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Versloot AHC, Jackson JA, van Rijn RM, Elbers RG, Søgaard K, Macri EM, Koes B, Burdorf A, Chiarotto A, Gerger H. Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update. Appl Ergon 2024; 118:104277. [PMID: 38579494 DOI: 10.1016/j.apergo.2024.104277] [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] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/23/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.
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Affiliation(s)
- Annelotte H C Versloot
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Pychology, University of Gävle, Gävle, Sweden
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands; PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Karen Søgaard
- Research Unit of General Practice, Department of Public Health & the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark; Dep of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Research Unit of General Practice, Department of Public Health & the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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Fu Y, Madsen SD, Shaheed CA, de Zoete A, Chiarotto A, Koes B. Moderators of treatment effect of non-steroidal anti-inflammatory drugs for patients with (sub) acute low back pain: Protocol for a systematic review with individual participant data meta-analysis. MethodsX 2024; 12:102713. [PMID: 38660043 PMCID: PMC11041908 DOI: 10.1016/j.mex.2024.102713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
A Cochrane review found that non-steroidal anti-inflammatory drugs (NSAIDs) are slightly more effective than placebo on acute and subacute low back pain (LBP) outcomes (pain intensity, disability, and global improvement). Our objectives are: (1) to assess the overall treatment effect of NSAIDs in adults with acute and subacute LBP; (2) to identify the moderation of baseline patients' characteristics on treatment effect. We will conduct a systematic search of RCTs on effectiveness of NSAIDs compared with placebo in adults with non-chronic LBP in Medline ALL, Embase, Cochrane Central Register of Controlled Trials*. We will screen the records after January 2020, and include eligible RCTs before January 2020 screened by the Cochrane review mentioned above. Our primary outcomes are pain intensity, disability, and health-related quality of life, secondary outcomes are adverse events. Our IPD dataset will consist of the information on each eligible trial characteristics and included variables according to a predefined coding scheme. We will assess risk-of-bias of included RCTs with the Cochrane Risk Of Bias (RoB)-2 assessment tool. We will perform power calculations with closed-form solutions and prioritize a one-stage approach for IPD-MA. For reporting the results, we will adhere to the PRISMA-IPD statement.
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Affiliation(s)
- Yanyan Fu
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Simon Dyrløv Madsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Campusvej 55 5230, Odense, Denmark
| | - Christina Abdel Shaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Research Unit of General Practice, Department of Public Health & Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Gerger H, Macri EM, Jackson JA, Elbers RG, van Rijn R, Søgaard K, Burdorf A, Koes B, Chiarotto A. Physical and psychosocial work-related exposures and the incidence of carpal tunnel syndrome: A systematic review of prospective studies. Appl Ergon 2024; 117:104211. [PMID: 38199092 DOI: 10.1016/j.apergo.2023.104211] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.
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Affiliation(s)
- Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Rogier van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands; Performing Artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Karen Søgaard
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark; Dep of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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Fu Y, Feller D, Koes B, Chiarotto A. Prognostic Models for Chronic Low Back Pain Outcomes in Primary Care Are at High Risk of Bias and Lack Validation-High-Quality Studies Are Needed: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 38356405 DOI: 10.2519/jospt.2024.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE: To provide an updated overview of available prognostic models for people with chronic low back pain (LBP) in primary care. DESIGN: Prognosis systematic review LITERATURE SEARCH: We searched for relevant studies on MEDLINE, Embase, Web of Science, and CINAHL databases (up to July 13, 2022), and performed citation tracking in Web of Science. STUDY SELECTION CRITERIA: We included observational (cohort or nested case-control) studies and randomized controlled trials that developed or validated prognostic models for adults with chronic LBP in primary care. The outcomes of interest were physical functioning, pain intensity, and health-related quality of life at any follow-up time-point. DATA SYNTHESIS: Data were extracted using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and the Prediction model Risk of Bias Assessment Tool (PROBAST) tool was used to evaluate the risk of bias of the models. Due to the number of studies retrieved and the heterogeneity, we reported the results descriptively. RESULTS: Ten studies (out of 5593 hits screened) with 34 models met our inclusion criteria, of which six are development studies and four are external validation studies. Five studies reported the area under the curve of the models (ranging from 0.48 to 0.84), whereas no study reported calibration indices. The most promising model is the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form. CONCLUSIONS: Given the high risk of bias and lack of external validation, we cannot recommend that clinicians use prognostic models for patients with chronic LBP in primary care settings. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 15 February 2024. doi:10.2519/jospt.2024.12081.
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Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Rose JM, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study. J Orthop Sports Phys Ther 2024:1-26. [PMID: 38630543 DOI: 10.2519/jospt.2024.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
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Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location Vrije Universiteit, Amsterdam Movement Sciences, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam A Williams
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - John M Rose
- Neil Smith Research Chair in Sustainable Transport Futures, Institute of Transport and Logistics Studies, The University of Sydney Business School, Sydney, New South Wales, 2006, Australia
| | - Jack J Devonshire
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Esposto M, Pellicciari L, Cecchetto S, Chiarotto A, Testa M, Turolla A, Polli A. Italian versions of the Neurophysiology of Pain Questionnaire (NPQ): psychometric properties and an investigation on the understanding of pain neurophysiology in physical therapists. Musculoskelet Sci Pract 2024; 72:102957. [PMID: 38642475 DOI: 10.1016/j.msksp.2024.102957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/29/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES The Neurophysiology of Pain Questionnaire (NPQ) is widely used to assess pain knowledge among clinicians and patients with pain, but an Italian version is not available. This study aimed to translate and cross-culturally adapt the NPQ into Italian, to test its psychometric properties, to assess the knowledge of Italian physical therapists (PTs) on pain, and to evaluate which characteristics are associated with pain knowledge. METHODS The NPQ was translated into Italian, integrated with some additional questions (IT-NPQ-New), and sent by email via the Italian Association of Physiotherapy newsletter. Rasch analysis (RA) was used to test the psychometric properties of the Italian versions. Multivariable regression analyses were used to check for associations between participants' characteristics and their NPQ scores. RESULTS A sample of 753 PTs completed the survey. RA of the NPQ-19 and IT-NPQ-New revealed that 10 (IT-NPQ-10) and 18 (IT-NPQ-18) items fit the model. Both questionnaires showed good psychometric properties. The overall median score among Italian PTs was 6.0 [5.0-7.0] and 11.0 [9.0-13.0] points for the IT-NPQ-10 and the IT-NPQ-18, respectively. These scores were statistically different among groups according to gender, age, years of professional activity, post-graduate specialization and days attended of targeted pain courses, with the latter being the most influential variable. CONCLUSIONS Italian PTs now dispose of two tools to assess their basic knowledge related to pain science. Our study also showed that pain knowledge among Italian PTs needs improvement, especially considering recent biopsychosocial approaches to pain.
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Affiliation(s)
- Massimo Esposto
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, C/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | | | - Simone Cecchetto
- Health Professional and Rehabilitation Service APSS Trento, Trento, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Polli
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Vrije Universiteit Brussel (VUB), Centre for Environment & Health, Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Research Foundation - Flanders (FWO), Belgium
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Khorami AK, Chiarotto A, de Schepper EIT, Bindels PJE, Koes BW, van den Driest JJ. The prevalence, incidence and management of low back pain with radiating leg pain in Dutch general practice: A population-based cohort study in the Rijnmond Primary Care Database. Eur J Pain 2024. [PMID: 38572961 DOI: 10.1002/ejp.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Radiating leg pain is common in patients with low back pain (LBP). In this study, we aimed to determine the prevalence and incidence of LBP with radiating leg pain in Dutch general practice, and to describe the prescribed medications and requested imaging diagnostics. METHODS The Rijnmond Primary Care Database containing over 500,000 primary care patients was used to select patients ≥18 years with LBP with radiating leg pain between 2013 and 2021. Data on patient characteristics, LBP episodes, prescribed medication and requested imaging in the first 3 months of an episode was extracted. Descriptive statistics were used to present patient characteristics and diagnostic/therapeutic interventions. RESULTS A total of 27,695 patients were included. The total number of LBP with radiating leg pain episodes in these patients was 36,268. In 2021, the incidence and prevalence were 19.1 and 25.7 per 1000 patient years, respectively. In 60% of patients, the episode duration was shorter than 1 month. In 62% of the episodes, patients visited the general practitioner (GP) one to two times. In 59% of the episodes, at least one medication was prescribed, non-steroidal anti-inflammatory drugs (NSAIDs) being the most common one (45%). In approximately 11% of the episodes, additional diagnostic imaging was requested. CONCLUSION LBP with radiating leg pain is common in Dutch general practice patients. About 2/3rd were prescribed pain medications. Dutch request few to none diagnostic imaging for these patients which is in line with clinical practice guidelines. SIGNIFICANCE In this new study, we have gained insights into the incidence and prevalence of LBP with radiating leg pain in Dutch general practice. Both remained fairly stable over the study period of 9 years (2013-2021). Overall, the care burden regarding seeking contact with the GPs and the requested diagnostics seem not to be that high. In 62% of the care episodes, there were one or two consultations with the GP, and in 11% of the episodes a diagnostic imaging was requested. Pain medications frequently prescribed (i.e. 2/3rd of the episodes), with NSAIDs being the most common ones.
