Healthcare Monitoring Using Low-Cost Sensors to Supplement and Replace Human Sensation: Does It Have Potential to Increase Independent Living and Prevent Disease?

Continuous monitoring of health status has the potential to enhance the quality of life and life expectancy of people suffering from chronic illness and of the elderly. However, such systems can only come into widespread use if the cost of manufacturing is low. Advancements in material science and engineering technology have led to a significant decrease in the expense of developing healthcare monitoring devices. This review aims to investigate the progress of the use of low-cost sensors in healthcare monitoring and discusses the challenges faced when accomplishing continuous and real-time monitoring tasks. The major findings include (1) only a small number of publications (N = 50) have addressed the issue of healthcare monitoring applications using low-cost sensors over the past two decades; (2) the top three algorithms used to process sensor data include SA (Statistical Analysis, 30%), SVM (Support Vector Machine, 18%), and KNN (K-Nearest Neighbour, 12%); and (3) wireless communication techniques (Zigbee, Bluetooth, Wi-Fi, and RF) serve as the major data transmission tools (77%) followed by cable connection (13%) and SD card data storage (10%). Due to the small fraction (N = 50) of low-cost sensor-based studies among thousands of published articles about healthcare monitoring, this review not only summarises the progress of related research but calls for researchers to devote more effort to the consideration of cost reduction as well as the size of these components.

A Single Subject, Feasibility Study of Using a Non-Contact Measurement to "Visualize" Temperature at Body-Seat Interface.

Measuring temperature changes at the body-seat interface has been drawing increased attention from both industrial and scientific fields, due to the increasingly sedentary nature from daily leisure activity to routine work. Although contact measurement is considered the gold standard, it can affect the local micro-environment and the perception of sitting comfort. A non-contact temperature measurement system was developed to determine the interface temperature using data gathered unobtrusively and continuously from an infrared sensor (IRs). System performance was evaluated regarding linearity, hysteresis, reliability and accuracy. Then a healthy participant sat for an hour on low/intermediate density foams with thickness varying from 0.5−8 cm while body-seat interface temperature was measured simultaneously using a temperature sensor (contact) and an IRs (non-contact). IRs data were filtered with empirical mode decomposition and fractal scaling indices before a data-driven artificial neural network was utilized to estimate the contact surface temperature. A strong correlation existed between non-contact and contact temperature measurement (ρ > 0.85) and the estimation results showed a low root mean square error (RMSE) (<0.07 for low density foam and <0.16 for intermediate density foam) and high Nash-Sutcliff efficiency (NSE) values (≈1 for both types of foam materials).

Review of Measuring Microenvironmental Changes at the Body-Seat Interface and the Relationship between Object Measurement and Subjective Evaluation.

Being seated has increasingly pervaded both working and leisure lifestyles, with development of more comfortable seating surfaces dependent on feedback from subjective questionnaires and design aesthetics. As a consequence, research has become focused on how to objectively resolve factors that might underpin comfort and discomfort. This review summarizes objective methods of measuring the microenvironmental changes at the body-seat interface and examines the relationship between objective measurement and subjective sensation. From the perspective of physical parameters, pressure detection accounted for nearly two thirds (37/54) of the publications, followed by microclimatic information (temperature and relative humidity: 18/54): it is to be noted that one article included both microclimate and pressure measurements and was placed into both categories. In fact, accumulated temperature and relative humidity at the body-seat interface have similarly negative effects on prolonged sitting to that of unrelieved pressure. Another interesting finding was the correlation between objective measurement and subjective evaluation; however, the validity of this may be called into question because of the differences in experiment design between studies.

Transcranial direct current stimulation and working memory: Comparison of effect on learning shapes and English letters.

