Obesity effect on a multimodal physiotherapy program for low back pain suffers: patient reported outcome

Cuesta‐Vargas, Antonio; Gónzalez-Sánchez, Manuel

doi:10.1186/1745-6673-8-13

Cited by 14 publications

(9 citation statements)

References 24 publications

(44 reference statements)

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“…Whether or not obese patients respond differently to non-pharmacological treatment approaches for spinal pain is controversial [ 25 – 27 , 44 ]. While one cohort study found that obese patients responded similarly to treatment compared to their lean counterparts [ 44 ], other studies found that obesity was associated with a failure to improve [ 26 , 27 , 45 ]. Furthermore, retrospective studies suggest that obese patients express higher levels of fear avoidance than their lean counterparts and therefore are at risk for worse treatment response [ 25 ] and respond poorer to cognitive behavioral therapy, a treatment aimed at addressing fear of movement [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

Wertli

Held²,

Campello

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe influence on the treatment response in patients with low back pain (LBP) and neck pain (NP) is unknown. The aim of the study was to investigate the influence of body weight in patients with low back pain (LBP) and neck pain (NP) on baseline and end of treatment disability.MethodsCross-sectional analysis of baseline factors. Longitudinal analysis of prospectively collected patient information at an outpatient physical therapy registry (data from June 2010 to December 2012). WHO-BMI classification was used: underweight, lean, overweight, obesity class I, obesity class II and III. The influence of body weight and a predefined set of confounders was analyzed by multiple regression models.ResultsIn LBP, disability increased with increasing BMI [lean = reference, obesity class I Beta 5.41 (95 % CI 0.75; 10.07), obesity class II-III Beta 7.58 (95 % CI 2.13; 13.03)]. Compared to lean patients, disability after treatment improved in overweight subjects [Beta −3.90 (95 % CI −7.4; −0.41)] but not in subjects with obesity class II–III [Beta 3.43 (95 % CI −3.81; 10.68)]. There were insufficient patients in the sample with severe obesity and therefore this trend has to be confirmed. The likelihood for meaningful important change (MID) was similar in all BMI subgroups. For patients with NP, BMI was not associated with baseline disability, and did not predict end of treatment disability or the likelihood of a MID. These findings must be interpreted with caution as BMI subgroups did not meet the required sample size.ConclusionOverweight and obesity are associated with higher levels of disability before treatment in LBP patients, but not in NP. In severely obese patients class II–III with LBP the rate of MID was lowest indicating that these patients experienced the least treatment response compared to the other groups. Further studies should address the impact of severe obesity on the prognosis of LBP. In patients with LBP, severe obesity may be an important factor to consider during the physical therapy treatment. In particular, combined treatment strategies combining weight management, cardiovascular fitness, and low back pain rehabilitation should be investigated.

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Section: Discussionmentioning

confidence: 99%

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

Wertli

Held²,

Campello

et al. 2016

BMC Musculoskelet Disord

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“…As mentioned above, this is in contrast to a similar study performed by Oliveira, et al [18]. Cuesta-Vargas, et al specifically addressed this issue in a prospective study of chronic axial low back pain patients enrolled in an 8-week course of physical therapy (n = 53) [11]. Subjects were divided into two groups based on BMI: a non-obese group (BMI < 30) and an obese group (BMI > 3 0).…”

Section: Discussionmentioning

confidence: 93%

“…A mental health diagnosis, specifically a history of depression, has been associated with poorer outcomes in patients with low back pain [8][9][10]. Increased body mass index (BMI), has also been studied in the context of physical therapy practices and has been associated with decreased response to treatment [11,12]. To our knowledge, few studies addressing prognostic factors for improvement have been conducted in the context of a multidisciplinary spine center that incorporates physical and occupational therapy, chiropractic treatment, and interventional spine procedures provided by physiatrists.…”