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Affiliation(s)
- Ahmad Khoshal Khorami
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Research Unit of General practice, Departement of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jacoline J van den Driest
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van der Veer SN, Ali SM, Yu Z, McBeth J, Chiarotto A, James B, Dixon WG. Reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting. Pain Rep 2024; 9:e1131. [PMID: 38375091 PMCID: PMC10876220 DOI: 10.1097/pr9.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Many people worldwide suffer from chronic pain. Improving our knowledge on chronic pain prevalence and management requires methods to collect pain self-reports in large populations. Smartphone-based tools could aid data collection by allowing people to use their own device, but the measurement properties of such tools are largely unknown. Objectives To assess the reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting. Methods We recruited people with fibromyalgia, rheumatoid arthritis, and/or osteoarthritis and access to a smartphone and the internet. Data collection included the Global Pain Scale at baseline and follow-up, and 30 daily pain drawings completed on a 2-dimensional, gender-neutral manikin. After deriving participants' pain extent from their manikin drawings, we evaluated convergent and discriminative validity, test-retest reliability, and responsiveness and assessed findings against internationally agreed criteria for good measurement properties. Results We recruited 131 people; 104 were included in the full sample, submitting 2185 unique pain drawings. Manikin-derived pain extent had excellent test-retest reliability (intraclass correlation coefficient, 0.94), moderate convergent validity (ρ, 0.46), and an ability to distinguish fibromyalgia and osteoarthritis from rheumatoid arthritis (F statistics, 30.41 and 14.36, respectively; P < 0.001). Responsiveness was poor (ρ, 0.2; P, 0.06) and did not meet the respective criterion for good measurement properties. Conclusion Our findings suggest that smartphone-based manikins can be a reliable and valid method for pain self-reporting, but that further research is warranted to explore, enhance, and confirm the ability of such manikins to detect a change in pain over time.
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Affiliation(s)
- Sabine N. van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - S. Mustafa Ali
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Ziqiao Yu
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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de Oliveira Grigorini AE, Pereira LSM, Koes B, da Silva SLA, Chiarotto A, Felício DC, Leopoldino AAO. Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium. BMC Geriatr 2024; 24:230. [PMID: 38443807 PMCID: PMC10916242 DOI: 10.1186/s12877-024-04803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations. METHODS Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person's country of residence influenced this relationship. RESULTS The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. CONCLUSION Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.
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Affiliation(s)
- Adriana Estela de Oliveira Grigorini
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diogo Carvalho Felício
- Department of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Amanda Aparecida Oliveira Leopoldino
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil.
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Nijs J, Kosek E, Chiarotto A, Cook C, Danneels LA, Fernández-de-Las-Peñas C, Hodges PW, Koes B, Louw A, Ostelo R, Scholten-Peeters GGM, Sterling M, Alkassabi O, Alsobayel H, Beales D, Bilika P, Clark JR, De Baets L, Demoulin C, de Zoete RMJ, Elma Ö, Gutke A, Hanafi R, Hotz Boendermaker S, Huysmans E, Kapreli E, Lundberg M, Malfliet A, Meziat Filho N, Reis FJJ, Voogt L, Zimney K, Smeets R, Morlion B, de Vlam K, George SZ. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. Lancet Rheumatol 2024; 6:e178-e188. [PMID: 38310923 DOI: 10.1016/s2665-9913(23)00324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 02/06/2024]
Abstract
The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alessandro Chiarotto
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Lieven A Danneels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Bart Koes
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Research Unit of General Practice, Department of Public Health and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Adriaan Louw
- Department of Pain Science, Evidence in Motion, Story City, IA, USA
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Michele Sterling
- RECOVER Injury Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Othman Alkassabi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physiotrio, Riyadh, Saudi Arabia; Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hana Alsobayel
- Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Darren Beales
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Jacqui R Clark
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Pains and Brains specialist pain physiotherapy clinic, Tauranga, New Zealand
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Belgium
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Ömer Elma
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rikard Hanafi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Sabina Hotz Boendermaker
- University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Eva Huysmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Mari Lundberg
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Ney Meziat Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta-UNISUAM, Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physical Therapy Department of Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; University of Applied Sciences, Rotterdam, Netherlands
| | - Kory Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Rob Smeets
- Maastricht University, Maastricht, Netherlands; Clinics in Rehabilitation, Eindhoven, Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Belgium; Skeletal Biology and Engineering Research Center, Dept of Development and Regeneration, KU Leuven, Belgium
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
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de Kleijn L, Jansen-Groot Koerkamp EAW, van der Kooij I, Veen M, Rijkels-Otters HJBM, Koes BW, Chiarotto A. Exploring the facilitators and barriers in opioid deprescribing for non-cancer pain treatment experienced by general practitioners: A qualitative study. Eur J Pain 2024. [PMID: 38287911 DOI: 10.1002/ejp.2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Guidelines recommend opioid deprescribing in patients on long-term opioid treatment for chronic non-cancer pain. This study aims to explore facilitators and barriers in opioid deprescribing among general practitioners in the Netherlands. In addition, this study aims to identify possibilities for improvement regarding opioid deprescribing in primary care. METHODS Focus group discussions with Dutch General practitioners were held by two skilled moderators. The focus group discussions were transcribed verbatim and analysed using MAXQDA software. Three independent reviewers searched for overarching themes using thematic analysis with an inductive approach. Discussions were organized until data saturation was reached. RESULTS Twenty-two general practitioners participated in four focus group discussions. Five main themes emerged from the data: (1) patient-centred care; (2) ensuring proper pain management (3) dilemmas and hardships in dealing with opioid use disorder; (4) the competency gap; (5) needs and possibilities to improve opioid deprescribing in primary care. The first theme addresses the main facilitators in opioid tapering. The following three themes emerged as main barriers in opioid deprescribing. The fifth theme identified possibilities for change. CONCLUSIONS This study indicates the importance of intrinsic motivation and a tailored approach to deprescribe opioids in patients with chronic pain on long-term opioid treatment. Identified barriers include struggles in pain management, challenges caused by opioid use disorder, insufficient capacities such as time constraints and lack of skills. Recommendations for improvement involve enhanced collaboration with healthcare professionals in primary and secondary care, provision of practical tools and assurance of sufficient time. SIGNIFICANCE This focus group study among 22 Dutch general practitioners elucidates the complexities of opioid deprescribing and reveals pivotal themes such as patient-centred care, pain management challenges, and competency gaps. The findings underscore the crucial role of intrinsic motivation and that of a tailored approach in opioid deprescribing, while demonstrating how a lack in effective pain treatments, practical capacities and challenges caused by opioid dependence, impede opioid deprescribing. By uncovering these complexities, this study aims to inform future deprescribing strategies.
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Affiliation(s)
- Loes de Kleijn
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elsemiek A W Jansen-Groot Koerkamp
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Iris van der Kooij
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mario Veen
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Pedersen JR, Strijkers R, Gerger H, Koes B, Chiarotto A. Clinical improvements due to specific effects and placebo effects in conservative interventions and changes observed with no treatment in randomized controlled trials of patients with chronic nonspecific low back pain: a systematic review and meta-analysis. Pain 2024:00006396-990000000-00494. [PMID: 38198235 DOI: 10.1097/j.pain.0000000000003151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/11/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT Little is known about the contribution of placebo effects and changes observed with no treatment in interventions for nonspecific low back pain (NSLBP). This systematic review assessed the proportions of the overall treatment effect that may be attributable to specific treatment effects, placebo effects, and changes observed with no treatment in randomized controlled trials (RCTs) in patients with NSLBP. Trials published before 2019 were identified from a published systematic review, and the search was updated in MEDLINE, Embase, and Cochrane Central for trials published between January 2019 and March 2023. Three-arm RCTs comparing the effects of experimental interventions vs placebo control vs no intervention reporting pain intensity, physical function, and/or health-related quality of life (HRQoL) were included. Sixteen RCTs with 1436 adults with chronic NSLBP testing conservative and mainly passive interventions were included. For pain intensity (16 studies), 33%, 18%, and 49% of the overall short-term treatment effect was attributable to specific treatment effects, placebo effects, and changes observed with no treatment, respectively. For physical function (11 studies) and HRQoL (6 studies), these proportions were 34%, 13%, and 53%, and 11%, 41%, and 48%, respectively. These results show that approximately half of the overall treatment effect of conservative and mainly passive interventions for patients with chronic NSLBP is attributable to changes observed with no treatment, rather than specific or placebo effects of treatments. However, the certainty of evidence was very low to low, suggesting that the true effects might be markedly different from the effect sizes underlying these estimates.
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Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rob Strijkers
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
- Research Unit of General Practice, Department of Public Health and the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
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do Espirito Santo CDM, Santos VS, Miyamoto GC, Chiarotto A, Santos M, Yamato TP. Measurement properties of the EQ-5D in children and adolescents: a systematic review protocol. Syst Rev 2024; 13:18. [PMID: 38183127 PMCID: PMC10768350 DOI: 10.1186/s13643-023-02443-7] [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: 02/22/2021] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although the EQ-5D instruments have been initially designed for adult populations, there are new studies evaluating and applying these instruments to children and adolescents. The EuroQol Group adapted and created two versions designed for these groups, i.e., the EQ-5D-Y versions. The measurement properties of the EQ-5D have been systematically reviewed in different health conditions. However, there is a lack of a proper systematic assessment including the studies' risk of bias and focusing on recent studies assessing the EQ-5D instruments in children and adolescents. The lack of a systematic assessment of the EQ-5D versions does not allow us to have a comprehensive evaluation of the validity, reliability, and responsiveness of these instruments among children and adolescents. This systematic review aims to critically appraise and summarize the evidence on the measurement properties of the EQ-5D instruments (self-reported version - answered by children and adolescents; and proxy versions - versions reported by parents, caregivers, or health professionals) in children and adolescents. METHODS A systematic review searching the following electronic databases: MEDLINE, EMBASE, CINAHL, EconLit, National Health Service Economic Evaluation Database (NHS-EED), Health Technology Assessment (HTA) database. Two independent reviewers will screen titles and abstracts and select full texts for eligibility. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology will be followed to conduct three main assessment steps: risk of bias, quality criteria for measurement properties, and evidence synthesis. DISCUSSION This systematic review will provide comprehensive information about the evidence regarding the measurement properties of EQ-5D instruments in children and adolescents of different settings and countries. SYSTEMATIC REVIEW REGISTRATION Open Science Framework with Registration https://osf.io/r8kt9/ and PROSPERO: CRD42020218382.
