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Mak, Nin-fung Joseph, and 麥年豐. "Electromyographic characterization of functional status of back musculature: applications in low back painrehabilitation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42182372.
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Law, Kam-yin. "The quality of life of patients with low back pain /." View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31683502.
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Law, Kam-yin, and 羅錦燕. "The quality of life of patients with low back pain." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45011643.
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Grewe, Jennifer R. "Detecting Malingering in Compensated Low Back Pain Patients: An Analog Study." DigitalCommons@USU, 2010. https://digitalcommons.usu.edu/etd/552.
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Given the prevalence and cost of low back pain, particularly among workers' compensation patients, it is advantageous to understand how various psychological constructs may be related to prolonged disability and failure to return to work. Malingering is a psychological construct that is clearly relevant for worker compensation populations and is a construct that is well suited for experimental control within an analog study. Malingering is the intentional exaggeration of physical or psychological symptoms that are motivated by external incentives such as time away from work. The ability to detect malingering in such a population with psychological assessments is unclear. An analog study was conducted in which we instructed college students to portray themselves as injured workers who received a back injury that required them to be off work while they recovered. Students were then told that they would be seeing a psychologist who would attempt to ascertain their abilities to return to work via the MMPI-2. Students were then randomly instructed to respond to the MMPI-2 in three different ways: a control condition was instructed to respond as if they suffered a workplace back injury that resulted in significant pain; a subtle fake-bad condition who received the control instruction plus were informed they did not enjoy their work and their back injury allowed them to enjoy personal and family time more; and a fake-bad condition that received the control instruction plus were asked to deliberately portray themselves as experiencing physical symptoms severe enough to keep them off work longer. Currently, no assessment of malingering exists within a compensated low back pain population. The purpose of this study was to determine if the MMPI-2 can be used to differentially identify "patients" who are instructed to report symptoms veridically versus "patients" instructed to consciously feign and magnify symptoms in an effort to avoid returning to work. Malingering and non-malingering patients' scores on the MMPI-2 validity and clinical scales were subjected to a cluster analysis to determine if a malingering profile could be accurately identified. A 5-cluster validity solution and 4-cluster clinical (both with K correction) solution were accepted. Substantially lower scores on L and K, elevated scores on F on the 5-cluster validity solutions, distinguished the "malingering" profile. The 4-cluster clinical solution was characterized by elevated scores on the clinical scales of hypochondriasis, depression, paranoia, and schizophrenia, which distinguished the "malingering" profile. The results indicate that the MMPI-2 could be useful in detecting malingering in compensated back pain patients. Results are discussed in the context of pain studies.
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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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Zadurian, Natalie. "The role of coping in primary care low back pain patients." Thesis, Keele University, 2011. http://eprints.keele.ac.uk/3833/.
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Low back pain affects a large proportion of the general population. For some individuals, back pain becomes chronic, complex and difficult to treat effectively, with patients reporting continued pain and disability. A biopsychosocial framework has been adopted within research and clinical practice, as psychosocial factors have been recognised to be important in terms of pain management and recovery from back pain. Coping-related factors have been identified as particularly important, however a comprehensive examination of a wide range of coping factors is missing from available literature. A systematic review of the published literature identified important psychological factors that are predictive of low back pain outcome. Several factors emerged as potentially important, but fear avoidance beliefs appeared to be the most consistent predictor. Very few studies were found that investigated the role of behavioural coping, therefore a new measurement instrument was developed to aid further research. A detailed analysis of the Coping Strategies Questionnaire-24 was undertaken. Exploratory and confirmatory factor analyses were used and it was concluded that the measure was appropriate for use within this thesis. Data from a large cohort of primary care low back pain patients (n = 1,591) was used for analysis. Cross-sectional analyses revealed potential confounders of the relationship between coping and outcome at 12 months follow-up, which were controlled for within the longitudinal analyses. Only five coping variables were independently predictive of outcome – anxiety, depression, catastrophizing, self-efficacy and passive behavioural coping – along with pain duration and employment status. Change in coping over time predicted low back pain outcome, and it was found that coping worsening was particularly important. Coping worsening also partially mediated the relationship between pain duration and outcome. The major thesis findings were integrated into an overall conceptual model of coping, and key implications of this for clinical practice and research were discussed.
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Hill, Jonathan. "Identifying subgroups among patients with low back pain in primary care: Evaluating the STarT Back Tool." Thesis, Keele University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.491699.
