Prognostic factors and underlying mechanisms in chronic low back pain

Nonspecific chronic low back pain (CLBP) is generally approached from a biopsychosocial perspective. A variety of multidisciplinary treatments has been developed aimed at improving activity and participation of subjects with CLBP, but effectiveness is limited. One of the explanations could be the heterogeneity of the CLBP population, which makes it unlikely that all patients will benefit from the same generic treatment. As such, more insight is needed in the role of underlying biopsychosocial mechanisms in subjects with CLBP. Knowledge of these aspects is expected to provide a better match of treatment to the patient’s characteristics and improve the effectiveness of multidisciplinary treatments. The main aim of this thesis is to gain insight in these mechanisms, both in relation to treatment outcome, as in differences with respect to asymptomatic controls

Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome

Objectives: (1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. Methods: Data were derived from a randomized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care. The primary outcome measure was the Roland and Morris Disability Questionnaire and secondary outcomes were the Physical and Mental Component Summary Scales, derived from the Short Form Health Survey. Outcomes were expressed as the differences between baseline and follow-up (8 wk and 6 mo) values. A confirmatory and an exploratory model were defined. Baseline predictors included in the confirmatory model were pain intensity, work status, and Multidimensional Pain Inventory subgroup membership. The exploratory model included sick leave, compensation, depression, and fear-avoidance beliefs. Statistical analysis was performed using multiple linear regression analysis. Results: One hundred and sixty-three patients participated in the study. More pain was prognostic for more improvement in the rehabilitation group. No value was found for work status or the Multidimensional Pain Inventory subgroups. For the exploratory model, more depression and fear-avoidance beliefs predicted more improvement after rehabilitation. The explained variance ranged from 18.5% to 43.8% depending on the length of follow-up evaluation, the treatment group, and the outcome variable of interest. Discussion: The results of this study do not support the construction of a clinical prediction model. Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors

Targeted social care for highly vulnerable pregnant women: Protocol of the Mothers of Rotterdam cohort study

Introduction: Social vulnerability is known to be related to ill health. When a pregnant woman is socially vulnerable, the ill health does not only affect herself, but also the health and development of her (unborn) child. To optimise care for highly vulnerable pregnant women, in Rotterdam, a holistic programme was developed in close collaboration between the university hospital, the local government and a non-profit organisation. This programme aims to organise social and medical care from pregnancy until the second birthday of the child, while targeting adult and child issues simultaneously. In 2014, a pilot in the municipality of Rotterdam demonstrated the significance of this holistic approach for highly vulnerable pregnant women. In the Mothers of Rotterdam' study, we aim to prospectively evaluate the effectiveness of the holistic approach, referred to as targeted social care. Methods and analysis: The Mothers of Rotterdam study is a pragmatic prospective cohort study planning to include 1200 highly vulnerable pregnant women for the comparison between targeted social care and care as usual. Effectiveness will be compared on the following outcomes: (1) child development (does the child show adaptive development at year 1?) and (2) maternal mental health (is maternal distress reduced at the end of the social care programme?). Propensity scores will be used to correct for baseline differences between both social care programmes. Ethics and dissemination: The prospective cohort study was approved by the Erasmus Medical Centre Ethics Committee (ref. no. MEC-2016-012) and the first results of the study are expected to be available in the second half of 2019 through publication in peer-reviewed international journals. Trial registration number NTR6271; Pre-results

Many Labs 2: Investigating Variation in Replicability Across Samples and Settings

We conducted preregistered replications of 28 classic and contemporary published findings, with protocols that were peer reviewed in advance, to examine variation in effect magnitudes across samples and settings. Each protocol was administered to approximately half of 125 samples that comprised 15,305 participants from 36 countries and territories. Using the conventional criterion of statistical significance (p < .05), we found that 15 (54%) of the replications provided evidence of a statistically significant effect in the same direction as the original finding. With a strict significance criterion (p < .0001), 14 (50%) of the replications still provided such evidence, a reflection of the extremely highpowered design. Seven (25%) of the replications yielded effect sizes larger than the original ones, and 21 (75%) yielded effect sizes smaller than the original ones. The median comparable Cohen’s ds were 0.60 for the original findings and 0.15 for the replications. The effect sizes were small (< 0.20) in 16 of the replications (57%), and 9 effects (32%) were in the direction opposite the direction of the original effect. Across settings, the Q statistic indicated significant heterogeneity in 11 (39%) of the replication effects, and most of those were among the findings with the largest overall effect sizes; only 1 effect that was near zero in the aggregate showed significant heterogeneity according to this measure. Only 1 effect had a tau value greater than .20, an indication of moderate heterogeneity. Eight others had tau values near or slightly above .10, an indication of slight heterogeneity. Moderation tests indicated that very little heterogeneity was attributable to the order in which the tasks were performed or whether the tasks were administered in lab versus online. Exploratory comparisons revealed little heterogeneity between Western, educated, industrialized, rich, and democratic (WEIRD) cultures and less WEIRD cultures (i.e., cultures with relatively high and low WEIRDness scores, respectively). Cumulatively, variability in the observed effect sizes was attributable more to the effect being studied than to the sample or setting in which it was studied.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Haagse kansrijke start: Onderzoek naar de ondersteuningsbehoeften in het ouderschap bij aanstaande ouders en ouders met jonge kinderen

