scholarly journals Evaluation of a PRImary-ORthopaedic (PRIOR) low back pain care model in Hong Kong: a pilot study

2020 ◽  
Author(s):  
Shirley Yue Kwan Choi ◽  
Sheung Wai Law ◽  
William WL Wong ◽  
Jamie Lau ◽  
Shaau Yiu Ko ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Health Service ◽  
Waiting Time ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Discharge Rate ◽  
Patient Specific ◽  
Adherence Rate ◽  
Low Back

Abstract Introduction: Low back pain (LBP) is a common and disabling condition with significant socioeconomic burden. A LBP care delivery model with collaborative input from primary care physicians, orthopaedic surgeons and allied health professionals has been implemented in one of the local tertiary hospital to streamline LBP care.Objective: To evaluate the preliminary effectiveness of the primary-orthopaedic (PRIOR) LBP care model.Methods: This was a 6-month quasi-experimental study with pre and post assessment. Participants (N=30) with chronic LBP were recruited and stratified by physiotherapists at the triage station located at Orthopaedic Special Outpatient Clinic. Eligible participants were referred to attend primary physicians with trained musculoskeletal skills for risk-matched treatment at Family Medicine Clinic. Patient-specific outcomes included the acceptance rate, Roland Morris Disability (RMD) scores, the self-pain efficacy scores (PSE) scores and the Euro-Qol-5D. The health service outcomes included the waiting time, discharge rate, adherence rate and healthcare resources utilization. Results: Of the 33 participants screened, 30 were eligible and enrolled for the study, the recruitment rate was 91% (X2=0.569, p=0.451). At 6 months, participants reported overall improvement of the RMD scores (β coefficient -4.3, 95% confidence interval CI -5.9 to – 2.7, P<0.001) and PSEQ scores (β coefficient 7.3, 95% CI 3.0-12.0, P=0.002). The waiting time of the FM clinic was 11.6 ±1.6 weeks, the overall discharge rate was 73%, and the adherence rate was 87%.Conclusions: The study suggested that the PRIOR LBP model could potentially improve the clinical outcomes of LBP patients and enhance the overall LBP health service delivery.

scholarly journals Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

2009 ◽  
Vol 89 (12) ◽  
pp. 1275-1286 ◽  
Author(s):  
Leonardo O.P. Costa ◽  
Christopher G. Maher ◽  
Jane Latimer ◽  
Paul W. Hodges ◽  
Robert D. Herbert ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Exercise Intervention ◽  
Patient Specific ◽  
Low Back ◽  
Functional Scale ◽  
The Mean ◽  
Control Exercise

BackgroundThe evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled.ObjectiveThe purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.DesignThis was a randomized, placebo-controlled trial.SettingThe study was conducted in an outpatient physical therapy department in Australia.PatientsThe participants were 154 patients with chronic low back pain of more than 12 weeks’ duration.InterventionTwelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the low back region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.MeasurementsPrimary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery measured at 2 months. Secondary outcomes were pain; activity (measured by the Patient-Specific Functional Scale); patient's global impression of recovery measured at 6 and 12 months; activity limitation (measured by the Roland-Morris Disability Questionnaire) at 2, 6, and 12 months; and risk of persistent or recurrent pain at 12 months.ResultsThe exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months. The mean effect of exercise on activity (measured by the Patient-Specific Functional Scale) was 1.1 points (95% confidence interval [CI]=0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95% CI=0.4 to 2.5), and the mean effect on pain was 0.9 points (95% CI=−0.01 to 1.8), all measured on 11-point scales. Secondary outcomes also favored motor control exercise.LimitationClinicians could not be blinded to the intervention they provided.ConclusionsMotor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

A Patient-specific Approach for Measuring Functional Status in Low Back Pain

Physiotherapy ◽  
1996 ◽  
Vol 82 (8) ◽  
pp. 467 ◽  
Author(s):  
AJHM Beurskens ◽  
HCW de Vet ◽  
AJA Köke
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Functional Status ◽  
Patient Specific ◽  
Low Back ◽  
Specific Approach

scholarly journals Health professionals’ referral practice and related healthcare utilization for people with low back pain in Singapore: A retrospective study

2019 ◽  
Vol 39 (01) ◽  
pp. 1-14
Author(s):  
Fong-Ling Loy ◽  
Su-Yin Yang ◽  
Jamila Chemat ◽  
Soon-Yin Tjan
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Service ◽  
Pain Intensity ◽  
Health Service Utilization ◽  
Medical Utilization ◽  
Pain Interference ◽  
Low Back

