ORCID Profile
0000-0002-8544-0448
Current Organisations
Macquarie University
,
University of Sydney
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Publisher: JMIR Publications Inc.
Date: 10-01-2019
Abstract: ow back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated. his study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites. e conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website). e included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations. oncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP.
Publisher: BMJ
Date: 23-09-2017
Publisher: Wiley
Date: 27-10-2015
DOI: 10.1002/ACR.22619
Abstract: To investigate the contribution of symptoms of depression to future episodes of low back pain (LBP). A search was conducted of AMED, CINAHL, Embase, Health and Society (H&S), LILACS, MEDLINE, PsycINFO, Scopus, and Web of Science databases. We included cohort studies investigating the effect of symptoms of depression on the development of new episodes of LBP, either lifetime incidence or a recurrent episode, in a population free of LBP at baseline. We accepted the original study's definition for a new episode of LBP, and for classifying patients as LBP-free at study entry. Two independent investigators extracted data and assessed methodological quality. Meta-analyses with random effects were used to pool risk estimates. We included 19 studies, with 11 incorporated in the meta-analyses. Overall pooled results showed that symptoms of depression increased the risk of developing LBP (odds ratio [OR] 1.59, 95% confidence interval [95% CI] 1.26-2.01). The risk was similar in studies that used the diagnostic interview method (OR 1.66, 95% CI 1.14-2.42) and in studies using self-report screening questionnaires (OR 1.68, 95% CI 1.05-2.70). No statistically significant relationship was observed when we pooled studies that employed nonspecific screening questionnaires (OR 1.17, 95% CI 0.48-2.87). Three studies provided results in incremental categories of symptoms of depression and the pooled OR for the most severe level of depression (OR 2.51, 95% CI 1.58-3.99) was higher than for the lowest level (OR 1.51, 95% CI 0.89-2.56). In iduals with symptoms of depression have an increased risk of developing an episode of LBP in the future, with the risk being higher in patients with more severe levels of depression.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BERH.2017.04.002
Abstract: Guidelines for low back pain (LBP) often recommend the use of self-management such as unsupervised exercise, booklets, and online education. Another potentially useful way for patients to self-manage LBP is by using smartphone applications (apps). However, to date, there has been no rigorous evaluation of LBP apps and no guidance for consumers on how to select high-quality, evidence-based apps. This chapter reviews smartphone apps for the self-management of LBP and evaluates their content quality and whether they recommend evidence-based interventions. This chapter shows that generally app developers are selecting interventions that are endorsed by guidelines, although their quality is low. There are many apps available for the self-management of LBP, but their effectiveness in improving patient outcomes has not been rigorously assessed. App developers need to work closely with healthcare professionals, researchers, and patients to ensure app content is accurate, evidence based, and engaging.
Publisher: Wiley
Date: 22-02-2021
Abstract: To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales. We sourced data from the New South Wales Emergency Department Records for Epidemiology. We included all ED presentations aged 15 years and older with a diagnosis of LBP to the 178 public EDs across New South Wales from 1 January 2016 to 31 December 2019. We calculated the ratio (95% confidence interval) between the 2016 and 2019 age‐standardised rates to determine whether an increase in the rate of ED LBP presentations has occurred. To assess geographical variation, we aggregated presentations by their home postcode. We calculated age‐standardised rates per 100 000 person year for each of those areas using data from 2016 to 2019. We included 188 275 LBP presentations for patients aged 15 years or older. Their mean (standard deviation) age was 51.3 (20.0) years. From 2016 to 2019, we observed a 5.3% increase in the age‐adjusted LBP ED presentation rates (age‐standardised ratio 1.05, 95% confidence interval 1.04–1.06). We found a 20‐fold variation in LBP ED age‐standardised presentation rates across the different local government areas of New South Wales. Higher rates were mostly observed in rural and regional areas. The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20‐fold variation in presentation rates across different regions.
Publisher: BMJ
Date: 03-04-2023
Publisher: JMIR Publications Inc.
Date: 20-06-2023
Abstract: bjectives: Low back pain (LBP) was the 5th most common reason for an Emergency Department (ED) visit in 2020–21 in Australia, with ,000 presentations 1/3 of these patients were subsequently admitted to hospital. Admitted patient care accounts for half of the total healthcare expenditure on low back pain in Australia. The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, re-presentations and readmissions to the traditional hospital, demonstrate non-inferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. Methods and analysis: This is a hybrid effectiveness-implementation type-I feasibility study. To evaluate effectiveness, we plan to conduct an interrupted time series study at three metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged ≥16 years with a primary diagnosis of musculoskeletal low back pain presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff ch ions, and an ‘audit and feedback’ process. Implementation of ‘Back@Home’ will be evaluated over 12-months, and compared to a 48-month pre-implementation period, using monthly time-series trends in average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the pre-implementation period. Linear segmented regression will identify changes in level and slope of fitted lines, indicating immediate effects of the intervention, as well as effect over time. Ethics approval has been granted for protocol X21-0278 & 2021/ETH10967. Data will be fully anonymised, with informed consent collected for patient-reported outcomes.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.MATH.2012.10.007
Abstract: Alcohol intake has been widely reported as a risk factor for low back pain (LBP), however, the literature is inconclusive about this association. To determine, in a systematic review, the relationship between alcohol intake and LBP. A search was conducted in CINAHL, LILACS, Medline, National Research Register and Web of Science to identify studies that investigated the association between alcohol intake and LBP. Quantitative results and its estimators were extracted. When possible, meta-analyses were performed using a random effects model. Twenty-six studies were included in this review. Twenty-three studies were retrospective cohorts, two were case-controls, and one employed a longitudinal design. Pooled results from nine studies (two case-controls and seven retrospective cohorts) showed that alcohol consumption is slightly associated with LBP (OR: 1.3 95% CI: 1.1-1.5). This association appears to be present in studies investigating alcohol as an abuse dependence substance in chronic LBP. Remaining in idual studies tended to report no statistical significant association. No dose-response relationship was identified. Only one longitudinal study was identified and even though alcohol consumption was found to be negatively associated with a future episode of LBP (OR: 0.7 95% CI: 0.5-0.9) this association lost significance for future incidence of LBP in people with no LBP at baseline. Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence. Clinicians in the musculoskeletal field could use this information to design educational strategies for this population.
