Introduction
An ability to assess longitudinal changes in health status is crucial for the outcome measures used in treatment efficacy trials. The aim of this study was to verify the responsiveness ...of the Italian versions of the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) in subjects with subacute or chronic low back pain (LBP).
Material and methods
At the beginning and end of an 8 week rehabilitation programme, 179 patients completed a booklet containing the ODI, the RMDQ, a 0–10 numerical rating scale (NRS), and the 36-item Short-Form Health Survey (SF-36). A global perception of change scale was also completed at the end of the programme, and collapsed to produce a dichotomous outcome (i.e. improved vs. not improved). Responsiveness was assessed by means of distribution methods minimum detectable change (MDC); effect size (ES); standardised response mean (SRM) and anchor-based methods (ROC curves).
Results
The MDC for the ODI and RMDQ was, respectively, 13.67 and 4.87; the ES was 0.53 and 0.68; and the SRM was 0.80 and 0.81. ROC analysis revealed an area under the curve of 0.71 for the ODI and 0.64 for the RMDQ, thus indicating discriminating capacity; the best cut-off point for the dichotomous outcome was 9.5 for the ODI (sensitivity 76% and specificity 63%) and 2.5 for the RMDQ (sensitivity 62% and specificity 55%). These estimates were comparable between the subacute and chronic subjects. Both the ODI and the RMDQ moderately correlated with the SF-36 and NRS (Spearman’s and Pearson’s correlation coefficients of >0.30).
Conclusion
The Italian ODI and RMDQ proved to be sensitive in detecting clinical changes after conservative treatment for subacute and chronic LBP. Our findings are consistent with those published in the literature, thus allowing cross-cultural comparisons and stimulating cross-national studies.
•Rates of surgery for LBP continue to rise but poor outcomes remain common•Understanding the role of social determinants of health can inform equitable care•Low education and low income independently ...contribute to poor outcomes•Further research is important to guide best-practice through a health equity lens
Low back pain is a major cause of morbidity and disability worldwide and is responsible for vast societal impact. Rates of surgical intervention for lumbar spine disorders continue to rise but poor outcomes remain common. Understanding how the social determinants of health (SDH) influence spinal surgical outcomes stands to inform appropriately tailored care practices and lead to better patient outcomes.
To determine the relationships between the SDH and pain, opioid use, disability and work absenteeism following lumbar spine surgery.
Systematic review and narrative synthesis.
We searched Embase, the Cochrane Library, Medline, and Web of Science from inception to April 21, 2020. Studies eligible for inclusion involved participants receiving lumbar spine surgery and investigated the relationship between at least one SDH and post-surgical pain, opioid use, disability or work absenteeism. We evaluated the risk of bias of included studies and used the PROGRESS-Plus framework to organize a narrative synthesis of findings.
Relevant data was extracted from twenty-three studies involving 30,987 adults from 12 countries. A total of 107 relationships between the SDH and post-surgical outcomes were evaluated, 67 in multivariate analyses. Education was investigated in 23 analyses (14 studies): 70% revealed significant independent relationships between lower education and poorer outcomes. Socioeconomic status was investigated in nine analyses (four studies): 67% revealed independent relationships between lower socioeconomic status and poorer outcomes. Gender was investigated in 40 analyses (22 studies): indications that male versus female sex was associated with poorer outcomes were equivocal. Place of residence, race/ethnicity, and social capital were infrequently investigated.
Low educational attainment and low-income status are clear independent contributors to poorer outcomes following lumbar spine surgery. Occupational factors and work context are likely to be influential. Further research is critical to guide best-practice spinal surgery through a health equity lens.
PROSPERO registration number CRD42015015778
Objective:
To assess the effectiveness of 12 weeks of Pilates practice on disability, pain and kinesiophobia in patients with chronic non-specific low back pain.
Design:
This is a randomized ...controlled trial.
Setting:
This study was conducted in the university laboratory.
Subjects:
A total of 64 participants with chronic non-specific low back pain were included.
Interventions:
Participants were randomly allocated to intervention group consisted in Pilates intervention during 12 weeks (n = 32) or control group who received no treatment (n = 32).
Main measures:
Disability, pain and kinesiophobia were assessed by Roland Morris Disability Questionnaire, visual analogue scale and Tampa Scale of Kinesiophobia, respectively. Measurements were performed at baseline, at 6 and 12 weeks after study completion.
Results:
There were significant differences between groups with observed improvement in Pilates intervention group in all variables after treatment (P < 0.001). Major changes on disability and kinesiophobia were observed at six weeks of intervention with no significant difference after 12 weeks (P < 0.001). Mean changes of the intervention group compared with the control group were 4.00 (0.45) on the Roland Morris Disability Questionnaire and 5.50 (0.67) in the Tampa Scale of Kinesiophobia. Pain showed better results at six weeks with a slightly but statistically significant improvement at 12 weeks with Visual Analogue Scale scores of 2.40 (0.26) (P < 0.001).
