http://www.researchonline.mq.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:25682 1 page(s) 2013-05-23T06:00:22.079Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:25647 The purpose of this study was to investigate the outcome of rehabilitation following cerebrovascular accident (CVA) in one Sydney unit. This unit has implemented a philosophy of training based on a motor learning model for rehabilitation proposed by Carr and Shepherd (1987a and b). The proposed motor learning model stresses the need for task and context specific training of everyday actions. Data, including patient characteristics and Motor Assessment Scale (MAS) scores, were collected through a retrospective audit of all patients diagnosed as having a CVA and discharged from the unit during 1989. The major finding of this study was that, following rehabilitation within a multi-disciplinary program, patients were able to improve their motor performance as demonstrated by changes in MAS scores. The measurement of outcome of rehabilitation for this unit has contributed to quality assurance by identifying motor tasks that warrant further emphasis in training in order to improve upon the reported outcome of rehabilitation. 2013-05-22T01:30:36.557Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:25332 2 page(s) 2013-04-26T05:20:26.664Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:25281 Background: The 6-minute walk test (6MWT) is widely used in clinical practice and research. Few studies have investigated activity level as a predictor of 6-minute walk distance (6MWD), and existing predictive models do not allow for activity level. Objectives: To evaluate if knowledge of the level of physical activity enhanced the ability to predict 6MWD, and if the inclusion of activity level added to the predictive accuracy of existing models for the 6MWT in healthy older women; and to validate existent predictive models for 6MWD in a new sample. Design: Cross-sectional, observational study. Setting: Four elderly communities. Participants: A convenience sample of healthy active and sedentary older non-smoking females with no musculoskeletal or lung disorders. Main outcome measures: Age, height, weight, spirometric values and 6MWD. Results: Seventy-seven out of 154 females met the inclusion criteria [mean age 66 (standard deviation 6.5) years]: 46 were active and composed the active group and 31 were sedentary and composed the sedentary group. The active group had significantly greater 6MWD than the sedentary group (mean 44 m; 95% confidence interval 14 to 73 m; P < 0.01). Previous published models that did not allow for activity level either over or underestimated the 6MWD in this sample. The activity level was shown to be an important independent predictor of 6MWD. Conclusion: This study demonstrates the importance of considering the level of physical activity when predicting 6MWD in older women. 2013-04-22T20:10:57.226Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22001 2 page(s) 2013-04-11T11:44:50.973Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22002 Objective: To conduct a systematic review and meta-analysis on the prognosis of acute idiopathic neck pain and disability. Data Sources: EMBASE, CINAHL, Medline, AMED, PEDro, and CENTRAL were searched from inception to July 2009, limited to human studies. Reference lists of relevant systematic reviews were searched by hand. Search terms included: neck pain, prognosis, inception, cohort, longitudinal, observational, or prospective study and randomized controlled trial. Study Selection: Eligible studies were longitudinal cohort studies and randomized controlled trials with a no treatment or minimal treatment arm that recruited an inception cohort of acute idiopathic neck pain and reported pain or disability outcomes. Eligibility was determined by 2 authors independently. Seven of 20,085 references were included. Data Extraction: Pain and disability data were extracted independently by 2 authors. Risk of bias was assessed independently by 2 authors. Data Synthesis: Statistical pooling showed a weighted mean pain score (0100) of 64 (95% confidence interval [CI], 6167) at onset and 35 (95% CI, 3238) at 6.5 weeks. At 12 months, neck pain severity remained high at 42 (95% CI, 3945). Disability reduced from a pooled weighted mean score (0100) at onset of 30 (95% CI, 2832) to 17 (95% CI, 1519) by 6.5 weeks, without further improvement at 12 months. Studies varied in length of follow-up, design, and sample size. Conclusions: This review provides Level I evidence that the prognosis of acute idiopathic neck pain is worse than currently recognized. This evidence can guide primary care clinicians when providing prognostic information to patients. Further research to identify prognostic factors and long-term outcomes from inception cohorts would be valuable. 2013-04-11T11:44:48.955Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24491 Objective: To investigate the relationship between the strength of muscles of the affected lower limb and walking speed after stroke. Design: A cross-sectional observational study. Setting: University laboratory. Participants: Stroke survivors (N=60; mean age ± SD, 69±11y) 1 to 6 years poststroke, able to walk 10m independently without aids. Interventions: Not applicable. Main Outcome Measures: Maximum isometric strength of 12 muscle groups (hip flexors/extensors, adductors/abductors, internal/external rotators, knee flexors/extensors, ankle dorsiflexors/plantarflexors, invertors/evertors) of the affected lower limb was measured using hand-held dynamometry. Comfortable walking speed was measured using the ten-meter walk test. Results: Univariate analysis revealed that strength of the hip flexors (r=.35, P=.01), hip extensors (r=.29, P=.03), hip internal rotators (r=.30, P=.02), hip adductors (r=.29, P=.03), knee extensors (r=.27, P=.03), knee flexors (r=.30, P=.02), ankle dorsiflexors (r=.50, P=.00), ankle plantarflexors (r=.29, P=.03), and ankle evertors (r=.33, P=.01) were all positively associated with walking speed. Multivariate analysis (n=58) revealed that the combined strength of the ankle dorsiflexors and the hip flexors accounted for 34% of the variance in walking speed (P<.001). The ankle dorsiflexors accounted for 31% of the variance (P<.001). Conclusions: The strength of muscle groups other than the lower limb extensors, particularly the ankle dorsiflexors, has an important role in determining walking speed after stroke. 2013-03-06T08:04:21.590Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24494 Objective: The study investigated associations between the active and passive mechanical properties of the calf muscle in children with cerebral palsy and the spatiotemporal features of their gait on both level ground and over stairs. Methods: 26 children with hemiplegic cerebral palsy (age 4 - 10 years) walked barefoot across a level ten metre pathway and a staircase. Walking speed, stride length and cadence were calculated and spasticity, maximum isometric strength, stiffness and hysteresis of the affected side calf muscle measured. Multiple linear regression was used to determine the associations among variables. Results: Walking speed and stride length were significantly associated with dorsiflexor muscle strength and the stiffness of the calf muscle, while stair ascent and descent speeds were significantly and inversely related to the amount of hysteresis displayed by the calf muscle. Conclusion: Passive mechanical properties of the calf muscle are influential in gait performance in these children. 2013-03-06T08:04:15.487Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24507 The purpose of this study was to test the ability of students in scoring an observational tool for measuring physical disability, the Motor Assessment Scale (MAS) for stroke, before and after training in order to establish whether current training and testing procedures for students are adequate. Sixteen students were tested using items 1-8 of the MAS before and after training. The students were required to observe the videotaped performance of four patients with stroke being assessed using the MAS and to score the performance of each patient. After training, the students were retested. The percent exact agreement between students' scores and criterion scores was calculated for each student and for each item. They were then compared before and after training using Student t test. When compared with criterion, the students achieved a mean of 79.6% (standard deviation, 10.8%) exact agreement before training and 83.9% (standard deviation, 6.7%) after training. While this increase in percent exact agreement was not statistically significant (p = 0.10), all students reached at least 75% exact agreement after training. Percent exact agreement on the items increased significantly (p = 0.03) so that seven of the eight items reached at least 75% exact agreement after training. The results of this study suggest that training is important to ensure that all students reach an acceptable standard. 2013-03-06T08:03:50.366Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24512 Objective To evaluate the effectiveness of 2 rehabilitative approaches for improving paretic limb reaching by chronic stroke subjects. Design Pre- and posttest reaching to targets ipsilateral, midline, and contralateral to the impaired side. Setting Training in subjects' homes; testing in a laboratory setting. Participants Twelve poststroke volunteers were matched using the Motor Assessment Scale (MAS) and then were randomly assigned to 1 of 2 training conditions. Subjects were subsequently categorized as at a high or low functional level, using the reaching pretest movement time scores. Interventions Training (trunk unrestrained) using the paretic limb was 4 weeks (12 sessions). Task-related training (TRT) involved reaching to objects placed across the workspace. Progressive resistive exercise (PRE) involved whole-arm pulling against resistive therapeutic tubing in planes and distances similar to that in TRT. Main outcome measures Kinematic analysis of arm trajectory and trunk motion using the Peak Performance System, as well as scores on the MAS and the Rivermead Motor Assessment (RMA). Results For low-level groups, TRT resulted in increased substitutive trunk use at the target ipsilateral to the moving arm, and for midline and contralateral targets after PRE. Only low-level, TRT subjects straightened hand paths, which suggested better coordination of elbow-shoulder motion, and improved on the RMA. High-level subjects decreased trunk use at ipsilateral target after PRE, which was not observed after TRT. No significant differences between training conditions were found for other kinematic variables. Conclusions Training benefits appear to depend on initial level of functioning. Although compensatory trunk use was evident, low-level subjects seemed to benefit most from TRT. High-level subjects, whose kinematics showed fairly normal movement organization, demonstrated less compensatory movement after PRE. 2013-03-06T08:03:37.752Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24534 Objective: To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and handicap associated with poor walking performance after stroke. Design: Randomized, placebo-controlled clinical trial with a 3-month follow-up. Setting: General community. Participants: A volunteer sample of 29 ambulatory individuals (less 2 dropouts) who were living in the community after having suffered a stroke more than 6 months previously. Interventions: The experimental group participated in a 30-minute treadmill and overground walking program, 3 times a week for 4 weeks. The control group received a placebo consisting of a low-intensity, home exercise program and regular telephone contact. Main Outcome Measures: Walking speed (over 10m), walking capacity (distance over 6min), and handicap (stroke-adapted 30-item version of the Sickness Impact Profile) measured by a blinded assessor. Results: The 4-week treadmill and overground walking program significantly increased walking speed (P=.02) and walking capacity (P<.001), but did not decrease handicap (P=.85) compared with the placebo program. These gains were largely maintained 3 months after the cessation of training (P≤.05). Conclusions: The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke. This suggests that the routine provision of accessible, long-term, community-based walking programs would be beneficial in reducing disability after stroke. 2013-03-06T08:02:57.474Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24539 Objective: The purposes were threefold: to develop an obstacle ambulation training programme, to recruit and retain individuals post chronic stroke and to assess the effectiveness of the obstacle ambulation training programme. Design: Intervention study; case series; baseline to post-intervention measures and one month follow-up after intervention. Setting: An outpatient department. Subjects: Five individuals with chronic stroke with mild to moderate functional limitations; convenience sample. Interventions: Therapy consisted of twice weekly sessions for four weeks during which subjects walked along a walkway and over obstacles. Main outcome measures: Motor Assessment Scale - walking section (MAS - time), Six-minute Walk Test distance, walking velocity, and Medical Outcomes Study-36 Health Status Measurement (SF-36). Results: Significant improvements were seen baseline to post intervention for walking velocity, Six-minute Walk Test, MAS and SF-36 physical function score (p ≤ 0.025 for all measures). Most improvements noted at the end of training were retained one month later. The effect sizes ranged from 0.33 to 1.20. Conclusions: Substantial improvement in ambulation function and disability level were seen as a result of the obstacle training programme for individuals with chronic stroke. Further investigation is warranted. 