We present the results of a study investigating whether there is an effect of Anodal-Transcranial Direct Current Stimulation (A-tDCS) on working memory (WM) performance. The relative effectiveness of A-tDCS on WM is investigated using a 2-back test protocol using two commonly used memory visual stimuli (shapes and letters). In a double-blinded, randomised, crossover, sham-controlled experiment, real A-tDCS and sham A-tDCS were applied separately to the left dorsolateral prefrontal cortex (L-DLPFC) of twenty healthy subjects. There was a minimal interval of one week between sham and real A-tDCS sessions. For the letters based stimulus experiment, 2-back test recall accuracy was measured for a set of English letters (A-L) which were presented individually in a randomised order where each was separated by a blank interval. A similar 2-back protocol was used for the shapes based stimuli experiment where instead of letters, a set of 12 geometric shapes were used. The working memory accuracy scores measured appeared to be significantly affected by memory stimulus type used and by the application of A-tDCS (repeated measures ANOVA p<0.05). A large effect size (d = 0.98) and statistical significance between sham and real A-tDCS WM scores (p = 0.01) was found when shapes were used as a visual testing stimulus, while low (d = 0.38) effect size and insignificant difference (p = 0.15) was found when letters were used. This results are important as they show that recollection different stimuli used in working memory can be affected differently by A-tDCS application. This highlights the importance of considering using multiple methods of WM testing when assessing the effectiveness of A-tDCS.

In-Depth Investigation into the Transient Humidity Response at the Body-Seat Interface on Initial Contact Using a Dual Temperature and Humidity Sensor.

Relative humidity (RH) at the body-seat interface is considered an important factor in both sitting comfort and generation of health concerns such as skin lesions. Technical difficulties appear to have limited research aimed at the detailed and simultaneous exploration of RH and temperature changes at the body-seat interface; using RH sensors without the capability to record temperature where RH is recorded. To explore the causes of a spike in RH consistently produced on first contact between body and seat surface, we report data from the first use of dual temperature and RH (HTU21D) sensors in this interface. Following evaluation of sensor performance, the effect of local thermal changes on RH was investigated. The expected strong negative correlation between temperature and RH (R² = -0.94) supported the importance of considering both parameters when studying impact of sitting on skin health. The influence of sensor movement speed (higher velocity approach: 0.32 cm/s ± 0.01 cm/s; lower velocity approach: 0.17 cm/s ± 0.01 cm/s) into a static RH region associated with a higher local temperature were compared with data gathered by altering the rate of a person sitting. In all cases, the faster sitting down (or equivalent) generated larger RH outcomes: e.g., in human sitting 53.7% ± 3.3% RH (left mid-thigh), 56.4% ± 5.1% RH (right mid-thigh) and 53.2% ± 2.7% RH (Coccyx). Differences in size of RH change were seen across the measurement locations used to study the body-seat interface. The initial sitting contact induces a transient RH response (duration ≤ 40 s) that does not accurately reflect the microenvironment at the body-seat interface. It is likely that any movement during sitting would result in similar artefact formation. As a result, caution should be taken when investigating RH performance at any enclosed interface when the surfaces may have different temperatures and movement may occur.

A pilot study assessing patient-centred care in patients with chronic health conditions attending chiropractic practice.

OBJECTIVES: The primary aim of this pilot study was to determine the feasibility of conducting a mixed- methods study assessing the extent patients with chronic health conditions perceive chiropractic care to be patient-centred. DESIGN: A sequential mixed methods feasibility study with a quantitative priority. SETTING: Two private chiropractic clinics in Calgary, Alberta, Canada. MAIN OUTCOME MEASURES: Feasibility outcomes included pilot study participation, consent and completion rates. Demographic and health information and a modified version of the Patient Assessment of Chronic Illness Care (PACIC). RESULTS: Over three weeks, 90 participants were recruited, 86 enrolled, and 78 provided complete data, with only one who commented on the clarity of paperwork. Included participants were on average 47.1 years of age and 60.3% were female. They had an average of 1.8 chronic conditions with 60% having chronic spinal pain. They reported seeing an average of 2.9 other health professionals for their chronic health condition and averaged 12.9 chiropractic visits in the past year. The average overall modified PACIC score was 3.29 on a 5-point scale. Higher scores were seen on the 'patient activation', 'delivery system design/decision support', and 'problem solving/contextual' subscales, with lower scores seen on the 'goal-setting/tailoring' and 'follow-up/coordination' subscales. Interview data generally supported those findings. CONCLUSIONS: The pilot study results support the feasibility of the methods for a subsequent large-scale study. These preliminary results suggest that the degree of patient-centredness compares favourably to similar studies in primary medical care.

