Management Approach Combining Prognostic Screening and Targeted Treatment for Patients with Low Back Pain Compared with Standard Physiotherapy: A Systematic Review & Meta-analysis

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9767 ◽

2021 ◽

pp. 7

Author(s):

Collins Ogbeivor

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

English Language ◽

Weighted Mean Difference ◽

Economic Benefits ◽

Management Approach ◽

Controlled Trials ◽

Low Back ◽

Stratified Care

Introduction: Research evidence suggests that a stratified care management approach is better at improving clinical and economic outcomes for low back pain (LBP) patients compared with usual care in the short term. However, it is unclear if these health and economic benefits are sustainable in the longer term. The aim of this study was, therefore, to determine the effectiveness of stratified care compared with standard physiotherapy for LBP treatment. Methodology: A comprehensive search was undertaken of seven electronic databases (CINAHL, MEDLINE, Pedro, EMBASE, PsycINFO, Cochrane Register for Controlled Trials, and Web of Science with full text). Although no time limits were applied, studies were limited to English language publications and those involving human participants only. Study selection, data extraction, and appraisal of study were independently undertaken by both reviewers (CO and LE). Result: In total, 6842 patients (aged 18 years and above) were included in the eight trials reviewed; four were randomized controlled trials (RCTs) and four were non-RCTs. The pooled analysis of three studies (n = 2460) demonstrated a strong evidence in favor of stratified care over standard care at improving overall pain (Weighted Mean Difference (WMD) [random] 0.46 [95% CI 0.21, 0.71]; P < 0.0003), with overall effect (Z = 3.6) and (Roland-Morris disability questionnaire (RMDQ) scores (WMD [random] 0.71 [95% CI 0.05, 1.37]; P < 0.03), with overall effect (Z = 2.11) at three-, four-, and six-months’ follow-up periods. Conclusion: This current review demonstrated that a stratified care approach provides substantial clinical, economic, and health-related cost benefits in the medium- and high-risk subgroups compared with usual care. Further research is needed for longer-term benefits.

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Systematic review and meta-analysis of effects of acupuncture on pain and function in non-specific low back pain

Acupuncture in Medicine ◽

10.1136/acupmed-2017-011622 ◽

2020 ◽

Vol 38 (4) ◽

pp. 235-243

Author(s):

Yun-xia Li ◽

Su-e Yuan ◽

Jie-qiong Jiang ◽

Hui Li ◽

Yue-jiao Wang

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Meta Analysis ◽

Functional Improvement ◽

Controlled Trials ◽

Low Back ◽

Short Term ◽

Significant Difference

Objective: To assess the effectiveness of acupuncture for non-specific low back pain (NSLBP) through systematic review of published randomised controlled trials (RCTs). Methods: Studies were identified in electronic databases from their inception to February 2018, and were grouped according to the control interventions. The outcomes of interest were pain intensity and disability. Methodological quality was evaluated using the Cochrane risk-of-bias criteria and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: 25 trials (n=7587 participants) were identified and included in a meta-analysis. The results showed that acupuncture was more effective at inducing pain relief than: no treatment (standardised mean difference (SMD) −0.69, 95% CI −0.99 to −0.38); sham acupuncture in the immediate term (SMD −0.33, 95% CI −0.49 to −0.18), short term (SMD −0.47, 95% CI −0.77 to −0.17), and intermediate term (SMD −0.17, 95% CI −0.28 to −0.05); and usual care in the short term (SMD −1.07, 95% CI −1.81 to −0.33) and intermediate term (SMD −0.43, 95% CI −0.77 to −0.10). Also, adjunctive acupuncture with usual care was more effective than usual care alone at all time points studied. With regard to functional improvement, the analysis showed a significant difference between acupuncture and no treatment (SMD −0.94, 95% CI −1.57 to −0.30), whereas the other control therapies could not be assessed. Conclusion: We draw a cautious conclusion that acupuncture appears to be effective for NSLBP and that acupuncture may be an important supplement to usual care in the management of NSLBP.

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Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04028-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Siew Wan Hee ◽

◽

Dipesh Mistry ◽

Tim Friede ◽

Sarah E. Lamb ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Individual Participant Data ◽

Low Back ◽

Individual Participant ◽

Randomised Controlled

Abstract Background Proven treatments for low back pain, at best, only provide modest overall benefits. Matching people to treatments that are likely to be most effective for them may improve clinical outcomes and makes better use of health care resources. Methods We conducted an individual participant data meta-analysis of randomised controlled trials of three types of therapist delivered interventions for low back pain (active physical, passive physical and psychological treatments). We applied two statistical methods (recursive partitioning and adaptive risk group refinement) to identify potential subgroups who might gain greater benefits from different treatments from our individual participant data meta-analysis. Results We pooled data from 19 randomised controlled trials, totalling 9328 participants. There were 5349 (57%) females with similar ratios of females in control and intervention arms. The average age was 49 years (standard deviation, SD, 14). Participants with greater psychological distress and physical disability gained most benefit in improving on the mental component scale (MCS) of SF-12/36 from passive physical treatment than non-active usual care (treatment effects, 4.3; 95% confidence interval, CI, 3.39 to 5.15). Recursive partitioning method found that participants with worse disability at baseline gained most benefit in improving the disability (Roland Morris Disability Questionnaire) outcome from psychological treatment than non-active usual care (treatment effects, 1.7; 95% CI, 1.1 to 2.31). Adaptive risk group refinement did not find any subgroup that would gain much treatment effect between psychological and non-active usual care. Neither statistical method identified any subgroups who would gain an additional benefit from active physical treatment compared to non-active usual care. Conclusions Our methodological approaches worked well and may have applicability in other clinical areas. Passive physical treatments were most likely to help people who were younger with higher levels of disability and low levels of psychological distress. Psychological treatments were more likely to help those with severe disability. Despite this, the clinical importance of identifying these subgroups is limited. The sizes of sub-groups more likely to benefit and the additional effect sizes observed are small. Our analyses provide no evidence to support the use of sub-grouping for people with low back pain.

