Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium

Background: Although back complaints are common among older people, limited information is available in the literature about the clinical course of back pain in older people and the identification of older persons at risk for the transition from acute back complaints to chronic back pain. The aim of this study is to assess the course of back complaints and identify prognostic factors for the transition from acute back complaints to chronic back complaints in older people who visit a primary health care physician. Methods/design. The design is a prospective cohort study with one-year follow-up. There will be no interference with usual care. Patients older than 55 years who consult a primary health care physician with a new episode of back complaints will be included in this study. Data will be collected using a questionnaire, physical examination and X-ray at baseline, and follow-up questionnaires afte

Influence of psychological factors on the prognosis of chronic shoulder pain : protocol for a prospective cohort study

Introduction: Shoulder pain is a highly prevalent condition. Psychological factors could play an essential role in the prognosis of chronic shoulder pain (CSP). The aims of the study will be to analyse the level of association between psychological factors and pain-disability at baseline and prospectively to assess their prognostic role; to evaluate the association of pain catastrophising and kinesiophobia at baseline and prospectively in the relationship between pain intensity and disability, or between self-efficacy and disability in patients with CSP; to explore the association of self-efficacy at baseline and prospectively in the relationship between pain intensity and disability, in comparison with kinesiophobia and pain catastrophising. Methods and analysis: The study is a longitudinal, prospective cohort study with a 12-month follow-up. It will be conducted in 4 primary-care centres and one hospital of the province of Malaga, Spain. 307 participants aged between 18 and 70 years suffering from CSP (3 months or more) will be included. Primary outcomes will include pain, disability and self-efficacy, whereas kinesiophobia, pain-related fear, pain catastrophising, anxiety, depression, patient expectations of recovery, age, gender, duration/intensity of symptoms, educational level and other factors will be predictive measures. Follow-up: baseline, 3, 6 and 12 months. Ethics and dissemination: The local ethics committee (The Costa del Sol Ethics Committee, Malaga, 28042016) has approved this protocol. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals

Doctor of Philosophy

dissertationLow back pain (LBP) is a common and costly problem. Among the top primary care research priorities are identifying prognostic subgroups of patients with LBP and identifying specific management strategies based on relevant subgroups. The Start Back Screening Tool (SBST) is a primary care decision tool that stratifies patients into prognostic subgroups based on the patient's risk for prolonged disability. Other subgrouping strategies screen for patients who fit a prediction rule (CPR) that may identify them as likely to respond to spinal manipulation (SM). It is unclear whether patients who are stratified by the SBST (high- and medium-risk) and who meet a CPR respond differentially to SM with exercise based on their risk stratification. In a secondary analysis of a randomized controlled trial, we found no 2-way interactions between risk stratification and treatment group at 4-week, 3-month or 1-year time points for disability or pain, indicating that the effects of treatment were no different between the medium- and high-risk groups. When we examined the effects of treatment separately within each risk subgroup, SM with exercise was superior to usual care at 3 months for disability and pain in those categorized as high-risk (mean difference = 3.95, 95% CI: 0.02, 7.87). After controlling for covariates, the SBST accounted for 2.4% (β = 4.25, p = 0.035) of the variance in the 4-week disability. In the same group of patients, we explored the relationship between the SBST and treatment expectations. Expectations of benefit from ten commonly used interventions for LBP were represented by four principal components: Exercise, Passive, Rest/Medication and Surgery). There were no associations between the components and the SBST (high versus medium- and low-risk). Finally, we retrospectively examined the influence of a mental health (MH) comorbidity on LBP-related healthcare costs in new consulters to primary care for LBP. Interaction terms between mental health comorbidity and patient factors were explored as contributors to predicting total costs. Individuals with a comorbid MH condition had higher LBP-related costs than those without. Males with a MH comorbidity experienced greater LBP-related healthcare costs than females (mean difference = $1077.26 USD, 95% CI = 428.10 - 1776.43)

The burden of hip and knee complaints

Bouter, L.M. [Promotor]Dekker, J. [Promotor]Terwee, C.B. [Copromotor]Windt, D.A.W.M. van der [Copromotor

Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice

BACKGROUND: Complaints of arm, neck and shoulder are common in Western societies. Of those consulting a general practitioner (GP) with non-traumatic arm, neck or shoulder complaints, about 50% do not recover within 6 months.Kinesiophobia (also known as fear of movement/(re)injury) may also play a role in these complaints, as it may lead to avoidance behaviour resulting in hypervigilance to bodily sensations, followed by disability, disuse and depression. However, in relation to arm, neck and shoulder complaints little is known about kinesiophobia and its associated variables.Therefore this study aimed to: describe the degree of kinesiophobia in patients with non-traumatic complaints of arm, neck and shoulder in general practice; to determine whether mean scores of kinesiophobia change over time in non-recovered patients; and to evaluate variables associated with kinesiophobia at baseline. METHODS: In this prospective cohort study set in general practice, consulters with a first or new episode of non-traumatic arm, neck or shoulder complaints (aged 18-64 years) entered the cohort. Baseline data were collected on kinesiophobia using the Tampa Scale for Kinesiophobia, the 13-item adjusted version: TSK-AV, and on patient-, complaint-, and psychosocial variables using self-administered questionnaires. The mean TSK-AV score was calculated. In non-recovered patients the follow-up TSK-AV scores at 6 and 12 months were analyzed with the general linear mixed model. Variables associated with kinesiophobia at baseline were evaluated using multivariate linear regression analyses. RESULTS: The mean TSK-AV score at baseline was 24.8 [SD: 6.2]. Among non-recovered patients the mean TSK-AV score at baseline was 26.1 [SD: 6.6], which remained unchanged over 12- months follow-up period. The strongest associations with kinesiophobia were catastrophizing, disability, and comorbidity of musculoskeletal complaints. Additionally, having a shoulder complaint, low social support, high somatization and high distress contributed to the kinesiophobia score. CONCLUSION: The mean TSK-AV score in our population seems comparable to those in other populations in primary care.In patients who did not recover during the 12- month follow-up, the degree of kinesiophobia remained unchanged during this time period.The variables associated with kinesiophobia at baseline appear to be in line with the fear-avoidance model

Psychological Factors In HIV-Related Headaches

Headache is one of the most commedical complaints reported by individuals suffering from HIV/AIDS, but conflicting data exist regarding their prevalence, prototypical characteristics, and relationship to HIV severity. A well-established field of research indicates a strong association between psychiatric comorbidities/psychological factors and headache disorders, but this association has not been explored frequently among HIV patients with headaches. Data on headache symptoms and psychological factors were collected on 200 HIV/AIDS patients from two outpatient clinics using structured interviews and self-report measures. Of these, 107 patients (53.5%) endorsed problematic headaches, most of which (n = 103; 51.5%) were consistent with characteristics of primary headache disorders. Among those who met criteria for primary headaches, 88 (85.44%) met criteria for migraine, while 15 (14.56%) met criteria for tension-type headache. Severity of HIV (as indicated by CD4 cell counts), but not duration of HIV, was strongly predictive of headache severity, frequency, and disability. Those with headache endorsed higher levels of comorbid depression, anxiety, and stress, as well as higher levels of pain catastrophizing, anxiety sensitivity, and fear of pain than did those without headache. These group differences were not attributable to differences in HIV duration, number of prescribed antiretroviral medications, or demographic differences such as age, gender, or race. The results indicate the presence of two distinct groups of individuals: one that is relatively healthy, both physically and emotionally without the presence of headaches or psychological dysfunction, and one that is relatively unhealthy with frequent disabling headaches and comorbid psychological dysfunction. Implications for treatment and future research are discussed