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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 13 - 13
1 Sep 2019
de Schepper E Koes B Veldhuizen E Oei E Bierma-Zeinstra S Luijsterburg P
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Background

An understanding of the patterns of healthcare services used after MRI of the spine in general practice would provide information about how MRI scans are used in primary care.

Aim

To describe the healthcare use of patients referred for lumbar MRI in general practice, and to investigate the association between specific patient characteristics, back pain characteristics and MRI abnormalities with subsequent specialist consultation.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 34 - 34
1 Sep 2019
Schreijenberg M Koes B Lin C
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Introduction

Analgesic drugs are often prescribed to patients with low back pain (LBP). Recommendations for non-invasive pharmacological management of LBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy.

Methods

Guideline recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacotherapy, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 19 - 19
1 Sep 2019
Schreijenberg M Lin C McLachlan A Williams C Kamper S Koes B Maher C Billot L
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Introduction

The PACE trial was the first randomized controlled trial (RCT) investigating the efficacy of paracetamol in acute low back pain. Non-compliance to study medication was considered to be a limitation of this RCT. In contrast to conventional statistical methods, complier average causal effects (CACE) analysis may provide unbiased estimates of the effects for participants compliant to paracetamol.

Methods

Intention to treat (ITT), as-treated, propensity weighted CACE and joint modeling CACE estimates were calculated for pain intensity, disability, global perceived effect and function at two weeks of follow up with compliance defined as an average of at least four tablets per day during the first two weeks of the trial. For pain intensity, exploratory analyses were conducted using additional time points and definitions of compliance.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 41 - 41
1 Sep 2019
van den Berg R Jongbloed E de Schepper E Bierma-Zeinstra S Koes B Luijsterburg P
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Background

About 85% of the patients with low back pain seeking medical care have nonspecific low back pain (NsLBP), implying that no definitive cause can be identified. Many pain conditions are linked with elevated serum levels of (pro-)inflammatory biomarkers.

Purpose

To unravel the etiology and get better insight in the prognosis of NsLBP, the aim of this study was to assess the association between (pro-)inflammatory biomarkers and the presence and severity of NsLBP.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 27 - 27
1 Sep 2019
van den Berg R Enthoven W de Schepper E Luijsterburg P Oei E Bierma-Zeinstra S Koes B
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Background

The majority of adults will experience an episode of low back pain during their life. Patients with non-specific low back pain and lumbar disc degeneration (LDD) may experience spinal pain and morning stiffness because of a comparable inflammatory process as in patients with osteoarthritis of the knee and/or hip. Therefore, this study assessed the association between spinal morning stiffness, LDD and systemic inflammation in middle aged and elderly patients with low back pain.

Methods

This cross-sectional study used the baseline data of the BACE study, including patients aged ≥55 years visiting a general practitioner with a new episode of back pain. The association between spinal morning stiffness, the radiographic features of lumbar disc degeneration and systemic inflammation measured with serum C-reactive protein was assessed with multivariable logistic regression models.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_2 | Pages 29 - 29
1 Feb 2018
Chiarotto A Boers M Deyo R Buchbinder R Corbin T Costa L Foster N Grotle M Koes B Kovacs F Lin C Maher C Pearson A Peul W Schoene M Turk D van Tulder M Terwee C Ostelo R
Full Access

Background & purpose

Measurement inconsistency across clinical trials is tackled by the development of a core outcome measurement set. Four core outcome domains were recommended for clinical trials in patients with non-specific LBP (nsLBP): physical functioning, pain intensity, health-related quality of life (HRQoL), and number of deaths. This study aimed to reach consensus on core instruments to measure the first three domains.

Methods & Results

The Steering Committee overseeing this project selected 17 potential core instruments for physical functioning, three for pain intensity, and five for HRQoL. Evidence on their measurement properties in nsLBP was synthesized in three systematic reviews using COSMIN methodology. Researchers, clinicians, and patients (n = 208) were invited in a Delphi survey to seek consensus on which instruments to endorse as core. Consensus was a-priori set at 67% of participants agreeing on endorsing an instrument. Two Delphi rounds were run (response rates = 44% and 41%). Agreement was reached on endorsing the Oswestry Disability Index (ODI 2.1a) for physical functioning, the Numeric Rating Scale (NRS) for pain intensity, but not on other instruments. Several participants demanded to have free of charge core instruments. Taking these results into account, the steering committee formulated the following recommendations: ODI 2.1a or 24-item Roland Morris Disability Questionnaire for physical functioning, NRS for pain intensity, Short-Form 12 or 10-item PROMIS Global Health for HRQoL.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 24 - 24
1 Feb 2014
Jacobs W Peul W Rubinstein S Koes B van Tulder M
Full Access

Purposes of the study and background

The objective of this overview was to evaluate the available evidence from systematic reviews on the effectiveness of surgical interventions for sciatica due to disc herniation. The last search was conducted in 2011. Since then new reviews have been published or existing reviews have been updated.

Summary of the methods used and results

A comprehensive search was performed in multiple databases including Cochrane database of systematic reviews (CDSR), Database of Reviews of Effectiveness (DARE) and Pubmed. Included are Cochrane and non-Cochrane systematic reviews on sciatica due to disc herniation published in peer-reviewed journals. We evaluated surgery versus conservative care and different surgical techniques compared to one another. The methodological quality of the systematic reviews was evaluated using AMSTAR by two independent reviewers. Nine, mostly high quality, systematic reviews on surgical interventions for disc herniation were included. Four reviews compared surgery with conservative treatment and concluded consistently that surgery has only short term benefits while the long term results showed no difference in effect. Four reviews compared open discectomy with micro(endo)scopic discectomy and found no significant and/or clinically relevant differences. The quality of evidence on alternative minimal invasive techniques (laser discectomy, automated percutaneous discectomy, and nucleoplasty or coblation) is consistently low in four recent reviews.