Psychosocial Interventions for Low Back Pain in Primary Care

Windt, Daniëlle van der; Hay, Elaine M; Jellema, Petra; Main, Chris J.

doi:10.1097/brs.0b013e31815e39f9

Cited by 123 publications

(56 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Change in fear during therapy might prove a stronger predictor of FS outcomes compared to fear level at intake, as has been suggested. 62 Regardless of the FS outcomes measure, 15,18,25 assessing the level of fear-avoidance beliefs at initial evaluation for patients with lumbar spine dysfunctions seems warranted, particularly if evaluation results are used to develop targeted interventions that are used to assist in patient management for improved functional outcomes. Therefore, we recommend that clinicians use methods like the one described here to identify patients with elevated fearavoidance beliefs and decide whether to use targeted interventions for those with elevated fear.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

show abstract

“…Considering the personal and industrial burdens of spinal pain, identifying risk factors through prospective studies or multiple domain associated factors through cross-sectional studies for the condition is important for this population. Indeed, a focus on modifiable risk factors for back pain which address occupational factors was recently identified as a priority research area 11) . As a starting point is it important to know the prevalence and factors associated with a condition in order to inform occupationally-specific preventative and management programmes, rather than generic interventions.…”

Section: Reviewmentioning

confidence: 99%

Prevalence and Associated Factors for Thoracic Spine Pain in the Adult Working Population: A Literature Review

Briggs

Bragge

Smith

et al. 2009

Journal of Occupational Health

View full text Add to dashboard Cite

Spinal pain is a significant occupational health issue. Whilst neck pain and low back pain have received considerable attention, thoracic spinal pain (TSP) has not. The objective of this study was to systematically identify and report the evidence describing the prevalence and correlates of TSP within occupational groups. Methods: This literature review systematically searched for reports of TSP prevalence and associated factors for TSP in working adult cohorts using nine electronic databases. Studies were evaluated for level of evidence and epidemiologic data were narratively synthesised. Results: 52 studies were identified describing 65 cohorts covering manual labourers, office workers, health professionals, manufacturing and industrial workers, drivers, military personnel and performing artists. Prevalence varied with occupational group and time period. One year prevalence of TSP ranged from 3.0-55.0%, with most occupational groups having medians around 30%. Significant odds ratios for individual (concurrent musculoskeletal disorders, exercising, pre-menstrual tension and female gender), general work-related (high work load, high work intensity, perceiving ergonomic problems in the workplace, working in some specialised areas, performing boring/tedious work tasks, certain year levels of study, employment duration, driving specialised vehicles, and a high number of flying hours), physical work-related (manual physiotherapy tasks, climbing stairs and high physical stress) and psychosocial work-related (perceived risk of injury and high mental pressure) factors were reported. Conclusions:The high median prevalence rates suggest TSP may be a significant occupational health problem. The multiple domains of associated factors point to the need for prospective research encompassing these domains to inform targeted occupational interventions. (J Occup Health 2009; 51: 177-192)

show abstract

“…13,14 While there is considerable evidence for the utility of psychosocial interventions for individuals with chronic musculoskeletal conditions, the utility of such interventions for individuals in the acute or subacute phase of recovery remains to be established. 15 Research from our laboratory has been exploring how ''activity'' might be used strategically to target psychosocial risk factors for prolonged pain and disability. As noted earlier, psychosocial factors such as catastrophic thinking, fear of movement, and disability beliefs have been shown to impede progress in rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain

Sullivan

Adams²

2010

Physiotherapy Canada

View full text Add to dashboard Cite

Purpose: The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression. Methods: The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention. Results: At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes. Conclusions: The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.Key Words: catastrophizing, fear of pain, musculoskeletal pain, psychosocial factors, rehabilitation, return to work Sullivan MJL, Adams H. Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain. Physiother Can. 2010;62:180-189. RÉ SUMÉObjectif : La pré sente é tude examine le profil des changements physiques et psychologiques qui surviennent lors d'interventions en physiothé rapie chez les patients qui participent é galement à une intervention psychosociale. L'intervention psychosociale, assuré e par des physiothé rapeutes, a comme objectif de cibler la pensé e catastrophique, la peur de la douleur, l'incapacité perc¸ue et la dé pression. Mé thode : L'é chantillon é tudié se composait de 48 personnes envoyé es pour des traitements de ré adaptation pour des maux de dos incapacitants. La moitié des personnes participaient aussi à une intervention psychosociale en plus de recevoir des soins en physiothé rapie. Ré sultats : En post-traitement, les deux groupes traité s n'affichaient pas de grandes diffé rences en ce qui a trait aux mesures d'intensité de la douleur, à la fonction physique ou à l'incapacité signalé e par le sujet. La tendance à ne voir que la douleur, la peur de bouger et la dé pression ont toutefois é té grandement ré duites chez les patients qui prenaient part à une intervention psychosociale en plus de recevoir leurs soins en physiothé rapie. Ces ré ductions des facteurs de risque psychosociaux ont contribué à ré duire l'utilisation des soins de santé et des mé dicaments contre la...

show abstract

Psychosocial Interventions for Low Back Pain in Primary Care

Cited by 123 publications

References 50 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Prevalence and Associated Factors for Thoracic Spine Pain in the Adult Working Population: A Literature Review

Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain

Contact Info

Product

Resources

About