BACKGROUND CONTEXT: Robust evidence links maladaptive (negative) responses to low back pain (LBP)... more BACKGROUND CONTEXT: Robust evidence links maladaptive (negative) responses to low back pain (LBP) with the development of persistent LBP and disability. Emerging evidence demonstrates the importance of adaptive (positive) responses in determining good outcomes in patients with LBP. However, the relative importance of negative and positive beliefs is unclear. PURPOSE: The aim of this study was to assess the predictive validity of negative and positive pain beliefs in patients with LBP. STUDY DESIGN/SETTING: Retrospective cross-sectional and longitudinal analyses of patient data at baseline and during treatment from an outpatient physical therapy registry. PATIENT SAMPLE: All patients with LBP undergoing baseline and during treatment assessment between January 2012 and July 2016 were included. OUTCOME MEASURES: The outcomes were the baseline Oswestry Disability Index (ODI) score (range: 0-100, cross-sectional analysis) and the meaningful clinical important difference (MCID) for the ODI (>30% decrease from baseline, longitudinal analysis). METHODS: Demographic variables were also collected. Negative beliefs were assessed with the distress subscale of the STarT Back Screening Tool (SBST, five items, range: 0 to 5 points). Positive beliefs were assessed using two questions: positive outcome expectations "I believe that my condition is going to get better" and self-efficacy "I am confident I can cope with my condition" (10 point Likert scale: strongly disagree to strongly agree). The prediction models were fitted to the outcome. Predictor variables were selected using the AIC. RESULTS: Overall, 1733 patients (57% women, median age 53 years) were included in the cross-sectional analysis; 665 (38%) completed a follow-up assessment and were included in the longitudinal analysis. SBST scores were associated with higher disability scores at baseline (Beta 2.36, 95% CI 1.86-2.86) but did not predict a MCID. The association between baseline positive beliefs questions and baseline ODI was minimal but both positive beliefs questions were associated with outcome in longitudinal analysis. Only the self-efficacy question predicted a MCID at follow up (OR 1.095, 95% CI 1.01-1.18 per one point increase). Results from the multiple analysis on treatment outcome (MCID ODI >30%) using AIC selection of variables: Pos
Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a... more Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders. Methods Recommendations were developed through two Delphi methods with international and multi-professional panels. Results In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-ba...
Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 coun... more Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. Methods On September 17–18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. Results In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitatio...
Background In the midst of the coronavirus pandemic, the International Chiropractors Association ... more Background In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory aut...
Discussion. Subjects who received PiPT were more likely to report learning PiPT concepts than tho... more Discussion. Subjects who received PiPT were more likely to report learning PiPT concepts than those who did not. is indicates that the transfer of PiPT knowledge from the PT to the patient was successful. is paper is limited; in that, subjects included only ADSM, and the generalizability of the findings is unknown.
This study assesses the feasibility of training U.S. Navy Physical Therapy staff members (PT staf... more This study assesses the feasibility of training U.S. Navy Physical Therapy staff members (PT staff) aboard a U.S. Navy Aircraft Carrier in psychologically informed physical therapy (PiPT). Training was conducted prior to deployment over 3 d and included background information, skills development, and application in the form of role playing and case studies. During deployment, nine phone conferences were conducted to reinforce training, assess skills, and discuss implementation. PiPT knowledge was assessed by a written test and role-playing skills. The adoption of the training was determined by analysis of clinical notes and verbal responses of the PT staff during phone conferences. There were two PT staff members on the carrier. Both received passing knowledge test scores and demonstrated role-playing proficiency. Clinical note assessment and discussions during conference calls also indicated successful implementation. The feasibility of training Navy PT staff to implement PiPT was demonstrated. PT staff successfully translated training into practice. This is significant, since PiPT has the potential to limit attrition due to musculoskeletal injuries in Navy personnel. Factors believed to be associated with the success of the training include adoption of the PiPT model by PT staff and reinforcement of changes in clinical practice during deployment.
Background Context: Negative beliefs are known to influence treatment outcome in patients with sp... more Background Context: Negative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. Purpose: Assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. Study Design/Setting: Retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). Patient Sample: Patients with SP with a baseline assessment and follow-up assessment. Outcome Measure: Perceived disability (oswestry disability index (ODI) or neck disability index (NDI). A clinical meaningful change (MCID) was defined as decrease in ODI / NDI of ≥30%. Methods: We used the Akaike Information Criterion (AIC) from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. This study was not funded and the authors have no conflict of interest to declare. Results: In the cross-sectional analysis 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. SBST-distress was positively associated with perceived disability in both LBP and NP; LBP (Beta 2.31, 95% CI 1.75-2.88) and NP (Beta 2.57, 95% CI 1.47-3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (Beta 0.50, 0.29-0.72) but not for NP while less positive expectations was associated with more perceived disability in Page 2 of 37 3 NP (Beta 0.57, 0.02-1.12) but not in LBP. In the longitudinal analysis LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience a MCID in perceived disability (OR per point increase 0.89, 95% CI 0.83-0.96) and there was a similar trend in NP (0.90, 0.79-1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 1.01-1.19). In NP, self-efficacy was not included in the final model. Conclusions: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability however, in this study only positive beliefs were associated with treatment outcome.
