Disability reduction following a lumbar stabilization exercise program for low back pain: large vs. small improvement subgroup analyses of physical and psychological variables.

BACKGROUND: Little is known about why patients with low back pain (LBP) respond differently to treatment, and more specifically, to a lumbar stabilization exercise program. As a first step toward answering this question, the present study evaluates how subgroups of patients who demonstrate large and small clinical improvements differ in terms of physical and psychological changes during treatment. METHODS: Participants (n = 110) performed the exercise program (clinical sessions and home exercises) over eight weeks, with 100 retained at six-month follow-up. Physical measures (lumbar segmental instability, motor control impairments, range of motion, trunk muscle endurance and physical performance tests) were collected twice (baseline, end of treatment), while psychological measures (fear-avoidance beliefs, pain catastrophizing, psychological distress, illness perceptions, outcome expectations) were collected at four time points (baseline, mid-treatment, end of treatment, follow-up). The participants were divided into three subgroups (large, moderate and small clinical improvements) based on the change of perceived disability scores. ANOVA for repeated measure compared well-contrasted subgroups (large vs. small improvement) at different times to test for SUBGROUP × TIME interactions. RESULTS: Statistically significant interactions were observed for several physical and psychological measures. In all these interactions, the large- and small-improvement subgroups were equivalent at baseline, but the large-improvement subgroup showed more improvements over time compared to the small-improvement subgroup. For psychological measures only (fear-avoidance beliefs, pain catastrophizing, illness perceptions), between-group differences reached moderate to strong effect sizes, at the end of treatment and follow-up. CONCLUSIONS: The large-improvement subgroup showed more improvement than the small-improvement subgroup with regard to physical factors typically targeted by this specific exercise program as well as for psychological factors that are known to influence clinical outcomes.

Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial.

BACKGROUND: Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. METHODS: The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. FINDINGS: Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). CONCLUSION: The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain.

Pelvic floor symptoms and symptom-related quality of life in the mothers of children with cerebral palsy: a pilot cross-sectional study.

Pelvic floor symptoms may occur in women with low back pain due to dysfunction of the spinal stabilization muscles. Low back pain is the most common musculoskeletal problem experienced by the mothers of children with cerebral palsy (CP). Therefore, our aim in this study was to examine pelvic floor symptoms and symptom-related quality of life in the mothers of children with CP. The study included 48 mothers of children with CP (n = 23) or without neurodevelopmental problems (n = 25). The mothers' pelvic floor symptoms and symptom-related quality of life were evaluated with the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). PFDI-20 and PFIQ-7 scores did not differ between the two groups of mothers (p > .05). Additionally, moderately significant positive correlations were found between the age of the child with CP and duration of carrying and the PFDI-20 (r = 0.419, p = .047) and PFIQ-7 (r = 0.427, p = .042) scores. Pelvic floor symptoms and symptom-related quality of life in the mothers of children with CP were similar to those in the mothers of children without neurodevelopmental problems. As the age of the child with CP and duration of carrying increase, the urinary symptoms and urinary and colorectoanal symptoms-related quality of life in their mothers may worsen.

Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study.

BACKGROUND AND PURPOSE: Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP). METHODS: This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used. RESULTS: The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05). DISCUSSION: This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Low back pain patients' experience and expectations: A qualitative study focusing on physiotherapist and physician care.

BACKGROUND: Low back pain (LBP) is a common and disabling musculoskeletal disorder. LBP experiences and expectations can vary from one person to another and influence their clinical outcomes. Despite the existence of numerous evidence-based treatment recommendations, LBP management in primary care remains challenging. This study aims to investigate the experiences and expectations of patients with LPB in primary care settings. METHODS: A qualitative study with an inductive thematic analysis was conducted. Semi-structured interviews were performed using individuals who had experienced LBP in the past year and had consulted a family physician (FP) or a physiotherapist (PT). RESULTS: Ten participants with LBP were interviewed (5 women, 5 men, mean age 49 ± 17). Five themes were identified: (1) I am always upset because I can't do anything; (2) I waited to consult; I thought it would go away; (3) I want to see what is going on with my LBP; (4) I want to see the person that will provide the right treatment; (5) I need support to get over it. Participants consulted when their pain was severe and disabling. They expected an imaging test to explain the cause of their LBP and placed more importance on the imaging test results than the FP's or PT's evaluation. Their opinions on care selection and being listened to were important for the participants. CONCLUSION: This study has highlighted the importance of the patient's point of view in their care. This consideration is important to ensure a comprehensive and collaborative approach with evidence-based practice care.

Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial.

OBJECTIVE: A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up. DESIGN: Single-centre, single-blinded placebo-controlled randomised controlled trial. SETTING: Single-centre study. PARTICIPANTS: Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block (>50% pain reduction after 60 min). INTERVENTIONS: 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups. MAIN OUTCOME MEASURES: Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months. RESULTS: There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints. CONCLUSIONS: Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up. TRIAL REGISTRATION NUMBER: NCT04786145.

Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study.

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.

How and why do people with chronic low back pain modify their physical activity? A mixed-methods survey.

BACKGROUND: This study investigated the impact of Chronic Low Back Pain (CLBP) on individuals' physical activity (PA) behaviours, specifically, how they modify, cease, or continue PA when experiencing CLBP. The primary aim was to explore the relationship between CLBP and PA and how this is influenced in different contexts (e.g., necessity of a task). METHODS: A mixed-methods survey was administered to 220 participants, including self-reported outcomes, and capturing responses to three distinct questions related to PA and CLBP. The data was analysed via a content analysis. RESULTS: The findings revealed that individuals with CLBP are most likely to modify PA in work-related contexts and least likely to cease it in the same setting. Housework emerged as the most common domain for cessation of PA, while work/study activities were predominantly continued. Reasons for these trends were typically task-based rather than health or enjoyment based and influenced by the perceived necessity of the task in question. CONCLUSION: The study highlights the role of occupational and educational settings in individual responses to CLBP. The findings also highlight a gap in public awareness regarding effective CLBP management strategies, emphasising the need for increased education and awareness programs.

Does movement preparation enhance attending to bodily sensations in the back in people with persistent low back pain?

Attention has been proposed to play an important role in persisting pain, with excessive attentional processes towards pain information leading to worse pain outcomes and maladaptive behaviors. Nevertheless, research on somatosensory attending during the anticipation of pain-related movements is still scarce. This study investigated if individuals with chronic and recurrent lower back pain compared to pain-free controls, show enhanced attending to somatosensory information in the back while anticipating back-recruiting movements. 43 healthy control, 33 recurrent (RLBP) and 33 chronic low back (CLBP) pain sufferers were asked to perform back-recruiting movements. Before the movement initiation cue, a task-irrelevant tactile stimulus was administered to participants' lower back to elicit somatosensory evoked potentials (SEPs), used as an index of somatosensory attending. In contrast to our hypothesis, most identified SEP components did not differ across groups. The only exception was the P175 amplitude which was larger for the CLBP group compared to individuals with RLBP and healthy controls. The current study did not find robust evidence of enhanced somatosensory attending to the back in people with persisting lower back pain. The finding that CLBP, but not RLBP individuals, had larger amplitudes to the P175 component, is discussed as possibly reflecting a higher state of emotional arousal in these patients when having to prepare the back-recruiting movements.

The mediating role of depressive symptoms among Turkish population related to gender and low back pain: evidence from a national health survey.

BACKGROUND: Low back pain (LBP), though non-life-threatening, burdens healthcare with treatment expenses and work hours lost. Globally, 70-84% experience it, with risk factors tied to societal structure, income, and living conditions, making it a leading cause of disability. METHODS: This study utilized data from the 2019 Türkiye Health Survey, which consisted of 17,084 individuals aged 15 and above. Our study focused on investigating the factors related to low back pain through a cross-sectional analysis. To analyze these factors, we employed binary multivariate logistic regression. Additionally, we conducted post-hoc analyses to assess the potential mediating effect of depressive symptoms on the relationship between low back pain and gender. RESULTS: We found that 31.9% of the population experienced low back pain, with women being 58% more likely [aOR = 1.58; 95% CI (1.45-1.73)] than men to report symptoms. Individuals aged 55 + years old had a 90% [aOR = 1.90; 95% CI (1.61-2.23)] chance of experiencing low back pain, indicating an age-related increase. In the general population, having depressive symptoms was 2.49 [95% CI (2.23-2.78)] times more likely associated with low back pain. Our mediation analysis showed that gender (i.e., women vs. men), indicated by direct effects with ß-estimates e = 0.78, predicted the likelihood of low back pain. Additionally, the relationship between gender and low back pain, mediated through a history of depressive symptoms, had a significant total indirect effect (i.e., ß-estimate given as e = 0.49). Specifically, a history of depressive symptoms accounted for 17.86% [95% CI (9.67-20.10)] of the association between women having a higher likelihood of low back pain compared to men. CONCLUSION: We observed that a higher likelihood of low back pain associated with gender and aging. Additionally, BMI served as a significant predictor, particularly in adults. Depression mediated the association between gender and low back pain. Acknowledging these associations may help identify and address contributing factors to LBP, potentially increasing awareness and alleviating the burden. Policymakers and healthcare professionals may consider these findings when developing prevention and treatment programs for low back pain.

