or in the clinical environment. A systematic review of the literature was performed to determine whether sonographers taught to use proper body mechanics, stretching, and/or therapeutic techniques experience less pain. The results suggest that education workshops and stretching techniques have the potential to benefit sonographers. Sonographers who incorporate stretching into the work day may experience a reduction in pain. Education workshops may improve the long-term outcomes for sonographers. Additional research is necessary to determine the outcomes of the various therapeutic methods. Those methods that are proven valuable should be adopted into the sonography profession by educators and clinical sites. Managers, supervisors, physicians, and sonographers should be provided information regarding research outcomes in order to advocate for evidence-based practice changes.
Collapse
Affiliation(s)
- Cherie F. Tator
- Imaging Department, Endless Mountains Health Systems, Montrose, PA, USA
| | - Christina Truluck
- Department of Radiologic Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
41
|
Abstract
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
Collapse
Affiliation(s)
- Chris Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Melbourne, VIC, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
42
|
Kamalikhah T, Morowatisharifabad MA, Rezaei-Moghaddam F, Ghasemi M, Gholami-Fesharaki M, Goklani S. Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain. Iran Red Crescent Med J 2017; 18:e31218. [PMID: 28144457 PMCID: PMC5253206 DOI: 10.5812/ircmj.31218] [Citation(s) in RCA: 5] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/15/2015] [Accepted: 07/29/2015] [Indexed: 12/02/2022]
Abstract
Background Individuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions. Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP. Objectives The present study applied an integrative model (IM) of behavioral prediction for improvement of AT training. Methods This was a quasi-experimental study of female teachers with nonspecific LBP in southern Tehran in 2014. Group A contained 42 subjects and group B had 35 subjects. In group A, AT lessons were designed based on IM constructs, while in group B, AT lessons only were taught. The validity and reliability of the AT questionnaire were confirmed using content validity (CVR 0.91, CVI 0.96) and Cronbach’s α (0.80). The IM constructs of both groups were measured after the completion of training. Statistical analysis used independent and paired samples t-tests and the univariate generalized linear model (GLM). Results Significant differences were recorded before and after intervention (P < 0.001) for the model constructs of intention, perceived risk, direct attitude, behavioral beliefs, and knowledge in both groups. Direct attitude and behavioral beliefs in group A were higher than in group B after the intervention (P < 0.03). Conclusions The educational framework provided by IM for AT training improved attitude and behavioral beliefs that can facilitate the adoption of AT behavior and decreased CLBP.
Collapse
Affiliation(s)
- Tahereh Kamalikhah
- Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | | | - Farid Rezaei-Moghaddam
- Physical Medicine and Rehabilitation, Army University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Ghasemi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Salma Goklani
- Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
43
|
Little P, Stuart B, Hobbs FR, Kelly J, Smith ER, Bradbury KJ, Hughes S, Smith PWF, Moore MV, Lean MEJ, Margetts BM, Byrne CD, Griffin S, Davoudianfar M, Hooper J, Yao G, Zhu S, Raftery J, Yardley L. An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4:821-8. [PMID: 27474214 DOI: 10.1016/s2213-8587(16)30099-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care. METHODS We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m(2) or more (or ≥28 kg/m(2) with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+-a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703. FINDINGS Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6-2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34-2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96-2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31-2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI -129 to 195) for POWeR+F and -£25 (-268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported. INTERPRETATION Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year. FUNDING Health Technology Assessment Programme of the National Institute for Health Research.
Collapse
Affiliation(s)
- Paul Little
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Beth Stuart
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emily R Smith
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Katherine J Bradbury
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter W F Smith
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike E J Lean
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barrie M Margetts
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chris D Byrne
- Southampton National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Simon Griffin
- Cambridge Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mina Davoudianfar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Hooper
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
44
|
Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). Programme Grants Appl Res 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
45
|
Preece SJ, Jones RK, Brown CA, Cacciatore TW, Jones AK. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 2016; 17:372. [PMID: 27568007 DOI: 10.1186/s12891-016-1209-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022] Open
Abstract
Background Both increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action. Methods A cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects. Results Following AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait. Conclusions This is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening. Trial registration ISRCTN74086288, 4th January 2016, retrospectively registered.
