Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study

Objectives: To assess if body function, activity, participation, health-related quality of life and lifestyle behavioural factors can predict activity limitation in women with chronic low back pain (CLBP) in primary healthcare (PHC) 2 years later. Design: A 2-year prospective longitudinal cohort study within PHC. Settings: PHC in southwestern Sweden. Participants: The cohort comprised 130 women with CLBP attending PHC at baseline 2004-2005 and were reassessed after 2 years. Measures: The dependent outcome variable was self-reported activity limitation (Roland Morris disability questionnaire (RMDQ)) at 2-year follow-up. Independent predictors at baseline were age, body mass index, smoking, alcohol consumption, sleep quantity and quality, leisure time physical activity, a questionnaire of clinical manifestation of stress (Stress and Crises Inventory (SCI-93)), pain localisation, pain intensity, fatigue, anxiety, depression, RMDQ, work status, private social support, health-related quality of life and measures of physical performance specified as 6 min walk test (6MWT) and hand grip strength. Relation between baseline predictors and variation in later self-reported activity limitation (RMDQ) was analysed using multivariate linear regression. Results: Ninety-five per cent (n=123/130) were followed up after 2 years. The participants were middle-aged (mean 45 (SD 10) years), mostly educated > 9 years (88%; 108/123), mainly living with another adult (76%; 93/122) and born in Sweden (90%; 111/123). Seventy nine per cent (97/123) were categorised as having work ability at baseline. The final prognostic model including 6MWT, SCI-93 and RMDQ at baseline explained 54% of the variance in self-reported activity limitation (RMDQ) at the 2-year follow-up. Conclusions: Lower physical performance, more severe clinical stress symptoms and more severe activity limitation predicted activity limitation after 2 years in women with CLBP within PHC. The results can give guidance for interventional trials aiming to improve physical capacity and decrease stress. The impact of the interaction between prognostic factors and interventions on activity limitation needs further investigation

Predictors for future activity limitation in female patients with chronic low back pain

Introduction: Non-specific chronic low back pain (CLBP) have various impact on body functions, activity and participation in daily life and it is a common cause for consulting primary care.The knowledge about various prognostic factors for the recovery for patients with CLBP is still limited. Purpose/Aim: To investigate prognostic factors for future activity limitation in women with CLBP consulting primary care. Materials and Methods: A prospective longitudinal cohort study. Female patients with CLBP consulting primary care were assessed at baseline and re-assessed after two years. Prognostic factors for self-reported activity limitation related to low back pain were analysed by multivariate regression. Results: At the two years 95 % (n=123/130) were followed up. A walk test, self-reported clinical stress symptoms and activity limitation predicted activity limitation at the two -year follow up. Conclusion(s): Physical performance, self-reported clinical stress and activity limitation at baseline was shown to be of prognostic value for future activity limitation in women with CLBP

Gender differences in care-seeking behavior and health care consumption after work-related whiplash injuries injuries: Arthur Tenenbaum

Background: The aim was to study gender differences in care-seeking behaviour regarding type of facility, time span and type of treatment after work-related motor vehicle trauma (WRMVT) and to investigate the incidence of WRMVT. Methods: - Design: Cross-sectional retrospective study. - Setting: A population-based register in a Swedish county from 1999 to 2008. - Participants: A cohort of 820 persons, 18-65 years of age, involved in traffic accidents, either working at the time of the trauma, or on their way to or from work, resulting in a clinical whiplash diagnosis. Results: Women sought care at primary health care units more often than men, who sought care mainly at hospitals (p = 0.0048). Four percent of the injured persons were treated at hospital. Twelve percent of all patients involved in WRMVT sought care with a delay of at least three days. Women sought care later than men (p = 0.011). There was no difference in gender regarding type of treatment after trauma. Ninety-one percent were treated and discharged and six percent were sent home untreated after examination. Fifty-two percent of the injured persons sought care at primary care units. The annual incidence of WRMVT decreased from 68/100 000 to 43/100 000. Conclusion: The incidence of WRMVT in the rural and urban county declined during 1999-2008. Women sought care at primary care units more often then men. Women sought care later then men after the trauma which may reduce especially women's probability of getting workers compensation. Key messages: • Gender differences exist in WRMVT, women seek primary health care more often, and later than men do which may affect insurance outcomes for women. • The annual incidence of acute whiplash disorders due to WRMVT decreased from 68/100 000 to 43/100 000 inhabitants annually between 1999 to 2008

