Challenges in delivering optimal care for low back pain in Nepal

Low back pain (LBP) is the leading cause of disability worldwide. Delivering optimal healthcare for LBP is particularly challenging in low- and middle-income countries (LMICs)

Crosstalk between circadian rhythms, sleep and eating habits to improve public health

Lifestyle changes in the past few decades have resulted in irregularity in sleep and meal timings. People are taking less sleep and resorting more to unhealthy food and eating habits. These factors are the most important health determinants. Sleep, food choices and eating habits are closely associated with each other. Thus, the crosstalk between circadian rhythms, sleep, and food needs urgent attention and discussion for better health management. Various research studies indicate that a healthy trend in sleep augments the regularity in meal timings and good eating habits. Healthy food and eating habits, in turn, boost sleep quality. Deterioration in the quality of anyone adversely affects the other. Several health disorders like obesity, diabetes, cancer, cardiovascular problems, and low immunity can be linked to these disturbances. The present review considers several previous studies to point out the inter-relationship between sleep and eating habits and the various health disorders arising from poor attention. Poor sleep promotes the tendency to eat junk food or eat at odd times, such as snacking late at night, leading to weight gain and other health problems. Junk food and unhealthy eating habits cause sleep disturbances. This inter-relationship of sleep and food preferences is important as it can have important treatment implications for health disorders arising due to these modifiable behavioural factors. Circadian alignment, improvements in sleep timings, and healthy eating habits have positive effects on other health behaviours as well. 

Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

Objective To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain. Results 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4). Conclusion Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain. Practice implications Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.Dr Mary O'Keeffe is supported by funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 75049

Translation and cross-cultural adaptation of Nepali versions of the patient-reported outcomes measurement information system (PROMIS®) pain intensity, pain interference, pain behavior, depression, and sleep disturbance short forms in chronic musculoskeletal pain

Purpose: The Patient-Reported Outcomes Meaurement Information System (PROMIS®) measures have been translated into many languages and have been shown to have strong measurement properties across a wide range of clinical conditions. However, Nepali translations of the PROMIS short forms are not yet available. The aim of this study was to translate and cross-culturally adapt the PROMIS Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms into Nepali. Methods: We used the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which incorporated two forward translations, synthesis of the translations, a back-translation, and three independent reviews, harmonization, cognitive debriefing, revisions, and proof reading. The translation and review teams were fluent in Nepali and English and represented five different countries and four continents. We evaluated the short forms for comprehensibility and relevance (two key aspects of the content validity of an instrument), conducting cognitive debriefing with six adults with chronic musculoskeletal pain, in compliance with recommendations by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The final version was proofread by two native Nepali speakers before and three new proofreaders after cognitive debriefing. Results: All five short forms were successfully translated and cross-culturally adapted into Nepali while maintaining equivalence to the source. Conclusions: The translation and review team, along with a sample from the target population with chronic musculoskeletal pain and the proofreaders considered all five PROMIS short forms relevant and comprehensible. An important next step is to evaluate the measurement properties of these instruments

Global Media Coverage of the Benefits and Harms of Early Detection Tests

This cross-sectional study examines global media coverage of the benefits and harms of early detection tests for asymptomatic individuals

Overdiagnosis in low back pain

This thesis is organised into eight chapters. It is written so that each chapter can be read independently and has its own reference list. Four of the eight chapters have been published in peer-reviewed scientific journals. The University of Sydney permits the published papers that arose during the candidature to be included in the thesis. Chapter One introduces the problem of overdiagnosis in low back pain, and presents gaps in knowledge, which this thesis aimed to address. Chapter Two is a systematic review of 69 qualitative studies on clinician and patient beliefs about diagnostic imaging for low back pain. This manuscript is presented as published in British Medical Journal Open. Chapter Three highlights challenges in managing low back pain in low- and middle-income countries, using Nepal as an example. This manuscript is presented as published in the Journal of Global Health. Chapter Four is a randomised controlled trial of 418 members of the public testing the effect of information format on intention and beliefs regarding diagnostic imaging for non-specific low back pain. This manuscript is presented as published in the Patient Education and Counselling. Chapter Five is a focus group study of community response to a public health campaign aimed at reducing unnecessary diagnostic imaging for low back pain. This manuscript is presented as published in the Health Expectations. Chapter Six is a controlled experimental study with BABA design to determine the effect of a waiting room communication strategy to raise awareness of potential harms of unnecessary imaging on lumbar imaging rates in the Emergency Department. This manuscript is presented as submitted to Annals of Behavioural Medicine. Chapter Seven is a retrospective analysis of electronic medical record data on care for low back pain in three emergency departments in Sydney before and during the COVID-19 pandemic. This manuscript is presented as submitted to The Spine Journal. Chapter Eight summarises the main findings of this thesis and makes recommendations for future research and practice

A look into the challenges and complexities of managing low back pain in Mexico

Low back pain is a global health problem. In Mexico it is one of the most common musculoskeletal conditions as well as the leading cause of disability. This review provides an overview of the challenges and complexities of managing low back pain in Mexico. It begins with an explanation of the Mexican healthcare system and an overview of the burden of low back pain. Usual care for low back pain in Mexico is then contrasted with recommended best practice care to highlight common evidence-practice gaps and drivers of poor care. Finally, solutions are proposed based on positive experiences from other countries. Delving into the Mexican health framework and the burden of low back pain will provide a better understanding of why it is important to pay attention to this musculoskeletal disorder. Potential steps required to reduce the burden are also outlined to benefit not only the people suffering from low back pain but also the Mexican economy and society

Translation and cross-cultural adaptation of Nepali versions of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms in chronic musculoskeletal pain

Purpose: The Patient-Reported Outcomes Meaurement Information System (PROMIS®) measures have been translated into many languages and have been shown to have strong measurement properties across a wide range of clinical conditions. However, Nepali translations of the PROMIS short forms are not yet available. The aim of this study was to translate and cross-culturally adapt the PROMIS Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms into Nepali. Methods: We used the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which incorporated two forward translations, synthesis of the translations, a back-translation, and three independent reviews, harmonization, cognitive debriefing, revisions, and proof reading. The translation and review teams were fluent in Nepali and English and represented five different countries and four continents. We evaluated the short forms for comprehensibility and relevance (two key aspects of the content validity of an instrument), conducting cognitive debriefing with six adults with chronic musculoskeletal pain, in compliance with recommendations by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The final version was proofread by two native Nepali speakers before and three new proofreaders after cognitive debriefing. Results: All five short forms were successfully translated and cross-culturally adapted into Nepali while maintaining equivalence to the source. Conclusions: The translation and review team, along with a sample from the target population with chronic musculoskeletal pain and the proofreaders considered all five PROMIS short forms relevant and comprehensible. An important next step is to evaluate the measurement properties of these instruments