scholarly journals How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years

2019 ◽  
Vol 54 (11) ◽  
pp. 642-651 ◽  
Author(s):  
Aron Downie ◽  
Mark Hancock ◽  
Hazel Jenkins ◽  
Rachelle Buchbinder ◽  
Ian Harris ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Emergency Care ◽  
Meta Analysis ◽  
Relative Increase ◽  
Low Back ◽  
Eligibility Criteria ◽  
Moderate Quality ◽  
Quality Evidence

ObjectivesTo (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.Data sourcesElectronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.Eligibility criteria for selecting studiesObservational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.Results45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.Summary/conclusionOne in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.Trial registration numberCRD42016041987.

scholarly journals Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis

2020 ◽  
pp. bjsports-2019-101436
Author(s):  
Tarcisio F de Campos ◽  
Chris G Maher ◽  
Joel T Fuller ◽  
Daniel Steffens ◽  
Stephanie Attwell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Exercise Programme ◽  
Low Back ◽  
Prevention Strategies ◽  
Moderate Quality ◽  
Prevention Programmes ◽  
Quality Evidence

ObjectiveTo evaluate the evidence from randomised controlled trials (RCTs) on the effectiveness of prevention strategies to reduce future impact of low back pain (LBP), where impact is measured by LBP intensity and associated disability.DesignSystematic review with meta-analysis.Data sourcesMEDLINE, Embase, CINAHL, PEDro and The Cochrane (CENTRAL) databases from inception to 22 October 2018.Eligibility criteriaRCTs evaluating any intervention aiming to prevent future impact of LBP, reporting an outcome measure of LBP intensity and/or disability measured at least 3 months post-randomisation, and the intervention group must be compared with a group that received no intervention/placebo or minimal intervention. Trials restricting recruitment to participants with current LBP were excluded.Results27 published reports of 25 different trials including a total of 8341 participants fulfilled the inclusion criteria. The pooled results, from three RCTs (612 participants), found moderate-quality evidence that an exercise programme can prevent future LBP intensity (mean difference (MD) −4.50; 95% CI −7.26 to −1.74), and from 4 RCTs (471 participants) that an exercise and education programme can prevent future disability due to LBP (MD −6.28; 95% CI −9.51 to −3.06). It is uncertain whether prevention programmes improve future quality of life (QoL) and workability due to the overall low-quality and very low-quality available evidence.ConclusionsThis review provides moderate-quality evidence that an exercise programme, and a programme combining exercise and education, are effective to reduce future LBP intensity and associated disability. It is uncertain whether prevention programmes can improve future QoL and workability. Further high-quality RCTs evaluating prevention programmes aiming to reduce future impact of LBP are needed.

scholarly journals What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews

PLoS ONE ◽  
2019 ◽  
Vol 14 (12) ◽  
pp. e0225414 ◽  
Author(s):  
Gabrielle S. Logan ◽  
Andrea Pike ◽  
Bethan Copsey ◽  
Patrick Parfrey ◽  
Holly Etchegary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Medical Record ◽  
Emergency Care ◽  
Meta Analysis ◽  
Low Back

scholarly journals Associates of Insomnia in People with Chronic Spinal Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3175
Author(s):  
Thomas Bilterys ◽  
Carolie Siffain ◽  
Ina De Maeyer ◽  
Eveline Van Looveren ◽  
Olivier Mairesse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Associated Factors ◽  
Meta Analysis ◽  
Spinal Pain ◽  
Low Back ◽  
Quality Evidence ◽  
Chronic Spinal Pain

Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the relation between sleep and pain are still not fully understood. Additionally, no reviews regarding the prevention of insomnia and/or associated factors in people with CSP are currently available. To gain a better understanding of the occurrence of insomnia and associated factors in this population, we conducted a systematic review of the literature exploring associates for insomnia in people with CSP in PubMed, Web of Science and Embase. Three independent reviewers extracted the data and performed the quality assessment. A meta-analysis was conducted for every potential associate presented in at least two studies. A total of 13 studies were found eligible, which together identified 25 different potential associates of insomnia in 24,817 people with CSP. Twelve studies had a cross-sectional design. Moderate-quality evidence showed a significantly higher rate for insomnia when one of the following factors was present: high pain intensity, anxiety and depression. Low-quality evidence showed increased odds for insomnia when one of the following factors was present: female sex, performing no professional activities and physical/musculoskeletal comorbidities. Higher healthcare use was also significantly related to the presence of insomnia. One study showed a strong association between high levels of pain catastrophizing and insomnia in people with chronic neck pain. Last, reduced odds for insomnia were found in physically active people with chronic low back pain compared to inactive people with chronic low back pain. This review provides an overview of the available literature regarding potential associates of insomnia in people with CSP. Several significant associates of insomnia were identified. These findings can be helpful to gain a better understanding of the characteristics and potential origin of insomnia in people witch CSP, to identify people with CSP who are (less) likely to have insomnia and to determine directions of future research in this area.