Publisher: BMJ
Date: 09-10-2020
DOI: 10.1136/EMERMED-2020-209588
Abstract: Most low back pain trials have limited applicability to the emergency department (ED) because they provide treatment and measure outcomes after discharge from the ED. We investigated the efficacy and safety of pharmacological and non-pharmacological interventions delivered in the ED to patients with non-specific low back pain and/or sciatica on patient-relevant outcomes measured during the emergency visit. Literature searches were performed in MEDLINE, EMBASE and CINAHL from inception to week 1 February 2020. We included all randomised controlled trials investigating adult patients (≥18 years) with non-specific low back pain and/or sciatica presenting to ED. The primary outcome of interest was pain intensity. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias of each trial using the Physiotherapy Evidence Database (PEDro) scale. The overall quality of evidence, or certainty, provided by a set of trials evaluating the same treatment was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers imprecision, inconsistency, indirectness and bias in the evidence. Fifteen trials (1802 participants) were included with 12 of 15 at low risk of bias (ie, PEDro score ). Based on results from in idual trials and moderate quality evidence, ketoprofen gel was more effective than placebo for non-specific low back pain at 30 min (mean difference (MD) −15.0, 95% confidence interval (CI) −21.0 to −9.0). For those with sciatica (moderate quality evidence), intravenous paracetamol (acetaminophen) (MD −15.7, 95% CI −19.8 to −11.6) and intravenous morphine (MD −11.4, 95% CI −21.6 to −1.2) were both superior to placebo at 30 min. Based on moderate quality of evidence, corticosteroids showed no benefits against placebo at emergency discharge for non-specific low back pain (MD 9.0, 95% CI −0.71 to 18.7) or sciatica (MD −6.8, 95% CI −24.2 to 10.6). There were conflicting results from trials comparing different pharmacological options (moderate quality evidence) or investigating non-pharmacological treatments (low quality evidence). Ketoprofen gel for non-specific low back pain and intravenous paracetamol or morphine for sciatica were superior to placebo, whereas corticosteroids were ineffective for both conditions. There was conflicting evidence for comparisons of different pharmacological options and those involving non-pharmacological treatments. Additional trials measuring important patient-related outcomes to EDs are needed.
Publisher: Universidade Federal de Sao Paulo
Date: 30-06-2014
Publisher: Oxford University Press (OUP)
Date: 22-06-2017
DOI: 10.1093/PTJ/PZX067
Abstract: Although recurrence is common after an acute episode of low back pain, estimates of recurrence rates vary widely and predictors of recurrence remain largely unknown. The purposes of the study were to determine the 1-year incidence of recurrence in participants who recovered from an acute episode of low back pain and to identify predictors of recurrence. The design was an inception cohort study nested in a case-crossover study. For 12 months, 832 of the 999 participants who initially presented to primary care within the first 7 days of an episode of low back pain were followed. Of these participants, 469 recovered (1 month pain free) from the index episode within 6 weeks and were included in this study. Recurrence was defined as a new episode lasting more than 1 day, or as an episode of care seeking. Putative predictors were assessed at baseline and chosen a priori. Multivariable regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The 1-year incidence of recurrence of low back pain was 33%, and the 1-year incidence of recurrence of low back pain with care seeking was 18%. Participants reporting more than 2 previous episodes of low back pain had increased odds of future recurrences (OR = 3.18, CI = 2.11–4.78). This factor was also associated with recurrent episodes that led to care seeking (OR = 2.87, CI = 1.73–4.78). No other factors were associated with recurrences. There are limitations inherent in reliance on recall. After an acute episode of low back pain, one-third of patients will experience a recurrent episode, and approximately half of those will seek care. Experiencing more than 2 previous episodes of low back pain triples the odds of a recurrence within 1 year.
