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OBJECTIVE: To describe the context of low back pain (LBP) presentations to emergency departments (EDs) by remoteness areas, hospital delineation level and staffing portfolios. DESIGN: A retrospective observational study using routinely captured ED and admission data over a 5-year period (July 2014-June 2019). SETTINGS: Thirty seven EDs across a large health district in NSW, Australia, covering major cities, inner regional areas and outer regional areas. PARTICIPANTS: Emergency department (ED) presentations with a principal or secondary diagnosis of LBP based on ICD-10 code (M54.5). MAIN OUTCOME MEASURES: ED presentation and associated admission measures, including presentation rate, referral source, time in ED, re-presentation rate, admission details and cost to the health system. RESULTS: There were 26 509 ED presentations for LBP across the 5 years. Time spent in ED was 206 min for EDs in major cities, 146 min for inner regional EDs and 89 min for outer regional EDs. Re-presentation rates were 6% in major cities, 8.8% in inner regional EDs and 11.8% in outer regional EDs. Admission rates were 20.4%, 15.8% and 18.8%, respectively. CONCLUSIONS: This study describes LBP presentations across 37 EDs, highlighting the potential burden these presentations place on hospitals. LBP presentations appear to follow different pathways depending on the ED remoteness area, delineation level and staff portfolio.
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Dor Lombar , Austrália/epidemiologia , Serviço Hospitalar de Emergência , Humanos , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Estudos Retrospectivos , População RuralRESUMO
PURPOSE: To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. METHODS: We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). RESULTS: The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. CONCLUSIONS: Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.
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Promoção da Saúde , Estilo de Vida Saudável , Dor Lombar/reabilitação , Obesidade/terapia , Osteoartrite do Joelho/reabilitação , Sobrepeso/terapia , Dor Crônica/complicações , Dor Crônica/reabilitação , Avaliação da Deficiência , Exercício Físico , Humanos , Dor Lombar/complicações , Obesidade/complicações , Osteoartrite do Joelho/complicações , Sobrepeso/complicações , Medição da Dor , Qualidade de Vida , Redução de PesoRESUMO
BACKGROUND: The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese. METHODS: An economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6 weeks and 26 weeks. The primary cost-effectiveness analysis was performed from the societal perspective. RESULTS: Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values. CONCLUSIONS: From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis. TRIAL REGISTRATION NUMBER: ACTRN12615000490572 , registered 18th May 2015.
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Obesidade/prevenção & controle , Osteoartrite do Joelho/epidemiologia , Telefone , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos , Idoso , Análise Custo-Benefício , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de SaúdeRESUMO
BACKGROUND: Low back pain is a highly prevalent condition with a significant global burden. Management of lifestyle factors such as overweight and obesity may improve low back pain patient outcomes. Currently there are no randomised controlled trials that have been conducted to assess the effectiveness of lifestyle behavioural interventions in managing low back pain. The aim of this trial is to determine if a telephone-based lifestyle behavioural intervention is effective in reducing pain intensity in overweight or obese patients with low back pain, compared to usual care. METHODS/DESIGN: A randomised controlled trial will be conducted with patients waiting for an outpatient consultation with an orthopaedic surgeon at a public tertiary referral hospital within New South Wales, Australia for chronic low back pain. Patients will be randomly allocated in a 1:1 ratio to receive a lifestyle behavioural intervention (intervention group) or continue with usual care (control group). After baseline data collection, patients in the intervention group will receive a clinical consultation followed by a 6-month telephone-based lifestyle behavioural intervention (10 individually tailored sessions over a 6-month period) and patients in the control group will continue with usual care. Participants will be followed for 26 weeks and asked to undertake three self-reported questionnaires at baseline (pre-randomisation), week 6 and 26 post randomisation to collect primary and secondary outcome data. The study requires a sample of 80 participants per group to detect a 1.5 point difference in pain intensity (primary outcome) 26 weeks post randomisation. The primary outcome, pain intensity, will be measured using a 0-10 numerical rating scale. DISCUSSION: The study will provide robust evidence regarding the effectiveness of a lifestyle behavioural intervention in reducing pain intensity in overweight or obese patients with low back pain and inform management of these patients. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry, ACTRN12615000478516 , Registered 14/05/2015.
