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Snelgrove, Sherrill. "A longitudinal investigation into patients' experiences of chronic low back pain (CLBP) using interpretative phenomenological analysis (IPA)." Thesis, Swansea University, 2010. https://cronfa.swan.ac.uk/Record/cronfa42594.
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Background/aim: Chronic low back pain (CLBP) is a variant of chronic pain and an overarching term for a diverse number of painful and benign conditions of the lower spine. Research has shown that CLBP challenges biomedical explanation and treatments and incurs passive coping strategies. Despite the enduring nature of CLBP there are few longitudinal studies. The aim of this investigation was to gain understandings of any consistencies and changes in the experiences of participants' experiences of living with CLBP. Design: A qualitative, longitudinal IP A research project that explored participants' pain experiences over two years (2005-2007). Methods: Semi-structured interviews were conducted with a purposeful sample of ten participants recruited from the waiting list of a chronic pain clinic. Each participant was interviewed prior to attendance and twice after treatment. The data were recorded and transcribed accounts were analysed using IPA. Results: The participants foreground the physicality of the pain. Further interpretive work showed that whilst participants emphasised the physicality of their condition they experienced embodied, multidimensional experiences characterised by loss. Most participants' continued to manage their pain within a biomedical model of understanding and behavioural focused coping strategies. In comparison, participants who experienced a period of painlessness due to medical interventions demonstrated a reappraisal of their situation and a trend towards adopting a wider, biopsychosocial understanding accompanied by changing coping strategies. Conclusion: The accounts revealed the relationship between the participants' painful body and self concept. For some participants, a respite from pain paralleled increasing psychosocial coping strategies and a future orientation that reflected changes in illness beliefs in the absence of a formal psychological intervention. In comparison, remaining participants continued to demonstrate a narrow repertoire of coping and loss orientation. Participants' responses to CLBP resonated with the grieving processes of bereaved individuals. Clinical implications are discussed with recommendations for future research.
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Mukandoli, Kumuntu. "Predisposing factors of chronic low back pain (CLBP) among sedentary office workers (SOW) in Nairobi, Kenya." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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Chronic low back pain is a highly prevalent condition in industrialized nations. It is associated with activity limitations, disability, has significant economic impact on society and incurs personal cost. Today's working environment increasingly demands more time spent sitting due to computerization and other advances in technology. Sitting for hours without taking breaks may influence posture, and alignment of the lumbar spine. Therefore, it may influence low back pain. Kenya as a developing country has an increasing number of people involved in sedentary work. The aim of this study was to identify the predisposing factors of chronic low back pain among sedentary office workers in Nairobi. The main objectives were to establish the prevalence of chronc low back painto determine the possible predisposing factors of chronic low back pain and to determine the impact of chronic low back pain on work related quality of life among sedentary office workers in Nairobi, Kenya.
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Campos, Lara. "Predição da Resposta de Sucesso a um Programa de Exercício em Meio Aquático para Utentes com Dor Lombar Crónica." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2014. http://hdl.handle.net/10400.26/7683.
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Relatório do Projeto de Investigação apresentado para cumprimento dos
requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de
especialização em Fisioterapia em Condições Músculo- EsqueléticasPALAVRAS-CHAVE: Dor Lombar Crónica (DLC), Factores de Prognóstico, Intensidade da Dor, Incapacidade Funcional Introdução e Objectivo: A evidência existente acerca de potenciais factores que possam predizer resultados de sucesso em utentes com DLC é não só escassa, mas sobretudo pouco consistente. O presente estudo teve como objectivo identificar factores de prognóstico para os bons resultados da Fisioterapia, a curto e médio prazo, ao nível da intensidade da dor, capacidade funcional e percepção de melhoria em indivíduos com DLC, que realizaram um programa de exercício em meio aquático. Metodologia: Foi realizado um estudo de coorte prospectivo, com 42 participantes com DLC; os quais foram submetidos a um programa de exercício aquático, com duração de 6 semanas. Os resultados do programa foram avaliados imediatamente após o seu término, e três meses após o final do tratamento. Os outcomes de interesse foram a intensidade da dor, medida pela Escala Visual Analógica (EVA), a incapacidade funcional, medida pela Quebek Back Pain Disability Scale – Versão Portuguesa (QBPDS-PT), e a percepção global de melhoria, medida pela Patient Global Impression Change Scale – Versão Portuguesa (PGIC-PT). As características sociodemográficas e clínicas avaliadas no início do estudo foram incluídas como potenciais factores de prognóstico. Como critérios de sucesso, foram utilizadas as Diferenças Clínicas Minimamente Importantes (DCMIs) definidas na literatura para os três instrumentos utilizados. Resultados: Os resultados obtidos sugerem que: 1) ao nível da intensidade da dor, as variáveis de prognóstico intensidade da dor reportada na baseline (OR= 1,049; 95% IC 1,004-1,097) e presença de irradiação para o membro inferior (OR=13,418; 95% IC 1,963- 91,716) estão significativamente associadas com os resultados de sucesso imediatamente após o programa de exercício aquático (6 semanas); e a intensidade da dor reportada na baseline está significativamente associada com os resultados de sucesso, três meses após o final do tratamento (OR=1,045; 95% IC 1,004-1,089); 2) ao nível da incapacidade funcional, apenas a pontuação na QBPDS-PT reportada na baseline se encontra estatisticamente associada com a incapacidade funcional registada 6 semanas após o início do estudo (OR=1,061 95% IC 1,009-1,115). Conclusões: Utentes com níveis mais elevados de intensidade de dor e presença de irradiação da dor para o membro inferior, no início do estudo, apresentam maior probabilidade de sucesso, ao nível da intensidade da dor, imediatamente após um programa de exercício aquático; e utentes com maiores níveis de intensidade da dor, no início do estudo, apresentam maior probabilidade de sucesso, também ao nível da intensidade da dor, três meses após o final do tratamento. Utentes com maiores níveis de incapacidade funcional no início do estudo, apresentam maior probabilidade de atingirem resultados de sucesso, ao nível da incapacidade funcional, imediatamente após o final do programa de exercício aquático.
Abstract:Introduction and Objectives: There is little evidence about potential prognostic factors that can influence the successful outcomes of patients with CLBP. The aim of this study was to assess prognostic factors for the success of an aquatic exercise program, for pain intensity, disability and global impression change, in patients with CLBP; immediately after the treatment and in a 3 months follow-up. Methodology: It was used a prospective cohort study with 42 participants, who undertake an exercise aquatic program for 6 weeks. The results of the program were assessed immediately after the treatment, and at 3 months follow-up. The primary outcomes were pain intensity, measured by Visual Analogic Scale (VAS), functional disability, measured by Quebek Back Pain Disability Scale – Portuguese Version (QBPDS-PT), and the global impression of change, measured by the Patient Global Impression Change Scale – Portuguese Version (PGIC-PT). The socio-demographic and clinical data were used as potential prognostic factors. Success with the treatment was defined considering the Minimal Clinically Important Difference (MCID) reported on the literature for the three instruments used. Results: For pain intensity, the variables pain intensity in the baseline (OR= 1,049; 95% IC 1,004-1,097) and presence of irradiating pain (OR=13,418; 95% IC 1,963-91,716), were associated with successful results for pain intensity, immediately after the end of the exercise aquatic program; and the pain intensity in the baseline were associated with successful results in the 3 months follow-up (OR=1,045; 95% IC 1,004-1,089). In what concerns to functional disability, only the score obtained in the QBPDS-PT, at the baseline, was associated with the functional disability assessed immediately after the end of the treatment (OR=1,061 95% IC 1,009-1,115). Conclusions: Participants with more pain intensity and presence of irradiating pain in the baseline, were more associated with results of success in pain intensity, immediately after a program of aquatic exercise; and participants with more pain intensity, in the baseline, were more probably associated with results of success in pain intensity, at the follow-up of 3 months. Participants with more disability at the baseline were more likely to present successful results, in functional disability, immediately after the end of the treatment.
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Harman, Katherine. "Sleep and chronic low back pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ26854.pdf.
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Harman, Katherine (Katherine Maureen) Carleton University Dissertation Psychology. "Sleep and chronic low back pain." Ottawa, 1997.
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Armstrong, Mary P. "Chronic low back pain : effectiveness of pain management programmes." Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273038.
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Sudwell, Mark Ian. "Chronic back pain : a narrative analysis." Thesis, University of Exeter, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367457.
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Seidler, Anna Lene, Constanze Rethberg, Jochen Schmitt, Albert Nienhaus, and Andreas Seidler. "Health utilities for chronic low back pain." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-230878.
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Background
Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making.
Methods
Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method.
Results
Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender.
Conclusion
On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.
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Newton, Mary. "Assessment and rehabilitation of chronic low back pain." Thesis, University of Glasgow, 1996. http://theses.gla.ac.uk/4250/.
