Back pain, a communicable disease?

Raspe, Heiner; Hueppe, Angelika; Neuhauser, Hannelore

doi:10.1093/ije/dym220

Cited by 33 publications

(22 citation statements)

References 19 publications

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“…5 Some argue that episodic LBP is a universal part of human experience. 6,7 Half of the adult population in the UK (49%) report LBP lasting at least 24 hours in a one year period. 5 The 2010 Global Burden of Disease study identified LBP as the leading cause of years lived with disability internationally.…”

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confidence: 99%

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Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Patel

Hee

Mistry

et al. 2016

Programme Grants Appl Res

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Total word count including appendix: 93,499 ii ABSTRACT BackgroundThere is good evidence that therapist delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority. Aim and objectivesOverall aim was to improve the clinical and cost-effectiveness of LBP treatment by providing patients, their clinical advisors, and health service purchasers with better information about which participants are most likely to benefit from which treatment To achieve these objectives required substantial methodological work including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse main effect of interventions and no such interpretations should be made.iii MethodsFirstly, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with >179 participants to share their data with us; some further smaller trials offered to us were also included. Using these trials we developed a repository of individual participant data of therapist delivered interventions for LBP. Using this dataset we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical and cost effectiveness outcomes.We did an ANCOVA to identify potential moderators to apply in our main analyses.Subsequently we developed and applied three methods of subgroup identification; recursive partitioning (interaction trees and subgroup identification based on a differential effect search), adaptive risk group refinement, and an individual participant data indirect network meta-analysis to identify sub-groups defined by multiple parameters. ResultsWe included data from 19 randomised controlled trials with 9,328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small, and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of sub-group identification that we identified. Additionally we explored the application of Bayesian indirect network metaanalysis. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile. ConclusionThese data lack clinical or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas.iv The pooled repository database will serve as a valuable resource to the LBP research community. FundingFunding from the NIHR Programme Grants for Ap...

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“…The scoring for each item ranges from 0 (less than 1 day per week) to 3 (5 to 7 days per week). The scoring for items 2, 6,7,12, 14,16,18,20,21 and 23 is reversed.MZDI score = sum of all items.The range of the score is from 0 to 69 where higher score indicates more depressed. …”

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Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Patel

Hee

Mistry

et al. 2016

Programme Grants Appl Res

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“…Trotz der Erleichterung der Arbeitsplatzbedingungen in den Industrienationen in den letzten Jahrzehnten ist die Prävalenz von Rückenschmerzen nicht zurückgegan-gen [25]. Vergleichende Untersuchungen in verschiedenen Ländern zeigen deutlich, dass Rückenschmerzen überall auf der Welt häufig sind.…”

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Quality indicators for managing patients with low back pain

Chenot

2010

Schmerz

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Deriving valid and pragmatic QI from LBP guidelines for evaluating care for LBP is difficult. The core messages of guidelines are only recommendations with limited precision and transferability to individual patients. For pragmatic reasons definition of an upper or lower proportion of patients receiving a given health care service is recommended instead of tedious individual evaluation. Reasonable estimates can be based on data from research on health care services. Because of this uncertainty QIs should be evaluated before they are used as a steering instrument.

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“…Episodes of acute low back pain are a universal human experience (1). Usually, this is a benign, selflimiting disorder that does not require professional advice or specific treatment (2).…”

Section: Martin Underwoodmentioning

confidence: 99%

Diagnosing acute nonspecific low back pain: Time to lower the red flags?

Underwood¹

2009

Arthritis & Rheumatism

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Episodes of acute low back pain are a universal human experience (1). Usually, this is a benign, selflimiting disorder that does not require professional advice or specific treatment (2). Once someone with acute low back pain presents for care, a plethora of management guidelines are available to treating clinicians. These guidelines typically recommend that serious disorders (cauda equina syndrome, fracture, infection, inflammatory disorders, malignancy) should be excluded, using a number of "red flag" questions, before making a diagnosis of nonspecific low back pain (3). In contrast to the high-quality data available for at least some treatments of nonspecific low back pain, systematic reviews of the use of red flag questions to identify malignancy and fractures show that the strength of the evidence underpinning these screening questions is weak (4,5). Furthermore, few of the data that are available were collected in a primary care setting, where most consultations for back pain take place.In this issue of Arthritis & Rheumatism, Henscke and colleagues report on the performance of commonly recommended red flags in a prospective study of 1,172 consecutive patients presenting to a primary care setting because of acute low back pain (duration of Ͼ24 hours but Ͻ6 weeks) (6). After careful followup over 1 year, a serious cause for back pain was identified in only 11 patients (0.9%; 95% confidence interval [95% CI] 0.5-1.7%). The incidence of spinal fractures (8 [0.7%] of 1,172 patients [95% CI 0.4-1.3%]) and malignancy (none of 1,172 patients [95% CI 0-0.3%]) was much lower than the commonly quoted values for osteoporotic fractures and malignancy (ϳ4% and ϳ0.7%, respectively) (7).An important strength of this study is that data were collected from members of different health professions who provide first-contact care for acute back pain in a primary care setting. This approach also results in an important weakness of the study: only first presentations for a new episode of low back pain were considered. Serious disorders causing low back pain are likely to be more common in some other patient groups. Persons in such groups include those presenting for a second, third, or subsequent primary care consultation because of pain that is not resolving, those presenting to an emergency room, and those who had been referred for specialist care. Thus, even though the incidence of serious disease is very low at the time of first consultations for new episodes of acute low back pain, clinicians do need to keep their diagnosis of nonspecific low back pain under review during the subacute and early chronic phases of low back pain (8). Indeed, these serious disorders can develop in patients with established disabling chronic low back pain and thus cannot be disregarded regardless of how long the patient has been experiencing low back pain. With this extremely low incidence of serious disease identified following a first consultation for a new episode of acute low back pain, the large number of patients with 1 or more red flag sy...

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Back pain, a communicable disease?

Abstract: Various processes may have contributed to the observed changes. Our hypothesis is corroborated by experimental research showing that BP-related beliefs, attitudes and behaviour could positively be influenced by media campaigns and by insights from another recent epidemic.

Cited by 33 publications

References 19 publications

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Quality indicators for managing patients with low back pain

Diagnosing acute nonspecific low back pain: Time to lower the red flags?

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