2013-03-06T08:02:43.984Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24557 Objective: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. Design: A nonrandomized ABA trial. Setting: Sydney school. Subjects: Eight children with cerebral palsy, aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia. Intervention: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses. Main outcome measures: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test. Results: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained. Conclusions: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time. 2013-03-06T08:02:06.503Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24456 Background: Persisting neck pain is common in society. It has been reported that the prevalence of neck pain in office workers is much higher than in the general population. The costs to the worker, employer and society associated with work-related neck pain are known to be considerable and are escalating. The factors that place office workers at greater risk of developing neck pain are not understood. The aim of this study is to investigate the incidence and risk factors of work-related neck pain in Australian office workers. Methods/design: We will conduct a prospective cohort study. A cohort of office workers without neck pain will be followed over a 12 month period, after baseline measurement of potential risk factors. The categories of risk factors being evaluated are physical (cervical spine posture, range of movement, muscle endurance and exercise frequency), demographic (age, sex), work environment (sitting duration, frequency of breaks) and psychosocial (psychological distress and psychosocial work factors). Cox regression analysis will be used to identify risk factors associated with work-related neck pain, and will be expressed as hazard ratios with 95% confidence intervals. The data will also enable the incidence of neck pain in this population to be estimated. Discussion: In addition to clarifying the magnitude of this occupational health problem these data could inform policy in workplaces and provide the basis for primary prevention of neck pain in office workers, targeting the identified risk factors. 2013-02-28T09:40:54.777Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23740 1 page(s) 2013-02-27T05:31:22.235Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24425 Question: What are clinical physiotherapists' perceptions about delivering two interventions during a randomised trial: the MOBILISE trial? Design: Mixed methods study using semi-structured interviews involving closed- and open-ended questions. Participants: Thirteen physiotherapists involved in delivering the intervention for the trial. Results: All thirteen physiotherapists (100%) had a preference for their patients to get one of the interventions, mostly dependent on the individual patient. Most were frustrated if their patients were not allocated to their preferred intervention but 62% were satisfied with the intervention they delivered and 100% would be happy to be involved in future research. Two significant themes emerged from the open-ended data: that there were both positive and negative aspects of being involved in the trial. The positive aspects included the trial's value as a way of participating in research and as a way of providing evidence for practice. The negative aspects were that the design of the trial was not always reflective of usual clinical practice and the trial's impact on departments, therapists and patients. Conclusion: Clinical physiotherapists had both positive and negative perceptions about delivering two different interventions in a clinical trial. However, they were all interested in participating in future research, suggesting that the positive aspects outweighed the negative. 2013-02-27T05:21:03.586Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24427 18 page(s) 2013-02-27T05:21:01.583Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24426 Summary of: van de Port IGL et al (2012) Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial. BMJ 344: e2672 doi: 10.1136/ bmj.e2672. [Prepared by Nicholas Taylor, CAP Co-ordinator.]. Question: Does task oriented circuit training improve mobility in patients with stroke compared with individualised physiotherapy? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: Nine outpatient rehabilitation centres in the Netherlands. Participants: Patients with a stroke who had been discharged home and who could walk 10. m without assistance were included. Cognitive deficits and inability to communicate were key exclusion criteria. Randomisation of 250 participants allocated 126 to task oriented circuit training and 124 to individualised physiotherapy. Interventions: The task oriented circuit training group trained for 90. min twice-weekly for 12 weeks supervised by physiotherapists and sports trainers as they completed 8 mobility-related stations in groups of 2 to 8 participants. Individualised outpatient physiotherapy was designed to improve balance, physical conditioning, and walking. Outcome measures: The primary outcome was the mobility domain of the stroke impact scale measured at 12 weeks and 24 weeks. The domain includes 9 questions about a patient's perceived mobility competence and is scored from 0 to 100 with higher scores indicating better mobility. Secondary outcome measures included other domains of the stroke impact scale, the Nottingham extended ADL scale, the falls efficacy scale, the hospital anxiety and depression scale, comfortable walking speed, 6-minute walk distance, and a stairs test. Results: 242 participants completed the study. There were no differences in the mobility domain of the stroke impact scale between the groups at 12 weeks (mean difference (MD) -0.05 units, 95% CI -1.4 to 1.3 units) or 24 weeks (MD -0.6, 95% CI -1.8 to 0.5). Comfortable walking speed (MD 0.09. m/s, 95% CI 0.04 to 0.13), 6-minute walk distance (MD 20. m, 95% CI 35.3 to 34.7), and stairs test (MD -1.6. s, 95% CI -2.9 to -0.3) improved a little more in the circuit training group than the control group at 12 weeks. The memory and thinking domain of the stroke impact scale (MD -1.6 units, 95% CI -3.0 to -0.2), and the leisure domain of the Nottingham extended ADL scale (MD -0.74, 95% CI -1.47 to -0.01) improved a little more in the control group than the circuit training group at 12 weeks. The groups did not differ significantly on the remaining secondary outcomes at 12 weeks or 24 weeks. Conclusion: In patients with mild to moderate stroke who have been discharged home, task oriented circuit training completed in small groups was as effective as individual physiotherapy in improving mobility and may be a more efficient way of delivering therapy. 2013-02-27T04:50:04.646Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24178 Background: Acute low back pain is a common condition resulting in pain and disability. Current national and international guidelines advocate general practitioner care including advice and paracetamol (4 g daily in otherwise well adults) as the first line of care for people with acute low back pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy (SMT) are advocated in many guidelines as second line management options for patients with acute low back pain who are not recovering. No studies have explored the role of NSAIDs and/or SMT in addition to first line management for acute low back pain. The primary aim of this study is to investigate if NSAIDs and/or SMT in addition to general practitioner advice and paracetamol results in shorter recovery times for patients with acute low back pain. The secondary aims of the study are to evaluate whether the addition of SMT and/or NSAIDs influences pain, disability and global perceived effect at 1, 2, 4 and 12 weeks after onset of therapy for patients with significant acute low back pain. Methods/design: This paper presents the rationale and design of a randomised controlled trial examining the addition of NSAIDs and/or SMT in 240 people who present to their general practitioner with significant acute low back pain. 2013-02-18T06:33:40.013Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24179 As increasing resources are devoted to the production of online learning materials it is important that both the usability of such resources by educators and the educational usefulness of these resources for student learning are evaluated. Outcomes from such evaluations provide information that can be used to inform future development of online learning materials. This paper describes two clinical reasoning templates that were developed to enable easy incorporation of content materials by educators without specialist web design skills, and easy access to the materials by students with minimal software requirements. Preliminary evaluation data will be presented describing the usability of the templates by educators and students. 2013-02-18T06:33:39.162Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:24175 Background: E-learning is a common and popular mode of educational delivery, but little is known about its effectiveness in teaching practical skills. The aim of this study was to determine whether the Physiotherapy eSkills Training Online resource in addition to usual teaching improved the performance of practical skills in physiotherapy students. Method: This study was a non-randomised controlled trial. The participants were graduate entry physiotherapy students enrolled in consecutive semesters of a neurological physiotherapy unit of study. The experimental group received the Physiotherapy eSkills Training Online resource as well as usual teaching. The Physiotherapy eSkills Training Online resource is an online resource incorporating (i) video-clips of patient-therapist simulations; (ii) supportive text describing the aim, rationale, equipment, key points, common errors and methods of progression; and (iii) a downloadable PDF document incorporating the online text information and a still image of the video-clip for each practical skill. The control group received usual teaching only. The primary outcomes were the overall performance of practical skills as well as their individual components, measured using a practical examination. Results: The implementation of the Physiotherapy eSkills Training Online resource resulted in an increase of 1.6 out of 25 (95% CI -0.1 to 3.3) in the experimental group compared with the control group. In addition, the experimental group scored 0.5 points out of 4 (95% CI 0 to 1.1) higher than the control group for 'effectiveness of the practical skill' and 0.6 points out of 4 (95% CI 0.1 to 1.1) higher for 'rationale for the practical skill'. Conclusion: There was improvement in performance of practical skills in students who had access to the Physiotherapy eSkills Training Online resource in addition to usual teaching. Students considered the resource to be very useful for learning. 2013-02-12T04:40:08.130Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23883 1 page(s) 2013-01-24T17:00:30.663Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23888 3 page(s) 2013-01-24T17:00:23.564Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23894 2 page(s) 2013-01-24T17:00:12.289Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23847 Selecting an appropriate control group or placebo for randomised controlled trials of spinal manipulative therapy is essential to the final interpretation and usefulness of these studies. Prior to starting a randomised controlled trial of spinal manipulative therapy for acute low back pain we wanted to ensure that the placebo selected would be considered appropriate by experts in the field thereby making the results more likely to be accepted and more likely to influence clinical practice. We developed ten placebo techniques that aimed to mimic spinal manipulative therapy as closely as possible which, while not including the active component of spinal manipulative therapy, were still credible. This list of placebo techniques with detailed descriptions was sent to 25 experts in the field from Australia and New Zealand including both clinicians and academics. We asked the experts to rate whether they believed each technique was appropriate for use as a placebo in a trial of spinal manipulative therapy. Sixteen (64%) of the experts responded. There were extremely low levels of agreement between the experts on which placebos were appropriate (kappa = 0.05, 95% CI 0.01 to 0.10). For nine of the ten placebos at least one expert considered the placebo to include the active component of spinal manipulative therapy while at least one other expert believed the same placebo was not only not active but also not credible. The results of this study demonstrate the different views of experts on what constitutes an appropriate placebo for trials of spinal manipulative therapy. Different beliefs about what is the active component of spinal manipulative therapy appear to be responsible for much of the disagreement. 2013-01-24T03:21:01.841Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23858 2 page(s) 2013-01-24T03:20:45.054Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23854 1 page(s) 2013-01-24T01:10:10.821Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23804 Study Design: Prospective inception cohort study of 62 consecutive patients seen in 2 orthopaedic clinics following ankle fracture. Objectives: To investigate 4 putative predictors (age, fracture classification, acute management [surgical or nonsurgical], and ankle dorsiflexion range of motion measured at the time of cast removal) of outcome after ankle fracture and to develop simple predictive models of outcome after ankle fracture. Background: Ankle fracture is a common condition. However, few studies have investigated factors that predict outcome after ankle fracture. Methods and Measures: Sixty-two consecutive subjects aged 17 or older with ankle fractures were recruited from 2 hospital orthopaedic clinics. Outcome measures recorded at 6 weeks and 6 months after cast removal included 2 functional questionnaires, patients' ratings of global improvement, and a measure of ankle dorsiflexion. The predictive value of 4 variables selected a priori was analyzed using bivariate and stepwise multiple linear regression. Results: Ankle dorsiflexion and fracture classification predicted outcome 6 weeks and 6 months after cast removal for all outcome measures used (P<.05, r² = 0.09-0.47). Fracture management (surgical or nonsurgical) inconsistently predicted outcome at both 6 weeks and 6 months, and age did not predict outcome at either 6 weeks or 6 months after cast removal. The predictive models explain between 19% and 58% of the variance in outcomes 6 weeks after cast removal and 19% to 52% of the variance in outcomes 6 months after cast removal. Conclusion: Ankle dorsiflexion measured at the time of cast removal and fracture classification are clinically significant predictors of outcome after ankle fracture; however, much unexplained variation in outcomes still exists. 