Onderzoek naar de ondersteuningsbehoeften in het ouderschap bij aanstaande ouders en ouders met jonge kinderen. Het kenniscentrum GUTS heeft vanuit het lectoraat Jeugdhulp in transformatie een onderzoek uitgevoerd en dit rapport gepubliceerd. Hierbinnen is gebruik gemaakt van het thema lab Kansrijke Start van het Living Lab Publieke Gezondheid van het Kenniscentrum -Health Innovation van De Haagse Hogeschool. Een mooie co- creatie van 2 kenniscentr

A Systematic Review of Sociodemographic, Physical, and Psychological Predictors of Multidisciplinary Rehabilitation—or, Back School Treatment Outcome in Patients With Chronic Low Back Pain

Objective. To determine predictors of outcome of multidisciplinary rehabilitation–or back school treatment for patients with chronic low back pain. Summary of Background Data. Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. Methods. Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. Results. Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain-> worse outcome), several work-related parameters (e.g., high satisfaction-> better outcome), and coping style (less active coping-> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. Conclusions. It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors

Feasibility of a Sensor-Based Technological Platform in Assessing Gait and Sleep of In-Hospital Stroke and Incomplete Spinal Cord Injury (iSCI) Patients

Recovery of the walking function is one of the most common rehabilitation goals of neurological patients. Sufficient and adequate sleep is a prerequisite for recovery or training. To objectively monitor patients&rsquo; progress, a combination of different sensors measuring continuously over time is needed. A sensor-based technological platform offers possibilities to monitor gait and sleep. Implementation in clinical practice is of utmost relevance and has scarcely been studied. Therefore, this study examined the feasibility of a sensor-based technological platform within the clinical setting. Participants (12 incomplete spinal cord injury (iSCI), 13 stroke) were asked to wear inertial measurement units (IMUs) around the ankles during daytime and the bed sensor was placed under their mattress for one week. Feasibility was established based on missing data, error cause, and user experience. Percentage of missing measurement days and nights was 14% and 4%, respectively. Main cause of lost measurement days was related to missing IMU sensor data. Participants were not impeded, did not experience any discomfort, and found the sensors easy to use. The sensor-based technological platform is feasible to use within the clinical rehabilitation setting for continuously monitoring gait and sleep of iSCI and stroke patients

Impaired foot placement strategy during walking in people with incomplete spinal cord injury

BACKGROUND: Impaired balance during walking is a common problem in people with incomplete spinal cord injury (iSCI). To improve walking capacity, it is crucial to characterize balance control and how it is affected in this population. The foot placement strategy, a dominant mechanism to maintain balance in the mediolateral (ML) direction during walking, can be affected in people with iSCI due to impaired sensorimotor control. This study aimed to determine if the ML foot placement strategy is impaired in people with iSCI compared to healthy controls. METHODS: People with iSCI (n = 28) and healthy controls (n = 19) performed a two-minute walk test at a self-paced walking speed on an instrumented treadmill. Healthy controls performed one extra test at a fixed speed set at 50% of their preferred speed. To study the foot placement strategy of a participant, linear regression was used to predict the ML foot placement based on the ML center of mass position and velocity. The accuracy of the foot placement strategy was evaluated by the root mean square error between the predicted and actual foot placements and was referred to as foot placement deviation. Independent t-tests were performed to compare foot placement deviation of people with iSCI versus healthy controls walking at two different walking speeds. RESULTS: Foot placement deviation was significantly higher in people with iSCI compared to healthy controls independent of walking speed. Participants with iSCI walking in the self-paced condition exhibited 0.40 cm (51%) and 0.33 cm (38%) higher foot placement deviation compared to healthy controls walking in the self-paced and the fixed-speed 50% condition, respectively. CONCLUSIONS: Higher foot placement deviation in people with iSCI indicates an impaired ML foot placement strategy in individuals with iSCI compared to healthy controls