The association between sleep quality, low back pain and disability: A prospective study in routine practice

BACKGROUND

The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice.

METHODS

This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period.

RESULTS

Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]).

CONCLUSIONS

Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability.

SIGNIFICANCE

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

[Music versus diazepam to reduce preoperative anxiety: a randomized controlled clinical trial]

OBJECTIVES

To compare the effectiveness of music to that of diazepam in reducing preoperative anxiety.

PATIENTS AND METHODS

Patients were randomized to 2 groups to receive diazepam or listen to music on the day of surgery and the previous day. Just before the operation, anxiety was assessed with the State-Trait Anxiety Inventory. Cortisol levels, heart rate, and blood pressure were also recorded.

RESULTS

Two hundred seven patients were enrolled. No significant differences in any of the outcome measures (anxiety, cortisol level, heart rate, or blood pressure) were found between the 2 groups (music vs sedative).

CONCLUSIONS

Our findings indicate that music is as effective as sedatives for reducing preoperative anxiety.

[Reduction of anxiety in the anteroom of the operating theater in pediatric patients]

Research indicates that anxiety before surgical intervention in paediatric patients negatively affects on post hospital recovery. Numerous investigations are, therefore, conducted to alleviate anxiety through different psychological techniques at this critical moment that the child is undergoing in surgery. In our case, we have considered one of the resources of the Sant Joan de Déu Hospital: a voluntary team that works in the anteroom of the operating theatre to keep the children company. The aim of our research has been to train these volunteers (who previously did not have any specific training for their task) and to observe the effect on the children's anxiety. The subjects of our study were 140 boys and girls between the ages of 0 and 18 years old. Results indicate that training not only produces significative changes on volunteers' behaviour, but also has resulted in the children's presurgical anxiety behaviour. In this way, we recommend that all children be accompanied by a trained volunteer.

Identification of factors that influence tolerance of upper gastrointestinal endoscopy

OBJECTIVE

Unsedated gastroscopy is unpleasant for some patients. The identification of factors related to tolerance would permit the selection of patients for sedation. The aim of the present study was to identify these factors.

METHODS

Five hundred and nine patients underwent diagnostic gastroscopy after the administration of topical pharyngeal anaesthesia, without sedation. Patients were grouped as to whether they had undergone prior examinations or not. Tolerance was assessed with a visual analogue scale and a questionnaire.

RESULTS

Two hundred and seventy-three (54%) patients underwent gastroscopy for the first time, and 236 (46%) patients had prior experience. Patient tolerance was poor in 84 of 273 (31%) patients undergoing gastroscopy for the first time, and in 61 of 236 (26%) patients with prior experience. Logistic regression analysis identified the following variables related to poor tolerance: (a) in patients undergoing gastroscopy for the first time: presence of gag reflex (odds ratio (OR) = 3.42, 95% confidence interval (CI) 1.90-6.17), apprehension (OR = 2.57, CI 1.33-4.95), young age (OR = 0.95, CI 0.93-0.98) and high level of anxiety (OR = 1.91, CI 0.96-3.89); (b) in patients with prior experience: apprehension (OR = 4.21, CI 1.93-9.20), poor tolerance of prior examinations (OR = 4.92, CI 1.93-12.5) and female (OR = 2.23, CI 1.09-4.57).

CONCLUSIONS

The above-mentioned factors are predictive of poor tolerance, and may enable the identification of those patients who might benefit more from sedation for gastroscopy.

[Effectiveness of audiovisual materials as a preparation for surgery in pediatric patients]

Research on paediatric surgical patients points to the urgent need to prepare them psychologically for hospitalization and surgery. In this respect, studies conducted outside Spain have shown that seeing a video on hospitalization and procedures for surgery is an effective technique for helping children and their parents to deal with this situation. The aim of the present work was to verify the effectiveness of this technique within the context of our hospitals. The results indicate that it is highly advisable to show such a video to patients and their parents before admission to hospital, since this: 1) clears up any doubts they might have; 2) gives a friendlier image of the hospital; 3) encourages parents to talk to their children; and 4) increases satisfaction among parents concerning the information they receive. One of the data which most clearly reflects the effectiveness of using the type of the audiovisual described is that 98.2% of parents would recommend other families to see it.