Field Of Low Back Pain Research Articles

The contemporary management of nonspecific lower back pain.

Low back pain (LBP) is extremely common and causes an enormous burden on the society. This perspective article aims to provide an evidence-based summary in the field of LBP. More specifically, we aimed to present epidemiological data on cost, diagnosis, prognosis, prevention and interventions for patients with LBP. It is critical that both clinicians and policymakers follow best practices by using high-value care for patients with LBP. In addition, nonevidence-based procedures must be immediately abandoned. These actions are likely to reduce societal costs and will improve the quality of life of these patients.

'TEXT4MYBACK' - the development process of a self-management intervention delivered via text message for low back pain

Purpose: To systematically develop a bank of text messages designed to provide a lifestyle-focused intervention for people with low back pain seeking care from pharmacists. The intervention is based on the provision of advice, motivation, and behaviour change support. Methods: The iterative development process consisted of 3 phases: (i) Concept development phase: this first phase consisted of a pre-development meeting with researchers, consumer advocates and clinicians with specific knowledge of low back pain. The key domains considered to be important for this patient demographic, the sources of content for the key messages and the volume and timing of messages considered acceptable were identified in two 2-hour workshops. (ii) Content development phase: the second phase was completed by a team of writers and based on recent evidence (Lancet Series on Low Back Pain; the NICE guidelines for low back pain; Chartered Society of Physiotherapy consumer information; and the Manage your pain consumer guide developed by Musculoskeletal Australia). Six domains were identified: exercise, education, mood, sleep, use of care and medication. Moreover, each of them had one of three aims: education, motivation or behavioural change. (iii) Writing phase: a bank with 86 draft messages was developed and each message was meant to convey one of the six domains. The theoretical basis of the messages was the behaviour change technique, which included: provision of information and encouragement; prompting about consequences, intention formation, monitoring self-behaviour, and barrier identification; advice about setting graded tasks; and strategies aimed at relapse prevention and the use of prompting and cues. Results: After the bank was developed, all the messages were reviewed by a researcher with expertise in behavioural change and text messages. This was followed by 2 other review phases: (i) Expert review phase: the expert review panel members were identified by the investigators as key opinion leaders and clinicians in the field of low back pain. The review panel comprised a multidisciplinary team including researchers, pharmacists, physiotherapists, GP’s, nurses and clinical psychologist. Each of them reviewed 15 messages, scored them using a 5-item psychometric scale according to the appropriateness of content and likely clinical effectiveness and provided recommendations for improvement. This process ensured that every message was reviewed by a minimum of 2 experts and had an average from 2-10 points. It was established that those messages which received a sum score inferior than 8 points by any reviewer would be changed and improved according to the reviewers’ comments to maximize their quality and likelihood of effectiveness. After that, 29 messages, representing 34% of the bank of drafts, were modified accordingly. The mean score of the bank of messages was of 8.3/10 points. (ii) Consumer review phase: consumers with low back pain were identified by Musculoskeletal Australia and invited to review 15 messages. 12 consumers reviewed and scored the messages using a 5-item psychometric scale according to the utility and understanding of the text content and language acceptability. This process ensured that every message was reviewed by a minimum of 2 consumers and had an average from 3-15 points. They were also asked to provide recommendations for improvement. It was established that those messages receiving a sum score inferior than 12 points by any reviewer would be changed and improved even if their sum score was above 12. There were 36 messages, representing 42% of the bank of drafts, modified accordingly. The mean score of the bank of messages was of 12.5/15 points. Conclusions: A final bank of 86 text messages designed to support lifestyle-focused intervention for patients with low back pain has been developed through a multistep iterative process. The description of this process can provide a scientific support for future development of text message interventions within the musculoskeletal field of research.

Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study

BackgroundClinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published.ObjectivesThe aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP.MethodsA total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis.ResultsThe participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises.ConclusionsIt seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.

A Cohort Study Protocol of Low Back Pain In Rural Area Inhabitants: Fasa Low Back Pain Cohort Study (FABPACS)

Background: Low back pain (LBP) is one of the main causes of disability in most societies that imposes much cost to the economic and health systems. In Iranian population, a prevalence as high as 27% has been reported for chronic LBP. So this study was designed to investigate the factors associated with low back pain in Iranian population. Methods/ Design: In Fasa Cohort Study, a branch of Persian cohort study, LBP patients were registered among the participants. A total of 10000 peoples, 1700 patients enrolled in cohort study were registered as LBP patients. In addition to detailed demographic, socioeconomic, anthropometric, nutrition, and medical history, limited physical examinations, determination of physical activity and body composition that was obtained in the cohort study, history of LBP, assessment of the pain severity, McGill pain inventory, and Oswestry questionnaire was filled for the LBP patients. All data are stored online using a dedicated software. Discussion: The cohort study is the best way to collect the necessary information required for policy making in the field of LBP. This study will help in providing some information about LBP in our area to establish a better management of the disease. Moreover, this study will provide many opportunities for clinical trials in this field, and we are going to do interventional studies in the cohort in future.[GMJ.2016;5(4):225-29]

The influences of recovery on low back pain development: A theoretical model.

