Psychological assessments by manual physiotherapists in the Netherlands in patients with nonspecific low back pain

Background In the Netherlands, direct access to physical therapy was introduced in 2006. Although many patients with back pain visit physical therapists through direct access, the frequency and characteristics of episodes of care are unknown. Objective The purposes of this study were: (1) to investigate the prevalence of direct access to physical therapy for patients with low back pain in the Netherlands from 2006 to 2009, (2) to examine associations between mode of access (direct versus referral) and patient characteristics, and (3) to describe the severity of the back complaints at the beginning and end of treatment for direct access and referral-based physical therapy. Design A cross-sectional study was conducted using registration data of physical therapists obtained from a longitudinal study. Method Data were used from the National Information Service for Allied Health Care, a registration network of Dutch physical therapists. Mode of access (direct or referral) was registered for each episode of physical therapy care due to back pain from 2006 to 2009. Logistic regression analysis was used to explore associations between mode of access and patient/clinical characteristics. Results The percentage of episodes of care for which patients with back pain directly accessed a physical therapist increased from 28.9% in 2006 to 52.1% in 2009. Characteristics associated with direct access were: middle or higher education level (odds ratio [OR]=1.3 and 2.0, respectively), previous physical therapy care (OR=1.7), recurrent back pain (OR=1.7), duration of back pain <7 days (OR=4.2), and age >55 years (OR=0.6). Limitations The study could not compare outcomes of physical therapy care by mode of access because this information was not registered from the beginning of data collection and, therefore, was missing for too many cases. Conclusions Direct access was used for an increasing percentage of episodes of physical therapy care in the years 2006 to 2009. Patient/clinical characteristics associated with the mode of access were education level, recurrent back pain, previous physical therapy sessions, and age.

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Low back pain in primary care.Effectiveness of diagnostic and therapeutic interventions. MW van Tulder BW Koes LM Bouter (Eds), EMGO Institute, The Netherlands, 1996

Physiotherapy Research International ◽

10.1002/pri.100 ◽

1997 ◽

Vol 2 (3) ◽

pp. 195-196

Author(s):

Fredericke van Wijcke

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Therapeutic Interventions ◽

Low Back

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Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/9/7/032 ◽

2008 ◽

Vol 9 (1) ◽

pp. 32-39 ◽

Cited By ~ 25

Author(s):

Mark P. Arts ◽

Wilco C. Peul ◽

Bart W. Koes ◽

Ralph T. W. M. Thomeer ◽

_ _

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Drop Foot ◽

Acute Surgery ◽

Laser Disc

Object Although clinical guidelines for sciatica have been developed, various aspects of lumbar disc herniation remain unclear, and daily clinical practice may vary. The authors conducted a descriptive survey among spine surgeons in the Netherlands to obtain an overview of routine management of lumbar disc herniation. Methods One hundred thirty-one spine surgeons were sent a questionnaire regarding various aspects of different surgical procedures. Eighty-six (70%) of the 122 who performed lumbar disc surgery provided usable questionnaires. Results Unilateral transflaval discectomy was the most frequently performed procedure and was expected to be the most effective, whereas percutaneous laser disc decompression was expected to be the least effective. Bilateral discectomy was expected to be associated with the most postoperative low-back pain. Recurrent disc herniation was expected to be lowest after bilateral discectomy and highest after percutaneous laser disc decompression. Complications were expected to be highest after bilateral discectomy and lowest after unilateral transflaval discectomy. Nearly half of the surgeons preferentially treated patients with 8–12 weeks of disabling leg pain. Some consensus was shown on acute surgery in patients with short-lasting drop foot and those with a cauda equina syndrome, and nonsurgical treatment in patients with long-lasting, painless drop foot. Most respondents allowed postoperative mobilization within 24 hours but advised their patients not to resume work until 8–12 weeks postoperatively. Conclusions Unilateral transflaval discectomy was the most frequently performed procedure. Minimally invasive techniques were expected to be less effective, with higher recurrence rates but less postoperative low-back pain. Variety was shown between surgeons in the management of patients with neurological deficit. Most responding surgeons allowed early mobilization but appeared to give conservative advice in resumption of work.