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Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials

Acupuncture in Medicine ◽

10.1136/acupmed-2017-011445 ◽

2019 ◽

Vol 38 (1) ◽

pp. 15-24

Author(s):

Yan Xiang ◽

Jin-yuan He ◽

Huan-huan Tian ◽

Bing-yan Cao ◽

Rui Li

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Pain Reduction ◽

Mean Difference ◽

Controlled Trials ◽

Low Back ◽

Randomised Controlled

Objectives: To assess the evidence for the efficacy of acupuncture for non-specific low back pain (NSLBP), compared with sham or placebo therapies. Methods: We searched Cochrane CENTRAL to December 2016, and conducted searches from 1980 to December 2016 in PubMed, MEDLINE and Embase. There were no regional restrictions applied. We included only randomised controlled trials of adults with NSLBP. Placebo/sham procedures were required of the control interventions. The trials were combined using meta-analysis when the data reported allowed for statistical pooling. Results: 14 trials (2110 participants) were included in the review, and 9 were included in the meta-analysis. Immediately after the acupuncture treatment we found statistically significant differences in pain reduction between acupuncture and sham or placebo therapy (standardised mean difference (SMD) −0.40, 95% CI −0.54 to −0.25; I2 7%; 753 participants; 9 studies), but there were no differences in function (weighted mean difference (WMD) −1.05, 95% CI −3.61 to 1.52; I2 79%; 462 participants; 4 studies). At follow-up, there were significant differences in pain reduction (SMD −0.46, 95% CI −0.82 to −0.09; I2 67%), but not in function (WMD −0.98, 95%CI −3.36 to 1.40; I2 87%). We conducted subgroup analyses both immediately after treatment and at follow-up. Conclusion: There is moderate evidence of efficacy for acupuncture in terms of pain reduction immediately after treatment for NSLBP ((sub)acute and chronic) when compared to sham or placebo acupuncture. Registration: PROSPERO registration no. CRD42017059438.

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Effects of kinesiotape on pain and disability in individuals with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials

Clinical Rehabilitation ◽

10.1177/0269215518817804 ◽

2018 ◽

Vol 33 (4) ◽

pp. 596-606 ◽

Cited By ~ 17

Author(s):

Yuejie Li ◽

Ying Yin ◽

Gongwei Jia ◽

Hong Chen ◽

Lehua Yu ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Randomized Controlled Trials ◽

Chronic Low Back Pain ◽

English Language ◽

Meta Analysis ◽

Controlled Trials ◽

Low Back ◽

Randomized Controlled

Objective: To explore the effects of kinesiotape on pain and disability in individuals with chronic low back pain. Data sources: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for English language publications from inception to 13 February 2018. Review methods: This study was registered in PROSPERO (CRD42018089831). Our key search terms were ((kinesio taping) OR (kinesiotaping) OR (kinesiotape)) AND (low back pain). Randomized controlled trials evaluating the effects of kinesiotape published in English language were included in this review. The reference lists of retrieved studies and relevant reviews were also searched. Quality of the included trials was assessed according to 2015 updated Cochrane Back and Neck Review Group 13-Item criteria. Results: A total of 10 articles were included in this meta-analysis. A total of 627 participants were involved, with 317 in the kinesiotape group and 310 in the control group. The effects of kinesiotape on pain and disability were explored. While kinesiotape was not superior to placebo taping in pain reduction, either alone ( P = 0.07) or in conjunction with physical therapy ( P = 0.08), it could significantly improve disability when compared to the placebo taping ( P < 0.05). Conclusion: Since kinesiotape is convenient for application, it could be used for individuals with chronic low back pain in some cases, especially when the patients could not get other physical therapy.

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Treatment-Based Classification versus Usual Care for Management of Low Back Pain

10.21236/ada575229 ◽

2012 ◽

Author(s):

Daniel Rhon ◽

Julie Fritz ◽

Joshua Cleland ◽

Deydre Teyhen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Low Back

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Treatment-Based Classification versus Usual Care for Management of Low Back Pain

10.21236/ada612923 ◽

2014 ◽

Author(s):

Daniel Rhon ◽

Julie Fritz ◽

Joshua Cleland ◽

Deydre Teyhen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Low Back

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Overuse of diagnostic testing in healthcare: a systematic review

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012576 ◽

2021 ◽

pp. bmjqs-2020-012576

Author(s):

Joris L J M Müskens ◽

Rudolf Bertijn Kool ◽

Simone A van Dulmen ◽

Gert P Westert

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Diagnostic Tests ◽

Patient Population ◽

English Language ◽

Diagnostic Testing ◽

Low Back ◽

Preoperative Testing ◽

Healthcare Settings ◽

Major Variation

BackgroundOveruse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting.MethodsPubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens.Results118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation.ConclusionOur findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse.

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