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Purpose
To describe the frequency of different patterns of pain response and their association with outcomes (prognosis) and MRI findings in patients experiencing sciatica.
Methods
176 consecutive consenting patients with radicular pain underwent an MRI and a clinical assessment at baseline using a standardized procedure of repeated lumbar movements and positioning guided. Based on their pain response, patients were divided into five groups: abolition centralization, reduction centralization, unstable centralization, peripheralization, and no effect on pain.
Purpose
To compare the effectiveness of the McKenzie method and spinal manipulation when used adjunctive to information and advice for patients with clinical signs suggestive of disc-related symptoms for duration of more than 6 Weeks.
Background
The conclusions drawn from previous randomised studies have been contradictory. The need for studies testing treatment strategies to specific diagnostic subgroups has been emphasised.
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.
Background
Patient preferences have been shown to be associated with treatment effects (
Aim
To determine the treatment preferences of LBP patients and whether these affect clinical outcome.
Purpose and background
Although low back pain (LBP) with leg pain, is considered by most a poor prognostic indicator, it is at the same time believed to have a favourable natural resolution, and is often treated along similar lines to non-specific LBP, in line with current guidelines. It is unclear whether patients with LBP and leg pain are a distinct subgroup that might benefit from early identification and targeted interventions. We set out to investigate the impact of LBP with leg pain on health outcomes and health resources compared with that of LBP alone, and to explore which factors contribute to the observed disability outcomes.
Methods
A systematic literature search of all English language peer reviewed publications was conducted using Medline, EMBASE, and CINAHL for the years 1994 to 2009.
Aims/background
Current treatment recommendations advocate various exercise modalities for people with chronic Low Back Pain (cLBP)
Methods
A systematic review was undertaken to examine the effectiveness of walking interventions across a range of chronic musculoskeletal pain conditions, including LBP. Six electronic databases were searched for relevant studies. Data for pain and self reported function were extracted and where appropriate, results were pooled and analysed using RevMan (v.5).
Background and purpose
Sleep disturbance is frequently reported by people with chronic low back pain (CLBP >12 weeks), but there is limited knowledge of their sleep quality compared to healthy people. While disturbed sleep influences patients' mood, quality of life and recovery, few studies have comprehensively investigated sleep in CLBP. This study investigated differences in sleep profiles of people with CLBP, compared to age- and gender matched controls over seven consecutive nights.
Methods
Thirty-two consenting subjects (n=16 with CLBP, n=16 matched controls), aged 24-65 years (43.8% male) underwent an interview regarding sleep influencing variables (e.g. mattress firmness, caffeine consumption), completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, SF36-v2, Hospital Anxiety and Depression Scale, and CLBP measures (i.e. Oswestry Disability Index and Numerical Pain Scales), recorded seven consecutive nights of sleep in their home using actigraphy, and completed a Devices Utility Questionnaire.
Background and purpose
Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of physiotherapy for this problem. This study evaluated the feasibility of a randomised controlled trial (RCT) exploring the effects of physiotherapy on sleep disturbance in CLBP [Current controlled trial ISRCTN 54009836].
Methods
A sample of 60 consenting patients with CLBP [23 M, 37 F; mean (SD) age = 44.93 (13.41) years] were recruited in Beaumont Hospital, Dublin and randomly allocated to one of three groups [supervised exercise class (SEC), walking programme (WP) and usual physiotherapy (UP)] in a concealed manner. The main outcomes were sleep quality, functional disability, pain, and quality of life at baseline, 3 and 6 months.
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 Coping Strategies Questionnaire (CSQ), and the Fear-Avoidance-Beliefs Questionnaire (FABQ).
Methods
Questionnaires were handed out to LBP patients aged 18 – 65 years in 19 chiropractor clinics during a 4 weeks period. Patients were anonymous and returned the completed forms in a sealed envelope. Associations between the risk groups and MDI, CSQ, and FABQ were tested by means of linear regression.
Purpose of study and background
This systematic review sought to determine the efficacy of such targeted treatment in adults with non-specific low back pain (NSLBP).
Many clinicians and researchers believe that tailoring treatment to subgroups of NSLBP positively impacts on patient outcomes.