Publisher: BMJ
Date: 18-08-2014
Publisher: Walter de Gruyter GmbH
Date: 09-03-2019
Abstract: There has been no comprehensive evaluation of the efficacy of transcutaneous electric nerve stimulation (TENS) for acute low back pain (LBP). The aim of this systematic review was to investigate the efficacy and safety of TENS for acute LBP. We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL and PsycINFO (inception to May 2018) for randomised placebo controlled trials. The primary outcome measure was pain relief in the immediate term (within 2-weeks of administration) assessed using the 100 mm visual analogue scale. A mean difference of at least 10 points on the 100-point pain scale was considered clinically significant. Methodological quality of the eligible studies was assessed using the PEDro scale and overall quality assessment rating was assessed using GRADE. Three placebo controlled studies ( n = 192) were included. One low quality trial ( n = 63) provides low quality evidence that ~30 min treatment with TENS in an emergency-care setting provides clinically worthwhile pain relief for moderate to severe acute LBP in the immediate term compared with sham TENS [Mean Difference (MD) – 28.0 (95% CI – 32.7, −23.3)]. Two other studies which administered a course of TENS over 4–5 weeks, in more usual settings provide inconclusive evidence MD −2.75 (95% CI −11.63, 6.13). There was limited data on adverse events or long term follow-up. The current evidence is insufficient to support or dismiss the use of TENS for acute LBP. There is insufficient evidence to guide the use of TENS for acute LBP. There is low quality evidence of moderate improvements in pain with a short course of TENS (~30 min) during emergency transport of patients to the hospital. Future research should evaluate whether TENS has an opioid sparing role in the management of acute LBP.
Publisher: BMJ
Date: 10-03-2021
DOI: 10.1136/BMJQS-2020-012337
Abstract: Overuse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department. We conducted a stepped-wedge, cluster-randomised trial in four EDs in New South Wales, Australia. After a 13-month control phase of usual care, the EDs received a multifaceted intervention to support guideline-endorsed care in a random order, based on a computer-generated random sequence, every 4 weeks over a 4-month period. All sites were followed up for at least 3 months. The primary outcome was the proportion of low back pain presentations receiving lumbar imaging. Secondary healthcare utilisation outcomes included prescriptions of opioid and non-opioid pain medicines, inpatient admissions, length of ED stay, specialist referrals and re-presentations. Clinician beliefs and knowledge about low back pain care were measured before and after the intervention. Patient-reported pain, disability, quality of life and satisfaction were measured at 1, 2 and 4 weeks post ED presentation. A total of 269 ED clinicians and 4625 episodes of care for low back pain (4491 patients) were included. The data did not provide clear evidence that the intervention reduced lumbar imaging (OR 0.77 95% CI 0.47 to 1.26 p=0.29). It did reduce opioid use (OR 0.57 95% CI 0.38 to 0.85 p=0.006) and improved clinicians’ beliefs (mean difference (MD), 2.85 95% CI 1.85 to 3.85 p .001 on a scale from 9 to 45) and knowledge about low back pain care (MD, 0.48 95% CI 0.13 to 0.83 p .01 on a scale from 0 to 11). There was no difference in pain scores at 1-week follow-up (MD, 0.04 95% CI −1.00 to 1.08 p=0.94 on a scale from 0 to 10). A similar trend was observed for all other patient-reported outcomes and time points. This study found no effect on the other secondary healthcare utilisation outcomes. It is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED however, it did reduce opioid prescriptions without adversely affecting patient outcomes. Trial registration number ACTRN12617001160325.
Publisher: BMJ
Date: 21-05-2020
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019470
Abstract: Little is known about how to reduce unnecessary imaging for low back pain. Understanding clinician, patient and general public beliefs about imaging is critical to developing strategies to reduce overuse. To synthesise qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain. We will perform a qualitative evidence synthesis of relevant qualitative research exploring clinician, patient and general public beliefs about diagnostic imaging for low back pain. Exclusions will be studies not using qualitative methods and studies not published in English. Studies will be identified using sensitive search strategies in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Two reviewers will independently apply inclusion and exclusion criteria, extract data, and use the Critical Appraisal Skills Programme quality assessment tool to assess the quality of included studies. To synthesise the data we will use a narrative synthesis approach that involves developing a theoretical model, conducting a preliminary synthesis, exploring relations in the data, and providing a structured summary. We will code the data using NVivo. At least two reviewers will independently apply the thematic framework to extracted data. Confidence in synthesis findings will be evaluated using the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool. Ethical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal. CRD42017076047 .
Publisher: BMJ
Date: 10-10-2017
DOI: 10.1136/BJSPORTS-2016-097333
Abstract: To investigate the efficacy and safety of dietary supplements for patients with osteoarthritis. An intervention systematic review with random effects meta-analysis and meta-regression. MEDLINE, EMBASE, Cochrane Register of Controlled Trials, Allied and Complementary Medicine and Cumulative Index to Nursing and Allied Health Literature were searched from inception to April 2017. Randomised controlled trials comparing oral supplements with placebo for hand, hip or knee osteoarthritis. Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size .80) and clinically important effects for pain reduction at short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain at medium term. No supplements were identified with clinically important effects on pain reduction at long term. Similar results were found for physical function. Chondroitin demonstrated statistically significant, but not clinically important structural improvement (effect size −0.30, –0.42 to −0.17). There were no differences between supplements and placebo for safety outcomes, except for diacerein. The Grading of Recommendations Assessment, Development and Evaluation suggested a wide range of quality evidence from very low to high. The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low. Some supplements with a limited number of studies and participants suggested large treatment effects, while widely used supplements such as glucosamine and chondroitin were either ineffective or showed small and arguably clinically unimportant treatment effects. Supplements had no clinically important effects on pain and function at medium-term and long-term follow-ups.
