Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care.
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Activities of Daily Living↗
Biomedical subjects
Even Laerum
Publications and source records attributed to Even Laerum.
Prevalence of low back pain and sickness absence: a "borderline" study in Norway and Sweden.
AIMS: Low back pain (LBP) is a major public health problem in both Norway and Sweden. The aim of the study was to estimate the prevalence of LBP and sickness absence due to LBP in two neighbouring regions in Norway and Sweden. The two areas have similar socioeconomic status, but differ in health benefit systems. METHODS: A representative sample of 1,988 adults in Norway and 2,006 in Sweden completed questionnaires concerning LBP during 1999 and 2000. For this study only individuals in part or full time jobs, (n = 1,158 in Norway and n = 1,129 in Sweden) were included. RESULTS: In Norway the lifetime prevalence was 60.7% and in Sweden 69.6%, the one-year prevalence was 40.5% and 47.2%, and the point prevalence 13.4% and 18.2% respectively. There was a significantly higher risk of reporting LBP in Sweden, even after controlling for gender, age, education, and physical workload. There was no difference in risk of self-certified short-term sickness absence (1-3 days), but it was a 40% lower risk of sickness absence with medical sickness certification in Sweden compared with Norway. CONCLUSION: The prevalence of LBP was higher in the Swedish area than in the Norwegian. The risk of self-certified sickness absence, however, showed no differences and the risk of medically certified sickness absence was lower in the Swedish area. This contradiction might partly be explained by the economical "disincentives" in the Swedish health compensation system.
Adult↗
What is "the good back-consultation"? A combined qualitative and quantitative study of chronic low back pain patients' interaction with and perceptions of consultations with specialists.
OBJECTIVE: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ("The Good Back-Consultation"). DESIGN: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded. SUBJECTS: Thirty-five patients with chronic low back pain referred to a specialist. METHODS: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method. RESULTS: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of "The Good Back-Consultation" was that the specialist took the patient seriously. CONCLUSION: The findings may represent an important potential for enhancing clinical communication with patients.
Adult↗
Beliefs about low back pain in the Norwegian general population: are they related to pain experiences and health professionals?
STUDY DESIGN: A baseline study of the general population and the health care providers in 3 Norwegian counties. OBJECTIVE: To investigate if beliefs about low back pain (LBP) are related to personal experiences and profession sought for care. SUMMARY OF BACKGROUND DATA: Myths about LBP that are abandoned by health professionals are still alive in the public. Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP. METHODS: A sample of 1502 randomly selected people was interviewed by telephone, and all the 1105 physicians, physiotherapists, and chiropractors in the area were sent a questionnaire in April 2002. All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP. RESULTS: Personal back pain experiences were important for beliefs about LBP. People with a history of previous back pain had more faith in the 2 statements "Back pain recovers best by itself" (52.2%) and "In most cases back pain recovers by itself in a couple of weeks" (32.5%) than those with current pain (36.9% and 20.9%, respectively, P < 0.000). There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements, and these differences were also reflected in the beliefs of patients treated by the different professional groups. CONCLUSIONS: Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain. Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider. These differences may frustrate the public and patients who visit more than one provider, and hinder collaboration among professional groups.
Adult↗
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial.
STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To examine the effects of a treatment program focusing on specific stabilizing exercises after a 2-year follow-up period. SUMMARY OF BACKGROUND DATA: An individualized treatment approach with specific stabilizing exercises is shown to be effective for women with pelvic girdle pain 1 year after delivery. No previous study has examined the long-term effects of treatment for women with postpartum pelvic girdle pain. METHODS: Eighty-one women with pelvic girdle pain postpartum were assigned randomly to 2 treatment groups for 20 weeks. Patient self-reported questionnaires measuring pain, disability, and health-related quality of life were collected after 20 weeks of treatment and 1 and 2 years postpartum. RESULTS: All 81 women returned the questionnaires for the 2-year follow-up. Sixteen were excluded from the analysis, mainly due to new pregnancies. The significant differences between the groups in functional status, pain, and physical health (SF-36) were maintained 2 years after delivery. Minimal disability was found in 85% of the specific stabilizing exercise group as compared to 47% in the control group. The control group showed significant improvement in functional status with median change score of 6.0 (Q1-Q3 of -12-0). Minimal evening pain was reported by 68% in the specific stabilizing exercise group versus 23% in the control group. However, the group differences disappeared for all measures when controlling for score level 1 year after delivery by regression analysis. CONCLUSION: The significant differences between the groups persisted with continued low levels of pain and disability in the specific stabilizing exercise group 2 years after delivery. Significant reduction in disability was found within the control group. Those with the highest level of disability and greatest potential for improvements recovered most, regardless of intervention group.
Adult↗
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial.
STUDY DESIGN: A randomized controlled trial with stratified block design. OBJECTIVES: To evaluate a treatment program focusing on whether specific stabilizing exercises for patients with pelvic girdle pain after pregnancy reduce pain, improve functional status, and improve quality of life. SUMMARY OF BACKGROUND DATA. : The evidence of effectiveness of treatment for pelvic girdle pain is weak. Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region. To the authors' knowledge, the efficacy of applying these principles for pelvic girdle pain has not previously been evaluated in a randomized controlled trial. METHODS: Eighty-one women with pelvic girdle pain were assigned randomly to two treatment groups for 20 weeks. One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises. Assessments were administered by a blinded assessor, at baseline, after intervention and 1 year post partum. Main outcome measures were pain, functional status and quality of life. RESULTS: There were no dropouts. After intervention and at 1 year post partum, the specific stabilizing exercise group showed statistically and clinically significant lower pain intensity, lower disability, and higher quality of life compared with the control group. Group difference in median values for evening pain after treatment was 30 mm on the Visual Analog Scale. Disability was reduced by more than 50% for the exercise group; changes were negligible in the control group. Significant differences were also observed for physical tests, in favor of the specific exercise group. CONCLUSION: An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy.