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Background: Identification of low back pain subgroups has been highlighted as a .priority for secondary prevention of persistent problems in primary care. The aim of this PhD was to develop and evaluate a new clinical tool (called the STarT Back Tool) to allocate patients with back pain into initial treatment subgroups based on treatmentmodifiable prpgnostic indicators. Methods: The setting was, UK primary care adults consulting with non-specific pack ··pain:Constructs that were independent prognostic indicators for persistence were identified from secondary analysis of 2 existing cohorts and published literature and single screening questions identified. Psychometric properties of the tool, including concli.rrent and discriminant validity, internal consistency, repeatabili~y, were assessed . within a 'development' cohort (n=131) and tool score cut-offs established to enable alloc~tion to three subgrOlJPs ('low', 'medium' and 'high' risk). Predictive and ext~rnal . validity were evaluated within an 'independent external' cohort (n=500). The tool was . compared to an existing musculoskeletal screening tool (Orebro Musr:;uloskeletal Pain Screening Questionnaire) and to clinical acumen using video taped clinical interviews, . reviewed by primary care clinical-experts. Finally, the practical application of the tool was tested in. a pilot study and demonstrated to be feasible and acceptable to both . patients and clinicians. Results: The Tool included nine items: referred leg pain; comorbid pain; disability (two items); bothersomeness; catastr~phising; fear; anxiety, and depression. The latter 5 items were identified as a psychosocial subscale. The Tool demonstrated good reliability and validity and was acceptable to patients and clinicians. Conclusions: Identifying treatment subgroups with distinct clinical characteristics among patients in primary care presenting wi.th low back pain is pospible and feas'ible in clinical practic~. The tool shows potential for enabling early targeted interventions for the prevention of persistent disabling back problems.
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Leung, Siu-lun Arran, and 梁兆麟. "Low back pain in Hong Kong: prevalence, service utilization and disability." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31238865.
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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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Tobin, Derek. "An RCT comparison of advice versus usual care in low back pain patients classified as low risk with the start-back tool." Thesis, Glasgow Caledonian University, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.726788.
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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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Kaliarntas, Konstantinos T. "Supported treadmill walking for low back pain patients : a biomechanical randomised controlled trial." Thesis, University of Strathclyde, 2011. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=16797.
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Kim, Jung-Yong. "Patterns of trunk neuromuscular performance in normal subjects and low-back pain patients /." The Ohio State University, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487868114109762.
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Tafazzoli, Faryaneh. "Mechanical behaviour of hamstring muscles in low-back pain patients and control subjects." Thesis, University of Ottawa (Canada), 1994. http://hdl.handle.net/10393/9583.
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Seferlis, Thanassis. "Acute low-back pain : a randomised controlled trial of sick-listed patients, with emphasis on co-morbidity, clinical outcome, predictors and costs /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3349-9/.
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Nabar, Sean J. "Modern Techniques of Adjunctive Pain Control Lower Opioid Use, Pain Scores, and Length-of-Stay in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis." Thesis, The University of Arizona, 2013. http://hdl.handle.net/10150/281776.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.
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Gagnon, Laura. "Efficacy of pilates exercises as therapeutic intervention in treating patients with low back pain." Access full text, 2005. http://etd.utk.edu/2005/GagnonLaura.pdf.
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Thesis (Ph.D.) -- University of Tennessee, Knoxville, 2005.UMI no.: 3177252. "A dissertation presented for the Doctor of Philosophy Degree, The University of Tennessee, Knoxville". "May 2005". Includes bibliographical references (leaves 80-89). Also available via the World Wide Web.
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Siu, Hiu-fai, and 蕭曉暉. "Quantitative lumbar surface EMG topographic analysis: comparison between normal and low back pain patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B4327870X.
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Siu, Hiu-fai. "Quantitative lumbar surface EMG topographic analysis comparison between normal and low back pain patients /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B4327870X.
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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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Razmjou, Helen. "Inter-tester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0005/MQ32502.pdf.
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Potter, Louise J. "An exploration of the physiological effects of spinal manipulation in patients with low back pain." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.491146.
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Spinal manipulation (SM) is effective in reducing back pain, despite poor understanding of the physiological mechanisms by which it exerts its effect. There is some evidence of a biomechanical effect whereby joint 'gapping' stretches the joint capsules and weak evidence of a reflex muscular response. In terms of the latter it is far from clear whether this reflex is attributable to a SM and is not just a result of general movement or other non-specific effects nor whether it is associated with any therapeutic effect. SM is thought to be associated with an anti-algesic effect, although no previous work has considered which element of manipulation might be responsible for this or whether the effect changes with repeated applications. This thesis attempts to address some of these questions and in particular focuses on the reflexogenic and anti-nociceptive effects of SM. Method: To address this knowledge deficit, highlighted by a review of the current literature, a single blind pilot randomised controlled trial was designed in order to explore the physiological effects of SM. After testing for reliability of a number of the outcome measures and research to establish the specific dysfunctional spinal segment, 60 patients were randomised to receive a single high velocity low amplitude thrust or a sham manipulation of the lumbar spine. Physiological effect, in a number of muscle groups was explored through assessment of pressure pain threshold (PPT) and muscle activity using algometry and surface electromyography (sEMG). The sEMG reflex response, and a record of whether cavitation was achieved, was recorded during the manipulation. Other more subjective assessments of pain were also measured (visual analogue scale (VAS) and Roland Morris questionnaire). The intervention was repeated on three separate occasions over three weeks to test for a dose related response. Results: There was no statistically significant difference in the magnitude of the sEMG reflex response to a single SM, but at the third application a significantly larger sEMG reflex response was seen in the SM group, compared to the sham manipulation (for multifidus and gluteus maximus). There were no associations between the size of the reflex response and any of the subject's baseline characteristics or changes in pain at any time point. There was a significant increase in the PPT ofthe local spinal muscles in the SM group compared to the sham manipulation group, although this was mainly seen at the first treatment. There were no significant differences in the VAS or Roland Morris questionnaire scores between groups over the course of the experiment. There were no statistically significant differences in any of the pain measures if the groups were split according to whether the SM resulted in cavitation. Discussion and conclusion: It is unlikely SM influences pain and function via a muscular reflexogenic effect. It may be that the longitudinal change in the reflex response is indicative of a biomechanical change in one group. This study lends further support to the theory that SM has an anti-nociceptive effect, however this is only seen as a local effect (changes in PPT) and is therefore most likely to be at a spinal level. Specific application of the thrust to a clinically relevant spinal segment, seems to be the most important factor to achieve therapeutic benefit, irrespective of whether this resulted in cavitation. SM seems to have local specific effects on pain (evoked by mechanical stimulation) but little effect on disability or overall pain states
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El-Gohary, Tarek. "Partial versus full range of back extension endurance testing using the swiss ball in discogenic low back pain patients : a comparative study." Diss., NSUWorks, 2010. https://nsuworks.nova.edu/hpd_pt_stuetd/32.
