Background. There is concern that a sedentary lifestyle in childhood is harmful to spinal health. The literature stands divided, as there are reports also of an increased injury rate in children who are physically active. Children cannot be expected to remember correctly amount of physical activity in the past nor can they remember correctly past events of backpain. We therefore used a new method, SMS-Track, to collect weekly data over a long period of time. Methods and material. In a prospective Danish study, the effect of increased physical activity was tested vs. “business-as-usual” in 10 primary schools. We collected data on time spent on physical activities and any backpain in the preceding week. For this we sent the children weekly text-messages, to which the children/parents responded with a text-message as well. If the child reported having had any backpain during the preceding week, the parents were contacted, the child seen by a health professional, and treatment initiated if necessary. Results. Compliance for responding to the text-messages was 92%. The total risk time was 35,238 weeks for the participating 1208 children. As the assumption for proportional hazards was not met, negative binomial regression was used to test the association between level of physical activity and incidence of backpain. In addition, we adjusted for age, school and grade level and used robust standard errors. Adjustment for clustering in the school classes was also made. Sport participation reduced the incidence rate significantly with 0.08 for each day with organised sport after school. Conclusion. These interim analyses indicate that sport participation is protective, reducing the risk of reporting backpain in childhood

Purpose. The purpose of this study was to discover if student led clinics (SLC) are feasible delivery mechanisms for Low back pain (LBP) self-management support and to develop a service model. Background. LBP is the most commonly reported musculoskeletal disorder worldwide. The increasing service and workforce demands of LBP are challenging for providers and policy makers. self-management is appropriate for many people living with LBP yet guidance for self-management is lacking. One potential delivery mechanism is through SLC. These are ‘clinics’ run by students, supervised by clinicians. Methods and Results. A scoping review has found that SLC can be effective for supporting self-management of various long-term conditions and can provide cost benefits compared with traditional clinical services. In principle, their use for providing LBP services could have similar advantages as well as mitigating the clinical placement shortage. A further scoping review of self-management support for LBP was used to develop a model for student-led LBP clinics. The proposed model is a student led LBP supported self-management service. The service users will be triaged using the Psychosocial Flags Framework to identify obstacles to participation, followed by 1–6 sessions of self-management support comprising of; 1) empathetic listening and education to build a therapeutic relationship and to dispel LBP myths; 2) collaboratively setting meaningful goals; 3) imparting knowledge and skills to overcome the identified obstacles; 4) developing an evidence-informed plan for self-management, agreed with relevant stakeholders. Conclusion. Previous experience and the evidence-base suggest that SLC are feasible for delivering self-management support for LBP. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Background. Emerging research has indicated that ‘significant others’ (spouses/relatives) may have important influences on continued work participation for individuals with chronic non-specific musculoskeletal pain (CMP). In order to expand on this novel area of research, data from studies conducted in The Netherlands and the UK were assimilated. Method. In both studies, worker and significant other perceptions of pain self-efficacy, perceived partner responses to pain, pain catastrophizing, and contribution to work participation were explored in relation to the worker's CMP. In the Netherlands, questionnaire data were collected from workers with CMP and their significant others (n=103), and in the UK, in-depth semi-structured interviews were conducted (n=10). Appropriate quantitative and qualitative analysis techniques were applied. Results. In the Dutch study, moderate to high levels of perceived pain self-efficacy, moderate levels of significant other solicitous and distracting responses, and low levels of significant other punishing responses and catastrophizing were reported by both significant others and workers. Significant others were viewed as crucial in helping maintain continued work participation by workers with CMP. Overall group averages indicated no significant differences, with the exception of greater pain catastrophizing reported by significant others (14.4 versus 11.1 p<0.01), although this was not deemed clinically relevant (ES=0.34). Qualitative data from the UK study supports these findings, further elaborating on the above concepts. Conclusions. This study adds further weight to the evidence which recognizes the importance of social context for successful pain management and vocational rehabilitation interventions. Conflicts of interest: No conflicts of interest. Sources of funding: Funded by Instituut Gak and the BUPA foundation

