Morris Disability Questionnaire Research Articles

Photobiomodulation using high- or low-level laser irradiations in patients with lumbar disc degenerative changes: disappointing outcomes and remarks.

BackgroundLaser therapy seems to be a beneficial physical agent for chronic low back pain (LBP), and it is commonly used in the clinical rehabilitation practice. However, there are still no indisputable and clearly defined protocols and practical guidelines, and further, the methodology of the previous reports leaves many unsatisfied and raises some reservations.ObjectiveThe aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in patients with lumbar disc degenerative changes based on the analysis of the short- and long-term results and in comparison with the placebo effect.DesignThis study was a prospective and placebo-controlled clinical trial.Materials and methodsA group of 68 participants were qualified for the therapy and were assigned to four comparative groups in the order they volunteered: HILT of 1,064 nm, 60 J/cm2, 10 minutes (HILT); sham (HILT placebo); LLLT of 785 nm, 8 J/cm2, 8 minutes; and sham (LLLT placebo). The following tests were used to assess the effectiveness of treatment: 1) the visual analogue scale; 2) the Laitinen Questionnaire Indicators of Pain; 3) the Oswestry Disability Index; 4) the Roland–Morris Disability Questionnaire; 5) Lasegue test; and 6) Schober’s test. All measurements were carried out before and after irradiations (3 weeks) and in follow-ups (1 and 3 months).ResultsAfter applying verum or placebo laser irradiation, therapeutic progress was observed in all comparative groups; however, no statistically significant differences were observed among the procedures.ConclusionThe high- and low-energy laser therapy methods used in the present article are ineffective in relation to patients with lumbar disc degenerative changes in both the short- and long-term perspectives and do not show a significant advantage over the placebo effect.

Neuromuscular electrical stimulation for treating postpartum low back pain.

In this retrospective study, we investigated the effect of neuromuscular electrical stimulation (NMES) in patients with postpartum low back pain (PPLBP).We included 67 patients with PPLBP in this study. All patients received NMES, each session 30 minutes, 1 session weekly for a total of 4 weeks. The primary outcome was measured by the reduction in pain intensity, based on the visual analogue scale (VAS). The secondary outcomes included functional status, measured by the Roland–Morris disability questionnaire (RMDQ), and quality of life, measured by the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), as well as the adverse events related to the treatment. The outcome data were evaluated at baseline and at the end of 4-week treatment.After 4-week treatment, NMES did not exert better outcomes in pain relief, measured by VAS, and functional status, measured by RMDQ compared with those before the treatment. In addition, no significant improvement in quality of life, measured by WHOQOL-BREF, compared to it before the treatment.The results of our study did not find that NMES is effective in patients with PPLBP after 4-week treatment.

Efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for chronic low back pain: A study protocol for a randomized, controlled, assessor-blinded, multicenter clinical trial.

Background:Back pain is one of the most common diseases, and many patients with recurrent pain seek alternative treatment strategies. Thread embedding acupuncture involves thread insertion at the acupuncture point for continuous physical and chemical stimulation. Although thread embedding is widely used in clinical practice, there is no sound evidence of its efficacy for chronic back pain. We describe the protocol for a randomized controlled trial for investigation of the efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for chronic low back pain.Methods:This randomized, controlled, assessor-blinded, 2-armed, parallel, multicenter clinical trial will include 38 outpatients with chronic low back pain recruited from 4 traditional Korean Medicine hospitals. The patients will be randomly allocated to a treatment group (conventional acupuncture + thread embedding acupuncture) and a control group (only conventional acupuncture) in a 1:1 ratio. The treatment group patients will receive thread embedding acupuncture treatment at 10 acupuncture points (multifidus muscle, 4 points; spinal erector muscles, four points; lumbar quadrate muscle, 2 points) once a week for 8 weeks (8 sessions). In addition, all patients will receive conventional acupuncture treatment at 14 acupuncture points (GV3, EX-B5, and bilateral BL23, BL24, BL25, BL26, BL40, and BL60) twice a week for 8 weeks (16 sessions). The primary outcome will be the change in the visual analog scale score from visit 1 to visit 16, analyzed by independent t tests, in both groups. The groups will also be compared with regard to the clinical relevance (minimal clinically important difference), quality of life (3-level version of Euroqol-5D), disability level (Roland and Morris Disability Questionnaire), global assessment (patient global impression of change), and safety. Cost data for cost–benefit and cost-effectiveness analyses will be collected.Discussion:Our study results will provide evidence of the efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for the management of chronic low back pain. Even though the assessors will be blinded, the patients will not be blinded to treatment because of the lack of a sham embedding acupuncture group; this is a limitation of our study.Trial registration:Clinical Research Information Service: KCT0002666

