Abstract Background Context It has been proposed that depression plays an important role in the course of low back pain; however, there is considerable uncertainty on its predictive value. Purpose ...This systematic review aims to investigate the effect of depression on the course of acute and subacute low back pain. Study Design This is a systematic review. Methods We searched the following databases using optimized search strategies: AMED, CINAHL, EMBASE, Health & Society Database, LILACS, MEDLINE, PsycINFO, Scopus, and Web of Science. We only included prospective studies that investigated a cohort of participants with acute or subacute non-specific low back pain (pain of less than 12 weeks' duration). The prognostic factor of interest was depression or symptoms of depression assessed at baseline. The outcomes of interest included pain intensity, chronicity (non-recovery from low back pain), disability, return to work, health-related quality of life, and overall patient satisfaction. Two independent reviewers selected the studies, extracted the data, and assessed the methodological quality of the studies that were included. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest-associated biases. Results Seventeen articles reporting 13 cohort studies were included in this review. There was considerable variability between studies in terms of the method of assessment of depression and low back pain, statistical methods, and follow-up length, which precluded the quantitative synthesis of the results. Definition of outcomes varied across studies, but overall they could be divided into work-related outcome measures, followed by disability, pain, self-perceived recovery, and mixed outcomes. Eleven out of 17 articles (or 8 out of 13 cohorts) reported that symptoms of depression at baseline are related to worse low back pain outcomes (measured in various ways) at follow-up, and the effect sizes (odds ratio OR) ranged from 1.04 to 2.47. Only two studies that did not find a statistically significant association reported quantitative results: OR=1.03, 95% confidence interval (CI) 0.98–1.08; and OR=1.02, 95% CI 0.99–1.06. All included studies, regardless of statistical significance, showed an effect in the direction of harm. Conclusions Although a definitive answer on the effect of depression on the course of low back pain is not available, the findings of this systematic review suggest that depression might have an adverse effect on the prognosis of low back pain. Future large studies that enroll an inception cohort and that employ a standardized method for assessing depression and low back pain are needed.
Abstract Background context The relationships between obesity and low back pain (LBP) and lumbar disc degeneration (LDD) remain unclear. It is possible that familial factors, including genetics and ...early environment, affect these relationships. Purpose To investigate the relationship between obesity-related measures (eg, weight, body mass index BMI) and LBP and LDD using twin studies, where the effect of genetics and early environment can be controlled. Study design A systematic review with meta-analysis. Methods MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE databases were searched from the earliest records to August 2014. All cross-sectional and longitudinal observational twin studies identified by the search strategy were considered for inclusion. Two investigators independently assessed the eligibility, conducted the quality assessment, and extracted the data. Metaanalyses (fixed or random effects, as appropriate) were used to pool studies' estimates of association. Results In total, 11 articles met the inclusion criteria. Five studies were included in the LBP analysis and seven in the LDD analysis. For the LBP analysis, pooling of the five studies showed that the risk of having LBP for individuals with the highest levels of BMI or weight was almost twice that of people with a lower BMI (odds ratio OR 1.8; 95% confidence interval CI 1.6–2.0; I2 =0%). A dose-response relationship was also identified. When genetics and the effects of a shared early environment were adjusted for using a within-pair twin case-control analysis, pooling of three studies showed a reduced but statistically positive association between obesity and prevalence of LBP (OR 1.5; 95% CI 1.1–2.1; I2 =0%). However, the association was further diminished and not significant (OR 1.4; 95% CI 0.8–2.3; I2 =0%) when pooling included two studies on monozygotic twin pairs only. Seven studies met the inclusion criteria for LDD. When familial factors were not controlled for, body weight was positively associated with LDD in all five cross-sectional studies. Only two cross-sectional studies investigated the relationship between obesity-related measures and LDD accounting for familial factors, and the results were conflicting. One longitudinal study in LBP and three longitudinal studies in LDD found no increase in risk in obese individuals, whether or not familial factors were controlled for. Conclusions Findings from this review suggest that genetics and early environment are possible mechanisms underlying the relationship between obesity and LBP; however, a direct causal link between these conditions appears to be weak. Further longitudinal studies using the twin design are needed to better understand the complex mechanisms underlying the associations between obesity, LBP, and LDD.