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Estilo de Vida , Dor Lombar/epidemiologia , Dor Lombar/terapia , Sobrepeso/epidemiologia , Sobrepeso/terapia , Comportamento de Redução do Risco , Estudos de Coortes , Feminino , Humanos , Dor Lombar/psicologia , Masculino , New South Wales/epidemiologia , Obesidade/epidemiologia , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/psicologiaRESUMO
The aim of this study was to determine the extent to which patients with hip and knee osteoarthritis (OA) referred for orthopaedic consultation at a large Australian public hospital reported using conservative management strategies as recommended by current practice guidelines. A therapist-assisted questionnaire was employed within the context of a standard physiotherapy assessment in a consecutive cohort of patients with hip or knee OA. Two hundred and two patients with hip or knee OA comprised the included sample. Thirty-nine percent (n=79) reported having only previously consulted their general practitioner. Only 20% (n=41) felt that they had been sufficiently educated about the diagnosis, their treatment options and prognosis. Thirty-three percent (n=66) had not previously engaged in any non-pharmacological management strategy considered a core clinical practice guideline recommendation. The findings of this study suggest that several inconsistencies may exist between current Australian clinical practice and OA clinical guideline recommendations. Identification of the barriers to the use of conservative management requires timely investigation coupled with a national implementation framework to support the translation of guideline recommendations into practice.
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Medicina Geral/métodos , Ortopedia/métodos , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Austrália , Estudos de Coortes , Feminino , Medicina Geral/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Educação em Saúde/estatística & dados numéricos , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/estatística & dados numéricos , Inquéritos e Questionários , Redução de Peso/fisiologiaRESUMO
QUESTION(S): What are the perceptions and knowledge of physiotherapists who treat musculoskeletal disorders towards prognosis? DESIGN: Exploratory phenomenological study. PARTICIPANTS: 15 physiotherapists involved in the treatment of musculoskeletal disorders. DATA ANALYSIS: Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis. RESULTS: Four themes were identified. First, participants perception of prognosis was influenced by how they defined prognosis. Participants often perceived that prognosis was the timeline to recovery related to function, tissue health, or pain. Second, some participants could not recall foundational knowledge about prognosis being taught during their entry-level physiotherapy program. Others recalled it being taught in relation to the tissue healing model. Third, participants described learning about prognosis through experience, professional development, or from peers. Finally, participants identified that a potential learning opportunity is to conceptualise prognosis as separate outcomes associated with function, tissue health, and pain. Each can impact upon prognosis, have a prognosis of their own, and can occur simultaneously. CONCLUSION: How physiotherapists perceive and understand the concept of prognosis is influenced by their foundational knowledge. It appears for physiotherapists, prognosis may be conceptualised within the biomedical model of health. Indeed, physiotherapists may perceive that prognosis is the timeline for recovery determined by the tissue model of healing. Physiotherapists also rely on experiential knowledge gained from clinical practice, professional development, and their peers to enhance learning about prognosis. The understanding of prognosis may be enhanced if physiotherapists conceptualise prognosis in terms of the multifactorial outcomes associated with function, tissue health, and pain.
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OBJECTIVE: To describe the health characteristics, condition-specific measures, chronic disease risk factors, and healthcare and medication use over time of individuals with musculoskeletal conditions awaiting orthopaedic surgical consultation. Study importance: Musculoskeletal conditions are highly prevalent in the general population and often coexist with chronic diseases. However, little is documented about the overall health of this group. This study describes the health of these individuals, with particular emphasis on modifiable risk factors of chronic disease. STUDY TYPE: A repeated measures longitudinal cohort study of individuals referred for orthopaedic consultation across three time points (2014, 2015 and 2016). METHODS: This study was undertaken in the orthopaedic outpatient service of a public tertiary referral hospital in New South Wales, Australia. Participants were aged 18 years and older and were referred for and awaiting orthopaedic surgical consultation for a musculoskeletal condition (back, neck, hand or wrist pain, or hip or knee osteoarthritis). Measures included patient demographics, condition-specific indicators (e.g. pain, disability, quality of life [QoL]) and chronic disease risk factors (e.g., excess weight, smoking). RESULTS: The mean age of participants was 57.7 years, and 7.3% identified as Aboriginal and/or Torres Strait Islander. Back (43.1%) and knee (35.0%) pain were the most prevalent conditions. At baseline (N = 1052), participants reported moderate pain (mean numerical pain rating scale score of 6.4, standard deviation [SD] 2.4) and QoL (Physical Component Score of 32.7, SD 10.7; Mental Component Score of 46.6, SD 13.3). Chronic disease risk factors were highly prevalent, with 74.6% of participants having three or more. For most measures, there were only small changes over time. CONCLUSION: Individuals with musculoskeletal conditions who are awaiting orthopaedic surgical consultation have a complex clinical picture and numerous chronic disease risk factors. Given the modifiable nature of many of these risk factors, identifying and addressing them before or while awaiting consultation may improve the health of these individuals.
