Randomised controlled trials (RCTs) of non-specific low back pain (LBP) interventions commonly estimate sizes of treatment effect from subjective scales. It is not clear which scales are most commonly used. Moreover, the standardized effect sizes, d, of interventions are typically small (d ≈0.3) and many trials may be underpowered to detect d at this magnitude, regardless of scale used. We identified RCTs reported between 1980 and 2000 from the European guidelines for low back and extended the search to 2006 using MEDLINE, EMBASE, PsycINFO, Cochrane, and Lilacs. We extracted data from identified studies concerning outcome measure use and power to detect d. Following analysis of 222 papers, the most commonly used outcome measure was the visual analogue pain scale (VAS-P), used by 42% of trials, followed by the Roland Morris disability questionnaire (RMDQ), used by 34% of trials. Secondary measure use was diverse; 5% of trials included 10 or more measures and 40% involved at least one objective measure. 57% of the trials were powered to detect d = 0.8, only 37% could detect d = 0.5, only 6% were able to detect d = 0.3 and only one trial could detect Cohen’s definition of a small effect, d = 0.2. In sum, the VAS-P is the most commonly used outcome measure in trials of non-specific LBP and the majority of trials are too small to show effect sizes that might realistically occur.
The steering committee produced checklists of predictors and outcomes based on systematic reviews and a Delphi focus group. The international teams of experts coded each item for inclusion or exclusion, and recommended new items. This process was iterated twice to resolve disagreement between teams, and to receive scores for new items. The steering committee carried out a consensus synthesis and produced the final lists for predictors and outcome. Finally, the measurements for each factor were selected based on:
original systematic review recommendations from existing systematic review Recommendations from consensus statements and narrative reviews consultation with independent experts.
The effect of pain on lifestyle is paramount to the patient, physical symptoms for the clinician. Acknowledging this disparity may reduce frustration experienced in consultations as both have different communication and management needs. Indicating treatment success by focusing on lifestyle improvement in patients rather than reductions in physical symptoms may be more appropriate.
reported practice (based on a vignette of a patient with non-specific LBP) beliefs and attitudes about LBP(using the HC-PAIRS, Rainville et al 1995)
We conducted a community survey of the prevalence, health impact and location of chronic pain. We explored the relationship and patterns of chronic pain that commonly occur, with a view to understanding why some treatment approaches may be more appropriate than others for particular patterns of pain. In 2002, 2504 randomly sampled patients from 16 General Practices in the South East of England responded to a postal questionnaire about chronic pain. Those with chronic pain completed a pain drawing. We calculated descriptive statistics, relative risk and correlations to identify the associations and risks of having linked pain. The highest prevalences were low back (23%), shoulder (20%) and knee (18%) pain. The number of pain sites experienced was age related in men but less so in women. Lower body pain was more age related than upper body and non musculoskeletal pain. Multi site pain was more common than single site pain. Of those with low back, knee and shoulder pain, 14%, 4.5 % and 1.9% had only low back, knee and shoulder pain respectively. Correlations and minimum spanning trees showed that chronic upper and lower body pain are distinct and axial pain link the two. Chronic pain is more likely to be multi site, especially at middle age. Research, physical treatments and approaches to managing chronic pain are often site specific, therefore specialising treatment to one area eg low back pain often negates the bigger issue. This may help explain the self perpetuating problem of persistent chronic pain.
Patients who consulted complementary practitioners were more likely to be female, to be psychologically distressed, to work, to have left school aged over 16 and to have severe pain (p<
0.05 in all cases). Working was independently associated with consulting a complementary practitioner (Exp (B) = 2.0, p=0.00)
11/19 studies reported inconclusive results, 8/19 showed a statistical association between drawings and the psychological assessment tool. However the more clinically relevant, sensitivity data ranged from 24–93%, specificity 44–91%, positive predictive values 28–93%, and negative predictive values 35–92%. The range of this data is too wide to be acceptable clinically as predictive of psychological state.
1) beliefs and attitudes about LBP 2) reported practice (using a clinical vignette)
A total of 3602 questionnaires were posted to simple random samples of UK registered chiropractors (n=611), osteopaths (n=1367) and physiotherapists (n=1624). Intervention packages were sent to consenting practitioners in March 2004, and the follow-up is planned for September 2004.
Explored patient’s or practitioners; beliefs and expectations, or both. Studied patients with chronic musculoskeletal pain, which does not have a known systemic, inflammatory or malignant origin treated in primary or community care. The full review group resolved disagreements. Full text articles meeting the inclusion criteria will be obtained and coded further into non-randomised studies, randomised studies and qualitative studies. Data abstraction forms will be developed for each type of study. Data abstraction will be undertaken by two members of the group working independently.
To determine the most powerful predictors of consultation for CLBP from pain severity, troublesomeness, health related quality of life and psychological distress
Chi square tests will be undertaken to explore the relationship between troublesomeness of CLBP and consultations for pain in general and with whether consulted mainstream or complementary practitioners. Multiple logistic regression will be undertaken to explore the most powerful predictors of consultation for CLBP.
Participants were identified from respondents reporting chronic pain in a postal questionnaire survey administered through a local general practice. Participants were allocated to groups according to the severity of their pain, as measured by the Chronic Pain Grade. Those with grades II and I were allocated to group one and those with grades III and IV to group two.