Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain

2019 ◽  
Vol 166 (5) ◽  
pp. 336-341 ◽  
Author(s):  
Dean Conway ◽  
P Ladlow ◽  
J Ferreira ◽  
S Mani-Babu ◽  
A N Bennett
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Psychosocial Outcomes ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Functional Therapy ◽  
Multidisciplinary Rehabilitation ◽  
British Military ◽  
Patient Reported

IntroductionLow back pain (LBP) has been reported as the most common reason for presentation to the Medical Centre in the British Military, and the most common re-referral for the same condition. In 2015, the UK Defence Medical Rehabilitation Centre (DMRC) adopted a cognitive functional therapy (CFT) approach to spinal rehabilitation in line with National Institute for Health and Care Excellence and military best practice guidelines. The aim of this study is to evaluate the functional and psychosocial outcomes of all patients with chronic LBP treated with CFT-based multidisciplinary rehabilitation at DMRC, Headley Court.MethodsA prospective observational service evaluation of British Military patients (n=238) with LBP who attended 3 weeks of inpatient multidisciplinary CFT-based programme from 2015 to the end of 2017 at DMRC was analysed. Functional outcomes include: multistage locomotion test (MSLT) and sit and reach test. Psychosocial outcomes include: Tampa Scale of Kinesiophobia, Oswestry Disability Index, Brief Pain Inventory (BPI), General Anxiety Disorder-7 and Patient Health Questionnaire-9.ResultsThere were significant improvements in endurance (MSLT), range of motion, kinesiophobia, pain-related lifestyle interference (BPI-Lifestyle), anxiety and depression (p≤0.001). However, no improvements in pain intensity (BPI-Intensity) were demonstrated (p>0.05).ConclusionAfter 3 weeks of CFT-based multidisciplinary rehabilitation, function and psychosocial health improved with symptoms of pain being less obtrusive to activities of daily activity. There were however no patient-reported reductions in pain intensity. The improvements demonstrated are indicative of outcomes that facilitate greater integration back to work or into society.

scholarly journals Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study (Preprint)

2018 ◽  
Author(s):  
Robert Froud ◽  
Carol Fawkes ◽  
Jonathan Foss ◽  
Martin Underwood ◽  
Dawn Carnes
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Outcome Measures ◽  
Roc Curves ◽  
Low Back ◽  
Metric Properties ◽  
Android Apps ◽  
Patient Reported ◽  
Transition Question

BACKGROUND The Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts. OBJECTIVE The goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser. METHODS We recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95. RESULTS We included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS. CONCLUSIONS The eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population.

Cupping as An Effective Complementary Therapy to Reduce Chronic Low Back Pain in Medical Rehabilitation Subdivision Perkebunan Hospital Jember

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Debie Saktyana Iriawandani ◽  
Hanik Badriyah Hidayati ◽  
Wahyudi Widada ◽  
Zuhrotul Eka Yulis ◽  
Azham Purwandhono
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Chronic Low Back Pain ◽  
Intervention Group ◽  
Cupping Therapy ◽  
Medical Rehabilitation ◽  
Control Group ◽  
P Value ◽  
Low Back

Pain, especially chronic pain lasts prolonged weariness, usually persistent and recurring. Thus, pain is often found in patients with Chronic Low Back Pain (CLBP). One alternative treatment to reduce chronic low back pain is cupping therapy. The main principle of cupping therapy is using of negative pressure to attract toxin substances, free radicals in the blood, inflammation cells, metabolic waste or Causative Pathological Substances (CPS), scarification in the form of skin removal and removing CPS. The aim of this study was to analyze the effect of cupping therapy on pain intensity of CLBP patients in Medical Rehabilitation Sub Division Perkebunan Hospital Jember. The design in this study was quasi experiment nonequivalent control group. The population was all CLBP patients who underwent physiotherapy in the physiotherapy room at Perkebunan Hospital Jember. The sample consisted of 34 respondents (17 respondents in the intervention group and 17 respondents in the control group) using purposive sampling. A cupping therapy was done once in the intervention group. Statistical test results using Wilcoxon obtained p value 0.000 with a value of α <0.05, so it can be concluded that there is an effect of cupping therapy on pain intensity of CLBP patients in Medical Rehabilitation Sub Division Perkebunan Hospital Jember. Cupping Therapy can be used as a complementary or alternative therapy to reduce pain of CLBP patients at Perkebunan Hospital Jember.