Psychologically and physically straining work conditions increase the risk of low back pain (LBP) development. According to recent recovery theories, leisure time recovery can counteract the negative influences of work stress on health. Similarly, a recent empirical work has indicated a moderating role of recovery on the link between stress and health issues. In this paper, a theoretical model is deduced to integrate the moderating effects of recovery on work stress and LBP development. Based on theoretical and empirical results, 2 separate recovery paths are distinguished: on the one hand, recovery can prevent the experience of stress because a well-recovered person can cope more easily with work demands; while on the other hand, recovery refills the depleted resources after confrontation with work strain and reduces stress experiences. Given that work strains is a main risk factor for LBP development, recovery in leisure time seems to be a highly relevant aspect, which has not been investigated to date in the field of LBP.

Assessment after the UEMS accreditation of a PRM programme of care for patients with low back pain

Abstract / Annals of Physical and Rehabilitation Medicine 54S (2011) e272–e280 CO28-011–EN Assessment after the UEMS accreditation of a PRMprogramme of care for patients with low back pain A. Juocevicius Vilnius University, medical faculty, Center of PMR Europe; UEMS;Accreditation; Programme of care; Quality of care; Low back pain; Lithuania Aim.– Evaluation of the improvement of the quality of rehabilitation care delive-red by the Rehabilitation, Physical and Sports Medicine Department after PRMPC for patients with low back pain accreditation. Procedureandresults.– Theactionplanforthisprogrammewassetupaccordingto its weak points expressed in the accreditation procedure:–PRM specialists should obtain the full responsibility of the patient during thecourse of the programme, especially for the medical diagnosis revision;–advocacy should be developed in order to promote good health behaviour e.g.visiting working environment;–scientific activities and research works should be increased in the field of lowback pain rehabilitation.The accreditation process and promotion of the programme was a good opportu-nity to implement team meetings, to systematically assess teamwork and to payattention to some weak aspect of the programme. The process was an additionalmotivation to look at the team’s everyday practice.Our analysis of the programme outcomes shows that PRM PC for patientswith low back pain and lumbo-sacral radiculopathy was brought up closer tointernational evidence-based standards. After completion of the acute and earlyacutecomprehensiverehabilitationofpatientswithLBP,theindicesatdischargebecame statistically significantly different between main group of patients andcontrols. The length of stay in rehabilitation programmes of those patients wasshorter and a financial effect was proved.The results we got through this accredited programme will foster the develop-mentofNationalhealthcarestandardsforpeoplewithlowbackpain,andinducethe development of National guidelines for implementation of ICF for low backpain.

Discussion paper: what happened to the ‘bio’ in the bio-psycho-social model of low back pain?

Over 20years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people's low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain. This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain. Six potential misunderstandings are discussed. (1) Until diagnosis is shown to improve outcomes it is not worth investigating; (2) without a gold standard it is not possible to investigate diagnosis of low back pain; (3) the presence of pathology in some people without low back pain means it is not important; (4) dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy; (5) suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice; (6) we seem to have forgotten the 'bio' in biopsychosocial low back pain. We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Psychosocial risk factors for chronic low back pain in primary care--a systematic review

Low back pain (LBP) is a major public health problem, often encountered in primary care. Guidelines recommend early identification of psychosocial factors that could prevent recovery from acute LBP. To review the evidence on the prognostic value of psychosocial factors on transition from acute to chronic non-specific LBP in the adult general population. Systematic review is the design of the study. A systematic search was undertaken for prospective studies dealing with psychosocial risk factors for poor outcome of LBP in primary care, screening PubMed, PsychInfo and Cochrane Library databases. The methodological quality of studies was assessed independently by two reviewers using standardized criteria before analysing their main results. Twenty-three papers fulfilled the inclusion criteria, covering 18 different cohorts. Sixteen psychosocial factors were analysed in three domains: social and socio-occupational, psychological and cognitive and behavioural. Depression, psychological distress, passive coping strategies and fear-avoidance beliefs were sometimes found to be independently linked with poor outcome, whereas most social and socio-occupational factors were not. The predictive ability of a patient's self-perceived general health at baseline was difficult to interpret because of biomedical confounding factors. The initial patient's or care provider's perceived risk of persistence of LBP was the factor that was most consistently linked with actual outcome. Few independent psychosocial risk factors have been demonstrated to exist. Randomized clinical trials aimed at modifying these factors have shown little impact on patient prognosis. Qualitative research might be valuable to explore further the field of LBP and to define new management strategies.

A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks' duration

Systematic reviews and randomised controlled trials (RCTs) generally support the use of exercise interventions to reduce pain and improve function in patients with chronic non-specific low back pain (LBP). However, many RCTs in the field of LBP include small numbers of subjects, have significant methodological limitations and use diverse exercise interventions. This review shows that the smaller RCTs often overestimate the true effectiveness or fail to detect true benefits. Also, statistically significant results from RCTs of low methodological quality might not be valid. This review showed that evidence from RCTs that are larger (≥ 40 subjects in exercise group), score high on the adapted van Tulder methodological quality criteria (≥ 5/10) and have used adequate statistical tests, support the use of exercise for patients with LBP of at least 6 weeks' duration, although the effect sizes tend to be smaller. This higher quality evidence particularly supports the use of strengthening exercises, (organised) aerobic exercises, general exercises, hydrotherapy and McKenzie exercises for back pain of at least 6 weeks' duration.