Effects of Qigong practice in office workers with chronic non-specific low back pain: A randomized control trial

ObjectiveTo investigate the effects of Qigong practice, Guan Yin Zi Zai Gong level 1, compared with a waiting list control group among office workers with chronic nonspecific low back pain (CNLBP). MethodsA randomized controlled trial was conducted at offices in the Bangkok Metropolitan Region. Seventy-two office workers with CNLBP were screened for inclusion/exclusion criteria (age 20–40 years; sitting period more than 4 h per day) and were allocated randomly into two groups: the Qigong and waiting list groups (n = 36 each). The participants in the Qigong group took a Qigong practice class (Guan Yin Zi Zai Gong level 1) for one hour per week for six weeks at their workstation. The participants were encouraged to conduct the Qigong exercise at home every day. The waiting list group received general advice regarding low back pain management. The primary outcomes were pain intensity, measured by the visual analog scale, and back functional disability, measured by the Roland and Morris Disability Questionnaire. The secondary outcomes were back range of motion, core stability performance index, heart rate, respiratory rate, the Srithanya Stress Scale (ST-5), and the global perceived effect (GPE) questionnaire. ResultsCompared to the baseline, participants in the Qigong group experienced significantly decreased pain intensity and back functional disability. No statistically significant difference in these parameters was found in the waiting list group. Comparing the two groups, Qigong exercise significantly improved pain intensity, back functional impairment, range of motion, core muscle strength, heart rate, respiratory rate, and mental status. The Qigong group also had a significantly higher global outcome satisfaction than the waiting list group. ConclusionQigong practice is an option for treatment of CNLBP in office workers.

Thoracic hyperkyphosis non invasively measured by general practitioners is associated with chronic low back pain: A cross-sectional study of 1364 subjects

ObjectiveThe aim of this study was to examine the association between trunk sagittal posture and nonspecific chronic low back pain (CLBP) by evaluating plumb-line distances in subjects recruited in an everyday clinical setting. MethodsOf the 1364 subjects recruited, 63.1% were female (mean age ± SD: 56.2 ± 16.8 years). Subjects were categorized into CLBP and control groups and were prospectively assessed over a 3-month period. They provided information about their daily activities and their history of CLBP. Prognostic factors were analysed using univariate and multivariate logistic regression analyses. A physical examination was performed to record demographic (i.e. age, height and weight) and pain characteristics, and the intensity of pain was assessed using a numerical visual analogue scale. Disability was assessed using the Roland–Morris Disability Questionnaire (RMDQ). A simple measure generally used for sagittal plane screening purposes during growth was also utilized. ResultsMultivariate logistic regression analysis revealed that gender (OR = 1.70), RMDQ score (OR = 0.51) and thoracic hyperkyphosis (C7 + L3 at the plumb-line distance) (OR = 1.57) were associated with CLBP. The final regression model explained 85.6% (R2 = 0.56; P < 0.001) of the variability. ConclusionsGeneral practitioners can clinically and easily assess trunk posture in subjects with low back pain to identify subjects at higher risk of CLBP.

Influence of Paravertebral Muscle Quality on Treatment Efficacy of Epidural Steroid Infiltration or Surgical Decompression in Lumbar Spinal Stenosis-Analysis of the Lumbar Spinal Outcome Study (LSOS) Data: A Swiss Prospective Multicenter Cohort Study.