Modelling the effect of electrode displacement on transcranial direct current stimulation (tDCS).

OBJECTIVE: Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers a low-intensity, direct current to cortical areas with the purpose of modulating underlying brain activity. Recent studies have reported inconsistencies in tDCS outcomes. The underlying assumption of many tDCS studies has been that replication of electrode montage equates to replicating stimulation conditions. It is possible however that anatomical difference between subjects, as well as inherent inaccuracies in montage placement, could affect current flow to targeted areas. The hypothesis that stimulation of a defined brain region will be stable under small displacements was tested. APPROACH: Initially, we compared the total simulated current flowing through ten specific brain areas for four commonly used tDCS montages: F3-Fp2, C3-Fp2, Fp1-F4, and P3-P4 using the software tool COMETS. The effect of a slight (~1 cm in each of four directions) anode displacement on the simulated regional current density for each of the four tDCS montages was then determined. Current flow was calculated and compared through ten segmented brain areas to determine the effect of montage type and displacement. The regional currents, as well as the localised current densities, were compared with the original electrode location, for each of these new positions. MAIN RESULTS: Recommendations for montages that maximise stimulation current for the ten brain regions are considered. We noted that the extent to which stimulation is affected by electrode displacement varies depending on both area and montage type. The F3-Fp2 montage was found to be the least stable with up to 38% change in average current density in the left frontal lobe while the Fp1-F4 montage was found to the most stable exhibiting only 1% change when electrodes were displaced. SIGNIFICANCE: These results indicate that even relatively small changes in stimulation electrode placement appear to result in surprisingly large changes in current densities and distribution.

Performance Assessment of a Humidity Measurement System and Its Use to Evaluate Moisture Characteristics of Wheelchair Cushions at the User-Seat Interface.

Little is known about the changes in moisture that occur at the body-seat interface during sitting. However, as increased moisture can add to the risk of skin damage, we have developed an array of MEMS (Micro-Electro-Mechanical System) humidity sensors to measure at this interface. Sensors were first evaluated against traceable standards, followed by use in a cross-over field test (n = 11; 20 min duration) using different wheelchair cushions (foam and gel). Relative humidity (RH) was measured at the left mid-thigh, right mid-thigh and coccyx. Sensors were shown to be unaffected by loading and showed highly reliable responses to measured changes in humidity, varying little from the traceable standard (<5%). Field-test data, smoothed through a moving average filter, revealed significant differences between the three chosen locations and between the gel and foam cushions. Maximum RH was attained in less than five minutes regardless of cushion material (foam or gel). Importantly, RH does not appear to distribute uniformly over the body-seat interface; suggesting multiple sensor positions would appear essential for effectively monitoring moisture in this interface. Material properties of the cushions appear to have a significant effect on RH characteristics (profile) at the body-seat interface, but not necessarily the time to peak moisture.

Effect of Anodal-tDCS on Event-Related Potentials: A Controlled Study.