Collapse
|
46
|
Abstract
The present paper discusses attentional focus in motor learning and performance from the point of view of mindful movement practices, taking as a starting point the Feldenkrais method. It is argued that earlier criticism of the Feldenkrais method (and thereby implicitly of mindful movement practices more generally) because of allegedly inappropriate attentional focus turns out to be unfounded in light of recent developments in the study of motor learning and performance. Conversely, the examples of the Feldenkrais method and Ki-Aikido are used to illustrate how both Western and Eastern (martial arts derived) mindful movement practices might benefit sports psychology.
Collapse
|
47
|
Patel S, Hee SW, Mistry D, Jordan J, Brown S, Dritsaki M, Ellard DR, Friede T, Lamb SE, Lord J, Madan J, Morris T, Stallard N, Tysall C, Willis A, Underwood M. Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials. Programme Grants Appl Res 2016. [DOI: 10.3310/pgfar04100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThere is good evidence that therapist-delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority.Aim and objectivesTo improve the clinical effectiveness and cost-effectiveness of LBP treatment by providing patients, their clinical advisors and health-service purchasers with better information about which participants are most likely to benefit from which treatment choices. Our objectives were to synthesise what is already known about the validity, reliability and predictive value of possible treatment moderators (patient factors that predict response to treatment) for therapist-delivered interventions; develop a repository of individual participant data from randomised controlled trials (RCTs) testing therapist-delivered interventions for LBP; determine which participant characteristics, if any, predict clinical response to different treatments for LBP; and determine which participant characteristics, if any, predict the most cost-effective treatments for LBP. Achieving these objectives required substantial methodological work, including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse the main effect of interventions and no such interpretations should be made.MethodsFirst, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with > 179 participants to share their data with us; some further smaller trials that were offered to us were also included. Using these trials we developed a repository of individual participant data of therapist-delivered interventions for LBP. Using this data set we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical effectiveness and cost-effectiveness outcomes. We undertook an analysis of covariance to identify potential moderators to apply in our main analyses. Subsequently, we developed and applied three methods of subgroup identification: recursive partitioning (interaction trees and subgroup identification based on a differential effect search); adaptive risk group refinement; and an individual participant data indirect network meta-analysis (NWMA) to identify subgroups defined by multiple parameters.ResultsWe included data from 19 RCTs with 9328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of subgroup identification that we identified. Additionally, we explored the application of Bayesian indirect NWMA. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile.ConclusionsThese data lack clinical effectiveness or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas. The pooled repository database will serve as a valuable resource to the LBP research community.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands (AWM) and the Wolfson Foundation.
Collapse
Affiliation(s)
- Shilpa Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Jordan
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Surrey Health Economic Centre, School of Economics, University of Surrey, Guildford, UK
| | - Sally Brown
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David R Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah E Lamb
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joanne Lord
- Brunel University, Health Economics Research Group, Uxbridge, UK
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Colin Tysall
- Universities/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Adrian Willis
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | |
Collapse
|
48
|
Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Med 2016; 17:1353-1375. [PMID: 27165971 PMCID: PMC4925170 DOI: 10.1093/pm/pnw099] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. RESULTS Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14). CONCLUSION Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
Collapse
|
49
|
Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL. “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil 2016; 39:779-790. [DOI: 10.3109/09638288.2016.1161844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chinonso N. Igwesi-Chidobe
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria
| | - Sheila Kitchen
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Isaac O. Sorinola
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Emma L. Godfrey
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| |
Collapse
|
50
|
Lauche R, Schuth M, Schwickert M, Lüdtke R, Musial F, Michalsen A, Dobos G, Choi KE. Efficacy of the Alexander Technique in treating chronic non-specific neck pain: a randomized controlled trial. Clin Rehabil 2016; 30:247-258. [DOI: 10.1177/0269215515578699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective: To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain. Design: A randomized controlled trial with 3 parallel groups was conducted. Setting: Outpatient clinic, Department of Internal and Integrative Medicine. Subjects: A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain. Interventions: Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each. Main measures: The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety. Statistics: Analyses of covariance were applied; testing ordered hypotheses. Results: No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life ( P<0.05). Adverse events mainly included slightly increased pain and muscle soreness. Conclusion: The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.
Collapse
Affiliation(s)
- Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia
| | - Mareike Schuth
- Department of Anesthesiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Myriam Schwickert
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Germany
| | - Rainer Lüdtke
- Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Frauke Musial
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, Uit The Arctic University of Norway, Tromsö Norway
| | - Andreas Michalsen
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Kyung-Eun Choi
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|