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This thesis presents a set of studies which investigated chronic low back pain. The specific aim of this thesis was to develop reliable methods for the assessment and rehabilitation of chronic low back pain. The two assessment methods tested were a broad based clinical evaluation and an isokinetic assessment of trunk muscle strength. The first part of the thesis describes the reliability and validity studies of the clinical methods for measuring trunk mobility, trunk muscle strength, spinal shape and palpation. A total of 27 physical tests were studied using 70 patients and 10 normal subjects. Twenty-three of these tests were found to be reliable and were incorporated into the isokinetic assessment study. The second part of the study reports the standardisation and reliability studies for the isokinetic assessment of trunk muscle strength in 70 normal subjects and 120 patients with chronic low back pain. The results showed that the main isokinetic measures were reliable for both normal subjects and patients. There was a significant learning effect from test 1 to test 2 in both normal subjects and patients. The magnitude of this learning effect was greater in patients than normal subjects. The normal subjects were followed up by a postal questionnaire in a two year prospective study to predict future back pain using the isokinetic measures. None of the measures used showed any significant differences between those subjects who developed back pain and those who did not. The third part of the thesis describes studies to develop a rehabilitation programme for patients with chronic low back pain using the isokinetic machines, both as a means of monitoring progress and as an exercise regime. The first study of 26 patients indicated that the programme was safe and effective, but also revealed a major problem with adherence to a six week exercise programme. The second study investigated the problem of adherence and examined the time course of response to isokinetic exercise by repeating the tests at three weeks and six weeks.
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Cooper, Nicholas A. "Gluteus medius dysfunction in chronic low back pain." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5445.
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Low back pain is a common but severe health problem. Chronic low back pain accounts for the bulk of the burden of low back pain. Exercise interventions are effective in the management of chronic low back pain. Current clinical thinking in physical therapy treats low back pain as a heterogeneous entity seeking to match specific interventions to subpopulations. None of these subgroups assess the role of gluteus medius dysfunction in chronic low back pain. These projects seek to describe the prevalence of gluteus medius weakness in people with chronic low back pain and test the effectiveness of a gluteus medius strengthening exercise intervention in people with chronic low back pain.
Gluteus medius strength was assessed in 150 people seeking care for chronic low back pain and 75 healthy people without low back pain. Gluteus medius was found to be weaker on affected sides compared to unaffected sides within people with chronic low back pain and weaker than people without low back pain. Gluteus medius weakness was a strong predictor of the presence of low back pain.
A gluteus medius strengthening program was compared with lumbar stabilization exercises in 56 people with chronic low back pain. Although there was a clinically significant improvement in pain in people who performed the gluteus medius strengthening exercise program, this was not significantly different from the stabilization exercise intervention. Adherence to exercise was significantly correlated with reduction in pain and perceived improvement of low back pain.
Although gluteus medius weakness is common in people with low back pain and treating this weakness with a targeted exercise intervention is effective, it is not better than a standard stabilization exercise intervention. Doing exercise is likely more important than what exercise is done.
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Shojaei, Iman. "LOWER BACK BIOMECHANICS AT NON-CHRONIC STAGE OF LOW BACK PAIN." UKnowledge, 2018. https://uknowledge.uky.edu/cbme_etds/52.
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Prior studies have reported differences in lower back biomechanics during activities of daily living between individuals with and without chronic low back pain (LBP). Nevertheless, the literature on lower back biomechanics of patients with non-chronic LBP is scant. Therefore, the objective of this study, as the first step towards future prospective studies, was to investigate the lower back biomechanics in patients with non-chronic LBP. Case-control studies were conducted wherein measures of lumbo-pelvic coordination during bending and return tasks as well as measures of mechanical demand on the lower back during lifting tasks in the sagittal plane were investigated between patients with non-chronic LBP and matched asymptomatic individuals. Patients were enrolled into the study at the non-chronic stage of their LBP. We found distinct difference in measures of lumbo-pelvic coordination as well as mechanical demands on the lower back between patients with non-chronic LBP and controls. Reduced lumbar range of flexion and slower task pace as well as the more in-phase and less variable lumbo-pelvic coordination observed in patients with non-chronic low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Such a neuromuscular adaptation, however, resulted in a larger shearing demand on the lower back. Persistent abnormal lumbo-pelvic coordination might play a role in transition to chronic stage or recurrence of LBP. However, such inferences need to be further investigated using prospective studies as well as clinical trials involving a combination of physical and psychological treatments aimed at correction of lumbo-pelvic coordination.
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Goldby, Lucy. "The physiotherapy management of chronic low back disorder." Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251746.
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Musculoskeletal physiotherapy is the most common intervention for chronic low back disorder. Any observation on clinical practice or investigation into the clinical and scientific literature indicates that musculoskeletal physiotherapy encompasses a plethora of treatment modalities and approaches. The aim of the present investigation was to determine the most common intervention(s) that comprise musculoskeletal physiotherapy and to critically explore their empirical therapeutic basis. Two components were highlighted as the most frequently employed interventions; namely manually applied therapy (manual therapy) and exercise(s) to rehabilitate the lumbar spine's stabilising system. In the course of an extensive literature search, work was uncovered that suggested that the mechanisms required for spinal stability could be better facilitated using methods other than those in current clinical use. These discoveries culminated in the creation of a ten-week rehabilitation programme which was primarily developed to facilitate rehabilitation of spinal stabilisation but also permitted an empirical analysis of this component of musculoskeletal physiotherapy. The efficacy of the regime was then assessed in comparison to manual therapy and to a control (an education booklet) in a randomised controlled trial. Following a series of pilot studies, 300 patients with chronic low back disorder were randomly assigned to groups and completed their respective management programmes. Data were collected on pain, disability, handicap, impairment and quality of life prior to entry and at three, six, twelve and twenty-four months post intervention. The results indicated a consistent trend for greater improvement in the spinal stabilisation group in the pain, handicap, impairment, disability, dysfunction and medication variables. These trends reached statistical significance at the three-month follow-up stage as evidenced by quality of life (P = 0.025), at the six-month follow-up stage in pain (P = 0.009) and dysfunction (P = 0.042) and at the one-year follow-up stage in medication (P = 0.007), dysfunction (P = 0.048), disability (P = 0.0098) and quality of life (P = 0.003). It was therefore concluded that the spinal stabilisation programme was a more effective component of musculoskeletal physiotherapy (when analysed in isolation) than manually applied therapy or an education booklet in the management of chronic low back disorder. Various sub-analyses of the data were conducted. Subjects who entered the study with high levels of low back pain (greater than 50 numerical rating scale) demonstrated a statistically Significant reduction in pain levels (P = 0.04) in both the manual therapy group and the spinal stabilisation group in comparison to the education control group at the three-month follow-up stage. These data provide empirical evidence towards the efficacy of these two musculoskeletal physiotherapy management regimes as being effective in pain reduction in comparison to an active control intervention. This has not hitherto been demonstrated on patients with chronic low back disorder.
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Boyd, Kelly. "Chronic low back pain: exploring trends and potential predictors." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123222.
