The purpose of this study was to survey the level of fear-avoidance beliefs for practicing general practitioners and physical therapists and to relate this to self-reported practice behaviors for patients with back pain. To this end, 60 general practitioners and 71 physical therapists were recruited. These participants completed a questionnaire including 11 items slightly revised from instruments designed to assess fear-avoidance beliefs in patients, and four items about treatment practices. The results indicated that these health care practitioners on the average generally held beliefs that are consistent with the current evidence, but there were also indications that some practitioners held beliefs reflecting fear-avoidance. More than two-thirds reported that they would advise a patient to avoid painful movements, more than one-third believed a reduction in pain is a prerequisite for return-to-work, while more than 25% reported that they believe sick leave is a good treatment for back pain. These beliefs were found to be related to reported practice behavior. Those with high levels of fear-avoidance beliefs were compared to those with low levels. Those with high levels of fear-avoidance belief had an increased risk for believing sick leave to be a good treatment (RR = 2.0; 90%CI = 1.02-3.92), not providing good information about activities (RR = 1.7; 90%CI = 1.19-2.45), and being uncertain about identifying patients at risk for developing persistent pain problems (RR = 1.5; 90%CI = 1.00-2.27). It is concluded that some practitioners hold beliefs reflecting fear-avoidance and that these beliefs may influence treatment practice.
BACKGROUND: Back pain is a major health problem and the most important disorder associated with sickness absence. This report presents experiences from a back pain outpatient clinic. MATERIAL AND METHODS: We collected demographic data, diagnoses on the referrals (ICPC) and in the outpatient clinic (ICD-9) and recommendations given to 206 patients, referred 1 January to 30 April 1998. RESULTS: 41% were women (mean age 45), 59% men (mean age 44). Mean waiting time before appointment was 35 days compared to 49 days before the clinic was opened. 43% were prioritized for an appointment within two weeks; mean waiting time in this group was 16 days. 125 (63%) of 200 were referred with non-specific low back pain. Of these, 99 (79%) were given the same diagnosis in the clinic. 75 (37%) had a referral diagnosis of lumbar disk injury with radiation, of whom 46 (61%) were diagnosed with lumbar nuclear prolapse or lumbar spinal stenosis in the clinic. INTERPRETATION: An outpatient clinic may be a useful way to organise the specialist health service system for back pain patients.
The practice of chiropractic was for many years regulated by "The Quack Act" in Norway, and the numbers of chiropractors decreased year by year. They are now authorized health care practitioners with academic training; most Norwegian students attending courses in chiropractic or clinical biomechanics go to European universities. An international council ensures reciprocity and a quality assured academic programme in all recognized colleges of chiropractic. Recent research have broadened our understanding of the biomechanical interrelationship between the nervous system, the musculature and the skeletal articulations. In the early 1990s, several studies documented favourable effect of chiropractic treatment of low back disorders. These studies are now substantiated by new studies, especially concerning cost-effectiveness. Several reports also give evidence that chiropractic manipulation is beneficial especially in combination with light exercise. There are conflicting results concerning the efficacy of varying types of exercise programmes. Patients may benefit from increased cooperation between medical doctors and chiropractors. Most acute low back syndromes should be assessed by the chiropractor in order to prevent chronic illness.
To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain.
Blinded comparison between spine kinematic variables, Oswestry disability questionnaire scores, and work status.
Multidisciplinary occupational rehabilitation clinic of a university hospital.
Population-based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain.
This study was part of a population-based randomized clinical trial. Patients were randomized to 4 different methods of management: usual care, rehabilitation, ergonomics, or rehabilitation and ergonomics.
Oswestry disability questionnaire, kinematic analysis of the spine during flexion and extension of the trunk, and work status were collected at weeks 4, 12, 24, and 52 after the back accident.
Kinematic variables were poorly to moderately related to work status and Oswestry questionnaire scores. Kinematic variables were also unresponsive to change in work status and Oswestry questionnaire scores over time.
Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain.