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Affiliation(s)
- Caique de Melo do Espirito Santo
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo Rua Cesário Galeno, 448/475, São Paulo, Tatuapé, 03071-000, Brazil.
| | - Verônica Souza Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo Rua Cesário Galeno, 448/475, São Paulo, Tatuapé, 03071-000, Brazil
| | - Gisela Cristiane Miyamoto
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo Rua Cesário Galeno, 448/475, São Paulo, Tatuapé, 03071-000, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marisa Santos
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Tiê Parma Yamato
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo Rua Cesário Galeno, 448/475, São Paulo, Tatuapé, 03071-000, Brazil
- School of Public Health, Faculty of Medicine and Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Center for Pain, Health and Lifestyle, Sydney, Australia
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Innocenti T, Schleimer T, Salvioli S, Giagio S, Ostelo R, Chiarotto A. In trials of physiotherapy for chronic low back pain, clinical relevance is rarely interpreted, with great heterogeneity in the frameworks and thresholds used: a meta-research study. J Physiother 2024; 70:51-64. [PMID: 38072712 DOI: 10.1016/j.jphys.2023.11.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 01/07/2024] Open
Abstract
QUESTIONS How do authors of randomised controlled trials (RCTs) interpret the clinical relevance of the effects of physiotherapy interventions compared with no intervention on pain intensity, physical function and time to recovery in people with chronic low back pain (CLBP)? How can the clinical relevance be re-interpreted based on the available smallest worthwhile effect (SWE) threshold for this comparison? Are the studies in this field adequately powered? DESIGN Cross-sectional meta-research study. PARTICIPANTS People with CLBP. OUTCOME MEASURES Pain intensity, physical function and time to recovery. RESULTS This review included 23 RCTs with 1,645 participants. Twenty-two and 18 studies were included in the analysis of pain intensity and physical function, respectively. No studies investigated time to recovery. Sixteen studies reported varying thresholds to interpret clinical relevance for physical function and pain intensity. Discrepancies between interpretation using the minimal important difference and SWE values were observed in five studies. Study power ranged from 9% to 98%, with only four studies having a power > 80%. CONCLUSION Little attention is given to the interpretation of clinical relevance in RCTs comparing physiotherapy with no intervention in CLBP, with great heterogeneity in the frameworks and thresholds used. Future trials should inform patients and clinicians on whether the effect of an intervention is large enough to be worthwhile, using a reliable and comprehensive approach like available SWE estimates. REGISTRATION medRxiv https://doi.org/10.1101/2022.12.14.22283454.
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Affiliation(s)
- Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; GIMBE Foundation, Italy.
| | - Tim Schleimer
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, Germany
| | - Stefano Salvioli
- GIMBE Foundation, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Movement Sciences Research Institute, The Netherlands
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Innocenti T, Salvioli S, Logullo P, Giagio S, Ostelo R, Chiarotto A. The Uptake of the Core Outcome Set for Non-Specific Low Back Pain Clinical Trials is Poor: A Meta-Epidemiological Study of Trial Registrations. J Pain 2024; 25:31-38. [PMID: 37604361 DOI: 10.1016/j.jpain.2023.08.006] [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] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
We conducted a meta-epidemiological study on all non-specific low back pain (NSLBP) trial registrations on the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We aimed to 1) assess the uptake of the core outcome set (COS) for NSLBP in clinical trials; 2) assess the uptake of the core outcome measurement set for NSLBP in clinical trials; and 3) determine whether specific study characteristics are associated with the COS uptake. After applying the relevant filters for the condition, study type, and phase of the trial, 240 registry entries were included in this study. Only 50 (20.8%) entries showed a full COS uptake, and this rate did not increase over time. Most registry entries that planned to measure physical functioning (n = 152) used the Roland-Morris Disability Questionnaire (n = 74; 48.7%); a small percentage used the numeric rating scale (n = 60; 27.3%) or Short Form-12 (n = 5; 8.3%) if they planned to measure pain intensity (n = 220) or health-related quality of life (n = 60), respectively. Only the planned sample size (OR = 1.02; 95% CI = 1.01, 1.03) showed a significant but small association with COS uptake. The uptake of the COS for NSLBP is poor. Only 21% of the randomized controlled trials aimed to measure all COS domains in their study registration and COS uptake is not increased over time. Great heterogeneity in measurement instruments was also observed, revealing poor core outcome measurement set uptake. PERSPECTIVE: The Core Outcome Set (COS) for non-specific low back pain was published more than 20 years ago. We evaluated whether trial registrations are using this set of outcomes when testing interventions for low back pain. Full uptake was found only in 21% of the sample, and this is not increasing over time. Researchers should use the COS to ensure that trials measure relevant outcomes consistently.
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Affiliation(s)
- Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; GIMBE Foundation, Bologna, Italy
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Patricia Logullo
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Movement Sciences research institute, the Netherlands
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Jansen-Groot Koerkamp EAW, de Kleijn L, Fakhry R, Chiarotto A, Heringa M, Rijkels-Otters HJBM, Blom JW, Numans ME, Koes BW, Bouvy ML. Pragmatic Delphi study aimed at determining practical components for a tool designed to assist Dutch primary care-givers in opioid deprescribing for non-cancer pain. Fam Pract 2023; 40:827-843. [PMID: 37237431 PMCID: PMC10745274 DOI: 10.1093/fampra/cmad058] [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] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Over the past decades, opioid prescriptions have increased in the Netherlands. The Dutch general practitioners' guideline on pain was recently updated and now aims to reduce opioid prescriptions and high-risk opioid use for non-cancer pain. The guideline, however, lacks practical measures for implementation. OBJECTIVE This study aims to determine practical components for a tool that should assist Dutch primary care prescribers and implements the recently updated guideline to reduce opioid prescriptions and high-risk use. METHODS A modified Delphi approach was used. The practical components for the tool were identified based on systematic reviews, qualitative studies, and Dutch primary care guidelines. Suggested components were divided into Part A, containing components designed to reduce opioid initiation and stimulate short-term use, and Part B, containing components designed to reduce opioid use among patients on long-term opioid treatment. During three rounds, a multidisciplinary panel of 21 experts assessed the content, usability, and feasibility of these components by adding, deleting, and adapting components until consensus was reached on the outlines of an opioid reduction tool. RESULTS The resulting Part A consisted of six components, namely education, opioid decision tree, risk assessment, agreements on dosage and duration of use, guidance and follow-up, and interdisciplinary collaboration. The resulting Part B consisted of five components, namely education, patient identification, risk assessment, motivation, and tapering. CONCLUSIONS In this pragmatic Delphi study, components for an opioid reduction tool for Dutch primary care-givers are identified. These components need further development, and the final tool should be tested in an implementation study.
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Affiliation(s)
- Elsemiek A W Jansen-Groot Koerkamp
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Loes de Kleijn
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Romina Fakhry
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | | | - Jeanet W Blom
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Research Unit of General Practice, Department of Public Health and the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Marcel L Bouvy
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Vigdal ØN, Storheim K, Killingmo RM, Rysstad T, Pripp AH, van der Gaag W, Chiarotto A, Koes B, Grotle M. External validation and updating of prognostic prediction models for nonrecovery among older adults seeking primary care for back pain. Pain 2023; 164:2759-2768. [PMID: 37490100 DOI: 10.1097/j.pain.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/23/2023] [Indexed: 07/26/2023]
Abstract
ABSTRACT Prognostic prediction models for 3 different definitions of nonrecovery were developed in the Back Complaints in the Elders study in the Netherlands. The models' performance was good (optimism-adjusted area under receiver operating characteristics [AUC] curve ≥0.77, R2 ≥0.3). This study aimed to assess the external validity of the 3 prognostic prediction models in the Norwegian Back Complaints in the Elders study. We conducted a prospective cohort study, including 452 patients aged ≥55 years, seeking primary care for a new episode of back pain. Nonrecovery was defined for 2 outcomes, combining 6- and 12-month follow-up data: Persistent back pain (≥3/10 on numeric rating scale) and persistent disability (≥4/24 on Roland-Morris Disability Questionnaire). We could not assess the third model (self-reported nonrecovery) because of substantial missing data (>50%). The models consisted of biopsychosocial prognostic factors. First, we assessed Nagelkerke R2 , discrimination (AUC) and calibration (calibration-in-the-large [CITL], slope, and calibration plot). Step 2 was to recalibrate the models based on CITL and slope. Step 3 was to reestimate the model coefficients and assess if this improved performance. The back pain model demonstrated acceptable discrimination (AUC 0.74, 95% confidence interval: 0.69-0.79), and R2 was 0.23. The disability model demonstrated excellent discrimination (AUC 0.81, 95% confidence interval: 0.76-0.85), and R2 was 0.35. Both models had poor calibration (CITL <0, slope <1). Recalibration yielded acceptable calibration for both models, according to the calibration plots. Step 3 did not improve performance substantially. The recalibrated models may need further external validation, and the models' clinical impact should be assessed.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Wendelien van der Gaag
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Karran EL, Cashin AG, Barker T, Boyd MA, Chiarotto A, Dewidar O, Mohabir V, Petkovic J, Sharma S, Tejani S, Tugwell P, Moseley GL. Using PROGRESS-plus to identify current approaches to the collection and reporting of equity-relevant data: a scoping review. J Clin Epidemiol 2023; 163:70-78. [PMID: 37802205 DOI: 10.1016/j.jclinepi.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/27/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Our objectives were to identify what and how data relating to the social determinants of health are collected and reported in equity-relevant studies and map these data to the PROGRESS-Plus framework. STUDY DESIGN AND SETTING We performed a scoping review. We ran two systematic searches of MEDLINE and Embase for equity-relevant studies published during 2021. We included studies in any language without limitations to participant characteristics. Included studies were required to have collected and reported at least two participant variables relevant to evaluating individual-level social determinants of health. We applied the PROGRESS-Plus framework to identify and organize these data. RESULTS We extracted data from 200 equity-relevant studies, providing 962 items defined by PROGRESS-Plus. A median of 4 (interquartile range = 2) PROGRESS-Plus items were reported in the included studies. 92% of studies reported age; 78% reported sex/gender; 65% reported educational attainment; 49% reported socioeconomic status; 45% reported race; 44% reported social capital; 33% reported occupation; 14% reported place and 9% reported religion. CONCLUSION Our synthesis demonstrated that researchers currently collect a limited range of equity-relevant data, but usefully provides a range of examples spanning PROGRESS-Plus to inform the development of improved, standardized practices.