2013-01-20T22:00:32.525Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23739 Study Design. Retrospective design. Objectives. To compare the responsiveness and test-retest reliability of the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire in detecting change in disability in patients with work-related low back pain. Summary of Background Data. Many low back pain-specific disability questionnaires are available, including the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire. No previous study has compared the responsiveness and reliability of these questionnaires. Methods. Files of patients who had been treated for work-related low back pain at a physical therapy clinic were reviewed, and those containing initial and follow-up Functional Rating Index and 18-item Roland-Morris Disability Questionnaires were selected. The responsiveness of both questionnaires was compared using two different methods. First, using the assumption that patients receiving treatment improve over time, various responsiveness coefficients were calculated. Second, using change in work status as an external criterion to identify improved and nonimproved patients, Spearman's ρ and receiver operating characteristic curves were calculated. Reliability was estimated from the subset of patients who reported no change in their condition over this period and expressed with the intraclass correlation coefficient and the minimal detectable change. Results. One hundred and forty-three patient files were retrieved. The responsiveness coefficients for the Functional Rating Index were greater than for the 18-item Roland-Morris Disability Questionnaire. The intraclass correlation coefficient values for both questionnaires calculated from 96 patient files were similar, but the minimal detectable change for the Functional Rating Index was less than for the 18-item Roland-Morris Disability Questionnaire. Conclusion. The Functional Rating Index seems preferable to the 18-item Roland-Morris Disability Questionnaire for use in clinical trials and clinical practice. 2013-01-14T18:03:18.426Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23741 1 page(s) 2013-01-14T18:03:14.810Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23749 2 page(s) 2013-01-14T18:02:37.209Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23755 Purpose: To compare effects on strength in the early phase of resistance training with one or three sets and fast or slow speeds. Methods: A total of 115 healthy, untrained subjects were randomized to a control group or one of four training groups: one set fast (∼140°·s-1). three sets fast, one set slow (∼50°·s-1), or three sets slow. All subjects attended training 3× wk-1 for 6 wk. Subjects in the training groups performed unilateral elbow flexion contractions with a target six- to eight-repetition maximum load. Control subjects sat at the training bench but did not train. One repetition maximum strength, arm circumference, and biceps skinfold thickness were measured before and after training. Results: One slow set increased strength by 25% (95% CI 13-36%, P < 0.001). Three sets of training produced greater increases in strength than one set (difference = 23% of initial strength, 95% CI 12-34%, P < 0.001) and fast training resulted in a greater increase in strength than slow training (difference = 11%. 95% CI 0.2-23%, P = 0.046). The interaction between sets and speed was negative (-15%) and of borderline significance (P = 0.052). suggesting there is a benefit of training with three sets or fast speeds, but there is not an additive benefit of training with both. Conclusions: Three sets of exercise produce twice the strength increase of one set in the early phase of resistance training. Training fast produces greater strength increases than training slow: however, there does not appear to be any additional benefit of training with both three sets and fast contractions. 2013-01-14T18:02:08.189Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23756 Evidence that unilateral training increases contralateral strength is inconsistent, possibly because existing studies have design limitations such as lack of control groups, lack of randomization, and insufficient statistical power. This study sought to determine whether unilateral resistance training increases contralateral strength. Subjects (n = 115) were randomly assigned to a control group or one of the following four training groups that performed supervised elbow flexion contractions: 1) one set at high speed, 2) one set at low speed, 3) three sets at high speed, or 4) three sets at low speed. Training was 3 times/wk for 6 wk with a six- to eight-repetition maximum load. Control subjects attended sessions but did not exercise. Elbow flexor strength was measured with a one-repetition maximum arm curl before and after training. Training with one set at slow speed did not produce an increase in contralateral strength (mean effect of -1% or -0.07 kg; 95% confidence interval: -0.42-0.28 kg; P = 0.68). However, three sets increased strength of the untrained arm by a mean of 7% of initial strength (additional mean effect of 0.41 kg; 95% confidence interval: 0.06-0.75 kg; P = 0.022). There was a tendency for training with fast contractions to produce a greater increase in contralateral strength than slow training (additional mean effect of 5% or 0.31 kg; 95% confidence interval: -0.03-0.66 kg; P = 0.08), but there was no interaction between the number of sets and training speed. We conclude that three sets of unilateral resistance exercise produce small contralateral increases in strength. 2013-01-14T18:02:04.935Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23254 1 page(s) 2012-12-06T02:41:07.469Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:23259 2 page(s) 2012-12-06T02:40:58.355Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22580 Background. Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons. Objective. Investigate whether an exercise intervention can enhance mobility, prevent falls, and increase physical activity among community-dwelling people after stroke. Method. A randomized trial with blinding of physical outcome assessment was conducted through local stroke clubs. Both groups, on average 5.9 years poststroke, received exercise classes, advice, and a home program for 12 months. The experimental group (EG) program (n = 76) aimed to improve walking, prevent falls and increase physical activity. The control group (CG) program (n = 75) aimed to improve upper-limb and cognitive functions. The primary outcomes were walking capacity, walking speed measured before and after the intervention, and fall rates monitored monthly. Results. At 12 months, the EG walked 34 m further in 6 minutes (95% confidence interval [CI] = 19-50; P <.001) and 0.07 m/s faster over 10 m (95% CI = 0.01-0.14; P =.03) than the CG. The EG had 129 falls, and the CG had 133. There were no differences in proportion of fallers (relative risk = 1.22; 95% CI = 0.91-1.62; P =.19) or the rate of falls between groups (incidence rate ratio = 0.96; 95% CI = 0.59-1.51; P =.88). Conclusion. The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls. 2012-11-01T00:10:10.202Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22238 Contemporary clinical assessment of back pain is based on the diagnostic triage paradigm. The most common diagnostic classification is nonspecific back pain, considered to be of nociceptive etiology. A small proportion are diagnosed with radicular pain, of neuropathic origin. In this study we review the body of literature on the prevalence of neuropathic features of back pain, revealing that the point prevalence is 17% in primary care, 34% in mixed clinical settings and 53% in tertiary care. There is evidence that neuropathic features of back pain are not restricted to typical clinical radicular pain phenotypes and may be under-recognized, particularly in primary care. The consequence of this is that in the clinic, diagnostic triage may erroneously classify patients with nonspecific back pain or radicular pain. A promising alternative is the development of mechanism-based pain phenotyping in patients with back pain. Timely identification of contributory pain mechanisms may enable greater opportunity to select appropriate therapeutic targets and improve patient outcomes. 2012-10-23T00:31:30.427Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22095 Study Design.: Cross sectional Objective.: To investigate the ability of the neurological examination to identify the specific level of a disc herniation in patients with sciatica and confirmed disc herniation. Summary of Background Data.: Tests included in a neurological examination theoretically provide accurate diagnostic information about the level of the herniated disc. However, there is currently very little evidence about the diagnostic accuracy of individual tests or combinations of tests. Methods.: The study included 283 patients with sciatica and confirmed disc herniation from a previous randomized controlled trial. The reference test for the current study was the MRI scan, reported for level of disc herniation. Index tests investigated were a neurologist's overall impression of the level of disc herniation, individual neurological tests (e.g., sensation testing) and multiple test findings (i.e., the number of positive tests). The index tests were performed blinded to the MRI results. The diagnostic accuracy of the index tests in predicting herniations at the lower three lumbar discs was investigated using area under the curve (AUC), sensitivity and specificity. Results.: None of the individual neurological tests from the clinical examination were highly accurate for identifying the level of disc herniation (AUC < 0.75). The outcome of multiple test findings was slightly more accurate but did not produce high sensitivity and specificity. The dermatomal pain location was generally the most informative individual neurological test. The overall suspected level of disc herniation rated by the neurologist after a full examination of the patient was more accurate than individual tests. At L4/5 and L5/S1 herniations the AUC for neurologist ratings was 0.79 and 0.80 respectively. Conclusion.: The current study did not find evidence to support the accuracy of individual tests from the neurological examination in identifying the level of disc herniation demonstrated on MRI. A neurologist's overall impression was moderately accurate in identifying the level of disc herniation. 2012-10-17T00:40:04.045Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22031 Purpose: To evaluate whether patients' treatment preferences, characteristics, or symptomatic response to assessment moderated the effect of the McKenzie method for acute low back pain (LBP). Methods: This study involved a secondary analysis of a previous RCT on the effect of adding the McKenzie method to the recommended first-line care for patients with acute non-specific LBP. 148 patients were randomized to the First-line Care Group (recommended first-line care alone) or the McKenzie Group (McKenzie method in addition to the first-line care) for a 3-week course of treatment. The primary outcome was pain intensity at 3 weeks. The ability of six patient characteristics to identify those who respond best to McKenzie method was assessed using interaction terms in linear regression models. Results: The six investigated potential effect modifiers for response to the McKenzie method did not predict a more favorable response to this treatment. None of the point estimates for effect modification met our pre-specified criterion of clinical importance of a 1 point greater improvement in pain. For five of the six predictors, the 95% CI did not include our criterion for meaningful clinical improvement. Conclusion: We were unable to find any clinically useful effect modifiers for patients with acute LBP receiving the McKenzie method. 2012-10-15T07:14:11.059Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22038 Pain self-efficacy and fear of movement have been proposed to explain how pain can lead to disability for patients with chronic low back pain. However the extent to which pain self-efficacy and fear of movement mediate the relationship between pain and disability over time has not been investigated. This study aimed to investigate whether pain self-efficacy and/or fear of movement mediate the relationship between pain intensity and disability in patients with recent onset chronic low back pain. In a two-wave longitudinal design, 184 chronic low back pain patients completed measures for pain intensity, disability, pain self-efficacy and fear of movement at baseline and 12 months after the onset of chronic low back pain. Regression analyses were used to test the mediational hypothesis. We found that, when measured at the same time, both pain self-efficacy and fear of movement beliefs partially mediated the effects of pain intensity on disability at the onset of chronic low back pain. However, in the longitudinal analyses, only improvements in self-efficacy beliefs partially mediated the relationship between changes in pain and changes in disability over a 12 months period. We found no support for the theory that fear of movement beliefs mediate this relationship. Therefore, we concluded that pain self-efficacy may be a more important variable than fear of movement beliefs in terms of understanding the relationship between pain and disability. 