How do non-specific back pain patients think about their adherence to physiotherapy, and what strategies do physiotherapists use to facilitate adherence? A focus group interview study.

BACKGROUND: Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT. METHOD: Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded. RESULTS: Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives. CONCLUSION: Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.

Strategies to facilitate and tools to measure non-specific low back pain patients' adherence to physiotherapy - A two-stage systematic review.

BACKGROUND: Sustainable management for non-specific low back pain relies on adherence. This requires effective strategies to facilitate but also tools to measure adherence to physiotherapy. OBJECTIVE: This two-stage systematic review aims to identify (1) tools to measure non-specific back pain patients' adherence to physiotherapy and (2) the most effective strategy to facilitate patients' adherence to physiotherapy. METHOD: PubMed, Cochrane, PEDro, and Web of Science were searched for English language studies measuring adherence in adults with low back pain. Following PRISMA recommendations, scoping review methods were used to identify measurement tools (stage 1). The effectiveness of interventions (stage 2), followed a predefined systematic search strategy. Two independent reviewers selected eligible studies (software Rayyan), analyzed these for risk of bias using the Downs and Black checklist. Data relevant to assess adherence were collected in a predesigned data extraction table. Results were heterogeneous and hence summarized narratively. RESULTS: Twenty-one studies were included for stage 1 and 16 for stage 2. Identified were 6 different tools to measure adherence. The most used tool was an exercise diary; the most common more multidimensional tool was the Sports Injury Rehabilitation Adherence Scale. Most included studies were not designed to improve or measure adherence but used adherence as a secondary outcome for new exercise programs. The most promising strategies for facilitating adherence were based on cognitive behavioral principles. CONCLUSION: Future studies should focus on the development of multidimensional strategies to facilitate adherence to physiotherapy and appropriate tools to measure all aspects of adherence.

Sensorimotor and body perception assessments of nonspecific chronic low back pain: a cross-sectional study.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal disorders, causing significant personal and social burden. Current research is focused on the processes of the central nervous system (particularly the sensorimotor system) and body perception, with a view to developing new and more efficient ways to treat chronic low back pain (CLBP). Several clinical tests have been suggested that might have the ability to detect alterations in the sensorimotor system. These include back-photo assessment (BPA), two-point discrimination (TPD), and the movement control tests (MCT). The aim of this study was to determine whether the simple clinical tests of BPA, TPD or MCT are able to discriminate between nonspecific CLBP subjects with altered body perception and healthy controls. METHODS: A cross-sectional study was conducted. At one point in time, 30 subjects with CLBP and 30 healthy controls were investigated through using BPA, TPD and MCT on the lower back. Correlations among the main covariates and odds ratios for group differences were calculated. RESULTS: MCT showed an odds ratio for the presence of CLBP of 1.92, with a statistically significant p-value (0.049) and 95%CI. The TPD and BPA tests were unable to determine significant differences between the groups. CONCLUSIONS: Of the three tests investigated, MCT was found to be the only suitable assessment to discriminate between nonspecific CLBP subjects and healthy controls. The MCT can be recommended as a simple clinical tool to detect alterations in the sensorimotor system of nonspecific CLBP subjects. This could facilitate the development of tailored management strategies for this challenging LBP subgroup. However, further research is necessary to elucidate the potential of all the tests to detect alterations in the sensorimotor system of CLBP subjects. TRIAL REGISTRATION: No trial registration was needed as the study contains no intervention. The study was approved by the Swiss Ethics Commission of Northwest and Central Switzerland (EKNZ) reference number 2015-243.

Intertester and intratester reliability of a movement control test battery for patients with knee osteoarthritis and controls.

OBJECTIVES: To develop a test battery of movement control (MC) tests and assess its intertester and intratester reliability. METHODS: 29 subjects with knee OA with mean age of 64.7 (SD 8.7) years and 12 controls without either knee pain or previous diagnosis of OA (mean age 36.6 (SD 16.2) years) were included. Two experienced physiotherapists rated the filmed test performance of six MC tests blinded to the patients and to each other on 3-point scale as correct, incorrect or failed. Weighted kappa coefficient (wK) with 95% confidence interval (95%CI) and the percentage of agreement were calculated for each test. RESULTS: One-leg stance, one-leg squat 30 degrees and step down tests showed moderate to excellent inter- and intratester reliability with wK ranging between 0.43-0.85 for intertester and 0.51-0.80 for intratester reliability. The reliability of the 90 degrees squat test, small squat and step up tests was poor (wK ranging between 0.09-0.50). CONCLUSIONS: One-leg stance test, one-leg squat 30 degrees and step down test are reliable in the subjects with knee OA and controls. Further studies are needed to evaluate the discriminative validity of the reliable tests.

[Two-point discrimination for phantom pain: effect of a 4-week therapy in an upper arm amputee with phantom pain]. / Zweipunktediskrimination bei Phantomschmerzen: Effekt einer 4-wöchigen Therapie bei einem oberarmamputierten Patienten mit Phantomschmerzen.

There is evidence that phantom pain is associated with a disrupted organization of the sensory cortex and that this organization can be normalized by training with two-point discrimination (TPD). In this case study a reduction in all three phantom modalities (i.e. phantom pain, phantom feeling and painful phantom sensation) and a reduction in pain level from m= 4.13/10 visual analogue scale (VAS) to m= 0.67/10 (VAS) could be observed in a patient with an upper limb amputation during a test period of 28 days with TPD. The quality of life and performance increased significantly. This can be a promising indication for a better social and work reintegration.

Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls.

BACKGROUND: Voluntary lumbopelvic control is compromised in patients with back pain. Loss of proprioceptive acuity is one contributor to decreased control. Several reasons for decreased proprioceptive acuity have been proposed, but the integrity of cortical body maps has been overlooked. We investigated whether tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to lumbopelvic control in people with back pain. METHODS: Forty-five patients with back pain and 45 age- and sex-matched healthy controls participated in this cross-sectional study. Tactile acuity at the back was assessed using two-point discrimination (TPD) threshold in vertical and horizontal directions. Voluntary motor control was assessed using an established battery of clinical tests. RESULTS: Patients performed worse on the voluntary lumbopelvic tasks than healthy controls did (p<0.001). TPD threshold was larger in patients (mean (SD)=61 (13) mm) than in healthy controls (44 (10) mm). Moreover, larger TPD threshold was positively related to worse performance on the voluntary lumbopelvic tasks (Pearson's r=0.49; p<0.001). DISCUSSION: Tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to voluntary lumbopelvic control. This relationship raises the possibility that the former contributes to the latter, in which case training tactile acuity may aid recovery and assist in achieving normal motor performance after back injury.