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Affiliation(s)
- Emma L Karran
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia.
| | - Aidan G Cashin
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Mark A Boyd
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vina Mohabir
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Petkovic
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Saurab Sharma
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Sinan Tejani
- InBalance Physiotherapy, Launceston, Tasmania, Australia
| | - Peter Tugwell
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - G Lorimer Moseley
- The 'Identifying Social Factors that Stratify Health Opportunities and Outcomes (ISSHOOs) in Pain Research' Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
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Piano L, Chiarotto A, Mascarello M, Turolla A, Cecchetto S, Gianola S, Castellini G. Teaching evidence-based practice to physiotherapy students in Italy: a cross sectional study. Arch Physiother 2023; 13:19. [PMID: 37779190 PMCID: PMC10544500 DOI: 10.1186/s40945-023-00174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy. METHODS This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript. RESULTS Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021-2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%). CONCLUSIONS The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards.
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Affiliation(s)
- Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Fondazione Dei Santi Lorenzo E Teobaldo, 12050, Rodello, Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marco Mascarello
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences-DIBINEM, Alma Mater Studiorum, Università Di Bologna, 40138, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138, Bologna, Italy
| | | | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
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Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of nonsteroidal anti-inflammatory drugs and exercise therapy for acute and chronic low back pain: a benefit-harm trade-off study. J Physiother 2023; 69:240-248. [PMID: 37730447 DOI: 10.1016/j.jphys.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
QUESTION What are the smallest worthwhile effects of nonsteroidal anti-inflammatory drugs (NSAIDs) for people with acute and chronic low back pain (LBP)? What is the smallest worthwhile effect of individualised exercise for people with chronic LBP compared with no intervention? DESIGN Benefit-harm trade-off study. PARTICIPANTS Participants were recruited by advertisement on social media and included if they were English-speaking adults in Australia who had non-specific LBP. OUTCOME MEASURE Pain intensity. RESULTS A total of 116 people with acute LBP and 230 people with chronic LBP were recruited. For acute LBP, the smallest worthwhile effect of NSAIDs additional to no intervention was a 30% (IQR 10 to 40%) reduction in pain intensity. For chronic LBP, the smallest worthwhile effect of NSAIDs additional to no intervention was a 27.5% (IQR 10 to 50%) reduction in pain intensity. For chronic LBP, the smallest worthwhile effect of exercise additional to no intervention was a 20% (IQR 10 to 40%) reduction in pain intensity. There were small associations between baseline pain, duration of pain and level of exercise and the smallest worthwhile effect of NSAIDs for acute LBP. There were no other clear associations. CONCLUSIONS For people with LBP, the smallest worthwhile effect of exercise and NSAIDs additional to no intervention is approximately a 20 to 30% reduction in pain. These results can inform the interpretation of the effects of NSAIDs and exercise in randomised trials and meta-analyses, incorporating consumers' perspectives. Further research on comparisons between different interventions and on other core LBP outcomes may inform decision-making. REGISTRATION OSF osf.io/3erjx/.
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Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.
| | - Matthew D Jones
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam A Williams
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Jack J Devonshire
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael C Ferraro
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Innocenti T, Hayden JA, Salvioli S, Giagio S, Piano L, Cosentino C, Brindisino F, Feller D, Ogilvie R, Gianola S, Castellini G, Bargeri S, Twisk JWR, Ostelo RW, Chiarotto A. Bias in the measurement of the outcome is associated with effect sizes in randomized clinical trials on exercise therapy for chronic low back pain: a meta-epidemiological study. J Clin Epidemiol 2023; 162:145-155. [PMID: 37704114 DOI: 10.1016/j.jclinepi.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To explore the relationships between the risk of bias and treatment effect estimates for exercise therapy interventions on pain intensity and physical functioning outcomes in randomized controlled trials (RCTs) involving patients with chronic low back pain. STUDY DESIGN AND SETTING A cross-sectional meta-epidemiological study of the 230 RCTs (31,674 participants) in the 2021 'Exercise therapy for chronic low back pain' Cochrane Review were included. Study design characteristics, sample size, prospective trial registration, flowchart information, interventions, and comparisons were extracted. Independent pairs of reviewers assessed the risk of bias using the Cochrane Risk of Bias 2 tool. RESULTS The metaregression included 220 (pain intensity) and 203 (physical functioning) effect sizes. Unadjusted and adjusted metaregression models showed no significant associations between the bias domains and pain intensity effect sizes. Only domain 'bias in the measurement of the outcome' was significantly associated with physical functioning (standardized mean difference: -0.40, 95% confidence interval: -0.77 to -0.02) when adjusted for flowchart reported (yes/no), prospective trial registration, sample size, and comparator type. CONCLUSION The risk of bias in the measurement of the outcome could lead to slight overestimates of the effect size for physical functioning. Clinicians should consider this when they read and assess RCT results in this field. We encourage metaresearchers to replicate our findings using a consistent approach for evaluating the risk of bias (i.e., the RoB 2 tool) in other musculoskeletal conditions and interventions to investigate their generalizability.
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Affiliation(s)
- Tiziano Innocenti
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; GIMBE Foundation, Bologna, Italy.
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Fondazione dei Santi Lorenzo e Teobaldo, Rodello, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Daniel Feller
- Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Raymond W Ostelo
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences research institute, The Netherlands
| | - Alessandro Chiarotto
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Fu Y, Chiarotto A, Enthoven W, Skou ST, Koes B. The influence of comorbidities on outcomes for older people with back pain: BACE-D cohort study. Ann Phys Rehabil Med 2023; 66:101754. [PMID: 37276834 DOI: 10.1016/j.rehab.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. OBJECTIVES To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. METHODS We analyzed data from the 'Back Complaints in the Elders' Dutch study cohort (BACE-D) and included participants aged >55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. RESULTS Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14-0.39; 12-month β = 0.31, 95% CI 0.17-0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31-0.77; 12-month β = 0.64, 95% CI 0.37-0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41-1.37; 12-month β = 1.17, 95% CI 0.65-1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71-2.52; 12-month β = 1.85, 95% CI 0.82-2.89, P-value < 0.001) compared to participants without musculoskeletal comorbidities. CONCLUSIONS More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.
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Affiliation(s)
- Yanyan Fu
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Søren Thorgaard Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Chamoro M, de Luca K, Ozbulut O, Oei EHG, Vleggeert-Lankamp CLA, Koes BW, Bierma-Zeinstra SMA, Chiarotto A. Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review. Osteoarthritis Cartilage 2023; 31:1158-1175. [PMID: 37150286 DOI: 10.1016/j.joca.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/16/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Spinal osteoarthritis is difficult to study and diagnose, partly due to the lack of agreed diagnostic criteria. This systematic review aims to give an overview of the associations between clinical and imaging findings suggestive of spinal osteoarthritis in patients with low back pain to make a step towards agreed diagnostic criteria. DESIGN We searched MEDLINE, Embase, Web of Science, and CINAHL from inception to April 29, 2021 to identify observational studies in adults that assessed the association between selected clinical and imaging findings suggestive of spinal osteoarthritis. Risk of bias was assessed using the Newcastle Ottawa Scale and the quality of evidence was graded using an adaptation of the GRADE approach. RESULTS After screening 7902 studies, 30 met the inclusion criteria. High-quality evidence was found for the longitudinal association between low back pain (LBP) intensity, and both disc space narrowing and osteophytes, as well as for the association between LBP-related physical functioning and lumbar disc degeneration, the presence of spinal morning stiffness and disc space narrowing and for the lack of association between physical functioning and Schmorl's nodes. CONCLUSIONS There is high- and moderate-quality evidence of associations between clinical and imaging findings suggestive of spinal osteoarthritis. However, the majority of the studied outcomes had low or very low-quality of evidence. Furthermore, clinical and methodological heterogeneity was a serious limitation, adding to the need and importance of agreed criteria for spinal osteoarthritis, which should be the scope of future research.
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Affiliation(s)
- Mirna Chamoro
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Katie de Luca
- Discipline of Chiropractic, CQ University, Brisbane, Australia.
| | - Omer Ozbulut
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurosurgery, Spaarne Hospital, Haarlem/Hoofddorp, the Netherlands.
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Minnucci S, Innocenti T, Salvioli S, Giagio S, Yousif MS, Riganelli F, Carletti C, Feller D, Brindisino F, Faletra A, Chiarotto A, Mourad F. Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2023; 53:510-528. [PMID: 37561605 DOI: 10.2519/jospt.2023.11708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to estimate the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched the MEDLINE, Cochrane CENTRAL, Embase, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022. STUDY SELECTION CRITERIA: RCTs evaluating SMT compared to guideline-recommended and nonrecommended interventions, sham SMT, and no intervention for adults with neck pain were eligible for our systematic review. Prespecified outcomes included pain, range of motion, disability, health-related quality of life. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogenous RCTs at short-term and long-term outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool. We used the Grading of Recommendations, Assessment, Development, and Evaluations approach to judge the certainty of evidence. RESULTS: We included 28 RCTs. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short term (standardized mean difference [SMD], 0.66; 95% confidence interval [CI]: 0.35, 0.97) and long term (SMD, 0.73; 95% CI: 0.31, 1.16), and for reducing disability at short-term (SMD, 0.95; 95% CI: 0.48, 1.42) and long term (SMD, 0.65; 95% CI: 0.23, 1.06). Transient side effects only were found (eg, muscle soreness). CONCLUSION: There was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. J Orthop Sports Phys Ther 2023;53(9):510-528. Epub: 10 August 2023. doi:10.2519/jospt.2023.11708.