OBJECTIVE: The aim of this study was to investigate the construct validity of 6 physical performance tests that had already been shown to have acceptable repeatability. DESIGN: Data were collected in a randomized controlled multi-centre study. SUBJECTS: 126 women and 105 men sick-listed for spinal pain carried out the tests and provided personal and background data at inclusion in the study. METHODS: One test measured stepping up onto and down from a stool, 2 measured lifting ability and 3 walking speed. Construct validity was examined by analysing the influence of some variables on test performance. RESULTS: High-rated pain behaviour and perceived high pain intensity during testing or during the previous 4 weeks were connected with low test performance. Exercise twice a week was connected with high test performance. The test with the highest ability to detect disability in the women with lumbar pain was a lumbar lifting test, while for the men, it was a cervical lifting test. The test with the highest ability to detect disability in the participants with neck pain was the cervical lifting test in addition to a gait test with burden for the women. CONCLUSION: Back pain hampered the test performance more than neck pain. Impairments and activity limitations expressed by the patient should guide the choice of test.
To explore and describe what physiotherapists experience they need to know about patients with non-specific low back pain (NSLBP) to make decisions about intervention.
Four focus groups containing a total of 21 physiotherapists were carried out in Sweden. Interviews were transcribed and qualitative content analysis performed. The manifest content was coded and categorised, and a theme emerged. Extracted symptoms and signs were linked to ICF codes.
Physiotherapists' clinical reasoning represented a broad view on low back pain (LBP) including codes from all ICF components. The participants argued for individualisation of intervention to a specific patient's problems. A theme of case complexity emerged, involving three levels: easy case, characterised by impairment in body function with close relation to specific body structures; complex case, characterised by impairments in body function, particular mental functions, activity limitations and participation restrictions, particular management of activity level and very complex case, characterised by impairments in body function, activity limitations and participation restrictions, and contextual factors, with help-seeking behaviour as a particular feature.
The physiotherapists' clinical reasoning reflected a broad view on patients with NSLBP, with variations related to case complexity. The use of ICF codes contributed to understanding that the physiotherapists applied a broad perspective on NSLBP as a health condition as well as to knowledge about how physiotherapists' understand patients with NSLBP. Physiotherapists' use of the ICF in clinical practice might facilitate identification and assessment of specific patient's back pain problem as they occur in daily life and therefore be helpful in rehabilitation planning. Findings might also have an educational value.
Posterior-anterior (PA) pressure technique is widely used for assessing and treating spinal segments. PA pressure is manually applied and stiffness is subjectively assessed. The method has been deemed unreliable and is associated with occupational strain.
To introduce a new ergonomically designed hand-held device measuring spinal stiffness, and to assess its repeatability.
Quasi experimental study.
A convenience sample of 30 university students, 20-30 years old was used. The participants were tested two consecutive days by two physical therapy students using the new device; the PA pressure Puffin. The spinal segments under study were L1, Th12, Th7 and Th6 which all were tested three times with 9 kg force by both testers, both days. Intra-class correlation coefficients (ICC3,k) were used to assess intra- and inter-tester repeatability and analysis of variance with alpha-level at 0.05 was used to assess differences in joint mobility at the four segments measured. Linear regression analyses were used to assess repeatability.
Inter-tester and intra-tester coefficients (ICCs) ranged from 0.88 to 0.97 and from 0.83 to 0.97, respectively. There was no significant difference in displacement between Th6 and Th7 but all other joints were significantly different from each other. Displacement was always significantly greater the second day compared with day one (p
To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging.
Discourse analysis was performed of four focus groups' talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated.
Four focal themes appeared: Responsibility for health and health-related problems; Normalization - what counts as a normal back pain problem in relation to living an ordinary life; Change process - how to lead one's life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists' point of view. The themes shape an over-arching pattern of Problem-solving - which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome.
Physiotherapists' attitudes and approaches seem to entail components of professional and personal values which may influence patients' access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients' roles in specific face-to-face encounters are needed.