Method and results
MEDLINE, EMBASE, Current Contents, AMED, the Cochrane Central Register of Controlled Trials, reference list searching and citation tracking. Inclusion criteria were randomised controlled trials of targeted manual therapy and/or exercise for NSLPB that used trial designs capable of providing robust information on targeted treatment (treatment effect modification) for the outcomes of activity limitation and pain. Included trials needed to be hypothesis-testing studies published in English, Danish or Norwegian. Method quality was assessed using the Cochrane Back Review Group criteria.
Four high-quality trials of targeted manual therapy and/or exercise for NSLBP met the inclusion criteria. One study showed statistically significant effects for short-term outcomes using McKenzie directional preference-based exercise. Other included studies showed effects that might be clinically important in size but were not statistically significant with their samples sizes, as research into subgroups requires much larger sample sizes than traditional two-group trials.
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.
Background
It is generally acknowledged that low back pain (LBP) is a common condition already in childhood. However, not many studies have looked at the way LBP tracks over age and how common it is until early adulthood.
Purposes
The purposes of this presentation are to show the prevalence estimates at three different ages (9,13,15) and how the LPB reporting tracks over these age groups.
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.
Background
The prevalence estimates of LBP are so far well documented. However, only few longitudinal studies have described the variability of LBP in the same population over time. Therefore, little is known about the course of LBP at the individual level.
Purpose
The aim of this study was to describe changes in low back pain (LBP) reporting over an eight-year period in a cohort of adult Danes.
Purpose
To compare the contribution of physical, psychological and social indicators to predicting disability after one year between consulters with low back pain (LBP) of less than 3 months duration and more than 3 months duration.
Methods
Data from two large prospective cohort studies of consecutive patients consulting with LBP in general practices were merged, with disability measured by the Roland Morris Disability Questionnaire (RMDQ). There were complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow-up. Univariate and adjusted multivariate regression analyses of various potential prognostic indicators for disability at 12 months were carried out.
Background
Social context may be important in chronic pain. One focus is reactions to pain between persons with LBP and their partners. Researchers have investigated partner reactions and found influences on pain levels and psychological outcomes, but little is known about factors underpinning these reactions.
Aim
To investigate the associations of relationship quality and perceived partner responses with LBP intensity and disability.
Background
The clinical assessment of Chronic Low Back Pain (CLBP) is usually undertaken at a single time point at clinic rather than through continuous monitoring. To address this, a wearable prototype sensor to monitor motion of the lumbar spine and pelvis has been developed.
Sensor Development, Testing and Results
The system devised was based on inertial sensor technology combined with wireless Body Sensor Network (BSN) platform. This was tested on 16 healthy volunteers for ten common movements (including sit to stand, lifting, walking, and stairs) with results validated by optical tracking.
Preliminary findings suggest good agreement between the optical tracker and device with mean average orientation error (°) ranging from 0.1 ± 2.3 to 4.2 ± 2.6. The sensor repeatability errors range from 0 to 4° while subject movement variability ranged from 4% to 14%. Parameters of angular motion suggest greater movement of the lumbar spine compared to the pelvis with mean velocities (°/s) for lumbar spine ranging from 15.3 to 74.13 and pelvis ranging from 5.6 to 40.74. Further analysis revealed the extent to which the pelvis was engaged, as a proportion of the total movement. This demonstrated that the pelvis underwent smooth transitions from low (0.02), moderate (0.4) to high (0.99) use during different movement phases.
Background
The outcome of studies on back pain is usually measured at specific intervals (1 month, 3 months, etc.) However, because LBP is a recurring condition it would be more relevant to identify outcome in relation to course over time. A new data collection tool was recently developed (SMS-Track), allowing this to be done.
Aims
present the SMS-Track system give some examples of how the course pattern varies between patients with back pain.
Background and purpose
It is likely that the most common method for calculating a Roland Morris Disability Index (RMDQ) sum score is to simply ignore any unanswered questions. In contrast, the raw sum score on the Oswestry Disability Index (ODI) is converted to a 0-100 scale, with the advantage of allowing missing data to be accommodated by proportional recalculation. The aim of this study was to quantify the calculation error in RMDQ scores when one or more questions were unanswered and compare this with the error present when the ODI was scored in the same way.