We aim to measure the postintervention effects of A-tDCS (anodal-tDCS) on brain potentials commonly used in BCI applications, namely, Event-Related Desynchronization (ERD), Event-Related Synchronization (ERS), and P300. Ten subjects were given sham and 1.5 mA A-tDCS for 15 minutes on two separate experiments in a double-blind, randomized order. Postintervention EEG was recorded while subjects were asked to perform a spelling task based on the "oddball paradigm" while P300 power was measured. Additionally, ERD and ERS were measured while subjects performed mental motor imagery tasks. ANOVA results showed that the absolute P300 power exhibited a statistically significant difference between sham and A-tDCS when measured over channel Pz (p = 0.0002). However, the difference in ERD and ERS power was found to be statistically insignificant, in controversion of the the mainstay of the litrature on the subject. The outcomes confirm the possible postintervention effect of tDCS on the P300 response. Heightening P300 response using A-tDCS may help improve the accuracy of P300 spellers for neurologically impaired subjects. Additionally, it may help the development of neurorehabilitation methods targeting the parietal lobe.

The factors and motivations behind United Kingdom chiropractic professional association membership: a survey of the Welsh Institute of Chiropractic Alumni.

BACKGROUND: There are many professional associations representing chiropractors and chiropractic in the United Kingdom (UK). Each has its unique selling points (USPs) and chiropractors can choose to join as many as they like; however, cost of membership has to be weighed against perceived benefits. The predictors of UK chiropractic association membership and motivational factors to join these associations, have not formally been identified. This research study aimed to identify some of the factors and motivations in Welsh Institute of Chiropractic (WIOC) Alumni regarding their decision to join (or not) a UK chiropractic professional association. METHODS: An online survey instrument, comprising 23 questions, was administered from November-December 2015 via a link announced on 'The WIOC Alumni' Facebook group (N = 655), the active platform for the WIOC Alumni Organisation. RESULTS: One hundred forty-eight respondents (approximately 22.6 % of 'The WIOC Alumni' Facebook group membership) completed the survey. Ten factors were reported to be important in decision making: 'promoting public awareness of chiropractic' (91.2 %), 'access to professional indemnity insurance' (89.2 %), 'overall professionalism of the association' (87.2 %), 'the identity of the association' (77.7 %), 'positive attitude to research' (77.0 %), 'workplace support and advice' (68.9 %), 'access to events \ courses \ seminars' (64.2 %), 'Continuing Professional Development (CPD) activities' (62.2 %), 'cost of membership' (59.5 %) and 'addresses my area of interest' (56.1 %). 'Many of my friends have joined' (71.6 %) was considered unimportant, whereas 'Lobbying: Influencing policy' and 'career development' were considered important by almost twice as many as those that consider them unimportant (45.3 %: 25.7 % and 43.9 %: 27.0 % respectively), 'requirement of employment' and 'associations newsletter' were seen as unimportant by roughly twice as many as those considering them important (44.6 %: 28.4 % and 35.8 %: 28.4 % respectively). Should it become an option, almost 71 % of respondents would support the unification of the four main UK chiropractic associations, (the British, McTimoney, Scottish and United, Chiropractic Associations: BCA MCA, SCA and UCA, respectively). CONCLUSIONS: Several factors have an important effect on motivations to join UK chiropractic professional associations. Further research is required to determine if this is WIOC specific or can be extrapolated more generally.

A methodology using in-chair movements as an objective measure of discomfort for the purpose of statistically distinguishing between similar seat surfaces.

This study presents a method for objectively measuring in-chair movement (ICM) that shows correlation with subjective ratings of comfort and discomfort. Employing a cross-over controlled, single blind design, healthy young subjects (n = 21) sat for 18 min on each of the following surfaces: contoured foam, straight foam and wood. Force sensitive resistors attached to the sitting interface measured the relative movements of the subjects during sitting. The purpose of this study was to determine whether ICM could statistically distinguish between each seat material, including two with subtle design differences. In addition, this study investigated methodological considerations, in particular appropriate threshold selection and sitting duration, when analysing objective movement data. ICM appears to be able to statistically distinguish between similar foam surfaces, as long as appropriate ICM thresholds and sufficient sitting durations are present. A relationship between greater ICM and increased discomfort, and lesser ICM and increased comfort was also found.