Recommandations européenes (COST B 13) en matiè de prévention et de prise en charge de la lombalgie non spécifique

Objectives. To produce guidelines based on scientific evidence for the management of low back pain. These guidelines were developed within the framework of the COST Action B13 “Low back pain : guidelines for its management”, issued by the European Commission, Research Directorate-general, Department of Policy, Coordination and Strategy. Methods. Thirty eight experts in the field of low back pain coming from 13 different European countries have contributed to these guidelines. The experts were assigned to three working groups. The group 1 has formulated guidelines for the management of acute low back pain, the group 2 has developed guidelines for the management of chronic low back pain and, finally, the group 3 has proposed guidelines for the prevention in low back pain. The evidence underpinning the guidelines was retrieved through systematic searches of the scientific literature up to the end 2003. Systematic review, randomised controlled trials, and existing guidelines were included. The methodological quality of the selected articles was evaluated using the scoring system developed by the “Cochrane Back Review Group”. Results and conclusion. This paper is a summary in French of the recommendations based on scientific evidence that should be taken into consideration by physicians, health care providers and policy makers when dealing with patients suffering from low back pain. Nevertheless, many aspects of care need to be validated before recommendations can be issued.

Outcome of non-invasive treatment modalities on back pain: an evidence-based review.

At present, there is an increasing international trend towards evidence-based health care. The field of low back pain (LBP) research in primary care is an excellent example of evidence-based health care because there is a huge body of evidence from randomized trials. These trials have been summarized in a large number of systematic reviews. This paper summarizes the best available evidence from systematic reviews conducted within the framework of the Cochrane Back Review Group on non-invasive treatments for non-specific LBP. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated with additional trials, if available. Traditional NSAIDs, muscle relaxants, and advice to stay active are effective for short-term pain relief in acute LBP. Advice to stay active is also effective for long-term improvement of function in acute LBP. In chronic LBP, various interventions are effective for short-term pain relief, i.e. antidepressants, COX2 inhibitors, back schools, progressive relaxation, cognitive-respondent treatment, exercise therapy, and intensive multidisciplinary treatment. Several treatments are also effective for short-term improvement of function in chronic LBP, namely COX2 inhibitors, back schools, progressive relaxation, exercise therapy, and multidisciplinary treatment. There is no evidence that any of these interventions provides long-term effects on pain and function. Also, many trials showed methodological weaknesses, effects are compared to placebo, no treatment or waiting list controls, and effect sizes are small. Future trials should meet current quality standards and have adequate sample size.

Trend in methodological quality of randomised clinical trials in low back pain

During the past decades, the number of published randomised clinical trials evaluating the efficacy of conservative treatments for low back pain has substantially increased. At the same time several initiatives were undertaken in order to improve the methodological quality of published randomised clinical trials, also in the field of low back pain. We investigated how the methodological quality of randomised clinical trials in the field of low back pain developed over time since the first published trial in 1961. Methodological scores of 269 RCTs included in 15 Cochrane reviews of conservative treatment for low back pain were compared. Overall many trials showed methodological shortcomings. The median overall quality scores ranged from 36 to 82% depending on the type of intervention. There were no improvements in median overall methodological quality over time from 1960 to 2004. Improvements were apparent for a few validity criteria only.

Advances in the field of low back pain in primary care: a report from the fourth international forum.

Review of advances in the primary care research on low back pain (LBP) from a unique international forum, and analysis of open-ended questionnaires from participants. LBP continues to be one of the most common and challenging problems in primary care. It is associated with enormous costs in terms of direct health care expenditures, and indirect work and disability-related losses. To ascertain the current status and state of the art regarding LBP in primary care. Four reviewers independently assessed the content and implications of presentations at the Fourth International Forum for Primary Care Research on LBP, pooled the data, and then augmented it with open-ended questionnaires completed by 35 participants. The Fourth Forum documented the field's emergent new paradigm-a transition from thinking about back pain as a biomedical "injury" to viewing LBP as a multifactorial biopsychosocial pain syndrome. The paradigm shift has occurred in the context of increased interest in evidence-based medicine regarding LBP in primary care. The Forum demonstrated the strides taken in moving from research and evidence gathering, through guidelines and policy formulations and finally to the dissemination and implementation imperative. There was an increasing confidence among the Forum researchers that LBP can be managed successfully in primary care settings through a combination of encouraging activity, reassurance, short-term symptom control, and alteration of inappropriate beliefs about the correlations of back pain with impairment and disability. There is also recognition that a wide range of international, evidence-based guidelines now exists that have very similar messages. The Fourth Forum reflected a major shift in the conceptualization of LBP in primary care and an increased emphasis on implementation and dissemination of LBP research findings and clinical guidelines. Although there is a wide array of challenges ahead, the Fourth Forum provided a clear message regarding the need to focus research energies on changing practitioner behavior.