Translation, validity and reliability of the pain attitudes and beliefs scale for physiotherapists in French.

BACKGROUND: The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire evaluates manual therapists' biomedical and biopsychosocial beliefs regarding the management of chronic low back pain. Its usage in clinical settings is an important step in the implementation of national guidelines and policies to improve patient management. OBJECTIVES: The objective of this study was to translate the PABS-PT questionnaire into French, to adapt it culturally, and to conduct a psychometric analysis. DESIGN: Qualitative and cross-sectional study. METHOD: The translation process followed published guidelines with cross-cultural validation by an expert committee. We followed a forward and backward translation procedure and an expert committee, including the original author of the questionnaire and a linguistics expert ensuring good cultural adaptation, issued a finalised version. Psychometric analysis of the French version of the questionnaire was conducted among 390 French manual therapists in two phases. The first phase evaluated structural validity as well as external validity compared with the TSK and BBQ questionnaires. Then, reliability and scalability were analysed. The second phase evaluated test-retest reproducibility by sending the same questionnaire 3 months later. RESULTS: The validity study revealed three subscales: the classic biomedical subscale and two subscales for biopsychosocial beliefs (aetiology of pain and physical activity). With 21 items in total for the PABS-PT-FR, the structural validity scores were good (BM: alpha = 0.82, H = 0.38; Physical Activity: alpha = 0.62, H = 0.32; Aetiology of Pain: alpha = 0.55, H = 0.29). CONCLUSIONS: This study provides a validated tool to assess French physiotherapists' and, more generally, healthcare providers' beliefs about chronic low back pain, with a new insight into the BPS subscale internal construct.

Health coaching intervention with or without the support of an exercise buddy to increase physical activity of people with chronic low back pain compared to usual care: a feasibility and pilot randomised controlled trial.

BACKGROUND: Exercise buddies (people to exercise together with) might support people with low back pain (LBP) to become active. However, involving buddies in randomised controlled trials (RCT) might challenge recruitment, data collection and follow-up. OBJECTIVES: To explore the feasibility of the intervention, recruitment and data collection approaches and potential effects of a health coaching intervention (focused on physical activity) with or without exercise buddies' support on physical activity of people with chronic LBP versus usual discharge care. DESIGN: Feasibility and pilot RCT. METHODS: Adults (n = 30) discharged from LBP treatment were randomised to the Buddy-Assisted (health coaching intervention with exercise buddy's support), Individual-Only (health coaching only), or usual care groups. Data were collected at baseline, three and six months. The feasibility of trial's procedures was assessed through recruitment rate (acceptable if >70%), data completion rate (acceptable if ≤ 20% missing data), and follow-up rate (successful if ≥ 85%). The intervention's acceptability was assessed via feedback questionnaires. Preliminary effects on physical activity and other outcomes were also explored. RESULTS: Recruitment and baseline data completion were acceptable. However, data collection and follow-up rates post-randomisation were not. 85% of the Buddy-Assisted Group believed the buddies helped them to increase physical activity and would recommend the intervention. 70% of the Individual-Only and Control groups believed exercise buddies would help them to become further active. CONCLUSION: The data collection and follow-up approaches were not successful and need amending before a large-scale RCT. Nonetheless, the buddy-assisted intervention was well-accepted. A future RCT will focus on differences in clinical outcomes. TRIAL REGISTRATION: The study was registered at the Australian New Zealand Clinical Trial Registry (ACTRN12620001118998).

An exploration of low back pain beliefs held by health care professionals in Northern America.

BACKGROUND: Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. METHODS: Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. RESULTS: One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. CONCLUSIONS: These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.

Subgroup characteristics in care workers with low back pain: cluster analysis-based severity of central sensitivity syndromes and low back pain.