Prospective multicenter cohort study. To study the question whether paravertebral muscle quality may affect the clinical outcome of epidural steroid infiltration (ESI) or surgical decompression in patients with symptomatic lumbar spinal stenosis (LSS). To the present, the impact of paravertebral muscle quality on clinical outcome of ESI or surgical decompression in patients with LSS has not been clarified. The Lumbar Stenosis Outcome Study was used as database. Patients with symptomatic LSS who received an ESI (group I) or lumbar decompression surgery (group II), had a follow-up of at least 12 months and a pretreatment lumbar magnetic resonance imaging were included (n = 205). Paravertebral muscle quality was quantified by the degree of fatty degeneration (according to Goutallier) on the level L3. Clinical outcome was assessed using the Spinal Stenosis Measure, Numeric Rating Scale, Roland and Morris Disability Questionnaire, and EQ-5D-3L sum score. Reinfiltration, surgery following infiltration, or revision was defined as treatment failure. ESI (group I) and surgical treatment (group II) were associated with a failure rate of 60% and 12.7%, respectively. In group I, there was a tendency for the rate of reintervention to be less in patients with bad muscle quality (P = 0.22). In group II, improvements in the clinical outcomes up to 12 months did not differ between Goutallier stage ≤1 and ≥2. Patients with Goutallier stage ≤1 had more improvement in Spinal Stenosis Measure symptoms (P = 0.04). Relevant fatty degeneration of the paravertebral musculature, as a sign of low muscle quality, has low impact on clinical outcome and the high failure rates with conservative treatment by ESI compared to surgical decompression. Therefore fatty degeneration has no relevant prognostic value for LSS treatment. 2.

The Influence of Single-level Versus Multilevel Decompression on the Outcome in Multisegmental Lumbar Spinal Stenosis

This is prospective multicenter cohort study. To assess whether patients with confirmed multisegmental lumbar spinal stenosis benefit more from a single-level or a multilevel decompression. In multisegmental lumbar spinal stenotic cases, the decision as to how many levels of stenosis need to be operated to achieve the best possible clinical outcome is still unknown and remains a controversy between spine surgeons. Patients of the Swiss Lumbar Stenosis Outcome Study (LSOS) with confirmed multisegmental LSS undergoing first-time decompression without fusion were enrolled in this study. The main outcomes of this study were Spinal Stenosis Measure (SSM) symptoms and function over time, measured at baseline, 6, 12, and 24 months follow-up. Further outcomes of interest were changes in SSM, numeric rating scale, feeling thermometer, the EQ-5D-EL, and the Roland and Morris disability questionnaire from baseline to 6, 12, and 24 months. After 12 months, a total of 141 patients met the inclusion criteria; of these, 33 (23%) underwent a single-level and 108 (77%) a multilevel decompression. Multilevel decompression was associated with a significantly less favorable SSM symptoms and function score, respectively, as compared with single-level decompression. In all further outcomes of interest single-level as well as multilevel patients improved over time. Our study showed that in multisegmental stenotic cases a single-level decompression was associated with a significantly more favorable SSM symptoms and function score, respectively, as compared with multilevel decompression. This study provides evidence that in multisegmental stenotic cases a single-level decompression might be sufficient to improve patient's symptoms and function.

Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica.

Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. Adults with persistent symptoms of sciatica of 1-6 months' duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. Outcomes were measured at the start, and after 6 weeks' and 6 months' follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland-Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost-utility analysis. The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. Current Controlled Trials ISRCTN14569274. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.

Transcultural adaptation and validation of Hindi version of Quebec Back Pain Disability Scale

Purpose: To transculturally adapt the Quebec Back Pain Disability Scale for Hindi-speaking population and examine its psychometric properties in patients with low back pain.Materials and methods: The Quebec Back Pain Disability Scale was translated and cross-culturally adapted into Hindi following international guidelines. Hindi version of the scale was completed by 120 patients with low back pain and 60 healthy controls. Patients with low back pain were also administered the Hindi-Roland Morris Disability Questionnaire and Visual Analog Scale. Psychometric evaluation included test–retest reliability, convergent and discriminative validity. Exploratory factor analysis was carried out to determine the factor structure.Results: The factorial analysis revealed a four-factor solution (bending/carrying, ambulation/reach, prolonged postures and rest). Convergent validity was confirmed by high correlation of Hindi Quebec Back Pain Disability Scale to the Hindi version of Roland Morris Disability Questionnaire (r = 0.77 and p < 0.001) as well as Visual Analog Scale (r = 0.682 and p < 0.001) scores. Discriminative validity was established by significantly different scores for patients with low back pain and the healthy controls (35.36 ± 18.6 vs. 9.13 ± 6.08 and p < 0.001). The translated version of the scale showed remarkable internal consistency (Cronbach α = 0.98) and the intraclass correlation coefficient of test–retest reliability was excellent (ICC2,1=0.96). MDC95 and SEM scores obtained were 10.28 and 3.71, respectively.Conclusion: The Hindi version of Quebec Back Pain Disability Scale has good test–retest reliability, discriminative and convergent validity and is appropriate for clinical and research use in Hindi-speaking low back pain patients.Implications for rehabilitationLinguistically and culturally adapted questionnaires help researchers make adequate inferences about instruments measuring health and quality of life.The translated version would serve as a valid research tool allowing comparability of data across cultures thus, providing opportunities for large multicenter, multicountry trials.A Hindi Quebec Back Pain Disability Scale version will help to improve the quality and efficacy of assessment of low back pain by developing in patients, a better understanding of the items which can be easily correlated with the activities of daily living.

