A systematic review and meta-synthesis of the impact of low back pain on people's lives

Copyright @ 2014 Froud et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Low back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people’s lives. Methods - Two reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people’s experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach. Results - We included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly. Conclusions - The social component of the biopsychosocial model is not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients’ experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.Arthritis Research U

Prediction of breast self-examination in a sample of Iranian women: an application of the Health Belief Model

<p>Abstract</p> <p>Background</p> <p>Iranian women, many of whom live in small cities, have limited access to mammography and clinical breast examinations. Thus, breast self examination (BSE) becomes an important and necessary approach to detecting this disease in its early stages in order to limit its resultant morbidity and mortality. This study examined constructs arising from the Health Belief Model as predictors of breast self examination behavior in a sample of women living in Bandar Abbas, Iran.</p> <p>Methods</p> <p>This study was conducted in eight health centers located in Bandar Abbas, Iran. The sample consisted of 240 eligible women who were selected from referrals to the centers. The inclusion criteria were as follows: aged 30 years and over; and able to read and write Farsi. Women with breast cancer, who were pregnant, or breast feeding, were excluded from the study. Data were collected by using a self administered questionnaire which included demographic characteristics and Champion's Health Belief Model Scale. This instrument measures the concepts of disease susceptibility (3 items), seriousness (6 items), benefits (4 items), barriers (8 items) and self-efficacy (10 items).</p> <p>Results</p> <p>The subjects' mean age was 37.2 (SD = 6.1) years. Just under a third of the subjects (31.7%) had performed BSE in the past and 7.1% of them performed it at least monthly. Perceived benefits and perceived self-efficacy of the women who performed BSE were significantly higher compared with women who did not practice BSE (p < 0.03). Furthermore, perceived barriers were lower among those who had performed BSE (p < 0.001). Logistic regression analysis indicated that women who perceived fewer barriers (OR: 0.70, 95% CI: 0.63-0.77, p < 0.001) and had higher self-efficacy (OR: 1.08, 95% CI: 1.02-1.13, p = 0.003) were more likely to perform BSE (R²= 0.52).</p> <p>Conclusion</p> <p>Findings from this study indicated that perceived barriers and perceived self-efficacy could be predictors of BSE behavior among the sample of women. Therefore, BSE training programs that emphasize self-efficacy and address perceived barriers are recommended.</p

Waterpipe smoking among health sciences university students in Iran: perceptions, practices and patterns of use

<p>Abstract</p> <p>Background</p> <p>In recent years waterpipe smoking has become a popular practice amongst young adults in eastern Mediterranean countries, including Iran. The aim of this study was to assess waterpipe smoking perceptions and practices among first-year health sciences university students in Iran and to identify factors associated with the initiation and maintenance of waterpipe use in this population.</p> <p>Results</p> <p>Out of 371 first-year health sciences students surveyed, 358 eight students completed a self-administered questionnaire in the classrooms describing their use and perceptions towards waterpipe smoking. Two hundred and ninety six responders met study inclusion criteria. Waterpipe smoking was common among first-year health sciences university students, with 51% of students indicating they were current waterpipe smokers. Women were smoking waterpipes almost as frequently as men (48% versus 52%, respectively). The majority of waterpipe smokers (75.5%) indicated that the fun and social aspect of waterpipe use was the main motivating factor for them to continue smoking. Of waterpipe smokers, 55.3% were occasional smokers, using waterpipes once a month or less, while 44.7% were frequent smokers, using waterpipes more than once a month. A large number of frequent waterpipe smokers perceived that waterpipe smoking was a healthier way to use tobacco (40.6%) while only 20.6% thought it was addictive. Compared to occasional smokers, significantly more frequent smokers reported waterpipe smoking was relaxing (62.5% vs. 26.2%, <it>p </it>= 0.002), energizing (48.5% vs. 11.4%, <it>p </it>= 0.001), a part of their culture (58.8% vs. 34.1%, <it>p </it>= 0.04), and the healthiest way to use tobacco (40.6% vs. 11.1%, <it>p </it>= 0.005).</p> <p>Conclusions</p> <p>Social and recreational use of waterpipes is widespread among first-year health sciences university students in Iran. Women and men were almost equally likely to be current waterpipe users. Public health initiatives to combat the increasing use of waterpipes among university students in Iran must consider the equal gender distribution and its perception by many waterpipe smokers as being a healthier and non-addictive way to use tobacco.</p