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Mngoma, Nomusa F. "Evaluating outcomes of a return-to-work rehabilitation program for patients with work-related low back pain." Thesis, Kingston, Ont. : [s.n.], 2007. http://hdl.handle.net/1974/824.
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Elfving, Britt. "Lumbar muscle fatigue and recovery : evaluation of electromyography in patients with long-term low-back pain and in healthy subjects /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-391-0/.
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Braddock, Sharon. "Does a physiotherapy cognitive behavioural chronic low back pain programme alter patients' health locus of control?" Thesis, Manchester Metropolitan University, 2016. http://e-space.mmu.ac.uk/617670/.
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BACKGROUND: Health locus of control (HLOC) is a person’s belief of where responsibilities for his/her health condition lies. It is associated with health attitudes, behaviours and outcomes in non-specific chronic low back pain (NSCLBP). It is unknown whether a physiotherapy cognitive-behavioural chronic low back pain (CBCLBP) programme affects patients’ HLOC. AIMS: To examine: (1) the effect of a six-week CBCLBP programme on the patients’ primary outcome-HLOC, and also pain intensity, disability, fear-avoidance belief (FAB) and self-care attitude; (2) the association between changes in pain intensity, disability and FAB and changes in HLOC; and (3) the cost of producing any effect. METHODS: In an A-B-A same-subject design, patients referred to the CBCLBP programme with high FAB (TSK score > 37) were recruited. Patients attended a six-week programme. Outcomes were measured four weeks before (-4 weeks), at the start, at completion, 3- and 6-months after the programme. Friedman’s ANOVA and Wilcoxon signed-rank tests determined changes between phases. Multiple regression determined the relationship between HLOC and outcome of interest. Significance was set at 0.05. RESULTS: A total of 70 patients were recruited. Fifty-five patients entered the programme and all completed 6-months follow-up. The CBCLBP programme significantly improved HLOC (p < 0.001), pain intensity (p < 0.001), disability (p < 0.001), FAB (p < 0.001) and self-care attitude (p < 0.001), with such improvement being sustained for 6 months. Changes in HLOC explained 6%, 0.5% and 31.9% variances in changes in pain, disability and FAB respectively, after controlling other variables. Increased internal locus of control (ILOC) was a significant predictor of reduction in FAB (p=0.002). HLOC was not predictive of reduction in pain intensity or disability. Mean provider cost of the programme was £285.82 per patient. CONCLUSION: Our 6-week CBCLBP programme was effective in changing a person’s belief about where responsibility for his/her health condition lies. It also improved their pain, disability, FAB and attitude to self-care. Making patients believe that they can take control, and they are the one responsible for their NSCLBP management is linked to reduction in FAB, highlighting the potential importance of improving ILOC in attaining better FAB outcome. We have also provided guidance to managers and budget allocators that this costs £285.82 per patient.
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Watterson, Kyle A. "Physical Therapy Utilization and Length of Stay among Patients with Low Back Pain in Florida Hospitals." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6978.
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Purpose: The purpose of this work was identify key factors associated with inpatient physical therapy utilization and length of stay for patients with low back pain (LBP) in Florida hospitals.
Rationale: Little is known about factors associated with inpatient physical therapy or length of hospitalization for patients with LBP. This group of works identified the key factors associated with inpatient physical therapy and long lengths of hospitalization for this patient population. Since physical therapy and reduced length of stay are known cost-reducers, identifying key factors may represent significant cost savings to the health care system.
Methods: Several mixed method procedures were utilized to examine physical therapy utilization and length of hospitalization between the years of 1992 and 2014. Policy, patient and hospital characteristics, as well as, hospital procedures during a patient’s stay were examined as contributors to either physical therapy utilization or length of hospitalization.
Conclusion: Many factors are associated with inpatient physical therapy utilization and length of stay for patients with LBP in Florida hospitals.
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Perry, J. "The neurophysiological effects of physiotherapy (spinal manual and manipulative therapies) on patients with low back pain." Thesis, Coventry University, 2013. http://curve.coventry.ac.uk/open/items/9bdd5b0c-87ae-4be4-ab28-0703ed195efc/1.
