Competitive Adsorption of Surfactants and Polymers at the Free Water Surface. A Computer Simulation Study of the Sodium Dodecyl Sulfate- Poly(ethylene oxide) System

International audienc

Adsorption of Poly(ethylene-oxide) at the Free Water Surface. A Computer Simulation Study

International audienc

ADHERENCE TO PRESCRIBED EXERCISE AND CLINICAL OUTCOMES IN PEOPLE WITH CHRONIC NONSPECIFIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND Exercise is widely accepted as a first-line treatment for chronic non-specific low back pain (CNSLBP). However, the benefits of exercise diminish over time, as does adherence to exercise. It is unclear whether greater exercise adherence is associated with improvements in pain intensity (PI) and functional limitation (FL). We explored the relationship between exercise adherence and patient-reported outcomes in people with CNSLBP. METHODS We conducted a secondary analysis of the Cochrane systematic review, ‘Exercise therapy for chronic low back pain’, using a subset of 24 trials that measured exercise adherence compared to usual care. Random-effects meta-analysis was performed in R for PI and FL at the closest time point post-intervention. We used predefined subgroups of exercise adherence of ‘Good’ (90-100%), ‘Moderate’ (70-89%), or ‘Poor’ (14-69%) adherence. We used the risk of bias judgements provided by Cochrane. RESULTS All trials included were deemed low risk of bias. Compared to usual care, ‘Good’ adherence was associated with reduced PI by 17.83 points on a 100-point scale (95% CI -26.23 to -9.43; I2 = 81.7%) and FL by 9.69 points on a 100-point scale (95% CI -12.64 to -6.74; I2 = 18.9%). ‘Moderate’ adherence was associated with reduced PI by 6.93 points (95% CI -10.43 to -3.44; I2 = 18.3%) and FL by 3.80 points (95% CI -6.10 to -1.49; I2 = 0%). ‘Low’ adherence was associated with reduced PI by 7.50 points (95% CI -19.83 to -4.84; I2 = 89.7%) and FL by 3.35 points (95% CI -10.45 to -3.74; I2 = 82.7%). CONCLUSIONS Greater adherence to exercise is associated with greater improvements in PI and FL in adults with CNSLBP. Further research is needed to understand the causal effect of adherence on patient-reported outcomes. Better reporting of this potentially important exercise parameter in randomised trials is also needed

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence.

Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP

Are Exercise Interventions in Clinical Trials for Chronic Low Back Pain Dosed Appropriately to Meet the World Health Organization's Physical Activity Guidelines?

Objective This study aimed to estimate the proportion of exercise interventions tested in clinical trials of people with chronic low back pain (CLBP) that meet the World Health Organisation’s (WHO) physical activity guidelines. Methods A secondary analysis of the 2021 Cochrane review of exercise therapy for CLBP was performed. Data from each study was extracted by one reviewer and checked by a second reviewer. Data extracted related to the frequency, duration and intensity of each exercise intervention and the proportion of exercise interventions that met the WHO’s physical activity guidelines (aerobic, muscle strengthening, or both) were determined. Results The 249 included trials comprised 426 exercise interventions. Few interventions reported an exercise type and dose consistent with the WHO guidelines (aerobic: 1.6%, muscle strengthening: 5.6%, both: 1.6%). Poor reporting of exercise intensity limited our ability to determine whether interventions met the guidelines. Conclusion Few interventions tested in clinical trials for people with CLBP prescribe an exercise type and dose consistent with the WHO guidelines. Therefore, they do not appear sufficiently dosed to achieve broader health outcomes. Future trials should investigate the effect of WHO guideline-recommended exercise interventions on patient-reported outcomes (pain and disability) as well as health-related outcomes in people with CLBP. Impact This exploratory analysis showed the lack of exercise interventions in the CLBP literature that meet the WHO’s physical activity guidelines. With people in chronic pain groups, such as people with CLBP, being at higher risk for non-communicable disease, it appears this is a key consideration for exercise practitioners when designing interventions for people with CLBP