Publisher: BMJ
Date: 22-08-2017
Publisher: Wiley
Date: 15-04-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2017
Publisher: BMJ
Date: 31-03-2015
DOI: 10.1136/BMJ.H1225
Abstract: To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee. Systematic review and meta-analysis. Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014. Randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee. Two independent reviewers extracted data on pain, disability, and quality of life. Secondary outcomes were adverse effects, patient adherence, and use of rescue medication. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst possible pain or disability). We calculated weighted mean differences or risk ratios and 95% confidence intervals using a random effects model. The Cochrane Collaboration's tool was used for assessing risk of bias, and the GRADE approach was used to evaluate the quality of evidence and summarise conclusions. 12 reports (13 randomised trials) were included. There was "high quality" evidence that paracetamol is ineffective for reducing pain intensity (weighted mean difference -0.5, 95% confidence interval -2.9 to 1.9) and disability (0.4, -1.7 to 2.5) or improving quality of life (0.4, -0.9 to 1.7) in the short term in people with low back pain. For hip or knee osteoarthritis there was "high quality" evidence that paracetamol provides a significant, although not clinically important, effect on pain (-3.7, -5.5 to -1.9) and disability (-2.9, -4.9 to -0.9) in the short term. The number of patients reporting any adverse event (risk ratio 1.0, 95% confidence interval 0.9 to 1.1), any serious adverse event (1.2, 0.7 to 2.1), or withdrawn from the study because of adverse events (1.2, 0.9 to 1.5) was similar in the paracetamol and placebo groups. Patient adherence to treatment (1.0, 0.9 to 1.1) and use of rescue medication (0.7, 0.4 to 1.3) was also similar between groups. "High quality" evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests (3.8, 1.9 to 7.4), but the clinical importance of this effect is uncertain. Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines. PROSPERO registration number CRD42013006367.
Publisher: Wiley
Date: 06-06-2016
Publisher: OMICS Publishing Group
Date: 2013
Publisher: Wiley
Date: 16-11-2017
Abstract: Low back pain is a common condition seen in the ED. However, its management in this setting has received relatively little attention and there have been few efforts to develop strategies to improve emergency care of low back pain. In order to ensure that care is appropriately delivered for low back pain patients in the ED, emergency physicians must understand issues of providing low-value care and consider potential solutions to the problem. In this paper, we describe the usual emergency care provided for non-serious low back pain and present possible strategies for restructuring ED practice and approaches for changing physician and patient behaviour. A better understanding of how non-serious low back pain is currently being managed and discussion on how to provide evidence-based care according to current guideline recommendations will help emergency physicians improve the value of care for these patients.
Publisher: Pro Ciencia Periodicos Cientificos
Date: 24-11-2014
DOI: 10.17784/MTPREHABJOURNAL.2014.12.199
Abstract: Introduction: Balance deficits are frequently observed in in iduals with hemiparesis and lead to disabilities in daily activities, such as the ability to walk. The sit-to-stand movement is essential for independent gait, and balance is one of the main requirements for its performance. Objective: To analyse the balance parameters during the sit-to-stand movement in in iduals with chronic hemiparesis, stratified according to the level of functional performance. Method: In iduals above 20 years of age with a time since the onset of the stroke of at least six months were ided into three functional groups, according to their walking speeds: Household ambulation ( .4 m/s), limited community ambulation (0.4 to 0.8 m/s), and complete community ambulation ( .8 m/s). The following balance parameters were assessed by the sit-to-stand test of the Balance Master System: (1) weight transfer time, (2) rising index, and (3) the centre of gravity sway velocity. It was considered a significance level of α .05. Results: Eight-six in iduals (56±13 years) participated. Statistically significant differences regarding weight transfer time were observed only between the household group and the others (limited community ambulation and complete community ambulation (F=4.42 =0.01). Similarly, regarding the rising index, significant differences were observed only for the household ambulation group (F=8.46 .01). Conclusion: In iduals with chronic hemiparesis, who had lower functional performance levels (household ambulation) spent more time to perform the sit-to-stand movement with less weight transfer to the lower limbs. These findings suggest that within clinical contexts when balance training is carried out to improve mobility and gait performance in in iduals with household ambulation, parameters related to the transfer time and rising index should be emphasized.
Publisher: JMIR Publications Inc.
Date: 07-05-2019
DOI: 10.2196/13357
Publisher: BMJ
Date: 21-04-2023
DOI: 10.1136/EMERMED-2022-212718
Abstract: Disparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically erse (CALD) and non-CALD patients. This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission. Of the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76–0.87), yet no difference was found in the use of any opioid or strong opioids. Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.
Publisher: Wiley
Date: 02-08-2020
Publisher: BMJ
Date: 02-02-2017
DOI: 10.1136/ANNRHEUMDIS-2016-210597
Abstract: While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. We performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain. We searched MEDLINE, EMBASE, CINAHL, CENTRAL and LILACS for randomised controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain. Reviewers extracted data, assessed risk of bias and evaluated the quality of evidence using the Grade of Recommendations Assessment, Development and Evaluation approach. A between-group difference of 10 points (on a 0-100 scale) was used for pain and disability as the smallest worthwhile effect, as well as to calculate numbers needed to treat. Random-effects models were used to calculate mean differences or risk ratios with 95% CIs. We included 35 randomised placebo-controlled trials. NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo. Six participants (95% CI 4 to 10) needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction. When looking at different types of spinal pain, outcomes or time points, in only 3 of the 14 analyses were the pooled treatment effects marginally above our threshold for clinical importance. NSAIDs increased the risk of gastrointestinal reactions by 2.5 times (95% CI 1.2 to 5.2), although the median duration of included trials was 7 days. NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.