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Context: Hundreds of thousands of Quebec residents suffer from chronic pain, for which treatment is far from optimal. Despite low back pain being the second most common reason to visit a primary care physician, management remains challenging. Additionally, chronic low back pain (CLBP) has been found to be the most common reason for patients to be referred to tertiary pain centers. Recently, there has been an increasing acceptance that bio-psycho-social factors play a crucial role the clinical course of CLBP. Objectives: The purpose of this study was to identify subgroups of CLBP patients treated in tertiary care, as defined by their changes in pain and disability over time, and to explore possible characteristics associated with these changes. Specific objectives were: 1) to establish whether there are distinct subgroups of patients with CLBP with different characteristics associated with change in pain and disability at 6, 12, and 24 months following an initial visit in a tertiary pain clinic; and 2) to identify potential social, psychological, biological, and environmental factors that may predict their responses in pain intensity and disability in accordance with the Revised Wilson and Cleary Model for Health-Related Quality of Life. Design: Observational prospective design to follow a cohort of patients who were enrolled in the web-based Quebec Pain Registry. Setting: The Quebec Pain Registry, a research database comprised of close to 5000 chronic pain patients. Eligible participants included all patients who 1) have been diagnosed with lumber without radicular pain, LBP (diagnostic code 3.1), lumbar & radicular pain, LRP (diagnostic code 3.2), or diffuse lumbar pain, DLP (diagnostic code 3.4), 2) who provided written consent for their data to be used for research purposes, and 3) have completed their initial visit to the pain clinic by May 31, 2011. Intervention: The data required for this project had previously been collected and entered in the Quebec Pain Registry. Basic descriptive results were produced using SAS® software 9.2. This analysis described the characteristics of the 917 patients included in the study at baseline. Additional data were explored to examine patterns of changes over two years for certain characteristics. A generalized estimating equations model (GEE) was used to analyze data at 6, 12, and 24 months after the initial visit. Results: 299 (32.6%) patients were diagnosed LBP, 522 (56.9%) with LRP, and 96 (10.4%) with DLP. In general, all patients were relatively comparable in terms of their characteristics with the exception of DLP, where proportions were noticeably different. Patients diagnosed with DLP had a higher pain duration median (6.0 years) and the most frequently current employment status was permanent disability (both in regards to proportions). The most common ethnicity was Caucasian among all diagnoses. Income was similarly distributed among all groups and secondary school was the highest level of education completed for all. The top three medical conditions reported other than CLBP were rheumatoid arthritis/osteoarthritis, hypertension, and depressive disorders. DLP patients reported "accident at work" as the most common circumstance surrounding their onset of pain. DLP also had noticeably different mean scores for average pain, worst pain, depression, catastrophizing, disability, mental and physical summary scores on the health-related quality of life questionnaire at baseline, 6, 12, and 24 months (in regards to proportions). Patients with higher worst pain scores, longer pain duration, and lower physical summary scores at the initial visit were significantly less likely to show improvements in pain intensity and disability at six and 12 months. Conclusions: Although modifying the analysis prohibited conclusions for a two-year follow to be made, characteristics, such as worst pain, pain duration, and lower physical summary scores at both six and 12 months were discovered.Contexte: Des centaines de milliers de résidents du Québec souffrent de douleurs chroniques. En dépit de la douleur au bas du dos étant la deuxième cause la plus fréquente de consulter un médecin de soins primaires. . Récemment, il y a eu une acceptation croissante que les facteurs bio- psychosociale (biologiques, psychologiques et sociaux ) jouent un rôle crucial de l'évolution clinique de la lombalgie chronique , mais peu de recherches concernant la lombalgie chronique ont étés achevé plus d'un an . Objectif: Les objectifs spécifiques sont : 1) d'établir s'il existe des groupes distincts de patients atteints de lombalgie chronique avec des caractéristiques de réponse à 6, 12 et 24 mois après la visite initiale, et 2) pour identifier le potentiel social, psychologique, biologique et environnemental caractéristiques, conformément à la modèle révisée Wilson et Cleary pour la qualité liée à la santé de la vie. Conception: analyse prospective d'une cohorte historique. Cadre: Le Registre québécois de la douleur, une base de données de recherche unique composée de près de 5000 patients souffrant de douleurs chroniques de centres de la douleur tertiaires. Participants: adultes diagnostiqués avec la douleur chronique au bas du dos qui sont inscrits dans le registre de la douleur Québec. Les participants admissibles inclus tous les patients qui ont été diagnostiqués avec le bois sans douleur radiculaire , LBP (code de diagnostic 3.1), lombaire et douleur radiculaire , LRP (code de diagnostic 3.2) , ou une douleur lombaire diffuse , DLP (code de diagnostic 3.4) et ont terminé leur formation initiale visite à la clinique de la douleur avant le 31 mai 2011. Intervention: Les données nécessaires à ce projet avaient déjà été recueillies et consignées sur le registre de la douleur Québec. Résultats descriptives de base ont été produites en utilisant SAS ® 9.2 logiciel. L'analyse descriptive a décrit les 917 patients inclus dans l'échantillon de l'étude au départ, générant des scores moyens. Des données supplémentaires ont été explorées pour observer des modèles sur deux ans pour certaines caractéristiques. Un modèle des équations d'estimation généralisées (GEE) a été utilisé pour analyser des données corrélées à six, 12 et 24 mois. Résultats: 299 (32.6%) patients ont été diagnostiqués LBP, 522 (56.9%) avec LRP, et 96 (10.4%) avec DLP. En général, tous les diagnostics étaient comparables à l'exception de DLP. Les patients diagnostiqués avec DLP avaient une durée médiane de la douleur plus élevé (6,0) et l'invalidité permanente le plus fréquemment rapporté pour le statut actuel de l'emploi. L' ethnie la plus fréquente était de race blanche parmi tous les diagnostics . Le revenu a été distribué similaire dans tous les groupes, et à l'école secondaire était le plus haut niveau de scolarité atteint pour tous. Les trois conditions médicales rapportées étaient la polyarthrite rhumatoïde / arthrose, l'hypertension et les troubles dépressifs. DLP patients ont signalé « accident du travail » comme circonstance la plus courante qui entoure leur apparition de la douleur. DLP a également indiqué sensiblement différents scores moyens pour la douleur moyenne, pire douleur, la dépression, catastrophisme, le handicap, le score résumé mental, et le score résumé physique au départ, 6, 12 et 24 mois. Les patients ayant les plus mauvais scores de la douleur, la durée de la douleur plus élevé, et des scores plus bas sommaires physiques étaient significativement moins susceptibles de montrer des améliorations dans la douleur et le handicap à six et 12 mois. Conclusions: Bien que la modification des conclusions interdites d'analyse pour un suivi de deux ans à faire, des caractéristiques importantes telles que la pire douleur, la durée de la douleur, et les scores sommaires physiques inférieurs aux deux six et 12 mois ont été découverts.
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Sokunbi, Oluwaleke Ganiyu. "Effects of stabilisation exercise on subclinical chronic low back pain." Thesis, University of Brighton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436801.
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This was a mixed method study incorporating a randomized controlled trial (RCf) and focus group interviews to explore the effects of spinal stabilization exercises on sub-clinical chronic low back disorders and participants' perceptions of this type of treatment programme. Eighty four participants (34 males and 50 females) in the RCf were randomly allocated to control (no exercise) or exercise treatment groups in which they carried out stabilization exercises at different frequencies i.e. once weekly, twice weekly or three times weekly. Outcome measures used in the RCT were plasma serotonin concentration measured using an enzyme linked immunoassay technique, multifidus cross sectional area measured with diagnostic ultrasound imaging, pain intensity measured with numeric rating scale, functional disability measured with the Roland- Moris Disability Questionnaire and quality of life measured with Nottingham Health Profile. Data were collected at baseline, after six weeks of intervention and at 18 weeks follow up assessments. The results of the RCf showed that spinal stabilization exercises produced a significant increase in plasma serotonin concentration by 17.8% at all stages of data collection in all the exercise groups. All the participants in the treatment groups experienced significant reduction, by more than SO %, in pain and functional disability and improvement by more than 50% in quality of life scores after six weeks of treatment (P <0.05). The extent of reduction in pain and functional disability scores and improvement in quality oflife showed a clear trend in favour of the three times weekly exercise group at 18 weeks follow up assessments. Significant increase in the size of multifidus cross sectional area was observed only in the three times weekly exercise group (P <0.05). A linear regression analysis showed significant correlation between the changes in plasma serotonin and each of pain, functional disability and quality of life scores. (r values ranged from 0.42 to 0.67, P < 0.05). Following the RCf, nine participants (3 males and 6 females) took part in two focus groups interviews. Open ended questions were used to maximize discussion. Audio recording was used to record participant's opinions during the interview process. Careful checking, reading, and correction of the transcripts was carried out and a thematic analysis was conducted on the data. The main themes that emerged from the data analysis from the focus group interviews were: • Participants' perception of the causes and aggravating factors for their low back disorders. • Physical dimensions of participants' experience of low back disorders. • Emotional and psychological dimensions of participants' experience of low back disorders. • Perceived treatment effects on pain intensity and functional limitation. • Impact of the treatment programme on participants' empowerment and self efficacy. • Impact of information on participants' attitude to treatment. • Relationship with the therapist. • Compliance with the home programme of stabilization exercises. • Suggestion for improvement in future studies involving spinal stabilization exercises. The results of this study have indicated that an increased plasma serotonin concentration gained by the use of stabilization exercises could have a role to play in the outcome of treatment in patients with subclinical chronic LBP. The results generally indicated a better outcome of treatment in the three times weekly exercise group. Participants' explanations for the perceived improvements included major increases in confidence levels and formulation of self help strategies. They also reflected on their ability to exert better control over their own back pain, due to increased empowerment and self efficacy based on better understanding of the spine and how it works.
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Pearce, Julian Mark. "A biographical study of men with chronic low back pain." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/348803/.
