Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain:a systematic review

Question: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain? Design: Systematic review with meta-analysis of prospective inception cohort studies. Participants: Adults with acute or subacute non-specific low back pain. Outcome measure: Absence from usual work at a given time point greater than 12 weeks after the onset of pain due to ongoing pain. Results: Ten studies involving 4683 participants were included in the review. Participants with acute or subacute pain and negative expectations about their recovery had significantly greater odds of being absent from usual work at a given time point more than 12 weeks after the onset of pain: OR 2.17 (95% CI 1.61 to 2.91). The exclusion of five studies with the greatest risk of bias showed that the result was similar when more rigorous quality criteria were applied: OR 2.52 (95% CI 1.47 to 4.31). Conclusion: The odds that adults with acute or subacute non-specific low back pain and negative recovery expectations will remain absent from work due to progression to chronic low back pain are two times greater than for those with more positive expectations. These results were consistent across the included studies despite variations in the risk of bias. [Hallegraeff JM, Krijnen WP, van der Schans CP, de Greet MHG (2012) Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain: a systematic review. Journal of Physiotherapy 58:165-172]

The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis

The aim of the present study was to compare the effect of a new prefabricated Thamert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the splint group. They wore the orthotic devices for 6 weeks. Outcome measures were obtained at baseline and directly after the intervention. These outcome measures were maximal grip strength on the involved side with a pain scale from I to 10 to determine the extent of pain during gripping, and the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ). Analysis of variances with repeated measures, a Mann Whitney test and multiple linear regression analysis were used to compare the two groups. Main effect for time was significant for maximal grip strength and sum scores on the PRFEQ, but no differences between groups were found, even when a distinction between acute and chronic symptoms was made. Change in pain score during gripping did not differ significantly between the groups. A multiple linear regression analysis showed that the use of the splint did not significantly contribute to the prediction of change in maximal grip strength and in overall PRFEQ. The conclusion is that the forearm/hand splint is not more effective than the elbow band as a treatment for lateral epicondyliti