Conclusion:
Pilates intervention in patients with chronic non-specific low back pain is effective in the management of disability, pain and kinesiophobia.
Chronic low back pain (CLBP) is the most common chronic pain condition worldwide. Currently, primary care physiotherapy is one of the main treatment options, but effects of this treatment are small. ...Virtual Reality (VR) could be an adjunct to physiotherapy care, due to its multimodal features. The primary aim of this study is to assess the (cost-)effectiveness of physiotherapy with integrated multimodal VR for patients with complex CLBP, compared to usual primary physiotherapy care.
A multicenter, two-arm, cluster randomized controlled trial (RCT) including 120 patients with CLBP from 20 physiotherapists will be conducted. Patients in the control group will receive 12 weeks of usual primary physiotherapy care for CLBP. Patients in the experimental group will receive treatment consisting of 12 weeks of physiotherapy with integrated, immersive, multimodal, therapeutic VR. The therapeutic VR consists of the following modules: pain education, activation, relaxation and distraction. The primary outcome measure is physical functioning. Secondary outcome measures include pain intensity, pain-related fears, pain self-efficacy and economic measures. Effectiveness of the experimental intervention compared to the control intervention on primary and secondary outcome measures will be analyzed on an intention-to-treat principle, using linear mixed-model analyses.
This pragmatic, multicenter cluster randomized controlled trial, will determine the clinical and cost-effectiveness of physiotherapy with integrated, personalized, multimodal, immersive VR in favor of usual physiotherapy care for patients with CLBP.
This study is prospectively registered at ClinicalTrials.gov (identifier: NCT05701891).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
STUDY DESIGN.Population based prospective cohort study.
OBJECTIVE.We explored the cross-sectional relationships between lumbar multifidus (LM) intramuscular adipose tissue (IMAT) infiltration and low ...back pain (LBP) at 3 successive time points and investigated the role of IMAT in predicting the occurrence of LBP after 5 and 9 years.
SUMMARY OF BACKGROUND DATA.Although LBP is a major source of disease burden, the biological determinants of LBP are poorly understood.
METHODS.Participants were 40-year-old adults randomly sampled from a Danish population and followed up at 45 and 49 years of age. At each time point, participants underwent magnetic resonance imaging and reported ever having had LBP, LBP in the previous year, nontrivial LBP in the previous year, or a history of pain radiating into the legs. Pixel intensity and frequencies from T1-weighted magnetic resonance images identified the greatest proportion of LM IMAT at the L4 and L5 spinal levels. IMAT infiltration was categorized as normal/mild, moderate, or severe based on tertile divisions. Associations were explored with crude and adjusted odds ratios (aORs) from logistic regression models. Model covariates included sex, body mass index, and occupational and leisure time physical activity.
RESULTS.A total of 401 participants were enrolled, with 331 (83%) and 286 (71%) participants followed up at 5 and 9 years, respectively. The cross-sectional analyses demonstrated that at the age of 40 years, participants with severe IMAT infiltration demonstrated increased odds of ever experiencing LBP (aOR 95% confidence interval, 95% CI = 3.16 1.45–6.89), nontrivial LBP (aOR 95% CI = 2.82 1.36–5.81), LBP in the past year (aOR 95% CI = 1.95 1.07–3.53), and leg pain (aOR 95% CI = 2.08 1.19–3.62). There were no consistent cross-sectional associations between LBP/leg pain and LM IMAT at 45 or 49 years of age and LM IMAT did not predict future LBP or leg pain.
CONCLUSION.The relationship between LM IMAT and LBP/leg pain is inconsistent and may be modified by age.Level of EvidenceN/A
The incidence of intervertebral disc (IVD) degeneration disease, caused by changes in the osmotic pressure of nucleus pulposus (NP) cells, increases with age. In general, low back pain is associated ...with IVD degeneration. However, the mechanism and molecular target of low back pain have not been elucidated, and there are no data suggesting specific biomarkers of low back pain. Therefore, the research aims to identify and verify the significant gene biomarkers of low back pain. The differentially expressed genes (DEGs) were screened in the Gene Expression Omnibus (GEO) database, and the identification and analysis of significant gene biomarkers were also performed with various bioinformatics programs. A total of 120 patients with low back pain were recruited. Before surgery, the degree of pain was measured by the numeric rating scale (NRS), which enables comparison of the pain scores from individuals. After surgery, IVD tissues were obtained, and NP cells were isolated. The NP cells were cultured in two various osmotic media, including iso-osmotic media (293 mOsm/kg H
O) to account for the morbid environment of NP cells in IVD degeneration disease and hyper-osmotic media (450 mOsm/kg H
O) to account for the normal condition of NP cells in healthy individuals. The relative mRNA expression levels of CCL5, OPRL1, CXCL13, and SST were measured by quantitative real-time PCR in the in vitro analysis of the osmotic pressure experiments. Finally, correlation analysis and a neural network module were employed to explore the linkage between significant gene biomarkers and pain. A total of 371 DEGs were identified, including 128 downregulated genes and 243 upregulated genes. Furthermore, the four genes (CCL5, OPRL1, SST, and CXCL13) were identified as significant gene biomarkers of low back pain (P < 0.001) based on univariate linear regression, and CCL5 (odds ratio, 34.667; P = 0.003) and OPRL1 (odds ratio, 19.875; P < 0.001) were significantly related to low back pain through multivariate logistic regression. The expression of CCL5 and OPRL1 might be correlated with low back pain in patients with IVD degeneration disease caused by changes in the osmotic pressure of NP cells.