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Low back pain is a common condition that will affect 80% of the population at some point in their lives. For the majority of people the pain and associated disability will be resolved and they will resume normal activities. For a small proportion of this group however, the condition will remain unresolved with associated long-term pain and disability; this is termed chronic low back pain (CLBP). The costs associated with CLBP are high both physically and emotionally for the individual, and in terms of the economic burden placed on society pertaining to healthcare costs and lost productivity. CLBP is a multifaceted condition. Whilst a biopsychosocial model of care, as opposed to the traditional biomedical model, is advocated as the best approach for its management it has been suggested that the impact on the self-concept and identity of individuals with this condition has not been fully explored or addressed. This study employed a biographical approach with the aim of understanding the impact on the lives and identities of men living with CLBP. Five men were recruited and in-depth interviews were undertaken which were audio-recorded, transcribed verbatim and analysed thematically. The identity of all the participants in the study had been affected by CLBP. Clear themes emerged that included feeling defined by their CLBP, experiencing feelings of frustration and anger, the inability to retain their masculine role, the impact on fatherhood, public and private identities, physicality and feeling a liability or burden to others. The support received from significant others was also highlighted. The participants detailed how exercise and education were major aspects in the management of their condition whilst resilience and the use of humour were also very apparent in their narratives as mechanisms to enable them to cope with CLBP.
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Oduah, Chukwudi. "Chronic Low Back Pain- A Needs Assessment for Practice Change." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4666.
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There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for evidence-based practice change, the chronic care model, and the middle-range theory of self-care of chronic illness were used. The evidence included the analysis of the Patient Assessment of Chronic Illness Care Survey (PACIC) data from 100 patients treated in this pain clinic. The clinic used the PACIC questionnaire to collect data from its 100 chronic low back pain patients, selected by simple random sampling method. The average weighted scores of these patients' responses were below the norm on all PACIC subscales and summary scores. According to study results, this pain clinic did not meet the self-management support needs of its chronic low back pain patients. Evidence-based recommendations were made for the improvement in the medical model of patient care by including nurse-led patient education and support. The positive social change is the improvement in the health status of this growing health population by meeting their identified education and support needs. Positive results from this nurse-led intervention could lead to the dissemination and widespread implementation of these recommendations in other pain clinics.
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Hyde, Susan Ann. "Facial expressive behaviour of a chronic low back pain population." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/27113.
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Assessment of the subjective experience of pain represents an ongoing concern in clinical, experimental and natural settings (Melzack, 1983). Previous laboratory studies (Craig & Patrick, 1985; Patrick, Craig & Prkachin, in press) using induced pain have suggested that facial expressive behaviour may provide a useful source of information additional to that offered by self-report in assessing the pain experience. There are, however, problems associated with the use of such behaviour, these being related to the issue of the voluntary and involuntary control that individuals have over their facial behaviour.
The present study attempted to extend the findings of the earlier analogue research using a clinical sample of chronic low back pain patients. Self-report of pain was also investigated as were several variables of clinical interest, i.e., duration of complaint and disability status. An attempt was made to overcome the tendency of people to attenuate their facial expressiveness in the presence of others scrutinizing the behaviour. Finally, the ability to control facial expression of pain was also investigated by requesting subjects to mask their facial expression during a painful movement and by requesting them to pose an expression of painful distress.
Subjects (60 male and 60 female patients at the Shaughnessy Hospital Back Pain Clinic) underwent a standardized physiotherapy protocol of four movements designed to induce low back or hip joint pain. Half of the subjects of each sex were given a set of instructions designed to enhance their overall global expressiveness. All subjects rated their acute discomfort as well as their more chronic discomfort as experienced on a "typical" basis. Subjects' facial expressions were videotaped during the standardized protocol and subsequently scored by two independent sets of coders using the Facial Action Coding System (Ekman & Friesen, 1978b) and using a global expressiveness rating system.
It was hypothesized that if the Instructional Set manipulation was successful then those subjects receiving the instructions would be rated as more globally expressive than those who did not receive instruction. It was also hypothesized that greater facial activity would be present in the posed expression of painful distress than in the genuine and masked displays.
A positive, albeit modest, relationship was found to exist between facial activity and self-report. This desynchrony between behaviour and self-report is common in the literature (Fordyce et al. 1984). The manipulation to enhance the global expressiveness of the subjects was unsuccessful. Males and females differed marginally, however, in terms of judges' ratings of global expressiveness with females being rated as more expressive. This difference was also discussed in light of the absence of a sex difference on the FACS variables.
Subjects were somewhat successful in deliberately attenuating their facial activity during a painful movement.
It was concluded that future research should focus on further investigation of the existence of configurations of facial actions expressive of pain, any one or more of which might be-displayed, rather than pursuing the existence of a prototypical pain expression. It was suggested that a prototypic expression might be more characteristic of a posed display and further research could investigate this possibility.Arts, Faculty of
Psychology, Department of
Graduate
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Sato, Kaori D. "Pain medication use by participants in a yoga study for chronic low back pain." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21249.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Recent studies have shown the efficacy and practicality of the integration of complementary and alternative therapies and biomedical treatments for various diseases and illnesses, including high blood pressure, diabetes, epilepsy, and cancer. Saper et al. (2013) demonstrated that once-weekly yoga classes were equally as effective for relieving chronic low back pain in low-income, minority populations than twice-weekly yoga classes. Pain medication data collected from this 12-week study was used to examine the effect of yoga on analgesic use. Pain medications were categorized into four major groups: (1) acetaminophen, (2) opiates, (3) non-steroidal anti-inflammatory drugs (NSAIDS), and (4) other. The average number of NSAID pills taken daily decreased from baseline to 12 weeks. In addition, there was no statistically significant difference in the average number of any type of analgesic taken between once- and twice-weekly yoga groups from baseline to 12 weeks. Our findings suggest that yoga is most useful for individuals with mild to moderate chronic low back pain; however, further studies with more powerful sample sizes must be conducted in order to make more precise conclusions.
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De, Gagné Théo A. "The evolution of chronic pain, adjustment status following treatment for acute low back pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ36801.pdf.
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Reilly, James Phillip. "The efficacy of a pain management programme for people with chronic low back pain." Thesis, University of Liverpool, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250272.
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Kool, Jan Pieter. "Physiotherapy and sick leave in patients with chronic low back pain." [Maastricht] : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 2005. http://arno.unimaas.nl/show.cgi?fid=6532.
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Rofail, Diana. "Treatment satisfaction and dissatisfaction in patients with chronic low back pain." Thesis, Brunel University, 2010. http://bura.brunel.ac.uk/handle/2438/4616.
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This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to define the concept, and establish appropriate measurement based on patient input and evidence to support the reliability and validity of items. Chapter 4 presents study 2, a qualitative study. Ten patients with CLBP taking medication and/or receiving physiotherapy were interviewed. A conceptual model of CLBP and a thematic map of treatment satisfaction and dissatisfaction were developed. Satisfaction was related to being 'happy' or 'pleased', and maintaining normal functioning. Treatment not working, causing discomfort, or negatively affecting health-related quality of life, as well as inconvenience of medication, lack of information, not feeling involved in treatment decisions, lack of trust and confidence in healthcare professionals, and being misdiagnosed or undiagnosed, were associated with dissatisfaction. Chapter 5 documents the development of the CLBP Treatment Satisfaction Questionnaire, based on patient input from study 2. Cognitive debriefing showed items were relevant and understood by patients. Chapter 6, study 3, explored the psychometric properties of the questionnaire. The longitudinal design involved data collection from 249 patients, some of whom participated in follow-ups. Results indicated that treatment satisfaction/dissatisfaction involves an appraisal of the following seven domains: 'Information Provided about Back Pain and Treatment', 'Burden of Back Pain', 'Impact of Back Pain and Treatment on Relationships', 'Satisfaction with the Treatment Process', 'Problems with Side Effects of Medication', 'Adherence to Physiotherapy', and 'Medication Acceptability'. Some evidence of reliability and validity are presented. This thesis concludes with Chapter 7, a discussion of the main findings of the studies, strengths and limitations, and recommendations for future research.
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O'Neill, Katherine M. "The psychological management of chronic low back pain : a controlled trial." Thesis, University of Surrey, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321037.
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Adem, Ahmed. "Exploring self-management of chronic low back pain in Saudi Arabia." Thesis, Sheffield Hallam University, 2017. http://shura.shu.ac.uk/19155/.
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Aim: The main purpose of this research project is to explore both patients’ and physiotherapists’ perceptions and understanding of self-management for chronic low back pain (CLBP) in the Kingdom of Saudi Arabia (KSA) and moreover, to explore current physiotherapy practice for managing CLBP in KSA. Methods: This research project used a mixed methods approach with sequential designs. The first section contains a quantitative study and the second section includes two qualitative studies. The quantitative section allowed exploration of current physiotherapy practices for CLBP management using a large population. The qualitative section has provided a more in-depth understanding of both patients' and physiotherapists' perceptions in regards to self-management and physiotherapy management for CLBP. Results: In the current study, physiotherapists acknowledged the importance of exercise and advice. Moreover, these represented the most common treatment methods used in daily practice. However, patients’ preferences for passive approaches, such as rest, massage and modalities were frequently reported. This shows conflict between physiotherapists and patients with CLBP in terms of the preferred approach for managing the disorder. Physiotherapists’ extensive use of modalities where evidence of effectiveness was lacking or insufficient was a common practice for physiotherapy management in patients with CLBP in the current research project. Moreover, physiotherapists and patients showed limited understanding of self-management as a concept. Conclusion: Promoting self-management in daily physiotherapy practice appears to be a complex issue. It involves various factors, such as promoting an evidence-based practice culture among physiotherapists; a patient-centred approach; access to guidelines and evidence; and organisational support through developing policy, local guidelines and CPD training. This research presents a platform of recommendations for future researchers, professionals, educators and policymakers to enhance the quality of care for patients with CLBP in the KSA in general and may increase the adoption of self-management.
