Background and objectives

The Alexander Technique (AT) is a self-care method usually taught in one-to-one lessons. AT lessons have been shown to be helpful in managing long-term health-related conditions (Int J Clin Pract 2012;66:98−112). This systematic review aims to draw together evidence of the effectiveness of AT lessons in managing musculoskeletal (MSK) conditions, with empirically based evidence of physiological changes following AT training, to provide a putative theoretical explanation for the observed benefits of Alexander lessons.

Purpose and Background. Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain. The aims were: 1/ to assess how patients with low back pain respond to osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management (BPM) course; and 2/ to assess if it is feasible and acceptable for osteopath participants to receive weekly SCED data and use it to guide patient management. Methods and Results. A multiple baseline single case experimental design trial (. clinicaltrials.gov. , on 18/10/2021, ID number NCT05120921) with 11 UK osteopaths was conducted. Patients were randomised to early, middle or late treatment start dates. Statistical analysis assessed the change between baseline, intervention and follow-up periods. Primary outcomes were the Numeric Pain Rating (NPR) and Patient Specific Function Scales (PSFS), measured during the baseline, the 6-week intervention, and during a 12-week follow-up period. At baseline, the osteopaths reported stronger biopsychosocial attitudes to pain, compared to biomedical beliefs (PABS: 34 behavioural scale; 29 biomedical scale). Overall, patient participants showed daily increases in symptoms during the pre-treatment phase (+0.24/day, p<0.001), and daily decreases during treatment (−2.94 over the treatment phase, p<0.001), which continued post-treatment (−3.36 over 12 weeks, p=0.04). Similar improvements were observed for function. Conclusion. Osteopathic care was shown to help patients with persistent low back pain. Patient recruitment was challenging because of the randomisation. With further development, the method shows feasibility as a means of enhancing research activity among practising clinicians. Previous presentations or publications of the work. The protocol was published (. https://doi.org/10.1016/j.ijosm.2023.100660. ) and presented at SBPR in 2022. The results were presented to an osteopathic conference in October 2023. Ethics approval was received from the University College of Osteopathy Research Ethics Committee. Conflicts of interests. Jerry Draper-Rodi receives fees from the sales of the e-learning course on the biopsychosocial management on the UCO CPD platform. Sources of funding. The research was funded by the Osteopathic Foundation

Background. Osteopathy has been shown to be effective in the management of chronic low back pain. Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain but there is a lack of evidence comparing standard osteopathic care, which has traditionally been based on dated and disputed biomechanical theories of dysfunction, with more contemporary biopsychosocial approaches. Methods and results. A multiple baseline single case experimental design trial with 11 UK osteopaths and 60 patients is currently assessing effectiveness of osteopathic treatment for patients with non-specific low back pain of more than 12 weeks’ duration. Patients are randomised to early, middle, or late treatment start dates to increase the validity of inferences about the effects of treatment. Osteopaths have participated in one course on the study protocol and processes pre-participation and will take an e-learning course on the biopsychosocial management of patients with low back pain after the first patient recruitment stage. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period. Conclusion. This experimental design will offer osteopaths in practice the opportunity to engage in research evaluating the effectiveness of osteopathic care and the influence of a training programme to augment biopsychosocial osteopathic care. Study registration: . https://clinicaltrials.gov/ct2/show/NCT05120921. Sources of funding: The Osteopathic Foundation. Conflict of interest: The authors declare no competing interests. Previous publication of work: This protocol is under review with a peer-reviewed journal

Purpose of Study and Background. Population ageing will facilitate an increase in health problems common in older adults, such as musculoskeletal conditions. Musculoskeletal conditions are the fourth largest contributor to disease burden in older adults; affecting quality of life, physical activity, mental wellbeing and independence. Therefore primary care health services must provide appropriate and efficacious management and treatment. However there are a number of complexities specific to older adults that are essential to address. Methods and Results. In order to identify these complexities, a review of the background literature was undertaken in addition to a Patient and Public Involvement and Engagement (PPIE) session. The PPIE group consisted of eight older adults who experience chronic musculoskeletal pain. This session was used to discuss and explore what factors are important to consider in GP consultations for musculoskeletal pain for older adults, in addition to those identified through background literature. A number of factors were highlighted through these methods, including the difference in mood and aspirations for older adults; taking a holistic approach; the impact of comorbidities; whether the GP is listening and ‘on the same wavelength’, and older adults' expectations regarding their pain and the consultation. Conclusion. Management of musculoskeletal pain for older adults in GP consultations is complex due to a range of factors, reinforcing the importance of taking a holistic approach. The impact of these factors upon the experience and outcomes of GP consultations will be further explored through in depth interviews with older adults with musculoskeletal pain. Conflicts of interest. No conflicts of interest. Sources of funding. This PhD is funded as part of an ACORN studentship awarded by Keele University. This PhD is nested within the Treatment for Aches and Pains Study, funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (grant number: RP-PG-1211-20010)

