Psychosocial factors associated with an MRI diagnosis of chronic non-specific low back pain in Saudi Arabia

Introduction In patients with chronic low back pain, psychosocial factors have a considerable influence on pain perceptions. These factors also affect treatment and rehabilitation responses, as well as increasing the probability of disability associated to back pain. It is postulated in various studies that in low back pain (LBP) patients, there could be a relationship between psychosocial factors, including catastrophising and fear avoidance, and treatment responses. However, at this time, the research exploring this relationship of psychosocial factors as predictors of pain and disability outcomes in chronic low back pain (CLBP) is insufficient. Although there is consensus in clinical guidelines that MRI is impractical for diagnosing CLBP, healthcare professionals continue to request further investigations to explain the symptoms radiologically. Despite evidence that MRI for CLBP does not change how the condition is managed, it is nevertheless associated with an increase in pain medication and doctors’ visits. However, the psychological impact of being given the results of an MRI on people with CLBP has not been reported in the literature. Several publications recommend that to avoid unnecessary medical procedures and keep medical costs down, alternative options be made available to patients. Physiotherapy is one such alternative to MRI that increases beneficial outcomes for LBP patients, as well as reducing medical expenditure. This project aims I) to identify the psychosocial factors associated with change in pain and disability in CLBP patients treated by a physiotherapist. II) to explores the psychosocial factors associated with MRI diagnosis, and finally, III) determine the feasibility of conducting a definitive randomised control trial to answer the question, does MRI diagnosis negatively influence psychosocial and disability outcomes in patients with CLBP treated by physiotherapy in Saudi Arabia. Methods This project has adopted the Medical Research Council framework for complex intervention. Firstly, the association between psychosocial factors and changes in pain and disability outcomes was determined by conducting a systematic review. Secondly, the psychosocial factors associated with receiving an MRI diagnosis were explored using in-depth qualitative interviews with three different groups (doctors, patients and physiotherapists). Finally, a feasibility trial with process evaluation was conducted to test the feasibility of a definitive trial to determine the impact of MRI diagnosis on psychosocial, pain and disability outcomes in people with CLBP treated with physiotherapy. People presenting to spine clinics were randomised to receive an MRI diagnosis (intervention) plus physiotherapy rehabilitation or physiotherapy alone (Non-MRI/control group). The acceptability of randomisation to the non-MRI or MRI group was tested during recruitment and by qualitatively interviewing study participants and referring physicians. Results Regardless of the form of physiotherapy, the psychosocial factors of catastrophising, depression, fear of movement and self-efficacy can predict disability outcomes following physiotherapy intervention. However, the influence of these factors on predicting pain severity after physiotherapy intervention is less likely. The qualitative data from 11 patients, six physiotherapists and six doctors highlighted that fear of movement and anxiety were the main psychosocial consequences following MRI diagnosis. Furthermore, the study identified a need for national clinical guidelines for CLBP management in Saudi Arabia. The feasibility study failed to reach the recruitment target: 16/24 participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified a number of factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, including limited availability of physicians’ time for research, lack of research infrastructure e.g. to support recruitment to trials and limited research capacity in terms of the knowledge and skills of the healthcare team and limited funding. Interviews with five participants from both groups and physicians raised concerns about the acceptability and feasibility of randomly allocating patients to non-MRI group. Conclusion The results of studies revealed that disability outcomes could be predicted reliably by measures of psychosocial factors including catastrophising, depression, fear of movement and self-efficacy regardless of the physiotherapy intervention. This indicates that future physiotherapy screening of CLBP patients ought to include an evaluation of these factors. The interview study indicated a lack of local clinical guidelines of CLBP management in Saudi Arabia and a mismatch in priorities between primary care and secondary care levels that might explain the long waiting time in secondary care doctors’ appointments. The study also highlighted a possible association between fear and anxiety in patients with CLBP following diagnostic MRI and an over-reliance on biomedical education from the healthcare practitioners. Various barriers limit the feasibility of conducting a definitive RCT to test the influence of MRI diagnosis on psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia. A large trial would require multiple recruitment centres, a lengthy recruitment period and research staff trained in good clinical practice. Moreover, physician and participant concerns surrounding the acceptability of randomising patients not to receive an-MRI may limit success and suggest that progressing to large scale RCT would be impractical at the present time

El perfil neuromuscular de los músculos extensores y flexores de rodilla en jugadores de fútbol profesionales en la Arabia Premier League