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Newman-Beinart, Naomi Angela. "Non-adherence to prescribed home exercise in chronic low back pain." Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/nonadherence-to-prescribed-home-exercise-in-chronic-low-back-pain(e64a992a-e4ba-46c6-8955-81d8f36cf480).html.
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Background: Adherence to prescribed home exercise for chronic low back pain (CLBP) is poor and this remains an under-researched area. There is no standard measure of exercise adherence and traditional health behaviour models are limited in their ability to explain non-adherence. This thesis aims to address these issues. Aim: To undertake a review of CLBP literature (Study 1), to develop a new measure (Study 2) and to investigate the role of psychosocial, clinical and executive function factors in explaining variation in exercise adherence in CLBP (Study 3). Design: Study 1 involved systematically reviewing factors associated with adherence to prescribed home exercise in CLBP. In Study 2, the Exercise Adherence Rating Scale (EARS) was developed. Study 3 was a prospective observational study of exercise adherence in a CLBP sample. Results: Study 1 found nine trials providing moderate evidence that higher health locus of control, supervision, participation in an exercise programme and participation in a behaviour change programme incorporating motivational strategies were associated with better exercise adherence in CLBP samples. In Study 2, a 1-factor solution explained 66% of the variance in adherence to exercise. Internal consistency (α = 0.758) and item-response theory methods indicated that EARS reliability was acceptable. In Study 3, longer duration of pain, higher present pain, lower educational level and being female significantly predicted poor adherence behaviour. Executive functions were not predictive of adherence behaviour. Conclusions: Study 1 highlighted a lack of good quality evidence and standardised measures of adherence. The EARS in Study 2 provided a valid and reliable assessment of adherence behaviour in a CLBP sample and now requires further testing. Results of Study 3 suggested factors influencing adherence to prescribed home exercise in patients with CLBP. The inclusion of these factors within health behaviour models may provide better explanatory models of exercise behaviour in CLBP.
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Mathieson, Ian. "Foot-type as a risk marker in chronic low back pain." Thesis, Cardiff Metropolitan University, 2004. http://hdl.handle.net/10369/6438.
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Foot function has been linked with various musculoskeletal pathologies. In recognition of the over-emphasised role of interventional trials and the underdeveloped role of observational studies in investigating such relationships, a case-control study was designed to examine the link with low back pain. Before this could proceed, several critical issues surrounding the validity and reliability of measures of 'foot-type' were examined to identify the optimal technique for use in observational research. Firstly, the ability of static measurements to reflect the dynamic state was investigated for two footprint and a calcaneal motion measure to examine a basic validity dimension. Although all measures differed between states, high correlations revealed a consistent dynamic increase. Subsequent content validity assessment involved examining the response of footprint and navicular motion measures to 50 changes in subtalar joint position. Navicular height was most sensitive (consistently changing value significantly with between 50 & 100 of calcaneal motion), whilst poor performance of footprint measures (requiring >150 of calcaneal motion to induce significant changes) compromised their further use. The original intention to categorise subjects according to subtalar axis orientation to increase the precision of this validity study was abandoned after its reliability was found to be poor. Finally, the optimal, motion-based, measures of foot-type identified were utilised in a case-control study, which recruited 64 cases with low back pain and 57 controls. A significantly higher magnitude of left-right asymmetry of calcaneal and navicular motion, and a significantly reduced score on a foot-health related quality of life assessment tool, the foot health status questionnaire, was found in cases. Despite concerns over the absolute reliability and validity of the motion-based measures used, and several limitations in the case-control design, the study implicates foot function with low back pain and suggests that further study to determine the extent of its involvement is warranted.
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MacRae, Catharine Sian. "The effectiveness of rocker sole shoes in chronic low back pain." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/the-effectiveness-of-rocker-sole-shoes-in-chronic-low-back-pain(f5e40434-d684-44a5-9cb4-56349404fd42).html.
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Shoes with a rocker sole are marketed as reducing low back pain. There is minimal evidence to support these claims. This investigation compared rocker sole shoes to flat sole shoes in people with chronic low back pain (CLBP). The thesis reports findings of a randomised clinical trial and a series of biomechanical experiments. Following preparatory pilot and reliability studies, 115 people with CLBP were randomised to wear rocker sole shoes or flat sole shoes; all participants attended an exercise and education programme. Participants were assessed without knowledge of group allocation pre-randomisation, at six weeks, six months, and one year (main outcome point). Primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Analysis was by intention-to-treat. Biomechanical experiments recruited 20 participants from the main study and investigated effects of wearing rocker sole and flat sole shoes on standing balance and gait, immediately and after 6 months of shoe wear, using centre of pressure and motion-analysis derived kinetic, kinematic and spatio-temporal measures. Balance and gait in people with and age-and gender-matched controls without CLBP were compared. Rocker sole shoes were no more beneficial than flat sole shoes for CLBP patients; flat sole shoes were more beneficial in a sub-group of CLBP aggravated by standing or walking. Biomechanical studies found rocker sole shoes introduced immediately greater postural instability than flat sole shoes but neither shoe had long-term training effects on postural control. Furthermore, although both shoes resulted in small immediate changes in kinetic, kinematic and spatio-temporal parameters of shod gait, neither shoe had long-term training effects on these parameters in barefoot gait. Finally, in contrast to some previous research, postural control during standing, and kinetics, kinematic, and spatio-temporal parameters during gait were similar between people with and without CLBP.
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Vlaeyen, Johannes Wolfgang Silvain. "Chronic low back pain assessment and treatment from a behavioral rehabilitation perspective /." Amsterdam [etc.] : Maastricht : Swets & Zeitlinger ; University Library, Maastricht University [Host], 1991. http://arno.unimaas.nl/show.cgi?fid=6194.
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Smeets, Robert Johannes Elise Marie. "Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both?" [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Universiteit Maastricht [host], 2006. http://arno.unimaas.nl/show.cgi?fid=5954.
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Snidvongs, Saowarat. "Lumbar facet joint injections for the management of chronic low back pain." Thesis, University of Exeter, 2018. http://hdl.handle.net/10871/34334.
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Background: Low back pain is a leading cause of disability worldwide and has a significant economic burden. Targeted lumbar facet joint injections may be used to relieve this pain and aid rehabilitation, but high quality clinical evidence to support their use is lacking. The National Institute for Health and Care Excellence (NICE) does not recommend spinal injections for the management of chronic low back pain. Critical appraisal of systematic reviews: A critical appraisal of systematic reviews of randomised controlled trials concluded that the existing evidence to support the use of facet joint injections in low back pain management is equivocal, with methodological variability detected across the studies and reviews. FACET feasibility study: The FACET feasibility study was a blinded parallel two-arm pilot randomised controlled trial to assess the feasibility of carrying out a definitive study evaluating the effectiveness of lumbar facet joint injections compared with a sham procedure, in patients with non-specific low back pain of more than three months’ duration. The study recruited from the pain and spinal orthopaedic clinics at Barts Health NHS Trust only, although a multicentre study was planned. Adult patients referred to the specialist clinics with non-specific low back pain despite NICE-recommended best non-invasive care were randomised and blinded to receive either intra-articular lumbar facet joint injections with steroid or a sham procedure, following a positive response to diagnostic medial branch nerve blocks. Both groups were invited to attend a combined physical and psychological programme. Measures of feasibility included the recruitment and retention rate, and adherence to the study protocol. Questionnaires were used to assess a range of pain- and disability-related issues. Of 628 participants screened for eligibility, nine were randomised to receive the study intervention and eight participants completed the study. Failure to recruit sufficient participants led to early closure of the study by the funder, and no conclusions were drawn on the clinical effectiveness of lumbar facet joint injections for the management of non-specific low back pain in this sub-group of patients. Although the target recruitment rate was not achieved, a robust study protocol was developed and the intended interventions delivered safely, thus addressing many of the feasibility objectives. Conclusions: Further high quality randomised controlled trials and systematic reviews are required to inform decision makers, with implications for both clinical practice and policy. Stronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory, suitable for inclusion in a future trial.
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Poole, Helen Margaret. "The efficacy of reflexology in the management of chronic low back pain." Thesis, Liverpool John Moores University, 2001. http://researchonline.ljmu.ac.uk/4915/.
