Purpose and Background. Patients’ engagement with self-management strategies (SMS) is key when managing low back pain (LBP) and relies on appropriate information being delivered by the treating Clinician. However, patients have differing
Background. A local authority approached us, for a cost-beneficial solution to their increasing low back pain referrals. We proposed developing a student-led clinic – an intervention delivered by students but supervised by clinicians. We then conducted scoping reviews on student-led clinics in the management of health conditions and on the self-management of back pain. The findings suggested that student-led self-management interventions for low back health should be feasible. The next step was to co-construct the intervention with key stakeholders. Co-Construction. A hybrid of Action Research and Design Science methodology was used to co-construct the intervention with five key stakeholder groups (council staff, managers and human resources, employee healthcare, students, and lecturers). Three rounds of focus groups explored the ‘problem’, the possible solutions, the process, and the content. Themes were taken from each of these focus groups and the similarities and differences were analysed. This analysis and subsequent synthesis with the evidence base created potential intervention models, which were discussed and refined with the stakeholder groups. Intervention. The proposed intervention is focused on providing evidence informed biopsychosocial support for work-relevant back pain, based on identifying obstacles and solutions to improve
Background. Chronic pain is a complex condition that demonstrates better outcomes in multidisciplinary rehabilitation, typically delivered to groups of patients by tertiary healthcare teams. An inter-disciplinary pain management course for individual patients was developed to increase the scope of physical therapists working in primary care by integrating osteopathic manual therapy with psychological interventions from Acceptance and Commitment Therapy (ACT), a form of ‘3rd wave’ Cognitive Behaviour Therapy. Method and Results. A single cohort study with pre-course (n=180) and post-course (n=79) self-report measures (44% response rate) evaluated six week interventions which combined individual manual therapy with self-management, delivered by teams of qualified and student osteopaths. Data included: quality of life (European Quality of Life Questionnaire); pain, mood and
Background. A cornerstone in treating low back pain (LBP) is the provision of information to patients, and the internet is increasingly being used as a source of health information delivery. However, the effect of and satisfaction with online information have been questioned. Purpose. To develop a multi-item instrument to measure an index score of satisfaction with online information for patients with LBP. Methods. The conceptualization of this patient reported outcome is modelled on the assumption of a formative model. The first draft of the questionnaire was developed based on a previous published interview study of 15 patients and evaluated for face validity by seven experts. The second draft of the questionnaire was pilot-tested in 20 patients to optimize content validity. Patients were recruited from a rehabilitation center and from social media. Results. An eight-item questionnaire was developed after assessing content and face validity. The items were related to design, readability, customization, credibility, usability, and
Purpose and background of the study. When talking to patients about pain, it has been shown that practitioners can positively or negatively influence health beliefs and treatment outcomes. Multidisciplinary physical and psychological interventions have demonstrated better outcomes for patients with long-term pain. Acceptance and Commitment Therapy (ACT) is a form of ‘third wave’ Cognitive Behavioural Therapy (CBT) that has been shown to promote resilience and wellbeing. A qualitative auto-ethnographic case study design was used to explore the communication processes and therapeutic outcomes associated with developing an innovative course integrating ACT interventions with osteopathic treatment, delivered by a single practitioner. Methods. Six individual consultations with four patients were audio-recorded, transcribed verbatim and coded. Linguistic Ethnography was used to identify pain discourses and analyse links with clinical decisions and patient responses. Transcript extracts were analysed at three levels; micro-level Conversation Analysis of communication processes; Interactional Sociolinguistic Analysis of changes in patient-practitioner roles; and macro-level Discourse Analysis of the wider biomedical and biopsychosocial context. Results. Two distinctive forms of discourse were identified. In predominantly ‘mechanistic’ communication, the ‘expert’ practitioner role was focused on fixing ‘broken’ parts and relieving pain. In ‘facilitative’ discourses, the ‘collaborative’ practitioner focused on promoting patients’ body awareness and active
Aims. The aims of this study were to investigate whether 1) multispecialist tertiary intervention for complex spinal pain lead to reductions in spine-related healthcare costs and 2) baseline characteristics are related to health care consuming costs. Patients and methods. A cost study in a natural prospective cohort was carried out to investigate healthcare data of patients admitted to the Groningen Spine Center (GSC) ranging from two years prior to referral until two year after discharge. GSC intervention consisted of a multi-professional and -specialist based diagnosis and treatment. Patients (18 and 80 years) were included, suffering from specific as well as multifactorial spinal pain. Clinical data was merged with Health Care Insurance data and included questionnaires on demographics, work, pain, disability, quality of life and psychosocial functioning. Univariable (paired sample t-tests) and multivariable analyses (pooled OLS Regression and fixed effects models) were carried out. Results. Included were 997 patients (mean age 52 years) filing a total of 700.533 health care declarations. The findings suggest that the intervention had a significant negative effect on spine-related healthcare costs (predominantly on medical specialist and allied care). Reduction in healthcare costs after treatment was predicted by lower age, lower duration, lower BMI, high education, high job satisfaction, low physical workload, high mental health, better
Pain catastrophising is an adverse
Background. The BACK To Health programme is part of the wider North of England back pain and radicular pain pathway. The purpose of this programme is to provide a CPPP approach based on the NICE guidelines CG88 for those with back pain that has not responded to early management and simpler therapies. The purpose of this study is to present preliminary results of this programme. Method. Referral onto the programme occurred through triage and treat practitioners or consultant clinics. A total of 44 patients were referred, with 31 attending the programme. The programme was delivered as a 3 week residential programme, with patients present 9am-5pm Monday to Thursday. A MDT provided an intense programme consisting of education, physical exercise, practical