Methods and results
The prevalence of unanswered RMDQ questions was measured in a research and a routine care setting. The accuracy of the RMDQ proportional recalculation method was measured using 311 fully completed RMDQ and matching ODI questionnaire sets. Raw sum scores were calculated, and questions systematically dropped. At each stage, sum scores were converted to a score on a 0-100 scale and the error calculated. Wilcoxon Tests were used to compare the magnitude of the error scores.
The prevalence of unanswered questions was 29.5% (RMDQ) in routine care, and 13.9% (ODI) and 20.3% (RMDQ) in a research project. Proportional recalculation was a more accurate method to calculate RMDQ sum scores than simply ignoring missing data.
Background and purpose
The prevalence of back pain has remained relatively constant in the population in spite of previous interventions. Persons with sub-acute back pain are assumed to benefit from extended multidisciplinary, interdisciplinary or transdiciplinary and multisectorial, intersectorial or trans-sectorial interventions as an alternative to traditional mono-professional interventions. The purpose of this health technology assessment (HTA) was to document the possible effect of such interventions in patients suffering from back pain of 4-12 weeks duration.
Methods and results
A systematic literature review is the overall basis for this HTA and the analysis of the interventions in relation to technology, patients, organization, and economics. HTA reports, systematic reviews, and recent primary studies were included. Further, primary data from Danish institutions (public and private) with experience in working with this technology were collected. There is moderate evidence that early multidiciplnary, interdisciplinary and transdiciplinary interventions are more effective than monodiciplinary interventions or no interventions in primary care. The effects are mainly seen in relation to reduced sick leave at or beyond 12-months follow-up and not in relation to reduced pain or improved function. The interventions appear to be cost-effective. Danish back centers mainly use sequential and/or parallel collaborative models.
Staying active, including walking is promoted as being beneficial for patients with low back pain (LBP). The abdominal muscles appear to influence the stability of the spine and their activity has been shown to change when patients have LBP. Walking with Nordic walking poles has been shown to influence forces on the lower limbs, but little research has investigated the effect on the trunk muscles. Aim: to study the effect of walking using Nordic walking poles on abdominal muscle activity and lower limb forces.
Method 15 healthy subjects gave informed consent (5 males. 10 females, age 21.06 yrs.(±88), height 174.45cms (±11.1), weight 71.44 kg (±15.2)). Following a period of walking training with Nordic walking poles data was obtained during a period of walking for internal IO) and external oblique (EO) using surface electromyography activity and vertical lower limb forces (Newtons, (N)) with (WP) and without Nordic walking poles (NP). SEMG data was normalised to maximum voluntary contraction.
Results
There were significant increases in IO (p=0.02, NP 31.94 (±39.9) WP 53.05 (±40.61)), EO (p=0.02, NP 46.45, (±30.9), WP 87.93 ± (±60.5)) and vertical forces with poles (p=0.008, NP871.6 (±237.00)N, WP 968.33, (±210.8) N).
Discussion
Using Nordic walking poles significantly increases activity of IO and EO, which may be of value in the rehabilitation of some patients with LBP. Vertical forces increased when walking with poles which is contrary to previous research. This may be due to the data collection setting of a research laboratory or the subjects being novice walkers.
Purpose of study
The Royal College of Radiology (RCR) provides guideline criteria to order lumbar spine X-rays for back pain. An audit was undertaken in our hospital to see compliance with this guideline.
Methods
200 lumbar spine radiology requests received in the hospital radiology department from General Practitioners over a 12 month period were identified. These 200 requests and their corresponding radiology reports were retrospectively analyzed.
Purposes of the study and background
MRI of the lumbar spine is a clinically important examination in low back pain (LBP) when serious underlying pathology or radiculopathy is suspected or when pain does not improve, e.g. to identify herniated discs. The general population has high confidence in this modality. Little documented knowledge exists about how the MRI results should be communicated to the patients in an optimal way. The aim of this study was to explore the patients' perspectives, i.e. worries, thoughts and interpretations of terms used when health care providers convey the MRI results.