2012-10-15T07:13:53.416Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22043 Some patients with low back pain recover quickly while others continue to experience pain beyond 3 months. The primary aim of this study was to develop a simple prediction rule to help clinicians identify patients with acute low back pain likely to recover at different rates. The secondary aim was to compare a clinician's prognosis judgement to the prediction rule. The study sample included 239 patients with acute low back pain who participated in a randomised controlled trial. The primary outcome was days to recovery from pain. Potential prognostic factors were initially tested for univariate association with recovery using Cox regression (p < 0.1). Continuous prognostic factors with a significant association were dichotomised using a median split. Significantly associated prognostic factors were then included in a multivariate forward stepwise Cox regression. We then separated participants into strata according to the number of predictors in the final model for which they were positive. Our results suggest that a clinical prediction rule using three simple prognostic factors was able to differentiate between patients who recover quickly and those who recover slowly. Patients with lower than average initial pain intensity, shorter duration of symptoms and fewer previous episodes recovered more quickly (HR = 3.5, 95% CI, 1.8-7.0) than patients without these characteristics. Therapists were able to predict patients likely to recover at different rates, (HR = 1.6, 95% CI, 1.2-2.1), however, they did not perform as well as the clinical prediction rule. The rule requires validation in a different sample of patients. 2012-10-15T07:13:47.685Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22044 Purpose The purpose of this study is to investigate if lumbar disc pathology identified on MRI scans is more common in patients with acute, likely discogenic, low back pain than matched controls. Methods We compared rates of MRI findings between 30 cases with low back pain and 30 pain-free controls. Cases were patients presenting for care with likely discogenic low back pain (demonstrated centralisation with repeated movement testing), of moderate intensity and with minimal past history of back pain. Controls were matched for age, gender and past history of back pain. Cases and controls underwent MRI scanning which was read for the presence of a range of MRI findings by two blinded assessors. Results The presence of disc degeneration, modic changes and disc herniation significantly altered the odds of a participant being a case or control. For example subjects were 5.2 times more likely to be a case than a control when disc degeneration grade of C3 was present, and 6.0 times more likely with modic changes. The presence of a high-intensity zone or annular tear was found to significantly alter odds for one assessor but not the other assessor. Conclusion MRI findings including disc degeneration, modic changes and herniation are more common in selected people with current acute (likely discogenic) low back pain than in controls without current low back pain. Further investigation of the value of MRI findings as prognostic factors and as treatment effect modifiers is required to assess the potential clinical importance of these findings. 2012-10-15T07:13:43.774Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22047 Purpose Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people's low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain. Methods This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain. Results Six potential misunderstandings are discussed. (1) Until diagnosis is shown to improve outcomes it is not worth investigating; (2) without a gold standard it is not possible to investigate diagnosis of low back pain; (3) the presence of pathology in some people without low back pain means it is not important; (4) dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy; (5) suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in cu rrent clinical practice; (6) we seem to have forgotten the 'bio' in biopsychosocial low back pain. Conclusions We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain. 2012-10-15T07:13:38.399Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22049 Lack of standardization of terminology in low back pain (LBP) research has significantly impeded progress in this area. The diversity in existing definitions for a 'recurrence of an episode of LBP' and 'recurrent LBP' is an important example. The variety of definitions used by researchers working in this area has prevented comparison of results between trials and made meta-analyses of this data unfeasible. The aim of this study was to use a modified Delphi approach to gain consensus on definitions for a 'recurrence of an episode of LBP' (e.g. outcome event) and for 'recurrent LBP' (e.g. patient population). Existing definitions for both constructs were classified into the main features comprising the definition (e.g. 'duration of pain') and the items that defined each feature (e.g. 'pain lasting at least 24 h'). In each round, participants were asked to rate the importance of each feature to a definition of a 'recurrence of an episode of LBP', and a definition of 'recurrent LBP' and rank the items (defining each feature) in order of decreasing importance. Forty-six experts in LBP research, from nine different countries, participated in this study. Four rounds were completed with responses rates of 94, 91, 83, and 97% in rounds 1, 2, 3, and 4, respectively. Consensus definitions were reached in both areas with 95% of panel members supporting the definition of a 'recurrence of an episode of LBP' and 92% of panel members supporting the definition of 'recurrent LBP'. Future research is necessary to evaluate these definitions. 2012-10-15T07:13:34.113Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22054 Several versions of the 24-item Roland Morris Disability Questionnaire (RMDQ) have been proposed; however, their responsiveness has not been extensively explored. The objective of this study was to compare the responsiveness of four versions of the RMDQ. Perceived disability was measured using the 24-item, two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six randomised controlled trials. Responsiveness was calculated using effect size, Guyatt's responsiveness index (GRI) and receiver operating characteristics (ROC) curves. Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ. GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item. ROC curves revealed that the 11-item was less responsive than the other three versions, which had similar responsiveness. The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item. 2012-10-15T07:13:29.672Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22056 Recurrent low back pain (recurrent LBP) is a common condition, however, it is unclear if uniform definitions are used in studies investigating the prevalence and management of this condition. The aim of this systematic review was to identify how recurrent LBP is defined in the literature. A literature search was performed on MEDLINE, EMBASE, CINAHL, AMED, and PEDro. Studies were considered eligible if they investigated a cohort of subjects with recurrent LBP or if they were measuring the prevalence of recurrent LBP. Two independent reviewers assessed inclusion of studies and extracted definitions of recurrent LBP. Forty-three studies met the inclusion criteria. The majority of studies (63%) gave an explicit definition of recurrent LBP; however, the definitions varied greatly and only three definitions for recurrent LBP were used by more than one study. The most common feature given as part of the definition was the frequency of previous episodes of low back pain. Only 8% (3/36) of studies used previously recommended definitions for recurrent LBP. Large variation exists in definitions of recurrent LBP used in the literature, making interpretation of prevalence rates and treatment outcomes very difficult. Achieving consensus among experts in this area is required. 2012-10-15T07:13:25.124Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22058 The objective of this study was to assess the efficacy of paracetamol (acetaminophen) in the treatment of pain and disability in patients with non-specific low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of paracetamol in the treatment of pain and disability in patients with non-specific low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. Trials were eligible if they were randomized controlled trials comparing paracetamol to no treatment, placebo or another treatment in patients with non-specific low back pain. Two of the authors independently assessed trials for methodological quality on the PEDro Scale and extracted data. Continuous pain and disability data were converted to a common 0-10 scale; ordinal data were dichotomized (e.g., no pain, pain). The data was analyzed using the MIX version 1.61 meta-analysis software. Out of 205 unique articles found in the searches, 7 eligible trials were identified. The trials enrolled a total of 676 participants with 5 investigating acute low back pain, 1 investigating chronic low back pain and 1 investigating both. No trial provided data comparing paracetamol to placebo and only one trial compared paracetamol to no treatment. In general the trials were small (only 1 trial had >25 subjects per group) and of low methodological quality (only 2 had a score above 6 on the quality scale). All but one of the trials provided imprecise estimates of the effects of treatment with confidence intervals spanning clinically important beneficial and also harmful effects of paracetamol. No trial reported a statistically significant difference in favor of paracetamol. There is insufficient evidence to assess the efficacy of paracetamol in patients with low back pain. There is a clear need for large, high quality randomized controlled trials evaluating paracetamol, to provide reliable evidence of paracetamol's effectiveness in patients with low back pain and to establish the validity of the recommendations in clinical guidelines. 2012-10-15T07:13:22.753Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22059 A clinical prediction rule to identify patients most likely to respond to spinal manipulation has been published and widely cited but requires further testing for external validity. We performed a pre-planned secondary analysis of a randomised controlled trial investigating the efficacy of spinal manipulative therapy in 239 patients presenting to general practice clinics for acute, non-specific, low back pain. Patients were randomised to receive spinal manipulative therapy or placebo 2 to 3 times per week for up to 4 weeks. All patients received general practitioner care (advice and paracetamol). Outcomes were pain and disability measured at 1, 2, 4 and 12 weeks. Status on the clinical prediction rule was measured at baseline. The clinical prediction rule performed no better than chance in identifying patients with acute, non-specific low back pain most likely to respond to spinal manipulative therapy (pain P = 0.805, disability P = 0.600). At 1-week follow-up, the mean difference in effect of spinal manipulative therapy compared to placebo in patients who were rule positive rather than rule negative was 0.3 points less on a 10-point pain scale (95% CI -0.8 to 1.4). The clinical prediction rule proposed by Childs et al. did not generalise to patients presenting to primary care with acute low back pain who received a course of spinal manipulative therapy. 2012-10-15T07:13:18.679Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22060 Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4-5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: -LR = 0.21 (95%CI 0.12-0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3-4.4) and -LR of 0.29 (95%CI 0.12-0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. 2012-10-15T07:13:14.258Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22065 Background: Acute low back pain (LBP) is primarily managed in general practice. We aimed to describe the usual care provided by general practitioners (GPs) and to compare this with recommendations of best practice in international evidence-based guidelines for the management of acute LBP. Methods: Care provided in 3533 patient visits to GPs for a new episode of LBP was mapped to key recommendations in treatm ent guidelines. The proportion of patient encounters in which care arranged by aGPaligned with these key recommendations was determined for the period 2005 through 2008 and separately for the period before the release of the local guideline in 2004 (2001-2004). Results: Although guidelines discourage the use of imaging, over one-quarter of patients were referred for imaging. Guidelines recommend that initial care should focus on advice and simple analgesics, yet only 20.5% and 17.7% of patients received these treatments, respectively. Instead, the analgesics provided were typically nonsteroidal anti-inflammatory drugs (37.4%) and opioids (19.6%). This pattern of care was the same in the periods before and after the release of the local guideline. Conclusions: The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time. The unendorsed care may contribute to the high costs of managing LBP, and some aspects of the care provided carry a higher risk of adverse effects. 2012-10-15T07:13:07.117Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22066 There has been a recent increase in research evaluating treatment-based subgroups of non-specific low back pain. The aim of these sub-classification schemes is to identify subgroups of patients who will respond preferentially to one treatment as opposed to another. Our article provides accessible guidance on to how to interpret this research and determine its implications for clinical practice. We propose that studies evaluating treatment-based subgroups can be interpreted in the context of a three-stage process: (1) hypothesis generation-proposal of clinical features to define subgroups; (2) hypothesis testing-a randomised controlled trial (RCT) to test that subgroup membership modifies the effect of a treatment; and (3) replication-another RCT to confirm the results of stage 2 and ensure that findings hold beyond the specific original conditions. At this point, the bulk of research evidence in defining subgroups of patients with low back pain is in the hypothesis generation stage; no classification system is supported by sufficient evidence to recommend implementation into clinical practice. 