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van den Heuvel MM, Chiarotto A, Oei EH, van Middelkoop M. Low Back Pain in Adolescents: Associations With Demographics, Physical and Psychosocial Factors, and Magnetic Resonance Imaging Features of the Spine. Spine (Phila Pa 1976) 2023; 48:E216-E218. [PMID: 37195001 PMCID: PMC10249599 DOI: 10.1097/brs.0000000000004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Marleen M. van den Heuvel
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Gerger H, Søgaard K, Macri EM, Jackson JA, Elbers RG, van Rijn RM, Koes B, Chiarotto A, Burdorf A. Exposure to hand-arm vibrations in the workplace and the occurrence of hand-arm vibration syndrome, Dupuytren's contracture, and hypothenar hammer syndrome: a systematic review and meta-analysis. J Occup Environ Hyg 2023; 20:257-267. [PMID: 37000463 DOI: 10.1080/15459624.2023.2197634] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study provides an overview of the relationships between exposure to work-related hand-arm vibration and the occurrence of pre-defined disorders of the hands. We searched Medline, Embase, Web of Science, Cochrane Central, and PsycINFO for cross-sectional and longitudinal studies on the association between work-related vibration exposure and the occurrence of hand-arm vibration syndrome (including vibration-induced white finger), Dupuytren's contracture, or hypothenar hammer syndrome. We used a 16-item checklist for assessing the risk of bias. We present results narratively, and we conducted random effects meta-analyses if possible. We included 10 studies with more than 24,381 participants. Our results showed statistically significant associations between the exposure to hand-arm vibrations and the occurrence of the selected disorders, with pooled odds ratios ranging between 1.35 (95% CI: 1.28 to 2.80) and 3.43 (95% CI: 2.10 to 5.59). Considerable between-study heterogeneity was observed. Our analyses show that exposure to vibrating tools at work is associated with an increased risk for the occurrence of selected disorders of the hands. Due to the majority of studies being cross-sectional, no firm conclusion is possible regarding causal relationships between vibration exposure and disorder occurrence. Future research should specifically address whether reducing exposure to hand-held vibrating tools at work reduces the incidence of the disorders of the hands investigated in this systematic review.
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Affiliation(s)
- Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Karen Søgaard
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam Netherlands
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands
- Performing artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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Innocenti T, Schleimer T, Salvioli S, Giagio S, Ostelo R, Chiarotto A. The interpretation of clinical relevance in randomised clinical trials in patients with chronic low back pain: protocol for a meta-research study. MethodsX 2023; 10:102239. [PMID: 37305803 PMCID: PMC10251147 DOI: 10.1016/j.mex.2023.102239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Chronic low back pain (cLBP) is one of the leading worldwide causes of disability. The smallest worthwhile effect (SWE) parameter has been proposed to find a threshold of clinical relevance. Specific values of the SWE have been calculated in patients with cLBP for pain intensity, physical functioning and time to recovery for physiotherapy compared with no intervention. Our objectives are 1) To evaluate how authors have interpreted the clinical relevance of the effect of physiotherapy compared to no-intervention on pain, physical functioning and time to recovery; 2) To reinterpret the clinical relevance of these between-group differences based on the available SWE estimates; 3) To evaluate, for descriptive purposes, whether the studies are adequately powered or underpowered considering the published SWE values and a power threshold of 80%. A systematic search in Medline, PEDro, Embase and Cochrane CENTRAL will be conducted. We will search for RCT investigating the effectiveness of physiotherapy as compared to no interventions in people with cLBP. We will compare the authors' interpretation of results for clinical relevance with their results to determine if they meet their a-priori definitions. Then, we will perform a re-interpretation of the between-group differences based on SWE values published for cLBP.
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Affiliation(s)
- Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
- GIMBE Foundation, Italy
| | - Tim Schleimer
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| | - Stefano Salvioli
- GIMBE Foundation, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Movement Sciences research institute, the Netherlands
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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28
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Zhu Z, Chiarotto A, Koes BW. Biopsychosocial Intervention or Postural Therapy in Patients With Spine Pain. JAMA 2023; 329:1408. [PMID: 37097359 DOI: 10.1001/jama.2023.3059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Zhaochen Zhu
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Pira C, Aimasso U, Ippolito M, Merlo F, Ossola M, Chiarotto A, Anrò M. Use Of Teduglutide In The Treatment Of Chronic Intestinal Failure Associated With Short Bowel Syndrome In Adults: Real-Life Experience Of The Iicb Reference Centre Of The A.O.U. CittÀ Della Salute E Della Scienza Of Turin. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.263] [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: 03/29/2023]
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Chiarotto A, Gerger H, van Rijn RM, Elbers RG, Søgaard K, Macri EM, Jackson JA, Burdorf A, Koes BW. Physical and psychosocial work-related exposures and the occurrence of disorders of the elbow: A systematic review. Appl Ergon 2023; 108:103952. [PMID: 36493677 DOI: 10.1016/j.apergo.2022.103952] [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] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
This systematic review updates a previous systematic review on work-related physical and psychosocial risk factors for elbow disorders. Medline, Embase, Web of Science, Cochrane Central and PsycINFO were searched for studies on associations between work-related physical or psychosocial risk factors and the occurrence of elbow disorders. Two independent reviewers selected eligible studies and assessed risk of bias (RoB). Results of studies were synthesized narratively. We identified 17 new studies and lateral epicondylitis was the most studied disorder (13 studies). Five studies had a prospective cohort design, eight were cross-sectional and four were case-control. Only one study had no items rated as high RoB. Combined physical exposure indicators (e.g. physical exertion combined with elbow movement) were associated with the occurrence of lateral epicondylitis. No other consistent associations were observed for other physical and psychosocial exposures. These results prevent strong conclusions regarding associations between work-related exposures, and the occurrence of elbow disorders.
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Affiliation(s)
- Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Heike Gerger
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands; PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Roy G Elbers
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
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31
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Innocenti T, Ostelo R, Verhagen A, Pinto RZ, Salvioli S, Giagio S, Chiarotto A. Rehabilitation journal editors recognize the need for interventions targeted to improve the completeness of reporting, but there is heterogeneity in terms of strategies actually adopted: A cross-sectional web-based survey. J Evid Based Med 2023. [PMID: 36992559 DOI: 10.1111/jebm.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Tiziano Innocenti
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, Netherlands
- GIMBE Foundation, Bologna, Italy
| | - Raymond Ostelo
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Movement Sciences Research Institute, Amsterdam, Netherlands
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Rafael Zambelli Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessandro Chiarotto
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, Netherlands
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Wingbermühle RW, Chiarotto A, van Trijffel E, Stenneberg MS, Kan R, Koes BW, Heymans MW. External validation and updating of prognostic models for predicting recovery of disability in people with (sub)acute neck pain was successful: broad external validation in a new prospective cohort. J Physiother 2023; 69:100-107. [PMID: 36958979 DOI: 10.1016/j.jphys.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/22/2022] [Accepted: 02/09/2023] [Indexed: 03/25/2023] Open
Abstract
QUESTION Can existing post-treatment prognostic models for predicting neck pain recovery (primarily in terms of disability and secondarily in terms of pain intensity and perceived improvement) be externally validated and updated at the end of the treatment period and at 6 and 12 weeks of follow-up in a new Dutch cohort of people with neck pain treated with guideline-based usual care physiotherapy? DESIGN External validation and model updating in a new prospective cohort of three previously developed prognostic models. PARTICIPANTS People with (sub)acute neck pain and registered for primary care physiotherapy treatment. OUTCOME MEASURES Recovery of disability, pain intensity, and perceived recovery at 6 and 12 weeks and at the end of the treatment period. RESULTS Discriminative performance (c-statistic) of the disability model at 6 weeks was 0.73 (95% CI 0.69 to 0.77) and reasonably well calibrated after intercept recalibration. The disability model at 12 weeks and at the end of the treatment period showed discriminative c-statistic performance values of 0.69 (95% CI 0.64 to 0.73) and 0.68 (95% CI 0.63 to 0.72), respectively, and was well calibrated. Pain models and perceived recovery models did not reach acceptable performance. Cervical mobility added value to the disability models and pain catastrophising to the disability and pain models at 6 weeks. DISCUSSION Broad external validation of the disability model was successful in people with (sub)acute neck pain and clinicians may use this model in clinical practice with reasonable accuracy. Further research is required to assess the disability model's clinical impact and generalisability, and to identify additional valuable model predictors. REGISTRATION https://osf.io/a6r3k/.
