Wirksamkeit, Zweckmäßigkeit und Wirtschaftlichkeit des multimodalen Behandlungsansatzes bei chronisch lumbalen Rückenschmerzen

Zusammenfassung: Hintergrund: Der Nachweis der Behandlungskriterien Wirksamkeit, Zweckmäßigkeit und Wirtschaftlichkeit ist bei chronisch lumbalen Rückenschmerzen ["chronic low back pain" (CLBP)] notwendig, da Kostenträger die Übernahme von Behandlungskosten hiervon abhängig machen. Material und Methoden: Eine systematische Literatursuche zu den Behandlungskriterien der interdisziplinären, multimodalen Schmerztherapie ["multidisciplinary treatment" (MDT)] bietet einen Überblick über die aktuelle Literatur zur Behandlung von CLBP. Ergebnisse: Auf die moderate Wirksamkeit von MDT weisen 8Übersichtsarbeiten hin, wenn auch mit einigen Einschränkungen. Die Ergebnisse von 6 bisher in keine Übersichtsarbeit eingeschlossenen Originalarbeiten stützen die Ergebnisse der Übersichtsarbeiten. Die Langzeitergebnisse von MDT und operativen Behandlungen sind, bei höheren Kosten und Risiken für operative Behandlungen, vergleichbar. Die Wirtschaftlichkeit von MDT erreicht in 3Originalarbeiten eine moderate bis hohe Evidenz. Schlussfolgerungen: MDT sind sowohl moderat wirksam als auch wirtschaftlich. Daher sind sie eine kostengünstigere Behandlungsalternative zu operativen Verfahre

Resources for preventing sickness absence due to low back pain

Background After an episode of non-specific low back pain (LBP) some individuals fail to return to work. The factors leading to such LBP-related sickness absence are not yet fully understood. Aims To identify individual resources, over and above the already established predictors, for preventing LBP-related sickness absence in a population-based sample of workers experiencing an episode of LBP. Methods Cohort study with 1-year follow-up. Participants were from a working population who reported an episode of acute or subacute LBP at baseline. Four potential resources—life satisfaction, doing sports, job satisfaction and social support at work—were examined for their incremental value in predicting sickness absence over and above baseline sickness absence and fear-avoidance beliefs about work. Results In all, 279 workers participated in the study. All four resources showed an inverse relationship with regard to sickness absence. A multiple regression analysis revealed that life satisfaction as a resource protected against sickness absence, when controlling for established risk factors. Job satisfaction and social support at work minimized the influence of sickness absence at baseline and at 1-year follow-up. Conclusions In a non-clinical working sample of individuals experiencing an acute/subacute episode of LBP, life satisfaction was a unique predictor of sickness absence after 1 year. Prevention in the occupational setting should not only address common risk factors but also occupational and individual resources that keep workers satisfied with life despite having LB

Predicting the transition from acute to persistent low back pain

Background Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. Aims To identify factors that influence the progression of acute LBP to the persistent state at an early stage. Methods Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices ‘working condition', ‘depression and maladaptive cognitions' and ‘pain and quality of life'. Results The index ‘depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. Conclusions In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as ‘depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary preventio

Identification of prognostic factors for chronicity in patients with low back pain: a review of screening instruments

Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation”, and "pain". The strongest predictors for "work status” were psychosocial and occupational structures, whereas for "functional limitation” and "pain” psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core se

What comprises a good outcome in spinal surgery? A preliminary survey among spine surgeons of the SSE and European spine patients

Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients' and surgeons' perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients' as well as a surgeon's perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients' expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief, an improved work capacity, and better social life participation. Patients in southern Europe more often wanted to improve work capacity compared to those from central and northern European countries. No substantial differences were found when patients' and surgeons' perspective were compared. However, age and differences in national social security and health care system ("black flags”) have an impact on what is considered a good outcome in spinal surger

Aspectos didácticos en la formación de traductores para el ámbito económico e institucional

Este trabajo tiene que ver con uno de los objetivos perseguidos, en el marco del Proyecto Redes de Investigación en Docencia Universitaria del Instituto de Ciencias de la Educación de la Universidad de Alicante, por la red 2986 "Planificación docente y uso de COMENEGO (Corpus Multilingüe de Economía y Negocios) en la enseñanza de la traducción económica e institucional", relacionado, en concreto, con las metodologías docentes en traducción económica. Se presenta una síntesis de una serie de comunicaciones que se pronunciaron en el Congreso Internacional de Traducción Económica, Comercial, Financiera e Institucional, celebrado en la Facultad de Filosofía y Letras de la Universidad de Alicante a finales de mayo de 2014

Stress in nurses : stress-related affect and its determinants examined over the nursing day

Peer reviewedPostprin

What comprises a good outcome in spinal surgery? A preliminary survey among spine surgeons of the SSE and European spine patients

Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients' and surgeons' perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients' as well as a surgeon's perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients' expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief, an improved work capacity, and better social life participation. Patients in southern Europe more often wanted to improve work capacity compared to those from central and northern European countries. No substantial differences were found when patients' and surgeons' perspective were compared. However, age and differences in national social security and health care system ("black flags") have an impact on what is considered a good outcome in spinal surgery

Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

<p>Abstract</p> <p>Background</p> <p>There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study.</p> <p>Methods</p> <p>This study aims to examine if</p> <p>1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP</p> <p>2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP</p> <p>3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP.</p> <p>This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study.</p> <p>Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data.</p> <p>Conclusion</p> <p>This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP.</p