Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review

Ramond-Roquin, Aline; Bouton, Céline; Gobin-Tempereau, Anne-Sophie; Airagnes, Guillaume; Rodet-Belarbi, Isabelle; Huez, Jean-François

doi:10.1093/fampra/cmu008

Cited by 42 publications

(30 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of health care-outcomes has not been part of the previous studies of the ‘functional-disturbance’-model, but a recent systematic review concluded that a range of information-based or education-based interventions did not produce significant reductions in the use of health care [57]. …”

Section: Discussionmentioning

confidence: 99%

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

et al. 2017

View full text Add to dashboard Cite

BackgroundLow back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.DesignA cluster-randomized controlled trial.MethodsPublically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP—the ‘functional-disturbance’-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.ResultsThere was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08–3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.ConclusionReassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

et al. 2017

View full text Add to dashboard Cite

show abstract

“…A BPS intervention is not regularly implemented by physiotherapists in primary care, however, and the evidence for BPS interventions for patients with CLBP is lacking. Few systematic reviews have investigated the evidence from existing BPS primary care interventions but focused instead only on BPS interventions in patients with LBP in general (ie, acute, subacute, and chronic) or (sub)acute LBP specifically . No systematic review has been performed in patients with CLBP until now.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Primary Care Interventions Using a Biopsychosocial Approach in Chronic Low Back Pain: A Systematic Review

et al. 2018

View full text Add to dashboard Cite

Background and Objective Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process‐related factors (practical implementation). Methods We searched in scientific databases and reference lists. Randomized controlled trials (RCTs) evaluating primary care physiotherapist‐led BPS interventions in adults (≥18 years) with nonspecific CLBP (≥12 weeks) were included. Results Our search resulted in 943 references; 7 RCTs were included (1,426 participants). Results show moderate‐quality evidence (3 trials; 991 participants) that a BPS intervention is more effective than education/advice for reducing disability and pain in the short, medium, and long term. Low‐quality evidence (4 trials; 435 participants) was found for no difference with physical activity treatments. Conclusions BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).

show abstract

“…Indeed, there is good quality evidence for the predictive value of a set of psychosocial factors for poorer outcome in patients with LBP [7, 8]. These factors are multifactorial, interrelated, and only weakly associated to the development and prognosis of LBP [9], which might be one of the explanations why effects of treatments targeting those risk factors has been reported to be small, mostly short term, and there was little evidence that psychosocial treatments were superior to other active treatments [7, 10]. …”

Section: Introductionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

139

View full text Add to dashboard Cite

BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

show abstract

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review

Cited by 42 publications

References 61 publications

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

Effectiveness of Primary Care Interventions Using a Biopsychosocial Approach in Chronic Low Back Pain: A Systematic Review

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Contact Info

Product

Resources

About