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Affiliation(s)
- Roel W Wingbermühle
- SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Martijn S Stenneberg
- SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of Physiotherapy, Human Physiology and Anatomy, Experimental Anatomy Research Department, Vrije Universiteit Brussel, Belgium
| | - Ronald Kan
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
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33
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Bier J, Verhagen A, Ostelo R, Chiarotto A, Koes B. The Effect of a New Payment System on Physiotherapeutic Management of Patients With Low Back Pain in Primary Care. Arch Phys Med Rehabil 2023; 104:738-744. [PMID: 36758715 DOI: 10.1016/j.apmr.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To evaluate differences regarding the number of treatment sessions, costs, and outcomes (including relapses) between a regular payment-per-session system and the recently introduced product payment system. DESIGN Prospective cohort study. SETTING Dutch physical therapy practices in primary care over a 2-year period. PARTICIPANTS 16,103 patients with low back pain (LBP). INTERVENTION The new product payment system is compared with the regular payment-per-session system. MAIN OUTCOME MEASURES Pain, disability, recovery, number of physical therapy sessions, therapy duration, costs (per episode), and LBP relapse. RESULTS At baseline, we found greater pain and disability scores associated with an increased risk profile in both payment systems. With regard to the payment systems, we found greater costs (€283.8 vs €210.8) and a greater percentage of relapse (4.5% vs 2.8%) for the product payment system compared with the payment-per-session system. Comparing the 2 payment systems within each risk strata, we found no significant differences, except for a decrease in pain in the medium-risk stratum. Concerning the therapy characteristics, we found that in the payment-per-session group, the therapy took 6 days longer for low-risk patients (median 27 vs 21 days) and 7 days shorter for high-risk patients (median 42 vs 49 days) compared with the product payment group. Moreover, the mean number of sessions in the payment-per-session group was greater for low-risk patients (5.4 vs 4.8 sessions) and lower for high-risk patients (7.7 vs 8.1 sessions) compared with the payment-per-session group. Finally, the costs were significantly greater in all strata of the product payment group compared with the payment-per-session group. CONCLUSIONS The 2 payment systems are largely comparable regarding patient outcomes, therapy duration, and treatment sessions. Both the average cost per patient per LBP episode and the number of relapses in the product payment system are statistically significantly greater than in the payment-per-session system.
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Affiliation(s)
- Jasper Bier
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; FS Fysio, Capelle aan den IJssel, The Netherlands.
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Movement Sciences Research Institute, VU Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, VU Amsterdam, Amsterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Health Sciences, Faculty of Science, Movement Sciences Research Institute, VU Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, VU Amsterdam, Amsterdam, The Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Ali SM, Lee RR, McBeth J, James B, McAlister S, Chiarotto A, Dixon WG, van der Veer SN. Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study. JMIR Hum Factors 2023; 10:e42177. [PMID: 36753324 PMCID: PMC9947768 DOI: 10.2196/42177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. OBJECTIVE We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. METHODS Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. RESULTS Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. CONCLUSIONS To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | | | | | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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35
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Zhu Z, Chiarotto A, Enthoven WTM, Bierma-Zeinstra SMA, Koes BW. Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study. Eur J Pain 2023; 27:611-623. [PMID: 36695558 DOI: 10.1002/ejp.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Back pain is common among older adults resulting in the high societal and economic burden of persistent pain and disability. Pain medications are frequently prescribed for back pain, especially among older patients, but the efficacy of analgesics on back pain in this patient population remains under debate. In the present study, we investigated the outcomes (i.e. pain intensity and disability) of pain medication use in older people with back pain participating in a prospective cohort study. METHODS A total of 669 patients aged >55 years consulting a general practitioner for a new episode of back complaints were included in this study. The association between pain medication use and outcomes (pain intensity and disability) was assessed at 3-month follow-up. RESULTS Pain medication users were observed to experience more pain and disability at baseline compared with non-users. At 3-month follow-up, patients from all subgroups (e.g. pain medication users versus non-users) improved over time. Yet medication users had higher pain intensity and poorer disability scores compared with non-users. Patients who de-escalated or stopped pain medication had lower pain and disability than non-users. When comparing different types of medications (i.e. paracetamol, non-steroidal anti-inflammatory drugs, opioids), none of the groups showed better scores regarding pain and disability in users compared with non-users. Opioid users displayed the highest levels of pain and disability. CONCLUSIONS In the present study, although patients who de-escalated or stopped analgesics had less pain and disability, pain medication overall does not result in better outcomes in older people with back pain. SIGNIFICANCE Older patients taking pain medication did not report better outcomes than the ones who did not, except for those who de-escalated or stopped pain medication. Caution should be taken in prescribing pain medication for older patients with back pain in primary care.
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Affiliation(s)
- Z Zhu
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - A Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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36
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Karran EL, G. Cashin A, Barker T, A. Boyd M, Chiarotto A, Dewidar O, Petkovic J, Sharma S, Tugwell P, Moseley GL. The ' what' and ' how' of screening for social needs in healthcare settings: a scoping review. PeerJ 2023; 11:e15263. [PMID: 37101795 PMCID: PMC10124546 DOI: 10.7717/peerj.15263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
Background Adverse social determinants of health give rise to individual-level social needs that have the potential to negatively impact health. Screening patients to identify unmet social needs is becoming more widespread. A review of the content of currently available screening tools is warranted. The aim of this scoping review was to determine what social needs categories are included in published Social Needs Screening Tools that have been developed for use in primary care settings, and how these social needs are screened. Methods We pre-registered the study on the Open Science Framework (https://osf.io/dqan2/). We searched MEDLINE and Embase from 01/01/2010 to 3/05/2022 to identify eligible studies reporting tools designed for use in primary healthcare settings. Two reviewers independently screened studies, a single reviewer extracted data. We summarised the characteristics of included studies descriptively and calculated the number of studies that collected data relevant to specific social needs categories. We identified sub-categories to classify the types of questions relevant to each of the main categories. Results We identified 420 unique citations, and 27 were included. Nine additional studies were retrieved by searching for tools that were used or referred to in excluded studies. Questions relating to food insecurity and the physical environment in which a person lives were the most frequently included items (92-94% of tools), followed by questions relating to economic stability and aspects of social and community context (81%). Seventy-five percent of the screening tools included items that evaluated five or more social needs categories (mean 6.5; standard deviation 1.75). One study reported that the tool had been 'validated'; 16 reported 'partial' validation; 12 reported that the tool was 'not validated' and seven studies did not report validation processes or outcomes.
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Affiliation(s)
- Emma L. Karran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Mark A. Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University/Rotterdam, Rotterdam, Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Canada
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
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Ali SM, Selby DA, Bourke D, Bravo Santisteban RD, Chiarotto A, Firth J, James B, Parker B, Dixon WG, van der Veer SN. Feasibility and acceptability to use a smartphone-based manikin for daily longitudinal self-reporting of chronic pain. Digit Health 2023; 9:20552076231194544. [PMID: 37599898 PMCID: PMC10434844 DOI: 10.1177/20552076231194544] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Background As management of chronic pain continues to be suboptimal, there is a need for tools that support frequent, longitudinal pain self-reporting to improve our understanding of pain. This study aimed to assess the feasibility and acceptability of daily pain self-reporting using a smartphone-based pain manikin. Methods For this prospective feasibility study, we recruited adults with lived experience of painful musculoskeletal condition. They were asked to complete daily pain self-reports via an app for 30 days. We assessed feasibility by calculating pain report completion levels, and investigated differences in completion levels between subgroups. We assessed acceptability via an end-of-study questionnaire, which we analysed descriptively. Results Of the 104 participants, the majority were female (n = 87; 84%), aged 45-64 (n = 59; 57%), and of white ethnic background (n = 89; 86%). The mean completion levels was 21 (± 7.7) pain self-reports. People who were not working (odds ratio (OR) = 1.84; 95% confidence interval (CI), 1.52-2.23) were more likely, and people living in less deprived areas (OR = 0.77; 95% CI, 0.62-0.97) and of non-white ethnicity (OR = 0.45; 95% CI, 0.36-0.57) were less likely to complete pain self-reports than their employed, more deprived and white counterparts, respectively. Of the 96 participants completing the end-of-study questionnaire, almost all participants agreed that it was easy to complete a pain drawing (n = 89; 93%). Conclusion It is feasible and acceptable to self-report pain using a smartphone-based manikin over a month. For its wider adoption for pain self-reporting, the feasibility and acceptability should be further explored among people with diverse socio-economic and ethnic backgrounds.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - David A Selby
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- German Research Center for Artificial Intelligence (DFKI), Kaiserslautern, Germany
| | - Darryl Bourke
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Ramiro D Bravo Santisteban
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jill Firth
- Integrated Care Centre, Pennine MSK Partnership, Oldham, UK
| | | | - Ben Parker
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Sabet TS, Anderson DB, Stubbs PW, Buchbinder R, Terwee CB, Chiarotto A, Gagnier J, Verhagen AP. Identifying common core outcome domains from core outcome sets of musculoskeletal conditions: protocol for a systematic review. Syst Rev 2022; 11:248. [PMID: 36403060 PMCID: PMC9675955 DOI: 10.1186/s13643-022-02120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Core outcome sets (COSs) aim to reduce outcome heterogeneity in clinical practice and research by suggesting a minimum number of agreed-upon outcomes in clinical trials. Most COSs in the musculoskeletal field are developed for specific conditions. We propose that there are likely to be common core domains within existing musculoskeletal COSs that may be used as a starting point in the development of future COSs. We aim to identify common core domains from existing COSs and to facilitate the development of new COSs for musculoskeletal conditions. As a secondary aim, we will assess the development quality of these COSs. METHODS A systematic review including musculoskeletal COSs. We will search Core Outcome Measures in Effectiveness Trials (COMET) database, MEDLINE, EMBASE, Scopus, Cochrane Methodology Register and International Consortium for Health Outcome Measurement (ICHOM). Studies will be included if related to the development of a COS in adults with musculoskeletal conditions and for any type of intervention. Quality will be assessed using the Core Outcome Set-Standards for Development (COS-STAD) recommendations. Data extracted will include scope of the COS, health condition, interventions and outcome domains. Primary outcomes will be all core domains recommended within each COS. We define a common core outcome domain as one present in at least 67% of all COSs. All findings will be summarized and presented using descriptive statistics. DISCUSSION This systematic review of COSs will describe the core domains recommended within each musculoskeletal COS. Common domains found may be used in the initial stages of development of future musculoskeletal COSs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021239141.