2012-10-15T07:13:03.026Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22067 Background. Clinical practice guidelines recommend that the initial treatment of acute low back pain (LBP) should consist of advice to stay active and regular simple analgesics such as paracetamol 4 g daily. Despite this recommendation in all international LBP guidelines there are no placebo controlled trials assessing the efficacy of paracetamol for LBP at any dose or dose regimen. This study aims to determine whether 4 g of paracetamol daily (in divided doses) results in a more rapid recovery from acute LBP than placebo. A secondary aim is to determine if ingesting paracetamol in a time-contingent manner is more effective than paracetamol taken when required (PRN) for recovery from acute LBP. Methods/Design. The study is a randomised double dummy placebo controlled trial. 1650 care seeking people with significant acute LBP will be recruited. All participants will receive advice to stay active and will be randomised to 1 of 3 treatment groups: time-contingent paracetamol dose regimen (plus placebo PRN paracetamol), PRN paracetamol (plus placebo time-contingent paracetamol) or a double placebo study arm. The primary outcome will be time (days) to recovery from pain recorded in a daily pain diary. Other outcomes will be pain intensity, disability, function, global perceived effect and sleep quality, captured at baseline and at weeks 1, 2, 4 and 12 by an assessor blind to treatment allocation. An economic analysis will be conducted to determine the cost-effectiveness of treatment from the health sector and societal perspectives. Discussion. The successful completion of the trial will provide the first high quality evidence on the effectiveness of the use of paracetamol, a guideline endorsed treatment for acute LBP. Trail registration. 2012-10-15T07:13:02.057Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22072 To investigate the efficacy and tolerability of analgesic and adjuvant pain drugs typically administered in primary care for the management of patients with sciatica. Systematic review. Data source International Pharmaceutical Abstracts, PsycINFO, Medline, Embase, Cochrane Central Register of Clinical Trials (CENTRAL), CINAHL, and LILACS. Randomised controlled trials assessing the efficacy and tolerability of drugs versus placebo or other treatment for sciatica. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability outcomes were converted to a common 0 to 100 scale. Data were pooled with a random effects model, and the GRADE approach was used in summary conclusions. Twenty three published reports met the inclusion criteria. The evidence to judge the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality. Most of the pooled estimates did not favour the active treatment over placebo. The pooled results of two trials of corticosteroids (mean difference in overall and leg pain -12.2, 95% confidence interval -20.9 to -3.4) and a single trial of the anticonvulsant gabapentin for chronic sciatica (mean difference in overall pain relief -26.6, -38.3 to -14.9) showed some benefits but only in the short term. The median rate of adverse events was 17% (interquartile range 10-30%) for the active drugs and 11% (3-23%) for placebo. Trial limitations included failure to use validated outcome measures, lack of long term follow-up, and small sample size. As the existing evidence from clinical trials is of low quality, the efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear. 2012-10-15T07:12:50.984Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22074 Objectives: The aim of this study was to determine whether certain patient characteristics could identify people with acute low back pain who were more likely to respond to nonsteroidal anti-inflammatory drugs (NSAIDs), when administered in combination with paracetamol. Methods: This study involved a secondary analysis of a randomized controlled trial investigating the efficacy of diclofenac in 239 patients presenting to general practitioners for acute low back pain. All patients received advice to "stay active" and take regular paracetamol and then were randomized to receive either diclofenac (50mg twice daily) or placebo. The primary outcome was days to recovery from pain. The ability of 14 patient characteristics to identify those who respond best to diclofenac was assessed using interaction terms in Cox regression models. Results: Most of the 14 baseline characteristics investigated were uninformative in identifying those who respond best to diclofenac when added to paracetamol. Patients' sex and levels of fear regarding movement and pain were both independent statistically significant predictors of response to NSAIDs for one definition of recovery but not for the other. The interaction between fear avoidance (physical activity) and NSAIDs treatment was statistically significant (P=0.042, hazard ratio=1.059, 95% confidence interval 1.002 to 1.118) for recovery defined as a pain score of 0 or 1. The interaction between sex and NSAID treatment was statistically significant (P=0.044, hazard ratio=1.755, 95% confidence interval 1.014 to 3.038) for recovery defined as a pain score of 0 or 1 maintained for 7 consecutive days. Discussion: This study did not find any baseline patient characteristics, which consistently identified patients with acute low back pain who respond best to NSAIDs when provided in addition to paracetamol and advice. A patient's sex and level of fear avoidance may be weak predictors and warrant further prospective investigation. 2012-10-15T07:12:47.985Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22073 OBJECTIVES: To describe the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity. DESIGN: Inception cohort study with one year follow-up. SETTING: Primary care clinics in Sydney, Australia. PARTICIPANTS: The study sample was a subcohort of an inception cohort of 973 consecutive patients presenting to primary care with acute low back pain (<2 weeks' duration). 406 participants whose pain persisted for three months formed the inception cohort of patients with chronic low back pain. MAIN OUTCOME MEASURES: Outcomes and putative predictors measured at initial presentation, onset of chronicity (study entry), and follow-up at nine and 12 months. Recovery was determined from measures of pain intensity, disability, and work status. The association between potential prognostic factors and time to recovery was modelled with Cox regression. RESULTS: Completeness of follow-up was 97% of total person time for all outcomes. The cumulative probability of being pain-free was 35% at nine months and 42% at 12 months and for complete recovery was 35% at nine months and 41% at 12 months. Of the 259 participants who had not recovered from pain related disability at entry to the chronic study, 47% had recovered by 12 months. Previous sick leave due to low back pain, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia were associated with delayed recovery. CONCLUSION: More than one third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The prognosis is less favourable for those who have taken previous sick leave for low back pain, have high disability levels or high pain intensity at onset of chronic low back pain, have lower education, perceive themselves as having a high risk of persistent pain, and were born outside Australia. 2012-10-15T07:12:47.717Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22076 Objective: The study investigated the test-retest reliability and construct validity of the Global Perceived Effect (GPE) scale in patients with musculoskeletal disorders. Study Design and Setting: Data from seven clinical studies including 861 subjects were used for the analyses. Repeat measures taken at the same attendance and from attendances separated by 24 hours were compared to estimate test-retest reliability. Construct validity was evaluated by examining relationships between pre, post, and change scores in pain and disability measures with GPE measures. Results: Intraclass correlation coefficient values of 0.90-0.99 indicate excellent reproducibility of the GPE scale. In all but one data set, change scores on pain and disability measures correlated well (r = 0.40-0.74) with GPE; however, post scores nearly always correlated even more strongly (r = 0.58-0.84), and pre scores showed much weaker association (r = 0.00-0.28). Pre scores accounted for only a small amount of additional R2 when added to regression models including post score. Conclusions: Test-retest reliability of the GPE is excellent. GPE ratings are strongly influenced by current status, with the effect more obvious as transition time lengthens. This result questions whether transition ratings truly reflect change, or rather just current state. This finding also has implications for the use of GPE ratings as an external criterion of change in clinimetric studies. © 2010 Elsevier Inc. All rights reserved. 2012-10-15T07:12:45.082Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22075 Objective: To cross-culturally adapt the Short Form of the McGill Pain Questionnaire (SF-MPQ) into Brazilian-Portuguese and test the clinimetric properties of the newly developed SF-MPQ and the previously cross-culturally adapted Brazilian-Portuguese Long Form of the McGill Pain Questionnaire (LF-MPQ). Study Design and Setting: The SF-MPQ was translated and adapted into Brazilian-Portuguese following recommendations from current guidelines. Both SF-MPQ and LF-MPQ were administered in a prospective longitudinal design to 203 patients with a range of musculoskeletal conditions to evaluate their clinimetric properties. Results: Bot h questionnaires demonstrated high levels of internal consistency (Cronbach α range = 0.70-0.79), reliability (intraclass correlation coefficient 2,1 range = 0.69-0.85), and agreement (standard error of the measurement range = 0.80-6.92). We observed positive and moderate-to-high correlations among the SF-MPQ, the LF-MPQ, and the Numerical Rating Scale (Pearson r ranging from 0.49 to 0.68). No ceiling or floor effects were detected. Both versions demonstrated acceptable levels of responsiveness (effect size range = 0.30-0.60; correlations range = 0.23-0.51; and area under the curve range = 0.56-0.76). Conclusions: The Brazilian-Portuguese versions of the MPQ were found to be reproducible, valid, and responsive for the assessment of pain in patients with musculoskeletal conditions. 2012-10-15T07:12:44.928Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22078 Wrist pain is common. People with persistent pain commonly undergo arthroscopic investigation. Little is known about the prognosis or prognostic factors for these patients. The purpose of the study was to evaluate prognosis and prognostic factors for pain and functional disability in patients with persistent wrist pain who proceed to arthroscopic investigation. The study design used was a prospective cohort study. One hundred and five consecutive participants who underwent arthroscopic investigation for undiagnosed wrist pain for at least four-week duration were recruited. Patient-rated wrist and hand evaluation (PRWHE) scores were determined at baseline (before arthroscopy) and one year after arthroscopy. One-year follow-up data were obtained for 97 (92%) of 105 participants. Mean PRWHE total score declined from 49 of 100 (standard deviation [SD] 18.5) at baseline to 26 of 100 (SD 20.4) at one year. Two prognostic factors were identified: baseline PRWHE and duration of symptoms. These factors explained 19% and 5% of the variability in the final PRWHE score, respectively. Results of provocative wrist tests and arthroscopic findings did not significantly contribute to prognosis in this cohort. This study provides the first robust evidence of the prognosis of persistent wrist pain. Participants who underwent arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year; however, most continued to have some pain and disability. Duration of pain and PRWHE at baseline explained 24% of the one-year PRWHE score. Level of Evidence: Level 2. 2012-10-15T07:12:42.015Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22079 Objectives: The broad aim of this study was to assess the homogeneity of patients included in trials of nonspecific low back pain (NSLBP). To do this, we investigated the consistency and clarity of criteria used to identify and exclude participants with serious pathologies and nerve root compromise in randomized controlled trials, investigating interventions for NSLBP. Methods: We searched Medline database for randomized controlled trials of low back pain (LBP) published between 2000 and 2009. We then randomly selected and screened trials for inclusion until we had 50 eligible trials. Data were extracted on the criteria used to identify cases of serious conditions (e.g. cancer, fracture) and nerve root involvement. Results: The majority of papers (35/50) explicitly excluded patients with serious pathology. However, the terminology used and examples given were highly variable. Nerve root involvement was an exclusion criterion in the majority but not all studies. The criteria used for excluding patients with nerve root involvement varied greatly between studies. The most common criteria were 'motor, sensory or reflex changes' (nine studies), followed by 'pain radiating below the knee' (five studies) and 'reduced straight leg raise which reproduces leg pain' (five studies). In half of the included studies, the criteria used, while alluding to nerve root involvement, were not explained adequately for us to determine the types of patients included or excluded. Discussion: The inconsistent and unclear criteria used to identify cases of serious pathology and nerve root compromise means that published trials of LBP likely include heterogeneous patient populations. This trait limits our ability to make comparisons across trials or pool studies. Standardization and consensus is important for future research. 