Predictors of outcome in patients with (sub) acute low back pain differ across treatment groups

Study Design. Prospective study with 6 weeks of follow-up. Objective. To examine the predictors of outcome for patients with (sub) acute low back pain (LBP) receiving usual care (UC) or a minimal intervention strategy (MIS) aimed at psychosocial factors. Summary of Background Data. A randomized controlled trial in general practice showed no differences in average effect between UC and MIS. Methods. Socio-demographic variables, characteristics of LBP, and psychosocial factors were included as potential predictors of outcome. The outcome clinically important improvement was defined as a reduction of at least 30% on functional disability plus patient perceived recovery. Logistic regression analyses were used to study the associations between predictors and outcome at 6 weeks follow-up. Results. In the UC group (n = 163), the multivariable model included a shorter duration of the LBP episode, few previous episodes, less pain catastrophizing, and good perceived general health. The area under the curve (AUC) of the model was 0.77 (95% confidence interval, 0.70-0.85). In the MIS group (n = 142), the multivariable model included less somatizing symptoms, more solicitous responses by an important other, lower perceived risk for chronic LBP, more fear avoidance beliefs, higher level of education, and shorter duration of the LBP episode. This AUC was 0.78 (95% confidence interval, 0.71-0.86). Conclusions. As we found two different profiles, our approach may contribute to the important question: what intervention works for whom

Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice

OBJECTIVE: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice. DESIGN: Cluster randomised clinical trial. SETTING: 60 general practitioners in 41 general practices. PARTICIPANTS: 314 patients with non-specific low back pain of less than 12 weeks' duration, recruited by their general practitioner. INTERVENTIONS: In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised. MAIN OUTCOME MEASURES: Functional disability (Roland-Morris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks. RESULTS: The dropout rate was 8% in the minimal intervention strategy group and 9% in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain). CONCLUSION: This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual car

Принципи екологічної деонтології як засобу формування екологічного імперативу поведінки

Матеріал присвячений обґрунтуванню нової наукової дисципліни, яку автор назвав "екологічна деонтологія". Стаття містить погляди автора на принципи екологічної деонтології, окреслює її світоглядно-методологічний потенціал. Екологічна деонтологія розглядається як один із засобів вирішення актуальних глобальних проблем людства.Material is devoted the ground of new scientific discipline which an author named "ecological deontology". The article contains the looks of author to principles of ecological deontology, outlines it view-methodological potential. Ecological deontology is examined as a mean of decision of global issues of the day of humanity

Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

Background: Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients' quality of life. Little is known about the effect of training general practitioners in palliative care specific communication. We hypothesized that palliative care patients of general practitioners exposed to the 'Availability, Current issues and Anticipation' communication training programme would report better outcomes than patients of control general practitioners. Aim: To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design: In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire-III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants: General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results: Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire Ill and Availability, Current issues and Anticipation Scale. Conclusion: General practitioner participation in the Availability, Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated. Patients reported high levels of satisfaction with general practitioner care, regardless of group assignment. Future research might focus on general practitioners without special interest in palliative care