scholarly journals P268 Physiotherapists' awareness, knowledge and confidence in screening and referral of suspected axSpA: a survey of UK clinical practice

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Eliza Steen ◽  
Melinda Cairns ◽  
Carol McCrum
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Professional Education ◽  
Online Survey ◽  
Diagnostic Delay ◽  
Special Interest Groups ◽  
Free Text ◽  
Low Back ◽  
Nice Guidance

Abstract Background Axial spondyloarthritis (axSpA) is an inflammatory disease underlying around 5% of back pain presentations. It is essential that physiotherapists screen for possible axSpA and know when to refer to rheumatology. In the UK, diagnostic delays of 5-8.5 years are common. Challenges with differentiating axSpA from non-specific low back pain and poor awareness of features of axSpA that should prompt rheumatology referral may be contributing factors. Early intervention is important and NICE guidance on back pain and sciatica (2016), spondyloarthritis (2017) and the National Back and Radicular Pain Pathway (2017) aim to support better screening and earlier diagnosis. This study aimed to explore physiotherapistś awareness, knowledge and confidence in screening for and recognising signs, symptoms and risk factors of suspected axSpA and criteria for rheumatology referral. Methods An online survey of UK musculoskeletal physiotherapists was undertaken combining a multi-vignette design (axSpA, non-specific low back pain and radiculopathy) and questioning on awareness, knowledge and confidence in screening for axSpA. Distribution included online professional networks, special interest groups, social media and snowballing. Data analysis used descriptive statistics and conceptual content analysis for free text responses. Results One hundred and thirty-two surveys were analysed. Vignette analysis found only 67% of respondents (n=88/132) indicated inflammatory pathologies as a possible cause of persistent back pain. Only 60% (79/132) of respondents identified the vignette with features suspicious of axSpA compared to the vignettes of non-specific low back pain (94%) and radiculopathy (80%). Most respondents (92%, n=73/79) who correctly identified the axSpA vignette appropriately indicated referral to rheumatology. Demonstrating a ‘full awareness’ or ‘good awareness’ of NICE guidance (2017) referral criteria for axSpA was only evident within 50% of ‘clinical reasoning’ responses, and only within 20% of responses describing their approach to ‘further subjective screening’. Importance of features raising suspicion of axSpA was rated highest for family history of inflammatory arthritis (median=9/10) and least for male gender (median=5/10). Considerable importance was given to CRP, ESR and HLAB27 positivity (median=8/10). Despite expressing confidence (≥7/10) in recognising features of possible axSpA, a significant number failed to identify the axSpA vignette. Better awareness and knowledge of axSpA was associated with greater familiarity with the NICE guidance on spondyloarthritis and previous education on SpA. Conclusion The study suggests that physiotherapists may not be giving adequate consideration to possible axSpA in the differential diagnosis of persistent low back pain. Although certain features of SpA were better recognised, a significant lack of awareness and knowledge of signs, symptoms and risk factors for suspected axSpA was found. Awareness of criteria for referral to rheumatology was also limited. The consequences for diagnostic delay are significant and indicate the need for professional education and applying guidance to improve screening and earlier recognition. Disclosures E. Steen None. M. Cairns None. C. McCrum Honoraria; Novartis.

Low Back Pain in Commercial Airline Pilots

2020 ◽  
Vol 91 (12) ◽  
pp. 940-947
Author(s):  
Matthias Albermann ◽  
Maria Lehmann ◽  
Christian Eiche ◽  
Joachim Schmidt ◽  
Johannes Prottengeier
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Online Survey ◽  
German Population ◽  
Low Back ◽  
Airline Pilots ◽  
Acute Low Back Pain ◽  
Commercial Airline ◽  
Negative Effect

