The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis.

BACKGROUND: Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. METHODS: To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. RESULTS: We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. INTERPRETATION: Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. PROTOCOL REGISTRATION: PROSPERO - CRD42020207442.

Workplace sense of belonging and paramedic wellbeing using network analysis: A cross-sectional study.

BACKGROUND: Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing. METHODS: Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being-identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics. RESULTS: The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing. CONCLUSIONS: These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace.

The 'Feline Five': An exploration of personality in pet cats (Felis catus).

The idea of animals possessing personalities was once dismissed by the scientific community, but has since gained traction with evidence for potential application to improve captive animal management and welfare. Although domestic cats are popular companion animals, research has tended to overlook the value of personality assessment for management and care of pet cats. The aim of this study was to investigate personality in a large sample of pet cats with a view to understanding practical implications for pet cats in the home. Personality of 2,802 pet cats, from South Australia and New Zealand, was rated by their owners utilising a survey measuring 52 personality traits. Five reliable personality factors were found using principal axis factor analysis: Neuroticism, Extraversion, Dominance, Impulsiveness and Agreeableness. Implications for the 'Feline Five' are discussed in relation to their potential application to improving the management and welfare of pet cats. Highly Impulsive cats for example, may be reacting to something stressful in their environment, whereas cats with low Agreeableness scores, showing irritability may indicate underlying pain or illness. Thus, the need for a systematic and holistic approach to personality that includes both the individual pet cat and its environment is recommended, and opens the door to future interdisciplinary intervention.