Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese

AbstractWe assessed the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis (OA), who are overweight or obese. We conducted causal mediation analyses of aggregated data from two RCTs; which included 160 patients with chronic low back pain, and 120 patients with knee OA. Participants were randomised via one central randomisation schedule, to the intervention, or usual care. The intervention consisted of brief advice and referral to a 6-month telephone-based healthy lifestyle coaching service. Participants in the back pain trial were also offered a single physiotherapy consultation. The hypothesised primary mediator was self-reported weight, and alternative mediators were diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). Data were analysed using causal mediation analyses with sensitivity analyses for sequential ignorability. All mediation models were specified a priori. The intervention had no effect on pain intensity, disability or physical QoL. The intervention significantly improved mental QoL, however, the intervention effect was not channelled via the selected mediators. The intervention did not reduce weight, or the alternative mediators (diet, physical activity, pain beliefs), and these mediators were not associated with the outcomes (with one exception; poor diet was associated with lower mental QoL). The sensitivity analyses showed that our estimates were stable across all possible levels of residual confounding. Our findings show that the intervention did not cause a meaningful change in the hypothesised mediators, and these mediators were not associated with patient outcomes.

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Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese

Clinical Rehabilitation ◽

10.1177/0269215519831419 ◽

2019 ◽

Vol 33 (6) ◽

pp. 1088-1097 ◽

Cited By ~ 1

Author(s):

Amanda Williams ◽

Hopin Lee ◽

Steven J Kamper ◽

Kate M O’Brien ◽

John Wiggers ◽

...

Keyword(s):

Physical Activity ◽

Low Back Pain ◽

Back Pain ◽

Knee Osteoarthritis ◽

Lifestyle Intervention ◽

Chronic Low Back Pain ◽

Healthy Lifestyle ◽

Low Back ◽

Pain Beliefs ◽

Causal Mechanisms

Purpose: To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. Methods: We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). Results: The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. Conclusions: Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.

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Do depression and pain intensity interfere with physical activity in daily life in patients with Chronic Low Back Pain?

Pain ◽

10.1016/j.pain.2010.04.021 ◽

2010 ◽

Vol 150 (1) ◽

pp. 161-166 ◽

Cited By ~ 60

Author(s):

Ivan P.J. Huijnen ◽

Jeanine A. Verbunt ◽

Madelon L. Peters ◽

Philippe Delespaul ◽

Hanne P.J. Kindermans ◽

...

Keyword(s):

Physical Activity ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Daily Life ◽

Low Back

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Economic evaluation of a healthy lifestyle intervention for chronic low back pain: a randomised controlled trial

10.1101/296285 ◽

2018 ◽

Author(s):

A Williams ◽

JM van Dongen ◽

SJ Kamper ◽

KM O’Brien ◽

L Wolfenden ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Lifestyle Intervention ◽

Chronic Low Back Pain ◽

Healthy Lifestyle ◽

Intervention Group ◽

Sensitivity Analyses ◽

Control Group ◽

Low Back

AbstractWe performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Eligible patients with chronic low back pain (n=160) were randomised to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight, and body mass index. Costs included intervention costs, healthcare utilisation costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e. 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.

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Chronic low back pain beliefs and management practices in Africa: Time for a rethink?

Musculoskeletal Care ◽

10.1002/msc.1424 ◽

2019 ◽

Vol 17 (4) ◽

pp. 376-381 ◽

Cited By ~ 3

Author(s):

Josephine Ahenkorah ◽

Fiona Moffatt ◽

Claire Diver ◽

Paapa Kwesi Ampiah

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Management Practices ◽

Low Back ◽

Pain Beliefs

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Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-171039 ◽

2020 ◽

Vol 33 (5) ◽

pp. 785-791 ◽

Cited By ~ 1

Author(s):

