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Background
People with back pain often experience long-term pain with recurrences and fluctuations. However, few studies have considered which factors predict long-term outcomes.
Purpose
To determine the prognostic factors, measured around the time of a primary care back pain consultation, that predict clinically significant pain in both the short (6 months) and long-term (5 years).
Background
A wide array of measures has been developed to assess the role of psychological factors in the development and persistence of pain. Yet there is likely to be considerable conceptual overlap between such measures, and consequently a lack of clarity about the importance of psychological factors.
Purpose
To investigate whether conceptual overlap exists within psychological measures used in back pain research.
Background
Although the aetiology of chronic low back pain (CLBP) is unknown, it is suggested that several subgroups among CLBP-patients might be identified who are likely to benefit from different interventions. The results of these interventions might be improved by matching interventions to patient characteristics.
Purpose
The purpose of this longitudinal study is to determine which subgroup of CLBP-patients benefits most from the short, intensive pain management program of RealHealth_NL.
Introduction
Cauda equina syndrome represents the constellation of symptoms and signs resulting from compression of lumbosacral nerve routes. Combined with subjective neurological findings, a reduction in anal tone is an important sign deeming further imaging necessary. Our main objective was to investigate the validity of DRE for assessment of anal tone.
Method
75 doctors completed a questionnaire documenting their grade, speciality and experience in performing DRE. A model anus, using a pressure transducer surrounding an artificial canal, was assembled and calibrated. Participants performed 4 DREs on the model and predicted tone as ‘reduced’ or ‘normal’ (35 and 60 mmHg respectively), followed by a ‘squeeze’ test. 30 healthcare assistants (HCAs) with no training in DRE partook as a control group.
Purpose
To compare the efficacy and safety of balloon kyphoplasty (BKP) to non-surgical management (NSM) over 24 months in patients with acute painful fractures by clinical outcomes and vertebral body kyphosis correction and surgical parameters.
Material and Methods
Three hundred Adult patients with one to three VCF's were randomised within 3 months of the acute fracture; 149 to Balloon Kyphoplasty and 151 to Non-surgical management. Subjective QOL assessments and objective functional (Timed up and go [TUG]) and vertebral body kyphotic angulation (KA), were assessed over 24 months; we also report surgical parameters and adverse events temporally related to surgery (within 30-days).
Introduction
Senile kyphosis arises from anterior ‘wedge’ deformity of thoracolumbar vertebrae, often in the absence of trauma. It is difficult to reproduce these deformities in cadaveric spines, because a vertebral endplate usually fails first. We hypothesise that endplate fracture concentrates sufficient loading on to the anterior cortex that a wedge deformity develops subsequently under physiological repetitive loading.
Methods
Thirty-four cadaveric thoracolumbar “motion segments,” aged 70–97 yrs, were overloaded in combined bending and compression. Physiologically-reasonable cyclic loading was then applied, at progressively higher loads, for up to 2 hrs. Before and after fracture, and again after cyclic loading the
Background
Epidural steroid injections can provide temporary relief of symptoms in the treatment of lumbar spinal stenosis. Surgery is indicated when conservative measures fail. We hypothesise that patients who gain temporary relief of symptoms from the administration of epidural steroid injections are more likely to result in an improvement in symptoms following surgical intervention compared to patients who do not respond to injection therapy.
Method
The records of patients who had received both an epidural injection and surgical intervention for lumbar spinal stenosis between July 2008 and July 2010 were identified and retrospectively reviewed. Relief of symptoms following epidural injection was noted at 6 weeks post procedure and the patients symptoms following surgical intervention was noted and classified according to MacNab's criteria at 3 months post-surgery.
Aim
To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS).
Methodology
This was a National Research Ethical Committee approved RCT study. 63 patients underwent EULSS, out of which 14(29%) declined participation and 14(29%) were excluded. One did not have surgery therefore 34 were randomised to Standard (S) and intervention group (I) using sealed envelope. Standard group were given verbal information & leaflet while the Intervention group were given information on relevant section of
Purpose of study
To explore the clinical reasoning strategies used by extended scope physiotherapists (ESPs) when assessing patients with low back pain.
