Background. Chronic musculoskeletal pain increases an individual's risk of developing many chronic diseases and the risk of all-cause early mortality. There is irrefutable evidence supporting the role of physical activity (PA) in reducing these risks. Sustaining changes to PA behaviours is challenging and efforts are needed to understand the barriers and facilitators of change. Understanding these factors is a vital step in developing behaviour change interventions. Objectives. Explore barriers and facilitators to engaging in PA in adults accessing pain services. Explore barriers and facilitators to promoting PA by healthcare professionals, exercise professionals and charity staff/expert patients. Methods. A qualitative study using the theoretical domains framework (TDF). Two focus groups were conducted with service users (n=18). Three focus groups were held with; healthcare professionals (n=8); exercise professionals (n=6) and charity staff/expert patients (n=8). Two independent reviewers thematically analysed transcripts. Barriers and facilitators were subsequently coded according to the domains of the TDF. Results. For all groups barriers were frequently mapped to the domain ‘environmental context and resources’. Although there was variation across the groups, barriers were also frequently mapped to the domains of ‘knowledge’, ‘beliefs about consequences’, and ‘belief about capabilities’. For service-users' facilitators were frequently mapped to ‘social influences’. Conclusion. The TDF was used to identify deficits that are likely to influence behaviours; targeted intervention strategies have been developed to specifically target these deficits. The interventions that have been developed consider not only the behaviour of those at whom the intervention is targeted, but also those involved in its delivery. No conflicts of interest. Sources of funding: This research was funded by the Public Health Agency, HSC R&D Division through a Doctoral Fellowship awarded to J Marle

Introduction. Scoliosis surgery is a life-changing procedure, but not devoid of perioperative complications. Often patients' scoring systems do not cover their real-life needs, including return to pre-surgery activity. Return to school, physical education (PE) is an important indirect marker of recovery. Although anterior spinal fusion (ASF) may have advantages, compared to posterior spinal fusion (PSF), because of motion-saved segments, there is a paucity of literature about post-operative return to school/PE in the compared groups. Aim. To determine the recovery time for patients with scoliosis who underwent anterior spinal fusion (ASF) and posterior spinal fusion (PSF). Design. Prospective cohort. Methods. Patients undergoing Adolescent Idiopathic Scoliosis (AIS) surgery from 2018–2019, were examined. We excluded no-AIS and over 18y patients. The Scoliosis Sports Survey validated questionnaire was administered post-operatively regarding return to school, PE and other physical activities. ASF and PSF groups were subcategorised into: Selective Anterior Thoracic Fusion (SATF), Thoracolumbar Fusion (TLF), Short Posterior Spinal Fusion (SPSF) and Long Posterior Spinal Fusion (LPSF) procedures. Hospital length of stay (HLOS) and ICU LOS were recorded. Results. A total of 81 patients were contacted and 43 responded to the survey. The different procedures, return to school / PE, HLOS / ICU LOS, costoplasty are all analysed as shown below in Table 1. Conclusions. Anterior and posterior fusions had similar return to school rates at 1–3 months. The TLF and 2-stages groups returned to school the quickest, whilst the SATF had the longest return time. PSF patients returned to PE faster than ASF. Costoplasty, did not affect return time to school and PE. Further research assessing shorter fusions benefits should be conducted. For any figures or tables, please contact the authors directly

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

Background:. Internet interventions provide an opportunity to encourage patients with LBP to self-manage and remain active, by tailoring advice and providing evidence-based support for increasing physical activity. This paper reports the development of the ‘SupportBack’ internet intervention, designed for use with usual primary care, as the first stage of a feasibility RCT currently underway comparing: usual primary care alone; usual care plus the internet intervention; usual care plus the internet intervention with physiotherapist telephone support. Methods:. The internet intervention delivers a 6-week, tailored programme focused on graded goal setting, self-monitoring, and provision of tailored feedback to encourage physical activity/exercise increases or maintenance. 22 patients with back pain from primary care took part in ‘think aloud’ interviews, to qualitatively explore the intervention, provide feedback on its relevance and quality and identify any extraneous content or omissions. Results:. Valuable feedback and suggested amendments from patients included individually-tailoring the activity programme, using the individual's current pain or activity level. Patients reported that the goal setting module was helpful, and were content with the range of activities offered by ‘SupportBack’. The majority of patients reported they would accept their GP's recommendation and use a credible internet intervention such as this programme to help improve self-management. Conclusions:. The development of the ‘SupportBack’ internet intervention has worked with patients to create an acceptable online tailored resource to supplement primary care management for patients with low back pain. The intervention is currently being trialled to determine feasibility and the most appropriate way to support its delivery