Purpose: The neuromuscular system of soccer players is a key factor in their competitive performance, as it determines a player's immediate force response, reactivity and running speed during matches. The neuromuscular system has recently begun to be analyzed by tensiomyography (TMG). This study's primary aim was to generate normative data of the mechanical and neuromuscular profile for the knee extensor and flexor muscles. Method: This study used a cross-sectional study of 83 professional soccer players from three Saudi Premier League teams at the start of the preseason period. TMG was used to measure the radial muscle belly displacement in the knee extensor and flexor muscles in both legs. Results: The results suggest that the highest degree of symmetry corresponded to the vastus medialis (83.7 ± 14.3%) and the lowest to the biceps femoris (76.1 ± 10.9%). No statistical difference was found between the dominant and non-dominant muscles, or between on-field player positions across all four tested muscles. Conclusion:  The study presented normative data of a convenience sample of Saudi professional soccer players and observed that the highest asymmetry was seen in the vastus medialis and the lowest asymmetry in the biceps femoris.Propósito: El sistema neuromuscular de los jugadores de fútbol es un factor clave en su desempeño competitivo, ya que determina la respuesta de fuerza inmediata de un jugador, la reactividad y la velocidad de carrera durante los partidos. Recientemente se ha comenzado a analizar el sistema neuromuscular mediante tensiomiografía (TMG). El objetivo principal de este estudio fue generar datos normativos del perfil mecánico y neuromuscular de los músculos extensores y flexores de la rodilla. Método: Este estudio utilizó un estudio transversal de 83 futbolistas profesionales de tres equipos de la Liga Premier de Arabia Saudita al comienzo del período de pretemporada. La TMG se utilizó para medir el desplazamiento del vientre del músculo radial en los músculos extensores y flexores de la rodilla en ambas piernas. Resultados: Los resultados sugieren que el mayor grado de simetría correspondió al vasto medial (83,7 ± 14,3%) y el menor al bíceps femoral (76,1 ± 10,9%). No se encontraron diferencias estadísticas entre los músculos dominantes y no dominantes, o entre las posiciones del jugador en el campo en los cuatro músculos evaluados. Conclusión: El estudio presentó datos normativos de una muestra de conveniencia de futbolistas profesionales sauditas y observó que la mayor asimetría se observó en el vasto interno y la menor asimetría en el bíceps femoral

Psychosocial consequences of diagnosing nonspecific low-back pain radiologically: a qualitative study

BackgroundChronic low back pain (CLBP) is a complex biopsychosocial problem with financial implications for society. Most LBP is categorized as nonspecific CLBP (NS-CLBP); magnetic resonance imaging (MRI) is increasingly used in the investigation of LBP but has a high false-positive rate for NS-CLBP.PurposeTo explore the psychosocial factors associated with diagnosing NS-CLBP by MRI in Saudi Arabia.MethodsUsing a qualitative design, 11 patients with CLBP without a clear medical diagnosis who had received an MRI scan were interviewed using a semi-structured technique, and transcripts were analyzed using framework analysis.ResultsFour themes of relevance to the psychosocial consequences of using MRI to diagnose CLBP were identified: 1) impact on social participation after MRI diagnosis; 2) psychological impact of MRI diagnosis; 3) conflicting advice; and 4) patient education. Although some patients expressed a sense of relief following the identification of an objective explanation of their symptoms by MRI, a number of negative consequences were also identified. In particular, fear-avoidance behavior and anxiety were apparent.ConclusionThe use of MRI scanning in the diagnosis of LBP may lead to psychosocial factors influencing participation in physical and social daily activities

Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia

© 2020, The Author(s). Aim: To determine the feasibility of conducting a definitive randomised control trial (RCT) to answer the following questions: (1) Is early physiotherapy treatment acceptable and feasible for patients and direct healthcare providers? and (2) Is early physiotherapy intervention associated with better disability and psychosocial outcomes compared with the practice of routine MRIs? Methods: In a feasibility RCT in Riyadh City from 01 March 2018 until 29 July 2018, chronic low back pain (CLBP) patients presenting to spine clinics were randomised to receive an MRI (intervention) plus physiotherapy rehabilitation or physiotherapy alone (control group). The acceptability of randomisation to the control group (non-MRI) was tested during the recruitment by qualitatively interviewing study participants and referring physicians. Moreover, interviews with study participants explored the broader social, political, economic, and environmental (context) aspects that may influence trial delivery and intervention implementation. Results: The recruitment target was not met: 16/24 (66%) participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified numerous factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, the lack of research infrastructure to support recruitment to trials, limited research capacity in terms of knowledge and skills of the healthcare team, and limited funding. Conclusion: A definitive RCT to test the influence of MRI diagnosis on the psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia is feasible. However, the lack of research infrastructure, research capacity, the impact of MRI on patient outcomes, and a lack of clinical equipoise in the treatment and management of CLBP in Saudi Arabia pose major barriers to clinical trials

Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: a systematic review

Background: Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified.Methods: Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently.Results: In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes following physiotherapy.Discussion: Although limited by methodological shortcomings of included studies, and heterogeneity of physiotherapy interventions and measures of disability and psychosocial outcomes, the findings are consistent with other research in the context of back pain and physiotherapy, which suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist. However, a direct relationship cannot be concluded from this study.Conclusion: Findings suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist, which warrants further study

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Psychosocial factors associated with an MRI diagnosis of chronic non-specific low back pain in Saudi Arabia

Introduction In patients with chronic low back pain, psychosocial factors have a considerable influence on pain perceptions. These factors also affect treatment and rehabilitation responses, as well as increasing the probability of disability associated to back pain. It is postulated in various studies that in low back pain (LBP) patients, there could be a relationship between psychosocial factors, including catastrophising and fear avoidance, and treatment responses. However, at this time, the research exploring this relationship of psychosocial factors as predictors of pain and disability outcomes in chronic low back pain (CLBP) is insufficient. Although there is consensus in clinical guidelines that MRI is impractical for diagnosing CLBP, healthcare professionals continue to request further investigations to explain the symptoms radiologically. Despite evidence that MRI for CLBP does not change how the condition is managed, it is nevertheless associated with an increase in pain medication and doctors’ visits. However, the psychological impact of being given the results of an MRI on people with CLBP has not been reported in the literature. Several publications recommend that to avoid unnecessary medical procedures and keep medical costs down, alternative options be made available to patients. Physiotherapy is one such alternative to MRI that increases beneficial outcomes for LBP patients, as well as reducing medical expenditure. This project aims I) to identify the psychosocial factors associated with change in pain and disability in CLBP patients treated by a physiotherapist. II) to explores the psychosocial factors associated with MRI diagnosis, and finally, III) determine the feasibility of conducting a definitive randomised control trial to answer the question, does MRI diagnosis negatively influence psychosocial and disability outcomes in patients with CLBP treated by physiotherapy in Saudi Arabia. Methods This project has adopted the Medical Research Council framework for complex intervention. Firstly, the association between psychosocial factors and changes in pain and disability outcomes was determined by conducting a systematic review. Secondly, the psychosocial factors associated with receiving an MRI diagnosis were explored using in-depth qualitative interviews with three different groups (doctors, patients and physiotherapists). Finally, a feasibility trial with process evaluation was conducted to test the feasibility of a definitive trial to determine the impact of MRI diagnosis on psychosocial, pain and disability outcomes in people with CLBP treated with physiotherapy. People presenting to spine clinics were randomised to receive an MRI diagnosis (intervention) plus physiotherapy rehabilitation or physiotherapy alone (Non-MRI/control group). The acceptability of randomisation to the non-MRI or MRI group was tested during recruitment and by qualitatively interviewing study participants and referring physicians. Results Regardless of the form of physiotherapy, the psychosocial factors of catastrophising, depression, fear of movement and self-efficacy can predict disability outcomes following physiotherapy intervention. However, the influence of these factors on predicting pain severity after physiotherapy intervention is less likely. The qualitative data from 11 patients, six physiotherapists and six doctors highlighted that fear of movement and anxiety were the main psychosocial consequences following MRI diagnosis. Furthermore, the study identified a need for national clinical guidelines for CLBP management in Saudi Arabia. The feasibility study failed to reach the recruitment target: 16/24 participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified a number of factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, including limited availability of physicians’ time for research, lack of research infrastructure e.g. to support recruitment to trials and limited research capacity in terms of the knowledge and skills of the healthcare team and limited funding. Interviews with five participants from both groups and physicians raised concerns about the acceptability and feasibility of randomly allocating patients to non-MRI group. Conclusion The results of studies revealed that disability outcomes could be predicted reliably by measures of psychosocial factors including catastrophising, depression, fear of movement and self-efficacy regardless of the physiotherapy intervention. This indicates that future physiotherapy screening of CLBP patients ought to include an evaluation of these factors. The interview study indicated a lack of local clinical guidelines of CLBP management in Saudi Arabia and a mismatch in priorities between primary care and secondary care levels that might explain the long waiting time in secondary care doctors’ appointments. The study also highlighted a possible association between fear and anxiety in patients with CLBP following diagnostic MRI and an over-reliance on biomedical education from the healthcare practitioners. Various barriers limit the feasibility of conducting a definitive RCT to test the influence of MRI diagnosis on psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia. A large trial would require multiple recruitment centres, a lengthy recruitment period and research staff trained in good clinical practice. Moreover, physician and participant concerns surrounding the acceptability of randomising patients not to receive an-MRI may limit success and suggest that progressing to large scale RCT would be impractical at the present time

Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study

Abstract Background Pain is a leading cause of disability and accounts for many hospital and physical therapy visits. Current pain science understanding has evolved and changed substantially in the past 20 years; however, university health science curricula may not have progressed at the same rate. This study aimed to examine knowledge about pain neurophysiology among physical therapy students in Saudi Arabia, and to compare their knowledge across different education levels and by gender. Methods A cross-sectional study conducted to examine the pain neurophysiology knowledge among college physical therapy students in Saudi Arabia. The Revised Neurophysiology of Pain Questionnaire (12 items) was used. Descriptive statistics including frequencies and percentages were used to describe the sample. Analysis of variance and t-test were also used to examine the significant differences between scores. Results Physical therapy students (n = 202) from 18 different universities in Saudi Arabia participated in this study. The mean score of the participants on the questionnaire was 6.20 ± 2.07 (i.e., 52% ± 17%) and there was no significance difference between males and females. There was a statistically significant incremental increase in total score through the educational process (P < 0.05); however, this increase was very small comparing early- and final educational-level students (8% in RNPQ). Conclusion While final year physical therapy students showed higher levels of pain science knowledge than those at the beginning of their course, the magnitude of the difference was small and likely of little meaningful relevance. This may reflect the need for more emphasis on pain science in the physical therapy curriculum in Saudi Arabia

Adding A Structured Educational Session to the Rehabilitation Program of Soccer Players Following Anterior Cruciate Ligament Reconstruction: A Feasibility Study

# Background While a lack of psychological preparedness and fear of movement may be linked with the anterior cruciate ligament (ACL) re-injury, these variables are rarely addressed throughout the therapy stages via educational sessions. Unfortunately, in terms of reducing fear, increasing function, and returning to play, no research has been done yet on the efficacy of adding organized educational sessions to the rehabilitation programs of soccer players post-ACL reconstruction (ACLR). Therefore, the study's aim was to assess the feasibility and acceptability of adding organized educational sessions to the rehabilitation programs post-ACLR. # Methods A feasibility randomized controlled trial (RCT) was conducted in a specialized sports rehabilitation center. Participants post ACL reconstruction were randomized to either usual care with a structured educational session (intervention group) or usual care alone (control group). This feasibility study investigated three aspects: recruitment, intervention acceptability and randomization, and retention. The outcome measures included Tampa Scale of Kinesiophobia, ACL-Return to Sport after Injury, and International Knee Documentation Committee for knee function. Measurements were done at baseline and one week after the intervention. # Results All of the 36 players who were undergoing rehabilitation post-ACLR at the center at the time of the study were invited to participate in the study. Thirty-five players (97.2%) agreed to participate in the study. The participants responded to some questions about the acceptability of the intervention and randomization and most of them thought they were appropriate. 30 (85.7%) participants completed the follow-up questionnaires one week after the randomization. # Conclusion This feasibility research found that adding a structured educational session to the rehabilitation program for soccer players after ACLR is feasible and acceptable. Full-scale RCTs with longer follow-ups and multiple locations are recommended

Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia

To ensure the effective management of patients’ pain, it is important that physiotherapists have a good understanding of the neuroscience behind pain. A major barrier to adequate pain management is that, for patients, there is limited access to clinicians who are knowledgeable about pain. This study examined the level of knowledge regarding pain neurophysiology among physiotherapists currently practicing in Saudi Arabia. Method: The study was a cross-sectional web-based survey that utilized the 12-item Revised Neurophysiology of Pain Questionnaire. Descriptive and inferential statistics were used to describe levels of knowledge regarding pain neurophysiology and to examine differences in knowledge based on the characteristics of the participating physiotherapists (gender, educational level, experience, practice region, and country where their highest educational level was attained). Results: One hundred and eleven physiotherapists (58.6% male) from various regions and educational backgrounds participated in the study. Out of a maximum Revised Neurophysiology of Pain Questionnaire score of 12, the mean ± standard deviation (SD) was 6.7 ± 2.2; 90% of physiotherapists scored 9 (75%) or less. None of the examined characteristics of the participants were associated with knowledge. Conclusion: Physiotherapists in Saudi Arabia showed limited knowledge of the neurophysiology of pain; however, this was not related to the personal characteristics that were examined. The continuation of education in modern pain science is recommended for physiotherapists, especially those dealing with patients suffering from chronic pain. Clinical Relevance: The physiotherapists who took part in this study displayed limited knowledge of pain neuroscience; this limited knowledge might suggest the need for a more bio-anatomical approach to pain management. There is a need for tailored medical education to address pain neuroscience knowledge in current physiotherapist practitioners