A multi-faceted workplace intervention targeting low back pain was effective for physical work demands and maladaptive pain behaviours, but not for work ability and sickness absence: Stepped wedge cluster randomised trial

2016 ◽  
Vol 44 (6) ◽  
pp. 560-570 ◽  
Author(s):  
Charlotte Diana Nørregaard Rasmussen ◽  
Andreas Holtermann ◽  
Marie Birk Jørgensen ◽  
Anders Ørberg ◽  
Ole Steen Mortensen ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Randomised Trial ◽  
Physical Work ◽  
Cluster Randomised Trial ◽  
Workplace Intervention ◽  
Low Back ◽  
Work Demands ◽  
Stepped Wedge ◽  
Physical Work Demands ◽  
Cluster Randomised

Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial

2017 ◽  
Vol 27 (5) ◽  
pp. 355-364 ◽  
Author(s):  
Jeffrey Todd Kullgren ◽  
Erin Krupka ◽  
Abigail Schachter ◽  
Ariel Linden ◽  
Jacquelyn Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Randomised Trial ◽  
Choosing Wisely ◽  
Cluster Randomised Trial ◽  
Low Back ◽  
Stepped Wedge ◽  
Intervention Period ◽  
Cluster Randomised

BackgroundLittle is known about how to discourage clinicians from ordering low-value services. Our objective was to test whether clinicians committing their future selves (ie, precommitting) to follow Choosing Wisely recommendations with decision supports could decrease potentially low-value orders.MethodsWe conducted a 12-month stepped wedge cluster randomised trial among 45 primary care physicians and advanced practice providers in six adult primary care clinics of a US community group practice.Clinicians were invited to precommit to Choosing Wisely recommendations against imaging for uncomplicated low back pain, imaging for uncomplicated headaches and unnecessary antibiotics for acute sinusitis. Clinicians who precommitted received 1–6 months of point-of-care precommitment reminders as well as patient education handouts and weekly emails with resources to support communication about low-value services.The primary outcome was the difference between control and intervention period percentages of visits with potentially low-value orders. Secondary outcomes were differences between control and intervention period percentages of visits with possible alternate orders, and differences between control and 3-month postintervention follow-up period percentages of visits with potentially low-value orders.ResultsThe intervention was not associated with a change in the percentage of visits with potentially low-value orders overall, for headaches or for acute sinusitis, but was associated with a 1.7% overall increase in alternate orders (p=0.01). For low back pain, the intervention was associated with a 1.2% decrease in the percentage of visits with potentially low-value orders (p=0.001) and a 1.9% increase in the percentage of visits with alternate orders (p=0.007). No changes were sustained in follow-up.ConclusionClinician precommitment to follow Choosing Wisely recommendations was associated with a small, unsustained decrease in potentially low-value orders for only one of three targeted conditions and may have increased alternate orders.Trial registration numberNCT02247050; Pre-results.

scholarly journals Is low-back pain a limiting factor for senior workers with high physical work demands? A cross-sectional study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Patrick Pascal Nygaard ◽  
Sebastian Venge Skovlund ◽  
Emil Sundstrup ◽  
Lars Louis Andersen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Physical Work ◽  
Limiting Factor ◽  
Low Back ◽  
Work Demands ◽  
Cross Sectional ◽  
Physical Work Demands ◽  
Pain Outcome

Abstract Background Low-back pain (LBP) is highly prevalent among senior workers and may affect work ability, especially among those with hard physical work. This study determined the joint association of LBP intensity and physical work demands with work limitiations due to pain in senior workers. Methods In the SeniorWorkingLife study (2018), 11,738 senior workers (≥50 years) replied to questions about physical work demands, LBP intensity, and work limitations due to pain. Using logistic regression analyses and controlling for potential confounders, associations between the physical work demands and LBP intensity (interaction) with work limitiations due to pain (outcome) was modeled. Results Higher LBP intensity, as well as higher physical work demands, significantly increased the odds of experiencing work limitiations due to pain, and these two factors interacted with each other (p < 0.0001). In analyses stratified for LBP intensity, higher physical work demands gradually increased the odds of experiencing work limitiations due to pain. Conclusions Senior workers with a combination of physically demanding work and LBP are more affected by their pain during everyday work tasks compared to workers with similar LBP-intensity in sedentary occupations. Accommodation of work demands seems especially relevant for this group of workers.

scholarly journals Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030879 ◽  
Author(s):  
Arnela Suman ◽  
Frederieke G. Schaafsma ◽  
Johanna M. van Dongen ◽  
Petra J.M. Elders ◽  
Rachelle Buchbinder ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomised Trial ◽  
Intervention Group ◽  
Cost Utility ◽  
Secondary Outcome ◽  
Cluster Randomised Trial ◽  
Low Back ◽  
Pain Beliefs ◽  
Cluster Randomised

ObjectivesTo assess the effectiveness and cost-utility of a multifaceted eHealth strategy compared to usual care in improving patients’ back pain beliefs, and in decreasing disability and absenteeism.DesignStepped-wedge cluster randomised trial with parallel economic evaluation.SettingDutch primary healthcare.ParticipantsPatients diagnosed with non-specific low back pain by their general practitioner or physiotherapist. Patients with serious comorbidities or confirmed pregnancy were excluded. 779 patients were randomised into intervention group (n=331, 59% female; 60.4% completed study) or control group (n=448, 57% female; 77.5% completed study).InterventionsThe intervention consisted of a multifaceted eHealth strategy that included a (mobile) website, digital monthly newsletters, and social media platforms. The website provided information about back pain, practical advice (eg, on self-management), working and returning to work with back pain, exercise tips, and short video messages from healthcare providers and patients providing information and tips. The control consisted of a digital patient information letter. Patients and outcome assessors were blinded to group allocation.Primary and secondary outcome measuresThe primary outcome was back pain beliefs. Secondary outcome measures were disability and absenteeism, and for the preplanned economic evaluation quality of life and societal costs were measured.ResultsThere were no between-group differences in back pain beliefs, disability, or absenteeism. Mean intervention costs were €70— and the societal cost difference was €535—in favour of the intervention group, but no significant cost savings were found. The incremental cost-effectiveness ratio indicated that the intervention dominated usual care and the probability of cost-effectiveness was 0.85 on a willingness-to-pay of €10.000/quality adjusted life year (QALY).ConclusionsA multifaceted eHealth strategy was not effective in improving patients’ back pain beliefs or in decreasing disability and absenteeism, but showed promising cost-utility results based on QALYs.Trial registration numberNTR4329.

scholarly journals Correction: Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial

PLoS Medicine ◽  
2019 ◽  
Vol 16 (12) ◽  
pp. e1002993
Author(s):  
Nina Østerås ◽  
Tuva Moseng ◽  
Leti van Bodegom-Vos ◽  
Krysia Dziedzic ◽  
Ibrahim Mdala ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Structured Model ◽  
Cluster Randomised
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