Background: Low back pain is a common musculoskeletal disorder that can incur high financial burden. A significant proportion of this burden may be incurred from referrals to health services and subsequent healthcare usages. Patients’ overall experience of pain and its related life interferences may also have some relevance to this usage. Objective: This study aimed to examine the referral practices and subsequent health service utilization of patients with LBP within a tertiary specialist clinic setting. A secondary objective was to explore potential associations between primary independent variables of pain and life interferences with health service utilization. Methods: Participants were patients with low back pain, who completed a set of self-reported low back pain measures. These included measures for pain intensity, pain interference, disability and quality of life. The participants’ back pain-related referral and health service utilization in the subsequent 12 months were recorded. Results: A total of 282 patients completed the full measures. Of these, 59.9% were referred for physiotherapy, 26.3% for diagnostic imaging and 9.2% for interventional procedures. Compared to patients who were referred from tertiary care, those from primary care had lower pain intensity ([Formula: see text]), pain interference ([Formula: see text]), disability ([Formula: see text]), but better physical and mental quality of life ([Formula: see text], [Formula: see text]). High pain interference was a common factor among patients who were referred on to other services after first consultation. Levels of medical utilization and physiotherapy utilization were both associated with pain intensity ([Formula: see text], [Formula: see text] vs [Formula: see text], [Formula: see text]), pain interference ([Formula: see text], [Formula: see text] vs [Formula: see text], 0.01) and disability ([Formula: see text], [Formula: see text] vs [Formula: see text], [Formula: see text]). Regression analysis showed that the source of referral contributed to 6% of the variance in medical utilization and 3% of the variance in physiotherapy utilization. After controlling the demographic variables and referral sources, none of the independent variables added any significant variance to medical utilization. Only pain intensity contributed an additional 2% variance to physiotherapy utilization. Conclusion: Referral patterns and practices appear similar to those reported in other studies. Higher levels of pain intensity, interference, disability and quality of life appear to influence the referral to different health services and subsequent treatment utilization.

scholarly journals Are stabilisation exercises different to other treatments in improving physical activity or reducing disability for people with persistent low back pain? A systematic literature review

2020 ◽  
Vol 27 (11) ◽  
pp. 1-16
Author(s):  
Sara Gardiner ◽  
Helena Daniell ◽  
Benjamin Smith ◽  
Rachel Chester
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Confidence Interval ◽  
Patient Specific ◽  
Low Back ◽  
Fear Avoidance ◽  
Functional Scale ◽  
Disability Questionnaire ◽  
Randomised Controlled

Background/Aims Stabilisation exercises are commonly prescribed for people with persistent low back pain. However, for some patients, it has been hypothesised that stabilisation exercises could draw attention to protecting the core, promote hypervigilance and inhibit volitional movement. The aim of this study was to compare the effectiveness and reported adverse events, in particular fear avoidance, of stabilisation exercises compared with placebo or other treatments offered by physiotherapists on the outcome of disability and activity at 12- and 24-months' follow-up. Methods The following electronic databases were searched: Embase, Medline, AMED, CINAHL, from inception to June 2019. Only randomised controlled trails were included. Study selection, data extraction and appraisal of quality criteria using PEDro, were undertaken by two independent assessors. Results Seven studies (n=1820) were eligible. Of six studies that reported adverse effects in the group receiving stabilisation exercises, four reported none and two reported mild exacerbation of pain locally or elsewhere. Fear avoidance was not investigated in any of the studies. Across the studies, 12 analyses were reported and included seven different comparator groups and three outcome measures: Oswestry Disability Index (n=1), Roland Morris Disability Questionnaire (n=5), Patient Specific Functional Scale (n=4). Two studies included a 24-month follow up in addition to a 12-month follow up. Of the 12 studies, nine reported no significant differences between the effectiveness of stabilisation exercises and comparator groups. Stabilisation exercises were more effective than comparator groups for the following three analyses: compared to manual therapy or education at 12 but not 24 months for the Oswestry Disability Index (15.71, 95% confidence interval 19.3–10.01); compared to placebo for the Patient Specific Functional Scale (1.5, 95% confidence interval 0.7–2.2) but not the Roland Morris Disability Questionnaire; and compared to high load lifting for the Patient Specific Functional Scale (1.8 95% confidence interval 2.8–0.7). Conclusions Stabilisation exercises are safe and equally effective to other treatments, and possibly superior for some outcomes at some time points. No or only mild adverse effects were reported. However, none of the studies measured fear avoidance as an outcome and we recommend this be included in future randomised controlled trials measuring the effectiveness of stabilisation exercises.

Medical and non-medical direct costs of chronic low back pain in patients consulting primary care physicians in France

2010 ◽  
Vol 24 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Fanny Depont ◽  
Elke Hunsche ◽  
Abdelilah Abouelfath ◽  
Thierno Diatta ◽  
Isabelle Addra ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Primary Care Physicians ◽  
Direct Costs ◽  
Low Back

scholarly journals Low back pain and occupation among Irish health service workers

2006 ◽  
Vol 56 (7) ◽  
pp. 447-454 ◽  
Author(s):  
C. Cunningham ◽  
T. Flynn ◽  
C. Blake
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Health Service ◽  
Low Back ◽  
Service Workers

A patient-specific approach for measuring functional status in low back pain

1999 ◽  
Vol 22 (3) ◽  
pp. 144-148 ◽  
Author(s):  
Anna J. Beurskens ◽  
Henrica C. de Vet ◽  
Albére J. Kökeb ◽  
Eline Lindeman ◽  
Geert J. van der Heijden ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Functional Status ◽  
Patient Specific ◽  
Low Back ◽  
Specific Approach

scholarly journals Primary Care Physicians’ Attitudes and Beliefs towards Chronic Low Back Pain: An Asian Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (1) ◽  
pp. e0117521 ◽  
Author(s):  
Regina W. S. Sit ◽  
Benjamin H. K. Yip ◽  
Dicken C. C. Chan ◽  
Samuel Y. S. Wong
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Primary Care Physicians ◽  
Attitudes And Beliefs ◽  
Low Back ◽  
Asian Study
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