Articles: low-back-pain.
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The treatment for patients with low back pain varies considerably. The Dutch Physiotherapy Association issued an evidence-based physiotherapy guideline for non-specific low back pain. To establish changes in daily practice an active implementation strategy was developed. We evaluated the cost-effectiveness of this implementation strategy. ⋯ The active implementation strategy appears not to be cost effective as compared to the standard strategy.
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Randomized Controlled Trial Multicenter Study Comparative Study
Psychometric properties of the functional rating index in patients with low back pain.
The purpose of this study was to validate the psychometric properties of the functional rating index (FRI), establish the instrument's minimum clinically important difference (MCID), and compare its psychometric properties with the Oswestry questionnaire. ⋯ The FRI is less reliable than the Oswestry but appears to have comparable validity and responsiveness. Before the FRI can be recommended for widespread use in patients with neck and low back pain, it should be further tested in patients with neck pain.
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Europa medicophysica · Dec 2005
Comparative StudyCritical comparison of nine different self-administered questionnaires for the evaluation of disability caused by low back pain.
The aim of this study was to critically compare 9 self-administered questionnaires designed to evaluate disability caused by back pain. ⋯ On the basis of psychometric evaluations as well as feasibility considerations, the authors suggest using either the Roland-Morris or Oswestry questionnaire as the best assessment of the level of disability caused by back pain.
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Chronic lumbar radicular pain is the most common neuropathic pain syndrome. This was a double-blind, randomized, 2-period crossover trial of topiramate (50 to 400 mg) and diphenhydramine (6.25 to 50 mg) as active placebo to assess the efficacy of topiramate. Each period consisted of a 4-week escalation, a 2-week maintenance at the highest tolerated dose, and a 2-week taper. Main outcome was the mean daily leg pain score on a 0 to 10 scale during the maintenance period. Global pain relief was assessed on a 6-level category scale. In the 29 of 42 patients who completed the study, topiramate reduced leg pain by a mean of 19% (P = .065). Global pain relief scores were significantly better on topiramate (P < .005). Mean doses were topiramate 200 mg and diphenhydramine 40 mg. We concluded that topiramate treatment might reduce chronic sciatica in some patients but causes frequent side effects and dropouts. We would not recommend topiramate unless studies of alternative regimens showed a better therapeutic ratio. ⋯ The anticonvulsant topiramate might reduce chronic lumbar nerve root pain through effects such as blockade of voltage-gated sodium channels and AMPA/kainite glutamate receptors, modulation of voltage-gated calcium channels, and gamma-aminobutyric acid agonist-like effects.
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Previous research supports the fear-avoidance model in explaining chronic low back pain (LBP) disability. The aims of the present study were to determine: (1) whether fear-avoidance model variables are associated already during acute stages of LBP and (2) whether (increases in) pain-related fear are associated with other patient characteristics routinely assessed by the General Practitioner (GP). General practice patients consulting because of a new episode of LBP completed questionnaires on pain-related fear, avoidance, pain and disability. ⋯ Pain-related fear was slightly higher in patients reporting low job satisfaction and in those taking bedrest. These results suggest that the fear-avoidance model as it was developed and tested in chronic LBP, might not entirely apply to acute LBP patients. Future research should focus on the transition from acute to chronic LBP and the shifts that take place between fear-avoidance model associations.