2012-10-15T07:12:39.044Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22080 Background: Many clinicians and researchers believe that there are subgroups of people with spinal pain who respond differently to treatment and have different prognoses. There has been considerable interest in this topic recently. However, problems occur when conclusions about subgroups are made that are inappropriate given the randomized controlled trial design used. The research design to choose, when developing a study protocol that investigates the effect of treatment subgroups, depends on the particular research question. Similarly, the inferences that can be drawn from an existing study will vary, depending on the design of the trial. Objectives: This paper discusses the randomized controlled trial designs that are suitable to answer particular questions about treatment subgroups. It focuses on trial designs that are suitable to answer four questions: (1) 'Is the treatment effective in a pre-specified group of patients?'; (2) 'Are outcomes of treatment applied using a subgrouping clinical reasoning process, better than a control treatment?'; (3) 'Are the outcomes for a patient subgroup receiving a particular treatment (compared to a control treatment) better than for patients not in the subgroup who receive the same treatment?'; and (4) 'Are outcomes for a number of treatments better if those treatments are matched to patients in specific subgroups, than if the SAME treatments are randomly given to patients?'. Illustrative examples of these studies are provided. Conclusion: If the clinical usefulness of targeting treatments to subgroups of people is to be determined, an important step is a shared understanding of what different RCT designs can tell us about subgroups. 2012-10-15T07:12:38.648Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22081 Publication in peer-reviewed journals is the way to introduce new information that has clinical implications. However, clinicians may be reluctant to embark on the publication process because of lack of confidence or uncertainty about the process. The aim of this paper is to summarize the requirements of that process and to provide tips for successful publication to encourage potential clinical authors of manual therapy articles. In general, articles should contribute knowledge, corroborate or contradict previous knowledge, or summarize existing knowledge. Articles should be clearly structured, with abstract, introduction, methods, discussion, conclusion, and references; and often include tables and figures. The content of each of these sections is described. The use of standardized checklists is encouraged and the format should adhere to each journal's author guidelines. Submission is electronic and typically first the editor or deputy editor reviews for suitability, adherence to journal format, and quality of writing. If deemed suitable, the article is then sent out for blinded review by two reviewers with expertise in that area. Review typically takes 6-8 weeks, and all communication is via the editor. A decision is made then to either accept, accept with amendments to be made, reject but with advice to resubmit, or reject outright. In any re-submissions, the review teams' comments should be diligently addressed, either making the recommended changes or justifying why they have not been adopted. Common reasons for rejection of articles are given. Finally, the authors provide some tips for publication to help readers with successful submission of articles. 2012-10-15T07:12:36.270Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22086 Letter to the editor-in-chief. 2012-10-15T07:11:47.711Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22085 Low back pain (LBP) is an extremely common cause of pain and disability. While many treatments for acute LBP exist, one of the most widely used, but also most controversial, is spinal manipulative therapy (SMT). This therapy includes both high-velocity manipulative techniques and low-velocity mobilization techniques. The literature regarding the use of SMT is often conflicting, which explains the difference in recommendations regarding SMT in international LBP guidelines. The lack of a clear tissue diagnosis in the majority of patients with LBP combined with the unknown mechanism of action of SMT adds to the difficulty for clinicians in providing SMT in a logical and effective manner. Despite these limitations, the existing literature does provide some assistance to clinicians on when to provide SMT and how to provide it in an optimal way. This review aims to summarize the key research literature investigating SMT in LBP in order to help clinicians make informed decisions about the use of SMT for their patients with acute LBP. 2012-10-15T07:11:47.532Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22088 Background: We aimed to investigate whether the addition of non-steroidal anti-inflammatory drugs or spinal manipulative therapy, or both, would result in faster recovery for patients with acute low back pain receiving recommended first-line care. Methods: 240 patients with acute low back pain who had seen their general practitioner and had been given advice and paracetamol were randomly allocated to one of four groups in our community-based study: diclofenac 50 mg twice daily and placebo manipulative therapy (n=60); spinal manipulative therapy and placebo drug (n=60); diclofenac 50 mg twice daily and spinal manipulative therapy (n=60); or double placebo (n=60). The primary outcome was days to recovery from pain assessed by survival curves (log-rank test) in an intention-to-treat analysis. This trial was registered with the Australian Clinical Trials Registry, ACTRN012605000036617. Findings: Neither diclofenac nor spinal manipulative therapy appreciably reduced the number of days until recovery compared with placebo drug or placebo manipulative therapy (diclofenac hazard ratio 1·09, 95% CI 0·84-1·42, p=0·516; spinal manipulative therapy hazard ratio 1·01, 95% CI 0·77-1·31, p=0·955). 237 patients (99%) either recovered or were censored 12 weeks after randomisation. 22 patients had possible adverse reactions including gastrointestinal disturbances, dizziness, and heart palpitations. Half of these patients were in the active diclofenac group, the other half were taking placebo. One patient taking active diclofenac had a suspected hypersensitivity reaction and ceased treatment. Interpretation: Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy. 2012-10-15T07:11:44.056Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22087 Context: Functional strength measures correlate more closely with functional performance than non-functional strength measures. Objectives: To determine the reliability of the lateral step test as a measure of maximal strength. Design: Intertester repeated measures. Setting: Research laboratory. Participants: Twenty four healthy, pain free subjects. Intervention: Two protocols (A and B) were evaluated. The protocols were identical except protocol B involved a three second pause. Participants performed a one repetition maximum (1RM) for each protocol on two occasions separated by one week. Main Outcome Measures: Step height (nearest cm) representing 1RM. Results: Both protocols demonstrated excellent reliability, protocol A: ICC = 0.94 (95% CI, 0.87 to 0.97), SEM = 1.47 cm. Protocol B: ICC= 0.94 (95%CI, 0.85 to 0.97).Percent close agreement within 2 cm was 83.3% for protocol A and 79.1% for protocol B. Conclusion: Both protocols demonstrated excellent inter-tester reliability as measures of functional lower limb strength. 2012-10-15T07:11:43.964Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22089 Background. Several studies have investigated criteria for classifying patients with low back pain (LBP) into treatment-based subgroups. A comprehensive algorithm was created to translate these criteria into a clinical decision-making guide. Objective. This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting the criteria for each treatment subgroup and the reliability of the classification. Design. This was a cross-sectional, observational study. Methods. Two hundred fifty patients with acute or subacute LBP were recruited from the United States and Australia to participate in the study. Trained physical therapists performed standardized assessments on all participants. The researchers used these findings to classify participants into subgroups. Thirty-one participants were reassessed to determine interrater reliability of the algorithm decision. Results. Based on individual subgroup criteria, 25.2% (95% confidence interval [CI]=19.8%-30.6%) of the participants did not meet the criteria for any subgroup, 49.6% (95% CI=43.4%-55.8%) of the participants met the criteria for only one subgroup, and 25.2% (95% CI=19.8%-30.6%) of the participants met the criteria for more than one subgroup. The most common combination of subgroups was manipulation + specific exercise (68.4% of the participants who met the criteria for 2 subgroups). Reliability of the algorithm decision was moderate (kappa=0.52, 95% CI=0.27- 0.77, percentage of agreement=67%). Limitations. Due to a relatively small patient sample, reliability estimates are somewhat imprecise. Conclusions. These findings provide important clinical data to guide future research and revisions to the algorithm. The finding that 25% of the participants met the criteria for more than one subgroup has important implications for the sequencing of treatments in the algorithm. Likewise, the finding that 25% of the participants did not meet the criteria for any subgroup provides important information regarding potential revisions to the algorithm's bottom table (which guides unclear classifications). Reliability of the algorithm is sufficient for clinical use. 2012-10-15T07:11:40.823Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22090 Background. Clinical prediction rules (CPRs) for treatment selection in musculoskeletal conditions have become increasingly popular. Purpose. The purposes of this review are: (1) to critically appraise studies evaluating CPRs and (2) to consider the clinical utility and stage of development of each CPR. Data Sources. Pertinent databases were searched up to April 2009. Studies aiming to develop or evaluate a CPR for treatment response in musculoskeletal conditions were included. Two independent reviewers assessed eligibility and extracted methodological data, stage of development, and effect size information. Study Selection/Data Extraction and Synthesis. Eighteen studies, evaluating 15 separate CPRs, were included. Fourteen CPRs were at the derivation stage, and all CPRs had been evaluated using a single-arm trial design, thus it is not possible to determine whether the CPRs identify prognosis (regardless of treatment) or specifically response to treatment. The CPR at the validation stage investigated spinal manipulative therapy (SMT) for low back pain and had been evaluated in 2 separate well-conducted randomized controlled trials. The first trial demonstrated a clinically meaningful effect of the SMT CPR; the additional effect from SMT in patients "positive-on-the-rule" was 15 Oswestry disability units at week 1 and 9 units at week 4. The second trial showed that the CPR did not generalize to a different clinical setting, including a modified treatment. Limitations. Due to differences in methods of reporting and journal publication restraints (eg, word count restrictions), some quality assessment items may have been completed in the included studies, but not captured in this review. Conclusions. There is, at present, little evidence that CPRs can be used to predict effects of treatment for musculoskeletal conditions. The principal problem is that most studies use designs that cannot differentiate between predictors of response to treatment and general predictors of outcome. Only 1 CPR has been evaluated within an RCT designed to predict response to treatment. Validation of these rules is imperative to allow clinical application. 2012-10-15T07:11:33.663Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22091 Many researchers and clinicians believe the effectiveness of existing physical therapy interventions can be improved by targeting the provision of specific interventions at patients who respond best to that treatment. Although this approach has the potential to improve outcomes for some patients, it needs to be implemented carefully because some methods used to identify subgroups can produce biased or misleading results. The aim of this article is to assist readers in assessing the validity and generalizability of studies designed to identify subgroups of responders to physical therapy interventions. The key messages are that subgroups should be identified using high-quality randomized controlled trials, the investigation should be limited to a relatively small number of potential subgroups for which there is a plausible rationale, subgroup effects should be investigated by formally analyzing statistical interactions, and findings of subgroups should be subject to external validation. 2012-10-15T07:11:29.988Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22092 Letter to the editor regarding: Beneciuk JM, Bishop MD, George SZ. Clinical prediction rules for physical therapy interventions: a systematic review. Phys Ther. 2009;89:114–124. 2012-10-15T07:11:21.786Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22094 Commentary. To provide guidance for the design and interpretation of predictive studies of whiplash associated disorders (WAD). Numerous studies have sought to define and explain the clinical course and response to treatment of people with WAD. Design of these studies is often suboptimal, which can lead to biased findings and issues with interpreting the results. Literature review and commentary. Predictive studies can be grouped into four broad categories; studies of symptomatic course, studies that aim to identify factors that predict outcome, studies that aim to isolate variables that are causally responsible for outcome, and studies that aim to identify patients who respond best to particular treatments. Although the specific research question will determine the optimal methods, there are a number of generic features that should be incorporated into design of such studies. The aim of these features is to minimize bias, generate adequately precise prognostic estimates, and ensure generalizability of the findings. This paper provides a summary of important considerations in the design, conduct, and reporting of prediction studies in the field of whiplash. 