The association between psychosocial factors and mental health symptoms in cervical spine pain with or without radiculopathy on health outcomes: a systematic review.

BACKGROUND: Neck pain, with or without radiculopathy, can have significant negative effects on physical and mental wellbeing. Mental health symptoms are known to worsen prognosis across a range of musculoskeletal conditions. Understanding the association between mental health symptoms and health outcomes in this population has not been established. Our aim was to systematically review the association between psychosocial factors and/or mental health symptoms on health outcomes in adults with neck pain, with or without radiculopathy. METHODS: A systematic review of published and unpublished literature databases was completed. Studies reporting mental health symptoms and health outcomes in adults with neck pain with or without radiculopathy were included. Due to significant clinical heterogeneity, a narrative synthesis was completed. Each outcome was assessed using GRADE. RESULTS: Twenty-three studies were included (N = 21,968 participants). Sixteen studies assessed neck pain only (N = 17,604 participants); seven studies assessed neck pain with radiculopathy (N = 4,364 participants). Depressive symptoms were associated with poorer health outcomes in people with neck pain and neck pain with radiculopathy. These findings were from seven low-quality studies, and an additional six studies reported no association. Low-quality evidence reported that distress and anxiety symptoms were associated with poorer health outcomes in people with neck pain and radiculopathy and very low-quality evidence showed this in people with neck pain only. Stress and higher job strain were negatively associated with poorer health outcomes measured by the presence of pain in two studies of very low quality. CONCLUSIONS: Across a small number of highly heterogenous, low quality studies mental health symptoms are negatively associated with health outcomes in people with neck pain with radiculopathy and neck pain without radiculopathy. Clinicians should continue to utilise robust clinical reasoning when assessing the complex factors impacting a person's presentation with neck pain with or without radiculopathy. PROSPERO REGISTRATION NUMBER: CRD42020169497.

"Living more and struggling less": a qualitative descriptive study of patient experiences of physiotherapy informed by Acceptance and Commitment Therapy within a multidisciplinary pain management programme.

OBJECTIVES: Physiotherapists increasingly deliver treatment informed by cognitive-behavioural therapy, including Acceptance and Commitment Therapy (ACT), for persistent pain. This study explored patients' experiences of ACT-informed physiotherapy to better understand therapeutic processes and outcomes. DESIGN: A qualitative descriptive study was conducted. Focus groups explored participants' experience of ACT-informed physiotherapy in the context of a pain management programme. Responses were audio recorded, transcribed verbatim, and analysed using a hybrid inductive-deductive reflexive thematic analysis. SETTING: A single tertiary care pain management service. PARTICIPANTS: The sample consisted of fifteen patients from two treatment groups who completed an intensive multidisciplinary ACT-based pain management programme. Participants were included irrespective of their treatment response. RESULTS: One overarching theme (living more and struggling less) and four interconnected themes were generated from the data: 1) awareness and openness help to approach physical activities flexibly; 2) from battling against to working with the body compassionately; 3) from narrow focus to curiosity, freedom, and expansion; and 4) social connection is a catalyst for openness and engagement. CONCLUSIONS: Participants experienced ACT-informed physiotherapy as helping them to live more and struggle less with pain; this occurred in the context of a psychologically flexible relationship with the physiotherapist and was catalysed by social connection. These findings should be seen as preliminary given the small number and relatively brief duration of focus groups conducted. Further research is needed to explore how principles within ACT-informed physiotherapy may support patients and clinicians to respond effectively to the challenges that persistent pain can bring.

Association between psychosocial factors and mental health symptoms to cervical spine pain with or without radiculopathy on health outcomes: systematic review protocol.

