2,690 research outputs found
Evaluation of physiotherapy intervention for non-specific sub-acute and chronic low back pain
No full textThis thesis investigates routine physiotherapy management of patients with subacute
and chronic non specific low back pain.
In a pragmatic multi-centre trial patients were randomised to receive a course of
physiotherapy treatment or advice following a bio-psychosocial model. Disease
specific, patient specific and generic measures were used to assess outcome.
The 286 patients recruited in the trial had, on average, minimal to moderate low
back pain disability. Patients reported enhanced perceptions of benefit in the
physiotherapy group but there was no evidence of a long term effect in any other
outcomes. There were no differences between the groups in NHS costs although
patients in the physiotherapy group incurred significantly higher out of pocket
expenses. Further analysis of the outcome data confirmed that the primary outcome
measure (Oswestry Disability Index) was the most responsive instrument because it
was able to detect deterioration as well as improvement.
As the trial demonstrated no additional benefit of physiotherapy over brief advice, it
was important to investigate the effectiveness of the latter. A systematic review
found limited evidence that brief bio-psychosocial advice was more effective in
reducing fear avoidance and improving back beliefs in patients with acute and subacute
low back pain compared with traditional medical advice. There was no direct
evidence to support the use of brief bio-psychosocial advice (2 sessions or less) for
reducing pain or disability.
This thesis describes research that has contributed to European guidelines for the
management of chronic low back pain and reviews extensively the literature that
seeks to evaluate physiotherapy practice. The clinical implication of this research is
that for patients with non specific low back pain of mild severity, brief advice is
likely to be as effective as prolonged physiotherapy intervention. The extent to
which a single session of advice is more effective than no intervention needs further
assessment
IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol
No full textBackground: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions
BACK PAIN AND THE POSTURAL AND BEHAVIORAL HABITS OF STUDENTS IN THE MUNICIPAL SCHOOL NETWORK OF TEUTÔNIA, RIO GRANDE DO SUL
No full textto investigate the prevalence of back pain during a prior three-month period; to identify postural and behavioral habits; to assess whether a relationship exists between back pain and the postural and behavioral habits of elementary school students in the municipal school network in the city of Teutônia, Rio Grande do Sul (RS). METHODS: this was an epidemiological population study in which 833 5th to 8th grade students from schools in the municipal school network in Teutônia participated. The students completed a Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire that assessed back pain and postural and behavioral habits. The analysis was performed using descriptive statistics, calculating prevalence ratios (PR) and confidence intervals at the 95% level. The dependent variable was back pain, and the independent variables were postural and behavioral habits. The PR was calculated using a multivariate analysis with robust variance (α = 0.05). RESULTS: the prevalence of back pain in the previous three months was 54.1%. The majority of students reported feeling pain once per month, and 17.4% of the students reported that pain impaired their performance of daily activities. The multivariate analysis showed a correlation between back pain and time spent per day watching television (p = 0.046), sleeping posture (p = 0.048) and sitting Down to write (p = 0.032). CONCLUSIONS: these results demonstrate a high prevalence of back pain in schoolchildren, suggesting an urgent need to develop educational and preventative programs in schools
Living with Pain or Living in Pain : Narrative Journeys with Low Back Pain
No full textThis study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic.
