Articles: low-back-pain.
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Low back pain is the greatest contributor to the global burden of disease and can result in work disability. Previous literature has examined the influence of personal factors, the healthcare system, workplace, and income support systems on work disability due to low back pain. Income support systems may also influence healthcare and the workplace, leading to an impact on healthcare quality and functional capacity. However, there has been little insight as to how or in what contexts this influence occurs. This realist review aims to provide an explanation of how and in what contexts income support systems impact the healthcare quality and functional capacity of people who are unable to work due to low back pain. ⋯ Income support and healthcare systems are highly complex and fluid programmes. At the intersection between these systems are those with low back pain. By using realist review methods, we will provide explanatory rather than judgemental findings. The resulting multi-dimensional and contextual understanding of the impact of income support systems on important low back pain outcomes will provide valuable insight for future income support and healthcare policy development.
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The STarT Back Screening Tool (SBST) categorizes risk of future disability in patients with low back pain (LBP). Previous studies evaluating the use of SBST in physical therapy (PT) populations do not reflect the ethnic and socioeconomic diversity occurring in clinical practice and lack statistical power to evaluate factors associated with outcomes within each SBST risk category. ⋯ The SBST tool predicts outcomes of PT in a cohort of patients receiving outpatient PT for LBP. The odds of improvement varied according to baseline disability and SBST risk status. Race, insurance type, and history of previous PT influenced prediction independent of SBST risk status. Incorporating these variables and the interaction between SBST and baseline disability in outcome models has the potential to refine prediction of outcomes after PT.
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Multicenter Study Observational Study
Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain.
The goal of this study was to refine clinical MRS to optimize performance and then determine whether MRS-derived biomarkers reliably identify painful discs, quantify degeneration severity, and forecast surgical outcomes for chronic low back pain (CLBP) patients. ⋯ MRS correlates with PD and may support improved surgical outcomes for CLBP patients. Noninvasive MRS is a potentially valuable approach to clarifying pain mechanisms and designing CLBP therapies that are customized to the patient. These slides can be retrieved under Electronic Supplementary Material.
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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.