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Doenças Musculoesqueléticas , Encaminhamento e Consulta , Humanos , Masculino , Feminino , Doenças Musculoesqueléticas/epidemiologia , Pessoa de Meia-Idade , Estudos Longitudinais , Encaminhamento e Consulta/estatística & dados numéricos , New South Wales/epidemiologia , Idoso , Adulto , Fatores de Risco , Estudos de Coortes , Procedimentos Ortopédicos/estatística & dados numéricos , Qualidade de Vida , Doença Crônica , Ortopedia , Listas de EsperaRESUMO
QUESTION(S): How do individuals living with musculoskeletal disorders perceive the concept of prognosis? DESIGN: Exploratory phenomenological study. PARTICIPANTS: Individuals aged 18 years or older currently experiencing a musculoskeletal disorder. DATA ANALYSIS: Single semi-structured one-on-one interviews were conducted. Data was analysed using inductive coding and thematic analysis. RESULTS: Five themes were identified. First, participants defined prognosis as the likely outcome associated with their diagnosis. Their prognosis was often associated with outcomes related to pain, tissue health, and function. Second, participants perceived pain as having a negative impact on their prognosis by limiting their function and having a psychological impact. Third, participants held biomedical views in that tissue health was perceived as a cause for their pain and that tissue healing was essential for pain cessation. It was also difficult for participants to distinguish between pain related to tissue damage, and pain that was not. Fourth, participants use their ability to complete leisure and functional activities to determine the success of their recovery. Finally, participants perceived receiving individual prognoses for pain, tissue health, and function that may be simultaneously occurring as both important and beneficial. CONCLUSION: Overall, participants viewed receiving prognostic information as important and beneficial. When constructing their views on prognosis participants perceived that pain, tissue health, and functional ability could all impact upon prognosis, whilst having a prognosis of their own. Physiotherapists should consider conceptualising and discussing prognosis in terms of pain, tissue health, and function when managing musculoskeletal disorders.
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Doenças Musculoesqueléticas , Dor Musculoesquelética , Dor Nociceptiva , Humanos , Doenças Musculoesqueléticas/psicologia , Comportamentos Relacionados com a Saúde , Atividades Cotidianas , Prognóstico , Pesquisa Qualitativa , Dor Musculoesquelética/psicologiaRESUMO
QUESTION(S): What are the experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis? DESIGN: Exploratory phenomenological study. PARTICIPANTS: Individuals aged 18-year or older currently experiencing a musculoskeletal disorder and receiving treatment from a physiotherapist. DATA ANALYSIS: Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis. RESULTS: Five themes were identified. First, participants described seeking a cause for their pain. This influenced their experience of prognosis as they perceived a diagnosis was required to inform their prognosis. Second, whilst participants wished to receive a prognosis from their physiotherapist, this was often not their experience. Third, participants perceived that physiotherapists have the potential to impact prognosis through exercise prescription, management of conditions, and improving function. Fourth, receiving a prognosis can have both a positive and negative impact on the individual. Positive impacts include planning for the future, motivation, knowledge acquisition, and instilling hope. However, receiving a prognosis can be disheartening if a patient's expectations are unmet. Finally, participants have several preferences regarding receiving a prognosis including when and how often the prognosis is discussed, what prognostic information is provided, how the prognosis is presented, and what prognosis based on. CONCLUSION: Individuals wish to receive a prognosis, although this is not always their experience. Individuals perceive that physiotherapists have the ability to provide a prognosis and impact their prognosis. Furthermore, receiving a prognosis has an impact on itself. To ensure patient-centred care, physiotherapists should explicitly discuss the prognosis with patients and consider their preferences when providing a prognosis.