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Abdel-Moty, Alma R. "Stated versus observed performance levels in patients with chronic low back pain." FIU Digital Commons, 1992. http://digitalcommons.fiu.edu/etd/1079.
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This study examined the relationship between chronic low back pain (CLBP) patients' perceived (stated) levels of function and their measured (observed) performance in squatting and stair climbing activities as compared to healthy volunteers. Twenty patients with CLBP and 20 healthy subjects were asked through an interview to self-assess their ability to comfortably perform stair climbing and squatting as well as other tolerances. The subjects were then asked to perform the activities and their performance levels were recorded. Results of the t-tests and Analysis of Variance (ANOVA) procedures revealed that patients' estimate of squatting and stair climbing abilities as well as their demonstrated levels were significantly lower (p < 0.001) than those of the healthy subjects. There was a significant difference between groups in terms of the time required to perform squatting but not stair climbing. Both healthy subjects and patients with CLBP underestimated their physical capabilities. Findings indicate that the use of actual performance measurement combined with self-report of functional abilities is needed when assessing performance levels of both healthy as well as patients with CLBP.
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Caeiro, Carmen Sofia Frade. "Portuguese individuals' experiences and perceptions of non-specific chronic low back pain." Thesis, University of Brighton, 2016. https://research.brighton.ac.uk/en/studentTheses/447866d1-49ab-41fc-a534-24bc90a24d6f.
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Low back pain (LBP) is the most common form of chronic pain. Approximately 85% to 90% of chronic low back pain (CLBP) episodes in primary care cannot be related to serious pathology or neurocompression, being described as nonspecific chronic low back pain (NSCLBP). This disorder involves continuous pain or recurrent flare-ups that are responsible for high levels of distress, functional disability and work absenteeism. It has also a significant impact on health care systems and society in general. Considering the complexity inherent in the experience of NSCLBP, where personal and cultural contexts play a major role, research has highlighted the need to study this phenomenon in contexts that have not yet been investigated. This study aimed to explore the Portuguese individuals` experiences and perceptions of NSCLBP. An interpretative phenomenological analysis (IPA) was employed to explore the experiences of eight participants, who were recruited purposefully from three Portuguese health sites. Semi-structured one-to-one interviews were carried out in order to collect data. The interviews were audiorecorded and transcribed verbatim. Following an inductive process of data analysis, five themes emerged as interrelated parts of an extended account that explored the Portuguese individuals` experiences and perceptions of NSCLBP. In the first theme the disruptive nature of the NSCLBP experience was emphasised. In the second, the participants` meaning making of NSCLBP and their need to understand it were highlighted. In the third, the clinical encounters and their contribution to maintaining the lack of participants’ understanding about NSCLBP were emphasised. In the fourth, the meaning making of NSCLBP contribution to reshaping the participants` social interactions was explored. In the fifth, the participants` definition of their sense of self through the meaning making of NSCLBP was highlighted. In order to promote the transparency of data analysis, an audit trail was developed to document all relevant steps of this process. This study has offered the first insights into the Portuguese individuals’ experiences of NSCLBP disorder, which may help clinicians in transferring this knowledge to the therapeutic approach to patients with similar experiences. The knowledge produced may be used to inform recommendations for NSCLBP management.
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Steele, James. "Isolated lumbar extension exercise as an intervention for chronic low back pain." Thesis, Southampton Solent University, 2015. http://ssudl.solent.ac.uk/3173/.
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Low back pain (LBP) is highly prevalent, generally categorised as ‘non-specific’ as clear diagnosis for pain is often absent, and further categorised into acute, sub-acute and chronic, with 69-75% of acute cases developing into chronic. This chronic LBP population accounts for the majority of economic costs worldwide associated with LBP. Although LBP is often ‘non-specific’, many physical dysfunctions are associated with it. Thus LBP can be regarded as multifactorial in nature. Dysfunctions include, but are not limited to: deconditioning of the lumbar extensor musculature, limited range of motion (ROM), gait abnormality and disc disorders. The novel approach of this thesis was to consider lumbar extensor deconditioning, LBP and its associated physical dysfunctions within a multifactorial framework, and the potential improvement of associated dysfunctions from intervention using isolated lumbar extension (ILEX) specifically aimed at addressing lumbar extensor deconditioning. Findings from three empirical studies are reported. The first examined limited ROM ILEX exercise compared with full ROM exercise. Results from this study support that limited ROM training is as effective as full ROM training at improving full ROM ILEX strength, pain and disability. The second study examined the effects of ILEX exercise upon lumbar spine kinematic waveform pattern variability during gait. Results from this study demonstrate that ILEX exercise significantly improves sagittal plane variability in chronic LBP participants. The final study examined the effects of ILEX exercise upon disc hydration determined indirectly through measurement of spinal height using seated stadiometry. Results from this study showed improved ILEX strength, pain and disability but did not demonstrate improvement in disc hydration. These results provide evidence for adopting a multifactorial conceptualisation of LBP in the use of ILEX exercise as a treatment. It is concluded that a wide range of improvements including pain, disability and various aspects of function relating to the multifactorial model are possible through use of a single minimal intervention involving ILEX. This conclusion has potential implications for considering direction of treatments from clinicians towards chronic LBP. Such a minimal intervention offering a wide range of benefits may reduce the need for costly and complex multi-disciplinary interventions.
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Rispinto, Sarah C. "Treatment Outcomes of Patients with Low Back Pain Treated in a Pain Rehabilitation Program." Cleveland State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=csu1409235938.
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Hynes, Elizabeth. "Learning needs and perceived self-efficacy of patients with chronic low back pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq25851.pdf.
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Sheeran, Liba. "Motor control in non-specific chronic low back pain : a view to classification." Thesis, Cardiff University, 2010. http://orca.cf.ac.uk/54386/.
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Non-specific chronic low back pain (NSCLBP) is a complex bio-psycho-social pain disorder of frequently unknown aetiology. Impairments in motor control (MC) have been frequently associated with NSCLBP disorder. Although the causal relationship between LBP and motor control impairment (MCI) is a matter of debate, impaired MC has been proposed to increase loading of the spinal tissues, which over time may contribute to an ongoing pain, chronicity and subsequent disability. Therapeutic MC interventions have been shown to modify MC but larger clinical trials were unsuccessful in consistently improving clinical outcomes in patients with CLBP. This lack of success has been linked to the heterogeneity in patients with NSCLBP in whom the impaired MC and hence the most optimal therapeutic MC intervention may considerably vary. Bio-psycho-social classification systems (CS), which categorize NSCLBP patients based on the type of MCI, have been developed but its effectiveness in (i) revealing specific MC alterations in patients with different type of MCI, and (ii) guiding therapeutic MC interventions that are specific to the type of MCI have not been fully explored. Preliminary Study: The aim of this part was to establish the reliability of a novel measuring device, the Spinal Wheel, to measure the sagittal curvatures of the whole spine (thoracic and lumbar) in sitting and standing in MCI subgroups of patients with NSCLBP rather than small sections of the spine as other studies have. Typical measurement error was also studied. Excellent within-day, intra- and inter-tester reliability and substantial between-day, test-retest reliability was demonstrated thus warranting its use in the main study of this thesis. Main Study - Part 1 The aim of this part was to detect differences in sensory and motor parameters of MC, specifically proprioception (spinal position sense) and trunk muscle electromyography (EMG) amplitudes in asymptomatic subjects and two of the most frequently encountered patterns of MCI in NSCLBP, flexion pattern (FP-MCI) and active extension pattern (AEP-MCI) when performing neutral spine posture tasks in sitting and standing. Patients with FP- and AEP-MCI demonstrated unique impairments in some, but not all, of the measured parameters of MC. Main Study - Part 2 The aim of this part was to determine the effect of CS-guided postural motor learning intervention (CS-MLI) compared to generalized postural intervention (GPI) on clinical outcomes (patient-reported pain and disability) and MC outcomes (spinal position sense and trunk muscle EMG amplitudes) in NSCLBP patients with FP- and AEP-MCI using a pragmatic randomized, single-blinded, test-retest investigation. CS-MLI improved perceived disability and pain scores and produced immediate but short-lasting improvements in some elements of sensory function compared to minimal change in GPI. The pragmatic nature of the investigation, however, may not conclusively support that the specificity of CS-MLI to the MCI type was the deciding factor in the improved outcomes. This doctoral thesis on classification of NSCLBP highlighted the importance of classification in clinical research into NSCLBP and advanced its applicability within clinical practice. Classifying NSCLBP patients based on their MC characteristics was shown to be valuable in revealing the existence of unique alterations in some MC parameters in subgroups of patients with specific types of MCI, that appear to be lost when NSCLBP patients are treated as homogeneous. The thesis also advanced the knowledge base on the use of classification-guided therapeutic interventions in this population of patients.