Fear and avoidance beliefs in chronic pain. The translation and validation of the Hungarian version of the FABQ questionnaire

Chronic low back pain is one of the top reasons for seeking medical advice. In the background of the dysfunction besides the somatic pain dysfunctional thinking, negative emotional states, or interpersonal problems can be identified as well. One of the most important factors making the rehabilitation difficult is the fear and avoidance of physical activity. The aim of the study was to adapt and validate the Fear Avoidance Beliefs Questionnaire (FABQ-H) in Hungarian. The FABQ (16 items) was translated into Hungarian and filled in by 90 patients suffering from low back pain for at least three months. For cross validation the FABQ-H results of 43 patients were compared with pain intensity the Oswestry Low Back Pain Questionnaire (ODI), the Roland-Morris Disability Questionnaire (RDQ), the Zung Depression Scale (Zung) and the Pain Catastrophising Scale (PCS). The internal consistency of the FABQ-H was good: the Cronbach's alpha was 0.8. Correlation analysis revealed that the FABQ showed significant correlation only with the Pain Catastrophising Scale (r = 0.373, p = 0.014). Our results confirm that the FABQ-H is a valid questionnaire that can be well implemented. Orv Hetil. 2017; 158(24): 949-955.

Outcomes and prognostic variables of radiofrequency zygapophyseal joint neurotomy in Utah workers' compensation patients.

PurposeThe prevalence of radiofrequency zygapophyseal joint neurotomy (RFN) has increased substantially across the past decade. Limited research exists that has examined pre-procedure predictors of RFN outcomes, particularly within workers’ compensation populations. The purpose of this study was to determine if pre-procedure biopsychosocial variables are predictive of outcomes in a cohort of compensated Utah patients who have undergone RFN.Patients and methodsThis was a retrospective cohort study consisting of a review of pre-procedure medical records and a telephone outcome survey. The sample consisted of 101 compensated workers from Utah who had undergone RFN. Fifty-six patients (55%) responded to the outcome survey. Patients were an average of 46 months post-neurotomy at the time of follow-up. Outcome measures included patient satisfaction, disability status, Roland–Morris Disability Questionnaire, Stauffer–Coventry Index, and Short-Form Health Survey-36 (v.2). Statistical techniques utilized included frequencies, mean comparisons, and logistic and multiple regressions.ResultsForty percent of patients were totally disabled at the time of follow-up. Lawyer involvement, older age, and a positive history of depression were predictors of poor outcomes in logistic and multiple regression equations.ConclusionPresurgical biopsychosocial variables were predictive of multidimensional patient outcomes, and a high rate of total disability was observed. Additional research on the effectiveness of RFN for workers’ compensation patients is recommended.

Whole-body vibration training as a workplace-based sports activity for employees with chronic low-back pain.

The goal of this randomized and controlled study was to examine whether whole-body vibration (WBV) training is able to reduce back pain and physical disability in seated working office employees with chronic low-back pain in a real-world setting. A total of 41 subjects (68.3% female/mean age 45.5±9.1years/mean BMI 26.6±5.2) were randomly allocated to an intervention group (INT [n=21]) or a control group (CON [n=20]). The INT participated in WBV training 2.5 times per week for 3months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI), the Work Ability Index Questionnaire, the quality of life questionnaire SF-36, the Freiburger activity questionnaire, and an isokinetic test of the musculature of the trunk. Compliance with the intervention in the INT reached a mean of 81.1%±31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3months of WBV training in the INT compared to the CON regarding the RMQ (P=.027), the ODI (P=.002), the SF-36 (P=.013), the Freiburger activity questionnaire (P=.022), the post-interventional sick-leave in the INT (P=.008), and trends regarding a positive effect of the intervention on the muscular capacity of the muscles of the trunk in flexion. WBV training seems to be an effective, safe, and suitable intervention for seated working employees with chronic low-back pain.