INTRODUCTION: Cervical spine pain with or without radiculopathy (CSp ± R) has significant negative impacts to a person's quality of life. Psychosocial factors and/or mental health symptoms are associated with spinal pain with or without radiculopathy and negatively impact health outcomes. This area of research is not yet established for CSp ± R. Our objective is to conduct a systematic review assessing the association between psychosocial factors and/or mental health symptoms and health outcomes in adults with CSp ± R. METHODS: A systematic electronic search of 3 online databases will retrieve studies in which adults (older than 18 years) with CSp ± R, assessing how psychosocial factors or mental health symptoms impact outcomes related to disability, pain, and/or healthcare utilisation. Data extracted will include study design, CSp ± R definition, psychosocial and/or mental health symptoms, and health outcomes. Reporting study quality through the Newcastle-Ottawa Quality Scale Assessment and certainty through Grading of Recommendations, Assessment, Development and Evaluations will be completed. Studies will be assessed from a clinical perspective, methodology design, and statistical testing to determine whether studies can be pooled for meta-analysis. If there is significant clinical heterogeneity, narrative description will be undertaken. PERSPECTIVE: This will be a comprehensive synthesis review to enhance understanding of the association of psychosocial factors and/or mental health symptoms and CSp ± R on health outcomes. The findings will support the formulation of prognosis, collaborative management decisions, and guide healthcare resources to improve outcomes for this patient group. The review will identify gaps in research, thereby informing future experimental and observational study design.

Cervical spine radiculopathy epidemiology: A systematic review.

BACKGROUND AND OBJECTIVE: Cervical spine radiculopathy (CSR) is a disabling condition that has significant negative impacts on a person's mental health, physical functioning and social participation. Research has reported variable CSR incidence and prevalence among different populations. To date, no systematic review has been completed investigating the prevalence or incidence of CSR; therefore, our objective was to determine the incidence and/or prevalence of CSR in adults. DESIGN AND METHOD: A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE and CINAHL from inception to February 25, 2020. Studies including data on incidence and/or prevalence of CSR were included. Methodological quality was assessed using a modified Hayden, Cote and Bombardier appraisal checklist. Data were analysed narratively. RESULTS: Nine low- to high-quality studies were included in the final review. Incidence ranged between 0.832 and 1.79 per 1,000 person-years from two high-quality and one low-quality study. Prevalence values ranged from 1.21 to 5.8 per 1,000 from four medium- to high-quality studies. Prevalence values of 1.14% [95% confidence interval (CI): 0.45-1.82] and 1.31% (95% CI: 0.66-1.96) for males and females, respectively, were reported from one medium-quality study. One medium-quality study reported an unadjusted prevalence value of 6.3% for males and females. CONCLUSIONS: This is the first systematic review investigating the epidemiology of CSR in an adult population. This review reports a variable incidence rate and prevalence of CSR among specific populations; however, this was based on nine studies. There is a priority to investigate CSR epidemiology across other populations globally and standardising CSR diagnostic criteria.

Factors associated with physical activity participation in adults with chronic cervical spine pain: a systematic review.

OBJECTIVE: To determine the factors associated with physical activity participation in adults with chronic cervical spine pain. METHODS: A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE and CINAHL from inception to June 12th, 2016. Grey literature and reference checking was also undertaken. Quantitative studies including factors related to physical activity participation in adults with chronic cervical spine pain were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment. RESULTS: A total of seven studies met the selection criteria, however, four papers were finally included in the final review. A modified Downs and Black criteria was used to assess methodological quality, each study included was classed as moderate quality. A total of six factors were assessed against physical activity participation for people with chronic neck pain. These included: pain, fear of movement, smoking habits, socioeconomic status, gender, leisure and work time habits. A significant relationship was demonstrated between pain, leisure and work time habits and physical activity. Subjects were less likely to participate in physical activity if they were in pain. Subjects with neck pain were less likely to participate in physical activity in their leisure and work time. CONCLUSION: This review, based on a small number of heterogeneous studies demonstrated key factors that are likely to affect physical activity in people with chronic neck pain, most notably, pain levels, leisure and work habits. This review suggests that more in-depth, high quality studies are required to fully understand the impact of chronic pain on physical activity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42015027970.