Does Duration of Pain at Baseline Influence Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-based Pathway?

Jess, Mary-Anne; Ryan, Cormac; Hamilton, Sharon; Wellburn, Shaun; Greenough, C G; Ferguson, Diarmaid; Coxon, Andrew; Fatoye, Francis; Dickson, Joanne M.; Jones, Andrea; Atkinson, Greg; Martin, DJ

doi:10.1097/brs.0000000000002612

Cited by 13 publications

(24 citation statements)

References 26 publications

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“…The majority of patients had pain for three months or more. The minority of patients with shorter pain durations reported better outcomes, which is in line with previous findings [30].…”

Section: Discussionsupporting

confidence: 91%

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care

Riis

Karran

Thomsen

et al. 2020

BMC Musculoskelet Disord

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Background: According to clinical guidelines, advice to stay active despite experiencing pain is recommended to patients with non-specific low back pain (LBP). However, not all patients receive guideline-concordant information and advice, and some patients still believe that activity avoidance will help them recover. The purpose was to study whether guidelineconcordant beliefs among patients and other explanatory variables were associated with recovery. The main aim was to investigate whether believing staying active despite having pain is associated with a better functional outcome. Methods: This was a prospective cohort study involving adults with non-specific LBP referred from general practices to the Spine Centre at Silkeborg Regional Hospital, Denmark. Patients reported on their beliefs about the importance of finding the cause, the importance of diagnostic imaging, perceiving to have received advice to stay active, pain duration, pain intensity, and STarT Back Tool. Agreeing to: 'An increase in pain is an indication that I should stop what I'm doing until the pain decreases' adjusted for age, gender, and education level was the primary explanatory analysis. A 30% improvement in the Roland Morris Disability Questionnaire (RMDQ) score after 52 weeks was the outcome. Results: 816 patients were included and 596 (73.0%) agreed that pain is a warning signal to stop being active. Among patients not considering pain as a warning signal, 80 (43.2%) had a favourable functional improvement of ≥30% on the RMDQ compared to 201 (41.2%) among patients considering pain a warning signal. No difference was found between the two groups (adjusted P = 0.542 and unadjusted P = 0.629). However, STarT Back Tool high-risk patients had a less favourable functional outcome (adjusted P = 0.003 and unadjusted P = 0.002). Chronic pain was associated with less favourable functional outcome (adjusted P < 0.001 and unadjusted P < 0.001), whereas beliefs about finding the cause, diagnostic imaging, perceiving to have received advice to stay active, or pain intensity were not significantly associated with outcome. Conclusions: Holding the single belief that pain is a warning signal to stop being active was not associated with functional outcome. However, patients characterised by having multiple psychological barriers (high-risk according to the STarT Back Tool) had a less favourable functional outcome.

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“…The majority of patients had pain for three months or more. The minority of patients with shorter pain durations reported better outcomes, which is in line with previous findings [30].…”

Section: Discussionsupporting

confidence: 91%

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care

Riis

Karran

Thomsen

et al. 2020

BMC Musculoskelet Disord

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“…The mixed methods article (Cheshire, Polley, Peters, & Ridge, 2013) used a single sample design. Of the 11 quantitative articles, six were randomised controlled trials (Cherkin et al, 2018; Darlow et al, 2019; Gannon et al, 2019; Goertz et al, 2017; Hill et al, 2011; Riis et al, 2016), one was a non‐randomised controlled trial (Murphy, Blake, Power, & Fullen, 2016), one was a before and after sequential design (Foster et al, 2014), two were retrospective designs (Wilgenbusch, Wu, & Fourney, 2014; Zarrabian et al, 2017) and one was a longitudinal design (Jess et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Studies were primarily conducted in Europe (Cheshire et al, 2013; Foster et al, 2014; Hill et al, 2011; Jess et al, 2018; Murphy et al, 2016; Riis et al, 2016) and the United States (Cherkin et al, 2018; Gannon et al, 2019; Goertz et al, 2017; Table 1). Sample sizes ranged from 62 (Gannon et al, 2019) to 2071 (Jess et al, 2018) and mean age ranged from 43.4 (Murphy et al, 2016) to 73 years (Goertz et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

“…The predominant care pathway used in four of the articles (Cherkin et al, 2018; Foster et al, 2014; Hill et al, 2011; Murphy et al, 2016) was the Keele risk stratification Subgroup Targeted Treatment (STarT Back) approach (Hill et al, 2011). The mixed methods article by Cheshire et al (2013) and two additional articles (Jess et al, 2018; Riis et al, 2016), applied the validated STarT Back Screening Tool (SBST; Hill et al, 2008) to assess risk prior to care pathway allocation (Table 1). The remaining five care pathways were hybrid pathways incorporating a risk stratified care (Wilgenbusch et al, 2014; Zarrabian et al, 2017), or a matched care (Darlow et al, 2019; Gannon et al, 2019; Goertz et al, 2017) approach.…”