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Incidence of low back pain related occupational diseases in the Netherlands

European Journal of Pain ◽

10.1002/j.1532-2149.2013.00430.x ◽

2013 ◽

Vol 18 (6) ◽

pp. 873-882 ◽

Cited By ~ 12

Author(s):

H.S. Miedema ◽

H.F. van der Molen ◽

P.P.F.M. Kuijer ◽

B.W. Koes ◽

A. Burdorf

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Occupational Diseases ◽

Low Back

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Pain trajectories and possible predictors of a favourable course of low back pain in patients consulting musculoskeletal physicians in The Netherlands

Chiropractic & Manual Therapies ◽

10.1186/s12998-021-00392-3 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Wouter Schuller ◽

Raymond W. Ostelo ◽

Daphne C. Rohrich ◽

Martijn W. Heymans ◽

Henrica C. W. de Vet

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Latent Class ◽

Pain Clinic ◽

Low Back ◽

Multivariable Model ◽

Pain Trajectories ◽

Pain Patients

Abstract Background In The Netherlands, low back pain patients can consult physicians specialized in musculoskeletal (MSK) medicine. Previous studies have reported on the characteristics of patients consulting MSK physicians, and the treatment options used. There are no studies yet reporting on the course of Low Back Pain (LBP) after treatment by musculoskeletal (MSK) physicians in The Netherlands. Methods In an observational cohort study MSK physicians recorded data about all low back pain patients presenting for a first consultation. At baseline they recorded age, gender, type and duration of the main complaint, and concomitant complaints. At the end of treatment they recorded the type of treatment and the number of treatment sessions. Patients were recruited to answer questionnaires at baseline, and at 6-weekly intervals during a follow-up period of six months. Patient questionnaires included information about previous medical consumption, together with PROMs measuring the level of pain and functional status. Latent Class Growth Analysis (LCGA) was used to classify patients into different groups according to their pain trajectories. Baseline variables were evaluated as predictors of a favourable trajectory using logistic regression analyses, and treatment variables were evaluated as possible confounders. Results A total of 1377 patients were recruited, of whom 1117 patients (81%) answered at least one follow-up measurement. LCGA identified three groups of patients with distinct pain trajectories. A first group (N = 226) with high pain levels showed no improvement, a second group (N = 578) with high pain levels showed strong improvement, and a third group (N = 313) with mild pain levels showed moderate improvement. The two groups of patients presenting with high baseline pain scores were compared, and a multivariable model was constructed with possible predictors of a favourable course. Male gender, previous specialist visit, previous pain clinic visit, having work, a shorter duration of the current episode, and a longer time since the complaints first started were predictors of a favourable course. The multivariable model showed a moderate area under the curve (0.68) and a low explained variance (0.09). Conclusions In low back pain patients treated by musculoskeletal physicians in The Netherlands three different pain trajectories were identified. Baseline variables were of limited value in predicting a favourable course.

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POS0031 THE PREVALENCE OF INFLAMMATORY BACK PAIN AND HLA-B27 IN A LARGE POPULATION-BASED COHORT IN THE NETHERLANDS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3988 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 221.2-221

Author(s):