2012-10-15T07:11:13.777Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22096 Study Design. Exposure discordant twin study. Objective. To investigate the effect of injury on lumbar disc degeneration in monozygotic twins with discordant exposures to recalled previous injury/trauma to the lumbar spine. Summary of Backgrounf Data. Disc degeneration is considered a primary source of low back pain. Despite this, important determinants of disc degeneration other than genotype have not been identified. One possible important determinant of disc degeneration that has undergone limited investigation is previous back injury. Methods. We compared disc degeneration between 37 male monozygotic twin pairs with discordant exposures to recalled previous injury/trauma to the lumbar spine. Data on injury history were obtained through an extensive structured interview. Disc degeneration was assessed using quantitative measures of disc height and disc signal intensity. Results. Disc degeneration did not differ between twins who reported previous back injury and their uninjured cotwins. This finding was consistent for both disc height and disc signal intensity regardless of whether mean scores or greatest difference at any one lumbar level was used in the analysis. Disc height averaged 0.3 mm higher in the injured twin (P = 0.302), and was on average 0.05% higher at the level of the greatest cotwin difference (P = 0.302). There was no evidence that greater period since injury resulted in greater twin differences in disc degeneration. Conclusion. The current study suggests that back injury based on patient report is not an important predictor of future disc degeneration. 2012-10-15T07:10:58.571Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22098 Study Design. Systematic review. Objective. To identify the definitions of recurrence (and related recovery definitions) currently used in the literature. Summary of Background Data. Recurrence of low back pain (LBP) is a common and costly problem and the goal of many treatments is to prevent future recurrences. However, it is unclear whether standardized recurrence definitions are being used in the research literature evaluating the risk of recurrence and the effectiveness of treatments to prevent recurrence. Methods. A literature search was performed of MEDLINE, EMBASE, CINAHL, AMED, and PEDro, and from chosen systematic reviews investigating treatments that could plausibly affect recurrence of LBP. Studies were considered eligible if they investigated recurrence of LBP in a cohort of patients with LBP. Inclusion was assessed by 2 reviewers and definitions of recurrence (and related recovery) were extracted. Results. Fifty-three studies were identified by the review. Only 32% of studies gave explicit definitions of recurrence and only 10% gave a definition for both recurrence and recovery. Less than 10% of studies shared a common definition of recurrence. Conclusion. Because of a lack of an agreed terminology it is very difficult to compare results between studies reporting recurrence rates or evaluating strategies to prevent recurrence. Steps to achieve consensus on recurrence and recovery definitions are required. In the interim, it is recommended that a minimum pain duration of 24 hours with a minimum pain intensity equivalent to the appropriate minimal important change for the chosen scale, be used for defining a recurrence. If disability measures are used, it is also recommended that the appropriate minimal important change be used. For recovery, a minimum duration of 1 month pain-free should be used. 2012-10-15T07:10:44.280Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:22099 Background: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. Methods: We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time. Results: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48-57) at ba seline, 23 (95% CI 21-25) at 6 weeks, 12 (95% CI 9-15) at 26 weeks and 6 (95% CI 3- 10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44-59) at baseline, 33 (95% CI 29-38) at 6 weeks, 26 (95% CI 20-33) at 26 weeks and 23 (95% CI 16-30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. Interpretation: Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain. 2012-10-15T07:10:37.130Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21817 Objective: To review principles of behavioral management of nonspecific low back pain. Methods: Case presentation and review of the literature. Results: Low back pain is a common musculoskeletal disorder characterized by symptoms of pain, ache, and stiffness in the lumbosacral spine. The majority of those with back pain are classified as having nonspecific low back pain. The main features of guideline-based primary care for acute nonspecific back pain are provision of information and assurance about the condition and encouragement to maintain normal daily activity and work, in conjunction with simple analgesia. If recovery is slow or incomplete by 4 to 6 weeks, further assessment is required to check that specific pathology has not been missed and to identify possible psychosocial barriers. For patients with heightened psychosocial features at the subacute or chronic stage, cognitive behavioral treatment is recommended, with more intensive and multidisciplinary programs required for more disabled or complex cases. Cognitive behavioral management involves individualized advice and reassurance, activity upgrading using pacing, rationalization of medication, cognitive restructuring, and management of psychological distress and associated problems such as sleep disturbance. The patient is taught skills to gradually return to normal activity and work, even if symptoms have not fully resolved, and to utilize helpful coping strategies to manage the condition and prevent relapses. Conclusion: Early identification of those who require cognitive behavioral treatment is critical to prevent persistent disabling chronic pain. 2012-10-02T05:20:49.206Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21818 Low back pain (LBP) is a common health condition that is often associated with disability, psychological distress and work loss. Worldwide, billions of dollars are expended each year trying to manage LBP, often with limited success. Recently, some researchers have reported that LBP patients also report sleep disturbance as a result of their LBP. However, as most of this evidence was obtained from highly selected groups of patients or from studies with small samples, high quality data on prevalence of sleep disturbance for patients with LBP are lacking. It is also unclear whether sleep disturbance is more likely to be reported by patients with recent-onset LBP than by patients with persistent LBP. Finally, it is not known whether high pain intensity, the most relevant condition-specific variable, is associated with higher rates of reported sleep disturbance. The present study aimed to determine the prevalence of reported sleep disturbance in patients with LBP. In addition, we aimed to determine whether sleep disturbance was associated with the duration of back pain symptoms and whether pain intensity was associated with reported sleep disturbance. Data from 1,941 patients obtained from 13 studies conducted by the authors or their colleagues between 2001 and 2009 were used to determine the prevalence of sleep disturbance. Logist ic regression analyses explored associations between sleep disturbance, the duration of low back symptoms and pain intensity. The estimated prevalence of sleep disturbance was 58.7% (95% CI 56.4-60.7%). Sleep disturbance was found to be dependent on pain intensity, where each increase by one point on a ten-point visual analogue scale (VAS) was associated with a 10% increase in the likelihood of reporting sleep disturbance. Our findings indicate that sleep disturbance is common in patients with LBP. In addition, we found that the intensity of back pain was only weakly associated with sleep disturbance, suggesting that other factors contribute to sleep problems for LBP patients. 2012-10-02T05:20:45.242Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21820 Objectives: Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD. Methods: One hundred patients with WAD were assessed within 4 weeks of their accident and followed after 3 months; 24-hour average neck pain score, PPTs at the cervical spine and tibialis anterior, demographic factors, and psychological measures were collected. Results: Cervical PPT and neck pain score were significantly, but weakly correlated (r=-0.20 to -0.33). There was no significant correlation between tibialis anterior PPT and pain score at any time point (r=-0.01 to -0.21). Regression analyses indicated a strong influence of generalized psychological distress and fear avoidance on the relationship between PPT and pain report. Discussion: The competing explanations for these findings are that either PPTs provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with WAD. The latter explanation is supported by the confounding effect of psychological factors on pain score. 2012-10-02T05:20:41.658Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21821 The aim of this study was to test the capacity of the Fear Avoidance Model to explain the relationship between pain and disability in patients with whiplash-associated disorders. Using the method of Baron and Kenny [1], we assessed the mediating effect of fear of movement on the cross-sectional and longitudinal relationships between pain and disability. Two hundred and five subjects with neck pain due to a motor vehicle accident provided pain intensity (0 to 10 numerical rating scale), fear of movement (Tampa Scale of Kinesiophobia and Pictorial Fear of Activity Scale) and disability (Neck Disability Index) scores within 4 weeks of their accident, after 3 months, and after 6 months. The analyses were consistent with the Fear Avoidance Model mediating approximately 20% to 40% of the relationship between pain and disability. Contrary to our initial hypothesis, the proportion of the total effect of pain on disability that was mediated by fear of movement did not substantially change as increasing time elapsed after the accident. The proportion mediated was slightly higher when fear of movement was measured by Tampa Scale of Kinesiophobia as compared with Pictorial Fear of Activity Scale. The findings of this study suggest that the Fear Avoidance Model plays a role in explaining a moderate proportion of the relationship between pain and disability after whiplash injury. 2012-10-02T05:20:37.926Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21823 Objectives: To provide a concise overview of the prevalence and risk factors in the development of lumbar vertebral stress injuries in cricketers who are fast bowlers. Methods: A search of Medline, SPORTDiscus and CINAHL databases was conducted to find relevant studies pertaining to: cricket, cricket biomechanics and lumbar vertebral stress injuries. Narrative review methods were used to synthesise the data. Results: The prevalence of lumbar vertebral stress injuries in fast bowlers is high, with figures up to 67% reported. Potential risk factors identified include bowling action, overuse, age, lumbar muscle asymmetry and physical characteristics. While prospective studies provide evidence that bowling action and overuse are risk factors for developing lumbar vertebral stress injuries, to date there is limited evidence, largely from cross-sectional studies, regarding the other factors. Conclusions: This study provides an up-to-date overview of the current literature on prevalence and risk factors for lumbar vertebral stress injuries in fast bowlers. This information may assist clinicians to prevent injury through early identification of risk factors. Recommendations for future research directions include further prospective investigation of the role of age, physical characteristics and muscle asymmetry in the development of such injuries as well as gender specific risk factors. 2012-10-02T05:20:30.317Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21796 Objective. To explore patients' perceptions of recovery from low back pain, about which little is known. Methods. A qualitative study was conducted in which 36 participants, either recovered or unrecovered from low back pain, participated in focus groups. Interviews were audiorecorded and transcribed verbatim. Framework analysis was used to identify emergent themes and domains of recovery. Results. Patients' views of recovery encompassed a range of factors that can be broadly classified into the domains of symptom attenuation, improved capacity to perform a broad scope of self-defined functional activities, and achievement of an acceptable quality of life. An interactive model is proposed to describe the relationships between these domains, cognitive appraisal of the pain experience, and self-rated recovery. Pain attenuation alone was not a reliable indicator of recovery. Conclusion. The construct of recovery for typical back pain patients seeking primary care is more complex than previously recognized and is a highly individual construct, determined by appraisal of the impact of symptoms on daily functional activities as well as quality of life factors. These findings will be valuable for reassessing how to optimize measures of recovery from low back pain by addressing the spectrum of factors patients consider meaningful. 2012-09-28T05:20:55.804Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21795 Questions: Can clinical prediction rules be derived for injured Australian workers with persistent musculoskeletal pain? Are they valid? Design: Longitudinal observational study. Participants: 847 injured workers with persistent musculoskeletal pain undergoing rehabilitation. Outcome measures: At baseline, 12 putative predictors were measured. At 9 weeks, short-term outcomes such as pain (visual analogue scale), activity limitation (Functional Rating Index) and work upgrade (increase in work hours or duties) were measured. At 6 months, long-term work status (working or not working) was measured. Results: Data were obtained from 85% of the participants who were followed up at both 9 weeks (720 of 847) and 6 months (247 of 290). Predictors of outcome included high baseline pain and activity limitation, long duration of previous intervention, not working, non-English speaking background, and the area of pain. Accuracy was highest for clinical prediction rules predicting pain and level of activity limitation at 9 weeks (R 2 = 0.67 and 0.69 respectively) and work status at 6 months (LR- = 0.24). Conclusion: Accurate clinical prediction rules have been derived and validated for injured workers with persistent musculoskeletal pain, predicting activity limitation, pain, and work outcomes following exercise-based rehabilitation. Further research to validate these prediction rules in other populations and to assess the effectiveness of tailoring intervention based on the estimated prognosis would be valuable. 