Section: Resultsmentioning

confidence: 99%

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A systematic scoping review of patient health outcomes and perceptions following management of low back pain via care pathways in primary health care

Boyle

Fary

Kang

et al. 2020

Musculoskeletal Care

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Background Emerging evidence suggests that although care pathways for people with low back pain (LBP) improve health outcomes, there is a limited adoption/uptake of these pathways in primary care. To help identify and/or explain barriers and facilitators to implementation, research study designs applying a mixed methods approach including robust qualitative methodology may provide a more comprehensive understanding of patient health outcomes and patient perceptions of care. Methods A systematic search of MEDLINE, OVID EMBASE, Cumulative Index to Nursing and Allied Health Literature and Scopus (1980–2020) was conducted to identify relevant mixed methods, quantitative and qualitative studies. Results Three hundred and sixteen articles were screened for inclusion, with a total of 12 articles (1 mixed methods and 11 quantitative) included in the review. No solely qualitative studies were found. Broadly, patients reported overall improved health outcomes and higher satisfaction using the care pathway. In the mixed methods study, engaging patients in aspects of care were reported to be challenging. Further, while patient health outcomes (quantitative) and patient experiences of the care pathway (qualitative—free‐text survey responses) were presented separately, a lack of detailed convergence/triangulation of the data limits conclusions that could inform implementation into clinical settings. Conclusion Data supported the positive effect of care pathways on patient health outcomes, yet investigation of the patient experience was limited. Only one study used a mixed methods design and then only used free‐text survey responses for the qualitative component. Future efforts to integrate LBP care pathways into primary care may benefit from using mixed methods design with an emphasis on robust qualitative methodology.

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“…Across the North of England, there is a regional back pain pathway10 that provides a consistent approach to the management of patients based on the National Institute for Health and Care Excellence (NICE) guidelines for the management of LBP 6. Early evidence demonstrates positive outcomes for patients on this regional back pain pathway 11 12. Within these guidelines, many of the options relate to self-management 6.…”

Section: Introductionmentioning

confidence: 99%

Study protocol for an investigation of the effectiveness of the pain toolkit for people with low back pain: double-blind randomised controlled trial

Findley¹,

Ryan

Cartwright³

et al. 2019

BMJ Open

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IntroductionThe Pain Toolkit is a self-management tool for people with persistent pain. It is available for use worldwide in multiple formats. To date, no studies have investigated the effectiveness of this intervention. This study aims to investigate the effectiveness of the Pain Toolkit in comparison with a simple education control for people with low back pain.Methods and analysisParticipants who have been discharged from the North of England Regional Back Pain Pathway will be randomised using sealed, consecutively numbered opaque envelopes to receive either the Pain Toolkit and the Back Book (intervention group) or the Back Book only (control group). Both the therapist and the participant will be blind to group allocation. The primary outcome measure will be disability (Oswestry Disability Index (ODI)). Secondary outcome measures will be pain (0–10 numerical scale), healthcare use (number of healthcare professional visits) and quality of life (EuroQol-5D). Outcome measures will be completed at baseline and at 6 and 12 months. Data will be analysed using analysis of covariance, adjusting for baseline values. A change of 10 points in the ODI will be considered a clinically important change. Additionally, a subsample of participants from the intervention group will undergo semistructured interviews to explore individuals’ experience of the Pain Toolkit. Participants will be asked questions about the ease of use and acceptability of the Pain Toolkit and also for how long they used the Toolkit. The qualitative data will be analysed using thematic analysis.Ethics and disseminationApproval for the study was given by the Health Research Authority and the North East Newcastle, North Tyneside 2 Regional Ethics Committee (reference 18/NE/0144) and Teesside University (reference 176/17). Findings will be disseminated through peer-reviewed journals and presentation at relevant patient groups, and local, national and international conferences.Trial registration numberNCT03791164.

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Does Duration of Pain at Baseline Influence Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-based Pathway?

Abstract: 3.

Cited by 13 publications

References 26 publications

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care

A systematic scoping review of patient health outcomes and perceptions following management of low back pain via care pathways in primary health care

Study protocol for an investigation of the effectiveness of the pain toolkit for people with low back pain: double-blind randomised controlled trial

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