Publisher: BMJ
Date: 04-2023
DOI: 10.1136/BMJOPEN-2022-069517
Abstract: To determine the proportion of low back pain presentations that are admitted to hospital from the emergency department (ED), the proportion of hospital admissions due to a primary diagnosis of low back pain and the mean hospital length of stay (LOS), globally. We searched MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO and LILACS from inception to July 2022. Secondary data were retrieved from publicly available government agency publications and international databases. Studies investigating admitted patients aged years with a primary diagnosis of musculoskeletal low back pain and/or lumbosacral radicular pain were included. There was high heterogeneity in admission rates for low back pain from the ED, with a median of 9.6% (IQR 3.3–25.2 9 countries). The median percentage of all hospital admissions that were due to low back pain was 0.9% (IQR 0.6–1.5 30 countries). The median hospital LOS across 39 countries was 6.2 days for ‘dorsalgia’ (IQR 4.4–8.6) and 5.4 days for ‘intervertebral disc disorders’ (IQR 4.1–8.4). Low back pain admissions per 100 000 population had a median of 159.1 (IQR 82.6–313.8). The overall quality of the evidence was moderate. This is the first systematic review with meta-analysis summarising the global prevalence of hospital admissions and hospital LOS for low back pain. There was relatively sparse data from rural and regional regions and low-income countries, as well as high heterogeneity in the results.
Publisher: JMIR Publications Inc.
Date: 22-07-2020
Abstract: ow back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. he aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. n automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. n total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. sing an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). R2-10.1136/bmjopen-2017-019052
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-017689
Abstract: The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis. Systematic review and meta-analysis. A systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty. Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. 62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) −0.43 95% CI −0.67 to −0.19 P .001) and long term post-surgery (SMD −0.36 95% CI −0.47 to −0.24 P .001), as well as less disability at long term post-surgery (SMD −0.32 95% CI −0.36 to −0.28 P .001). They also report fewer postsurgical complications at short term (OR 0.48 95% CI 0.25 to 0.91 P .001) and long term (OR 0.55 95% CI 0.41 to 0.74 P .001) along with less postsurgical infections after hip arthroplasty (OR 0.33 95% CI 0.18 to 0.59 P .001), and knee arthroplasty (OR 0.42 95% CI 0.23 to 0.78 P=0.006). Presurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. CRD42016032711 .
Publisher: Springer Science and Business Media LLC
Date: 03-2015
DOI: 10.1007/S00586-015-3821-5
Abstract: The aim of this study is to systematically evaluate the efficacy of commonly used non-surgical treatments in acute care of adults with osteoporotic vertebral compression fractures (VCFs). A systematic approach was used to search eight electronic databases for randomized controlled trials (RCTs) examining analgesic medications, passive physical therapies, bed rest or orthoses. Data on pain, activity articipation and adverse events were extracted. Methodological quality and quality of evidence were assessed with the Physiotherapy Evidence Database (PEDro) scale (score range 0-10) and the GRADE criteria, respectively. Five RCTs (total n = 350) were identified including one placebo-controlled and four controlled trials examining analgesics (2 studies) and orthoses (3). PEDro scores ranged from 4 to 7. The overall quality of evidence ranged from very low to low. In two trials, spinal orthoses provided significantly higher medium-term pain relief [pooled standardized mean differences (SMD): -1.47, 95 % confidence interval (CI) -1.82, -1.13 I (2) = 0 %] and disability reduction (pooled SMD: -1.73, 95 % CI -2.09, -1.37 I (2) = 0 %) than no intervention. Immediate- and short-term pain effects of diclofenac (a non-steroidal anti-inflammatory drug) and tramadol (a strong opioid) were demonstrated when compared to a Chinese medicine, whereas non-significant effects were found for oxycodone and tapentadol (strong opioids) in a placebo-controlled trial. Low/insufficient statistical power, co-interventions and potential conflict of interest might have influenced the results. At present, there is insufficient evidence to inform conservative care for acute pain related to VCF. Large, multinational, placebo/sham-controlled trials to address this gap in evidence are needed.
Publisher: Wiley
Date: 07-10-2022
Abstract: Knowledge gaps exist around diagnostic and treatment approaches for patients admitted to hospital with low back pain. Medical record review of patients admitted to three Sydney teaching hospitals with a provisional emergency department diagnosis of non‐serious low back pain, from 2016 to 2020. Data on demographic variables, hospital costs, length of stay (LOS), diagnostic imaging and analgesic administration were extracted. Logistic regression was used to identify predictors of longer hospital stay, advanced imaging, and concomitant use of sedating medicines. Median inpatient LOS for non‐specific low back pain was 4 days (interquartile range [IQR] 2‐7), and for radicular low back pain was 4 days (IQR 3‐10). Older patients with non‐serious low back pain were more likely to stay longer, as were arrivals by ambulance. Plain lumbar radiography was used in 8.3% of admissions, whereas 37.6% of patients received advanced lumbar imaging (computed tomography or magnetic resonance imaging). Opioids were administered in ~80% of admissions 49% of patients with radicular low back pain were given an antiepileptic in addition to an opioid. In all, 18.4% of admissions resulted in at least one hospital‐acquired complication, such as an accidental fall (3.1%) or a medication‐related adverse effect (13.3%). Physiotherapists saw 82.6% of low back pain admissions. Costs of inpatient care were estimated at a mean of AU$ 14 000 per admission. We noted relatively high rates of concomitant use of sedating pain medicines and referrals for advanced lumbar imaging and laboratory tests. Strategies to address these issues in inpatient care of low back pain are needed.
