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.

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 coping mechanisms which may affect success with SMS. This study aimed to determine Patient and Physiotherapist's perceptions of coping responses and SMS in patients with LBP. Methods. Patient completed a Pain Coping strategies questionnaire, before and after LBP treatment. Semi-structured interviews gathered data from of 10 patients (6 males; and 6 physiotherapists. Questionnaire data was described descriptively, and qualitative data was transcribed/analysed thematically. Results. 5 patients were categorized as ‘active copers’ and 5 as ‘passive copers’ before treatment. SMS success appeared to be impacted by patient coping strategies they adopted. Spiritual religious coping strategies linked to cultural beliefs was a common strategy for all patients. However, the active copers were more likely to engage with active strategies compared to passive copers. All patients felt they had not received full education/details about the home exercises. One patient became an ‘active coper’ following treatment demonstrating high self-confidence to self-manage pain and accepted exercises as a lifestyle. Physiotherapists did not use a valid method for screening purposes for coping, although they referred to ascertaining this verbally and they did tailor exercises differently for passive and active copers. Conclusion. Screening for individual coping strategies would enhance targeting treatments and all patients would benefit from full exercise programmes for self- management and pain self-efficacy approaches to change patients ‘behaviour and enhance patients’ self-confidence. Conflicts of interest: No conflicts of interest. Sources of funding: The study is sponsored by Kuwait Government

Background. Free From Pain (aka Fear Reduction, Exercise Early with Food from plants, Rest and relaxation, Organisation and Motivation to decrease Pain from Arthritis and Increase Natural Strength) is a functional rehabilitation programme to combat sarcopenia and musculoskeletal pain in seniors. It is also published as a book (ISBN-0995676941). The aim of this audit was to evaluate the safety and suitability of the exercises and the usefulness of the exercise book. Methods and Results. Participants were volunteers who paid to attend the Free From Pain Exercise programme. Participants evaluated the exercises using a 5-point Likert scale and the Exercise Book using the Usefulness Scale for Patient Information Material (USE). 30 participants attended the Free From Pain programme. 26 participants completed the questionnaire. This included 20 females and 6 males, with a mean age of 76 years. The mean scores on the 0 to 5 Likert scales were A) Exercises were suitable? 4.69; B) Exercises were safe? 4.58; C) Absence of any injury or medical event whilst exercising? 4.58; D) Covered all body parts? 4.38; E) Easy to do at home? 4.42; F) Encouraged to do more exercise? 4.42; G) Recommend to family and friends? 4.50. The mean scores of the cognitive, emotional, and behavioural sub domains of the USE scale, scored 0 to 30, were 25.23, 23.73 and 23.69, respectively. Conclusion. The pre-pilot study suggests that the suggested exercises are safe and suitable for seniors, and that the exercise book is holistically useful. Conflict of Interest: G Ampat sells the Free From Pain Exercise book online through Amazon and other platforms. S Rhodes and J Sims are employed by Talita Cumi Ltd, of which Free From Pain is a trading name. Jacqueline Howard is a medical student and has no conflict of interest. Sources of funding: No funding was obtained

Purpose of the study and background. The preliminary study aimed to establish clinical and research expert opinion with regards to the key components of an assessment of a person with Mechanical Low Back Pain (MLBP). We aimed to identify the key subjective questions and objective tests which would be helpful for clinicians to develop the most appropriate self-management exercise programme. This is the first part of the study to develop the ‘Back-to-Fit’ digital tool offering personalised self-management exercise solutions for people with MLBP. Summary of the methods. A Bristol online survey which included a questionnaire with a series of open and closed questions was developed using the literature and was distributed among clinicians/researchers with a background in the clinical management of MLBP. The questionnaire included 6 demographic questions followed by sections related to subjective questions and objective tests of the MLBP assessment. 71 participants responded to the survey. Results. In the subjective assessment component, ≥80% level of agreement was obtained for 17 of 26 proposed subjective questions and 05 of the 21 suggested objective tests. Two more questions and two objective tests to be included in the assessment had been suggested by the partcipants. Conclusion. These expert agreements on questions and opinions provides an indication of the key subjective and objective components to be included in a self-assessment tool in a personalised self-management platform for MLBP. Further testing with a multiple round Delphi study in a large sample of experts is now required to obtain consensus for the above findings. Conflicts of interest: No conflicts of interest. Sources of funding: Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, UK

Background. Exercise can be effective in treating Chronic Low Back Pain (CLBP) (Hayden et al 2005). Pilates-based group exercise programmes may be useful in the treatment of CLBP. Aim. To carry out a feasibility study of group Pilates exercise course compared to individual physiotherapeutic intervention and a waiting list control, in the treatment of CLBP. Methods. 52 Patients with CLBP: referred for physiotherapy were randomly assigned to: (1) Conventional physiotherapy for 6 weeks; (2) 6-week course of Pilates group exercise; (3) Waiting list control. Outcome measures were; RMDQ, VAS for pain and SF-36 quality of life questionnaire; completed at baseline, seven weeks and three months. Results. Although the study was successful in recruiting patients, loss to follow up (25% at 7 weeks; 40% at 3 months) and patient adherence with treatment was a problem. Conclusion. Stricter inclusion criteria may be required in studies of this type defining, duration of symptoms, number of episodes of pain and upper age limit. A change in RMDQ score was used to calculate the power for a main RCT. 334 patients per group would allow for a 40% loss at follow-up

Aims

The aim of this study was to compare the effect of a percutaneous radiofrequency heat lesion at the medial branch of the primary dorsal ramus with a sham procedure, for the treatment of lumbar facet joint pain.

Osteoporotic vertebral compression fractures (VCFs) are an increasing public health problem. Recently, randomised controlled trials on the use of kyphoplasty and vertebroplasty in the treatment of these fractures have been published, but no definitive conclusions have been reached on the role of these interventions. The major problem encountered when trying to perform a meta-analysis of the available studies for the use of cementoplasty in patients with a VCF is that conservative management has not been standardised. Forms of conservative treatment commonly used in these patients include bed rest, analgesic medication, physiotherapy and bracing.

In this review, we report the best evidence available on the conservative care of patients with osteoporotic VCFs and associated back pain, focusing on the role of the most commonly used spinal orthoses. Although orthoses are used for the management of these patients, to date, there has been only one randomised controlled trial published evaluating their value. Until the best conservative management for patients with VCFs is defined and standardised, no conclusions can be drawn on the superiority or otherwise of cementoplasty techniques over conservative management.