Background. CB-CFT targeting specific pain provoking posture/movements in NSCLBP patients was shown more beneficial than current best practice. Resources for such interventions are substantial and so modifications for today's NHS are warranted. This study investigated feasibility and effect of CB-CFT delivered in a group setting (CB-CFT/G). Methods. Twenty three patients referred to Physiotherapy with NSCLBP undertook (i) 6 week CB-CFT/G(n=13) or (ii) current best practice (C)(n=10). Outcomes: Oswestry Disability Questionnaire (ODQ), pain (VAS), fear avoidance (Tampa Scale of Kinaesiophobia;TSK), physical activity (International Physical Activity Questionnaire;IPAQ), distress&risk assessment (DRAM), StarTBack and satisfaction. Unpaired t-tests assessed between-group difference in mean change of each outcome (p<0.05). Results. With no between-group baseline differences, there was a statistically significant difference between the groups mean change (SD) in ODQ [CB-CFT/G=14.9(8.0), C=5.2(12.4) p=.034], VAS [CB-CFT/G = 2.1(1.5), C=0.7(1.8) p=.045], TSK [CB-CFT/G=12.4(7.2), C=4.1(2.6) p=.002], IPAQ [CB-CFT/G =1855min(1085), C=19min(1672) p=.000] and StarTBack [CB-CFT/G =2.5(1.6), C=0.2(2.2) p=.009]. DRAM also showed greater improvements in CB-CFT/G [8.3(4.7) compared to C [-0.3(15.3) but this was not significant. CB-CFT/G group element was perceived as highly beneficial allowing patients to learn from each other, enhancing awareness and
Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. Post-hoc analysis. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p=0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual
Purpose. Health literacy, the ability to seek, understand and utilise health information, is important for health and health-related decisions. Suboptimal health literacy is associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). This study explored health literacy in a community cohort with and without CLBP. Methods and results. 117 adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, determined by a median split in Oswestry scores) participated. Using a mixed methods approach, data were collected on pain severity, LBP-related disability, fear avoidance, LBP beliefs, pain catastrophizing and health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). In-depth interviews were undertaken with 36 CLBP participants to explore beliefs about LBP and experiences in seeking, understanding and using LBP information. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were associated with disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Although S-TOFHLA scores suggested adequate health literacy across all participants and these were not related to LBP beliefs and attitudes, interviews revealed that individuals with CLBP-high disability adopted a more passive
Background. The ‘Subgroups for Targeted Treatment back tool’ (STarT) is supposed to divide patients with low back pain (LBP) into three groups with different risks of non-recovery. The objectives of this study were 1) to investigate whether these groups exist among Danish chiropractor patients, and if so 2) to test if the groups differ on psychological profile as measured by the Major Depression Inventory (MDI), the
Previous research has suggested that when subjected to painful lumbar stimulation, chronic low back pain (CLBP) patients with illness behaviour (IB) are unable to effectively engage a sensory modulation system utilised by patients without IB. 1. Furthermore, reduced insular cortex volume in CLBP patients with IB, may compound this problem. 2. . Pain Management Programs (PMP) has demonstrated reductions in IB and disability associated with chronic pain conditions. This current study aims to assess whether the pattern of cerebral response to pain in IB patients could be normalised by participation in a PMP. 12 patients with CLBP and IB (>4/5 Waddell signs present) were recruited prior to attending a 16-day PMP. FMRI scanning occurred prior to (PrePMP) and upon completion of the PMP (PostPMP). 8 healthy volunteers (HC) were scanned once. As in previous research, painful stimuli consisted of intense electrical stimulation delivered bilaterally to the lower back. The presentation of 3 colours indicated the likelihood of receiving 10second stimulation to the lower back (Always, Never and Maybe). IB scores were significantly reduced PostPMP (p <0.05). FMRI group activation maps for the Always condition revealed PostPMP patients increased activation in posterior regions, areas similarly activated by HC. For the Maybe condition, compared to PrePMP group, HC demonstrated greater activation in precuneus and middle and inferior frontal regions. Compared to their pre-treatment selves, PostPMP patients demonstrated increased activation in posterior and frontal regions. The results demonstrate that completion of a 16-day PMP leads to alteration in the brain's response to painful low back stimulation in CLBP patients with IB. Increased activation is seen in regions associated with the top-down modulation of pain. The response is similar to that seen in HC, and greater than before PMP confirming that the PMP process facilitates the utilisation of more normal
The aim of this study was to determine if positive Waddell signs
were related to patients’ demographics or to perception of their
quality of life. This prospective cross-sectional study included 479 adult patients
with back pain from a university spine centre. Each completed SF-12
and Oswestry Disability Index (ODI) questionnaires and underwent
standard spinal examinations to elicit Waddell signs. The relationship
between Waddell signs and age, gender, ODI, Mental Component Score
(MCS), and Physical Component Score (PCS) scores was determined.Aims
Patients and Methods
We compared a group of 46 somatised patients with a control group of 41 non-somatised patients who had undergone elective surgery to the lumbar spine in an attempt to identify pre-operative factors which could predict the outcome. In a prospective single-centre study, the Distress and Risk Assessment method consisting of a modified somatic perception questionnaire and modified Zung depression index was used pre-operatively to identify somatised patients. The type and number of consultations were correlated with functional indicators of outcome, such as the Oswestry disability index and a visual analogue score for pain in the leg after follow-up for six and 12 months. Similar improvements in the Oswestry disability index were found in the somatised and non-somatised groups. Somatised patients who had a good outcome on the Oswestry disability index had an increased number of orthopaedic consultations (50 of 83 patients (60%) vs 29 of 73 patients (39.7%); p = 0.16) and waited less time for their surgery (5.5 months) (
We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity. The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively. The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.