2012-09-28T05:20:53.728Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21797 Introduction: The aim of this study was to compare the clinical management of patients with occupational low back pain (LBP) presenting to secondary care practitioners in Australia with national and international practice guidelines. Methods: A consecutive cohort of 401 patients with LBP following a work injury was assembled at the time of referral to secondary rehabilitation. A comprehensive assessment was performed to collect demographic, clinical and occupational data, which were analysed using descriptive statistics. Clinical and occupational management data were compared with evidence-based guidelines for the management of LBP. Results: This study revealed that in this cohort presenting to secondary care, referral for guideline-based active treatment was delayed until, on average, 10 months post-injury; radiographic investigations had been ordered for almost every patient, including those presenting in the first three months of their injury; the prevalence of co-morbidities was high and there were signs that psychological distress was under-diagnosed. Conclusions: This study reveals a lack of compliance with clinical guidelines for occupational back pain management in Australia. 2012-09-28T05:20:50.464Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21798 2 page(s) 2012-09-28T05:20:49.438Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21801 Neck pain is more prevalent in office workers than in the general community. To date, findings from prospective studies that investigated causal relationships between putative risk factors and the onset of neck pain in this population have been limited by high loss to follow-up. The aim of this research was to prospectively evaluate a range of risk factors for neck pain in office workers, using validated and reliable objective measures as well as attain an estimate of 1-year incidence. We assembled a cohort of 53 office workers without neck pain and measured individual, physical, workplace and psychological factors at baseline. We followed participants for 1 year to measure the incidence of neck pain. We achieved 100% participant follow-up. Cox regression analysis was applied to examine the relationship between the putative risk factors and the cumulative incidence of neck pain. The 1-year incidence proportion of neck pain in Australian office workers was estimated in this study to be 0.49 (95% CI 0.36-0.62). Predictors of neck pain with moderate to large effect sizes were female gender (HR: 3.07; 95% CI: 1.18-7.99) and high psychological stress (HR: 1.64; 95% CI: 0.66-4.07). Protective factors included increased mobility of the cervical spine (HR: 0.44; 95% CI: 0.19-1.05) and frequent exercise (HR: 0.64; 95% CI: 0.27-1.51). These results reveal that neck pain is common in Australian office workers and that there are risk factors that are potentially modifiable. 2012-09-28T05:20:42.086Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21802 The topic assesses the extent to which a combination of pain self-management and antidepressant therapy could help patients manifesting musculoskeletal pain and depression. Depression and pain levels were measured using the Hopkins Symptom Checklist and the Brief Pain Inventory respectively. Patients who were administered pain medication and taught self-management of pain indicated significant improvement in depression and reduced pain and disability symptoms. 2012-09-28T05:20:38.562Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21803 Objectives: To investigate patients' views about two common outcome measures used for back pain: Numerical Rating Scales for pain and the Roland-Morris Disability Questionnaire. Subjects: Thirty-six working adults who had previously sought primary care for back pain and who could speak and read English. Method: Eight focus groups were conducted to explore participants' views about the 11-point Numerical Rating Scales and the 24-item Roland-Morris Disability Questionnaire. Each group was led by a facilitator and an interview topic guide was used. Audio recordings of focus groups were transcribed verbatim. Framework analysis was used to chart participants' views and an interpretive analysis performed to explain the findings. Results: Participants reported that neither the Roland-Morris nor the Numerical Rating Scales captured the complex personal experience of pain or relevant changes in their condition. The time-frame of assessment was identified as particularly problematic and the Roland-Morris did not capture relevant functional domains. Conclusion: This study provides empirical data that working adults with persistent back pain consider these clinical outcome measures largely inadequate. These measures currently used for back pain may contribute to misleading conclusions about treatment efficacy and patient recovery. 2012-09-28T05:20:36.213Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21805 Epidemiological and clinical studies of people with low back pain (LBP) commonly measure the incidence of recovery. The pain numerical rating scale (NRS), scores from 0 to 10, and Roland Morris disability questionnaire (RMDQ), scores from 0 to 24, are two instruments often used to define recovery. On both scales higher scores indicate greater severity. There is no consensus, however, on the cutoff scores on these scales that classify people as having recovered. The aim of this study was to determine which cutoff scores most accurately classify those who had recovered from LBP. Subjects from four clinical studies were categorized as 'recovered' or 'unrecovered' according to their self-rating on a global perceived effect scale. Odd ratios were calculated for scores of 0, 1, 2, 3 and 4 on the NRS and RMDQ to predict perceived recovery. Scores of 0 on the NRS and ≤2 on the RMDQ most accurately identify patients who consider themselves completely recovered. The diagnostic odds ratio (OR) for predicting recovery was 43.9 for a score of 0 on the NRS and 17.6 for a score of ≤2 on the RMDQ. There was no apparent effect of LBP duration or length of follow-up period on the optimal cutoff score. OR for the NRS were generally higher than those for RMDQ. Cutoffs of 0 on the NRS and 2 on the RMDQ most accurately classify subjects as recovered from LBP. Subjects consider pain more than disability when determining their recovery status. 2012-09-28T05:20:30.515Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21807 Recovery is commonly used as an outcome measure in low back pain (LBP) research. There is, however, no accepted definition of what recovery involves or guidance as to how it should be measured. The objective of the study was designed to appraise the LBP literature from the last 10 years to review the methods used to measure recovery. The research design includes electronic searches of Medline, EMBASE, CINAHL, Cochrane database of clinical trials and PEDro from the beginning of 1999 to December 2008. All prospective studies of subjects with non-specific LBP that measured recovery as an outcome were included. The way in which recovery was measured was extracted and categorised according to the domain used to assess recovery. Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs. There were nine single-item recovery rating scales. Eleven studies used a global change scale that includ ed an anchor of 'completely recovered'. Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance. In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently. This lack of consistency makes interpretation and comparison of the LBP literature problematic. It is likely that the failure to use a standardised measure of recovery is due to the absence of an established definition, and highlights the need for such a definition in back pain research. 2012-09-28T05:20:26.192Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21809 Background. Patient satisfaction is an important patient-centered health outcome. To date, no systematic review of the literature on patient satisfaction with musculoskeletal physical therapy care has been conducted. Purpose. The purpose of this study was to systematically and critically review the literature to determine the degree of patient satisfaction with musculoskeletal physical therapy care and factors associated with satisfaction. Data Sources. The databases CINAHL, MEDLINE, and EBM Reviews were searched from inception to September 2009. Study Selection. Articles were included if the design was a clinical trial, observational study, survey, or qualitative study; patient satisfaction was evaluated; and the study related to the delivery of musculoskeletal physical therapy services conducted in an outpatient setting. The search located 3,790 citations. Fifteen studies met the inclusion criteria. Data Extraction. Two authors extracted patient satisfaction data and details of each study. Data Synthesis. A meta-analysis of patient satisfaction data from 7 studies was conducted. The pooled estimate of patient satisfaction was 4.44 (95% confidence interva=4.41- 4.46) on a scale of 1 to 5, where 5 indicates high satisfaction and 1 indicates high dissatisfaction. Additional data were summarized in tables and critically appraised. Limitations. Nonrespondent bias from individual studies may affect the accuracy and representativeness of these data. Conclusion. Patients are highly satisfied with musculoskeletal physical therapy care delivered across outpatient settings in northern Europe, North America, the United Kingdom, and Ireland. The interpersonal attributes of the therapist and the process of care are key determinants of patient satisfaction. An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction. 2012-09-28T05:20:24.330Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21808 3 page(s) 2012-09-28T05:20:21.745Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:20184 Objective: To propose standardized, patient-centered measures of recovery from nonspecific low back pain (LBP) in research, underpinned by an empirically derived concept of recovery and informed by expert opinion. Design: Synthesis of literature reviews and expert panel opinion. Setting: Primary care centers for the management of nonspecific LBP. Participants: Persons with nonspecific LBP. Interventions: Conservative treatments for nonspecific LBP. Main Outcome Measures: Three phases of research were conducted. First, qualitative research that explored patients' perspectives of recovery from nonspecific LBP was reviewed. Second, measures of recovery used in LBP clinical trials during the past decade were investigated in a systematic review. Third, opinion was sought from an expert panel of clinicians and researchers about how to measure recovery from nonspecific LBP, in a workshop at the 10th International Forum for Primary Care Research in Low Back Pain. Results: An empirically derived and patient-centered concept of recovery from nonspecific LBP was developed from the qualitative research phase. The systematic review conducted in the second study phase revealed that researchers have used vastly heterogeneous measures of LBP recovery in clinical trials during the past decade. Finally, the key conclusions of the LBP Forum workshop were (1) that appropriate patient-centered instruments to measure recovery include global measures and patient-specific measures; and (2) that the benefits of implementing the same recovery measures for acute and chronic LBP outweigh the disadvantages of using different measures. Conclusions: The results were synthesized to inform our recommendation that researchers consider adopting 2 instruments as standardized measures of recovery from nonspecific LBP, as an adjunct to the existing core set of LBP outcome measures. These instruments are an 11-point Global Back Recovery Scale, for a simple measure of global recovery, and the Patient-Generated Index of Quality of Life-Back Pain, to evaluate specific relevant dimensions of recovery. This recommendation has majority endorsement by members of the Australian National Health and Medical Research Council Acute Low Back Pain Review Group. 2012-09-28T04:10:07.618Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21667 2 page(s) 2012-09-26T12:52:39.778Z ]]> http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:21416 Objective: To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson's disease. Design: Pilot randomized controlled trial of a six-week intervention followed by a further six weeks follow-up. Setting: Home-based treadmill training with outcome measures taken at a hospital clinic. Participants: Twenty cognitively intact participants with mild Parkinson's disease and gait disturbance. Two participants from the treadmill training group and one from the control group dropped out. Interventions: The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20-40 minutes, four times a week for six weeks. The control group received usual care. Main outcome measures: The feasibility of the intervention was assessed by recording exercise adherence and acceptability, exercise intensity, fatigue, muscle soreness and adverse events. The primary outcome measure of efficacy was walking capacity (6-minute walk test distance). Results: Home-based treadmill training was feasible, acceptable and safe with participants completing 78% (SD 36) of the prescribed training sessions. The treadmill training group did not improve their walking capacity compared to the control group. The treadmill training group showed a greater improvement than the control group in fatigue at post test (P = 0.04) and in quality of life at six weeks follow-up testing (P = 0.02). Conclusions: Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson's disease. Further investigation regarding the effectiveness of home-based treadmill training is warranted. 2012-09-13T12:00:43.598Z ]]>