Musculoskeletal science & practice
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Musculoskelet Sci Pract · Feb 2017
Quiet dissent: The attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance - A qualitative study.
Clinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. ⋯ Participants possess a strong professional identity fostered by their education. This bestows autonomy, authority and distinctness upon them. The central theme was modelled as a lens through which participants viewed research: the evidence pyramid appears inverted, explaining why participants value expert opinion above all other evidence. Guidelines and research are perceived to threaten professional identity. In contractual situations that oblige practitioners to follow guidelines management, perhaps reflecting a pragmatic response to health-care market forces, clinical practice is modified. Developing further understanding of osteopaths' attitudes and beliefs and behaviour in respect of evidence-based guidance in education is important to enhance the quality of clinical practice in osteopathy.
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Musculoskelet Sci Pract · Feb 2017
'I need to do another course' - Italian physiotherapists' knowledge and beliefs when assessing psychosocial factors in patients presenting with chronic low back pain.
Psychosocial factors play an important role in the development and subsequent recovery of individuals suffering from chronic low back pain (CLBP). The study explored physiotherapists' personal beliefs and knowledge about the biopsychosocial model and the different ways they assess and manage psychosocial factors in patients presenting with CLBP. ⋯ Physiotherapists showed a basic knowledge of the biopsychosocial model and partially recognised social, emotional, cognitive and psychological factors in chronic low back pain patients, and their contribution in the individual patient's pain and disability. Physiotherapists highlighted the presence of barriers in the evaluation and treatment of people with CLBP, and some participants displayed a lack of skills to overcome these barriers. Physiotherapists perceived limited education and training to successfully address psychosocial factors in the management of patients with chronic low back pain, indicating the need to incorporate the biopsychosocial model in the daily practice and improve the training and education of the psychosocial assessment and management.
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Musculoskelet Sci Pract · Feb 2017
Comparative StudyDistinguishing between nociceptive and neuropathic components in chronic low back pain using behavioural evaluation and sensory examination.
Diagnosis of chronic low back pain (CLBP) is traditionally predicated on identifying underlying pathological or anatomical causes, with treatment outcomes modest at best. Alternately, it is suggested that identification of underlying pain mechanisms with treatments targeted towards specific pain phenotypes may yield more success. Differentiation between nociceptive and neuropathic components of CLBP is problematic; evidence suggests that clinicians fail to identify a significant neuropathic component in many CLBP patients. The painDETECT questionnaire (PDQ) was specifically developed to identify occult but significant neuropathic components in individuals thought to have predominantly nociceptive pain. ⋯ We have demonstrated distinct clinical profiles for CLBP patient sub-groups classified by PDQ. Our results give diagnostic confidence in using the PDQ to characterise two distinct pain phenotypes in a heterogeneous CLBP population.
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Musculoskelet Sci Pract · Feb 2017
Comparative StudyCervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects.
Temporomandibular Disorders (TMD) refer to several common clinical disorders which involve the masticatory muscles, the temporomandibular joint (TMJ) and the adjacent structures. Although neck signs and symptoms are found with higher prevalence in TMD patients compared to the overall population, whether limitation of cervical mobility is an additional positive finding in this cohort is still an open question. ⋯ The results point out a potential involvement of the upper cervical joints (c1-c2) in women with myogenic TMD.