Воздействие менталитета белорусов на интеграционные процессы Беларуси на культурно-цивилизационной оси "Восток-Запад"

BACKGROUND: Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. METHODS: An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test. RESULTS: 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes. CONCLUSIONS: A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected

Low back pain and widespread pain in primary health care: Early access to physical therapy, treatment and prognostic factors

Abstract Low back pain (LBP) and widespread pain (WP) are common and incur considerable costs to society mainly due to work disability. Identification of prognostic factors, intervention and early access to care seems important for influencing and preventing pain and disability in LBP and WP but further knowledge is warranted. The overall purpose of the present thesis was to obtain knowledge about a) prevalence and characteristics for WP in chronic LBP (CLBP), b) prognostic factors for activity and work status, c) the effect of function based intervention on health status and body functions in patients with WP or fibromyalgia, and d) the effect of early access to physical therapy for subacute LBP. Study I The purpose was to estimate the prevalence of WP according to the American College of Rheumatology (ACR) 1990 criteria in women with CLBP consulting primary health care and to evaluate differences in body function, activity, participation, environmental factors, healthrelated quality of life and other health-related aspects between patients having CLBP with or without simultaneous WP. One hundred and thirty patients with CLBP were included in this cross-sectional study. Twenty-eight percent of the CLBP patients fulfilled the ACR’s criteria of WP. The CLBP+WP group showed significantly more severe impairments in body functions, more severe activity limitations, and participation restrictions (p<0.05). Moreover, the CLBP+WP group reported significantly more negative environmental impact in terms of private social support, lower health-related quality of life and other health-related aspects compared to the CLBP group (p<0.05). Study II This two-year prospective longitudinal cohort study of female patients with CLBP within primary health care investigated changes in body functions, activity, participation, environmental and other health-related factors. Prognostic factors were identified for activity and participation at the two-year follow-up. Ninety five percent (123/130) of the patients included in Study I were followed up at two years. Prognostic factors for later activity limitation (Roland Morris disability questionnaire (RMDQ)) and work ability (yes/no) were analyzed by multivariate regression analyses. Twenty eight percent (n=34) fulfilled the criteria of WP at the first assessment and 29% (n= 36) at the two-year follow-up. The 6-minute walk test (6MWT) predicted both future activity limitation and work ability. Other variables with predictive ability for activity limitation were the Örebro musculoskeletal pain screening questionnaire (ÖMPSQ) and Stress and Crises Inventory (SCI-93). Higher performance in the 6MWT, earlier work ability and lower scores in the Hospital Anxiety and Depression Scale, depression (HADS-D) predicted work ability after two years. These three factors were used to construct a nomogram for assessing the probability for future work ability. Study III The purpose was to evaluate the effect of pool exercise in patients with fibromyalgia (FM) or WP and to determine characteristics influencing the effects of treatment. A total of 134 women with FM and 32 with WP were randomized to a 20-session pool exercise and a 6-session education program or to a control group undertaking the same education program. The primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ) total score and the 6MWT. The FIQ-total (p = 0.04) improved in the intervention group, with an effect size of 0.32. Patients who had participated in at least 60% of the exercise sessions improved in the FIQ-total (effect size 0.44), the 6MWT (effect size 0.43) and FIQ-pain (effect size 0.69) compared with controls (p < 0.05). The exercise-education program showed significant, but small, improvement in health status in patients with FM and WP, compared with education only. Patients with milder symptoms improved most with this treatment. Study IV The purpose was to evaluate the effect of early access to physical therapy treatment for patients with subacute LBP compared to access with a four-week waiting list. Sixty consecutive primary health care patients with subacute LBP were randomized either to early access (EA) within two days for physical examination and individualized physical therapy treatment (n=32) or a control group (CG) with a four-week waiting list (n=28). The primary outcome measure was pain intensity (Borg’s category scale for ratings of perceived pain). Secondary outcomes included ÖMPSQ, RMDQ, sick-leave, visits to health care and physical therapy. No significant differences in pain between the groups were shown at discharge. At 6 months, the reduction of pain was significantly greater in the EA compared to the CG (p=0.025) indicating that early access to physical therapy resulted in greater improvement in perceived pain at 6 months compared to later access. Conclusions The presence of widespread pain was found to negatively impact body function, activity, participation, environmental factors, health-related quality of life and other health-related aspects, and should therefore be assessed in female patients with chronic low back pain. Lower performance in walk test (6MWT), higher risk scores for future disability (ÖMPSQ) and more severe clinical stress symptoms (SCI-93) predicted activity limitation (RMDQ) at the two-year follow-up. Higher performance in walk test (6MWT), lower level of distress (HADS-D) and earlier work ability predicted future work ability. Probability of future work ability could be assessed by calculations based on these three factors (a nomogram). Education combined with pool exercise was found to improve the health status of patients with widespread pain or fibromyalgia and should be considered as an intervention alternative for these patient groups. Early access to examination and individualized physical therapy treatment indicated clinical improvement for patients with subacute low back pain. An early physical therapist access model should be considered for the management of patients with low back pain in primary health care. Keywords: Low back pain, widespread pain, fibromyalgia, physical therapy, primary health care, treatment, exercise therapy, education, early access, outcome assessment (health care) prognostic factors. Copyright Lena Nordeman ISBN 978-91-628-8235-