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Low Back Pain (LBP) is a condition that most people experience at least once in their lifetime and for which many will seek physiotherapeutic intervention. Recently published and internationally recognised clinical guidelines for the management of LBP recommend the use of spinal manual and manipulative therapy techniques alongside exercise, advice, education and pharmaceutical therapies, particularly in the early stages. Other areas of development in the last decade include classification systems, clinical prediction rules (CPR’s), patient-reported outcome measures (PROMS’s) and minimum clinically important difference (MCID) thresholds. Additionally, sympathetic nervous system (SNS) measures of treatment responses are now recognised as providing quantifiable indicators of peripheral, spinal and central effects of manual therapy interventions although research in the lumbar spine is very limited with none providing data on a patient population. The aims of the study were; to determine the reliability and stability of the Biopac System in recording skin conductance (SC) activity levels and calculate the smallest real difference (SRD) statistic; to generate data on the magnitude of SC response to two commonly utilised treatments for LBP; and to observe the changes in a clinical population receiving guideline-endorsed physiotherapy treatment for the management of acute and sub-acute LBP. Furthermore, clinical data analysis sought to identify correlations of SC measures to PROM’s and evaluate the feasibility of using SC responses as a predictive tool for therapeutic outcome. The ability of the Biopac System to reliably record SNS activity was established by using SC measurements with 12 participants on two occasions, one-week apart. Data was recorded within a natural, non-laboratory setting. Results established that SC measurements could be reliably recorded between data sessions with a measurement variability of; ICC=0.99 (p<0.005) with an SRD value of 0.315 μmho’s (4.633%). In conclusion, any SC change above the SRD could be regarded as an SNS change that is independent of any measurement error or variability thus representing a real change ascribable to the intervention under investigation. The pre-clinical investigation compared the magnitude of SC response (SCR) of two, independently administered, specific MT techniques, applied, after randomisation, to the Lumbar 4/5 segment of 50 asymptomatic healthy volunteers. Treatments included; a rotatory lumbar manipulation technique or a repeated McKenzie extension in lying exercise. Findings revealed that both techniques produced statistically significant changes in SNS activity in the lower limbs (> SRD) with manipulative technique SCR’s (76%) that were twice the size of the McKenzie repeated extension in lying exercise (EIL) technique (35.7%)( p=0.0005). Only the manipulation technique had a lasting effect that was carried into the final rest period (p=0.012) but the SNS response was not a side-specific phenomenon (p= 0.76). The final clinical study recruited 60 acute and sub-acute LBP patients (symptoms of up to 12 weeks duration) who received guideline-recommended physiotherapy treatment within a hospital-based musculoskeletal out-patient physiotherapy department. SCRs were recorded throughout all treatment episodes with standardised, validated PROM’s used for comparison of status at inception, mid-point and at discharge. Functional impairment was determined using the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) with pain intensity evaluated with the Narrative Pain Rating Score (NPRS). A preliminary comparison, between the asymptomatic population and a random selection from the patient population, revealed that patients had treatment SCR’s that were significantly greater (three-fold) than those of the asymptomatic groups (manipulation, p=0.003; EIL exercises p=0.001). Analysis of the patient data indicated that pre-treatment/baseline SC activity levels in the inception data capture point were lower than at discharge (18 µMho’s; p<0.0005) but, conversely, that treatment SC levels were initially high, but diminished in magnitude by discharge (230 to 172 µMho’s; p<0.0005) representing a SCR reduction of 125%. Correlational analyses of change scores of maximum SCR’s to PROM’s, from inception to discharge suggested weak positive correlations of SCR treatment responses to functional disability score improvements (rho 0.278) and pain intensity reductions (rho=0.229) that were significant for function (p=0.033) but not significant for pain (p=0.080). The final analyses indicated that there were trends in the magnitude of response to specific elements of treatment with manipulation having the largest SCR (266%). Further evaluative analysis of SC readings as a predictor, at inception, of functional outcome, at discharge indicated that a critical/cut-off value of 195% may indicate those patients least and most likely to respond positively to MT treatment. Preliminary logistic regression analysis indicated that the 195% SCR value was excellent at identifying poor responders but less successful at identifying good responders, functionally, to treatment. Nonetheless, SCR was a better predictor of outcome than duration of symptoms and patient age. Characteristically, patients achieving the 195% value were most likely to have higher functional disability and pain intensity scores at inception but by discharge had required fewer treatments, had greater overall functional improvement and lower pain intensities than those not achieving this threshold. In conclusion, SC activity levels and SCR’s may be a reliable, stable, alternative and objective measure of LBP patients’ SNS status and changes that occur as a result of symptom abatement throughout a course of physiotherapy treatment. SC readings may (indirectly) reflect the state of dorsal horn (DH) sensitisation and of the central nervous system (CNS) processing system and its facilitatory capacity to activate the descending pain inhibitory system (DPIS). Further research, in patient populations (including chronic LBP patients), is recommended to verify these findings and validate the 195% SCR cut-off point. Definitive RCT’s are indicated to further the understanding of guideline-endorsed physiotherapy treatment (a complex intervention –MRC, 2000) and to determine whether the SNS activity measurements can be used to help classify, predict, and ultimately, direct the care of patients with LBP.