Nuray Alaca ◽

Hande Kaba ◽

Ayce Atalay

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Behavioral Therapy ◽

Short Form ◽

Low Back ◽

Pain Beliefs ◽

Fear Of Movement ◽

Severity Of Disability ◽

The Impact

BACKGROUND AND OBJECTIVES: Low back pain (LBP) is one of the leading forms of chronic pain and is among the leading causes of pain and disability. In this study, we investigated the associations between the severity of disability and fear of movement and pain beliefs as well as the impact of the fear of movement and pain beliefs on the quality of life in patients with chronic LBP. METHODS: A total of 89 patients (42.29 ± 16.05 years) with chronic low back pain were included in the study. The instruments used in the assessments include the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), the Tampa Kinesiophobia Scale (TKS), the Pain Belief Questionnaire (PBQ), and the SF 36-Short Form. Patients were assigned into three groups by disability severity based on ODI scores. Statistical analysis was performed using SPSS 15. RESULTS: No statistically significant intergroup differences were found in TKS and PBQ scores (p> 0.05). A positive correlation was found between TKS scores, age (r: 0.227/p< 0.05), PBQ organic (r: -0.250/p< 0.05) scores. CONCLUSIONS: Our study revealed high levels of kinesiophobia and similar pain beliefs, independent of the severity level of disability. We believe that cognitive-behavioral therapy that may reduce fear-avoidance behaviors and convert negative pain beliefs into positive ones should be added to rehabilitation procedures for LBP.

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An Evaluation of an Innovative Exercise to Relieve Chronic Low Back Pain in Sedentary Workers

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720820966082 ◽

2020 ◽

pp. 001872082096608

Author(s):

Pongsatorn Saiklang ◽

Rungthip Puntumetakul ◽

James Selfe ◽

Gillian Yeowell

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Muscle Fatigue ◽

Chronic Low Back Pain ◽

Muscle Activity ◽

Trunk Muscle ◽

Low Back ◽

Prolonged Sitting ◽

Lumbar Extension

Objective The purpose of the study was to examine the effectiveness of a novel supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue, and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants. Background Prolonged sitting can cause trunk muscle fatigue from continuous contraction of deep trunk muscles in seated postures. Deficiency of activity of deep muscles can reduce muscular support of the spine, causing stress on spinal structures, which could result in pain. Method Thirty participants with CLBP were randomly allocated: (a) control—sitting without exercise, and (b) intervention—supported dynamic lumbar extension with the ADIM technique. Results Compared to the intervention condition, the control condition demonstrated significantly greater deterioration in stature change, increased levels of deep trunk muscle fatigue, and an increase in pain during prolonged sitting. Conclusion The supported dynamic lumbar extension with the ADIM technique appears to provide a protective effect on detrimental stature change and deep trunk muscle fatigue. In addition, it prevented an increase in pain intensity during prolonged sitting in people with CLBP. Application Sedentary behavior harms health, particularly affecting the lower back. Clinicians can use the intervention to induce dynamic lumbar movement, and this exercise can maintain deep trunk muscle activity during prolonged sitting, thereby helping to prevent low back pain (LBP) problems.

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Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population

Spine ◽

10.1097/brs.0000000000003002 ◽

2019 ◽

Vol 44 (15) ◽

pp. E889-E898 ◽

Cited By ~ 2

Author(s):

Dalyah M. Alamam ◽

Niamh Moloney ◽

Andrew Leaver ◽

Hana I. Alsobayel ◽

Martin G. Mackey

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Saudi Arabian ◽

Low Back ◽

Fear Avoidance ◽

Arabian Population

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Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

Physical Therapy ◽

10.2522/ptj.20150335 ◽

2016 ◽

Vol 96 (7) ◽

pp. 1049-1056 ◽

Cited By ~ 10

Author(s):

Corey B. Simon ◽

Trevor A. Lentz ◽

Mark D. Bishop ◽

Joseph L. Riley ◽

Roger B. Fillingim ◽

...

Keyword(s):

Working Memory ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Pain Catastrophizing ◽

Future Research ◽

Low Back ◽

Cross Sectional ◽

Daily Pain

Abstract Background Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. Objective The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. Design This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Method Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Results Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R2=.07, standardized beta=−.308, P=.041) and movement-evoked pain intensity (R2=.14, standardized beta=−.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. Limitations The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Conclusion Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.

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