Background
Extended scope physiotherapists commonly work in back pain services and their training emphasises the acquisition of clinical skills and possible diagnostic tests (including MRI) to aid clinical reasoning and diagnosis. Whilst there has been some exploration of reasoning strategies of other professional groups (notably medically qualified) to date, the clinical reasoning strategies of ESP clinicians have not been reported.
The Purpose and background to Study
The purpose of the study is to develop a new and more effective approach to the management of the return to work process in employees troubled by musculoskeletal symptoms
For the last decade, secondary prevention of persistent pain and unnecessary disability has been identified as a major challenge. The importance in particular of psychosocial obstacles to recovery been recognised (Hopkinkon Conferemce, 2005) and stimulated the Decade of the Flags Think-Tank and Conference at Keele University in 2007, where clinical, occupational and wider contextual factors were explored leading to a number of publications on clinical Yellow Flags (Nicholas et al, 2011) and occupational Blue flags (primarily perceptions of work (Shaw et al.,2009) and organisational factors (Main et al, 2013), the conclusions and recommendations from which are the subject of this abstract
Methods and results
There are insufficient workplace-focused RCTs, systematic reviews or meta-analyses from which to develop an evidence-based intervention strategy and narrative review of the clinical and organisation literature into the management of work disability and return-to-work was undertaken of research.
The review considers evidence of the efficacy of interventions for addressing absenteeism and presenteeism, distinguishing worker-centred and workplace-centred interventions, and continues with consideration of new ways in which these challenges might be addressed.
Background
There is limited research investigating the effects of the Saddle Chair on spinal angles and it has not been determined if there is a difference between a self –selected comfortable posture (SSCP) and a standardised ergonomic posture (SEP).
Purpose of Study
Investigate if there is a difference in head tilt (HT); neck angle (NA); cervico-thoracic angle (CTA); thoracic angle (TA); lumbar angle (LA) and pelvic tilt (PT) when sitting on a saddle chair and adopting a SSCP compared with a SEP.
Background
Evidence suggests classification system (CS) guided treatments are more effective than generalized and practice guidelines based treatments for low back pain (LBP) patients. This study evaluated clinicians' and managers' attitudes towards LBP classification and its usefulness in guiding LBP management.
Methods
Data from 3 semi-structured interviews with physiotherapy service managers and advanced spinal physiotherapy practitioner and a focus group (5 physiotherapists) in two NHS Health Boards, South Wales, UK, was thematically analysed.
Background and purpose
Pilates is a popular exercise approach which is increasingly used in the management of LBP. However, to date the evidence base remains poor with a need to define the Pilates intervention and the outcome measures required for future high quality studies. The objective of this study was to explore the client's view of participating in Pilates classes: in particular the reasons for attendance and its effects.
Methods
Purposeful sampling was used to recruit clients (n=25; 4 male and 21 female, age range 28 to 65 years) who had attended Body Control Pilates classes for at least 24 sessions. Focus group discussions were guided by pre-determined questions, these were transcribed verbatim and analysed using the thematic approach. Ethical approval was obtained for the study from the University of Ulster's School of Health Sciences.
Aim
The aim of this study is to evaluate the causes of litigation in spinal surgery and to identify preventable causes.
Methods
Retrospective analysis of all claim data made available under Freedom of information act from NHS Litigation Authority between years 2000 to 2010.
Background and purpose of the study
Effective communication between healthcare professionals and patients is key to a successful consultation and is reported to affect both adherence to treatment and outcome. Despite this evidence, research on how best to open consultations is limited and the optimal way, unknown.
This study seeks the opinions of physiotherapists on how to open a clinical encounter in an adult musculoskeletal outpatient setting – a topic which has relevance to all clinicians aiming to build rapport with their patients.
Methods
Forty clinical encounters between physiotherapists in a primary care setting and patients with back pain were observed and audio-recorded. The clinicians' key questions inviting the patient to discuss their back pain were identified, together with a content analysis of the topics discussed prior to the conversation about their back pain. In 2012, a national survey was undertaken, approaching 34,922 physiotherapists from 3 networks on the interactive website hosted by the professional body, the Chartered Society of Physiotherapy asking participants to rank the data from clinical practice, to determine the preferred way to open a clinical encounter.