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Doenças Musculoesqueléticas , Fisioterapeutas , Humanos , Doenças Musculoesqueléticas/terapia , Pesquisa Qualitativa , Assistência Centrada no Paciente , Dor , Terapia por ExercícioRESUMO
OBJECTIVE: To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED; (ii) barriers and enablers they face when providing care to patients with LBP; and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. METHODS: We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary-level public hospital in New South Wales, Australia, using focus groups and individual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. RESULTS: Twenty-one clinicians participated (two individual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient-, clinician- and service-level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow-up options post-discharge and improved communication between ED and primary care. CONCLUSION: We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient-, clinician- and service-level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow-up options, access to resources and an 'LBP pathway' to support decision making.
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Dor Lombar , Assistência ao Convalescente , Serviço Hospitalar de Emergência , Humanos , Dor Lombar/terapia , Alta do Paciente , Pesquisa QualitativaRESUMO
BACKGROUND: Data regarding injuries in community-based wheelchair sport athletes is limited and long-term management of injuries and their impact upon participation unexplored. Little data examines benefits and barriers to wheelchair sports participation across the community. HYPOTHESIS: The prevalence and nature of injuries sustained by wheelchair sports participants and injury prevention and management strategies will be associated with level of sports participation. STUDY DESIGN: Cross-sectional survey. METHODS: Members of Wheelchair Sports New South Wales (WSNSW) completed a questionnaire developed from interviews with sports participants. Items examined demographics, sports played, injuries sustained, prevention and management practices, benefits and barriers to participation. Injury types and their management were collected for the previous 12 months. RESULTS: Seventy-one questionnaires were returned. Injuries were sustained by 59% of respondents, with 28% reporting injuries in the past twelve months. Injuries most frequently affected the shoulder (25%), were primarily muscle strains (32%), and commonly caused by contact (48%). Injury prevention strategies were reported by 75% of respondents most commonly involving warm-up and stretching activities. Participation benefits included improvements in fitness (85%), opportunities for friendship (83%), improvements in self-care abilities (83%) and setting/achieving goals (91%). Barriers included cost of sports wheelchairs (68%), availability of competitions/competitors (62%), and distance required for travel for training/competition (71%). CONCLUSION: Injuries in wheelchair sports participants and benefits and barriers to participation are multi-faceted. Injury types, their management and prevention strategies were identified. Perceived benefits were found in the domains of health, socialisation and skills. Strategies aimed at raising participation rates should focus on promoting the physical, social and skill-related benefits.
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Pessoas com Deficiência , Esportes para Pessoas com Deficiência , Cadeiras de Rodas , Austrália , Estudos Transversais , Humanos , PercepçãoRESUMO
OBJECTIVE: To assess the reporting quality of exercise interventions from clinical trials of low back pain (LBP). STUDY DESIGN AND SETTING: We conducted a systematic review to assess the reporting quality of randomised controlled trials (RCTs) that investigated the effectiveness of exercise interventions for patients with LBP. Five online databases and Clinical Trial Registries were searched (October 2018). We included RCTs that reported interventions for LBP, containing at least 50% exercise. The Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) reporting checklists were then used to assess quality of reporting. RESULTS: 582 trials were eligible for inclusion. Due to the large number of eligible studies, 100 studies were randomly selected for data extraction and coding with the TIDieR and CERT checklists. The random sample was representative of the 582 eligible trials. The overall completeness of reporting (median (IQR)) of TIDieR items was 59.2% (45.5%-72.7%) and CERT was 33.3% (22.2%-52.6%). CONCLUSIONS: We found poor overall reporting with both checklists, which has not improved over time or since the introduction of the checklists. More dedicated work is required to address poor reporting of exercise interventions in clinical trials.
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Pesquisa Biomédica/normas , Ensaios Clínicos como Assunto/normas , Confiabilidade dos Dados , Terapia por Exercício/métodos , Dor Lombar/terapia , Projetos de Pesquisa/normas , Relatório de Pesquisa/normas , Adulto , Pesquisa Biomédica/estatística & dados numéricos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa/estatística & dados numéricosRESUMO
BACKGROUND: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. METHODS: Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective. RESULTS: Mean total costs were lower in the intervention group than the control group (-$614; 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292; 95%CI: -872 to -33), medication costs (-$30; 95%CI: -65 to -4) and absenteeism costs (-$1,000; 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. CONCLUSIONS: The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings. SIGNIFICANCE: This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.
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Exercício Físico , Custos de Cuidados de Saúde , Estilo de Vida Saudável , Dor Lombar/terapia , Adulto , Índice de Massa Corporal , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/terapia , Anos de Vida Ajustados por Qualidade de Vida , Encaminhamento e Consulta , TelefoneRESUMO
We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain (>3 months in duration) and body mass index ≥27 kg/m and <40 kg/m were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval -8.0 to 21.0; P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.
