Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis

Objective: The assumption that low back pain (LBP) patients suffer from “disuse” as a consequence of high fear-avoidance beliefs is currently under debate. A secondary analysis served to investigate whether fear-avoidance beliefs are associated cross-sectionally and longitudinally with the physical activity level (PAL) in LBP patients

Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care

Background: Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods: Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results: More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions: Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial

Determinants for receiving acupuncture for LBP and associated treatments: a prospective cohort study

BACKGROUND: Acupuncture is a frequently used but controversial adjunct to the treatment of chronic low back pain (LBP). Acupuncture is now considered to be effective for chronic LBP and health care systems are pressured to make a decision whether or not acupuncture should be covered. It has been suggested that providing such services might reduce the use of other health care services. Therefore, we explored factors associated with acupuncture treatment for LBP and the relation of acupuncture with other health care services. METHODS: This is a post hoc analysis of a longitudinal prospective cohort study. General practitioners (GPs) recruited consecutive adult patients with LBP. Data on physical function, subjective mood and utilization of health care services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months. RESULTS: A total of 179 (13 %) out of 1,345 patients received acupuncture treatment. The majority of those (59 %) had chronic LBP. Women and elderly patients were more likely to be given acupuncture. Additional determinants of acupuncture therapy were low functional capacity and chronicity of pain. Chronic (vs. acute) back pain OR 1.6 (CL 1.4–2.9) was the only significant disease-related factor associated with the treatment. The strongest predictors for receiving acupuncture were consultation with a GP who offers acupuncture OR 3.5 (CL 2.9–4.1) and consultation with a specialist OR 2.1 (CL 1.9–2.3). After adjustment for patient characteristics, acupuncture remained associated with higher consultation rates and an increased use of other health care services like physiotherapy. CONCLUSION: Receiving acupuncture for LBP depends mostly on the availability of the treatment. It is associated with increased use of other health services even after adjustment for patient characteristics. In our study, we found that receiving acupuncture does not offset the use of other health care resources. A significant proportion of patients who received did not meet the so far only known selection criterion (chonicity). Acupuncture therapy might be a reflection of helplessness in both patients and health care providers

Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

<p>Abstract</p> <p>Background</p> <p>Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.</p> <p>Methods</p> <p>This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months</p> <p>Results</p> <p>A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.</p> <p>Conclusion</p> <p>The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.</p

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer fiveoriginal research questions related to moral judgments, negotiations, and implicit cognition. Participants from two separate large samples (total N > 15,000) were then randomly assigned to complete one version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: materials from different teams renderedstatistically significant effects in opposite directions for four out of five hypotheses, with the narrowest range in estimates being d = -0.37 to +0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for two hypotheses, and a lack of support for three hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, while considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim.</div

Psychologie körperlicher Aktivität bei Patienten mit Rückenschmerzen

Die vorliegende Arbeit setzt sich mit den psychologischen Determinanten und Fördermöglichkeiten von körperlicher Aktivität bei Rückenschmerzpatienten auseinander, wobei Daten einer multizentrischen cluster-randomisierten Studie (N= 1378) genutzt werden. Der theoretische Hintergrund aller Originalarbeiten gibt einen Überblick zu neuen Erkenntnissen zum Rückenschmerz und zur Aktivitätsförderung in der Gesundheitspsychologie und erläutert kurz zugrunde liegende Modelle. In der ersten Originalarbeit zeigt sich mithilfe einer Mehrebenen-Kovarianzanalyse, dass eine motivierende Beratung durch Arzthelferinnen die selbstberichtete körperliche Aktivität nicht stärker verändert als allein eine wiederholte Messung. In der zweiten Originalarbeit wird an der Kohortenstichprobe belegt, dass theoretisch abgeleitete Einflussvariablen wie Depressivität und Fear-Avoidance Beliefs (Angst-Vermeidungs-Überzeugungen) das Ausmaß an Bereitschaft zur Aktivität oder Aktivitätsänderungen innerhalb eines Jahres in dieser Stichprobe überwiegend akuter Rückenschmerzpatienten nicht vorhersagen können. Selbstwirksamkeit bezüglich körperlicher Aktivität erweist sich als ein bedeutsamerer Prädiktor in den Regressionsgleichungen. In der dritten Originalarbeit zeigt sich mithilfe eines Strukturgleichungsmodells in einem Cross-lagged Panel Design an einer Teilstichprobe der Rückenschmerzpatienten mit vollständigen Daten (n= 787), dass der Aktivitätsumfang nach einem Jahr nicht mit der Ausprägung vorangegangenen Fear-Avoidance Beliefs assoziiert ist. Einschränkungen bestehen in der zwar differenziert, aber nur im Selbstbericht erhobenen körperlichen Aktivität sowie in einem angenommenen Attrition-Bias. Es wird der Schluss gezogen, dass körperliche Aktivitätseinschränkungen und damit ein „Rekonditionierungsbedarf“ nicht in dem Maße bei Rückenschmerzpatienten bestehen, wie dies lange angenommen wurde. Der Wirkmechanismus bewegungstherapeutischer Therapieverfahren bedarf weiterer Erforschung. Gesundheitspsychologische individuumszentrierte Aktivitätsförderung sollte über rein kognitive Konstrukte verstärkt auch emotionale State- und Trait-Variablen im Prozess der Verhaltensänderung berücksichtigen

Thermische Speicher mit Phasenwechselmaterialien im Heizsystem

Many hydraulic systems implement thermal storages to profit from the combination of renewable energy and the heating system of a building. They serve as central component of the heating system. To analyze the thermal storage in combination with heating systems for one family houses, a study of the energetic and exergetic behaviour has been made.This PhD study outlines the influence of phase change material (PCM) which is integrated in a thermal storage (buffer storage). Therefore thermal storages are analyzed in dynamic simulations with a one dimensional modelling approach. In the first chapter the basics of thermal storages and the different modelling approaches are described.The models of the thermal storages are developed and validated and measurements of the behaviour of a water- and PCM-storage are made. The existing warm water storage model of the Institute for Energy Efficient Buildings and Indoor Climate was adapted with the help of parameter identification. For example the value of the number of nodes and the effective heat conduction are investigated.The centerpiece of the PCM-model is the implementation of the heat capacity in dependence on the temperature. More elements are the convection between fluid/PCM and the heat conduction inside of the PCM. The three developed PCM-storage-models -- a single plate, a stack and a pebble bed -- are build up with the mentioned elements. The influence on the heat transfer between water/PCM and different discretization numbers are analyzed. The last step is the validation of the PCM-model.In the fifth chapter the different thermal storages (stratified storage, buffer storage and a paraffin and salt hydrate storage) are evaluated in theoretical and dynamical studies. The theoretical potential of the PCM-storage is outlined by energetic and exergetic evaluations. Six hydraulic concepts consisting of boiler/heat pump with radiators or floor heating with/without solar thermal systems and two types of insulation standards from the years 1984 and 2009 are simulated and their energetic and exergetic behaviour is analyzed. The results show that the systems with salt hydrate have the lowest primary energy demand. The integration of a paraffin storage leads to the second lowest demand. The third one is the concept with a stratified storage and the last ones are the concepts with a buffer storage.It is not always possible to distinguish between the systems by their thermal efficiency or exergetic behaviour. Indeed the exergetic behaviour of the systems is sometimes equal. If the boundary is set up directly around the storage, it can be seen that the exergetic losses of the storage are different for each storage concept