Adult↗
The Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient involvement in general practice patients with complex health problems. Psychometric testing and development of a final version.
The Patient Perspective Survey (PPS) is designed to enhance consultation outcome and patient participation among general practice patients with complex health problems. This article presents the final version of the survey. This version is more condensed, tested for psychometric and clinical properties, and with increased emphasis on coping. The development and testing was performed in two phases with two groups of GPs and patients. Indications for use and criteria for rejection of items were defined, based on comprehensive data analysis and clinical judgement. The number of items was reduced to 38 items. The majority of diagnoses were related to psychosocial or musculoskeletal disorders. For the survey's main dimensions (psychological and somatic items, everyday life situation and coping) sound psychometric properties were identified. Seven open-ended questions were found useful for obtaining important new information and stimulating processes, often related to coping aspects. The revised 38-item PPS represents a condensed and final version, with increased focus on coping, and sound psychometric properties.
Activities of Daily Living↗
[Multidisciplinary outpatient clinics for back pain patients--a new treatment program].
Chronic low back pain (LBP) represents a major health problem, especially in Western Europe and North America. The aim of this study is to give an account of why a multidisciplinary treatment program in an outpatient spine clinic is the best treatment for many sub-acute and chronic LBP patients on long-term sick leave. We present an overview of documented treatment effects from multidisciplinary treatment programmes, an outline of the treatment in an outpatient spine clinic, and an account of why multidisciplinary programs are beneficial. The treatment of this patient group is also shown to be cost-effective when one differentiates between light and extensive multidisciplinary programmes. A future challenge rests in the fact that even after optimal treatment, approximately 20 % of patients still do not return to work.
Cost-Benefit Analysis↗
Factors associated with high prescribing of benzodiazepines and minor opiates. A survey among general practitioners in Norway.
OBJECTIVE: To determine the factors associated with high-volume prescribing of benzodiazepines and minor opiates--background characteristics, personal prescribing habits and general attitudes to prescribing. DESIGN: A questionnaire survey. Descriptive statistics, bivariate analysis and multiple logistic regression. SETTING: General practitioners in Norway. SUBJECTS: Every third general practitioner from the list of members of the Norwegian Medical Association. MAIN OUTCOME MEASURES: Odds ratios for being a high prescriber. RESULTS: The main predictors of high-volume prescribing were: patients allowed to influence prescribing decisions, benzodiazepines and minor opiates prescribed without consultation, prescribing perceived as difficult and the doctor being male. CONCLUSION: Emotional and relational aspects play an important part in decisions on prescribing benzodiazepine and minor opiates. Our findings indicate that there is potential for improvement in prescribing practice; for instance, by investigating how and to what extent prescribing decisions are influenced by patients and how the difficulties experienced influence the decision process. Better practice routines could be considered such as not prescribing these drugs without consultation.
Benzodiazepines↗
[How is the general practitioner managing the back pain?].
BACKGROUND: A great number of patients in general practice suffer from low back pain, and the total cost of this patient population is NOK 15 billion. The aim of this study was to find out how family doctors treat their low back pain patients. MATERIAL AND METHODS: During a two week period in 2001, all family doctors in Aust-Agder county were invited to register all patients suffering from low back pain. They also answered a questionnaire about themselves and their practice. RESULTS: Of the total 80 doctors invited, 53 (66%) recorded their patients, and 48 (60%) also answered the questionnaire. 220 patients were included; i.e. 3.4% of the total number of patients seen in these practices during this period. 81% of the patients underwent clinical examination, 40% were referred to X-ray or CT, 31% to an appropriate specialist, 32% to physiotherapist and 11% to chiropractor. Most of the patients were referred after 12 weeks of pain. 79% of patients received a prescription. Only 24% continued working activity. INTERPRETATION: Most patients in this study receive a medical treatment and a sick leave. More patients are referred to X-ray than what is recommended in the Norwegian guidelines.
Adult↗
[Guidelines concerning low back pain].
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Humans↗
[Evaluation of methods in the treatment of lumbar disk prolapse with root avulsion].
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Anti-Inflammatory Agents, Non-Steroidal↗
The final version of the Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient participation in general practice patients with complex health problems. Doctors' and patients' evaluation and guidelines for clinical use.
BACKGROUND: The Patient Perspective Survey (PPS) is a new clinical communication tool designed to stimulate patient involvement in the management of complex health problems in general practice and to improve patient and doctor satisfaction with the consultation. The development of this final 38-item version of the PPS has been described elsewhere. OBJECTIVE: The aims of this article are to present recommendations for clinical use and how GPs and patients have evaluated this new tool. METHODS: The study material included 159 patients (78% females) with a mean age of 45 years, mainly presenting with longstanding musculoskeletal and psychosocial disorders, selected by 32 GPs. After the PPS-based consultation, both doctor and patient were asked to fill in evaluation forms. RESULTS: In as many as 55-85% of the consultations' various aspects, it was perceived by the GPs that the use of the survey helped (to some extent, much or very much) in achieving improved clinical communication and a constructive consultation. The most important elements appeared to be stimulation of positive interaction/processes and obtaining new and relevant information. Similar results were found regarding patient evaluation. There was significantly more positive doctor evaluation if the doctor-patient relationship had lasted less than 1 year, and if the patient agreed to prepare a 'plan of action' for a follow-up consultation. Guidelines for clinical use are presented. CONCLUSION: We now regard the PPS to be completed for daily clinical use and believe that it has been shown to be a potent tool to improve consultation outcome in the large and challenging group of patients with complex health problems in general practice.
Adult↗