Summary of methods used and results
79 patients with chronic LBP were included in a broader study of consultations at Funen Back Centre by which the results of MRI were conveyed. 43 of these patients were selected for a qualitative study until information saturation was reached. After the clinical consultation, each patient was interviewed using a semi-structured interview guide. The interviews were audio-recorded and fully transcribed. The transcripts were analysed using Giorgi's method as modified by Malterud.
There was a broad variation in the patients' worries, thoughts and expectations prior to the consultations. Worries were linked to a diversity of possible causes (or finding no explanation) of the pain as well as consequences for function and treatment. We found a broad spectrum of interpretations of terms used, for instance content and meaning of “wear and tear” or disc herniation. Subjects had a high confidence in the reliability of MRI.
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.
Purpose
To investigate the association between vertebral endplate signal changes (VESC) and low back pain (LBP).
Methods and materials
This prospective observational study included 344 persons (161 men and 183 women) sampled from the Danish general population. All participants had an MRI and filled in questionnaires at the age of 40 and again at the age of 44. The following LBP outcomes were used: “LBP past month,” “LBP past year,” and “non-trivial LBP”. The type and size of VESC at each endplate level were evaluated using a standardized evaluation protocol. Associations between VESC and LBP were investigated using logistic regression analysis.
Purpose
By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP).
Materials and methods
MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies.
Introduction
Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and radiculopathy have been observed and this study investigated whether surgery impacts upon these changes.
Methods
Parameters of corticospinal control were examined on 3 occasions in 22 patients prior to, at 6 and 26 weeks following lumbar decompression surgery and in 14 control subjects at the same intervals. Electromyographic activity was recorded from tibialis anterior (TA), soleus (SOL), rectus abdominis (RA), external oblique (EO) and erector spinae (ES) muscles at the T12 & L4 levels in response to transcranial magnetic stimulation of the motor cortex.
Background
Fissures in the anulus fibrosus are common in disc degeneration, and are associated with discogenic pain. We hypothesise that anulus fissures are conducive to the ingrowth of blood vessels and nerves.
Purpose
To investigate the mechanical and chemical micro-environment of anulus fissures.
Introduction
Vertebral osteoporotic fracture increases both elastic and time-dependent (‘creep’) deformations of the fractured vertebral body during subsequent loading. This is especially marked in central and anterior regions of the vertebral body, and could explain the development of kyphotic deformity in life. We hypothesise that vertebroplasty can reduce these creep deformations.
Methods
Twelve
Introduction
Osteoporotic fracture reduces vertebral stiffness, and alters spinal load-sharing. Vertebroplasty partially reverses these changes at the fractured level, but is suspected to increase deformations and stress at adjacent levels. We examined this possibility.
Methods
Twelve pairs of three-vertebra cadaver spine specimens (67-92 yr) were loaded to induce fracture. One of each pair underwent vertebroplasty with PMMA, the other with a resin (Cortoss). Specimens were then creep-loaded at 1.0kN for 1hr. In 15 specimens, either the uppermost or lowest vertebra was fractured, so that compressive stress distributions could be determined in the disc between adjacent non-fractured vertebrae. Stress was measured in flexion and extension, at each stage of the experiment, by pulling a pressure-transducer through the disc whilst under 1.0kN load. Stress profiles quantified intradiscal pressure (IDP), stress concentrations in the posterior annulus (SPP), and compressive load-bearing by the neural arch (FN). Elastic deformations in adjacent vertebrae were measured using a MacReflex tracking system during 1.0kN compressive ramp loading.
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 coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made.
