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Latest & greatest articles for low back pain
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on low back pain or other clinical topics then use Trip today.
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Early Identification and Management of Psychological Risk Factors (``Yellow Flags``) in Patients With LowBackPain: A Reappraisal Originally the term "yellow flags" was used to describe psychosocial prognostic factors for the development of disability following the onset of musculoskeletal pain. The identification of yellow flags through early screening was expected to prompt the application of intervention guidelines to achieve secondary prevention. In recent conceptualizations of yellow (...) flags, it has been suggested that their range of applicability should be confined primarily to psychological risk factors to differentiate them from other risk factors, such as social and environmental variables. This article addresses 2 specific questions that arise from this development: (1) Can yellow flags influence outcomes in people with acute or subacute lowbackpain? and (2) Can yellow flags be targeted in interventions to produce better outcomes? Consistent evidence has been found
The effects of therapeutic climbing in patients with chronic lowbackpain: a randomized controlled study A randomized controlled study investigated the effects of therapeutic climbing in patients with chronic lowbackpain. Before and after 4 weeks of training, physical and mental well-being were measured by two questionnaires (36-Item Short Form Health Survey [SF-36]; Hannover Functional Ability Questionnaire for measuring backpain-related disability [FFbH-R]).Therapeutic climbing has been (...) clinical trial has investigated these psychological effects and it is unclear whether therapeutic climbing is comparable or superior to other forms of exercise.Twenty-eight patients with chronic lowbackpain conducted either a therapeutic climbing or a standard exercise regime. Each program took 4 weeks, including four guided training sessions per week. Before and after the program, patients answered two questionnaires assessing their physical and mental well-being.For the Hannover Functional Ability
Diagnostic Imaging for LowBackPain: Advice for High-Value Health Care From the American College of Physicians. Diagnostic imaging is indicated for patients with lowbackpain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing (...) could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to lowback imaging, as suggested by the American College of Physicians and American Pain Society guideline on lowbackpain, would provide better care to patients, improve outcomes, and reduce costs.
Cost-effectiveness of lumbar supports for home care workers with recurrent lowbackpain: an economic evaluation alongside a randomized-controlled trial Economic evaluation from a societal perspective alongside a 12-months randomized-controlled trial.To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent lowbackpain (LBP) (secondary prevention).LBP is a large medical and economical burden. Evidence on the secondary preventive use of lumbar
The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical lowbackpain Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical lowbackpain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do (...) criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks' duration. Exclusion criteria included "red flag" conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks.improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24
Botulinum toxin injections for low-backpain and sciatica. Adequate relief from low-backpain (LBP) is not always possible. Emerging evidence suggests a role for botulinum neurotoxin (BoNT) injections in treating pain disorders. Proponents of BoNT suggest its properties can decrease muscle spasms, ischemia and inflammatory markers, thereby reducing pain.To determine the effects of botulinum toxin injections in adults with LBP.We searched CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE (...) standardized forms. We performed a qualitative analysis due to lack of data.We excluded evidence from nineteen studies due to non-randomisation, incomplete or unpublished data. We included three randomised trials (N =123 patients). Only one study included patients with chronic non-specific LBP; the other two examined unique subpopulations. Only one of the three trials had a low risk of bias and demonstrated that BoNT injections reduced pain at three and eight weeks and improved function at eight weeks
What is the evidence base for the use of orthopaedic spinal surgery for mechanical lowbackpain or degenerative spondylolisthesis? What is the evidence base for the use of orthopaedic spinal surgery for mechanical lowbackpain or degenerative spondylolisthesis? What is the evidence base for the use of orthopaedic spinal surgery for mechanical lowbackpain or degenerative spondylolisthesis? Abbotts J, Macpherson K Record Status This is a bibliographic record of a published health technology (...) assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Abbotts J, Macpherson K. What is the evidence base for the use of orthopaedic spinal surgery for mechanical lowbackpain or degenerative spondylolisthesis? Glasgow: Healthcare Improvement Scotland. Evidence Note 36. 2011 Authors' conclusions In mechanical lowbackpain which has persisted despite optimal conservative management, there is evidence that spinal fusion can
Comparative effectiveness of exercise, acupuncture, and spinal manipulation for lowbackpain Comparative effectiveness of exercise, acupuncture, and spinal manipulation for lowbackpain Comparative effectiveness of exercise, acupuncture, and spinal manipulation for lowbackpain Standaert CJ, Friedly J, Erwin MW, Lee MJ, Rechtine G, Henrikson NB, Norvell DC CRD summary This review concluded that structured exercise and spinal manipulation appeared to offer equivalent benefits for adults (...) with chronic lowbackpain. This conclusion does not reflect the limited and contradictory evidence presented and is unlikely to be reliable. Authors' objectives To determine the relative effectiveness of structured exercise, spinal manipulation and acupuncture for the treatment of chronic lowbackpain. Searching The authors searched MEDLINE and The Cochrane Library to December 2010. Search terms were not reported. The search was limited to studies published in English. The reference lists of key articles
Comparison of stratified primary care management for lowbackpain with current best practice (STarT Back): a randomised controlled trial. Backpain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control (...) ).1573 adults (aged ≥18 years) with backpain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating