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Houweling, Taco August Wilhelm. "Description of outcomes, patient experiences and related costs of care in low back pain patients undergoing chiropractic treatment in the UK." Thesis, University of Portsmouth, 2013. https://researchportal.port.ac.uk/portal/en/theses/description-of-outcomes-patient-experiences-and-related-costs-of-care-in-low-back-pain-patients-undergoing-chiropractic-treatment-in-the-uk(fc402d9b-0521-4b42-a57b-43ee7f641238).html.
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Rationale: The prevalence of low back pain and associated costs to society are high. Despite this, the number of studies investigating observational data on the quality and costs of care in routine health care services, such as chiropractic, is relatively small in comparison to the clinical trial evidence available on the effectiveness and cost-effectiveness of manual therapies for low back pain. Objective: To document the quality and cost of care in low back pain patients undergoing routine chiropractic care in the United Kingdom. Design: Prospective single cohort multi-centre study. Participants: A sample of 120 chiropractors and 421 patients. Methods: Following the development of a data collection instrument and a pilot study, patients suffering from low back pain were recruited by chiropractic clinics in the United Kingdom. Information was recorded using a patient self-report questionnaire at baseline prior to the initial consultation, and participants were mailed a follow-up questionnaire at three months. Health outcomes, patient experiences of the process and safety of care, and related costs in the intervening three month period were documented. Results: Four hundred and twenty-one patients formed the baseline sample, and 238 (57%) of these returned the follow-up questionnaire at three months. Statistically significant change scores (p = 0.0001) were seen for the health status measures including the Roland-Morris Disability Questionnaire, Bournemouth Questionnaire, EuroQol-5D and bothersomeness scale. One hundred and sixty-eight of 238 (70%) patients reported a clinically significant improvement on the Perceived Global Effect scale, and 73 (31%) of these were considered recovered anytime during the study period using definitions of recovery (i.e. acceptable quality of life, no disability and no pain for a whole month). One hundred and twenty-nine (54%) of patients at follow-up rated chiropractic care for their low back condition as ‘very helpful’. The number of patients rating the process of care (i.e. time and explanations given by chiropractor as well involvement in decisions about care) as ‘very good’ ranged from 157 to 168 (66% to 71% respectively of the patients at follow-up). One hundred and twenty-five (52%) of patients at follow-up reported adverse events of care (i.e. worsening of their back pain, stiffness, soreness and/or general discomfort immediately or shortly after the chiropractic treatment visits); however, only 13 (5%) of these reported that they were unable to carry on with their usual activities and/or work as a result of these events. On average, the total cost of care was £481.83 (95% CI = 333.17 to 639.42) per patient. Lost productivity resulting from time away from work was the most important contributor to these costs (59.6%). The cost of chiropractic visits was the second most important contributor, which accounted for nearly one-third of total costs (32.8%). Other health care usage including general practitioner visits, medical procedures and diagnostic imaging were responsible for a small proportion of total costs ranging from 0.4% to 1.6%. Conclusions: This programme of research is the first prospective study conducted in routine chiropractic practice simultaneously documenting information about health outcomes and patient experiences and costs of care. Patients improved markedly within the first three months of care and expressed high satisfaction with the chiropractic treatment and consultation they received. Chiropractic care was relatively safe, with common yet benign adverse events that had little influence on activities of daily living. Taken overall, patients receiving chiropractic care reported improvement at arguably reasonable cost, suggesting this approach to the health care of patients with low back pain be considered in the wider context of health care delivery in the United Kingdom.
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Laslett, Mark. "Diagnostic accuracy of the clinical examination compared to available reference standards in chronic low back pain patients /." Linköping : Dept. of Health and Society, Univ, 2005. http://www.bibl.liu.se/liupubl/disp/disp2005/med894s.pdf.
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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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Alm, Patrik. "Test- retest reliability of a test for joint position sense in patients with mechanical low back pain." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74996.
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Abstract Background:Low back pain has a reported lifetime prevalence of about 70% and tops the list of years lived with disease in the developed countries. There is still to date areas on the mechanisms driving pain andmovement system impairments not fully understood. For some areas the research are evident butclinically friendly methods lack. A new test for measuring joint position sense (JPS) in the lumbar spine is tested forreliability. Objectives:Aim of this study was to evaluate test-retest reliability on a new test measuring JPS, using two laser pointers attached to the vertebrates off L1 and S1. Design:Cross-sectional observational test-retest. Methods:82 participants, 41 with mechanical low back pain and 41 healthy controls, were tested for repositioning error two times with 30-60minutes between tests. Movement directions tested was; Flexion, extension, rotation right and rotation left in sitting. Intraclasscorrelation coefficient (ICC) was used for measuring relative reliability and standard error ofmeasurement (SEM) for absolute reliability. Results:ICC in the LBP group ranged from -0,51 – 0,94 and for the whole group -0,19 – 0,84. The SEM in the LBP group ranged from 0,1 – 2,9 (95%CI -5,6 – 6,4) and for the whole group 0,1 – 3,2 (95%CI -6,3 – 6,2). Conclusions:The test-retest reliability of this JPS test shows poor to moderate reliability. Measuring joint positioning sense by using two laser pointers attached to S1 and L1 as in this study has shown not to be reliable enough to be used in clinical tests or research and can therefore not be recommended.