Publisher: Informa UK Limited
Date: 2010
DOI: 10.3109/09638281003611045
Abstract: To identify neck-pain-specific questionnaires and scales that measure functioning and disability and assess whether their contents are comparable to the international classification of functioning, disability and health (ICF). A systematic search was conducted in LILACS, MEDLINE, CINAHL, and SPORTSDISCUS databases, identifying questionnaires and scales used to assess neck-related functioning and disability from 1966 to November 2007. Each item of each scale or questionnaire was extracted and classified according to the ICF categories. The databases yielded a total of 888 articles, of which seven questionnaires were identified and included in the review. A total of 74 items were analyzed, 27 linked to body function, 46 to activities and participation, 1 to environmental factors, and 5 to non-classified items. While the pain disability index tends to focus on limitations to body functions, the functional rating index and the Copenhagen neck functional disability scale appear to be limited to measuring activity. Three questionnaires (the neck Bournemouth Questionnaire, the neck disability index, and the neck pain and disability scale) have demonstrated a well-balanced distribution of items across the ICF components. Most identified questionnaires reflect limitations or restrictions in one component only. These results provide valuable information on the content quality of these questionnaires for health-care providers and researchers.
Publisher: JMIR Publications Inc.
Date: 04-03-2021
DOI: 10.2196/22732
Abstract: Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. The aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. An automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. In total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. Using an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). RR2-10.1136/bmjopen-2017-019052
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-11-2019
Publisher: Wiley
Date: 30-01-2022
Abstract: We aimed to determine, in those who present to the ED with low back pain (LBP): (i) the prevalence of four key diagnostic categories, (ii) trends in lumbar imaging from 2015 to 2019 and (iii) the effect of a new model of care on lumbar imaging in the ED. We conducted a retrospective analysis of routinely collected medical data of four tertiary hospitals in Sydney, Australia. We analysed ED presentations for LBP between January 2012 and October 2019. Outcomes were the prevalence of four key diagnostic categories of LBP and use of lumbar imaging. We examined trends in lumbar imaging over time and used interrupted time series analysis to determine the impact of model of care implementation on imaging use. There were 31 168 presentations for LBP of which 64.5% were non‐specific LBP, 27.2% were problems beyond the spine, 5.3% were LBP with neurological signs and 2.3% were serious spinal conditions. 28.9% received lumbar imaging use did not change substantially between 2012 and 2019. Patients diagnosed with serious spinal conditions were more likely to receive imaging (59%) than those diagnosed with non‐specific LBP (29%). Implementation of a state‐wide model of care in November 2016 did not appear to influence imaging use. Most presentations to the ED for LBP are for non‐specific LBP. Around 2% will have specific spinal pathology. Use of imaging in those diagnosed with non‐specific LBP remains high and was unaffected by implementation of a state‐wide model of care.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.SPINEE.2016.08.010
Abstract: A previous study has shown that transient physical and psychosocial activities increased the risk of developing low back pain. However, the link between these factors in triggering nonpersistent or persistent episodes remains unclear. We aimed to investigate the association of transient exposures to physical and psychosocial activities with the development of nonpersistent or persistent low back pain. This was a case-crossover study with 12 months follow-up. We included 999 consecutive participants seeking care for a sudden onset of low back pain. Development of low back pain was the outcome measure. At baseline, participants reported transient exposures to 12 predefined activities over the 4 days preceding pain onset. After 12 months, participants were asked whether they had recovered and the date of recovery. Exposures in the 2-hour period preceding pain onset (case window) were compared with the 2-hour period, 24 hours before pain onset (control window) in a case-crossover design for all participants. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI), and interaction analyses were used to compare estimates of nonpersistent (i.e., <6 weeks duration) and persistent cases. This study received funding from Australia's National Health and Medical Research Council (APP1003608). There were 832 participants (83%) who completed the 12 months follow-up successfully. Of these, 430 participants had nonpersistent low back pain (<6 weeks duration), whereas 352 reported persistent symptoms (≥6 weeks duration). Exposure to several transient activities, such as manual tasks involving heavy loads, awkward postures, live people or animals, moderate or vigorous physical activity, and being fatigued or tired during a task or activity, significantly increased the risk of both nonpersistent and persistent low back pain, with ORs ranging from 2.9 to 11.7. Overall, the risk of developing a persistent or a nonpersistent episode of low back pain associated with the included physical factors did not differ significantly. Our results revealed that previously identified triggers contribute equally to the development of both nonpersistent and persistent low back pain. Future prevention strategies should focus on controlling exposure to these triggers as they have the potential to decrease the burden associated with both acute and chronic low back pain.
Publisher: Oxford University Press (OUP)
Date: 07-2021
Abstract: Imaging for low back pain is widely regarded as a target for efforts to reduce low-value care. We aimed to estimate the prevalence of the overuse and underuse of lumbar imaging in patients presenting with low back pain to the emergency department (ED). This was a retrospective chart review study of five public hospital EDs in Sydney, Australia, in 2019–20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Six hundred and forty-nine patients presented with a complaint of low back pain, of which 158 (24.3%) were referred for imaging. Seventy-nine (12.2%) had a combination of features suggesting that lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95% CI 6.8–11.2%) and 4.3% (28 of 649 cases, 95% CI 3.0–6.1%), respectively. Thirteen cases were classified as underuse because the patients were referred for uninformative imaging modalities (e.g. referred for radiography for suspected cauda equina syndrome). In this study of emergency care, there was evidence of not only overuse of lumbar imaging but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.