A statement of the purposes of the study and background. Lower back pain (LBP) is one of the ten leading causes of disease burden globally, producing significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and pain prevalence. The effectiveness of a locally run ‘Back to Fitness Programme’ (6-week education and exercise programme) in the most deprived local authority area in England was evaluated. A summary of the methods used and the results. Patients at Blackpool Hospitals NHS Trust over a 6-month timeframe were included. Initial data were collected from 49 patients (mean age 53.4 years, 67% female). The amount of final data collected varied per outcome measure due to a range of factors. Participants reported the programme had helped with their understanding of pain (n=16, 100%), ability to move around and function (n=15, 94%), and level of pain (n=14, 88%). Looking at Roland Morris Disability Questionnaire scores (n=17), 88% (n=15) of patients indicated a reduction (n=12, 71%) or no change (n=3, 18%) in perceived disability. The Pain Self Efficacy Questionnaire (n=18) showed that 78% (n=14) of participants perceived an increase in their average level of confidence to move despite pain. There was an overall improvement in understanding of pain reflected by Revised Neurophysiology of Pain Questionnaire scores (n=44): 89% (n=39) improved (n=36, 82%) or did not change (n=3, 7%). Regarding lumbar flexion post-programme (n=17), 77% (n=13) of participants demonstrated an improvement (n=9, 53%) or no change (n=4, 24%). Conclusion. The majority of clinical outcomes improved following participation, predominantly in relation to understanding of pain. Conflicts of interest: No conflicts of interest. Sources of funding: This study is supported by The University of Central Lancashire in partnership with The Blackpool Teaching Hospitals NHS Foundation Trust

Introduction. A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine Cohort will provide a 10-year prospective insight into the burden of CLBP for patients referred to multispecialty tertiary spine care in the Netherlands. This study reports first baseline results. Objective. To study the personal and societal impact of CLBP in patients visiting the UMCG tertiary spine center. Patients. Adult patients with CLBP. Methods. Patient-reported baseline questionnaire and health insurance costs one year prior to visiting the Spine Center. Primary outcomes: NIH minimal dataset Impact Stratification score (range 8–50), functioning (Pain Disability Index, PDI; 0–70), quality of life (EuroQol-5D, EQ5D; -0.33–1.00), work ability (single-item Work Ability Score, WAS; 0–10), work participation (absenteeism, disability), and health insurance costs. Descriptive statistics were applied. Results. N=1503 patients (age m=46.3, sd=12.8 years, 57% female) were included. NIH Impact Stratification m=35.2±7.5; severe impact (≥35) for 58% of patients. PDI = 38.2±14.1; EQ5D = 0.44±0.30; WAS = 3.8±2.9. Absenteeism: 43% of workers. Permanent work disability: 17%. Health insurance costs: med= €2432, IQR €4739. Discussion And Conclusions. In patients seeking multispecialty tertiary spine care, the personal and societal impact of CLBP is very high. Costs are substantially higher than what is already known about the burden of the average patient with CLBP. Clinical Message. More effective personalized stepped and matched care is urgently needed to reduce the burden of CLBP in a subgroup of patients seeking multispecialty tertiary spine care. No conflicts of interest. Sources of Funding: Funding from the University Medical Center Groningen

Aims

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

Aims

Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted.

Aims

We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences.

Aims

Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

Aims

The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion.

