Articles: low-back-pain.
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Musculoskelet Sci Pract · Apr 2019
Patients' experiences of how symptoms are explained and influences on back-related health after pre-surgery physiotherapy: A qualitative study.
Since the pre-surgery phase is a new setting for physiotherapy, exploring patients' experiences might contribute to new insights for future development of care in patients with degenerative lumbar spine disorders. ⋯ Improvements in back-related health in all the biopsychosocial dimensions emerged. Even those who expressed no symptom improvements, felt better performing exercises than being inactive, and exercises improved their frame of mind, a useful experience in possible low back pain recurrences. Pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Despite pre-surgery physiotherapy, back-related symptoms were mainly described in line with a biomedical explanatory model. Those using broader explanations were confident that physiotherapy and self-management could influence their symptoms. Suggesting more emphasis on explanatory models suitable for surgery, pre- and post-surgery physiotherapy and self-management in the professionals' dialogue with patients.
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We aimed to describe characteristics, etiology and health care use in children with low back pain (LBP) presenting to pediatric emergency department (ED) and to develop an algorithm to design a diagnostic approach. ⋯ Our study identified significative high-risk factors (red flags) associated with serious outcomes (SPC group) compared to the non-SPC group, thereby ensuring specific treatment. We developed an algorithm based on previous literature and the findings of our study, which will need to be validated by future prospective research.
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Comparative Study
Sociodemographic Variation in the Use of Conservative Therapy Before MRI of the Lumbar Spine for Low Back Pain in the Era of Public Reporting.
To evaluate the relationship between use of MRI of the lumbar spine for low back pain without prior conservative therapy and sociodemographic factors after the implementation of public reporting for Medicare's Hospital Outpatient Imaging Efficiency Measure for MRI Lumbar Spine for Low Back Pain (OP-8) metric. ⋯ Variations in use of conservative therapy according to factors other than clinically relevant factors, such as health status, are worrying. Further strategies are needed to improve appropriateness and equity in the provision of diagnostic imaging.
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Radiologic findings in combination with clinical symptoms are critical in the diagnosis and evaluation of the severity of lumbar spinal stenosis (LSS) as well as the need for surgical treatment. Dynamic radiographs, computerized tomography (CT), and magnetic resonance imaging (MRI) each provide different but interrelated pieces of information in the patient with lumbar spinal stenosis. Making a treatment decision based only on one of the radiographic studies may negatively affect the treatment outcome. ⋯ With the development of less invasive procedures, lumbar spinal stenosis is being evaluated and treated not only by spine surgeons but also by interventional pain and neuroradiology physicians that may not be totally familiar with the complexity of the pathology and neuro-radiology of LSS. Each radiologic study provides different information. The goal of this report is to provide a framework for the use of studies such as plain X-rays, dynamic films, MRI, and CT scans as well as the importance of different views, and how to use them in evaluating the abnormal radiologic anatomy seen with LSS and in selecting the most appropriate procedure.