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Lewis, Sandra. "The relationships between stature recovery, muscle activity and psychological factors in patients with chronic low back pain." Thesis, Manchester Metropolitan University, 2011. http://e-space.mmu.ac.uk/583373/.
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It has previously been established that individuals with mild chronic low back pain (CLBP) have a delayed rate of post-exercise stature recovery compared to asymptomatic controls, and that this is associated with increased paraspinal muscle activity, pain and disability. The purpose of this thesis was to explore these relationships further in NHS patients with CLBP and to establish if links exist between these measures and a number of psychological factors known to play an important role in the development of the condition. Forty seven patients were recruited from the waiting list for two physiotherapist-led rehabilitation programmes. Paraspinal muscle activity was assessed via surface EMG while standing at rest and stature recovery over a 40-minute unloading period was measured on a precision stadiometer. Self-report of pain was noted and patients were asked to complete a questionnaire booklet assessing disability, anxiety, depression, pain-related anxiety, fear of movement, self-efficacy, catastrophising and defensiveness. Where possible, patients returned for a second testing session after completing the rehabilitation programme (n = 23) and again after a further six months (n = 14). The effect of superficial heat treatment was additionally assessed via a similar testing session (n = 24), but on this occasion the participant put on a heat wrap two hours before the time of the appointment. Significant correlations were found between baseline muscle activity and both pain and disability. Pain was a significant mediator in the relationship between muscle activity and disability. Muscle activity also demonstrated links with self-efficacy, depression, anxiety, pain-related anxiety and catastrophising and was a significant mediator in the relationship between self-efficacy and pain. Stature recovery was not significantly related to any of the other baseline measures, perhaps reflecting the heterogeneous nature of the patients involved. A high prevalence of defensive high anxious individuals was found in the patient group. Changes in stature recovery immediately following the programme were significantly linked to improvements in pain and disability, although a significant increase in stature recovery was only observed by the end of the follow-up period. Resting EMG was not reduced following the rehabilitation programme. The heat wrap resulted in a significant decrease in non-normalised EMG levels and a positive effect on self-report of disability, self-efficacy, catastrophising and pain-related anxiety. In conclusion, the relationship between stature change and muscle activity appears to be more complex than originally hypothesized. However, six months after a rehabilitation programme, the rate of stature recovery had increased to levels similar to asymptomatic individuals, suggesting that the delayed recovery seen in CLBP patients is not primarily the result of pathology. The findings confirm that muscle activity plays an important role in CLBP, in particular as a pathway by which psychological factors may impact on clinical outcome. The role of muscle activity as a mediator between psychological factors and pain suggests that interventions that are able to reduce muscle activity may be of particular benefit to patients demonstrating characteristics such as low self-efficacy, which may help in the targeting of treatment for CLBP. The results also highlight that an immediate decrease in EMG levels following active treatment may not always be the optimal response for long-term improvements in clinical outcome and that a period of adaptation might be expected. The unexpectedly high prevalence of a defensive high anxious coping style suggests that this may represent a risk factor for CLBP, a predictor of poor outcome or an adaptation to a chronic condition.
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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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Tarescavage, Anthony Michael. "PREDICTING TREATMENT OUTCOMES AMONG LOW BACK PAIN PATIENTS USING THE MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2-RESTRUCTURED FORM." Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1447070671.
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Stenner, R. "Exercise prescription for patients with non-specific chronic low back pain : a qualitative exploration of physiotherapy practice." Thesis, University of the West of England, Bristol, 2014. http://eprints.uwe.ac.uk/22930/.
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Background: Providing an effective exercise prescription process for a patient with non-specific chronic low back pain (NSCLBP) within the limits of time that a busy clinician faces is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP, and calls for further investigation into the approaches used to prescribe exercise. Objective: To explore the characteristics and processes of physiotherapy exercise prescription for patients with NSCLBP, and investigate how shared decision making and patient partnership are addressed by physiotherapists in this process. Design: A qualitative study using a philosophical hermeneutic approach. In phase one of the study eight physiotherapists were each observed on three occasions undertaking their usual clinical activities. They participated in brief interviews after each observation and a later in depth semi-structured interview. In phase two semi-structured interviews with eight patients including use of some brief patient vignettes was undertaken to provide a rich descriptive text of their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their treatment plans. In depth iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. . Analysis: Thematic analysis (Braun and Clarke, 1996) was employed to search for themes and patterns from the observations and interviews with physiotherapists and patients. Findings: The findings provide a complex understanding of how physiotherapists regard and utilise exercise based management strategies for patients with NSCLBP. Patient partnership and shared decision making were rarely evident and were linked to the physiotherapists’ clinical orientations, cognitive and decision making processes, and assumptions about patients. The overall feeling of the patients was that the role they played in the therapeutic interaction was a marginal one, such that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute. Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes in these patients.
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Tarimo, Nesto Salia. "Knowledge, attitudes and beliefs on contributing factors among low back pain patients attending outpatients physiotherapy treatment in Malawi." Thesis, University of the Western Cape, 2011. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9816_1331807958.