Predictors for future activity limitation in female patients with chronic low back pain

Introduction: Non-specific chronic low back pain (CLBP) have various impact on body functions, activity and participation in daily life and it is a common cause for consulting primary care.The knowledge about various prognostic factors for the recovery for patients with CLBP is still limited. Purpose/Aim: To investigate prognostic factors for future activity limitation in women with CLBP consulting primary care. Materials and Methods: A prospective longitudinal cohort study. Female patients with CLBP consulting primary care were assessed at baseline and re-assessed after two years. Prognostic factors for self-reported activity limitation related to low back pain were analysed by multivariate regression. Results: At the two years 95 % (n=123/130) were followed up. A walk test, self-reported clinical stress symptoms and activity limitation predicted activity limitation at the two -year follow up. Conclusion(s): Physical performance, self-reported clinical stress and activity limitation at baseline was shown to be of prognostic value for future activity limitation in women with CLBP

Prevalence and characteristics of widespread pain in female primary health care patients with chronic low back pain

Objectives: To estimate the prevalence of widespread pain (WP) according to the American College of Rheumatology, 1990, in women with chronic low back pain (CLBP) consulting primary health care and to evaluate the differences in body function, activity, participation, environmental factors, health-related quality of life, and other health-related aspects between patients having CLBP with or without WP.\ud \ud Methods: A cross-sectional study of women with CLBP including clinical assessment and questionnaires was conducted. Patients were categorized as having CLBP with or without WP and differences between these groups were evaluated.\ud \ud Results: One hundred thirty patients were assessed. Twenty-eight percent (n=37) had WP. Patients with CLBP+WP showed more impaired physical performance (6-min walk test, handgrip strength), higher numbers of tender points, more severe pain, fatigue, and depression compared with CLBP (P<0.05). The CLBP+WP showed greater activity limitation (P=0.00047). Work disability was 35% (n=13/37) in CLBP+WP compared with 16% (n=15/93) in CLBP (P=0.032). Private social support was negatively impacted in CLBP+WP (P=0.010). The CLBP+WP showed lower health-related quality of life (SF-36) in the physical function, bodily pain, and vitality dimension (P<0.05). More severe clinical stress symptoms and risk for future disability were registered for the CLBP+WP (P<0.001).\ud \ud Discussion: Twenty-eight percent fulfilled the American College of Rheumatology 1990 criteria for WP. When WP was present, patients reported significantly more impaired body functions, more severe activity limitations, and participation restrictions. Environmental factors, health-related quality of life, and other health-related aspects were also negatively impacted. It is suggested that the presence of WP should be evaluated in female patients with CLBP

Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study

Objectives: To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care.\ud \ud Methods: A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression.\ud \ud Results: A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability.\ud \ud Discussion: The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years