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Adams, Nicola B. K. "Psychophysiological and neurochemical substrates of chronic low back pain and modulation by treatment." Thesis, University of Ulster, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.315794.
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DeBeus, Roger J. (Roger John). "Cluster Analysis of the MMPI-2 in a Chronic Low-Back Pain Population." Thesis, University of North Texas, 1997. https://digital.library.unt.edu/ark:/67531/metadc279112/.
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The Minnesota Multiphasic Personality Inventory (MMPI) is the most frequently used psychological measure in the assessment of chronic pain. Since the introduction of the MMPI-2 in 1989 only two published studies have focused on cluster analysis of chronic pain patients. This study investigated MMPI-2 cluster solutions of chronic low-back pain patients. Data was collected from 2,051 chronic low-back pain patients from a multidisciplinary pain clinic in the southwestern United States. A hierarchical clustering procedure was performed on K-corrected T-scores of the MMPI-2 using the three validity and ten clinical scales. Four relatively homogeneous subgroups were identified for each sex with the MMPI-2. In general, these results replicated the findings of previous researchers using both the MMPI and MMPI-2.
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Campbell, Ciara. "Measuring physical behaviour in physiotherapists and in people with chronic low back pain." Thesis, Ulster University, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.716363.
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Background This PhD thesis is in two main strands; the measurement of physical behaviour (physical activity and sedentary behaviour) in (i) health professionals and (ii) a clinical population. The physical behaviour of health professionals was investigated as evidence suggests that their promotion of healthy behaviour is increased if they are physically active (Brutons et al 2005). However, this link has not been investigated with UK physiotherapists. Physiotherapists should promote good health to all patients but particularly those with chronic low back pain (CLBP) (50% of musculoskeletal physiotherapists caseload, Foster et al 1999). There has been no large scale studies investigating sedentary behaviour in CLBP population. Methods For strand one, a questionnaire was designed and carried out with physiotherapists to ascertain their personal physical behaviour, knowledge of guidelines and health promotion practices. For strand two, a systematic review was undertaken to ascertain the most valid and reliable tool for measuring sedentary behavior in back pain. A secondary analysis was then carried out to determine the level and pattern of physical behaviour in people with CLBP. Results The majority of physiotherapists promoted physical activity to their patients, were physically active and self-reported knowledge of the guidelines was high. However, actual knowledge of the guidelines was low. The activPAL was the most appropriate device for measuring sedentary behavior in this CLBP population. The secondary analysis concluded people with CLBP spend 9.37 hours a day in sedentary behavior however this is regularly broken up. They also spend 1.82 hours in ‘standing/stepping’ activity but this is accumulated in short bouts less than 10 minutes, which is not long enough to incur health benefits (McVeigh et al 2016). Conclusions Physiotherapists promote physical activity but require training in implementation of the guidelines to ensure optimum health promotion practices. Future interventions with the CLBP population should seek to reduce total sedentary time.
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Osborn, Michael. "The personal experience of chronic benign low back pain : an interpretative phenomenological analysis." Thesis, University of Sheffield, 2002. http://etheses.whiterose.ac.uk/10194/.
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This thesis is a qualitative study of chronic benign low back pain (CBLBP). Psychological factors play an important role in the genesis and maintenance of CBLBP but the processes involved are poorly understood. The meaning of the pain for the sufferer is considered to be important and more research into this area that takes an idiographic approach is recommended in the literature. Three empirical studies are reported which employ Interpretative Phenomenological Analysis (IPA) to explore the personal experience of CBLBP. A range of themes are discussed that capture the meaning of the pain for the sufferer and help to understand the dynamic relationship between the pain sensation, distress and disability. The first study is exploratory, the participants' struggle to make a coherent sense of their pain is revealed along with the related personal and social implications. In the second study the experience of pain itself is focused on more closely in the context of a simple intervention. Descriptions of the pain are given which reveal its threatening aspect and suggest that the participants' self-appraisal in the face of this threat is important. The factors underlying change are discussed and the contribution of contextual factors is emphasised. The first two studies indicated that the self-concept was worthy of further study and it became the explicit focus of the third study. The relevance of the self was highlighted and it was shown to be indivisible from the lived experience of CBLBP. The three studies reveal the multi-dimensional complexity of CBLBP and highlight how its inherent `unpleasantnessr'e presentsm ore than a noxious sensory experience but unfolds within a dynamic personal and social context. The emergent themes are reviewed and discussed in relation to the literature and implications for further research and clinical practice are suggested.
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Casavant, David A. "A method to objectively assess muscular disorders of the lumbar back associated with chronic low back pain." Thesis, Boston University, 1987. https://hdl.handle.net/2144/38012.
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Thesis (M.S.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Recent information regarding chronic low back pain indicates that approximately 80% of all cases are muscular in origin. However, presently available diagnostic techniques and prescribed treatments are often ineffective in detecting and remedying this common ailment. The research effort reported in this thesis involves an electromyographic techniques used to objectively evaluate abnormal back muscle interactions associated with low back pain. In order to measure the functional state of the trunk extensor muscles. myoelectric (ME) activity was monitored from multiple sites of the lumbar musculature during sustained, isometric contractions. The fatigue characteristics of each muscle were quantified by observing the spectral shift of the power spectrum of the ME signal. The resulting "fatigue patterns" thus represented the dynamic interaction of the synergistic back muscles. Differences in these patterns associated with low back disorders may represent functional disturbances. To obtain an indication of the force contribution of each muscle, their relative activity levels were also monitored. Multifactor analysis of variance (ANOVA) techniques demonstrated significantly higher fatigue rates in the back extensor muscles of back patients as compared to pain-free controls. With regard to overall strength, however, back patients and controls were remarkably similar. Possible explanations of the observed endurance deficiency in back patients are: 1) muscle atrophy resulting from low patient motivation and inactivity, or 2) higher precontraction metabolic concentrations in the erector spinae muscles of back patients caused by high resting tensions and frequent muscle spasm, or 3) compensation by healthy muscles in order to relieve and/or protect deficient and/or injured synergists. In conjunction with the above-described study involving back patients, additional research was performed using pain-free controls to investigate the ability of the erector spinae muscles to recover following a fatiguing contraction. Recovery was quantified by observing the time required for the ME power spectrum to return to it's initial state following fatigue. Preliminary findings suggest the existence a circulatory reactive mechanism occurring immediately following a high level, ischemia-producing contraction. Furthermore, the reproducability of the back assessment procedure was established by repeating the procedure on the same day and on adjacent days. The results maintained that the assessment procedure is reliable.
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Leeuw, Maaike. "Safe but sorry Theory, assesment, and treatment of pain-related fear in chronic low back pain patients /." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=9708.
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林德 and Tak Lam. "An evidence-based guideline on yoga in reducing pain among adult patients with chronic low back pain." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193028.
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Low back pain (LBP) is a common complaint and health problem in Hong Kong, particularly among middle-aged individuals. LBP is the main cause of chronic disability which significantly affects the daily life activities of patients. Pain might result in repeated hospital admissions and subsequently increase the burden on health care providers in Hong Kong. LBP has an enormous effect on quality of life and therefore deserves research attention.
Growing evidence shows that yoga may help reduce the level of chronic LBP in adult patients. However, no systematic review has been conducted to support the translation of this theory into practice. Therefore, this thesis aims to evaluate the current evidence on the efficacy of yoga in reducing chronic LBP among adult patients to achieve the following objectives: formulate an evidence-based protocol on yoga practice, assess the implementation potential of the formulated protocol, and develop implementation strategies and evaluation plan for the use of this protocol in a local public hospital in Hong Kong.
Five databases were used for the systemic review of relevant studies. These databases were those of Cochrane Library, CINAHL Plus, PudMed, British Nursing Index and Medline (Ovid). A total of eight papers (randomized controlled trials) fulfilled the inclusion criteria of this study. The Scottish Intercollegiate Guidelines Network (SIGN) was used to extract the data and evaluate the paper quality. The findings of the selected papers indicated that yoga practice has a significant effect on reducing pain among adult patients with chronic LBP.
The innovation is proposed to be conducted in an adult orthopedic and traumatoloy (O&T) ward. Evidence-based yoga guideline is developed to guide nurses in the effective implementation of the protocol. The SIGN grading system is chosen to grade the recommendations in the guideline. Adult patients with persistent LBP longer than three months are the target population. All study participants practice specific yoga postures under the supervision of yoga instructors and trained nurses in the outpatient clinic. These patients continue home practice for 30 minutes daily or at least twice a week. Based on the findings of the reviewed literatures and the adaptation of these findings into the proposed innovation, the feasibility of implementing evidence-based yoga guideline in the local clinical setting in Hong Kong is demonstrated.