scholarly journals Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis

2021 ◽  
pp. bjsports-2020-103596
Author(s):  
Silvia Gianola ◽  
Silvia Bargeri ◽  
Gabriele Del Castillo ◽  
Davide Corbetta ◽  
Andrea Turolla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Muscle Relaxants ◽  
Low Back ◽  
Eligibility Criteria ◽  
Experienced Pain ◽  
Inflammatory Drugs

ObjectiveTo assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.DesignA systematic review of the literature with network meta-analysis.Data sourcesMedline, Embase and CENTRAL databases were searched from inception until 17 October 2020.Eligibility criteria for selecting studiesRandomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).ResultsForty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.ConclusionWith uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.

scholarly journals Spinal manipulative therapy and acupuncture for chronic low back pain: a systematic review and meta-analysis of RCTs

2021 ◽  
Author(s):  
Ting Yue ◽  
Jingjing Li ◽  
Jiaman Yang ◽  
Dehui Fan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Adverse Events ◽  
Chronic Low Back Pain ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Low Back ◽  
Quality Of Evidence ◽  
Moderate Quality

Abstract Background Spinal manipulation therapy (SMT) and acupuncture are commonly used for low back pain (LBP) among complementary and alternative therapies. However, it remains unclear which of the two therapies is more effective for LBP. Therefore, the purpose of this meta-analysis was to evaluate the effectiveness of SMT and acupuncture on LBP. Methods Four electronic databases were searched for randomized controlled trials (all years until July 2021), including PubMed, Embase, Web of Science, and Cochrane Library. Two reviewers independently abstracted data, assessed risk of bias, and rated the quality of evidence. The primary outcome was pain; secondary outcomes included functional status and adverse events. Review Manager 5.3 software and Stata 12.0 were used for all statistical analyses. Results 9 RCTs with a total of 714 participants were identified, who were on average middle aged (39-60 years) without signs of radiating pain. These trials included patients with mild to moderate pain. Overall, moderate quality of evidence suggested that SMT had better effects for pain relief (MD: 0.32, 95%CI: 0.09 to 0.55, I2=34%) and similar effects in function (MD: 0.24, 95%CI: -0.45 to 0.94, I2=21%) when compared to acupuncture. Moderate quality of evidence showed SMT reduced pain better than acupuncture at month 2 (MD: 0.61, 95%CI: 0.08 to 1.14, I2=0%) and at month 12 (MD: 1.02, 95%CI: 0.28 to 1.75, I2=42%). In addition, Low quality of evidence showed SMT may provide better improvement in pain at month 3 (MD: 0.74, 95%CI: 0.09 to 1.39, I2=42%) and in function at month 4 (MD: 3.50, 95%CI: 0.71 to 6.29). Adverse events associated with SMT and acupuncture were rare and mild. Conclusions SMT showed better effects than acupuncture for chronic low back pain, while SMT and acupuncture had similar effects in functional improvement. Although SMT and acupuncture were tolerable and safe, patients should be informed about the potential risks of adverse events before starting therapy.

scholarly journals Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects

2020 ◽  
Vol 9 (9) ◽  
pp. 3058
Author(s):  
Daniel Niederer ◽  
Tilman Engel ◽  
Lutz Vogt ◽  
Adamantios Arampatzis ◽  
Winfried Banzer ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Pain Intensity ◽  
Exercise Intervention ◽  
Meta Analysis ◽  
Control Group ◽  
Low Back ◽  
Meta Analyses ◽  
Quality Evidence

Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2391 patients were randomized; 1976 (3 weeks, short-term), 1740 (12 weeks, intermediate), and 1560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD = −0.15, −0.15, −0.19), pain intensity (SMD = −0.19, −0.26, −0.26) and disability (SMD = −0.15, −0.27, −0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.

Emergency department interventions for adult patients with low back pain: a systematic review of randomised controlled trials

2020 ◽  
Vol 38 (1) ◽  
pp. 59-68
Author(s):  
Crystian B Oliveira ◽  
Hugo E Amorim ◽  
Danielle M Coombs ◽  
Bethan Richards ◽  
Marco Reedyk ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Risk Of Bias ◽  
Low Back ◽  
Pharmacological Treatments ◽  
Moderate Quality ◽  
Intravenous Paracetamol ◽  
Randomised Controlled ◽  
Quality Evidence

