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

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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Meditation for adults with non-specific low back pain: a systematic review and meta-analysis

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0096 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Larissa O. Soares ◽

Giovanni E. Ferreira ◽

Leonardo O. P. Costa ◽

Leandro C. Nogueira ◽

Ney Meziat-Filho ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Pain Intensity ◽

Cochrane Library ◽

Low Back ◽

Short Term ◽

Minimal Intervention ◽

Better Than

Abstract Objectives We aim to determine the effectiveness of meditation for adults with non-specific low back pain. Methods We searched PubMed, EMBASE, PEDro, Scopus, Web of Science, Cochrane Library, and PsycINFO databases for randomized controlled trials that investigated the effectiveness of meditation in adults with non-specific low back pain. Two reviewers rated risk of bias using the PEDro scale and the certainty of the evidence using the GRADE approach. Primary outcomes were pain intensity and disability. Results We included eight trials with a total of 1,234 participants. Moderate-certainty evidence shows that meditation is better than usual care for disability at short-term (SMD = −0.22; 95% CI = −0.42 to −0.02). We also found that meditation is better than usual care for pain intensity at long-term (SMD = −0.28; 95% CI = −0.54 to −0.02). There is no significant difference for pain intensity between meditation and minimal intervention or usual care at short and intermediate-term. We did not find differences between meditation and minimal intervention for disability at intermediate-term or usual care in any follow-up period. Conclusions We found small effect sizes and moderate-certainty evidence that meditation is slightly better than minimal intervention in the short-term for disability. Low-certainty of evidence suggests that meditation is slightly better than usual care for pain in the long-term. Meditation appears to be safe with most trials reporting no serious adverse events.

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Update of Markov Model on the Cost-effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care

Spine ◽

10.1097/brs.0000000000003539 ◽

2020 ◽

Vol 45 (19) ◽

pp. 1383-1385

Author(s):

Patricia M. Herman ◽

Ryan K. McBain ◽

Nicholas Broten ◽

Ian D. Coulter

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Cost Effectiveness ◽

Markov Model ◽

Usual Care ◽

Chronic Low Back Pain ◽

Low Back ◽

The Cost

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Effect of Customized Foot Orthotics in Addition to Usual Care for the Management of Chronic Low Back Pain Following Work-Related Low Back Injury

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2013.06.002 ◽

2013 ◽

Vol 36 (6) ◽

pp. 359-363 ◽

Cited By ~ 2

Author(s):

Robert Ferrari

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Chronic Low Back Pain ◽

Back Injury ◽

Low Back ◽

Work Related ◽

Low Back Injury

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Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial

Pain Medicine ◽

10.1093/pm/pnz138 ◽

2019 ◽

Vol 20 (12) ◽

pp. 2588-2597 ◽

Cited By ~ 2

Author(s):

Susan Lynn Murphy ◽

Richard Edmund Harris ◽

Nahid Roonizi Keshavarzi ◽

Suzanna Maria Zick

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Chronic Low Back Pain ◽

Linear Models ◽

Pilot Trial ◽

Brief Pain Inventory ◽

Poor Sleep ◽

Low Back ◽

Brief Fatigue Inventory

Abstract Objective Chronic low back pain (CLBP) is associated with fatigue, pain, poor sleep, and disability. Acupressure is a low-risk treatment option used to manage symptoms in other groups, but its efficacy, particularly on fatigue and sleep, is unknown in CLBP. This study examined preliminary effects of two types of self-administered acupressure (relaxing and stimulating) on fatigue, pain, sleep, and reported disability. Methods A randomized pilot trial was conducted (N = 67) in which participants were randomized into six weeks of relaxing acupressure, stimulating acupressure, or usual care. Fatigue was measured by the Brief Fatigue Inventory, pain was measured by the Brief Pain Inventory, sleep was measured by the Pittsburgh Sleep Quality Index, and reported disability was measured by the Roland Morris Scale. Results Baseline characteristics were similar across groups. An intent-to-treat analysis using general linear models showed positive improvement in pain in acupressure groups compared with usual care. Pain was reduced by 35–36% in the acupressure groups. Improvement in fatigue was also found in stimulating acupressure compared with usual care. Adverse events were minimal and related to application of too much pressure. Discussion Although this was a small study, acupressure demonstrated promising preliminary support of efficacy for pain and fatigue reduction in this population.

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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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A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2012/953139 ◽

2012 ◽

Vol 2012 ◽

pp. 1-61 ◽

Cited By ~ 116

Author(s):

Andrea D. Furlan ◽

Fatemeh Yazdi ◽

Alexander Tsertsvadze ◽

Anita Gross ◽

Maurits Van Tulder ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Usual Care ◽

Data Extraction ◽

Meta Analysis ◽

Sham Acupuncture ◽

Care Utilization ◽

Low Back ◽

Short Term

Background. Back pain is a common problem and a major cause of disability and health care utilization.Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.Data Sources. Records without language restriction from various databases up to February 2010.Data Extraction. The efficacy outcomes of interest were pain intensity and disability.Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

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