Wearing American Football helmets increases cervicocephalic kinaesthetic awareness in "elite" American Football players but not controls.

BACKGROUND: While there have been investigations into the reduced neck injury rate of wearing protective helmets, there is little information on its effects on normal kinaesthetic neck function. This study aims to quantify the kinaesthetic and movement effects of the American football helmet. METHODS: Fifteen British Collegiate American football players (mean age 22.2, SD 1.9; BMI kg.m(2) 26.3, SD 3.7) were age and size matched to 11 non-American football playing university students (mean age 22.5, SD 3.6; BMI 24.3, SD 3.3 kg.m(2)). Both groups had their active cervical range of motion and head repositioning accuracy measured during neck flexion/extension using a modified cervical range of motion device and a similarly modified football helmet. RESULTS: Wearing helmets significantly reduced active cervical range of motion in extension in both groups (P = 0.007 and P = 0.001 Controls and American Footballers respectively). While both groups had similar repositioning when not wearing a helmet (flexion P = 0.99; extension P = 0.52), when wearing helmets, American football players appeared to be more accurate in relation to cervical kinaesthetic repositioning (ANOVA: P = 0.077: flexion effect size =0.84; extension effect size =0.38). CONCLUSIONS: Wearing American football helmets significantly reduces the active cervical range of motion in extension, along with a change in the neutral head position. American footballers have a greater accuracy in repositioning their head from flexion (potentially enhanced proprioception) when wearing a helmet. This finding might allow development of a simple objective test to help discern presence of minor concussive or cervical musculoskeletal injury on or off the field.

Microenvironment temperature prediction between body and seat interface using autoregressive data-driven model.

There is a need to develop a greater understanding of temperature at the skin-seat interface during prolonged seating from the perspectives of both industrial design (comfort/discomfort) and medical care (skin ulcer formation). Here we test the concept of predicting temperature at the seat surface and skin interface during prolonged sitting (such as required from wheelchair users). As caregivers are usually busy, such a method would give them warning ahead of a problem. This paper describes a data-driven model capable of predicting thermal changes and thus having the potential to provide an early warning (15- to 25-min ahead prediction) of an impending temperature that may increase the risk for potential skin damages for those subject to enforced sitting and who have little or no sensory feedback from this area. Initially, the oscillations of the original signal are suppressed using the reconstruction strategy of empirical mode decomposition (EMD). Consequentially, the autoregressive data-driven model can be used to predict future thermal trends based on a shorter period of acquisition, which reduces the possibility of introducing human errors and artefacts associated with longer duration "enforced" sitting by volunteers. In this study, the method had a maximum predictive error of <0.4 °C when used to predict the temperature at the seat and skin interface 15 min ahead, but required 45 min data prior to give this accuracy. Although the 45 min front loading of data appears large (in proportion to the 15 min prediction), a relative strength derives from the fact that the same algorithm could be used on the other 4 sitting datasets created by the same individual, suggesting that the period of 45 min required to train the algorithm is transferable to other data from the same individual. This approach might be developed (along with incorporation of other measures such as movement and humidity) into a system that can give caregivers prior warning to help avoid exacerbating the skin disorders of patients who suffer from low body insensitivity and disability requiring them to be immobile in seats for prolonged periods.

Survey based investigation into general practitioner referral patterns for spinal manipulative therapy.

