Can the Enhanced Transtheoretical Model Intervention (ETMI) Impact the Attitudes and Beliefs Regarding Low Back Pain of Family Medicine Residents.

BACKGROUND: Low back pain has been the leading cause for disability worldwide for several decades, and clinical guidelines for its management clearly emphasize a multifactorial approach. Yet, current guidelines are still not well implemented by clinicians. OBJECTIVES: To explore the attitudes of family medicine residents regarding low back pain and to determine whether they positively correlate with their treatment approaches. To test if these attitudes can be affected by the Enhanced Transtheoretical Model Intervention (ETMI), a guideline-based workshop. METHODS: Participants completed an online questionnaire regarding their attitudes toward low back pain and clinical habits, after which they attended an online ETMI educational workshop. One month later all participants were asked to complete the questionnaire a second time. Statistical analysis was conducted to explore the attitudes of the residents and clinical approaches, as well as any associations between them, as well as possible differences pre- and post-intervention. RESULTS: The participants exhibited highly psychologically oriented attitudes. Correlations between the attitudes and treatment did not show consistent coherency. Results regarding the participants clinical approaches were revealed to have two distinct and opposed inclinations: biomedically and biopsychosocially. Last, results for the re-activation subscale were significantly higher post-intervention. CONCLUSIONS: Family medicine residents seem to be highly psychologically oriented regarding low back pain; however, they do not necessarily treat their patients accordingly. Their clinical choices seem to follow two different approaches: guideline-consistent and non-guideline-consistent. An ETMI guideline-based workshop may sway their attitudes toward re-activation of patients. Further research is needed to determine whether similar results would arise in larger physician populations.

Smartphone-Based Sit-to-Stand Analysis for Mobility Assessment in Middle Age.

Background and Objectives: Mobility can decline in middle age and growing evidence highlights the importance of assessing mobility at this stage of life. Smartphone-based accelerometry during sit-to-stand has been shown to identify mobility impairments, but its utility in detecting subtle mobility deterioration in middle age has not been tested. This study aimed to examine whether smartphone-based accelerometry data measured during sit-to-stand tests performed on a regular chair and a cushioned sofa could be useful for detecting subtle changes in mobility in middle age. Research Design and Methods: Twenty-three young (25.0 ± 2.5 years), 25 middle-aged (52.0 ± 5.2 years), and 17 older adults (70.0 ± 4.1 years) performed the 5-times sit-to-stand test on both a standard chair and a sofa. A smartphone attached to the participants' lower back was used to measure lower-limb muscle power, maximal vertical velocity (MVV) during rising, the duration of the total task and the subphase of transition from sitting to standing (SiToSt), and repetition variability using the dynamic time warping method. Results: Middle-aged adults had reduced lower-limb muscle power compared to young adults (5.25 ±â€…1.08 vs 6.19 ±â€…1.38 W/kg, p = .034), being more pronounced on the sofa (6.23 ±â€…1.61 vs 8.08 ±â€…2.17 W/kg, p = .004). Differences between middle-aged and young adults in terms of MVV (p = .011) and SiToSt duration (p = .038) were only detected on the sofa, and the middle-aged adults showed less variability compared to the older adults on the chair (p = .018). There was no difference in total task duration between the middle-aged group and the young or older adults in either condition. Discussion and Implications: Most common tests are limited in their ability to detect early mobility deterioration in midlife due to a ceiling effect. Our results, which show the potential of smartphone-based sit-to-stand assessment in detecting subtle mobility decline in midlife, could serve as a screening tool for this purpose.

Cross-cultural adaptation, reliability, and validity of the pain self-efficacy questionnaire - Hebrew version.