Low back pain in pregnancy and post-partum period. Principles for medical rehabilitation

2018 ◽  
Vol 1 (19) ◽  
pp. 22
Author(s):  
Iulia Filipescu ◽  
Mihai Berteanu ◽  
George Alexandru Filipescu ◽  
Radu Vlădăreanu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Post Partum ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Post Partum Period ◽  
In Pregnancy

Protocol for a feasibility randomised controlled trial comparing cognitive functional therapy with usual physiotherapy care in people with persistent low back pain

2021 ◽  
pp. 1-14
Author(s):  
Christopher Newton ◽  
Gurpreet Singh ◽  
David Nolan ◽  
Vicky Booth ◽  
Claire Diver ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Low Back ◽  
Functional Therapy ◽  
Randomised Controlled ◽  
The Uk ◽  
Feasibility Rct

BACKGROUND: Combined physical and psychological programmes (CPPP) are recommended for people with disabling low back pain (LBP). Cognitive Functional Therapy (CFT) is a physiotherapist-led low intensity CPPP with positive effects in previous studies. The clinical and cost effectiveness of CFT has not previously been evaluated in a randomised controlled trial (RCT) in the United Kingdom (UK) National Health Service (NHS). Before a definitive RCT can be completed it is necessary to determine if completing such a study is possible. PURPOSE: To determine the feasibility of completing a definitive RCT, that will evaluate the clinical and cost-effectiveness of CFT in comparison to usual physiotherapy care for people with persistent LBP in the UK NHS. METHODS: A pragmatic two-arm parallel feasibility RCT comparing CFT with usual physiotherapy care for people with persistent LBP will be completed. Sixty participants will be randomly allocated to receive CFT or usual physiotherapy care. The primary outcome will be feasibility of completing a definitive RCT. Participant reported outcome measures will be recorded at baseline, three, six and twelve-month follow-up, including disability, pain intensity, quality of life and psychosocial function. Data will be analysed descriptively. A qualitative process evaluation will explore the acceptability of the research processes and interventions. DISCUSSION: The rationale and methodological design of a mixed methods feasibility RCT is presented. This study aims to inform the planning, design and completion of a future definitive RCT in the UK NHS. The results will be disseminated through peer reviewed open access journal publication.

scholarly journals Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

2013 ◽  
Vol 93 (12) ◽  
pp. 1603-1614 ◽  
Author(s):  
Karin Verkerk ◽  
Pim A.J. Luijsterburg ◽  
Martijn W. Heymans ◽  
Inge Ronchetti ◽  
Annelies L. Pool-Goudzwaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Low Back Pain ◽  
Prognostic Factors ◽  
Back Pain ◽  
Short Form ◽  
Low Back ◽  
Multidisciplinary Therapy ◽  
Patient Reported ◽  
Specific Disability

Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain–specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design A prospective cohort study was conducted. Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain–specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD=15.2), 31.1 (SD=18.2), and 29.1 (SD=20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.

scholarly journals Evaluation of the EQ-5D-3L and 5L versions in low back pain patients

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
A. M. Garratt ◽  
H. Furunes ◽  
C. Hellum ◽  
T. Solberg ◽  
J. I. Brox ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Missing Data ◽  
Measurement Properties ◽  
Low Back ◽  
Improve Measurement ◽  
Multicenter Randomized Controlled Trial ◽  
Patient Reported ◽  
Ceiling Effects

Abstract Background The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. Conclusion The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.

scholarly journals Rasterstereographic Analysis of Lateral Shift in Patients with Lumbar Disc Herniation: A Case Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Britta K. Krautwurst ◽  
Jürgen R. Paletta ◽  
Sylvia Mendoza ◽  
Adrian Skwara ◽  
Melvin Mohokum
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pelvic Tilt ◽  
Lumbar Disc ◽  
Lateral Shift ◽  
Healthy Controls ◽  
Low Back

Objective. Detection of a lateral shift (LS) in patients with diagnosed disc herniation compared to healthy controls. Summary of Background Data. A specific lateral shift (LS) pattern is observed in patients with disc herniation and low back pain, as shown in earlier studies. Methods. Rasterstereography (RS) was used to investigate the LS. Thirty-nine patients with lumbar disc herniation diagnosed by radiological assessment and low back pain and/or leg pain (mean age 48.2 years, mean BMI 28.5, 28 males and 11 females) and 36 healthy controls (mean age 47.4 years, mean BMI 25.7, 25 males and 11 females) were analysed. LS, pelvic tilt, pelvic inclination, lordotic angle, and trunk torsion were assessed. Results. The patient group showed a nonsignificant increase in LS, that is, 5.6 mm compared to the healthy controls with 5.0 mm (p = 0.693). However, significant differences were found between groups regarding pelvic tilt in degrees (patients 5.9°, healthy controls 2.0°; p = 0.016), trunk torsion (patients 7.5°, controls 4.5°; p = 0.017), and lordotic angle (patients 27.5°, healthy controls 32.7°; p = 0.022). The correlation between pain intensity and the FFbH-R amounted 0.804 (p = < 0.01), and that between pain intensity and the pain disability index was 0.785 (p < 0.01). Discussion. Although some studies have illustrated LS with disc herniation and low back pain, the present findings demonstrate no significant increase in LS in the patient group compared to healthy controls. Conclusion. The patients with lumbar disc herniation did not demonstrate an increased LS compared to healthy controls. Other parameters like pelvic tilt and inclination seemed to be more suitable to identify changes in posture measured by RS in patients with low back pain or disc herniation.

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