Abstract Introduction The aim of this study was to evaluate histologically the newly formed tissues after regenerative endodontic procedures (REPs) in dogs using either a blood clot (BC) or 2 ...different formulations of a chitosan hydrogel as scaffolds. Methods Apical periodontitis was induced by inoculating immature teeth with oral plaque in 4 beagle dogs. Teeth ( n = 96) were divided into 2 control ( n = 20) and 4 test groups ( n = 76) according to the treatment: apexification and REPs with BC, sodium hyaluronate:chitosan (HA:CS) scaffolds, or pectin:chitosan (P:CS) scaffolds. All root canals were disinfected with 2.5% sodium hypochlorite and a triple antibiotic paste intracanal medicament before evoked bleeding, clot formation, or scaffold placement. Thirteen weeks after treatment, the animals were sacrificed and the jaw blocks harvested for histologic processing, histomorphometric analysis, and statistical analysis. Results The lumens of the root canals were completely filled with mineral trioxide aggregate with evidence of a mineralized apical bridge between the root canal walls in 83% of the samples in the apexification group. Vital vascularized tissue was found in the REP groups; apical closure happened in 66.7% of these treatments, and root growth was detected more often as an increase in thickness (85.6%) than in length (45.6%). The greatest amount of mineralized tissue inside the canal was observed in the BC group, with statistical significance compared with the HA:CS and P:CS groups ( P < .05). Further histologic evaluation revealed the presence of apical papilla. Conclusions The addition of chitosan scaffolds to blood in regenerative procedures in dogs did not improve the formation of new mineralized tissues along the root canal walls or the histologic evidence of the regeneration of a pulp-dentin complex.
Abstract Background Context Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal ...relationships. Purpose This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors. Study Design This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain. Patient Sample The patient sample included 1,269 adult twins with a mean age of 53 years. Outcome Measures The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire. Methods Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic DZ twins) and fully (monozygotic MZ twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared. Results There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio OR: 1.81, 95% confidence interval CI: 1.34–2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05–1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50–2.13) and MZ twins (OR: 1.86, 95% CI: 0.63–5.51). Conclusions The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.
Abstract Background Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP), however its effectiveness has not been investigated. Purpose The aim of this ...review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP. Study Design Systematic review with meta-analysis Methods Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared to a control group. Trials deemed clinically homogeneous were grouped in meta-analyses. Results Eleven studies were included (N = 2280). In chronic LBP, telehealth interventions had no significant effect on pain at short four trials; 1,089 participants; weighted mean difference (WMD) -2.61 points; 95% CI: -5.23 to 0.01 or medium-term follow-up (two trials; 441 participants; WMD: -0.94 points; 95% CI: -6.71 to 4.84) compared to a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms. Conclusion There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (e.g. apps) and telehealth as an adjunct to usual care remain understudied.
Abstract Objective The aim of this systematic review was to investigate the literature on the effectiveness of communication skills training for clinicians on patients' clinical outcomes in primary ...care and rehabilitation settings. Methods We systematically reviewed the literature for randomized controlled trials investigating the effectiveness of communication skills training for clinicians on patients' satisfaction with care and on pain and disability in primary care and rehabilitation settings. The search strategy was conducted using AMED, PsycINFO, MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Central Register of Controlled Trials through June 2015. Methodological quality of included trials was assessed by 2 independent investigators using the PEDro scale, and consensus was used to resolve disagreements. Data were extracted, and meta-analyses were performed. Results Nineteen randomized controlled trials were included. Of these, 16 investigated communication training for clinicians that emphasized patient participation (eg, shared decision-making approaches). Communication training had small effects on patients' satisfaction with care when compared to control (4.1 points on a 100-point scale, 95% confidence interval CI, 1.1-7.0). Communication training also had small effects on pain and disability with pooled results showing weighted mean differences of − 3.8 points (95% CI, − 6.5 to − 1.1) and − 3.6 (95% CI, − 5.4 to − 1.7), respectively. Conclusions Studies show that communication training for clinicians produces small effects in improving patients' satisfaction with care or reducing pain and disability in primary care and rehabilitation settings.
Abstract Background Despite a large amount of research investigating physical activity (PA) levels in people with chronic low back pain (LBP), no study has investigated whether people with chronic ...LBP are meeting the World Health Organization (WHO) PA guidelines. Furthermore, with genetics and the early shared environment substantially influencing the presence of LBP and PA engagement, these factors could confound the association between LBP and PA and need to be controlled for. Purpose This study aimed to investigate the association between chronic LBP and meeting the PA guidelines, while controlling for the effects of genetics and early shared environment. Design This is a cross-sectional co-twin control study. Patient Sample A cross-sectional analysis was performed on 1,588 twins from the Murcia Twin Registry in Spain with available data on LBP and PA from the 2013 data collection wave. Outcome Measures The exposure and outcome variables in our study were self-reported. Twins reporting a history of chronic LBP were asked follow-up questions to inform on the presence of recent LBP (within the past 4 weeks), previous LBP (no pain within the past 4 weeks), and persistent LBP (no pain-free month in the last 6 months). These were our exposure variables. Our outcome variable was meeting the WHO PA guidelines, which involved at least 75 minutes of vigorous-intensity PA, or at least 150 minutes of moderate-intensity PA per week. Methods To investigate the association between chronic LBP and meeting the PA guidelines, we first performed a multivariate logistic regression on the total sample of twins. Co-variables entered the model if the univariate association between the co-variable, and both the exposure and the outcome reached a significance of p<.2. Second, to adjust for the influence of genetics and early shared environment, we performed a conditional multivariate logistic regression on complete twin pairs discordant for LBP. The Murcia Twin Registry is supported by Fundación Séneca, Regional Agency for Science and Technology, Murcia, Spain (08633/PHCS/08 and 15302/PHCS/10) and the Ministry of Science and Innovation, Spain (PSI11560-2009). Funding for this project has also been received from Fundación MAPFRE (2012). The authors declare that there are no conflicts of interest. Results There was a significant inverse association between recent LBP and meeting the PA guidelines (odds ratio OR=0.71, p=.034). When controlling for genetics and early shared environment, this association disappeared. There was no association between previous (OR=0.95, p=.779) or persistent LBP (OR=0.78, p=.192) and meeting the PA guidelines. Conclusion Twins with recent LBP are less likely to meet the PA guidelines than those with no history of chronic LBP, highlighting the importance of incorporating PA promotion in the treatment of these individuals. Genetics and early shared environment appear to be confounding the association between LBP and PA, although this needs to be further tested in larger twin samples.