A clinical diagnosis of Myofascial Pain Syndrome (MPS) requires manual palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies exist regarding the robustness of TP examination. Our aim was to determine the inter-observer agreement of TP examination among four examiners and whether reproducibility is influenced by examiner clinical experience. Two experienced and two inexperienced clinicians each performed a standardized palpation of the upper Trapezius musculature. Each observer was asked to judge the presents/absence of clinically relevant TP(s) using clinician global assessment (GA). A random case mix of 81 female participants was examined, 14 being asymptomatic and the remainder suffering from neck/shoulder pain. Examiners received psychomotor training and video analysis feedback provided prior to and during the study in order to improve protocol standardization. Kappa co-efficients were calculated for all possible examiner pairings. Good agreement was noted between the experienced pairing (κ= 0.63). Moderate levels of agreement were observed among the two mixed pairings (κ=0.35 and 0.47 respectively). However, poor agreement was observed for the inexperienced pairing (κ=0.22). Inter-observer agreement was not stable with the experienced pairing in particular, exhibiting a sharp decline in agreement during the latter portion of the study. Identification of clinically relevant TPs of the upper Trapezius musculature is a reproducible procedure when performed by two experienced clinicians. However, an experienced-inexperienced observer pairing can yield acceptable levels of agreement. A protracted period of data collection may be detrimental to inter-observer agreement.
Background
Several theories have been put forward with respect to the mechanical role of the thoracolumbar fascia (TLF) but none have been substantiated in part due to an inability to explore its function
Methods
Initially a cadaveric dissection of the fascia was performed to gain an appreciation of the 3-D orientation and representation of the TLF in the lumbar region. A conventional ultrasound system (Diasus, Dynamic Imaging Ltd) was then used to image the 3 layers of the fascia on 40 normal subjects (18 males and 22 females, mean age 27.3±5.8 years) and the reliability of these measures was investigated on a subset of this population.
Purpose
The importance of interpreting clinical trial results in terms of the benefits a treatment may offer to individuals with chronic pain is becoming more widely recognized. The clinical meaningfulness of group differences can better be described by looking at the percentages of responders in each treatment group, rather than between group mean differences. We have reassessed the outcomes of a clinical trial for chronic low back pain (LBP) from this new perspective.
Methods
The randomized clinical trial examined short- (12 weeks) and long-term (52 weeks) efficacy of high-dose, supervised trunk exercise (SET), spinal manipulative therapy (SMT), and a course of home exercise and self-care advice (HEA) for the treatment of LBP ≥ 6 weeks duration. We calculated response to care at 2 levels for 2 variables: numeric back pain scores (NRS) and Roland-Morris Disability (RMD), and at 3 timepoints (Weeks 12, 26 and 52). The 2 levels were calculated as percent improvement from baseline ≥ 30% and ≥75%. Finally, we calculated the relative proportion (± 95% confidence intervals) of the sample (∼100 per treatment group) that achieved each level of improvement.
Purpose and background
Research on people's own experiences of living with sciatica is limited and this study aims to contribute to a better understanding of the impact of sciatica and its treatment.
Methods
Longitudinal study based on in-depth interviews at baseline, six and twelve months follow-up. Thirty seven people were interviewed (15 men, 22 women) using a topic guide that allowed for detailed exploration of their story. All interviews were digitally recorded, fully transcribed, imported in the NVivo data management system and analysed thematically using the constant comparative method.
Introduction
It has previously been reported (
Methods
EMG data was recorded from 192 subjects across two years (initial contact, 12 months and 24 months). The data were analysed and the spectral half-widths calculated.
The ICA method was then applied to the original raw data. As the power spectrum of ECG runs from 0-20Hz the resultant spectra were analysed to calculate which of them had the most signal energy below 20Hz. A high band pass filter was used to remove all signal data below 20Hz from this independent component.
This method was chosen as there was signal data present in the chosen spectrum above 20Hz which would be EMG data. Removing data only below 20Hz preserved this EMG data.
The components were then re-integrated and re-analysed to calculate the new half-widths. These new half-widths were compared with the originals to generate the results.
Background
Low back pain is a common condition amongst Armed Services personnel and can have significant impact upon their ability to undertake military duties, including being deployed into austere environments.
Methods and results
This was a qualitative study of 16 military physiotherapists exploring their attitudes and beliefs towards management of low back pain. Semi-structured interviews were conducted and transcribed. The transcripts were analysed using a method of thematic content analysis. Six themes were identified; military culture, occupational issues, continuing professional development, clinical reasoning, need for a cure and labelling the patient. The highly challenging occupational demands placed on military patients appeared to prompt physiotherapists to request radiological investigations at an earlier stage than recommended in current guidelines. Justification for early investigation was considered to be both in the patients' and the Armed Services best interests, for the patient to initiate treatment with minimum delay whilst also decreasing the number of personnel unable to deploy for medical reasons.