Background. There is an increasing burden of LBP. Clinical guidelines promote physical activity (PA) and self-management strategies and aim to reform unhelpful clinical activity. This study explores osteopaths' beliefs about non-specific low back pain (NSLBP) and the role of activity in the treatment of NSLBP. Methods. Semi-structured interviews were conducted with a purposive sample of twelve qualified osteopaths in the UK. Interviews were transcribed verbatim and constructivist grounded theory was used to conceptualise, collect and analyse data. Results. Four categories; practitioners' beliefs and mode of practice, PA interventions used, challenges and obstacles to promoting activity and strategies used in practice; conceptualised three practitioner styles. Variation was reported in the management of NSLBP, perceptions of successful PA interventions and strategies used in practice. Perceived obstacles to PA were identified. A proposed model highlights how different practitioner styles adopted a biomedical or behavioural orientation towards NSLBP, leading to different approaches to behavioural change strategies and self-management in the treatment of NSLBP. Conclusion. There are opportunities for educational programs to enhance competencies in exercise prescription and activity promotion, and knowledge of behavioural change strategies to promote self-management in NSLBP. Further quantitative research is recommended to measure osteopaths' attitudes and behaviour related to activity promotion and to test clinical effectiveness of related interventions. No conflicts of interest. No funding obtained

Background. Advice to stay active should be delivered to all patients with low back pain (LBP) without a serious underlying condition. However, some patients still believe that the avoidance of activities will help them to recover. These patients may be less likely to experience favourable outcomes. Purpose. To investigate how many patients consider LBP to be a signal to stop being active. Methods. This was a cross sectional study involving adults with LBP referred from general practices to the Spine Centre at Silkeborg Regional Hospital, Denmark. Patients who completed a routinely delivered electronic questionnaire prior to initial consultation were considered for inclusion. Patients were excluded if serious pathology was suspected. Included patients replied to additional socio-demographic questions, attitudes to spinal imaging, and beliefs about LBP. The question: ‘if pain is increasing, it is a warning signal to stop with my physical activities until pain is decreasing’ from 0 to 10. Scores of 0–5 were coded as ‘disagree’ and scores of 6–10 were coded as ‘agree’. Results. 826 consecutive patients were included during 2017. Mean age was 52.7 years (SD 13.8) and 458 (55.5%) were women. 749 (90.7%) had chronic LBP, the mean NPR was 5.2 (SD 2.5), and the mean RMDQ score was 14.0 (SD 4.9). 605 (73.2%) agreed that pain is a warning signal to stop being active and 727 (88.1%) considered MR scans and x-rays to be important for their recovery. Conclusion. Patients with LBP patients frequently hold erroneous beliefs that may be detrimental for recovery. No conflicts of interest. No funding obtained

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 coping. Conclusion. CB-CFT/G is feasible, brings benefits to NSCLBP patients and meets with high levels of satisfaction. Long term effects are currently being evaluated

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)

