Individuals with low back pain: how do they view physical activity?

Background. Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity. Little is known about the relationship between low back pain and physical activity, and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population. Objectives. We aimed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain, and the impact of those perceptions and behaviour on physical activity. Methods. Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who, because of their low back trouble, had been referred by their GPs to a community-based, single-blind, randomized controlled trial (RCT) at the University of York, which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme. Fifty-four interviews were conducted with this subgroup of the RCT; four informants were interviewed once, 19 twice and four of them three times. Interviews were transcribed and analysed using manual and computer-aided approaches. Results. Physical activity was perceived as (i) activities of daily living, (ii) activities causing breathlessness that they went out of the way to do and (iii) more competitive-type activity. The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants' backs and changes in physical activity. These two factors hindered increases in physical activity, even though the majority of informants believed strongly that being physically active helped ease their low back pain. Conclusions. When advocating that individuals with acute low back pain return to or increase physical activity, it is important that clinicians identify avoidance of physical activity and/or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately. If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity, they should explore issues of fear of pain, and avoidance of and confidence to do physical activities, in addition to other factors influencing physical activity

Randomised controlled trial of exercise for low back pain : clinical outcomes, costs and preferences

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective

A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial).

Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches

Back pain: its management and costs to society

The aim of this Discussion Paper is to estimate the social costs of back pain in the UK and assess the potential for reducing these costs by increasing the appropriateness of management of back pain. 50% to 80% of the population suffer from back pain at some stage of their life. With or without treatment, 90% of back pain problems improve within six weeks, but repeated episodes are very common. Although back pain and its management has been the subject of several thousand research papers over the past three decades, it still remains something of an enigma. Only 15% of cases can be clearly diagnosed. However, the great majority are due to mechanical low back pain which is the focus of this paper. Due to the paucity of data it is only possible to make crude estimates of the costs of back pain to the NHS, and these probably lie between £265 million and £383 million. Most of these costs are generated in 1) General Practice, due to the large number of consultations, and 2) Hospital in-patient management, due to the high treatment cost per person. Between 1986 and 1992 sickness and invalidity benefit claims for back pain alone increased in the UK by about 104%, while claims for other causes of sickness increased by 60%. The intangible costs of back pain and disability affecting the individual are likely to be considerable. When the problem has become chronic and intractable after about six months, the individual’s function and social activities may become severely curtailed. The General Practitioner is the key worker for back pain patients, and recent data suggests that these account for between 5.8 to 8.6 million consultations every year. Most consultations are associated with a prescription for medication, and advice to rest, despite the fact that the evidence is heavily weighted towards early resumption of normal activities. The processes are not well understood and treatment therefore is usually palliative. High quality outcome research is hampered by a number of problems, such as diagnostic ambiguity, and the powerful effect of a placebo in reducing pain. There is some evidence of the usefulness of spinal manipulation, exercise and patient education to reduce back pain disability, although more research is needed to clarify which particular interventions are most effective for which category of problem. In the UK, the use of 900,000 hospital bed days each year for back pain patients requires careful review. Hospitalisation is not only expensive, but also in combination with prolonged bed rest and excessive investigations may be harmful, unless surgery is clearly indicated. Risk factors for back pain include manual handling, static postures, vibration exposure and smoking. Both physical and psychosocial factors in the workplace have been linked with back pain. A number of intervention studies have indicated that both primary and secondary prevention of back pain and injuries in the workplace can be cost effective, but this work is incomplete. Once the back pain has become chronic, more aggressive rehabilitation programmes appear to be the most effective way of returning individuals to their previous occupation. The goal is to reduce the disability that may result from mechanical lower back pain by appropriate active management. Reviews of the literature have pointed to more effective approaches to managing the problem of common low back pain, but these now need to be translated into practice to ensure that resources are used effectively.back pain, expenditure, cost

A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial)

BACKGROUND: Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven. METHODS AND DESIGN: This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants' experiences of the interventions and trial participation, and to inform interpretation of the quantitative data. Planned analysis will be by intention to treat (quantitative data) and thematic analysis (qualitative data) DISCUSSION: The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP. TRIAL REGISTRATION: Current controlled trial ISRCTN1759209

An investigation of the factors which influence the degree of patient involvement in the physiotherapeutic consultation

The term patient involvement is widely used within the physiotherapy vocabulary, yet it is poorly defined and understood. Little is known about NHS physiotherapists’ attitudes, knowledge or skills regarding patient involvement. The aims of this thesis were therefore to: i) identify the attributes which define the concept of patient involvement in physiotherapy using a method of concept analysis; ii) investigate physiotherapists’ attitudes towards the involvement of patients by means of a national survey; iii) explore patients’ attitudes towards their involvement in the physiotherapy consultation using a local survey; iv) explore physiotherapists’ ability to recognise effective practice in patient involvement by means of a regional study using video vignettes of simulated consultations; v) ascertain to what extent physiotherapists involve patients in their physiotherapy care by means of an in-depth local observational study.EThOS - Electronic Theses Online ServiceHull and East Yorkshire Hospitals NHS Trust (Sponsor)GBUnited Kingdo