PURPOSE: This study aims to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew Pain Self-Efficacy Questionnaire (PSEQ). METHODS: The study was designed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for patient-reported outcome measurement instruments. The PSEQ was initially translated into Hebrew and cross-culturally adapted. The Hebrew version of the PSEQ (PSEQ-H) was administered to participants suffering from chronic musculoskeletal pain, along with other self-report measures of pain (NPRS, FABQ, HADS, PCS, and SF-12). Eight hypotheses on expected correlations of the PSEQ-H with other instruments were formulated a priori to assess construct validity. Structural validity was assessed using confirmatory factor analysis. Floor and ceiling effects, test-retest, and internal consistency reliability were also assessed. RESULTS: The translation process retained the unidimensional model of the PSEQ. The PSEQ-H demonstrates excellent internal consistency (Cronbach's α = 0.97) and test-retest reliability (ICC = 0.88), and no significant floor and ceiling effects were observed. Construct validity was found satisfactory as 75% (six) of the analyses between the PSEQ-H and the other self-reported measures met the hypotheses. Factor analysis confirmed the single-factor structure of the questionnaire. CONCLUSIONS: The PSEQ-H version was found to have excellent reliability, good construct, and structural validity, and can be used with heterogeneous chronic musculoskeletal pain populations. Future studies should test the PSEQ-H's responsiveness and psychometric properties with specific pain populations.

Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy.

Low back pain (LBP) is a major cause of discomfort and disability. Physicians' attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians' attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.

Patients' prior perceptions and expectations of the Enhanced Transtheoretical Model Intervention for chronic low back pain: A qualitative study.

BACKGROUND: The Enhanced Transtheoretical Model Intervention (ETMI) is an approach for treating chronic low back pain (CLBP), which demonstrated clinical and cost-effectiveness outcomes. ETMI highlights reassurance, return to normal activities and encouragement of recreational physical activity. In order to optimally implement ETMI, it is important to gain an understanding of the expectations and perceptions of patients before they engage with the intervention. OBJECTIVES: To explore CLBP patients' perceptions and expectations of the ETMI method prior to their first consultation with physiotherapist. METHODS: Qualitative semi-structured interviews were conducted with 30 CLBP patients. The interviews were audio-recorded, transcribed, coded, and analysed thematically. Patients were first asked about their expectations of treatment, then they were asked to comment on the ETMI method. RESULTS: Three main themes emerged from the interviews: (1) Patient's perceptions of LBP; (2) patient's expectations from current physiotherapy and (3) Patient's expectations from ETMI method. The patients' perceptions of back pain centred on biomechanical causal factors, a desire for diagnostic tests and beliefs that rest cures the pain. Their expectations from current physiotherapy included pain reduction, passive treatment, a structured exercise program and clear information about LBP. In reference to the ETMI method, patients expected pain reduction, practical tools to self-manage, and a combination of ETMI with passive treatment. CONCLUSION: addressing issues around patient's perceptions and expectations of current physiotherapy and of the ETMI method, prior to their first consultation with physiotherapist, could be beneficial for understanding how to improve the ETMI implementation in the health care system.

Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study.

This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen's d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients' perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.

Cross-cultural adaptation, validation and psychometric evaluation of the attitudes to back pain scale in musculoskeletal practitioners - Hebrew version.

BACKGROUND: Research suggests that clinician's attitudes and beliefs towards low back pain (LBP) management may affect their patients' treatment course and outcomes. Attitudes to Back pain Scale in musculoskeletal practitioners (ABS-mp) is a questionnaire developed to assess musculoskeletal clinicians' attitudes and beliefs regarding LBP. OBJECTIVE: This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew version of the ABS-mp questionnaire. DESIGN: Cross-sectional study with nested prospective sub-sample. METHODS: The translation was performed in several steps following the cross-cultural adaptation process. Test-retest and internal consistency reliability of the scales were evaluated along with convergent validity exploration between the ABS-mp and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A convenience sample of 177 physical therapists were requested to participate in the study, out of which 132 have completed the survey, providing a 74% participation rate. RESULTS: The forward-backward translation process revealed minor discrepancies that were addressed by the expert panel. The test-retest reliability of the Hebrew ABS-mp was excellent (ICC = 0.906). Five items were found to be irrelevant for the Israeli physiotherapy health settings and were omitted. For internal consistency, the average inter-item correlation reached appropriate values for the Psychological, Biomedical, Re-activation, and Limitation on Sessions subscales (0.437, 0.265, 0.341, 0.197, respectively). For convergent validity, the ABS-mp's Biomedical subscale and the HC-PAIRS's total score were moderately correlated (0.535). CONCLUSIONS: The Hebrew version of the ABS-mp has been validated and has demonstrated excellent test-retest reliability, good convergent validity and acceptable internal consistency.