Introduction
Discogenic pain is associated with ingrowth of blood vessels and nerves, but uncertainty over the extent of ingrowth is hindering development of appropriate treatments. We hypothesise that adult human annulus fibrosus is such a dense crosslinked tissue that ingrowth
Methods
Disc tissue was examined from 61 patients (aged 37–75 yrs) undergoing surgery for disc herniation, degeneration or scoliosis. 5 µm sections were stained with H&E to identify structures and tissue types. 30 µm frozen sections were examined using confocal microscopy, following immunostaining for CD31 (an endothelial cell marker), PGP 9.5 and Substance P (general and nociceptive nerve markers, respectively). Fluorescent tags were attached to the antibodies. ‘Volocity’ software was used to calculate numbers and total cross-sectional area of labelled structures, and to measure their distance from the nearest free surface (disc periphery, or annulus fissure).
Purpose and background
Whether to order an MRI scan or not for patients with low back and leg pain (LBP). Resources are limited. Waiting for diagnostic imaging impacts time to treatment and may be critical to the “18 week target”. We have looked into devising a system in which we can ordered MRI scans for patients with LBP pre-clinical assessment based on questionnaire and accessing their referral letter.
Methods and results
49 patient's referrals were looked into (randomly picked). 23 had a questionnaire filled by either themselves or their GPs. the rests had MRI scans ordered based on their referral letters. MRI scans were requested pre-clinical assessment for patients with symptoms spreading beyond their knees and willing to consider interventional treatments (injections or operations). We considered MRI positive if the report mentioned stenosis or disc prolapse causing nerve root or cauda compression.
7 out of the 23 fitted the criteria for MRI. 6 (85%) of them had positive results. 26 of the GP referrals letters had MRI out of those 16 (61%) had positive results.
In total out of 33 MRI, 22 (66.7%) were positive.
Background
Alterations in the neural drive to trunk muscles have been implicated in low back pain (LBP). This is supported by evidence of reduced corticospinal excitability, delayed muscle activation, reduced endurance and enhanced fatigability of these muscles; whether these changes persist during pain free periods remain unclear. Neural drive (or voluntary activation-VA) can be measured using twitch interpolation and the aim of this study is to investigate if subjects with a history of LBP show reduced VA.
Methods
Twenty five subjects participated (13 with a history of LBP, 12 controls). Back extensor torque was measured using a dynamometer and bilateral electromyographic (EMG) activity was recorded from erector spinae and rectus abdominis. Transcranial magnetic stimulation of the motor cortex was applied while the subject, lying prone, performed graded voluntary back extensions. VA was calculated from the size of the twitches evoked by the TMS and EMG data were analysed for evidence of altered neural drive.
Background
Subjects with Low Back Pain (LBP) often have altered trunk muscle activity and postural sway during perturbations. Research suggests different perturbations have differing results on abdominal muscle activity and postural sway, however, the majority of perturbations investigated are not realistic daily tasks and little evidence exists if the changes are still present following resolution of symptoms. Aim: to determine trunk muscle activity, Lumbar multifidus (M), iliocostalis lumborum (IL), external oblique (EO), transversus abdominus/internal oblique TrA/IO and postural sway during two reaching tasks between subjects with history of LBP (HLBP) and those without.
Method
20 volunteers, 8 HLBP (22±2yrs, 174.9±6.0cm, 68.3±6.22kgs,) and 12 without HLBP (20.58±2.23 yrs, 174.5±9.8cm, 68.6±13.9kgs) gave informed consent. Surface Electromyography (sEMG) measured muscle activity of M, IL, TrA/IO, EO and VICON force plate measured postural sway (anterior posterior (AP)centre of pressure (CoP), medial lateral(ML)CoP during high (HRT) and low reaching tasks (LRT). sEMG data was normalized to maximum voluntary contractions. Force plate data was processed using Matlab R2009b. Results: Mann-Whitney U tests noted a significant increase in EO sEMG activity in HLBP group for HRT (p=0.03). Results were insignificant for HRT: M(p=0.64), IL(0.19), TrA/IO,(p=0.14), AP CoP(p=0.44), ML CoP(p=0.69), LRT: M(p=0.58), IL(0.35) TrA/IO(p=0.58), EO(p=0.28), AP CoP (p=0.39), ML CoP (p=0.24).