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Affiliation(s)
- Tamer S Sabet
- Discipline of Physiotherapy, Graduate School of Health, The University of Technology Sydney, New South Wales, Australia. .,Department of Health Professionals, Faculty of Medicine and Health Science, Macquarie University, New South Wales, Australia. .,Center for Health and Wellness, Healthcare Department, Occupational Health, QatarEnergy, Doha, Qatar.
| | - David B Anderson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Spine Institute, Burwood, New South Wales, Australia
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, The University of Technology Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Methodology, Amsterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Joel Gagnier
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, The University of Technology Sydney, New South Wales, Australia
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Castellini G, Pillastrini P, Vanti C, Bargeri S, Giagio S, Bordignon E, Fasciani F, Marzioni F, Innocenti T, Chiarotto A, Gianola S, Bertozzi L. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother 2022; 68:244-254. [PMID: 36266185 DOI: 10.1016/j.jphys.2022.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [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: 10/25/2021] [Revised: 03/08/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023] Open
Abstract
QUESTION Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? DESIGN A systematic review and network meta-analysis of randomised clinical trials. PARTICIPANTS Adults with CNSNP of at least 3 months duration. INTERVENTIONS All available pharmacological and non-pharmacological interventions. OUTCOME MEASURES The primary outcomes were pain intensity and disability. The secondary outcome was adverse events. RESULTS Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty. CONCLUSIONS While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence. REGISTRATION PROSPERO CRD42019124501.
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Affiliation(s)
- Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Carla Vanti
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Giagio
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | | | - Francesco Fasciani
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Francesco Marzioni
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - University of Bologna, Italy
| | - Tiziano Innocenti
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; GIMBE Foundation, Bologna, Italy
| | - Alessandro Chiarotto
- Department of Health Science - Faculty of Science - Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of General Practice - Erasmus MC - University Medical Center Rotterdam, The Netherlands
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Lucia Bertozzi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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van Hoek JPKD, van Riet RC, Khoshal Khorami A, Chiarotto A. Response to "The clinical effectiveness of a physiotherapy delivered physical and psychological group intervention for older adults with neurogenic claudication: the BOOST randomised controlled trial". J Gerontol A Biol Sci Med Sci 2022; 77:2341. [PMID: 35943362 DOI: 10.1093/gerona/glac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Renske Cornelie van Riet
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - A Khoshal Khorami
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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41
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Chiarotto A, Koes BW. Nonspecific Low Back Pain. Reply. N Engl J Med 2022; 387:479-480. [PMID: 35921471 DOI: 10.1056/nejmc2207597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Killingmo RM, Chiarotto A, van der Windt DA, Storheim K, Bierma-Zeinstra SMA, Småstuen MC, Zolic-Karlsson Z, Vigdal ØN, Koes BW, Grotle M. Modifiable prognostic factors of high costs related to healthcare utilization among older people seeking primary care due to back pain: an identification and replication study. BMC Health Serv Res 2022; 22:793. [PMID: 35717179 PMCID: PMC9206382 DOI: 10.1186/s12913-022-08180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Back pain is an extensive burden to our healthcare system, yet few studies have explored modifiable prognostic factors associated with high costs related to healthcare utilization, especially among older back pain patients. The aims of this study were to identify modifiable prognostic factors for high costs related to healthcare utilization among older people seeking primary care with a new episode of back pain; and to replicate the identified associations in a similar cohort, in a different country. METHODS Data from two cohort studies within the BACE consortium were used, including 452 and 675 people aged ≥55 years seeking primary care with a new episode of back pain. High costs were defined as costs in the top 25th percentile. Healthcare utilization was self-reported, aggregated for one-year of follow-up and included: primary care consultations, medications, examinations, hospitalization, rehabilitation stay and operations. Costs were estimated based on unit costs collected from national pricelists. Nine potential modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression models were used to identify and replicate associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and high costs related to healthcare utilization. RESULTS Four modifiable prognostic factors associated with high costs related to healthcare utilization were identified and replicated: a higher degree of pain severity, disability, depression, and a lower degree of physical health-related quality of life. Kinesiophobia and recovery expectations showed no prognostic value. There were inconsistent results across the two cohorts with regards to comorbidity, radiating pain below the knee and mental health-related quality of life. CONCLUSION The factors identified in this study may be future targets for intervention with the potential to reduce high costs related to healthcare utilization among older back pain patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04261309, 07 February 2020. Retrospectively registered.
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Affiliation(s)
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | | | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Orthopedics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Milada C Småstuen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | - Ørjan N Vigdal
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Ali SM, Lee RR, Chiarotto A, Dixon WG, McBeth J, van der Veer SN. Adoption of Digital Pain Manikins for Research Data Collection: A Systematic Review. Stud Health Technol Inform 2022; 290:748-751. [PMID: 35673117 DOI: 10.3233/shti220178] [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] [Indexed: 06/15/2023]
Abstract
Chronic pain is common and disabling. Researchers need robust methods to collect pain data in large populations to enhance knowledge on pain prevalence, causes and treatment. Digital pain manikins address this by enabling self-reporting of location-specific pain. However, it is unknown to what extent pain studies adopted digital manikins for data collection. Therefore, we systematically searched the literature. We included 17 studies. Most were published after 2017, collected pain data cross-sectionally in ≥50 participants, and reported pain distribution and pain extent as manikin-derived summary metrics. Across the studies, 13 unique manikins were used, of which four had been evaluated. Our review shows that adoption of digital pain manikins in research settings has been slow. Harnessing the digital nature of manikins, enabling use of personal devices, and assessing and improving the reliability, validity and responsiveness of digital manikins will expedite their adoption as digital data collection tools for pain research.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | | | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
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Affiliation(s)
- Alessandro Chiarotto
- From the Department of General Practice, Erasmus University Medical Center, Rotterdam (A.C., B.W.K.), and the Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam (A.C.) - both in the Netherlands; and the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (B.W.K.)
| | - Bart W Koes
- From the Department of General Practice, Erasmus University Medical Center, Rotterdam (A.C., B.W.K.), and the Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam (A.C.) - both in the Netherlands; and the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (B.W.K.)
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Langejan AI, de Kleijn L, Rijkels-Otters HJBM, Chudy SFJ, Chiarotto A, Koes BW. Effectiveness of non-opioid interventions to reduce opioid withdrawal symptoms in patients with chronic pain: a systematic review. Fam Pract 2022; 39:295-300. [PMID: 34849764 PMCID: PMC9030234 DOI: 10.1093/fampra/cmab159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dealing with the opioid crisis, medical doctors are keen to learn how to best treat opioid dependency in patients with chronic non-cancer pain. Opioid replacement therapy is commonly used, but success rates vary widely. Since many patients still experience severe withdrawal symptoms, additional interventions are necessary. OBJECTIVE To review the effectiveness of interventions in the treatment of withdrawal symptoms during opioid tapering or acute withdrawal in patients with long-term non-cancer pain. METHODS A systematic review was conducted in Embase.com, MEDLINE, Web of Science, PsycINFO, and Cochrane CENTRAL register of trials. Studies eligible for inclusion were (non-)randomized controlled trials in adults with long-term opioid prescriptions for non-cancer pain. Included trials had to compare a non-opioid intervention to placebo, usual care, no treatment, or non-opioid drug and had to report on withdrawal symptoms as an outcome. Study quality was assessed with the 2.0 Cochrane risk of bias (RoB) tool. Evidence quality was rated following the GRADE approach. RESULTS One trial (n = 21, some concerns regarding RoB) compared Varenicline to placebo. There was no statistically significant between-group reduction of withdrawal symptoms (moderate-quality evidence). CONCLUSIONS Evidence from clinical trials on interventions reducing withdrawal symptoms is scarce. Based on one trial with a small sample size, no firm conclusion can be drawn. Meanwhile, doctors are in dire need for therapeutic options to tackle withdrawal symptoms while tapering patients with prescription opioid dependence. We hope this review draws attention to this unfortunate research gap so that future research can provide doctors with answers.
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Affiliation(s)
- Annely I Langejan
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Loes de Kleijn
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Stan F J Chudy
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Abstract
OBJECTIVES Worldwide the use of opioids, both doctor-prescribed and illicit, has increased. In most countries, opioids are first prescribed by general practitioners (GPs). Identifying factors that influence GPs' opioid prescription decision-making may help reduce opioid misuse and overuse. We performed a systematic review to gain insight into GP attitudes towards opioid prescription and to identify possible solutions to promote changes in the field of primary care. DESIGN AND SETTING Systematic review of qualitative studies reporting GPs' attitudes towards opioid use in non-cancer pain management. METHODS We searched Embase, Medline, Web of Science Core Collection, Cochrane, PsychInfo, Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Google Scholar. Two independent reviewers selected studies based on prespecified eligibility criteria. Study quality was evaluated with the Critical Appraisal Skills Programme checklist, and their results were analysed using thematic analysis. Quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. RESULTS We included 14 studies. Four themes were established using thematic analyses: (1) GPs caught in the middle of 'the opioid crisis'; (2) Are opioids always bad? (3) GPs' weighing scale, taking patient-related and therapeutic relationship-related factors into account; and (4) GPs' sense of powerlessness-lack of alternatives, support by specialists and lack of time in justifying non-prescriptions. CONCLUSION GP attitudes towards opioid prescribing for non-cancer pain are subject to several GP-related, patient-related and therapeutic relationship-related factors. Raising GP and patient awareness on the inefficacy of opioids in chronic non-cancer pain management and providing non-opioid alternatives to treat chronic pain might help to promote opioid reduction in primary care. More research is needed to develop practical guidelines on appropriate opioid prescribing, tapering off opioid use and adopting effective communication strategies. PROSPERO REGISTRATION NUMBER CRD42020194561.Cite Now.