BACKGROUND: In the UK Physiotherapy, Chiropractic and Osteopathy are all statutory regulated professions. Though guidelines have supported the use of Spinal Manipulative Therapy (SMT) for low back pain (LBP), General Practitioners (GP) referral patterns to the 3 registered professions that perform SMT are generally unknown. METHOD: A short questionnaire was designed and piloted. Demographic information, patient referral to SMT and the GPs own personal utilisation of SMT were obtained. 385 GP's were contacted representing approximately 20% of the GP's in Wales Autumn 2007. RESULTS AND DISCUSSION: 182 (50.8%) completed questionnaires were returned. Profile characteristics: 2/3 of respondents were male, 79% were 40 years old or older (statistically reflective of the total population of GPs in Wales at that time) and 62% had 20 years or less in practise. Personal use of SMT by GP's: 48 respondents had sought SMT treatment and a further 56% of those that had not previously sought SMT indicated that they would consider doing so. Patient referral to SMT by GP's: 131 respondents (72%) had referred patients to SMT and of those who had not a further 13% would consider referring. The general referral pattern and utilisation pattern was Physiotherapy: Osteopathy: Chiropractic. 21% who had never referred patients neither had, nor would consider it for themselves. A small subgroup appeared to manage personal choice differently from patient referral: 5 individuals who had not referred patients either had or would consider it for themselves and 23 of the group that would refer patients neither had nor would seek it for themselves. CONCLUSIONS: This limited investigation indicates that GP's do practise consistently with guidelines on back pain and utilise SMT as a care option. Although the main option for referral was physiotherapy, slightly over 40% of respondents who expressed a preference would refer to either osteopathy or chiropractic, or both in preference to physiotherapy. There was a small proportion that did not and would not refer patients for SMT regardless of personal use of SMT; these suggested use of acupuncture. Further investigation is needed to determine the alternatives to SMT offered to patients and the decision-making criteria for patient referral to subtypes of SMT practitioner.

Studying thermal characteristics of seating materials by recording temperature from 3 positions at the seat-subject interface.

AIM OF THE STUDY: To determine whether 3 fixed positions of seat-subject interface temperature measurement offer more information than a single point of measurement. MATERIALS AND METHODS: Temperature data was simultaneously acquired (sampling frequency 1 Hz/sensor) from each of three sensor positions (right & left mid-thigh and coccyx), from the subject-seat interface. The data was acquired whilst subjects (6 males, 5 females: 21-40 yrs: BMI 19.3-26.4) sat for 20 min on each of three types of seat material (foam, gel mould and solid wood). Data collection was performed at the same time of day for each subject: ambient temperature between 21.1 and 21.2 °C, ambient relative humidity 50.9%. RESULTS: Analysis of data from the sensors, post mathematical smoothing, for each subject (n = 11; ANOVA, followed by post-hoc t-tests) revealed each of the measurement positions to have a significantly different recorded temperature (p < 0.01). However, profile of temperature change at the same measurement position using the same seating material during the 20 min sitting period, was highly correlated (r > 0.99) between subjects, a consistent finding across all 11 subjects regardless of seat material selected. CONCLUSION: Use of 3 positions of measurement (3 sensors) appears necessary when performing detailed studies of temperature change at the seat-subject interface. The high level of comparability of results between subjects supports potential of this method to resolve quantitative components of qualitative measurements, e.g., thermal comfort.

Settling down time following initial sitting and its relationship with comfort and discomfort.

This study examined the subjective rating of wheelchair comfort and discomfort (numerical rating scale questionnaire) and the duration of objective in-chair movement reduction "settling down time" following initial contact with the seating surface. Healthy young subjects (n = 22) sat for 5 min on contoured foam or wood cushion surfaces fitted to otherwise identical wheelchairs. Force sensing resistors attached to each quadrant of the sitting interface measured the relative movements of the subjects over time. A significant correlation was found between settling down time (SDT) and reported leg/feet discomfort (p = 0.003; correlation co-efficient = 0.44); and a significant negative correlation was found between SDT and overall comfort (p = 0.015; correlation co-efficient = -0.36). When comparing cushion surfaces: SDT was significantly longer (p < 0.0001) for subjects sitting on wood (5.8 s) compared to contoured foam (3.9 s); Leg/feet discomfort was significant higher (p = 0.007) for subjects sitting on wood (1.1 out of 10) compared to contoured foam (0.3 out of 10); Overall discomfort was significant higher (p = 0.009) for subjects sitting on wood (1.3 out of 10) compared to contoured foam (0.5 out of 10); Comfort was significantly lower (p = 0.001) for subjects sitting on wood (6.5 out of 10) compared to contoured foam (8.3 out of 10); Support was significantly lower (p = 0.001) for subjects sitting on wood (6.4 out of 10) compared to contoured foam (8 out of 10). The results of this study suggest that the shape and firmness of the surface at the buttock-wheelchair interface can affect a subject's SDT following initial contact with the seat as well as their perception of comfort and discomfort. In addition, there appears to be a relationship between longer SDT's and increased discomfort ratings, and shorter SDT's and increased comfort ratings. Therefore, testing for SDT's may be useful in the indirect objective assessment of wheelchair cushions and possibly other types of seating surfaces with design differences that aim to improve comfort and minimize discomfort.