Section: Research Articlementioning

confidence: 99%

Prognostic Factors for Disability and Pain Outcomes in Patients with Axial Low Back Pain Undergoing a Multidisciplinary Spine Treatment Program

Donohue¹,

J²,

M³

et al. 2020

Int J Physiatry

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Introduction: Several studies in the past have examined factors impacting improvement in low back pain in the primary care context. However, there is limited evidence regarding prognostic factors for pain and disability scores in patients with axial low back pain entering a multidisciplinary spine program. Objective: The goal of this study was to assess which baseline demographic, disability, and pain-related characteristics may be prognostic for improvement in pain and disability scores entering a multidisciplinary spine program. Design: This was a retrospective review of patients with axial low back pain who participated in a multidisciplinary spine program. Baseline demographic, pain, and disability data were collected and compared to follow-up questionnaire data gathered at discharge. Primary outcomes included change in pain as identified by the Numeric Pain Rating Scale (NPRS) and change in disability as measured by the Oswestry Disability Index (ODI). Setting: A multidisciplinary spine center at an academic institution. Results: A total of 204 subjects were included in this study. A univariate analysis showed significantly greater improvement in disability scores in the acute/subacute group compared to the chronic group (p = 0.003). Subjects with a history of mental health diagnosis experienced significantly less improvement in pain scores (p = 0.042). A multivariate regression analysis showed a chronic symptom duration and a higher initial disability score were significant predictors for higher disability scores following completion of the program (p = 0.003 and p < 0.0001, respectively). A mental health diagnosis (p = 0.008) and a higher initial pain score (p < 0.0001) were associated with less improvement in pain levels, while a higher BMI predicted lower final pain scores (p = 0.020). Conclusion: Patients with axial low back pain entering a spine treatment program with higher initial disability and pain scores, a mental health diagnosis, and chronic symptoms may demonstrate less improvement upon discharge.

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“…A scheme of the exercises, muscles on which they intervene and intensity of the exercises can be observed in Table 1 . A blinded physiotherapist supervised the session including the exercise workloads and educational behaviour intervention [ 14 , 18 , 19 ]. Self-stretching of myotendinous barriers of pectoralis, levator scapulae, upper trapezius and scalenus was used to restore mobility [ 1 , 2 ].…”

Section: Methodsmentioning

confidence: 99%

Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: A Prospective Cohort Study

Cuesta‐Vargas

Gónzalez-Sánchez

2015

PLoS ONE

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AimThe aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life.Methods175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. Intervention: 60-minute session (30 minutes of land-based exercise dedicated to improving mobility, motor control, resistance and strengthening of the neck muscles, and 30 minutes of adapted swimming with aerobic exercise keeping a neutral neck position using a snorkel). Health education was provided using a decalogue on CNSNP and constant repetition of brief advice by the physiotherapist during the supervision of the exercises in each session. Study outcomes: primary: disability (Neck Disability Index); secondary: physical and mental health states and quality of life of patients (SF-12 and EuroQoL-5D respectively). Differences between baseline data and that at the 8-week follow-up were calculated for all outcome variables.ResultsDisability showed a significant improvement of 24.6% from a mean (SD) of 28.2 (13.08) at baseline to 16.88 (11.62) at the end of the 8-week intervention. All secondary outcome variables were observed to show significant, clinically relevant improvements with increase ranges between 13.0% and 16.3% from a mean of 0.70 (0.2) at baseline to 0.83 (0.2), for EuroQoL-5D, and from a mean of 40.6 (12.7) at baseline to 56.9 (9.5), for mental health state, at the end of the 8-week intervention.ConclusionAfter 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design.Trial RegistrationClinicalTrials.gov NCT02046876

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Obesity effect on a multimodal physiotherapy program for low back pain suffers: patient reported outcome

Cited by 14 publications

References 24 publications

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

Prognostic Factors for Disability and Pain Outcomes in Patients with Axial Low Back Pain Undergoing a Multidisciplinary Spine Treatment Program

Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: A Prospective Cohort Study

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