Extracorporeal shock waves combined with intervertebral foramen injection for treating lumbar facet joint syndrome

Objective To observe the effect of extracorporeal shock wave (ESW) combined with intervertebral foramen injection on the lumbar facet joint syndrome. Methods Ninety-three patients presenting the syndrome were randomly divided into acombined group, ashock wave group and acontrol group, each of 31, according to a random number tab. All three groups were given a nonsteroidal anti-inflammatory drug, the shock wave group was additionally treated with a course of ESW, while the combined group received the shock wave treatment and lumbar intervertebral foramen injection. The three groups were assessed using theOswestry disability index (ODI), theRoland Morris Disability Questionnaire (RMDQ)and a life quality scale (QOL-SF36) beforetreatment and after 1, 4 and 8 weeks of treatment. Pain was reported using a visual analogue scale (VAS). Results Theaverage VAS, ODI, RMDQ and QOL-SF36 scores of the three groups had all improved after the treatment. After one week the average scores of VAS (2.6±1.4), ODI (15.9±8.3), RMDQ (9.9±5.4) and QOL-SF36 (74.6±17.1) of the combined group had improved significantly more than those of the control group [VAS (4.3±1.3), ODI(22.8±6.9), RMDQ (14.9±7.7) and QOL-SF36 (61.6±17.7)]. Fourweeks after the treatment, the average VAS, ODI, RMDQ and QOL-SF36 scores [(2.5±1.3), (15.1±7.3), (9.8±5.1) and (76.8±16.8)] of the shock wave group had improved significantly more than those of the control group [(3.9±1.4), (20.3±8.2), (13.9±8.1) and (67.2±20.6)]. Such significant improvements lasted until 8 weeks after the treatment. Conclusions ESW combined with intervertebral foramen injection can relieve the pain oflumbar facet joint syndrome, improve lumbar vertebral function and patients′ quality of life. It is worthy of clinical application. Key words: Lumbar facet joint syndrome; Extracorporeal shock wave; Intervertebral foramen; Injection

Taking ACTION to reduce pain: ACTION study rationale, design and protocol of a randomized trial of a proactive telephone-based coaching intervention for chronic musculoskeletal pain among African Americans

BackgroundRates of chronic pain are rising sharply in the United States and worldwide. Presently, there is evidence of racial disparities in pain treatment and treatment outcomes in the United States but few interventions designed to address these disparities. There is growing consensus that chronic musculoskeletal pain is best addressed by a biopsychosocial approach that acknowledges the role of psychological and environmental factors, some of which differ by race.Methods/DesignThe primary aim of this randomized controlled trial is to test the effectiveness of a non-pharmacological, self-regulatory intervention, administered proactively by telephone, at improving pain outcomes and increasing walking among African American patients with hip, back and knee pain. Participants assigned to the intervention will receive a telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing. The intervention will consist of 6 telephone counseling sessions over an 8–10 week period. Participants randomly assigned to Usual Care will receive an informational brochure and a pedometer. The primary outcome is chronic pain-related physical functioning, assessed at 6 months, by the revised Roland and Morris Disability Questionnaire, a measure recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). We will also examine whether the intervention improves other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement). Secondary objectives include examining whether the intervention reduces health care service utilization and use of opioid analgesics and whether key contributors to racial/ethnic disparities targeted by the intervention mediate improvement in chronic pain outcomes Measures will be assessed by mail and phone surveys at baseline, three months, and six months. Data analysis of primary aims will follow intent-to-treat methodology.DiscussionWe will tailor our intervention to address key contributors to racial pain disparities and examine the effects of the intervention on important pain treatment outcomes for African Americans with chronic musculoskeletal pain.Trial registrationClinicalTrials.gov: NCT01983228. Registered 6 November 2013.