Reliability of the parallel walk test for the elderly.

OBJECTIVE: To determine interrater agreement and test-retest reliability of the parallel walk test (PWT), a simple method of measuring dynamic balance in the elderly during gait. DESIGN: Cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Elderly fallers (N=34; mean ± SD age, 81.3±5.4y) registered at a falls clinic participated in this study based on Mini-Mental State Examination and Barthel Index scores. INTERVENTIONS: Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) wearing their own footwear. They were scored for foot placement on (1 point) or outside the lines (2 points) by 2 separate raters. Fifteen subjects were retested 1 week later. MAIN OUTCOME MEASURES: Footfall score and time to complete the PWT. Intraclass correlation coefficients (ICCs) and 95% limits of agreement were calculated for interrater and test-retest reliability. RESULTS: For widths of 20, 30.5, and 38cm, interrater reliability ICC range was .93 to .99 and test-retest ICC range was .63 to .90. CONCLUSIONS: The PWT was implemented easily by 2 raters with a high degree of interrater reliability. Test-retest reliability was not as high, possibly because of the high susceptibility of variation from 1 week to the next for frail elderly subjects. The 20- and 30.5-cm widths are recommended for future use of the PWT.

Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome.

BACKGROUND: In the last decade the sub grouping of low back pain (LBP) patients according to their likely response to treatment has been identified as a research priority. As with other patient groups, researchers have found few if any factors from the case history or physical examination that are helpful in predicting the outcome of chiropractic care. However, in the wider LBP population psychosocial factors have been identified that are significantly prognostic. This study investigated changes in the components of the LBP fear-avoidance beliefs model in patients pre- and post- their initial visit with a chiropractor to determine if there was a relationship with outcomes at 1 month. METHODS: Seventy one new patients with lower back pain as their primary complaint presenting for chiropractic care to one of five clinics (nine chiropractors) completed questionnaires before their initial visit (pre-visit) and again just before their second appointment (post-visit). One month after the initial consultation, patient global impression of change (PGIC) scores were collected. Pre visit and post visit psychological domain scores were analysed for any association with outcomes at 1 month. RESULTS: Group mean scores for Fear Avoidance Beliefs (FAB), catastrophisation and self-efficacy were all improved significantly within a few days of a patient's initial chiropractic consultation. Pre-visit catastrophisation as well as post-visit scores for catastrophisation, back beliefs (inevitability) and self-efficacy were weakly correlated with patient's global impression of change (PGIC) at 1 month. However when the four assessed psychological variables were dichotomised about pre-visit group medians those individuals with 2 or more high variables post-visit had a substantially increased risk (OR 36.4 (95% CI 6.2-213.0) of poor recovery at 1 month. Seven percent of patients with 1 or fewer adverse psychological variables described poor benefit compared to 73% of those with 2 or more. CONCLUSIONS: The results presented suggest that catastrophisation, FAB and low self-efficacy could be potential barriers to early improvement during chiropractic care. In most patients presenting with higher psychological scores these were reduced within a few days of an initial chiropractic visit. Those patients who exhibited higher adverse psychology post-initial visit appear to have an increased risk of poor outcome at 1 month.