A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

STUDY DESIGN: Clinical pilot study. PURPOSE: To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs. OVERVIEW OF LITERATURE: Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects. METHODS: Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire. RESULTS: The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (p=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (p<0.001, p=0.02, respectively). CONCLUSIONS: The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.

Clinical care improvement with use of health information technology focusing on evidence based medicine.

OBJECTIVES: Healthcare institutions need timely patient information from various sources at the point-of-care. Evidence-based medicine (EBM) is a tool for proper and efficient incorporation of the results of research in decision-making. Characteristics of medical treatment processes and practical experience concerning the effect of EBM in the clinical process are surveyed. METHODS: A cross sectional survey conducted in Tehran hospitals in February-March 2012 among 51 clinical residents. The respondents were asked to apply EBM in clinical decision-making to answer questions about the effect of EBM in the clinical process. A valid and reliable questionnaire was used in this study. RESULTS: EBM provides a framework for problem solving and improvement of processes. Most residents (76%) agreed that EBM could improve clinical decision making. Eighty one percent of the respondents believed that EBM resulted in quick updating of knowledge. They believed that EBM was more useful for diagnosis than for treatment. There was a significant association between out-patients and in-patients in using electronic EBM resources. CONCLUSIONS: Research findings were useful in clinical practice and decision making. The computerized guidelines are important tools for improving clinical process quality. When learning how to use IT, methods of search and evaluation of evidence for diagnosis, treatment and medical education are necessary. Purposeful use of IT in clinical processes reduces workload and improves decision-making.