PURPOSE: This multicentre, collaborative, cross-sectional study aimed to explore the characteristics of subgroups based on central sensitivity syndromes (CSSs) and low back pain (LBP) severity. Furthermore, we investigated the relationship between the classified subgroups and work status among the care workers. PATIENTS AND METHODS: In 660 care workers, we assessed LBP intensity, pain duration, pain sites, CSS (using the central sensitization inventory-9), psychological factors (using the pain catastrophizing scale and pain self-efficacy questionnaire), and work status (interference, amount of assistance, frequency of assistance, and work environment). We used hierarchical clustering analysis to divide the participants into subgroups based on CSS and LBP severity. We further performed multiple comparison analyzes and adjusted the residuals (chi-square test) to reveal differences between clusters. RESULTS: Care workers with LBP were divided into four subgroups (Cluster 1: no CSS and mild LBP, Cluster 2: mild CSS and severe LBP, Cluster 3: mild CSS and mild LBP, Cluster 4: severe CSS and moderate LBP). Cluster 4 tended to have a higher number of pain sites, severe pain catastrophizing, and poor pain self-efficacy. In addition, Cluster 4 showed a higher frequency of assistance and an inadequate working environment and equipment. By contrast, Cluster 2 tended to have low pain self-efficacy. In addition, Cluster 2 experienced the highest work-related interference compared with any of the subgroups. CONCLUSION: Our findings suggested that the severe LBP and severe CSS subgroups had common and different characteristics concerning psychological factors and work status, including interference with work. Our results may help to improve the management of care workers with LBP.

Conditioned pain modulation, kinesiophobia, and pain catastrophizing as prognostic factors for chronicity in a population with acute low back pain: An exploratory prospective study.

BACKGROUND: Psychosocial factors and alteration of the somatosensory functions have been associated with persistent low back pain (LBP). A decreased capacity of the central nervous system to modulate pain has been suggested as a potential contributor to the persistence of pain. OBJECTIVE: To investigate whether conditioned pain modulation (CPM), initial symptoms/disability, kinesiophobia, and pain catastrophizing is associated with the transition from acute to chronic LBP. DESIGN: Prospective cohort study. METHOD: Fifty participants presenting with acute LBP (<6 weeks) took part in three evaluation sessions (baseline, 3 and 6 months). At baseline and 3-month evaluations, all participants completed self-administered questionnaires (Oswestry Disability Index [ODI], Short Form of Brief Pain Inventory [BPI-SF], Tampa Scale of Kinesiophobia [TSK] and Pain Catastrophizing Scale [PCS]) and CPM was assessed. At the 6-month evaluation, questionnaires were readministered, and participants were dichotomized according to their status (Non-chronic LBP [NCLBP] or chronic LBP [CLBP]). Univariate tests were used to compare baseline variables between NCLBP and CLBP. RESULTS: No significant baseline difference was found for TSK (p = 0.48), PCS (p = 0.78), CPM (p = 0.82), ODI (p = 0.78), BPI-SF severity (p = 0.50), and interference subscales (p = 0.54) between those categorized as NCLBP or CLBP at 6 months. CONCLUSIONS: This exploratory study failed to support the hypothesis that inefficient CPM mechanisms and the presence of psychological factors could be factors associated with the transition to chronic pain in individuals with acute LBP.

A content analysis of the interventions for low back pain promoted on the websites of Australian pain clinics.

BACKGROUND: The Internet is a widely used source of health information, yet the accuracy of online information can be low. This is the case for low back pain (LBP), where much of the information about LBP treatment is poor. METHODS: This research conducted a content analysis to explore what pain treatments for LBP are presented to the public on websites of Australian pain clinics listed in the PainAustralia National Pain Services Directory. Websites providing information relevant to the treatment of LBP were included. Details of the treatments for LBP offered by each pain service were extracted. RESULTS: In total, 173 pain services were included, with these services linking to 100 unique websites. Services were predominantly under private ownership and located in urban areas, with limited services in non-urban locations. Websites provided detail on a median of six (IQR 3-8) treatments, with detail on a higher number of treatments provided by services in the private sector. Physical, psychological and educational treatments were offered by the majority of pain services, whereas surgical and workplace-focused treatments were offered by relatively few services. Most services provided details on multidisciplinary care; however, interdisciplinary, coordinated care characterised by case-conferencing was infrequently mentioned. CONCLUSIONS: Most websites provided details on treatments that were largely in-line with recommended care for LBP, but some were not, especially in private clinics. However, whether the information provided online is a true reflection of the services offered in clinics remains to be investigated.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis.

OBJECTIVE: To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. DESIGN: A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. METHODS: Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. RESULTS: Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. CONCLUSION: This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

The use of a biopsychosocial model in the treatment of patients with chronic.

OBJECTIVE: To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). METHODS: A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. RESULTS: According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. CONCLUSION: BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. PRACTICE IMPLICATION: Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research.

Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response.

Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.