Study Purpose
A preliminary study to compare continuous sagittal plane lumbar inter-vertebral kinematics in 10 healthy volunteers in recumbent and weight bearing configurations using quantitative fluoroscopy.
Background
There are no direct
Purpose of the Study
Assessment of long term results of Chemonucleolysis vs. surgery for soft disc herniation
Material and Methods
From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis(48) or surgery(52) after a three months trial of conservative treatment. Ten of the chemonucleolysis had surgery. At 10–13 year follow up, Sixty one of the original 100 patients responded, (32 chemonucleolysis; 29 surgery). At 25–27 year Forty four patients responded (24 chemonucleolysis; 20 surgery). Clinical outcome at one year was according to a self-assessment questionnaire: Completely, better improved, the same, or worse, and at the later follow up periods, according to the Macnab criteria. The results of two groups of patients were compared using Chi square and T test for independent samples.
The disc height of the affected disc was measured from the lateral lumbar spine radiograph taken pre-operatively, and at the later two time points, and compared to a normal adjacent disc expressed as a percentage.
Introduction
Osteoporotic vertebral fractures can cause severe vertebral wedging and kyphotic deformity. This study tested the hypothesis that kyphoplasty restores vertebral height, shape and mechanical function to a greater extent than vertebroplasty following severe wedge fractures.
Methods
Pairs of thoracolumbar “motion segments” from seventeen cadavers (70–97 yrs) were compressed to failure in moderate flexion and then cyclically loaded to create severe wedge deformity. One of each pair underwent vertebroplasty and the other kyphoplasty. Specimens were then creep loaded at 1.0kN for 1 hour. At each stage of the experiment the following parameters were measured: vertebral height and wedge angle from radiographs, motion segment compressive stiffness, and stress distributions within the intervertebral discs. The latter indicated intra-discal pressure (IDP) and neural arch load-bearing (FN).
Background
Individual illness perceptions have been shown to be important influences on both clinical and work outcomes for those with back pain, yet the influence of ‘significant others’ (spouse/partner/close family member) illness perceptions is rarely explored, particularly in relation to work participation.
Method
Semi-structured interviews based on the Illness Perceptions Questionnaire were conducted with two purposive samples of chronic back pain patients (working and work disabled), along with their significant others (n=28). Data were analysed using template analysis.
Background
Fear avoidance (FA) has been identified as a risk factor for poor prognosis and a target for intervention in patients with low back pain (LBP), but the mechanisms involved need clarification. Experimental studies would benefit from the use of carefully developed and controlled stimuli representing avoided movements in back pain, and matched stimuli of movements to provide a credible control stimuli. Existing stimuli depicting avoided movements in LBP are static, do not include a set of control stimuli, and do not control for possible systematic observer biases.
Method and results
Two studies were carried out aiming to develop and test LBP patients' responses to videos of models depicting commonly avoided movements associated with back pain, and those associated with a control condition, wrist pain. Two samples of LBP patients rated how much pain and harm each movement would cause them. They also reported how often they avoided the movement. The findings from the first study (N = 99) indicate that using videos of commonly avoided movements in low back pain is viable, and that movements associated with wrist pain provide an acceptable control stimuli. Participants in the second study (N=85) consistently rated movements depicted by females as causing more harm, and more frequently avoided than the same movements depicted by males.
Background/Purpose of study
The increasing aging of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery.
Methods
3′699 patients with degenerative lumbar disorders, undergoing surgery with the goal of pain relief, completed the multidimensional Core Outcome Measures Index (COMI; scored 0–10) before and 12 months after surgery. At 12mo they also rated the global treatment outcome and their satisfaction. Using the Eurospine Spine Tango Registry, surgeons documented surgical details, American Society of Anesthesiologists (ASA) scores and surgical/general complications.
Introduction
Changes in central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain(LBP) and lumbar radiculopathy have been observed and this study investigated whether surgery impacts upon these changes in the long term.