BACKGROUND: In their working life, airline pilots are exposed to particular risk factors that promote nonspecific low back pain (LBP). Because of the varying incidence internationally, we evaluated the point prevalences of acute, subacute, and chronic nonspecific LBP, as well as the current prevalences in German airline pilots. Furthermore, we compared the prevalence to the general German population and to European counterparts.METHODS: An anonymous online survey of 698 participating German airline pilots was evaluated. The impairment between groups was analyzed. Prevalences from our data were compared to existing data.RESULTS: The following point prevalences were found: 8.2% acute, 2.4% subacute, 82.7% chronic LBP; 74.1% of all individuals were suffering from current LBP when answered the questionnaire. A total time spent flying greater than 600 h within the last 12 mo was significantly related to acute nonspecific LBP. Individuals with any type of LBP were significantly impaired compared to those unaffected. It was found that German airline pilots suffer more often from current LBP than the general population and have a higher point prevalence of total LBP than their European counterparts.CONCLUSIONS: The evaluation showed a surprisingly high, previously unidentified, prevalence of nonspecific LBP in German airline pilots. Why German airline pilots suffer more often from LBP remains uncertain. The number of flying hours appears to have a negative effect on developing acute low back pain, but causation cannot be concluded. Other risk factors could not be confirmed.Albermann M, Lehmann M, Eiche C, Schmidt J, Prottengeier J. Low back pain in commercial airline pilots. Aerosp Med Hum Perform. 2020; 91(12):940947.

scholarly journals The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients

2021 ◽  
Author(s):  
J. W. H. Luites ◽  
P. P. F. M. Kuijer ◽  
C. T. J. Hulshof ◽  
R. Kok ◽  
M. W. Langendam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Prognostic Factors ◽  
Back Pain ◽  
Work Participation ◽  
Stepped Care ◽  
Low Back ◽  
Lumbosacral Radicular Syndrome ◽  
Care Approach ◽  
Radicular Syndrome

AbstractPurpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation “to advise”, low to very low in a recommendation “to consider”, unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines “lifting” and “whole body vibration”. The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.

PREVALENCE OF LOW BACK PAIN AND ASSOCIATED RISK FACTORS AMONG HIGH SCHOOL TEACHERS IN KERMAN, IRAN

2017 ◽  
Vol 20 (01) ◽  
pp. 1750005 ◽  
Author(s):  
Ghorbanali Mohammadi
Keyword(s):  
Risk Factors ◽  
High School ◽  
Low Back Pain ◽  
Back Pain ◽  
High School Teachers ◽  
Lower Back Pain ◽  
Low Back ◽  
School Teachers ◽  
Lower Back ◽  
Associate Risk

Low back pain (LBP) is one of the most frequent occupational health problems and accounts for a large number of losses in working days and disability for workers in modern industrialized countries. The aim of this paper was to investigate the prevalence of lower back problem and to associate risk factors among high school teachers. A cross-sectional study was conducted among high school teachers using self-administered questionnaires, which were distributed to randomly selected school teachers of 7 boys’ and 10 girls’ high schools across the city of Kerman and collected between October and November 2010. A total of 296 teachers returned completed questionnaires, yielding a response rate of 78.9%. The 12-month prevalence of LBP was 68.8%, which reporting with moderate disability. The results of multiple logistic regression analysis revealed that females [odds ratio (OR): 1.85, 95% confidence interval (CI): 1.51–2.00] were positively correlated to LBP. Awkward arm posture (OR: 1.81, 95% CI: 1.24–2.62) and awkward body posture (OR: 1.23, 95% CI: 0.87–1.49) were significantly associated with LBP. Psychosocial job demands and job dissatisfaction were also significantly associated with LBP. Smoking cigarette was three times more likely to develop lower back pain when compared with non-smokers. The prevalence of LBP was high among high school teachers. A wide variety of LBP risk factors were identified in the current study. The present study indicates that the high prevalence of lower back pain may lose difficulty to teachers in getting to work and “performing” the work required of them, resulting in work absenteeism, which may decrease work productivity.

scholarly journals Low Back Pain in Athletes Is Associated with General and Sport Specific Risk Factors: A Comprehensive Review of Longitudinal Studies

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Vahideh Moradi ◽  
Amir-Hossein Memari ◽  
Monir ShayestehFar ◽  
Ramin Kordi
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Low Back Pain ◽  
Back Pain ◽  
Longitudinal Studies ◽  
Methodological Quality ◽  
Low Back ◽  
Lumbar Flexion ◽  
High Body