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Low back pain (LBP) is a growing health and socio-economic problem worldwide, affecting humans from adolescent to adult age. In developed countries, more than 80% of adults are at risk of suffering a disabling episode of LBP at one point during their life time. In developing countries, particularly in Africa, the life time prevalence of LBP varies in population groups, but the disability due to LBP is increasing. The aetiology of LBP is multifactorial, and there is still no consensus on the exact cause and contributing factors to LBP. In addition, little is known about patients&rsquo
knowledge and beliefs on the contributing factors to their LBP. The current study therefore, aimed to identify patients&rsquo
knowledge, attitudes and beliefs on the contributing factors to LBP, among patients attending physiotherapy outpatient departments in Malawi.
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Russell, Brent S., Mark D. Geil, Jianhua Wu, and Kathryn T. Hoiriis. "Variability of vertical ground reaction forces in patients with chronic low back pain, before and after chiropractic care." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/kin_health_theses/3.
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Introduction
Many chiropractic articles and textbooks discuss gait, but there actually has been little research into the effects of chiropractic adjustment on gait. This pilot study used a quantitative method of gait evaluation before and after a series of chiropractic visits. Hypotheses: (1) adults with chronic low back pain (CLBP) would show increased variability in vertical ground reaction forces (VGRF) while walking, as compared to healthy control subjects, and (2) that, following chiropractic care, will show decreased variability.
Methods
VGRF data were collected for 6 controls and compared to 9 CLBP participants, who were also evaluated before and after the first visit of care and over 7 visits. Data were analyzed by Mean Standard Deviation (MSD), Mean Coefficient of Variation (MCV), and the Coefficient of Variation of loading rate. Chiropractic care consisted of “high velocity low amplitude” thrust type procedures, flexion-distraction, pelvic wedges, light mobilization, and stretching.
Results
CLBP participants had somewhat greater variability and became slightly less variable post-care; differences were not significant. Limitations: Some participants had no impairment of walking at baseline; MSD is an uncommon measure, and more research is needed; these results (small group seen by a single doctor) may not be generalizable.
Conclusions
Participants with CLBP had slightly more variability and had slight decreases in variability following chiropractic care. Differences were not statistically significant. With this small pilot study as a guide, more research should be done with larger groups and improved participant selection.
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Grönblom-Lundström, Lena. "Rehabilitation in light of different theories of health : Outcome for patients with low-back complaints - a theoretical discussion." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-33475.
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The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions. This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system. If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.digitalisering@umu
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Lambert, Martin. "Use of a Direction Tolerance System (DTS) in Patients with Low Back Pain: Intra-Rater Reliability and Outcome." Thesis, NSUWorks, 2014. https://nsuworks.nova.edu/hpd_pt_stuetd/49.
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Problem Statement: Because of the lack of evidence in support of a pathology-based approach to low back pain (LBP), many researchers advocate the use of classification systems that classify patients with LBP based on common clinical characteristics. Treatment based on direction tolerance can improve circulation, diminish pain and inflammation, restore normal motion, and reduce fear-avoidance beliefs. Treatment performed in the standing position can functionally integrate related regions of the body, can replicate normal tissue loading in standing position, replicate normal proprioceptive demands of motion performed in standing position, and address underlying movement impairments in related regions that may contribute to compensatory tissue pathology in the low back. The problem is that none of the existing functional classification systems for evaluation and treatment of LBP are designed for this purpose. The Direction Tolerance System (DTS) is a new functional classification system that is based on direction tolerance and performed entirely in the standing position. Objectives: The purpose of this research was to investigate the reliability, outcome, and prognostic ability of the DTS for evaluation and treatment of LBP. Methods: This exploratory research was a prospective cohort study with 60 patients seeking physical therapy (PT) for treatment of LBP by 5 different therapists. All patients were evaluated and treated for 8 visits using the DTS. Reliability was measured by comparing DTS scores (DTI) on visits 1 and 2. DTS treatment consisted of a scripted flexibility and strengthening exercise program based on motions that were determined to be non-aggravating during the DTS examination. Outcome was assessed using the DTI, modified Oswestry Disability Questionnaire (ODQ), Numeric Pain Rating Scale (NPRS) and Fear-Avoidance Beliefs Questionnaire Physical Activity Subscale (PABQ-PA). Baseline variables were assessed for correlation with successful outcome and ability to predict a successful outcome. Results: (1) Group intra-rater reliability between visits 1 and 2 using ICC (3,1) was good (.80, p<.001); (2) The group success rate was 62%, which exceeded the expected 50% success rate. (3) Baseline variables were not associated with a successful outcome and did not significantly predict a successful outcome. Discussion: The DTS is a simple, reliable and effective method of evaluating and treating LBP, and with proper training, can be used by clinicians.
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Espahbodi, Shima. "Investigation of lumbar artery haemodynamics in patients with low back pain and degenerative disc disease of the lumbar spine." Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416129.
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Murrie, Vanessa Louise. "Aspects of the effectiveness of Magnetic Resonance Imaging (MRI) in the assessment of patients with Low Back Pain (LBP)." Thesis, University of Cambridge, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.620005.
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Buchanan, Helen. "The efficacy of an adapted Roland-Morris disability questionnaire in measuring functional status of Patients with low back pain." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/26512.