Aim
The aim of this study was to describe, by means of weekly measures, the course of low back pain (LBP) in chiropractic patients. The primary outcome was number of days with bothersome pain, which was analyzed for association with known predictor variables (gender, leg pain, occupation and self rated health). Patients were followed for six months.
Method
A novel approach is used: short message services, SMS, sent to the respondents' mobile phones. Using specifically designed software, respondents received an SMS every week, which they responded to also using SMS. The question was: “How many days this previous week has your low back pain been bothersome (i.e. affected your daily activities or routines)? Please answer by a number from 0 to 7.”
Baseline variables were collected during the chiropractic consultation. Patients were further assessed at the 4th visit. A follow-up questionnaire was sent to the respondents at the end of the six months. The associations of the primary outcome with baseline variables were investigated using mixed linear models.
Purposes
To develop disease-specific quality indicators for patients with low-back-pain presenting to Danish chiropractic clinics.
Methods and results
A cross-disciplinary group of healthcare providers (the indicatorgroup) prioritized nine evidensbased indicators and standards in a systematic consensus process.
A pilot test including 206 low-back-pain patients was carried out in eight chiropractic clinics.
An audit meeting with the test-clinics was conducted after the test-period, and the indicatorgroup designed the final set of indicators.
The indicator domains were: Anamnesis, test for discogenic back pain, neurology, radiology, classification, exercise therapy, outcome assessment (process and result) and re-evaluation.
Two indicators: outcome assessment as a process-indicator (standard ≥ 95 %, standard reached (95% CI): 95.8 % (91.6 – 98.3)) and outcome assessment as a result-indicator (standard ≥ 50 %, standard reached: 67.7 % (59.9 – 74.8)) met the standards set by the indicatorgroup.
After evaluating the test-results the indicatorgroup decided to maintain all nine indicators, however, lowering the standards on anamnesis, discogenic back pain and classification.
Introduction
Previous work(
Methods
EMG data was recorded from 192 subjects across two years (initial contact, 12 months and 24 months). The data were analysed and SCMs produced. The 30 second test data was split into 30 one second epochs. Colour values were scaled to the individual data set maximum and divided into 12 bands according to frequency strength at a particular point. Median Frequency values were calculated for each epoch and a line of best fit added to the colour map to further aid the diagnosis process.
Maps with faulty recordings were excluded and 20 data sets from each group (BP and no BP) selected at random. Four observers were given only 5 minutes instruction and then asked to indicate whether they thought each map belonged to the LBP or no LBP group.
Purpose of study
A recent audit in our institution showed that 40% of Lumbar spine X-rays ordered by General Practitioners were outside the Royal College of Radiology guidelines. Little in 1998 had commented that GPs requested Lumber Spine X-rays for psychosocial reasons.
Methods
An online survey was conducted on
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
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.
Objectives
To assess health care professional's knowledge with regards to the urinary symptoms of CES and when treatment should be offered.
Background
Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment.
Objective
To assess the effectiveness of dynamic stabilisation as a treatment for discogenic pain compared to standard treatment of interbody fusion.
Study Design & Subjects
All patients were referred for a 2 year back-pain management programme. Patients with continued pain following conservative treatment underwent discography & MRI. Patients with painful degenerate discs on the above investigations were selected.
Patients underwent interbody fusion (PLIF/TLIF) or dynamic stabilisation.
Mean follow-up was 24 months with a minimum follow-up of 12 months.
Outcome Measures
All patients had pre-operative ODI and VAS scores. Patients were then sent further questionnaires at 6 month intervals.