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Estilo de Vida Saudável/fisiologia , Dor Lombar/psicologia , Dor Lombar/reabilitação , Encaminhamento e Consulta , Comportamento de Redução do Risco , Adulto , Idoso , Área Sob a Curva , Dor Crônica/reabilitação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , TelefoneRESUMO
INTRODUCTION: Low back pain (LBP) and knee osteoarthritis (OA) are highly prevalent and disabling conditions that cause societal and economic impact worldwide. Two randomised controlled trials (RCTs) will evaluate the effectiveness of a multicomponent lifestyle intervention for patients with LBP and knee OA who are overweight or obese. The key targets of this intervention are to improve physical activity, modify diet and correct pain beliefs. These factors may explain how a lifestyle intervention exerts its effects on key patient-relevant outcomes: pain, disability and quality of life. The aim of this protocol is to describe a planned analysis of a mechanism evaluation for a lifestyle intervention for overweight or obese patients with LBP and knee OA. METHODS AND ANALYSIS: Causal mediation analyses of 2 two-armed RCTs. Both trials are part of a cohort-multiple RCT, embedded in routine health service delivery. In each respective trial, 160 patients with LBP and 120 patients with knee OA waiting for orthopaedic consultation will be randomised to a lifestyle intervention, or to remain part of the original cohort. The intervention consists of education and advice about the benefits of weight loss and physical activity, and the Australian New South Wales Get Healthy Service. All outcome measures including patient characteristics, primary and alternative mediators, outcomes, and potential confounders will be measured at baseline (T0). The primary mediator, weight, will be measured at 6 months post randomisation; alternative mediators including diet, physical activity and pain beliefs will be measured at 6 weeks post randomisation. All outcomes (pain, disability and quality of life) will be measured at 6 months post randomisation. Data will be analysed using causal mediation analysis with sensitivity analyses for sequential ignorability. All mediation models were specified a priori before completing data collection and without prior knowledge about the effectiveness of the intervention. ETHICS AND DISSEMINATION: The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015-0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: ACTRN12615000490572 and ACTRN12615000478516; Pre-results.
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Estilo de Vida , Dor Lombar/reabilitação , Obesidade/reabilitação , Osteoartrite do Joelho/reabilitação , Sobrepeso/reabilitação , Comportamento de Redução do Risco , Protocolos Clínicos , Estudos de Coortes , Terapia por Exercício , Humanos , Dor Musculoesquelética/reabilitação , New South Wales , Obesidade/complicações , Sobrepeso/complicações , Qualidade de Vida , Encaminhamento e ConsultaRESUMO
INTRODUCTION: Knee osteoarthritis (OA) is one of the most common chronic diseases worldwide and is associated with significant pain and disability. Clinical practice guidelines consistently recommend weight management as a core aspect of care for overweight and obese patients with knee OA; however, provision of such care is suboptimal. Telephone-based interventions offer a novel approach to delivery of weight management care in these patients. The aim of the proposed study is to assess the effectiveness of referral to a telephone-based weight management and healthy lifestyle programme, previously shown to be effective in changing weight, in improving knee pain intensity in overweight or obese patients with knee OA, compared to usual care. METHODS AND ANALYSIS: A parallel, randomised controlled trial will be undertaken. Patients with OA of the knee who are waiting for an outpatient orthopaedic consultation at a tertiary referral public hospital within New South Wales, Australia, will be allocated to either an intervention or a control group (1:1 ratio). After baseline data collection, patients in the intervention group will receive a 6-month telephone-based intervention, and patients in the control group will continue with usual care. Surveys will be conducted at baseline, 6 and 26 weeks post-randomisation. The study requires 60 participants per group to detect a two-point difference in pain intensity (primary outcome) 26 weeks after baseline. ETHICS AND DISSEMINATION: The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015-0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: ACTRN12615000490572, Pre-results.