ABSTRACT The purpose of this chapter is to promote a model to prevent chronicity and disability f... more ABSTRACT The purpose of this chapter is to promote a model to prevent chronicity and disability from non-specific low back pain (NSLBP). Delayed recovery is defined in this chapter as the period between 4 and 8 weeks after onset of NSLBP during which a patient has not yet returned to work. The recognition of predictors associated with delayed recovery at onset of the problem helps health care providers in their treatment plan. An algorithm can be useful for health care providers and employers in guiding the employee back to work. A multidisciplinary return to work programme is an essential part of the algorithm.
Scandinavian journal of medicine & science in sports, 1996
Health care providers often prescribe exercises as treatment for nonspecific low back pain. Howev... more Health care providers often prescribe exercises as treatment for nonspecific low back pain. However, the effectiveness of this treatment is poorly documented in the literature. While the evidence suggests that exercise in general is beneficial, there is a lack of knowledge about the types, frequency and duration of exercises that should be prescribed and at what stage of injury they are most helpful. In addition, few studies have dealt with exercise treatment alone rather than in combination with other treatments, making it hard to decipher the unique contribution of exercise. Inadequate study designs also make conclusions difficult. Conversely, the literature clearly shows that inactivity has detrimental effects (i.e. delayed return to normal activity, and negative physiological and psychological effects) for low back pain patients.
The process of rehabilitation, accommodation and return-to-work entails an assessment of a patien... more The process of rehabilitation, accommodation and return-to-work entails an assessment of a patient's ability to engage in work activities, an analysis of job demands and the matching of these elements to determine whether the individual and the job are compatible. The process involves numerous stakeholders, whereby ergonomists may analyze the demands of the job, clinicians may assess the individual's abilities and the matching is conducted as a joint effort. The success of the joint effort depends on the communication between several professional disciplines. To improve the communication we need tools that advance the decision making. The process of ‘ergonomics for one’ requires tools and methodologies of sufficient resolution to address the individual's needs. From the ergo-nomist's perspective, do we have tools that support clinical decision making regarding the ability of an individual patient to return to work? Similarly, does the ergonomist have tools to assist in adapting the job to the individual's abilities? The session is aimed for practitioners involved in industrial ergonomics as well as rehabilitation. The panel will examine several attempts to address these questions conceptually or practically, limiting the scope of the discussion to rehabilitation and accommodations of physical impairments. The goal of the session is to identify areas and directions that need further research and development.
BACKGROUND CONTEXT: Musculoskeletal disorders of the spine in the US military account for the sin... more BACKGROUND CONTEXT: Musculoskeletal disorders of the spine in the US military account for the single largest proportion of the absence of sickness causes leading to early termination. We explored if selected psychological and physical factors were associated with poor outcome after episodes of low back pain (LBP). PURPOSE: To identify clinical, demographic, and psychological factors predictive of work duty status after a complaint of LBP. STUDY DESIGN: A prospective clinical cohort of US Navy personnel treated for LBP. PATIENT SAMPLE: Eligible cases were active duty US Navy or Marine Corps personnel presenting to an emergency clinic or primary care clinic with a complaint of LBP, where the index episode of LBP was no more than 12 weeks duration before enrollment. OUTCOME MEASURES: The subject's work status (full duty, light duty, sick in quarters [SIQ], limited duty, or medically released to full duty) was abstracted from the subject's electronic medical record at approximately 4 weeks and then again 12 weeks after study enrollment. Work status in this study population is assigned by a Navy health-care provider at the time of a clinical visit and based on the health-care provider's determination of medical fitness for duty. This study collapsed work status into two groups, ''full duty'' (consisting of ''full duty'' and ''medically released to full duty'') and ''not at full duty'' (consisting of ''light duty,'' ''SIQ,'' and ''limited duty''). METHODS: Volunteers completed a baseline questionnaire consisting of recommended wellvalidated measures, including attitudes and beliefs about LBP and work (Fear-Avoidance Beliefs Questionnaire [FABQ] and the Tampa Scale of Kinesiophobia), distress (the Pain Catastrophizing Scale), clinical depression (The Center for Epidemiologic Studies Depression scale), a numeric pain intensity scale, self-perceived disability (Oswestry Disability Index), and general health status (12-Item Short Form Health Survey). Navy health-care providers conducted a back pain-specific medical evaluation. Associations are expressed as multivariate-adjusted prevalence ratios (PRs) estimated using Poisson regression. RESULTS: Two hundred fifty-three participants were enrolled. Work status outcome was collected for 239 participants. Predictors of ''not at full duty'' at 4 weeks after enrollment included having back pain for 4 weeks or less before study enrollment (PR, 2.69; 95% CI, 1.21-5.97) and increased FDA device/drug status: Not applicable.
