Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study

Konstantinou, Kika; Dunn, Kate M.; Ogollah, Reuben; Vogel, Steven; Hay, Elaine M

doi:10.1186/s12891-015-0787-8

Cited by 71 publications

(66 citation statements)

References 41 publications

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“…Low back pain is defined as pain and discomfort localized between the costal margin and inferior gluteal fold, with or without leg pain 2 . In 60% of cases there might be pain irradiated to lower limb and this presentation is called lumbosciatic pain, which may be of radicular (e.g., compression by herniated disc) or referred (e.g., myofacial pain) origin 3 . Neuropathic pain (NP) is present in 37 to 55% of patients with pain irradiated to lower limb.…”

Section: Introductionmentioning

confidence: 99%

“…Neuropathic characteristic is correlated to more severe pain, more severe comorbidities and poorer quality of life (QL). In addition, costs are 67% higher as compared to pain of other etiologies [3][4][5][6] . Many references consider that acute nonspecific low back pain is self-limited, with recovery rate of 90% in the period of 4 to 7 weeks, and chronicity rate of 2 to 7%.…”

Section: Introductionmentioning

confidence: 99%

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Low back pain

Stump¹,

Kobayashi²,

Campos³

2016

Revista Dor

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low back pain

Stump¹,

Kobayashi²,

Campos³

2016

Revista Dor

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“…The ATLAS study cohort was led by the team at Keele University and recruited 610 participants in 23 months. 60 The two clinical sites supported by Keele signed their contracts just prior to trial closure. Although potential participants had started to be identified, there was insufficient time to recruit them.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica

Williams

Jenkins

Goulden

et al. 2017

Health Technol Assess

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Background Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. Objectives To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. Design Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. Setting Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. Participants Adults with persistent symptoms of sciatica of 1–6 months’ duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. Interventions After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. Main outcome measures Outcomes were measured at the start, and after 6 weeks’ and 6 months’ follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland–Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. Sample size To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. Analysis plan The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost–utility analysis. Results The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. Limitations Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. Conclusion The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. Trial registration Current Controlled Trials ISRCTN14569274. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.

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“…Það er í samraemi við erlendar niðurstöður sem sýna almennt lítið samraemi milli einkenna og niðurstaðna segulómunar, en þó einna helst samraemi milli verkjar niður í fót og rótarþrýstingsgreiningar frá hryggþófa við segulómun. 9,10,24 Þetta ósamraemi milli einkenna og segulómunar undirstrikar að varasamt er að byggja sjúkdómsgreiningu bakverkja eingöngu á segulómun, heldur þarf samþaett mat sem byggir einnig og ekki síst á nákvaemri, klínískri skoðun. Einnig sýnir þetta hve torvelt það er að greina vandamál í lendahrygg, sem aftur endurspeglast í miklum fjölda óskilgreindra bakverkja.…”

Section: Umraeðaunclassified

“…Þessar niðurstöður eru nokkuð sambaerilegar við niðurstöður nýlegrar framskyggnrar breskrar rannsóknar á niður-stöðum segulómunar hjá 554 sjúklingum, en þar greindist við segulómun þrýstingur á taugarót hjá um 60% þeirra sem höfðu sögu um verki niður í fót, en einnig hjá um þriðjungi þeirra sem ekki sýndu slík einkenni. 24 Helmingur þeirra þátttakenda sem höfðu einhver einkenni taugarótarþrýstings við skoðun greindust ekki með brjósklos úr segulómun í rannsókn okkar. Lítil fylgni klínískra einkenna við brjósklosgreiningu úr segulómun er í vissri mótsögn við niðurstöður hollenskrar rannsóknar á 338 manns með lendahryggjarverki, sem sýna að sagan sé aðalatriði í greiningu einstaklinga með brjósklos og fá próf eða rannsóknir baeti þar einhverju við.…”

Section: Umraeðaunclassified