A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥18 years) population with chronic (≥12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP

Educational intervention for promoting stretching exercise behavior among a sample of Iranian office employees: applying the Health Promotion Model

Mohammad Hossein Delshad,1 Sedigheh Sadat Tavafian,1 Anoshirvan Kazemnejad2 1Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; 2Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Introduction: Health Promotion Model (HPM) is one comprehensive model by which health behavior predicting factors could be determined.Purpose: This study aimed to investigate the effects of a designed interventional program based on HPM on promoting stretching exercise (SE) behavior among office employees.Patients and methods: This interventional designed study was carried out on 87 office employees who were working in the three health networks affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. These participants were randomly divided into intervention group (N=44) who complied with educational program based on HPM and control group (N=43) who did not receive the program. The data were collected through a demographic questionnaire and a researcher-made questionnaire based on HPM at three times of baseline, 3- and 6-month follow-ups and analyzed using SPSS version 19.Results: Totally, 40 office employees with mean age of (37.70&plusmn;7.40) in intervention and 37 ones with mean age of (35.97&plusmn;7.34) in control group were assessed. At baseline, both groups were the same regarding the HPM constructs of perceived barriers, perceived self-efficacy, commitment to plan, and interpersonal influences (P&gt;0.05). However, following intervention, there was a significant difference between two groups during 6-month follow-up in all these predictor factors (P&lt;0.0001). Furthermore, the mean score of SE behavior in intervention group (22.43&plusmn;6.50) was significantly better than the control group (15.45&plusmn;0.93) (P&lt;0.001). The pain severity also in intervention group (1&plusmn;1.22) also was significantly less than control group (2&plusmn;2.03) after 6-month follow-up (P&lt;0.001).Conclusion: The SE educational programs applied in this study were effective for promoting SE among office employees. Keywords: educational intervention, stretching exercises, Health Promotion Model, office employees &nbsp

Chronic low back pain, nurses, mental health, educational intervention

Introduction: Chronic back pain is a prevalent health problem in nursing job. The aim of this study was to determine the effect of interventional education based on psychological factors among nurses suffering from chronic low back pain. Methods: This study is a quasi-experimental research. The population of this study consisted of 84 nurses suffering from chronic back pain and working in Valiasser hospital in Tehran.The recruited nurses were randomly assigned into two groups of intervention and control (each 42 individuals). Three scales of pain assessment, mental health and quality of life were used to collect data at beginning of the study and three months after educational. Data were analyzed using descriptive and inferential statistics. Results: Totally 82 nurses (each group with 42 nurses) with mean age of 32 and 31.5 years in intervention and control group took part in the study. Two groups were not significantly different before intervention (P> 0/05). After the intervention in comparison with before, the mean scores of &nbsp;vitality were improved from 64/64 to 77/26, mental health from &nbsp;70/28 to 80/95, role limitations due to emotional problems from 64/28 to 87/30 and social performance from 69/64 to 85/11 indicating a significant effect of education (P<0/0001). Conclusion: According to the findings of this study educational interventions based on psychological factors could improve back pain and increase mental health in nurses

Patient’s Knowledge, Perception and Belief about the Reasons of Low Back Pain

Patients with chronic low back pain (LBP) hold various knowledge, perceptions and beliefs about their pain which are based on prior learning and social conditions. Since LBP is a bio- psycho-social phenomenon and there are not any reports about awareness and attitude of Iranian patients’ views regarding it, this descriptive study was employed to earn this information P to apply its results in health education planning. For data gathering, deeply interviewing with 24 patients were performed. Volunteer patients were from Rheumatology Research Center of Tehran University of Medical Science from July 1st to Sep 1st 2003 who had inclusive criteria such as: 18 years old or more, suffering from LBP more than 90 d and not having experience of surgical operation in last two years. Interviews were individually held at rheumatic disease center which was convenient to the participants and were being continued to earn data saturation regarding patient’s knowledge, perception and belief about LBP. The findings showed that the most popular risky behavior for LBP was hard manual activities, also this study revealed that knowledge of the patients about LBP and its risk factors was little and LBP was not understood by the majority of patients (74%).Only a few people (11%) believed risk factors and risky behaviors could deteriorate it. From this study it can be concluded that health educators should emphasize on perception and attitude of the patients regarding LBP for changing behavior and complying of recommended body mechanics