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Individual advice in addition to standard guideline care in patients with acute non-specific low back pain: A survey on feasibility among physiotherapists and patients.
Man Ther. 2007 Dec 28;
Authors: Bakker EW, Verhagen AP, van Trijffel E, Lucas C, Koning HJ, Koes BW
The medical costs associated with low back pain (LBP) potentially pose an enormous economic burden to society. Prevention (secondary) might be beneficial when there is no definitive conclusion on the most appropriate intervention. For this purpose, individual advice focusing on modification of spinal mechanical load obtained with the 24 Hour Schedule-24HS-(an instrument for quantifying spinal mechanical load) in addition to standard care of guideline-recommendations might be effective. Naturally, this should be examined in controlled studies. Considering the costs involved carrying out a controlled study, the feasibility of 24HS-advice should be assessed first. We performed two surveys in primary care setting in 97 patients with acute (<6 weeks) non-specific LBP (who received a 24HS assessment and 24HS-advice at baseline), and 18 physiotherapists (all involved in 24HS baseline assessments). Patients and physiotherapists were first contacted by telephone after 6 months by a research assistant and requested to complete a questionnaire developed to assess feasibility. During this interview patients again completed a follow-up 24HS assessment. Eighty-eight patients and 17 physiotherapists participated in the follow-up. The median score of patients’ questionnaire was 7 (interquartile range 5.9-8.3) and of physiotherapists’ questionnaire 8 (interquartile range 7-8.5). Both questionnaires exceeded the criteria for feasibility, which we had previously set at seven or higher (out of 10). Subsequently, 24HS-advice was considered feasible for use in primary care healthcare providers and patients with LBP. In patients, the absence of LBP during the follow-up period and in physiotherapists ‘lack of time’ were identified as factors that could potentially threaten the feasibility in 24HS-advice.
PMID: 18165146 [PubMed - as supplied by publisher]
(Source: Manual Therapy)
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Classification of low back-related leg pain-A proposed patho-mechanism-based approach.
Man Ther. 2007 Dec 28;
Authors: Schäfer A, Hall T, Briffa K
Leg pain is a frequent accompaniment to low back pain, arising from disorders of neural or musculoskeletal structures of the lumbar spine. Differentiating between different sources of radiating leg pain is important to make an appropriate diagnosis and identify the underlying pathology. It is proposed that low back-related leg pain be divided into four subgroups according to the predominating pathomechanisms involved. The first subgroup features central sensitization with mainly positive symptoms such as hyperalgesia, the second subgroup involves denervation with significant axonal damage showing predominantly negative sensory symptoms and possibly motor loss and the third subgroup involves peripheral nerve sensitization with enhanced nerve trunk mechanosensitization. The fourth subgroup features somatic referred pain from musculoskeletal structures, such as the intervertebral disc or facet joints. Accordingly, four groups of patients with leg pain associated with structures in the lower back can be identified: Each group presents with a distinct pattern of symptoms and signs. Although there may be considerable overlap between the classifications, the authors propose the existence of an overriding mechanism. The importance of distinguishing low back-related leg pain into these four groups is to facilitate diagnosis and provide a more effective, appropriate treatment.
PMID: 18165145 [PubMed - as supplied by publisher]
(Source: Manual Therapy)
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Relationship between spinal stiffness and outcome in patients with chronic low back pain.
Man Ther. 2007 Dec 27;
Authors: Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Maher C, Refshauge K
Many manual therapists assess and treat spinal stiffness of people with low back pain. The objectives of this study were to investigate: (i) whether spinal stiffness changes after treatment; (ii) the relationship between pre-treatment spinal stiffness and change in stiffness with treatment; (iii) the relationship between spinal stiffness, pain, disability and global perceived effect of treatment; (iv) whether spinal stiffness predicts outcome of treatment or response to treatment in chronic low back pain patients. One hundred and ninety-one subjects with chronic low back pain were randomly allocated to groups that received either spinal manipulative therapy, motor control exercise, or a general exercise program. Spinal stiffness was assessed before and after intervention. All three groups showed a significant decrease in stiffness following treatment (p<0.001). No difference between groups was observed. There was a significant negative correlation between pre-treatment stiffness and change in stiffness (r=-0.61; p<0.001). There was a significant but weak correlation (r=0.18; p=0.02) between change in stiffness and change in global perceived effect of treatment, and a significant but weak correlation between change in stiffness and change in function for subjects in the spinal manipulative therapy group (r=-0.28; p=0.02). No significant association was observed between initial stiffness score and any of the final outcome measures following treatment. Initial stiffness did not predict response to any treatment. In conclusion, spinal stiffness decreases over the course of an episode of treatment, more so in those with the stiffest spines, but the decrease is not dependent on treatment and is not generally related to outcome.
PMID: 18164644 [PubMed - as supplied by publisher]
(Source: Manual Therapy)