Background. Almost 80% of people experience low back pain at least once in their life. A quarter suffers from Nonspecific Chronic Low Back Pain (NS-CLBP), where symptoms cannot be justified radiologically. There is evidence that imaging negatively impacts outcomes (increased painkillers and doctors' visits) in NS-CLBP patients. Despite clinical guidelines recommending against the use of imaging, healthcare practitioners and patients still request imaging to explain symptoms. Method. Qualitative, semi-structured interviews with NS-CLBP patients, physiotherapists, and doctors conducted using purposeful sampling of 6–11 people from each group. The interviews were recorded, transcribed and analysed using framework analysis. Validity was ensured by data triangulation with participants. Results. Interviews with 11 patients who had an MRI scan, 6 physiotherapists and 6 spine surgeons. Four main themes emerged from synthesis of findings across these three groups. Discussion. This study provides an insight of the lived experience of NS-CLBP among three different groups. It highlights the difference in expectation between healthcare provider and patients about how CLBP should be managed and the lack of coordination between primary and secondary healthcare services. Although patients seek imaging to explain NS-CLBP, they react to the results negatively. In accordance with fear avoidance model, participants reported fear avoidance behaviours and anxiety following MRI. That affect daily life activities and participation. Conclusion. This study highlights the need for early management of NS-CLBP patients in primary care. The psychosocial consequences of diagnosing by MRI are fear avoidance and anxiety. The current biomedical education to those patients may promotes these consequences. Conflict of interest. No conflicts of interest. Study fund. This research was supported through a PhD scholarship from Prince Sattam bin Abdul-Aziz University, Saudi Arabia, at the University of Nottingham, United Kingdom

Background. Recruitment to time and target in clinical trials is a key challenge requiring careful estimation of numbers of potential participants. The SCOPiC trial ((HTA 12/201/09) (ISRCTN75449581)) is investigating the clinical and cost-effectiveness of stratified care for patients with sciatica in primary care. Here, we describe the approaches followed to achieve recruitment of our required sample size (n=470), the challenges encountered and required adaptations. Methods. We used recruitment data from the SCOPiC trial and its internal pilot, to show the differences between estimated and actual numbers of patients from consultation to participation in the trial. Patients were consented to the trial if they had a clinical diagnosis of sciatica (with at least 70% confidence) and met the trial eligibility criteria. Results. Initial recruitment estimates suggested we needed a source population of 146,000 adults registered at approximately 30 GP practices, and a monthly trial recruitment target of 22 patients per month over 22 months. The internal pilot trial phase resulted in revisions of these estimates to 256,000 and 42 GP practices. To date, 1,623 patients have been screened for eligibility and 450 randomised. The main reason for ineligibility is low confidence in the diagnosis of sciatica. Conclusion. Our experience highlights the challenge of recruitment to clinical trials of sciatica, particularly in terms of case definition, and the need for careful planning and an internal pilot phase prior to a main trial. We believe our experience will be helpful to others conducting trials with sciatica patients. No conflicts of interest. Funding. NEF is an NIHR Senior Investigator. KK is supported through a HEFCE Senior Clinical Lecturer award. The SCOPiC trial is funded by the National Institute for Health Research Health Technology Assessment Programme (NIHR HTA project number 12/201/09). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health

Background. Current policy and practice aimed at tackling work disability due to low back pain is largely aligned with the Psychosocial Flags Framework, which focuses on addressing individual beliefs and behaviours (yellow and blue flags). However, our understanding of the systemic and contextual factors (black flags) that are also proposed to act as obstacles within this Framework is under-represented, resulting in a disproportionate evidence base and suboptimal interventions. Methods. A ‘best-evidence’ synthesis was conducted to collate the evidence on those ‘black flags’ proposed to be the most important: compensatory systems (worker's compensation and disability benefits), healthcare provider systems and ‘significant others’ (spouse/partner/close family members). A systematic search of scientific and grey literature databases was performed, and the validity and merit of the available evidence was assessed using a system adapted from previous large-scale policy reviews conducted in this field. Results. Following a systematic exclusion process, 65 articles were selected from 1,762 records. Robust, credible and meaningful evidence was found to show that inflexible compensatory systems, a lack of ‘work-focused’ healthcare and communication amongst return-to-work stakeholders, along with inappropriate support from ‘significant others’ are obstacles to work participation for those with low back pain. Conclusions. This is the first attempt at synthesising the evidence on the ‘social’ factors proposed to be important influences on work disability due to low back pain within the Psychosocial Flags Framework. Results have relevance to researchers, policy makers, clinicians and employers, with wider implications for the revision of current psychosocial policy and practice. No conflicts of interest; no funding obtained

Aims

The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption.