S. Kieskamp ◽

S. Arends ◽

E. Brouwer ◽

H. Bootsma ◽

I. M. Nolte ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Chronic Low Back Pain ◽

Large Population ◽

Population Based ◽

Inflammatory Back Pain ◽

Low Back ◽

Hla B27 ◽

Research Support

Background:Although chronic low back pain (≥3 months) before the age of 45 and inflammatory back pain (IBP) are regarded as early presenting and key features of axial spondyloarthritis (axSpA), and Magnetic Resonance Imaging (MRI) can be used to demonstrate sacroiliitis, the substantial delay in the diagnosis of axSpA has not improved.(1) Additionally, knowledge on the prevalence of chronic low back pain before the age of 45 and IBP in combination with the axSpA-related genetic risk factor Human Leukocyte Antigen-B27 (HLA-B27) in the general population is scarce.Objectives:To estimate the prevalence of chronic low back pain before the age of 45 and IBP in combination with the presence of HLA-B27 in a large Dutch population based cohort.Methods:Participants of the Lifelines cohort, a large population-based cohort of the northern region of the Netherlands, filled out a questionnaire on chronic low back pain and IBP. Chronic low back pain was defined as an affirmative answer to the question ‘Did you suffer from low back pain for ≥3 months?’. IBP was questioned based on the validated European Spondyloarthropathy Study Group (ESSG) IBP criteria and was confirmed if at least 4 out of the following 5 criteria were present: (a) onset before age 45, (b) insidious onset, (c) improvement with exercise, (d) associated with morning stiffness, (e) at least 3 months duration. Participants reporting to have been diagnosed with axSpA were identified using variations of the search terms “Bechterew”, ”spondyloarthritis” and “ankylosing spondylitis”. The Illumina global screening array (GSA) beadchip-24 v1.0 was used to genotype genome-wide SNPs in a subset of Lifelines participants. HLA-B haplotypes were imputed using neighboring SNPs with HIBAG, which is an R-package, using published parameter estimates.(2) The predicted HLA-B haplotype was considered valid if the posterior probability was >80%.Results:In total 94,277 Lifelines participants answered the chronic low back pain question, of which 93,665 (99.4%) completed the ESSG IBP questions. Of these participants, 56,008 (59.8%) were female, mean age was 45.6 ± 12.8 years and 22,192 (23.7%) reported to have been suffering from chronic low back pain. In this chronic low back pain group, the pain began before the age of 45 in 17,122 (77.2%; 18,3% of entire Lifelines population) participants, and 13,514 (60.9%; 14.4% of entire Lifelines population) participants reported to have IBP according to the ESSG criteria.Of 32,785 participants genetic data were available and in 29,399 (89.7%) the HLA-B haplotype could be determined with high prediction accuracy, of which 2,279 (7.8%) participants were HLA-B27 positive. Of these HLA-B27 positive participants, 1,610 (70.6%) also had available chronic low back pain data, of which 373 (23.2%) reported chronic low back pain. Of these 373 patients with chronic back pain and HLA-B27 positivity, the pain began before the age of 45 in 296 (79.4%), and 237 (64.2%) fulfilled the ESSG IBP criteria of which only 11 (4.6%) participants reported to be diagnosed with axSpA.Conclusion:In this large population-based cohort, 18.3% of participants reported chronic low back pain that began before the age of 45. 14.4% of the participants reported IBP, which is relatively high in comparison to previous studies. HLA-B27 prevalence (7.8%) was similar to previously published data from the North-Western European population. The vast majority of participants with both IBP and the presence of HLA-B27 did not report an axSpA diagnosis. A next step in the analyses will be to explore associations with other demographic and clinical factors present including additional SpA features.References:[1]Zhao SS, et al. Rheumatology (Oxford). 2021; keaa807[2]Internet: https://zhengxwen.github.io/HIBAG/hibag_index.html (Accessed: 25 November 2020)Disclosure of Interests:Stan Kieskamp: None declared, Suzanne Arends Grant/research support from: Research support from Pfizer, Elisabeth Brouwer Speakers bureau: Roche, Consultant of: Roche, Hendrika Bootsma Grant/research support from: Roche, Ilja M. Nolte: None declared, Anneke Spoorenberg Consultant of: Abbvie, Pfizer, MSD, UCB, Novartis, Grant/research support from: Abbvie, Pfizer, UCB, Novartis.

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