Background
Some studies report greater repositioning error in LBP patients compared to healthy subjects with other studies showing no differences. This conflicting evidence may be due to different methodologies. A new tool, the Flexchair¯Back Balance Trainer measures consistency of lumbo-pelvic movement during visual tracking tasks which challenge the lumbo-pelvic region. This study aimed to establish the within day (WD) and between day (BD) reliability of a lumbo-pelvic tracking task using the Flexchair in healthy subjects,
Method
22 subjects gave informed consent (10 females, 12 males (age 38.40(±9.29) Height 171.35cms (±8.07) weight 76.21kg (±18.55) Subjects completed six different tracking tasks on the Flexchair, 3 times in the first day with 2 hour of intervals between each test and once on a second and third visit with 2 days in between. Tests 1-6 are of increasing difficulty.
Purpose
This pilot study tested the feasibility of a self-determination theory-based communication skills training programme designed to increase physiotherapists' psychological needs supportive behaviour when treating patients with chronic low back pain (CLBP>12 weeks).
Methods
Both control (
Background and purpose
The musculoskeletal system is a common, but often overlooked, cause of chest pain. Little is known about the efficacy of spinal manipulation for this condition. The purpose of the present study is to evaluate the relative effectiveness of two conservative treatment approaches for acute musculoskeletal chest pain, 1) a spinal manipulation-based therapy as a typical example of chiropractic treatment and 2) self-management as an example of minimal intervention.
Methods and results
In a non-blinded, randomised controlled trial set at an emergency cardiology department and four outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to four weeks of chiropractic treatment or self-management, with post-treatment questionnaire follow-up four and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Secondary measures included Medical Outcomes Study Short Form 36 (SF-36) scores, change in pain intensity (chest, thoracic spine, neck and shoulder/arm), and self-perceived change in general health. Preliminary results will be available at the time of presentation.
Background and purpose
The musculoskeletal system is recognized as a possible source of pain in patients with chest pain. The objectives of the present study were (1) to investigate the interobserver reliability of an overall diagnosis of musculoskeletal chest pain using a standardized examination protocol in a cohort of patients with chest pain suspected to be of non-cardiac origin, (2) to investigate the interobserver reliability of the single components of the protocol, and finally, (3) to investigate the importance of clinical experience on the level of interobserver reliability.
Methods and results
Eighty patients with acute chest pain were recruited from a cardiology department. Four observers (two chiropractors and two chiropractic students) performed a physical examination and an extended manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs and overall. Musculoskeletal chest pain was diagnosed in 44.0 % of patients. Interobserver kappa values were substantial for the chiropractors and overall, and moderate for the students. For single items of the protocol, both pairs showed fair to substantial agreement regarding pain provocation tests and poor to fair agreement regarding spinal segmental dysfunction tests.
The difficulties in the management of chronic lower back pain are recognised by professionals and patients alike but this recognition can stem from very different perspectives. This paper discusses how patients identify ways in which their experience and perception of pain changes over time and how that impacts on their relationship with professionals delivering a treatment regime. It presents the results of secondary analysis of longitudinal patient data collected under a serial qualitative interview methodology in which the analytical focus is on patients' changing expectations and perceptions of pain. This orientation to the data demonstrates not only established notions of ‘acceptance’ within biographical disruption, but also ways in which individuals revise, mediate, negotiate and integrate meanings of pain to gain both short and long-term coherence. By taking a more holistic view of patient narratives that situates treatment prescriptions and related behaviours within the context of individuals' everyday life, the analysis highlights ‘sense-making’ as a dynamic process. In doing so, it shows that patients draw reference points not only from their most immediate experiences of chronic low back pain but also from the (dis)continuities of lifecourse experience prior to the onset of pain and anticipated for the future. The paper therefore seeks to both illuminate the dynamics of the patient perspective and provide indicators of where some differences in patient/professional perceptions may lie. Suggestions for promoting concordance between patients and health care professionals will be discussed.
Purpose
Clinical trials for common health conditions are constantly being designed and implemented in our institution, often with some urgency to meet funding deadlines. The scope and complexity of these trials has resulted in the need for databased computer management systems typically tailored to each project. Even with current advanced software resources, development, testing and implementation can take months for each new project. This presentation describes a new approach to this problem involving an adaptive table-driven software system using project-specific recruitment and screening data which we have developed using visual basic.