Publisher: Wiley
Date: 25-02-2019
Publisher: Elsevier BV
Date: 2020
Publisher: Wiley
Date: 11-2016
Publisher: Wiley
Date: 08-2010
DOI: 10.1016/J.EJPAIN.2009.11.005
Abstract: Little is known about factors determining health care-seeking behavior in low back pain. While a number of studies have described general characteristics of health care utilization, only a few have aimed at appropriately assessing determinants of care-seeking in back pain, by comparing seekers and non-seekers. The objective of this systematic review was to identify determinants of health care-seeking in studies with well-defined groups of care-seekers and non-seekers with non-specific low back pain. A search was conducted in Medline, AMED, Cinahl, Web of Science, PsycINFO, National Research Register, Cochrane Library and LILACS looking for population- based surveys of non-specific low back pain patients older than 18 years, published since 1966. To be included in the review, studies needed to report on characteristics of well-defined groups of care-seekers and non-seekers. Methodological quality was assessed using a criteria list based on s ling, response rate, data reproducibility, power calculation and external validity. Risk estimates were expressed as odd ratios (95% confidence intervals). When possible, meta-analyses were performed, using a random effects model. Eleven studies were included in the review. Pooled results show that women are slightly more likely to seek care for their back pain as are patients with a previous history of back pain. Pain intensity was only slightly associated with care-seeking, whereas patients with high levels of disability were nearly eight times more likely to seek care than patients with lower levels of disability.
Publisher: Public Library of Science (PLoS)
Date: 30-03-2015
Publisher: BMJ
Date: 04-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-05-2017
DOI: 10.1097/J.PAIN.0000000000000952
Abstract: Older adults are largely under-represented in low back pain (LBP) research. In light of the ageing population, it is crucial to understand the influence of comorbidities and lifestyle factors on the risk and prognosis of LBP in older adults. The aims of this study were to describe the course of LBP in older men to investigate whether comorbidities/lifestyle factors can predict the course of LBP in older men to assess if comorbidities/lifestyle factors increase the risk of developing LBP in older men. The study s le comprised 1685 older men living in suburban Sydney, Australia. Low back pain, sociodemographic measures, lifestyle factors, and comorbidities were assessed. Of the 1012 men with LBP at baseline, 58% still reported having pain at the 24-month follow-up. Of those without pain at baseline (n = 673), 28% reported pain at follow-up. The odds of persistent pain at 24 months increased with each additional alcoholic drink/wk (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01-1.22 P = 0.03) and each additional unit of body mass index (OR = 1.28, 95% CI: 1.04-1.60 P = 0.02), but reduced for men who speak English at home (OR = 0.58, 95% CI: 0.35-0.96 P = 0.03). In older men, free of LBP at baseline (n = 673), for every additional comorbidity there was an increased risk of developing LBP (OR = 1.17, 95% CI: 1.00-1.37 P = 0.05). These results demonstrate the influence of lifestyle factors and comorbidities on LBP in older men and suggest that the consideration of these issues in management may improve outcomes.
Publisher: JMIR Publications Inc.
Date: 05-01-2020
Abstract: obile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Consequently, instruments of high psychometric quality for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA in various health domains. Only few validation studies investigating its psychometric quality exist with selected s les of MHAs. No study has evaluated the construct validity of the MARS and concurrent validity to other instruments. his study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS. ARS scoring data was pooled from 15 international app quality reviews to evaluate the psychometric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. App quality is determined for each dimension and overall. Construct validity was evaluated by assessing related competing confirmatory models that were explored by confirmatory factor analysis (CFA). A combination of non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices was used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations between the MARS and 1) another quality assessment tool called ENLIGHT, and 2) user star-rating extracted from app stores were investigated. Reliability was determined using Omega. Objectivity was assessed in terms of intra-class correlation. n total, MARS ratings from 1,299 MHA covering 15 different health domains were pooled for the analysis. Confirmatory factor analysis confirmed a bifactor model with a general quality factor and an additional factor for each subdimension (RMSEA=0.074, TLI=0.922, CFI=0.940, SRMR=0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC=0.82). The overall MARS rating was positively associated with ENLIGHT (r=0.91, P .01) and user-ratings (r=0.14, P .01). e psychometric evaluation of the MARS demonstrated its suitability for the quality assessment of MHAs. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2021-056339
Abstract: Long waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’), which aims to reduce waiting times for LBP. We will conduct a single-centre feasibility and pilot RCT with nested qualitative interviews. Sixty participants with LBP newly referred to a hospital outpatient clinic will be randomised to receive Rapid Stratified Telehealth or usual care. Rapid Stratified Telehealth involves matching the mode and type of care to participants’ risk of persistent disabling pain (using the Keele STarT MSK Tool) and presence of potential radiculopathy. ‘Low risk’ patients are matched to one session of advice over the telephone, ‘medium risk’ to telehealth physiotherapy plus App-based exercises, ‘high risk’ to telehealth physiotherapy, App-based exercises, and an online pain education programme, and ‘potential radiculopathy’ fast tracked to usual in-person care. Primary outcomes include the feasibility of delivering Rapid Stratified Telehealth (ie, acceptability assessed through interviews with clinicians and patients, intervention fidelity, appointment duration, App useability and online pain education programme usage) and evaluating Rapid Stratified Telehealth in a future trial (ie, recruitment rates, consent rates, lost to follow-up and missing data). Secondary outcomes include waiting times, number of appointments, intervention and healthcare costs, clinical outcomes (pain, function, quality of life, satisfaction), healthcare use and adverse events (AEs). Quantitative analyses will be descriptive and inform a future adequately-powered RCT. Interview data will be analysed using thematic analysis. This study has received approval from the Ethics Review Committee (RPAH Zone: X21-0221). Results will be published in peer-reviewed journals and presented at conferences. ACTRN12621001104842.