Low back pain among attendants to a Family Health Center in El-Dakahlia governorate, Egypt

Objective The aim of the study was to assess prevalence and degree of disability due to low back pain (LBP) among attendants to a Family Health Center. Background LBP is a serious medical and social problem and one of the most common causes of disability. Nearly everyone at some point suffers from LBP that interferes with work and recreational activity. Risk factors for LBP are multifactorial, including physical, improper social habits, and psychological factors. Patients and methods This was a case–control study nested in cross-sectional study. The study was conducted in Nusa-Gheit Family Health Center (El-Dakahlia governorate, Egypt) and included 154 attendances aged 18–60 years during the period of the study. Every participant was assessed for LBP through history taking and examination. In addition, the participants were assessed for degree of disability due to LBP using the Roland–Morris Disability Questionnaire. Results Prevalence of LBP was 53.2%. It was more among female patients (62.8%) than among male patients (38.3%). There was a statistically significant relationship between LBP and being female (P = 0.003, odds ratio = 2.71), smokers (P = 0.01, odds ratio = 6.5), and with increasing BMI. Furthermore, there was a statistically significant relationship between degree of disability and both different age groups (P = 0.002, odds ratio = 0.19) and marital status (P = 0.009, odds ratio = 0.06). As regards age, it was more common among patients aged greater than or equal to 40 years (86.2%). Regarding the severity of disability, severe disability was noted among male patients (78.3%) and married patients (80.5%). LBP affected the regularity of attending work. Conclusion LBP is highly prevalent among women, divorcees/windows, elderly, smokers, and obese individuals. Recommendation Primary healthcare physicians should use the evidence-based strategy in diagnosing and management of LBP. Integration of topic-related to diagnosis, management referral indication in Egyptian national guideline for family physician. Moreover, LBP prevention programs among patients should focus on improved working environment and decreased risk factors of LBP.

Predicting three-month functional outcomes after an ED visit for acute low back pain

BackgroundNearly 30% of patients who present to an ED with acute, new onset, low back pain (LBP) report LBP-related functional impairment three months later. These patients are at risk of chronic LBP, a highly debilitating condition. It has been reported previously that functional impairment, depression, and psychosomatic symptomatology at the index visit are associated with poor LBP outcomes. We wished to replicate those findings in a cohort of ED patients, and also to determine if clinical features present at one week follow-up could predict three-month outcomes in individual patients. MethodsThis was a planned analysis of data from a randomized comparative effectiveness study of three analgesic combinations conducted in one ED. Patients were followed by telephone one week and three months post-ED visit. The primary outcome was a three-month Roland–Morris Disability Questionnaire (RMDQ) score >0, indicating the presence of LBP-related functional impairment. At the index visit, we measured functional impairment (using the RMDQ), depressive symptomatology (using the Patient Health Questionnaire depression module), and psychosomatic features (using the 5-item Cassandra scale). At the one-week follow-up, we ascertained the presence or absence of LBP. We built a logistic regression model in which all the predictors were entered and retained in the model, in addition to socio-demographic variables and dummy variables controlling for investigational medication. Results are reported as adjusted odds ratios (adjOR) with 95% CI. To determine if statistically significant associations could be used to predict three-month outcomes in individual patients, we then calculated positive and negative likelihood ratios [LR(+) and LR(−)] with 95% CI for those independent variables associated with the primary outcome. ResultsOf 295 patients who completed the study, 14 (5%) were depressed and 18 (6%) reported psychosomatic symptoms. The median index visit RMDQ score was 19 (IQR: 17, 21) indicating substantial functional impairment. One week after the ED visit, 193 (65%) patients reported presence of LBP. 294 patients provided a three-month RMDQ score, 88 of whom (30%, 95% CI: 25, 35%) reported a score >0. Neither depression (adjOR 0.7 [95% CI 0.2, 3.1]), psychosomatic symptomatology (adjOR 0.5 [95% CI 0.1, 2.0]), nor index visit functional impairment (adjOR 1.0 [95% CI 1.0, 1.1]) were associated with three-month outcome. Pain at one week was strongly and independently associated with the three-month outcome when examined at the group level (adjOR 4.0 [95% CI 2.1, 7.7]). However, likelihood ratios for pain or its absence at one-week were insufficiently robust to be clinically useful in predicting three-month outcomes in individual patients (LR+: 1.4 [95% CI: 1.3, 1.7]; LR−: 0.4 [95% CI: 0.2, 0.6]). ConclusionsIn spite of a strong association at the group level between presence of LBP at one week and functional impairment at three months, when used to predict outcomes in individual patients, presence of pain failed to discriminate with clinically meaningful utility between acute LBP patients destined to have a favorable versus unfavorable three-month outcome.