Methods
The chief design criterion was that the software be reconfigurable by the user based on data tables that contain the parameters of the project design. Essentially, each new project would be implemented by generating new input to the tables, but without the need for reprogramming. The first system implemented was a branching phone screen application that presents questions in an interview format and records participant responses in a data table which can be judged against inclusion/exclusion criteria contained in another table as well as for status reports.
Introduction:
“Spine Class” was organised at Southport Hospitals NHS Trust. The course was awarded 6 CPD (Continuing Professional Development) points. We propose a new method for assessing the effectiveness of educational courses by pre and post testing and participant satisfaction.
Materials and Methods
The course was attended by 64 delegates (49 Allied Health Professionals e.g. Physiotherapists and 15 Physicians). 21 lectures were planned for the day. The lecturers were asked to submit 2 True/False questions (TFQs), a total of 42 questions. Questions were answered prior to the course and immediately after. The lectures were evaluated on a scale of 1 to 5.
The Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
Plasmacytoma is the localised form of multiple myeloma, which can affect any part of the body including the axial skeleton (Kelly et al, 2006; Ampil et al, 1995). These myelomas/plasmacytomas arise from one malignant clone of cells, which secrete the same type of immunoglobulin. Where the clone of cells remains localised, it is known as plasmacytoma, but when there is spread of the malignancy to multiple bones and marrow, it is known as multiple myeloma (Boccadoro and Pileri, 1995).
We present a case of solitary sacral bone plasmacytoma (SBP), in a seventy year old man which presented as low back pain, following a fall. He was neurologically intact, and had no sphincteric incontinence, but MRI revealed a large expansile lesion in S1, which caused severe spinal stenosis, involving the left L5 exiting foramen, with an irregular area of low signal posteriorly. Bone scan showed increased tracer uptake in L5 and a mixed hot/photopaenic appearance in the mid-sacral region indicating tumor involvement. Myeloma screen confirmed that the serum IgA was high, with positive kappa monoclonal band, positive Bence Jones Protein (BJP), normal IgM and IgG, and normal calcium profile. CT-guided biopsy revealed sheets of mature plasma cells, consistent with the diagnosis. Fine needle aspiration biopsy of an enlarged groin lymph node revealed neoplastic infiltration, consistent with myeloma. Skeletal survey and CT chest/abdomen/pelvis (CAP) were not contributory. The patient had six courses of radiotherapy and improved remarkably, and is being considered for chemotherapy as well as follow up in the out-patients' department.
Advisors
PhD J Hartvigsen, PhD P Aagaard, University of Southern Denmark. PhD G Br⊘nfort, Northwestern Health Sciences University, Minneapolis, MN, USA and NIKKB. PhD G Kawchuk, Canada Research Chair in Spinal Function, University of Edmonton, Alberta, Canada. PhD A Breen, Institute for muscoloskeletal research & clinical implementation, Bournemouth, England. PhD J Rasmussen, Institut for Maskinteknik og Anybody Group, Aalborg Universitet
Introduction
The overall issue of this project is to investigate the relationship between the lumbar spinal biomechanics, patient's pain and physiological effects of traditional conservative treatments.
Purpose of study and background
This study aimed to investigate if the PD-Q classification was predictive of outcomes at 3 and 12-months follow-up in LBP patients with associated leg pain.
Identification of clinically important subgroups and targeted treatment is believed to be important in low back pain (LBP) care. The PainDETECT Questionnaire (PD-Q) is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor and/or predicts treatment response.
Method and results
145 participants were recruited in secondary care. Inclusion criteria were 3-12 months LBP and leg pain. Baseline PD-Q scores classified participants into three groups (likely to have neuropathic pain, uncertain, unlikely) but did not affect treatment decisions. The outcome measures were LBP, leg pain, activity limitation and self-reported general health. Scores were compared between those with ‘likely’ neuropathic pain (neuropathic group) and ‘unlikely’ (non-neuropathic group), using Mann-Whitney, Friedman and Chi Square tests.
At baseline, the neuropathic group had worse scores on all outcome measures, and analgesic use, sick leave, sense of coherence and psychological profile (p=.000 to .044). At 3-months and 12-months both groups improved (p=.001 to .032). However, the groups remained different at each time point on all outcome measures (p=.000 to .033) except LBP (p=.054 to .214).