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Affiliation(s)
- Rani Punwasi
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - L de Kleijn
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - J B M Rijkels-Otters
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - M Veen
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
- Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
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Koes BW, Chiarotto A, Thorlund JB, Grønne DT, Roos EM, Skou ST. Does pain medication use influence the outcome of 8 weeks of education and exercise therapy in patients with knee or hip osteoarthritis? An observational study. Pain Med 2022; 23:1457-1463. [PMID: 34999896 PMCID: PMC9340625 DOI: 10.1093/pm/pnab352] [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] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Patients with osteoarthritis are mainly managed in primary care settings and many patients use pain medication as symptomatic treatment. We investigated in OA-patients receiving an education and exercise program, the use and type of pain medication and its impact on outcomes at 3 months follow-up. DESIGN, SETTING & SUBJECTS The design was a retrospective cohort study using prospectively collected data from the GLA: D® registry. The study included 15,918 primary care patients. RESULTS Among the included patients, 62% were pain medication users and 38% were non-users. Among the pain medications users, 35% were classified as paracetamol users, 54% as NSAID users, and 11% as opioid users. Medication users and non-users differed regarding a higher pain intensity, poorer physical and mental health. Pain medication use before and during the education and exercise program was associated with the pain intensity at 3 months follow-up. However, patients either using or not using pain medications improved over time, and the magnitude of the difference between patient groups was small (less than 10 mm on a 0-100 scale). CONCLUSIONS Pain medication use is weakly associated with outcome at 3 months follow up in OA-patients receiving an education and exercise program. Between-group differences, however, are small and probably not clinically important.
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Affiliation(s)
- Bart W Koes
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, the Netherlands.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Alessandro Chiarotto
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, the Netherlands
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Dorte Thalund Grønne
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved-Slagelse-Ringsted Hospitals, Denmark
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Innocenti T, Feller D, Giagio S, Salvioli S, Minnucci S, Brindisino F, Cosentino C, Piano L, Chiarotto A, Ostelo R. Adherence to the PRISMA statement and its association with risk of bias in systematic reviews published in rehabilitation journals: A meta-research study. Braz J Phys Ther 2022; 26:100450. [PMID: 36270163 PMCID: PMC9583447 DOI: 10.1016/j.bjpt.2022.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 09/02/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022] Open
Abstract
The mean overall adherence to the PRISMA checklist across the sample of systematic reviews published in rehabilitation journals was 61.4%. A high overall risk of bias was a significant predictor of lower adherence (B=−7.1%; 95%CI −12.1, −2.0). Studies published in fourth quartile journals displayed a lower overall adherence than those published in the first quartile. No association between adherence and publication options and publication year was found. The overall adherence increased (B= 11.9%; 95%CI 5.9, 18.0) when the SR protocol was registered
Background Systematic reviews (SRs) and meta-analyses are essential resources for the clinicians. They allow to evaluate the strengths and the weaknesses of the evidence to support clinical decision-making if they are adequately reported. Little is known in the rehabilitation field about the completeness of reporting of SRs and its relationship with the risk of bias (ROB). Objectives Primary: 1) To evaluate the completeness of reporting of systematic reviews (SRs) published in rehabilitation journals by evaluating their adherence to the PRISMA 2009 checklist, 2) To investigate the relationship between ROB and completeness of reporting. Secondary: To study the association between completeness of reporting and journals and study characteristics. Methods A random sample of 200 SRs published between 2011 and 2020 in 68 rehabilitation journals was indexed under the “rehabilitation” category in the InCites database. Two independent reviewers evaluated adherence to the PRISMA checklist and assessed ROB using the ROBIS tool. Overall adherence and adherence to each PRISMA item and section were calculated. Regression analyses investigated the association between completeness of reporting, ROB, and other characteristics (impact factor, publication options, publication year, and study protocol registration). Results The mean overall PRISMA adherence across the 200 studies considered was 61.4%. Regression analyses show that having a high overall ROB is a significant predictor of lower adherence (B=-7.1%; 95%CI -12.1, -2.0). Studies published in fourth quartile journals displayed a lower overall adherence (B= -7.2%; 95%CI -13.2, -1.3) than those published in first quartile journals; the overall adherence increased (B= 11.9%; 95%CI 5.9, 18.0) if the SR protocol was registered. No association between adherence, publication options, and publication year was found. Conclusion Reporting completeness in rehabilitation SRs is suboptimal and is associated with ROB, impact factor, and study registration. Authors of SRs should improve adherence to the PRISMA guideline, and journal editors should implement strategies to optimize the completeness of reporting.
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Affiliation(s)
- Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; GIMBE Foundation, Bologna, Italy.
| | - Daniel Feller
- Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Minnucci
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabrizio Brindisino
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Fondazione dei Santi Lorenzo e Teobaldo, Rodello, Italy
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences research institute, the Netherlands
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49
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de Luca K, Chiarotto A, Cicuttini F, Creemers L, de Schepper E, Ferreira PH, Foster NE, Hartvigsen J, Kawchuk G, Little CB, Oei EH, Suri P, Vleggeert-Lankamp C, Bierma-Zeinstra SMA, Ferreira ML. Consensus for Statements Regarding a Definition for Spinal Osteoarthritis for Use in Research and Clinical Practice: A Delphi Study. Arthritis Care Res (Hoboken) 2021; 75:1095-1103. [PMID: 34874115 DOI: 10.1002/acr.24829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine consensus among an international, multidisciplinary group of experts regarding definitions of spinal osteoarthritis for research and for clinical practice. METHODS A 15-member, multidisciplinary steering committee generated 117 statements for a 3-round Delphi study. Experts in back pain and/or osteoarthritis were identified and invited to participate. In round 1, participants could propose additional statements for voting. All statements were rated on a 1-9 Likert scale, and consensus was set at ≥70% of respondents agreeing or disagreeing with the statement and <15% of respondents providing the opposite response. RESULTS In total, 255 experts from 11 different professional backgrounds were invited. From 173 available experts, 116 consented to participate. In round 1, 103 participants completed the survey, followed by 85 of 111 participants in round 2 (77%) and 87 of 101 participants in round 3 (86%). One-third of participants were from Europe (30%), most were male (58%), one-fifth were physical therapists (21%), and over one-third had been in their profession for 11-20 years (35%). Of 131 statements, consensus was achieved for 71 statements (54%): 53 in agreement (75%) and 18 in disagreement (25%). CONCLUSION Although there was consensus for statements for definitions of spinal osteoarthritis that were analogous to definitions of osteoarthritis in appendicular joints, a future definition still needs refinement. Importantly, this Delphi highlighted that a future definition should be considered across a spectrum of structural changes and patient symptoms and expressed on a progressive scale.
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Affiliation(s)
- Katie de Luca
- CQ University, Brisbane, Queensland, Australia, and Macquarie University, Sydney, New South Wales, Australia
| | | | - Flavia Cicuttini
- Public Health and Preventive Medicine, Monash University Melbourne, Victoria, Australia
| | - Laura Creemers
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paulo H Ferreira
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadine E Foster
- STARS Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Brisbane, Queensland, Australia, and Primary Care Versus Arthritis Centre, School of Medicine, Keele University, Staffordshire, UK
| | - Jan Hartvigsen
- University of Southern Denmark, Odense, Denmark, and Chiropractic Knowledge Hub, Odense, Denmark
| | - Gregory Kawchuk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Labs, University of Sydney, Kolling Institute, Institute of Bone and Joint Research, St. Leonards, New South Wales, Australia
| | - Edwin H Oei
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pradeep Suri
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Seattle Epidemiologic Research and Information Center (ERIC) and Rehabilitation Care Services and Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Carmen Vleggeert-Lankamp
- Leiden University Medical Centre and the Hague Medical Centre, Leiden-Den Haag, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
| | | | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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50
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Pellicciari L, Chiarotto A, Giusti E, Crins MHP, Roorda LD, Terwee CB. Psychometric properties of the patient-reported outcomes measurement information system scale v1.2: global health (PROMIS-GH) in a Dutch general population. Health Qual Life Outcomes 2021; 19:226. [PMID: 34579721 PMCID: PMC8477486 DOI: 10.1186/s12955-021-01855-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To assess the psychometric properties of the Dutch-Flemish Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health (PROMIS-GH). Methods The PROMIS-GH (also referred to as PROMIS-10) was administered to 4370 persons from the Dutch general population. Unidimensionality (CFI ≥ 0.95; TLI ≥ 0.95; RMSEA ≤ 0.06; SRMR ≤ 0.08), local independence (residual correlations < 0.20), monotonicity (H > 0.30), model fit with the Graded Response Model (GRM, p < 0.001), internal consistency (alpha > 0.75), precision (total score information across the latent trait), measurement invariance (no Differential Item Functioning [DIF]), and cross-cultural validity (no DIF for language, Dutch vs. United States English) of its subscales, composed of four items each, Global Mental Health (GMH) and Global Physical Health (GPH), were assessed. Results Confirmatory factor analyses, on both subscales, revealed slight departures from unidimensionality for GMH (CFI = 0.98; TLI = 0.95, RMSEA = 0.22; SRMR = 0.04) and GPH (CFI = 0.99; TLI = 0.97; RMSEA = 0.12; SRMR = 0.03). Local independence, monotonicity, GRM model fit, internal consistency, precision and cross-cultural validity were supported. However, Global10 (emotional problems) showed misfit on the GMH subscale, while Global08 (fatigue) presented DIF for age. Conclusion The psychometric properties of the PROMIS-GH in the Dutch population were considered acceptable. Sufficient local independence, monotonicity, GRM fit, internal consistency, measurement invariance and cross-cultural validity were found. If future studies find similar results, structural validity of the GMH could be enhanced by improving or replacing Global10 (emotional problems). Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01855-0.
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Affiliation(s)
| | - Alessandro Chiarotto
- Department of Health Sciences, Amsterdam Movement Sciences Research Institute, VU University, Amsterdam, The Netherlands.,Department of General Practice, Erasmus MC, , University Medical Center, Rotterdam, The Netherlands
| | - Emanuele Giusti
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Martine H P Crins
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands.,Zuyderland MC Department of Quality and Safety, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, de Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
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