Methods
80 participants were recruited into the following groups: 25 surgery(S), 20 chronic LBP(CH), 14 spinal injection(SI), and 21 controls(C). Parameters of corticospinal control were examined before, at 6, 26 and 52 weeks following lumbar decompression surgery and equivalent intervals. Electromyographic(EMG) 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. Motor evoked potentials (MEP) and cortical silent periods(cSP) recruitment curves(RC) were analysed.
Background
Intervertebral disc cells exist in a challenging physiological environment. Disc degeneration occurs early in life implying that disc cells may no longer be able to maintain a functional tissue. We hypothesise that disc cells have a stress response different from most other cells because of the disc environment. We have compared the stress response of freshly isolated and cultured bovine nucleus pulposus (NP) cells with bovine dermal fibroblasts, representative of cells from a vascularised tissue.
Methods
Freshly isolated and passaged bovine NP cells and dermal fibroblasts were cultured for 3 days then subjected to either thermal stress at 45°C for 1h followed by recovery times of 6, 24 and 48h or nutrient stress involving culture without serum for 6, 24 and 48 h. At each time point, cell number and viability were assessed and heat shock protein 70 (Hsp70) measured in cell lysates by an enzyme-linked immunosorbent assay.
Background and Purpose
Most information regarding adverse events (AEs) following osteopathic treatment is anecdotal; empirical data are limited. We explored the feasibility of online questionnaires to capture AEs prospectively within an osteopathic teaching clinic, and explored associations between
Methods and Results
We piloted a prospective patient-completed online questionnaire rating (‘none’/‘mild’/‘moderate’/‘severe’/‘don't know’) 14 symptoms (
‘Pain’ (82%), ‘stiffness’ (40%) and ‘lack of mobility’ (28%) were the main presenting complaints, and ‘lower back’ (39%), ‘head/neck’ (26%) and ‘upper limb’ (14%) the commonest regions affected. AEs were reported by 83% of patients; ‘pain’ (74%), ‘stiffness’ (58%) and ‘unexpected tiredness’ (10%) were the most frequently reported. These peaked at 24, 48 and 24 hours respectively and were commonly rated as ‘mild’. There was no evidence for age, gender, HVLAT in crude or adjusted models; there were very weak/weak suggestions smoking cessation may be associated with reporting AEs; adjusted OR for ex-smokers versus never-smokers was 3.50 (0.66–18.40; P=0.14); ex-smokers versus smokers was 5.67 (0.85–37.80; P=0.07)).
Introduction
Herniated disc tissue removed at surgery usually appears degenerated, and MRI often reveals degenerative changes in adjacent discs and vertebrae. This has fostered the belief that a disc
Methods
Surgically-removed discs were examined using histology, immunohistochemistry and confocal microscopy. 21 samples of herniated tissues were compared with age-matched tissues excised from 11 patients whose discs had reached a similar Pfirrman grade of degeneration but without herniating. Degenerative changes were assessed separately in three tissue types (where present): nucleus, inner annulus, and outer annulus. Mann-Whitney U tests were used to compare ‘herniated’ vs ‘in-situ’ tissues.
Background and purpose
There is on-going debate about a possible link between manipulation and stroke in patients, and a growing interest in other treatment reactions such as increased pain. Evidence about manipulation is contradictory. There is little published information about outcomes in osteopathy. We aimed to address this gap.
Methods and results
A survey was sent to all UK practising osteopaths. Another survey was sent to patients recruited by osteopaths. Patients were surveyed before treatment, one day and two days after treatment and at six weeks. 1,082 (27.8%) osteopaths completed the practitioner survey. 2,057 patients, recruited from 212 osteopaths, completed questionnaires before, and directly after their treatment. 1,387 patients provided data six weeks after treatment.
Between 10% and 20% of patients experienced increased symptoms/pain related to their main complaint in the days directly following treatment. This was highest for new patients. At 6 weeks, 4% of patients reported temporary disability, which they attributed to osteopathic treatment. 10% of patients reported seeking further consultation for worsening symptoms associated with osteopathic care. The comparison between those that received manipulation and those that did not suggests that manipulation was not linked to worsening outcomes.
In the preceding year, 4% of osteopaths reported that they had patients who experienced a range of serious events. The most common event described was the occurrence of peripheral neurological symptoms. There were also 7 reports of stroke-like symptoms.