Background. Psychosocial (PS) factors have been described as the combination of the individual's cognitive, emotional and social status and they play an important role in the development and recovery from chronic low back pain (CLBP). The aims of the study where to explore/describe physiotherapists' personal beliefs and knowledge in relation to the assessment of PS factors in patients with CLBP in Italy. Methods and results. A qualitative research design with a constructivist grounded theory approach was used for semi-structured interviews and data collection/analysis. A purposive sample of eight physiotherapists practicing in Italy and having experience with patients presenting chronic musculoskeletal problems were recruited from private clinics. Three main categories were constructed:. 1). Conceptions of the biopsychosocial model and its role in CLBP;. 2). Evaluation and management of PS factors;. 3). Barriers in the assessment and treatment. The study revealed partial identification of these factors, limited understanding of the role they play in CLBP and lack of standardization in this area within the manipulative physiotherapy profession. Conclusions. Physiotherapists showed basic knowledge of the biopsychosocial model and partially recognized social, emotional, cognitive and psychological factors and their contribution in patients' pain and disability. Physiotherapists highlighted the presence of barriers in the evaluation and treatment of people with CLBP, and some participants displayed lack of skills to overcome these barriers. Physiotherapists perceived limited education and training to successfully address PS factors in the management of patients with CLBP, indicating the need to incorporate the biopsychosocial model in the daily practice and improve the training and education of the psychosocial assessment and management. Conflicts of interest: None. Source of funding: None

Background. Osteoarthritis (OA) and chronic low back pain (CLBP > 12 weeks duration) are two of the most common and costly chronic musculoskeletal conditions globally. Healthcare service demands mean that group-based multiple condition interventions are of increasing clinical interest and a priority for research, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions concurrently. Rapid review methodologies are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions. Methods. The electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched from the earliest date possible to August 26. th. 2013. Structured group-based interventions that aimed to promote self-management and that were delivered by health-care professionals (including at least one physiotherapist) involving adults with OA and/or CLBP were eligible for inclusion. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers. Results. 22 studies were found (10 OA, 12 CLBP). The most commonly assessed outcomes were pain, disability, quality of life and physical function. No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual general practitioner care for any outcome. Conclusion. GPSMI is as clinically effective as individual physiotherapy, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications. Conflicts of interest: No conflicts of interest. Sources of funding: This review was conducted as part of Health Research Award HRA_HSR/2012/24 from the Health Research Board of Ireland

Background. A proportion of patients with low back pain fail to respond to conventional medicine, physical therapy or surgery. Neurophysiological changes occur in chronic pain and research shows that Mindfulness and ‘3. rd. wave’ Cognitive Behavioural Therapy can help patients with long-term musculoskeletal conditions to live more actively, despite pain. This paper describes the development of the three year ‘OsteoMAP’ project (Osteopathy, Mindfulness and Acceptance Programme) to expand the scope of primary care by integrating these psycho-educational interventions into osteopathic practice. Methods. A before and after design is being used. Patients with disabling pain for more than six months attend a course of six, individual, one hour sessions, integrating mindfulness and acceptance-based exercises with manual therapy. Questionnaire data collected at the course start and after six months, analysed by an independent group, includes pain-related behaviour (Bournemouth Questionnaire), quality of life (EQ5D), self-efficacy (PSEQ) and mindfulness (MAAS). Results. The project started in June. Follow-up data is not yet available. Qualitative data from a pilot study will be presented. It supports the preliminary hypothesis that touch and osteopathic techniques combined with psycho-education and mindful movement may increase patients' embodied awareness, promote active self-management, and guide more patient-centred manual interventions. Conclusion. Despite the challenges of balancing practitioner-led manual therapy treatment with more collaborative acceptance-based interventions which aim to empower patients' active self-management capabilities, there appear to be potential benefits in expanding the scope of community-based healthcare for patients with long-term low back pain that is unlikely to be resolved by physical interventions alone

The widespread use of MRI has revolutionised the diagnostic process for spinal disorders. A typical protocol for spinal MRI includes T1 and T2 weighted sequences in both axial and sagittal planes. While such an imaging protocol is appropriate to detect pathological processes in the vast majority of patients, a number of additional sequences and advanced techniques are emerging. The purpose of the article is to discuss both established techniques that are gaining popularity in the field of spinal imaging and to introduce some of the more novel ‘advanced’ MRI sequences with examples to highlight their potential uses.

Cite this article: Bone Joint J 2015;97-B:1683–92.