In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure
Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature
No full textOver the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While many studies investigated COP excursions in low back pain patients and healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Six online databases were systematically searched followed by a manual search of the retrieved papers. The selection criteria comprised papers comparing COP measures derived from bipedal static task conditions on a force-plate of non-specific low back pain (NSLBP) sufferers to those of healthy controls. Sixteen papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data so only a qualitative data analysis was conducted. The majority of the papers (14/16, 88%) concluded that NSLBP patients have increased COP mean velocity and overall excursion as compared to healthy individuals. This was statistically significant in the majority of studies (11/14, 79%). An increased sway in anteroposterior direction was also observed in NSLBP patients. Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity. While the decreased postural stability in NSLBP sufferers further appears to be associated with the presence of pain, it seems unrelated to the exact location and pain duration. No correlation between the pain intensity and the magnitude of COP excursions could be identified
Self reported aggravating activities do not demonstrate a consistent directional pattern in chronic non specific low back pain patients: An observational study
No full textQuestion: Do the self-reported aggravating activities of chronic non-specific low back pain
patients demonstrate a consistent directional pattern? Design: Cross-sectional observational
study. Participants: 240 chronic non specific low back pain patients. Outcome measure: We
invited experienced clinicians to classify each of the three self-nominated aggravating
activities from the Patient Specific Functional Scale by the direction of lumbar spine
movement. Patients were described as demonstrating a directional pattern if all nominated
activities moved the spine into the same direction. Analyses were undertaken to determine if
the proportion of patients demonstrating a directional pattern was greater than would be
expected by chance. Results: In some patients, all tasks did move the spine into the same
direction, but this proportion did not differ from chance (p = 0.328). There were no clinical or
demographic differences between those who displayed a directional pattern and those who did
not (all p > 0.05). Conclusion: Using patient self-reported aggravating activities we were
unable to demonstrate the existence of a consistent pattern of adverse movement in patients
with chronic non-specific low back pain
Developing, testing and refining a physiotherapy model of care for acute low back pain
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis is concerned with the physiotherapy management of acute low back pain. Various national guidelines contain conflicting views regarding the role of physiotherapy in the management of acute low back pain. The discrepancies involve primarily the content and timing of physiotherapy intervention. There is a need to place the physiotherapy management of acute low back pain on a more firm research base. A comprehensive literature review was undertaken to develop a best practice model of care for acute low back pain. This model was tested in a randomised controlled trial. Subjects involved in the treatment model demonstrated significantly better short-term outcomes than subjects given advice only. Furthermore, subjects treated early demonstrated significantly better long-term
outcome than subjects who waited six weeks for their treatment. Changes in pain and
physical function were found to be the factors most closely associated with good outcome in the short-term. Good outcome in the long term was associated with improvement in a number of physical and psychological variables. It is recommended that changes be made to the treatment model to facilitate improvement in pain relief and maintenance of physical and social function to further enhance treatment effectiveness.This study was funded by a grant from the NHS R&D committee
Management of people with acute low-back pain: a survey of Australian chiropractors
No full textIntroduction: Chiropractors commonly provide care to people with acute low-back pain (LBP). The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active. / Methods: This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake. / Results: Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%). Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56%) indicated they would give advice to stay active when it was indicated. For the vignette where a fracture was suspected, 95% (95% CI: 91%, 97%) of chiropractors would order an x-ray. / Conclusion: The intention of chiropractors surveyed in this study shows low adherence to two recommendations from an evidence-based guideline for acute LBP. Quality of care for these patients could be improved through effective implementation of evidence-based guidelines. Further research to find cost-effective methods to increase implementation is warranted
Rakennusta tai laitetta koskevan erityisen oikeuden kirjaamisen tarkoitus, edellytykset ja oikeusvaikutukset
No full textMaakaaren 14:4.1:n 1 kohdan mukaan elinkeinotoiminnassa käytettävää kiinteistölle omistuksenpidätys- tai takaisinottoehdon tai vuokrasopimuksen perusteella tuotua rakennusta tai laitetta koskeva oikeus saadaan tiettyjen edellytysten täyttyessä kirjata lainhuuto- ja kiinnitysrekisteriin. Säännös perustuu erityisesti tarpeeseen suojata irtaimen esineen myyjää, sillä kauppasopimuksen omistuksenpidätys- tai takaisinottoehtoon perustuva oikeus pääesineeseen liitettyyn tai liitettäväksi tarkoitettuun sivuesineeseen ei vallitsevan kannan mukaisesti ole pääesineen velkojia tai vilpittömässä mielessä olevia seuraajia sitova. Näihin korkeimman oikeuden oikeuskäytännössä vakiintuneisiin riskeihin on mahdollista vaikuttaa julkistamalla sopimuksen mukainen oikeus kirjauksen avulla.