We aimed to examine systematically the available evidence on risk factors of low back pain (LBP) in athletes. We performed search without language restriction in PubMed, Ovid, Google Scholar, Scopus, and CINAHL. Longitudinal studies that examined possible risk factors of LBP in athletes were included in this systematic review. Based on methodological quality of studies, a best-evidence synthesis was conducted. Seven longitudinal studies were included, four of which had high methodological quality. Results showed that previous LBP, decreased lumbar flexion, and decreased lumbar extension are positively associated with LBP. There was moderate evidence for hip flexor tightness and high body weight as a risk factor. We found insufficient evidence for association between forward bending, previous injury, and amount of training per week, active years, age, and sex with LBP. In conclusion this study would provide a list of risk factors for LBP in athletes, though it showed a strong evidence for only a few including decrease lumbar flexion or extension, previous LBP, and high body weight. This review indicated a high heterogeneity of study characteristics including assessed risk factors and statistical techniques might limit the quality of evidence.

scholarly journals A Rare Cause of Postpartum Low Back Pain: Pregnancy- and Lactation-Associated Osteoporosis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Rabia Terzi ◽  
Hasan Terzi ◽  
Tülay Özer ◽  
Ahmet Kale
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Fragility Fractures ◽  
Low Back ◽  
Rare Form ◽  
Current Case ◽  
Pregnancy And Lactation ◽  
Significant Disability ◽  
Appropriate Therapy

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.

Description of content, structure and theoretical model of a group-based pain management programme in the treatment of patients with persistent non-specific low back pain and psychological risk factors in a secondary sector setting

2021 ◽  
pp. 026921552199518
Author(s):  
Mette Høj Skovbo ◽  
Karina Agerbo ◽  
Anna Jakobsen ◽  
Stine Aalkjær Clausen ◽  
Vivian Langagergaard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Theoretical Foundation ◽  
Management Programme ◽  
Low Back ◽  
Content Structure ◽  
Cognitive Behavioural ◽  
Intervention Description

Objective: To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. Method: The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. Intervention description: A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. Conclusion: The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.

scholarly journals Even Worse — Risk Factors and Protective Factors for Transition from Chronic Localized Low Back Pain to Chronic Widespread Pain in General Practice

Spine ◽  
2015 ◽  
Vol 40 (15) ◽  
pp. E890-E899 ◽  
Author(s):  
Annika Viniol ◽  
Nikita Jegan ◽  
Markus Brugger ◽  
Corinna Leonhardt ◽  
Jürgen Barth ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Practice ◽  
Low Back Pain ◽  
Back Pain ◽  
Protective Factors ◽  
Chronic Widespread Pain ◽  
Low Back ◽  
Widespread Pain

scholarly journals The incidence of work-related low back pain among currently practicing physiotherapists in Bloemfontein

2007 ◽  
Vol 63 (1) ◽  
Author(s):  
R. Barnes ◽  
J. Birch ◽  
M. M. Cloete ◽  
L. Joubert ◽  
A. C. Usher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Confidence Interval ◽  
Descriptive Study ◽  
Job Design ◽  
Physical Activities ◽  
Low Back ◽  
Physiotherapy Practice ◽  
Work Related

Physiotherapy practice involves the performance of strenuous physical activities related to the delivery of patient rehabilitation.  No evidence of studies relating to physiotherapy work-related low back pain (WRLBP) in South Africa could be found.  The aims of this study were to retrospectively investigate the incidence of work related low back pain among currently practicing physiotherapists in Bloemfontein, to determine the contributing risk factors, and to determine the responses of the physiotherapists to injury. Eighty four physiotherapists participated in this descriptive study. The results indicated that 67% of respondents had experienced work related low back pain and the 95% confidence interval for the incidence of WRLBP among physiotherapists in Bloemfontein is [56.8%; 76.6%].  Therapists performing cardio-thoracic related tasks had the most significant confidence interval of WRLBP [2.2%; 35.1%]. Fifty eight percent of respondents who had WRLBP reported that their symptoms were exacerbated by clinical practice.  The results of the study suggest that it is the nature of the job design which predisposes physiotherapists to injury and not a lack of kinetic handling knowledge. Further research is needed to develop methods to reduce the risks of WRLBP which are inherently part of physio-therapy practice.

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