Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: A qualitative study

Davidson, Simon; Bolsewicz, Katarzyna; Kamper, Steven J; Haskins, Robin; Petković, D.M.; Feenan, Nicole; Smith, D. H.; O'Flynn, Michael; Pallas, Jeremy; Williams, Christopher M.

doi:10.1111/1742-6723.13854

Cited by 10 publications

(3 citation statements)

References 25 publications

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“…Low back pain (LBP) is one of the complex bio-psychological health conditions that challenge clinicians in the developed world. 1 The cost of this condition is quite high and data from European countries have suggested the cost varies between 0.1-2%. 2 However; no data is available from low and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial)

Khan,

Hamayun zafar,

Syed Amir Gilani

et al. 2024

Pak J Med Sci

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Objective: This study aimed to investigate the added effect of jaw clenching on the efficacy of lumbar stabilization exercises to manage chronic non-specific low back pain. Methods: This randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation (SIPM&R) Karachi from April 2021 to April 2023. Eighty patients with chronic non-specific low back pain participated in this study. Forty patients each were randomly allocated to the lumbar stability exercise (LSE) group’ and the lumbar stability exercise with teeth clenching (LSETC) group. Patients in both groups performed respective exercises twice weekly for 12 weeks. The Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ), and Pressure Biofeedback Unit (PBU) were used to assess pain, disability, and muscle endurance respectively. Data were collected at the baseline, after six weeks and 12 weeks of intervention. A p-value of <0.05 was considered statistically significant. Results: Both groups showed statistically significant improvements in pain, disability, and muscle endurance. Upon further stratification, participants aged 20-30 years in the LSETC group showed significantly higher scores than the LSE group for NPRS, RMDQ, and PBU after 12 weeks. Overall, the LSETC group showed relatively higher improvement in mean scores for NPRS, RMDQ, and PBU than the LSE group. Conclusion: Lumbar stabilization exercises with and without jaw movement are effective for the treatment of chronic non-specific low back pain. The addition of teeth clenching enhanced the effectiveness of lumbar stability exercises, especially in young adults. Trial Registration: Clinicaltrials.gov (NCT04801212), Prospectively registered on March 16, 2021. doi: https://doi.org/10.12669/pjms.40.6.9208 How to cite this: Khan M, Zafar H, Gilani SA, Farooqui WA, Ahmad A. The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial). Pak J Med Sci. 2024;40(6):1116-1121. doi: https://doi.org/10.12669/pjms.40.6.9208 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Introductionmentioning

confidence: 99%

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial)

Khan,

Hamayun zafar,

Syed Amir Gilani

et al. 2024

Pak J Med Sci

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“…4,6,7 Relatively little is known about longitudinal patterns of all types of HCPs involved in an episode of LBP and association with guideline concordance and total cost. Research into the sequence of types of HCPs involved in an episode of LBP has tended to focus on service use rather than types of HCPs involved, and has often focused on a single type of initial contact HCP such as PCP 9,10 , physiatry 11 , emergency medicine (EM) 12,13 , and PT. 5,8,14 These studies identified variation in approaches to LBP, yet have not provide comprehensive insights into patterns of HCP involvement in LBP.…”

Section: Introductionmentioning

confidence: 99%

Low back pain care pathways – is the last provider seen more important than the first: A retrospective cohort study

Elton

Zhang

2022

Preprint

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Background: The associations between the type of health care provider (HCP) initially contacted by an individual with low back pain (LBP), guideline concordance, and cost of care are well understood. Less is known about types of HCP that become involved after the initial HCP, particularly the last HCP. The purpose of this retrospective cohort study was to examine sequence patterns in the types of HCP involved in an episode of LBP, exposure to 13 types of services, and total cost. Methods: A US national sample of commercially insured individuals with a single episode of non-surgical LBP occurring in 2017-2019 was analyzed using episode of care unit of analysis. The primary independent variable was the type of initial contact HCP. Dependent measures included types of subsequent HCPs involved in an episode of LBP, rate of use of 13 types of health care services, and total cost. Results: 503,958 individuals aged 18 years and older initially contacted 196,522 different HCPs for an episode of non-surgical LBP. 30.2% of individuals saw a second HCP, 11.8% a third, 5.2% a fourth and 2.5% a fifth. Compared to primary care providers (PCP) (71.0% of episodes), when chiropractors (DC) were the initial contact HCP they were the most likely to be the only and last HCP seen (84.0% of episodes) (risk ratio 1.18, 95% confidence interval 1.18-1.19). DCs were also the most likely to be the last HCP seen when the second HCP in an episode (72.7%) (1.10, 1.09-1.12), the third HCP (67.7%) (1.10, 1.08-1.13), or the fourth HCP (61.6%) (1.13, 1.08-1.17). Physical therapists (PT), while less likely than PCPs to be the only and last HCP seen (60.0%) (0.84, 0.83-0.86), were more likely than PCPs to be the last HCP when the second (70.9%) (1.08, 1.06-1.09), third (63.2%) (1.03, 1.00-1.06), or fourth HCP (60.7%) (1.11, 1.06-1.16) seen during an episode. PTs were the only type of HCP involved in more episodes as the second HCP (7,344) than as the initial HCP (5,114). Conclusions: DCs are the most likely to be the last HCP seen for an episode of non-surgical LBP. PTs are as likely as DCs to be the last HCP seen except when initially contacted by an individual with LBP. There are numerous potential confounders and limitations to consider when interpreting this novel finding.

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“…Some barriers reported by ED clinicians include fear of missing serious pathology, severe physical limitation, lack of physiotherapy staff in ED, lack of awareness or availability of alternate pathways, and performance-based targets such as the ED four-hour standard. 10 People from minority ethnic groups, and those not fluent in the majority language have increased risk of admission and prolonged length of stay. 6 Hospitalisation in these cases may be requested to obtain objective test results and screen for underlying serious condition, which suggests that clinician-patient communication plays a crucial role in this process.…”

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confidence: 99%

Back pain: a target for reducing hospital admissions?

Machado,

Metcalfe,

Underwood

et al. 2023

The Lancet Rheumatology

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Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: A qualitative study

Cited by 10 publications

References 25 publications

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial)

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial)

Low back pain care pathways – is the last provider seen more important than the first: A retrospective cohort study

Back pain: a target for reducing hospital admissions?

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