2011LancetControlled trial quality: predicted high
Surgery with disc prosthesis versus rehabilitation in patients with lowbackpain and degenerative disc: two year follow-up of randomised study. To compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic lowback pain.A prospective randomised multicentre study.Five university hospitals in Norway.173 patients with a history of lowbackpain for at least one year, Oswestry disability index of at least 30 points, and degenerative changes in one (...) or two lower lumbar spine levels (86 patients randomised to surgery). Patients were treated from April 2004 to September 2007.Surgery with disc prosthesis or outpatient multidisciplinary rehabilitation for 12-15 days.The primary outcome measure was the score on the Oswestry disability index after two years. Secondary outcome measures were lowbackpain, satisfaction with life (SF-36 and EuroQol EQ-5D), Hopkins symptom check list (HSCL-25), fear avoidance beliefs (FABQ), self efficacy beliefs for pain
Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic lowbackpain: the Japan lowbackpain exercise therapy study Prospective, randomized, controlled trial.To investigate the effectiveness of home-based exercise on pain, dysfunction, and quality of life (QOL) in Japanese individuals with chronic lowbackpain (CLBP).Exercise therapy is a widely used treatment for CLBP in many countries. The studies on its effectiveness have been (...) group was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and the exercise group performed trunk muscle strengthening and stretching exercises. The primary outcome measures were pain intensity (visual analogue scale) and dysfunction level (Japan Lowbackpain Evaluation Questionnaire [JLEQ] and Roland-Morris Disability Questionnaire [RDQ]) over 12 months. The secondary outcome measure was FFD (Finger-floor distance). Statistical analysis was performed using Wilcoxon signed-ranks and Mann
The impact of placebo, psychopathology, and expectations on the response to acupuncture needling in patients with chronic lowbackpain Comorbid psychopathology is a variable not explored in the acupuncture RCTs that could explain whether subgroups of patients with chronic lowbackpain have differential responses to acupuncture or placebo treatments. This was a controlled, blinded, crossover trial of verum acupuncture and validated sham acupuncture in 40 CLBP patients, with a Low or High level (...) acupuncture and placebo responses, not otherwise seen in the RCTs for lowbackpain. Using a blinded, crossover design, we report that it does not predict outcome, nor does it seem to modify the effect of expectancy (a known predictor) on acupuncture response.Copyright (c) 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
WITHDRAWN: Bed rest for acute low-backpain and sciatica. Low-backpain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain.To assess the effects of advice to rest in bed for patients with acute LBP or sciatica.We searched the Cochrane Back Group Specialized Registry, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to March 2003, reference lists of relevant articles, and contacted (...) authors of relevant articles.Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, where the effectiveness of advice to rest in bed was evaluated. The main outcomes of interest were pain, functional status, recovery and return to work.Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing
A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic lowbackpain A preliminary report of clinical study revealed that chronic discogenic lowbackpain could be treated by intradiscal methylene blue (MB) injection. We investigated the effect of intradiscal MB injection for the treatment of chronic discogenic lowbackpain in a randomized placebo-controlled trial. We recruited 136 patients who were found potentially eligible after (...) clinical examination and 72 became eligible after discography. All the patients had discogenic lowbackpain lasting longer than 6 months, with no comorbidity. Thirty-six were allocated to intradiscal MB injection and 36 to placebo treatment. The principal criteria to judge the effectiveness included alleviation of pain, assessed by a 101-point numerical rating scale (NRS-101), and improvement in disability, as assessed with the Oswestry Disability Index (ODI) for functional recovery. At the 24-month
American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with lowbackpain. Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here
Will this patient develop persistent disabling lowbackpain? Lowbackpain is extremely common. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management.To systematically review the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent disabling lowback pain.Electronic searches of MEDLINE (1966-January 2010) and EMBASE (1974 (...) -February 2010) and review of the bibliographies of retrieved articles.Prospective studies of patients with fewer than 8 weeks of lowbackpain from which likelihood ratios (LRs) were calculated for prediction of persistent disabling lowbackpain for findings attainable during the clinical evaluation.Two authors independently assessed studies and extracted data to estimate LRs.A total of 20 studies evaluating 10,842 patients were identified. Presence of nonorganic signs (median [range] LR, 3.0 [1.7-4.6
Motor control exercise for chronic lowbackpain: a randomized placebo-controlled trial The evidence that exercise intervention is effective for treatment of chronic lowbackpain comes from trials that are not placebo-controlled.The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic lowback pain.This was a randomized, placebo-controlled trial.The study was conducted in an outpatient physical therapy department in Australia. Patients (...) The participants were 154 patients with chronic lowbackpain of more than 12 weeks' duration.Twelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the lowback region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.Primary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery
Physical examination for lumbar radiculopathy due to disc herniation in patients with low-backpain. Low-backpain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation (...) and select patients for further imaging and possible surgery.(1) To assess the performance of tests performed during physical examination (alone or in combination) to identify radiculopathy due to lower lumbar disc herniation in patients with low-backpain and sciatica;(2) To assess the influence of sources of heterogeneity on diagnostic performance.We searched electronic databases for primary studies: PubMed (includes MEDLINE), EMBASE, and CINAHL, and (systematic) reviews: PubMed and Medion (all from