An effective communication plan is developed to gain support from stakeholders and efficiently implement the innovation. A two-month pilot study is designed to test the feasibility of the guideline. Pain level, which is the primary outcome of the study, is measured by using Pain Numerical Pain Scale (NRS). Evaluation will be completed after the pilot test and at the end of the whole programme and refinement of the protocol will be accomplished according if necessary. Protocol effectiveness will be determined by a decrease in back pain level after practicing yoga. Other outcomes include the knowledge and satisfactory level of the staff with regards to the protocol, as well as and the costs and benefits of program implementation.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Horton, John F. "Abdominal muscle characteristics of elite male golfers with and without chronic low back pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ49622.pdf.
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Frost, Helen. "Evaluation of physiotherapy intervention for non-specific sub-acute and chronic low back pain." Thesis, University of Warwick, 2007. http://wrap.warwick.ac.uk/39024/.
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This thesis investigates routine physiotherapy management of patients with subacute and chronic non specific low back pain. In a pragmatic multi-centre trial patients were randomised to receive a course of physiotherapy treatment or advice following a bio-psychosocial model. Disease specific, patient specific and generic measures were used to assess outcome. The 286 patients recruited in the trial had, on average, minimal to moderate low back pain disability. Patients reported enhanced perceptions of benefit in the physiotherapy group but there was no evidence of a long term effect in any other outcomes. There were no differences between the groups in NHS costs although patients in the physiotherapy group incurred significantly higher out of pocket expenses. Further analysis of the outcome data confirmed that the primary outcome measure (Oswestry Disability Index) was the most responsive instrument because it was able to detect deterioration as well as improvement. As the trial demonstrated no additional benefit of physiotherapy over brief advice, it was important to investigate the effectiveness of the latter. A systematic review found limited evidence that brief bio-psychosocial advice was more effective in reducing fear avoidance and improving back beliefs in patients with acute and subacute low back pain compared with traditional medical advice. There was no direct evidence to support the use of brief bio-psychosocial advice (2 sessions or less) for reducing pain or disability. This thesis describes research that has contributed to European guidelines for the management of chronic low back pain and reviews extensively the literature that seeks to evaluate physiotherapy practice. The clinical implication of this research is that for patients with non specific low back pain of mild severity, brief advice is likely to be as effective as prolonged physiotherapy intervention. The extent to which a single session of advice is more effective than no intervention needs further assessment.
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Luedtke, Kerstin. "Transcranial direct current stimulation for the reduction of chronic non-specific low back pain." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5248/.
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Non-specific chronic low back pain has serious personal and socio-economic consequences. International guidelines recommend multimodal cognitive behavioural management (CBT). The effectiveness of CBT might be enhanced by directly targeting central nervous system pain processing. Transcranial direct current stimulation (tDCS) is a novel approach aiming to influence pain by altering cortical excitability. An evaluation of existing reviews indicated the need for an up-to-date review of clinical and experimental pain trials. A systematic review including 14 trials (published 2006-2012) evaluating tDCS for the reduction of clinical and experimental pain identified a low level of evidence for its effectiveness. Only 1 trial had a low risk of bias. A meta-analysis of trials on clinical pain identified a small pain reducing effect that just reached clinical importance. To investigate the effectiveness of tDCS alone and in combination with CBT, a double-blind RCT was conducted; preceded by a feasibility study confirming practicability of trial procedures and patient acceptability of tDCS. Results indicated that tDCS alone or in combination with CBT did not significantly influence pain or disability. An updated meta-analysis, including this trial’s results, lowered the pain reducing effect of tDCS below clinical importance, and increased the level of evidence for its effectiveness to "high".
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Stidd, David A., Sergio Rivero, and Martin Weinand. "Spinal cord stimulation with implanted epidural paddle lead relieves chronic axial low back pain." Dove Press, 2014. http://hdl.handle.net/10150/621348.
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UA Open Access Publishing FundIntroduction: Spinal cord stimulation (SCS) provides significant relief for lumbosacral radiculopathy refractory to both medical and surgical treatment, but historically only offers limited relief for axial low back pain (LBP). We aim to evaluate the response of chronic axial LBP treated with SCS using a surgically implanted epidural paddle lead. Materials and methods: This is a retrospective review of a consecutive series of patients with exclusive LBP or predominant LBP associated with lower extremity (LE) pain evaluated and treated with SCS using an implanted paddle lead within the dorsal thoracic epidural space. Baseline LBP, and if present LE pain, were recorded using the visual analogue scale (VAS) at an initial evaluation. At a follow-up visit (a minimum of 12 months later), LBP and LE pain after a spinal cord stimulator implantation were again recorded using the VAS. Patients were also asked to estimate total LBP pain relief achieved. Results: Patients with either exclusive (n=7) or predominant (n=2) axial LBP were treated with SCS by implantation of a paddle lead at an average spine level of T9. The baseline VAS score for LBP was 7.2; after a follow-up of 20 months, the score decreased to 2.3 (P=0.003). The LE pain VAS score decreased from 7.5 to 0.0 (P=0.103). Patients also reported a subjective 66.4% decrease of their LBP at follow-up. There were no surgical complications. Conclusions: Axial LBP is refractory to many treatments, including SCS. SCS using a surgically implanted paddle electrode provides significant pain relief for chronic axial LPB, and is a safe treatment modality
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Abdal, Noor Hadi. "Chronic low back pain and the construction of illness identities in women from Kuwait." Thesis, University of Brighton, 2015. https://research.brighton.ac.uk/en/studentTheses/29d47dd7-4af0-4f90-87e5-0390989d4413.
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Chronic low back pain (CLBP) has been identified as a prominent health problem and a major cause of disability. Recent research has focussed on providing a better understanding of subjective experiences of people with CLBP; however, emphasis continues to be geared towards the physical restrictions associated with CLBP. There is a scarcity of literature that considers the relation between self and identity, and people‟s experiences with CLBP. Moreover, studies have concentrated on the experiences of people in Western contexts; to date, no studies have been carried out in Middle Eastern sociocultural contexts including Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experiences of women with CLBP and the impact on identity. This is the first study that investigates how women with CLBP construct illness identities in Kuwait. This study adopted a constructivist grounded theory methodology using dimensional analysis. In line with the grounded theory (GT) approach, data collection and analysis took place concurrently. A longitudinal study design was adopted. Semi-structured interviews were used to investigate women‟s perspectives on their experiences with CLBP in relation to their socio-political and cultural context. Eleven women were recruited from three musculoskeletal outpatient clinics in Kuwait. Initially, five women were purposively sampled. A follow up interview was conducted with four of those women one year after the initial interview to investigate any changes in their experiences. Subsequently, six women were theoretically sampled with the aim of comparing the influence of age, educational level, marital status, socioeconomic status and time on women‟s illness experiences. The findings of this study offer the first explanatory theory of the construction of illness identities of women with CLBP in Kuwait. Women‟s identities can be seen as part of a continuum from oppressed at one end to liberated at the other. Salience of oppressed identities was associated with periods of exacerbation of CLBP and passive coping behaviours. Appearance of liberated identities was accompanied with episodes of remission of CLBP and active coping approaches. Changes in women‟s social circumstances, thoughts and feelings over time were related to changes in the identities they portrayed, and changes in their manifestation of CLBP and illness experiences. The substantive theory developed through this study has implications for clinical practice, education and research, and may inform physiotherapy professional development activities in Kuwait.
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Curtis, Jane E. "The Efficacy of Multidisciplinary Treatment Programs for Chronic Low-Back Pain: A Meta-Analysis." DigitalCommons@USU, 1992. https://digitalcommons.usu.edu/etd/4221.
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Chronic low-back pain is a prevalent and costly problem for many adults in the United States. Currently, multidisciplinary treatment approaches are the treatment of choice for this problem. A meta-analysis was conducted on 43 published studies to describe the nature of these programs, the patients involved in them, treatment efficacy at discharge and follow-up, and possible relationships between these characteristics and outcome.
Results show that these programs were often in university medical settings, with an emphasis on active patient participation. Common treatment approaches included physical therapy, skills training, medication management, supportive therapy, and behavior modification. Patients involved in these programs tended to be middle-aged, married, unemployed, and high-school educated, with an average pain duration of about five years.
It was concluded that patients do show improvement at treatment completion (at least one-half standard deviation change) in physical fitness, reported distress levels, daily activity, and medication usage. At follow-up improvement over pre-treatment levels was still evidenced in reported distress levels, medication usage, mood, fitness levels, daily activities, and health perceptions.
Results of correlational analyses suggest that the more impaired patients in these studies tended to show greater improvement. Data also suggest that patient dropouts rates were negatively correlated to medication usage and mood over time. Thus, improvements in these areas may be artifacts due to patient drop-out rates.
Multidisciplinary treatment programs were found to be generally effective in promoting more adaptive functioning in their patients . However, it is recommended that closer attention be given to attrition rates and other potential sources of bias to maximize confidence in treatment effectiveness.