BackgroundMost low back pain trials have limited applicability to the emergency department (ED) because they provide treatment and measure outcomes after discharge from the ED. We investigated the efficacy and safety of pharmacological and non-pharmacological interventions delivered in the ED to patients with non-specific low back pain and/or sciatica on patient-relevant outcomes measured during the emergency visit.MethodsLiterature searches were performed in MEDLINE, EMBASE and CINAHL from inception to week 1 February 2020. We included all randomised controlled trials investigating adult patients (≥18 years) with non-specific low back pain and/or sciatica presenting to ED. The primary outcome of interest was pain intensity. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias of each trial using the Physiotherapy Evidence Database (PEDro) scale. The overall quality of evidence, or certainty, provided by a set of trials evaluating the same treatment was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers imprecision, inconsistency, indirectness and bias in the evidence.ResultsFifteen trials (1802 participants) were included with 12 of 15 at low risk of bias (ie, PEDro score >6). Based on results from individual trials and moderate quality evidence, ketoprofen gel was more effective than placebo for non-specific low back pain at 30 min (mean difference (MD) −15.0, 95% confidence interval (CI) −21.0 to −9.0). For those with sciatica (moderate quality evidence), intravenous paracetamol (acetaminophen) (MD −15.7, 95% CI −19.8 to −11.6) and intravenous morphine (MD −11.4, 95% CI −21.6 to −1.2) were both superior to placebo at 30 min. Based on moderate quality of evidence, corticosteroids showed no benefits against placebo at emergency discharge for non-specific low back pain (MD 9.0, 95% CI −0.71 to 18.7) or sciatica (MD −6.8, 95% CI −24.2 to 10.6). There were conflicting results from trials comparing different pharmacological options (moderate quality evidence) or investigating non-pharmacological treatments (low quality evidence).ConclusionKetoprofen gel for non-specific low back pain and intravenous paracetamol or morphine for sciatica were superior to placebo, whereas corticosteroids were ineffective for both conditions. There was conflicting evidence for comparisons of different pharmacological options and those involving non-pharmacological treatments. Additional trials measuring important patient-related outcomes to EDs are needed.

Do Patients with Acute Low Back Pain in Emergency Departments Have More Severe Symptoms than Those in General Practice? ASystematic Review with Meta-Analysis

Pain Medicine ◽  
2021 ◽  
Author(s):  
Crystian B Oliveira ◽  
Melanie Hamilton ◽  
Adrian Traeger ◽  
Rachelle Buchbinder ◽  
Bethan Richards ◽  
...  
Keyword(s):  
General Practice ◽  
Low Back Pain ◽  
Back Pain ◽  
Confidence Interval ◽  
Emergency Departments ◽  
Observational Studies ◽  
Meta Analysis ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Quality Evidence

Abstract Introduction There is a common belief that patients presenting to emergency departments have more severe pain levels and functional limitations than those who are seen in general practice. The aim of this systematic review was to compare pain and disability levels of patients with acute low back pain presenting to general practice vs those presenting to emergency departments. Methods Electronic searches were conducted in MEDLINE, EMBASE, and CINAHL from database inception to February 2019. Observational studies including patients with acute non-specific low back pain presenting to emergency departments and/or general practice were eligible. Pain and/or disability scores expressed on a 0–100 scale were the primary outcomes. Risk of bias was evaluated with a validated tool for observational studies, and the overall quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis with random effects and meta-regression were used to test for differences between the two settings. Results We included 12 records reporting results for 10 unique studies with a total of 6,999 participants from general practice (n = 6) and emergency departments (n = 4). There was low-quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher pain scores than those in general practice, with a mean difference of 17.3 points (95% confidence interval: 8.8 to 25.9 on a 0–100 scale). Similarly, there was low-quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher disability scores than those in general practice (mean difference: 21.7; 95% confidence interval: 4.6 to 38.7 on a 0–100 scale). Conclusion Patients with acute non-specific low back pain presenting to emergency departments may report higher levels of pain and disability than those seen in general practice.

scholarly journals Do people with low back pain walk differently? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Jo Armour Smith ◽  
Heidi Stabbert ◽  
Jennifer J Bagwell ◽  
Hsiang-Ling Teng ◽  
Vernie Wade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Meta Analysis ◽  
Reporting Quality ◽  
Healthy Controls ◽  
Low Back ◽  
Eligibility Criteria ◽  
Walking Gait

Objective To identify differences in biomechanics during gait in individuals with acute and persistent low back pain compared with back-healthy controls. Design Systematic review Data Sources A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Eligibility criteria Studies were included if they reported biomechanical characteristics of individuals with and without low back pain during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between groups. Results Ninety-seven studies were included. Two studies investigated acute pain and the rest investigated persistent pain. Eight studies investigated running gait. 20% of studies had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent low back pain walked more slowly (SMD -0.59 [95% CI -0.77 to -0.42]) and with shorter stride length (-0.38 [-0.60 to -0.16]). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the LBP groups (-0.60 [-0.90 to -0-.30]), and individuals with LBP exhibited greater amplitude of activation in the paraspinal muscles (0.52 [0.23 to 0.80]). Summary/Conclusion There is moderate to strong evidence that individuals with persistent LBP demonstrate impairments in walking gait compared with back-healthy controls.

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