Kirjaamismahdollisuutta voidaan pitää riskienhallintakeinona, joka koskee sanamuotonsa mukaisesti funktioltaan samankaltaisia rahoitus- ja vakuusjärjestelyjä. Vaikka kuvatut riskitilanteet koskevat selkeimmin omistuksenpidätys- ja takaisinottoehtoista kauppaa, lainkohdassa on mahdollistettu myös vuokrasopimukseen perustuvan oikeuden kirjaaminen. Tutkielman tarkoituksena on perehtyä niihin kannanottoihin, joita oikeuskirjallisuudessa sekä oikeuskäytännössä on esitetty rahoitusleasingsopimuksen ja omistuksenpidätysehdon rinnastamisen perusteista ja vai-kutuksista. Tavoitteena on pidetty rahoitus- ja vakuussopimusten yhdenmukaista kohtelua, jolloin on perusteltua lähteä siitä, että myös ainesosa- ja tarpeistosuhteen syntyedellytyksiä tulkitaan yhtenevästi, vaikka korkeimman oikeuden oikeuskäytännöstä ei ole löydettävissä perusteita samanlaisen riskienhallintakeinon tarpeelle rahoitusleasingsopimusten osalta. Perustelluimmalta johtopäätökseltä vaikuttaa se, että liitossuhteen syntyedellytysten tarkastelussa omistuomistuksen yhteisyyden vaatimusta pidetään yhtenä osana liitossuhteen pysyvyyden vaatimusta.
Kirjaukselle asetettuja edellytyksiä koskevassa osuudessa tuodaan esille edellytysten täyttymiseen liittyviä tulkinnallisia kysymyksiä. Yhtenä lainkohdan sanamuodon mukaista tulkintaa konkretisoivana kysymyksenä on sale and lease back -järjestelyn kirjattavuutta koskevat epäselvyydet, joita on käsitelty oikeuskirjallisuudessa. Korkein oikeus on myös myöntänyt valitusluvan, joka koskee tätä kysymystä. Tutkielmassa päädytään kirjaamismahdollisuutta koskevan lainkohdan sanamuodon perusteella lopputulokseen, jossa sale and lease back -järjestely ei täytä kirjaamiselle asetettuja edellytyksiä. Säädettävän lain kannalta olisi kuitenkin perusteltua, että kirjaaminen olisi tulevaisuudessa mahdollista. Kirjauksen oikeusvaikutukset velallisen konkurssissa eivät myöskään ole täysin selkeitä, sillä niistäkin oikeuskirjallisuudessa on esitetty erilaisia kannanottoja. Tutkielmassa käsitellään oikeusvaikutusten rajoja sekä kirjatun ja kirjaamattoman oikeuden sitovuutta konkurssirealisaatiossa. Tutkielmassa on päädytty siihen, että kirjattavan oikeuden merkitys ratkeaa omaisuuden myyntitavan perusteella ja että oikeuden kirjaaminen ei anna myyjälle ja rahoittajalle täyttä suojaa esineen liittämisestä aiheutuvia riskejä vastaan
Current evidence for a modulation of low back pain by human genetic variants
No full textThe manifestation of chronic back pain depends on structural, psychosocial, occupational and genetic influences. Heritability estimates for back pain range from 30% to 45%. Genetic influences are caused by genes affecting intervertebral disc degeneration or the immune response and genes involved in pain perception, signalling and psychological processing. This inter-individual variability which is partly due to genetic differences would require an individualized pain management to prevent the transition from acute to chronic back pain or improve the outcome. The genetic profile may help to define patients at high risk for chronic pain. We summarize genetic factors that (i) impact on intervertebral disc stability, namely Collagen IX, COL9A3, COL11A1, COL11A2, COL1A1, aggrecan (AGAN), cartilage intermediate layer protein, vitamin D receptor, metalloproteinsase-3 (MMP3), MMP9, and thrombospondin-2, (ii) modify inflammation, namely interleukin-1 (IL-1) locus genes and IL-6 and (iii) and pain signalling namely guanine triphosphate (GTP) cyclohydrolase 1, catechol-O-methyltransferase, μ opioid receptor (OPMR1), melanocortin 1 receptor (MC1R), transient receptor potential channel A1 and fatty acid amide hydrolase and analgesic drug metabolism (cytochrome P450 [CYP]2D6, CYP2C9)
- …