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The purpose of this study was to determine whether an adapted Roland Morris Disability Questionnaire (ARMDQ) could be used to determine functional status in subjects with chronic mechanical low back pain, and thereby assist the surgeon in deciding on the appropriateness of spinal fusion surgery for individual patients. The study aimed to detem1ine whether the Roland-Morris Disability Questionnaire (RMDQ) improved its ability to measure function and different aspects of function through the addition of a 26-item scale (AddS). The study design was retrospective and descriptive. A convenience sample of 42 subjects who consulted one Orthopaedic surgeon working in a private practice in the South Peninsula Municipal area of Cape Town, South Africa, was drawn. All subjects were diagnosed with chronic mechanical low back pain and no other known pathology. Subjects consulted the surgeon between August 2000 and July 200 I. All subjects had completed the adapted RMDQ (ARMDQ). A series of analyses were performed in which the items in the AddS scale were compared with those of the RMDQ to assess the degree to which they enhanced the performance of the RMDQ. Although there was a high correlation between the two scales (R=. 72; P<.00), Cronbach's alpha showed the reliability of the RMDQ to be higher than the AddS and the ARMDQ. This finding was supported in a number of subsequent analyses. There was a low correlation between the rating for surgery and total RMDQ scores (r=.40; P<.01). Despite deficiencies in the RMDQ, it is recommended as the basis for comparison in future studies within a variety of South African contexts.
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Berglund, Lars. "Deadlift training for patients with mechanical low back pain : a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises." Doctoral thesis, Umeå universitet, Fysioterapi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119939.
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Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise. All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness. There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline. The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention. The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.
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Eaves, Emery R., Karen J. Sherman, Cheryl Ritenbaugh, Clarissa Hsu, Mark Nichter, Judith A. Turner, and Daniel C. Cherkin. "A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies." BioMed Central Ltd, 2015. http://hdl.handle.net/10150/610275.
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BACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.
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Schafer, Lisa, Clarissa Hsu, Emery Eaves, Cheryl Ritenbaugh, Judith Turner, Daniel Cherkin, Colette Sims, and Karen Sherman. "Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study." BioMed Central, 2012. http://hdl.handle.net/10150/610362.
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BACKGROUND:Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.METHODS:To better understand how CAM providers view and respond to their patients' expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.RESULTS:CAM providers reported that they attempt to ensure that their patients' expectations are realistic. Providers indicated they manage their patients' expectations in a number of domains-- roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients' expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.CONCLUSIONS:Providers of four types of CAM therapies viewed patients' expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.
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Yungtsungyang and 楊詠琮. "A Study of the Electrical Properties of the Low Back Muscles of Low Back Pain Patients." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/59173682167902021595.
Full textAbstract:
碩士亞洲大學
光電與通訊學系碩士班
97
Low back pain is a common ailment, affecting people of all backgrounds and resulting in the loss of more working days than any other single medical condition. Some 60–80% of the global population experience low back pain during their lifetime. In Taiwan more than 2.14 million patients sought medical care for back pain in 1998 and that medical cost alone exceeded 3 billion New Taiwan Dollars. The aim of this study was to study the physiological changes of low back muscles of low back pain patients in order to develop a new approach, namely bioimpedance, for reliable, low-cost, non-invasive, and real-time diagnosis of muscle-related low back pain. Nine normal subjects and Nine patients (11 men and 7 women, age range 20-60) participated in this study. A precision impedance analyzer (Wayne Kerr 6420C) was used for all impedance measurements. Measurements were performed at seven frequencies of 20Hz, 25KHz, 50KHz, 200KHz, 800KHz, 3.2MHz and 10MHz, with the amplitude of the applied voltage limited to 200mV. Impedance, phase angle, real part of impedance, and imaginary part of impedance were assessed to see if significant difference in values obtained in normal and patient low back muscle existed. It was found that the normalized impedance of the low back muscle of the normal group was significant greater than that of low back pain patient group at the frequencies of 800KHz and 3.2MHz. In conclusion, bioimpedance at a particular frequency is a potentially promising technique for the diagnosis of muscle-related low back pain.
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Liao, Ching-Lung, and 廖慶龍. "Immediate effects of manipulative therapy in patients with low back Immediate effects of manipulative therapy in patients with low back pain." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/00872329350846413134.
Full textAbstract:
碩士中國醫藥大學
中西醫結合研究所
93
Despite a wealth of research concerning risk factors, patho-physiology, prognostic indicators, and treatment methods, low back pain continues to be an epidemic , yet poorly understood, problem. Low back pain is the most common cause of disability in patients younger than 45 years old and second only to arthritis in patients 45 to 60 years of age. Manipulative therapy is a well defined method , and may have dramatic effect for treatment of spinal problems. There are many systems of manipulative therapy, according to the tissue ( joint, disc, facet, muscle or fascia…..etc ) that was engaged. Despite the good effect of the manipulative therapy for spinal problems, there were no enough evidence for support this outcome. In this study, we propose some strategies of outcome measure for spinal manipulation. These strategies included Oswestry questionnaire for low back pain , visul analog scales , muscle activity (Myo III PS surface EMG) ,range of motion ( Flock of Bird motion tracking).