•A text message intervention was developed to support recovery from low back pain.•An iterative process with clinicians, researchers, and consumers was conducted.•This study offers scientific support ...for the elaboration of future interventions.
To develop a bank of text messages for a lifestyle-based self-management intervention for people with low back pain (LBP).
Iterative development process.
Community and primary care.
Fifteen researchers, clinicians, and consumer representatives participated in the concept and initial content development phase. Twelve experts (researchers and clinicians) and 12 consumers participated in the experts and consumers review phase. Full study sample of participants was N=39.
Not applicable.
We first conducted two 2-hour workshops to identify important domains for people with LBP, sources of content, appropriate volume, and timing of the messages. The messages were then drafted by a team of writers. Second, we invited expert researchers and clinicians to review and score the messages using a 5-item psychometric scale according to (1) the appropriateness of the content and (2) the likelihood of clinical effectiveness and to provide written feedback. Messages scoring ≤8 out of 10 points would be modified accordingly. Consumers were invited to review the messages and score them using a 5-item psychometric scale according to the utility of the content, the understanding of the content, and language acceptability and to provide feedback. Messages scoring ≤12 out of 15 points would be improved.
Exercise, education, mood, sleep, use of care, and medication domains were identified and 82 domain-specific evidence-based messages were written. Messages received a mean score of 8.3 out of 10 points by experts. Twenty-nine messages were modified accordingly. The mean score of the messages based on consumers feedback was of 12.5 out of 15 points. Thirty-six messages were improved.
We developed a bank of text messages for an evidence-based self-management intervention using a theory-based, iterative, codesign process with researchers, consumers, and clinicians. This article provides scientific support for future development of text message interventions within the pain field.
Purpose To determine the height and volume of the mandibular coronoid process (CP) by cone-beam computed tomography (CBCT) and to identify the presence of any correlations of these measurements with ...age, gender, facial type, and skeletal class. Materials and Methods The sample consisted of 132 patients from a departmental routine patient base. After CBCT, CP height was determined using OnDemand 3D software (CyberMed, Seoul, Republic of Korea), and CP volume was obtained using ITK-SNAP 3.0 software (Cognitica, Philadelphia, PA). Measurements were subjected to analysis of covariance against facial type, skeletal class, gender, and age, with a significance level of 5%. Results CP height and volume were similar regardless of age, facial type, and skeletal class. However, the 2 measurements were statistically different regarding gender, with larger values for men than for women. Conclusions These observations suggest that gender is the only factor influencing the height and volume of the CP.
Abstract Objective The purpose of this study was to analyze changes in the recruitment of the muscles longus colli (Lco) and sternocledomastoid (SCM) as measured by ultrasonography in patients with ...chronic neck pain before and immediately after a single cervical Maitland's posterior-anterior central mobilization technique. Methods This was a cross-sectional, case-control research design study. Ultrasonographic images of Lco and SCM were taken in 31 patients with chronic neck pain and matched controls during the 5 phases of the craniocervical flexion test before and after a Maitland's posterior-anterior central mobilization session at the cervical spine. Changes in muscle thickness during the test were calculated to infer muscle recruitment. Separate analysis of variance models for each muscle was built. Results Both groups showed increases in Lco and SCM recruitment between phases (F = 7.95, P < .001; F = 21.29, P < .001), with patients with chronic neck pain demonstrating lesser increases for Lco changes in thickness compared with controls, mainly at phase 5 (−0.09, P = .004; 95% confidence interval CI, 0.03-0.15). After the mobilization, Lco recruitment increased more significantly in patients with chronic neck pain, and previous difference between groups in phase 5 was no longer significant (−0.07, P = .07; 95% CI, −0.14 to 0.01). The SCM recruitment decreased in phase 1 for patients with chronic neck pain ( P = .01; 95% CI, −0.06 to −0.01). Conclusion Cervical mobilization appeared to modulate neck muscles function by increasing deep muscle and reducing superficial muscles recruitment.
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