Low back pain (LBP) is the leading cause of disability throughout the world and is economically burdensome. The recommended first line treatment for non-specific LBP is non-invasive care. A digital care program (DCP) delivering evidence-based non-invasive treatment for LBP can aid self-management by engaging patients and scales personalized therapy for patient-specific needs. We assessed the efficacy of a 12-week DCP for LBP in a two-armed, pre-registered, randomized, controlled trial (RCT). Participants were included based on self-reported duration of LBP, but those with surgery or injury to the lower back in the previous three months were excluded. The treatment group (DCP) received the 12-week DCP, consisting of sensor-guided exercise therapy, education, cognitive behavioral therapy, team and individual behavioral coaching, activity tracking, and symptom tracking – all administered remotely via an app. The control group received three digital education articles only. All participants maintained access to treatment-as-usual. At 12 weeks, an intention-to-treat analysis showed each primary outcome—Oswestry Disability Index ( p < 0.001), Korff Pain ( p < 0.001) and Korff Disability ( p < 0.001)—as well as each secondary outcome improved more for participants in the DCP group compared to control group. For participants who completed the DCP (per protocol), average improvement in pain outcomes ranged 52-64% (Korff: 48.8–23.4, VAS: 43.6–16.5, VAS impact on daily life: 37.3–13.4; p < 0.01 for all) and average improvement in disability outcomes ranged 31–55% (Korff: 33.1–15, ODI: 19.7–13.5; p < 0.01 for both). Surgical interest significantly reduced in the DCP group. Participants that completed the DCP had an average engagement, each week, of 90%. Future studies will further explore the effectiveness of the DCP for long-term outcomes beyond 12 weeks and for a LBP patient population with possibly greater baseline pain and disability. In conclusion, the DCP resulted in improved LBP outcomes compared to treatment-as-usual and has potential to scale personalized evidence-based non-invasive treatment for LBP patients.

BackgroundChronic knee pain, most commonly caused by knee osteoarthritis, is a prevalent condition which in most cases can be effectively treated through conservative, non-surgical care involving exercise therapy, education, psychosocial support, and weight loss. However, most people living with chronic knee pain do not receive adequate care, leading to unnecessary use of opiates and surgical procedures.ObjectiveAssess the efficacy of a remotely delivered digital care program for chronic knee pain.MethodsWe enrolled 162 participants into a randomized controlled trial between January and March 2017. Participants were recruited from participating employers using questionnaires for self-assessment of their knee pain, and randomized into treatment (n=101) and control (n=61) groups. Participants in the treatment group were enrolled in the Hinge Health digital care program for chronic knee pain. This is a remotely delivered, home-based 12-week intervention that includes sensor-guided exercise therapy, education, cognitive behavioral therapy, weight loss, and psychosocial support through a personal coach and team-based interactions. The control group received three education pieces regarding self-care for chronic knee pain. Both groups had access to treatment-as-usual. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale and KOOS Physical Function Shortform (KOOS-PS). Secondary outcomes were visual analog scales (VAS) for pain and stiffness respectively, surgery intent, and self-reported understanding of the condition and treatment options. Outcome measures were analyzed by intention to treat (excluding 7 control participants who received the digital care program due to administrative error) and per protocol.ResultsIn an intent-to-treat analysis the digital care program group had a significantly greater reduction in KOOS Pain compared to the control group at the end of the program (greater reduction of 7.7, 95% CI 3.0 to 12.3, P=.002), as well as a significantly greater improvement in physical function (7.2, 95% CI 3.0 to 11.5, P=.001). This was also reflected in the secondary outcomes VAS pain (12.3, 95% CI 5.4 to 19.1, P<.001) and VAS stiffness (13.4, 95% CI 5.6 to 21.1, P=.001). Participants’ self-reported likelihood (from 0% to 100%) of having surgery also reduced more strongly in the digital care program group compared to the control group over the next 1 year (–9.4 percentage points, pp, 95% CI –16.6 to –2.2, P=.01), 2 years (–11.3 pp, 95% CI –20.1 to –2.5, P=.01), and 5 years (–14.6 pp, 95% CI –23.6 to –5.5, P=.002). Interest in surgery (from 0 to 10) also reduced more so in the digital care program compared to control group (–1.0, 95% CI –1.7 to –0.2, P=.01). Participants’ understanding of the condition and treatment options (on a scale from 0 to 4) increased more substantially for participants in the digital care program than those in the control group (0.9, 95% CI 0.6 to 1.3, P<.001). In an analysis on participants that completed the intervention (per protocol analysis)...

The ways in which children appraise and cope with school bullying are likely to influence the long-term outcomes experienced. To examine this possibility, 219 Spanish undergraduate students (73 male, 146 female) aged between 18 and 40, completed an adapted version of the Retrospective Bullying Questionnaire (RBQ; Schäfer et al., 2004) and a distress scale (Rivers, 1999). Results indicated that neither coping strategies reported by victims of bullying nor the match between control appraisal and coping strategy influenced levels of distress experienced as adults. Control, threat and challenge appraisals did, however, influence long-term distress. Explanations for these effects are discussed, and include the possibility that appraisals may directly influence levels of distress and the quality of emotions experienced by victims during the actual bullying episode. Active strategies were perceived by students to be effective in dealing with bullying, whereas those centered on avoiding the conflict, or which involved aggression, were considered ineffective. Keywords: bullying, victimization, long-term consequences, coping, appraisal La forma en que los niños afrontan y resuelven los problemas de malos tratos entre compañeros/as escolares influyen posiblemente en los efectos que éstos experimentan, a largo plazo. Para examinar esta posibilidad, hemos estudiado un grupo de 219 estudiantes universitarios españoles (73 chicos y 146 chicas) con edades comprendidas entre 18 y 40 años, mediante la aplicación de una versión adaptada del Retrospective Bullying Questionnaire (RBQ; Schäfer et al., 2004) y una escala de estrés (River, 1999). Los resultados indican que ni las estrategias de afrontamiento usadas espontáneamente por las víctimas, ni el control sobre ellas, ejercen influencia sobre el estrés experimentado en la edad adulta. Sin embargo, sí ejerce influencia sobre el estrés a largo plazo la valoración que el sujeto hace de la situación violenta, como un reto controlable o como una amenaza que no puede ser controlada. Se discuten posibles explicaciones, incluyendo la posibilidad de que tales valoraciones quizás ejerzan una influencia directa en el propio nivel de estrés, especialmente en el tono emocional experimentado por las víctimas durante los episodios de violencia. Las estrategias activas de afrontamiento son valoradas como efectivas por los estudiantes, mientras que las estrategias que niegan el conflicto o incluyen respuesta agresiva se consideraron poco eficaces. Palabras clave : maltrato, victimización, efectos a largo plazo, afrontamiento, valoración

Terrorism using conventional weapons and explosive devices is a likely scenario and occurs almost daily somewhere in the world. Caring for those injured from explosive devices is a major concern for acute injury care providers. Learning from nations that have experienced conventional weapon attacks on their civilian population is critical to improving preparedness worldwide. In September 2005, a multidisciplinary meeting of blast-related injury experts was convened including representatives from eight countries with experience responding to terrorist bombings (Australia, Colombia, Iraq, Israel, United Kingdom, Spain, Saudi Arabia, and Turkey). This article describes these experiences and provides a summary of common findings that can be used by others in preparing for and responding to civilian casualties resulting from the detonation of explosive devices.

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