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Obesidade/prevenção & controle , Osteoartrite do Joelho/terapia , Encaminhamento e Consulta , Programas de Redução de Peso , Adulto , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Telefone , Resultado do TratamentoRESUMO
OBJECTIVES: To identify prognostic forms of clinical prediction rules (CPRs) related to the nonsurgical management of adults with low back pain (LBP) and to evaluate their current stage of development. STUDY DESIGN AND SETTING: Systematic review using a sensitive search strategy across seven databases with hand searching and citation tracking. RESULTS: A total of 10,005 records were screened for eligibility with 35 studies included in the review. The included studies report on the development of 30 prognostic LBP CPRs. Most of the identified CPRs are in their initial phase of development. Three CPRs were found to have undergone validation--the Cassandra rule for predicting long-term significant functional limitations and the five-item and two-item Flynn manipulation CPRs for predicting a favorable functional prognosis in patients being treated with lumbopelvic manipulation. No studies were identified that investigated whether the implementation of a CPR resulted in beneficial patient outcomes or improved resource efficiencies. CONCLUSION: Most of the identified prognostic CPRs for LBP are in the initial phase of development and are consequently not recommended for direct application in clinical practice at this time. The body of evidence provides emergent confidence in the limited predictive performance of the Cassandra rule and the five-item Flynn manipulation CPR in comparable clinical settings and patient populations.
Assuntos
Técnicas de Apoio para a Decisão , Dor Lombar/terapia , Adulto , Bases de Dados Factuais , Necessidades e Demandas de Serviços de Saúde , Humanos , Prognóstico , Reprodutibilidade dos Testes , Perfil de Impacto da DoençaRESUMO
STUDY DESIGN: Systematic review. OBJECTIVES: To identify diagnostic clinical prediction rules (CPRs) for low back pain (LBP) and to assess their readiness for clinical application. BACKGROUND: Significant research has been invested into the development of CPRs that may assist in the meaningful subgrouping of patients with LBP. To date, very little is known about diagnostic forms of CPRs for LBP, which relate to the present status or classification of an individual, and whether they have been developed sufficiently to enable their application in clinical practice. METHODS: A sensitive electronic search strategy using 7 databases was combined with hand searching and citation tracking to identify eligible studies. Two independent reviewers identified relevant studies for inclusion using a 2-stage selection process. The quality appraisal of included studies was conducted by 2 independent raters using the Quality Assessment of Diagnostic Accuracy Studies-2 and checklists composed of accepted methodological standards for the development of CPRs. RESULTS: Of 10 014 studies screened for eligibility, the search identified that 13 diagnostic CPRs for LBP have been derived. Among those, 1 tool for identifying lumbar spinal stenosis and 2 tools for identifying inflammatory back pain have undergone validation. No impact analysis studies were identified. CONCLUSION: Most diagnostic CPRs for LBP are in their initial development phase and cannot be recommended for use in clinical practice at this time. Validation and impact analysis of the diagnostic CPRs identified in this review are warranted, particularly for those tools that meet an identified unmet need of clinicians who manage patients with LBP. LEVEL OF EVIDENCE: Diagnosis, level 2a-.
Assuntos
Técnicas de Apoio para a Decisão , Dor Lombar/diagnóstico , Humanos , Dor Lombar/etiologia , Prognóstico , Estenose Espinal/diagnóstico , Espondilartrite/diagnósticoRESUMO
OBJECTIVE: To identify the types of clinical prediction rules (CPRs) for low back pain (LBP) that Australian physiotherapists wish to see developed and the characteristics of LBP CPRs that physiotherapists believe are important. DESIGN: Qualitative study using semi-structured focus groups. SETTING: Metropolitan and regional areas of New South Wales, Australia. PARTICIPANTS: Twenty-six physiotherapists who manage patients with LBP (77% male, 81% private practice). RESULTS: Participants welcomed the development of prognostic forms of LBP CPRs. Tools that assist in identifying serious spinal pathology, likely responders to interventions, patients who are likely to experience an adverse outcome, and patients not requiring physiotherapy management were also considered useful. Participants thought that LBP CPRs should be uncomplicated, easy to remember, easy to apply, accurate and precise, and well-supported by research evidence. They should not contain an excessive number of variables, use complicated statistics, or contain variables that have no clear logical relationship to the dependent outcome. It was considered by participants that LBP CPRs need to be compatible with traditional clinical reasoning and decision-making processes, and sufficiently inclusive of a broad range of management approaches and common clinical assessment techniques. CONCLUSION: There were several identified areas of perceived need for LBP CPR development and a range of characteristics such tools need to encompass to be considered clinically meaningful and useful by physiotherapists in this study. Targeting and incorporating the needs and preferences of physiotherapists is likely to result in the development of tools for LBP with the greatest potential to positively impact clinical practice.