Cross-sectional open population based study (nested in a prospective cohort study).
To explore the association of the different individual radiographic features, including osteophytes and disc space ...narrowing, with self-reported low back pain (LBP). Different definitions of lumbar disc degeneration with self-reported LBP and disability were considered in a large open population sample. Furthermore, in order to disentangle the discrepancies in reported strength of the associations, we characterized the frequency of the different individual radiographic features of lumbar disc degeneration and definitions of lumbar disc degeneration, as well as their association with LBP status, by age, gender, and vertebral level.
Currently within the literature, there have been no studies that have explored different definitions of lumbar disc degeneration and their association with LBP within one study sample.
The intervertebral disc spaces (L1/2 to L5-S1) were evaluated for the presence and severity of anterior osteophytes and disc space narrowing using a semiquantitative score (grade 0-3). Logistic regression was used to determine the association between these individual radiographic features of lumbar disc degeneration and different definitions of lumbar disc degeneration for LBP.
Lumbar radiographs were scored for 1204 men, and 1615 women. Osteophytes were the most frequent radiographic feature observed, with men having the greatest frequency. Disc space narrowing was more frequent in women than men. Both radiographic features increased in frequency with age.Disc space narrowing appeared more strongly associated with LBP than osteophytes, especially in men (odds ratio OR = 1.9; 95% confidence interval CI: 1.4-2.8). Disc space narrowing at 2 or more levels appeared more strongly associated with LBP than disc space narrowing at only 1 level (OR = 2.4; 95% CI: 1.6-3.4). After excluding level L5-S1, the strength of almost all associations increased.
We are the first to report different possible lumbar disc degeneration definitions and their associations with LBP. Disc space narrowing at 2 or more levels appeared more strongly associated with LBP than other radiographic features, especially after excluding level L5-S1.
STUDY DESIGN.Prospective cohort study of a cross-cultural low back pain (LBP) questionnaire
OBJECTIVE.The objectives of the present study were to translate and cross-culturally adapt the ...Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties.
SUMMARY OF BACKGROUND DATA.The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity.
METHODS.An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity.
RESULTS.Test-retest reliability was good (FABQ–workintraclass coefficient ICC = 0.74; FABQ—physical activityICC = 0.90; FABQ overallICC = 0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r = 0.283; P ≤ 0.05). Sensitivity to change was low.
CONCLUSION.The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic.Level of Evidence3
STUDY DESIGN.A cross-sectional study.
OBJECTIVE.This study was designed to analyze the relationship between the presence and severity of depression and low back pain (LBP) in a representative sample ...of the general population using a self-report screening questionnaire for depression.
SUMMARY OF BACKGROUND DATA.There is increasing evidence supporting an association between depression and LBP. However, the degree of the association between these two conditions in the general population is poorly understood.
METHODS.Health surveys and examinations were conducted on a nationally representative sample (n = 7550) of Koreans. LBP status was determined by a simple survey response concerning LBP >30 days during the past 3 months. Depression was defined as individuals with a total score >10 on the Patient Health Questionnaire (PHQ)-9 survey. The severity of depression was categorized as none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27) according to PHQ-9 score. Data regarding demographics, socioeconomic history, and comorbid health conditions were used to analyze adjusted, weighted logistic regression models.
RESULTS.In the Korean population, the prevalence of depression was significantly greater in individuals with LBP (20.3%) than in those without LBP (4.5%). On multivariate logistic regression analysis, the presence of depression was significantly associated with LBP (adjusted odd ratio aOR3.93, P < 0.001). The risk of LBP increased with increasing severity of depression as followssevere depression (aOR9.28, P < 0.001), moderately severe depression (aOR3.24, P = 0.001), moderate depression (aOR4.97, P < 0.001), and mild depression (aOR2.48, P < 0.001).
CONCLUSION.Depression is more common in patients with LBP among Koreans. The presence of depression was significantly associated with LBP, especially in severely depressed individuals.Level of Evidence3
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