RELATIONSHIP BETWEEN ATTACHMENT AND ADJUSTMENT WITH CHRONIC PAIN; WITH STUDY THE MODERATOR ROLE OF RESILIENCY

The present study investigated the relationship between attachment style with adjustment and resiliency in chronic pain patients and probable mediating role of resiliency between attachment and adjustment. &#x0D; Adult Attachment Inventory; Depression‚ Anxiety‚ Stress Scale (DASS_21) Resiliency Scale (CS_RISC) and Roland–Morris Disability Questionnaire (RDQ). Data were analyzed using parson’s correlation and regression.&#x0D; Results revealed that avoidant and ambivalent attachment styles negatively correlated with adjustment (positively correlated with depression, anxiety and stress) and positively with resiliency. Secure attachment wasn’t correlated with none of them. Resiliency didn’t mediate the impact of attachment style on adjustment. These findings suggest that insecure attachment style is a vulnerability factor for adjustment with chronic pain and predicts lower resiliency in these patients.&#x0D; Briefly present the conclusions and importance of the results. Concisely summarize the study’s implications. Please do not include any citations in the abstract.

Exploring What Factors Mediate Treatment Effect: Example of the STarT Back Study High-Risk Intervention.

Interventions developed to improve disability outcomes for low back pain (LBP) often show only small effects. Mediation analysis was used to investigate what led to the effectiveness of the Stratified Targeted Treatment (STarT) Back trial, a large primary care-based trial that treated patients consulting with LBP according to their risk of a poor outcome. The high-risk subgroup, randomized to receive either psychologically-informed physiotherapy (n = 93) or current best care (n = 45), was investigated to explore pain-related distress and pain intensity as potential mediators of the relationship between treatment allocation and change in disability. Structural equation modeling was used to generate latent variables of pain-related distress and pain intensity from measures used to identify patients at high risk (fear-avoidance beliefs, depression, anxiety, and catastrophizing thoughts). Outcome was measured using the Roland–Morris Disability Questionnaire. Change in pain-related distress and pain intensity were found to have a significant mediating effect of .25 (standardized estimate, bootstrapped 95% confidence interval, .09–.39) on the relationship between treatment group allocation and change in disability outcome. This study adds to the evidence base of treatment mediation studies in pain research and the role of distress in influencing disability outcome in those with complex LBP.PerspectiveMediation analysis using structural equation modeling found that change in pain-related distress and pain intensity mediated treatment effect in the STarT Back trial. This type of analysis can be used to gain further insight into how interventions work, and lead to the design of more effective interventions in future.

Armband activity monitor data do not correlate with reported pain scores in patients receiving vertebroplasty

BackgroundPrior research on the efficacy of vertebroplasty has focused primarily on subjective, patient-reported outcomes.ObjectiveTo apply an armband activity monitor (SenseWear by BodyMedia Inc, USA) to patients presenting for consideration for...

Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial

Background: Non-specific chronic low back pain (NSCLBP) is a major health problem. Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group. We developed a multimodal treatment (MMT) for patients with moderate to severe disability and medium risk of poor outcome. MMT includes a) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP, b) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk, and c) motor training to regain definite movement control of the trunk. A pilot study was conducted to investigate the feasibility of MMT, prior to a larger RCT, with focus on patients’ adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy. Method: We conducted a randomised controlled trial (RCT) in a primary care physiotherapy centre in Switzerland. Outcome assessment was 12 weeks after baseline. Patients with NSCLBP, considerable disability (five or more points on the Roland and Morris Disability Questionnaire (RMDQ) and medium or high risk of poor outcome on the Keele Start Back Tool (KSBT) were randomly allocated to either MMT or usual physiotherapy treatment (UPT) by an independent research assistant. Treatment included up to 16 sessions over 8 to 12 weeks. Both groups were given additional home training of 10 to 30 minutes to be performed five times per week. Adherence to treatment was evaluated in order to assess the feasibility of the treatment. Assessments were conducted by an independent blinded person. The primary outcome was pain (NRS 0-10) and the secondary outcome was disability (RMDQ). Between-group effects with Student’s t-test or the Mann-Whitney U test and the standardized mean difference of the primary outcome were calculated. (Continued on next page)