Purpose of the study and background. Physical activity and exercise therapy are among the guideline recommendations for the rehabilitation of people with chronic low back pain (CLBP ≥ 3 months); however, patient adherence is often poor. CONNECT is a theory-based communication skills training programme designed to enhance physiotherapists' support of their CLBP patients' psychological needs in order to increase adherence to their home-based rehabilitation programme. Methods and results. The CONNECT trial [Current Controlled Trials ISRCTN63723433] included six Dublin-area public clinics and their physiotherapists (n = 24) who received eight hours of communication skills training from a psychologist [experimental group] and physiotherapists (n = 26) from six equivalent clinics who formed a treatment as usual pragmatic control condition. New patients (n = 255, 54% female) diagnosed with CLBP and receiving physiotherapy at one of these clinics completed ratings of home-based adherence at 1, 4, 12, and 24 weeks after their initial treatment session; 24 weeks was the primary endpoint. Due to the nature of the intervention, physiotherapists were aware of treatment allocation; patients and assessors were blinded. Intention to treat analysis using a linear mixed model approach indicated that patients in the experimental group rated their home-based adherence significantly higher than patients in the control condition across time-points (P = .01), but the difference was not significant at the 24-week follow-up (P > .05). Conclusions. The CONNECT intervention had a positive effect on patients' self-rated adherence to home-based rehabilitation for CLBP, but the impact was not maintained over 24 weeks. Further analysis from the CONNECT trial will investigate its effects on pain and function, as well as hypothesised mediators of change

Background. The incidence of backpain is unknown in children because studies have been cross-sectional or longitudinal with few follow-ups of long intervals. Children cannot be expected to remember past events of backpain correctly. Therefore data-collection must be undertaken with short intervals and using other methods than questionnaires only. Methods and material. The 1208 children from grade 0 to grade 4, who participated in an intervention study (increased physical activity vs. “business-as-usual”) were followed with standardized questions submitted with weekly text-messages (SMS-Track). If they answered “yes” to backpain in the past week, their parents were called up, and the child was seen in person by health personnel. “Backpain” included any type of spinal pain. Results. Our interim analyses show that compliance was 92% for responding to text-messages. Over the total risk time of 35,238 weeks, 576 reported backpain at some time (individual range 0 to 11). The incidence ratio for gender was 0.72 for boys. The 2. nd. to 4. th. school-grades had significantly higher incidence ratios (1.4-2.1) when compared to grades 0 and 1. Conclusion. The results of these analyses show that it is possible to collect weekly incidence data on backpain in children. It was found to be surprisingly high

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 coping style and had a patho-anatomical view of their disorder compared to individuals with CLBP-low disability. Conclusion. While participants with CLBP have adequate S-TOFHLA scores, qualitative data revealed barriers in seeking, understanding and utilising LBP information

Background and purpose. Trajectories of change over time can illustrate the course of pain. Back pain trajectories have previously been identified among adults. Understanding different patterns of back pain among adolescents could shed light on how persistent back pain develops. We aimed to identify and compare trajectories of back pain among adolescents in the general population. Methods and results. This prospective cohort study followed 1,336 adolescents (initially aged 11 years) every three months for three years, using self-completion questionnaires. Latent class growth analysis was used to cluster subjects into distinct trajectories of back pain. Six clusters were identified. Most subjects (78%) had very low likelihood of back pain throughout follow-up. The second largest cluster (10%) had relatively low and falling probability of back pain. Two clusters (4% each) showed increasing probability of back pain. One cluster had a peak likelihood of pain around age 13 (2%). The smallest cluster (1%) had very high probability of back pain throughout follow-up. The more painful trajectories had significantly fewer males, higher levels of depression and somatization, and lower life satisfaction at baseline, but differed little in physical activity or BMI. Conclusions. Over a fifth of adolescents had trajectories indicating back pain, but a minority had persistent pain problems. Poorer baseline psychological status and female gender were linked with more frequently experienced pain. Trajectories indicating rising or persistent pain might be illustrating the beginning of a long-term pain problem. Headache, facial pain and stomach pain trajectories were also identified in this sample; findings were similar to back pain

Aims

To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set.

Aims

To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod.

Aims

To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management.

Aims

With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values.

Aims

Idiopathic scoliosis is the most common spinal deformity in adolescents and children. The aetiology of the disease remains unknown. Previous studies have shown a lower bone mineral density in individuals with idiopathic scoliosis, which may contribute to the causation. The aim of the present study was to compare bone health in adolescents with idiopathic scoliosis with controls.

Aims

Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB.

Aims

Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness.

Objectives

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls.