What triggers an episode of acute low back pain? A protocol of a replication case-crossover study.

OBJECTIVE: To describe all the procedures of a study that will replicate a previous case-crossover study investigating physical and psychosocial transient exposure risk factors for triggering an episode of acute non-specific low back pain (LBP) at emergency departments in an emerging country. METHODS: This case-crossover study will recruit 350 patients, aged between 18 and 80 years, with a new episode of acute non-specific LBP seeking care at emergency departments from public hospitals in Brazil. We will collect information about exposure to a range of physical (eg, awkward postures, lifting children or animals, vigorous physical activity) and psychosocial triggers (eg, distraction, tiredness, alcohol consumption) that were examined in the previous study. The exposure to each trigger during the 2 hours preceding the onset of LBP (case window) will be compared with exposure in the 2-hour periods ending 24 (24-26 hours) and 48 (48-50 hours) hours before the onset of back pain (control window). Conditional logistic regression models will be built to estimate ORs expressing the magnitude of increased risk of developing LBP associated with each factor. DISCUSSION: This study will enable the confirmation of previous findings regarding transient exposure to factors that increase risk for an episode of acute LBP in a different setting (at emergency departments of an emerging country). To minimise the potential for recall bias, the maximum time between episode onset and interview will be 7 days; we will encourage participants to use their smartphones and diaries to remember the investigated period. Also, our interview script asked participants to nominate the key aspects of each day. Despite these efforts, the retrospective study design means it is not possible to completely exclude potential for recall bias. Furthermore, participants will be blinded to the case and control periods. ETHICS AND DISSEMINATION: Ethics were granted by the Research Ethics Committee (#20310219.8.0000.0064). Study findings will be disseminated through publications and conference presentations.

Medium term effects of kinesio taping in patients with chronic non-specific low back pain: a randomized controlled trial.

BACKGROUND: Kinesio taping is a commonly used intervention for patients with chronic low back pain. However, the medium term effects of kinesio taping in these patients are unknown. OBJECTIVE: To investigate the effectiveness of kinesio taping in patients with chronic low back pain after 6 months from randomization. METHODS: This was a randomized controlled trial with a 6 months follow up. One hundred and forty eight participants were randomly assigned to the experimental (kinesio taping with skin convolutions) or control (kinesio taping without convolutions-Sham Taping) group. Participants from both groups had the tape reapplied twice a week for four weeks. The outcomes were pain, disability and global impression of recovery after 6 months. RESULTS: One participant was lost to follow up in the experimental group (n=73, response rate 99%) and two in the control group (n=72, response rate 97%). After 6 months there were no statistically significant between-group differences in pain intensity (between-group difference -0.8 points, 95% CI -1.7 to 0.2), global impression of recovery (0.4, -0.7 to 1.5), or disability (-1.1, -3.0 to 0.7). CONCLUSION: Four weeks of kinesio taping treatment was no better than sham taping for patients with chronic low back pain, at 6 months follow-up. Trial Registration Number (http://www.ensaiosclinicos.gov.br/): RBR-7ggfkv (Brazilian Registry of Clinical Trials).

What do physical therapists think about evidence-based practice? A systematic review.

Evidence-Based Practice (EBP) has been widely implemented in different health-related areas. Several studies investigated important characteristics in EBP by physiotherapists and systematic review is needed. Therefore the aim of this study is to describe the current evidence on EBP knowledge, skills, behaviour, opinions and barriers by physiotherapists. Searches were conducted on MEDLINE, EMBASE, CINAHL, PSYCINFO, LILACS, and SciELO in September 2014. We retrieved quantitative cross-sectional studies that investigated EBP knowledge, skills, behaviour, opinions, and barriers in physiotherapy. Risk of bias was assessed using a scale to evaluate representativeness of the sample, response rate, the accuracy of the data, evidence of power calculation and the instrument used. The search yielded 12,392 potentially eligible studies. Of these, 12 studies were included in the review (pooled sample = 6411 participants). In 3 studies that analysed knowledge, approximately 21-82% of respondents claimed to have received prior information on EBP. In 2 studies that reported skills and behaviour, nearly half of the sample had used databases to support clinical decision-making. In 6 studies that investigated opinions, the majority of the samples considered EBP necessary or important. The barriers most frequently reported were: lack of time, inability to understand statistics, lack of support from employer, lack of resources, lack of interest and lack of generalisation of results. Although the majority of physiotherapists have a positive opinion about EBP, they consider that they need to improve their knowledge, skills and behaviour towards EBP. They also faced barriers that might hinder the implementation of EBP.

Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial.

BACKGROUND: Back School and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic nonspecific low back pain. OBJECTIVE: The purpose of this study was to compare the effectiveness of Back School and McKenzie methods in patients with chronic nonspecific low back pain. DESIGN: The study was a prospectively registered, 2-arm randomized controlled trial with a blinded assessor. SETTING: The study was conducted in the outpatient physical therapy clinic in São Paulo, Brazil. PATIENTS: The study participants were 148 patients with chronic nonspecific low back pain. INTERVENTIONS: The 4-week treatment program (one session/week) was based on the Back School (delivered to the group) or McKenzie (delivered individually) principles. The participants also were instructed to perform a daily set of home exercises. MEASUREMENTS: Clinical outcomes were assessed at follow-up appointments at 1, 3, and 6 months after randomization. Primary outcome measures were pain intensity (measured by the 0-10 pain numerical rating scale) and disability (measured by the 24-item Roland-Morris Disability Questionnaire) 1 month after randomization. Secondary outcome measures were pain intensity and disability at 3 and 6 months after randomization, quality of life (measured by the World Health Organization Quality of Life-BREF instrument) at 1, 3, and 6 months after randomization, and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. RESULTS: Participants allocated to the McKenzie group had greater improvements in disability at 1 month (mean effect=2.37 points, 95% confidence interval=0.76 to 3.99) but not for pain (mean effect=0.66 points, 95% confidence interval=-0.29 to 1.62). No between-group differences were observed for all secondary outcome measures. LIMITATIONS: It was not possible to monitor the home exercise program. Therapists and participants were not blinded. CONCLUSIONS: The McKenzie method (a more resource-intensive intervention) was slightly more effective than the Back School method for disability, but not for pain intensity immediately after treatment in participants with chronic low back pain.