Aims

Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse.

Aims

Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.

Purpose and background. Over two-thirds of pregnant women experience low back pain (LBP) that interferes with everyday activities, work and sleep. Acupuncture appears a safe, promising intervention but there are no high quality trial data, regarding its clinical or cost-effectiveness in comparison to standard care. Methods. EASE Back was a feasibility and pilot RCT designed to inform a full trial evaluating the addition of acupuncture to standard care for pregnancy-related LBP. In preparation for the pilot trial, phase 1 of EASE Back consisted of semi-structured interviews exploring the views of pregnant women, midwives and physiotherapists about pregnancy-related LBP, use of acupuncture, and participation in clinical trials. Transcript data were anonymised and analysed using thematic analysis. Three members of the team independently coded a sample of transcripts to develop the coding framework. Results. 17 women, 15 midwives and 21 physiotherapists were interviewed (total n=53). Findings highlighted the impact of LBP in pregnancy, the paucity of effective treatment options and the challenges of recruiting pregnant women with LBP into research. Women and midwives expressed few concerns over the use and safety of acupuncture; physiotherapists were more cautious and had concerns about safety. Conclusions. Acupuncture for pregnancy- related LBP appears to be acceptable to women and midwives. Future research needs to consider strategies to support recruitment and retention, and should consider including interviews with eligible women who decline to take part in order to understand their reasons, as well as with women receiving treatment so as to understand their experiences of taking part. This abstract has not been published in whole or substantial part, nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. This project presents independent research funded by the National Institute for Health Research's Health Technology Assessment Programme (Grant Reference Number 10/69/05) and an NIHR Research Professorship for N.E. Foster (NIHR-RP-011-015). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HTA or the Department of Health

Purpose of study. NICE recommends 8-9 sessions of non operative therapy for back pain that has lasted for 6 weeks but less than 12 months. NICE recommended exercises, manual therapy, acupuncture and suggested that Lumbar supports, TENS, Ultrasound and Traction should not be offered. Since multiple methods and disciplines were available a survey was conducted among the local General Practitioners to determine what non operative methods they preferred and how it matched with NICE's recommendation. Methods. An online survey was conducted on . www.surveymonkey.com. among the local GPs to determine their practice and preferences in investigating low back pain. The 5 questions in the survey were “rating scale questions” on a scale of 1 and 10, where 1 = DISAgree and 10 = Agree. A request to participate in the survey was sent to all the local General Practitioners by e-mail. Results. 25 General Practitioners participated in the survey. A sample of the scores obtained were as follows. Method of treatment. Mean Score. Mobilisation exercises. 8.20. Specific Core Stability Exercises. 8.13. Physiotherapy. 7.96. Pilates. 7.21. Attending a Gymnasium. 6.32. Medications. 6.20. Yoga. 6.18. TENS (Transcutaneous electrical nerve stimulation). 5.44. Acupuncture. 5.44. Chiropractory. 5.42. Osteopathy. 5.41. Massage. 4.73. Ultrasound. 3.43. Traction. 2.75. Lumbar support. 2.65. Conclusion. This limited study demonstrates that General Practitioners prefer patients to use active modalities of treatment like exercises which require participation of the patient rather than passive methods of treatment like lumbar support and massage. The choices of the GPs are nearly in tune with the recommendations of NICE with some exceptions. TENS (not recommended by NICE) obtained a better score than Acupuncture (recommended by NICE)

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 coping pathways in response to CLBP

Aims

To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.