Publisher: BMJ
Date: 11-09-2020
DOI: 10.1136/EMERMED-2019-209294
Abstract: Low back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit. Electronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019. We screened for cohort studies or randomised trials investigating pain or disability in patients with non-specific low back pain presenting to EDs. We excluded studies that enrolled participants with minimal pain or disability scores at baseline. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias and quality of evidence. Estimates of pain and disability were converted to a common 0–100 scale. We estimated pooled means and 95% CIs of pain and disability as a function of time since ED presentation. Eight studies (nine publications) with a total of 1994 patients provided moderate overall quality evidence of the expected clinical course of low back pain after an ED visit. Seven of the eight studies were assessed to have a low risk of bias. At the time of the ED presentation, the pooled estimate of the mean pain score on a 0–100 scale was 71.0 (95% CI 64.2–77.9). This reduced to 46.1 (95% CI 37.2–55.0) after 1 day, 41.8 (95% CI 34.7 to 49.0) after 1 week and 13.5 (95% CI 5.8–21.3) after 26 weeks. The course of disability followed a similar pattern. Patients presenting to EDs with non-specific low back pain experience rapid reductions in pain intensity, but on average symptoms persisted 6 months later. This review can be used to educate patients so they can have realistic expectations of their recovery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
Publisher: BMJ
Date: 16-12-2016
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2019
Abstract: Mechanical Diagnosis and Therapy (MDT) is a treatment-based classification system founded on 3 core principles: classification into diagnostic syndromes, classification-based intervention, and appropriate application of force. Many randomized controlled trials have investigated the efficacy of MDT for low back pain however, results have varied. The inconsistent delivery of MDT across trials may explain the different findings. To compare treatment effect sizes for pain or disability between trials that delivered MDT consistent with the core principles of the approach and trials that met some or none of these principles. In this systematic review, databases were searched from inception to June 2018 for studies that delivered MDT compared to nonpharmacological, conservative control interventions in patients with low back pain and reported outcomes of pain or disability. Studies were classified as "adherent" (meeting the core principles of MDT) or "nonadherent" (using some or none of the principles of MDT). Data were extracted by 2 independent reviewers. Meta-regression procedures were used to analyze the effect of delivery mode on clinical outcomes, adjusting for covariates of symptom duration (less than or greater than 3 months) and control intervention (minimal or active). Studies classified as adherent to the MDT approach showed greater reductions in pain and disability of 15.0 (95% confidence interval: 7.3, 22.7) and 11.7 (95% confidence interval: 5.4, 18.0) points, respectively, on a 100-point scale compared to nonadherent trials. This review provides preliminary evidence that treatment effects of MDT are greater when the core principles are followed. Therapy, level 1a. J Orthop Sports Phys Ther 2019 (4):219-229. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8734.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Wiley
Date: 20-04-2022
Abstract: To investigate the proportion of patients with low back pain who receive an opioid analgesic prescription on hospital discharge, the proportion using opioid analgesics 4 weeks after discharge, and to identify predictors of continued opioid analgesic use at 4 weeks after an ED presentation in opioid‐naïve patients. An observational cohort study nested within a randomised controlled trial in four EDs in New South Wales, Australia. Participants were adults who presented to the ED with non‐specific low back pain or low back pain with lower limb neurological signs and symptoms. Electronic medical records supplemented the patient‐reported pain and use of opioid analgesics at 4‐week follow up. Of the 104 patients included, 33 (31.7%, 95% confidence interval [CI] 22.9–41.6) received an opioid analgesic prescription at hospital discharge and 38 (36.5%, 95% CI 27.3–46.6) reported taking an opioid analgesic for pain 4 weeks after the ED presentation. Among opioid‐naïve patients ( n = 85), older age (odds ratio [OR] 1.04, 95% CI 1.00–1.08, P = 0.031) was the only predictor for continued opioid analgesic use at 4 weeks post‐ED presentation. About one‐third of patients who present to the ED with low back pain receive an opioid analgesic prescription on discharge and are taking an opioid analgesic 4 weeks later. These findings justify future research to identify strategies to reduce the risk of long‐term opioid use in patients who present to the ED with low back pain.
Publisher: BMJ
Date: 28-04-2015
DOI: 10.1136/BMJ.H2223
Publisher: BMJ
Date: 04-06-2019
DOI: 10.1136/BMJQS-2019-009383
Abstract: To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital and to explore factors associated with these four outcomes. In this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs. There were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51). Many ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.
No related grants have been discovered for Gustavo Machado.