Smartphone apps for the self-management of low back pain: A systematic review

Guidelines for low back pain (LBP) often recommend the use of self-management such as unsupervised exercise, booklets, and online education. Another potentially useful way for patients to self-manage LBP is by using smartphone applications (apps). However, to date, there has been no rigorous evaluation of LBP apps and no guidance for consumers on how to select high-quality, evidence-based apps. This chapter reviews smartphone apps for the self-management of LBP and evaluates their content quality and whether they recommend evidence-based interventions. This chapter shows that generally app developers are selecting interventions that are endorsed by guidelines, although their quality is low. There are many apps available for the self-management of LBP, but their effectiveness in improving patient outcomes has not been rigorously assessed. App developers need to work closely with healthcare professionals, researchers, and patients to ensure app content is accurate, evidence based, and engaging

Skuteczność leczenia niespecyficznego bólu dolnego odcinka kręgosłupa: metaanaliza randomizowanych badań kontrolowanych placebo

Cel. Wyniki leczenia oceniane w randomizowanych badaniach kontrolowanych placebo są bardziej wiarygodne niż w badaniach o innej konstrukcji. Celem poniższej metaanalizy była ocena skuteczności różnych sposobów leczenia stosowanych w niespecyficznym bólu dolnego odcinka kręgosłupa na podstawie wyników randomizowanych badań kontrolowanych placebo. Metoda. Przeszukano bazy danych Medline, Embase, Cinahl, PsychInfo i Cochrane Central Register of Controlled Trials pod kątem odpowiednio dobranych badań — od najnowszych, do opublikowanych w październiku 2006 roku. Wyniki dotyczące bólu ciągłego przeliczono według wspólnej skali 0–100 i skomasowano z wykorzystaniem modelu losowego (random effects model). Wyniki. Analizą objęto 76 badań oceniających 34 sposoby leczenia. Istotne efekty wykazano w 50% ocenianych sposobów leczenia. W większości przypadków efekty były niewielkie lub umiarkowane: 47% wykazywało estymację punktową efektów leczenia poniżej 10 punktów w skali 100-punktowej, 38% — 10–20 punktów, a 15% — ponad 20 punktów. Tylko w jednym badaniu stwierdzono wyraźne efekty leczenia (> 20 pkt.). Wnioski. W poniższej metaanalizie dowiedziono, że efekt przeciwbólowy wielu sposobów leczenia niespecyficznego bólu dolnego odcinka kręgosłupa jest niewielki i nie różni się w populacjach z objawami ostrymi i przewlekłymi. Polski Przegląd Neurologiczny 2010; 6 (2): 105–11

Causal mechanisms in the clinical course and treatment of back pain

In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

Purpose The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40° and 90° Cobb angle. Methods From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with ≥70 % agreement. Data were analyzed qualitatively and quantitatively. Results Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of <80 % for 40°–70° curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre- and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning. Conclusions International consensus was found on many aspects of what does and does not constitute optimal operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future researchpublished_or_final_versio

HAPPi Kneecaps! Protocol for a participant- and assessor-blinded, randomised, parallel group feasibility trial of foot orthoses for adolescents with patellofemoral pain

BACKGROUND: Patellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of th