The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back p... more The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back pain (NSLBP) at a major U.S. Navy base. In this single blinded randomized clinical trial, subjects were drawn from a larger, prospective cohort of active duty service members seeking care for NSLBP pain at a U.S. Navy Branch Medical Clinic. Outcome measures included return to work, self-reported pain, function, and psychological distress. Subjects were randomly allocated to one of two study arms: a multidisciplinary reconditioning program or the current standard of care for low back pain. The intervention lasted 4 weeks with a 12-week follow-up. Thirty-three subjects were enrolled. Subjects allocated to multidisciplinary care reported significantly lower perceived disability (p = 0.014) and less pain than those allocated to usual care at the end of the intervention period. All subjects returned to their usual duty following the conclusion of the intervention. The implementation of the intervention program was successful. Subjects in the multidisciplinary program showed a clinically significant improvement in the perception of disability compared to the usual care group. This is an important finding since perception of disability is associated with longterm functional outcome.
... the physician completed the standardized medical forms. The initially low compliance rate [13... more ... the physician completed the standardized medical forms. The initially low compliance rate [13% in January 1994] rose to 98% by the end of the instruction period [January 1995] (27). Procedures at First and Subsequent Visits ...
A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidis... more A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidisciplinary rehabilitation program. To identify factors that predict work retention 24 months after treatment in patients with nonspecific LBP. There is evidence that select physical, psychologic, and psychosocial factors are related to positive outcome for work-related nonspecific LBP. However, there is very little information related to work retention following an episode of nonspecific LBP. This is an exploratory study to identify select physical and psychosocial factors related to work retention. Patients who returned to work after treatment (n = 67) were followed for 2 years. Physical baseline measures included tests of flexibility, strength, and functional capacity. Psychosocial baseline measures were The Symptoms Checklist 90-R, The Pain Beliefs and Perceptions Inventory, The Oswestry Scale of perceived disability, The Work Stress Inventory, and The Quality of Life Scale. All physical parameters, perceived disability, and quality of life were tested before and after treatment. The dependent variable, work retention, was defined as the number of days that the subject worked during the 2-year follow-up period. Survival analysis was used to establish the predictive model. The average time out of work before treatment was 9 months (standard deviation 12.8) for 67 subjects (mean age 40 years [standard deviation 9.6]), including 18 females and 49 males. There were 18 participants (25%) that had interruption of work retention at follow-up. Average work retention was 362 days (range 47-682). Variables that reached a P value of <0.10 in the bivariate analysis were included in the multivariate analysis. They were trunk flexion (hazard ratio [HR = 2.4], 95% confidence interval [CI] 1.24-4.38; P = 0.01), trunk extension (HR = 2.1, 95% CI 1.02-4.16; P = 0.04), the somatization scale from the Symptom Checklist 90 revised (HR = 2.0, 95% CI 1.03-4.05; P = 0.04), and the obsessive-compulsiveness scale from the Symptom Checklist 90 revised (HR = 0.4, 95% CI 0.12-1.15; P = 0.09). Results showed that post-test trunk flexion, somatization, and obsessive compulsiveness predicted work retention (final trunk flexion HR = 2.5 [95% CI 1.26-4.79; P = 0.01], somatization scale HR = 2.5 [95% CI 1.25-4.93; P = 0.01], and obsessive compulsion HR = 0.2 [95% CI 0.07-0.77; P = 0.02]). Psychosocial and physical factors are associated with work retention for patients with nonspecific LBP. The predictive value of certain constructs may vary with the time when they are assessed and how outcome is operationalized. Further studies are needed to confirm these findings.
Introduction This brief report describes the number and nature of cases of musculoskeletal pain a... more Introduction This brief report describes the number and nature of cases of musculoskeletal pain and injury among sailors and marines presenting to the ship’s physical therapist during recent, respective deployments of two U.S. Navy aircraft carriers. Materials and Methods The case definition for this study was cases of work-limiting medical complaints involving the musculoskeletal system presenting, or referred, to the ship’s physical therapy services for evaluation and treatment. The population for this study was drawn from ship’s company from two Nimitz class carriers on their respective deployments. Potential subjects were recruited at their index visit for their complaint. Participants completed a survey of their symptoms while at the ship’s medical department. Data for analysis consist of counts of cases, body part affected, self-reported mechanism of injury, age, and gender of the subject. Data were analyzed by generating descriptive tables. Results One hundred ninety-seven ca...
BACKGROUND CONTEXT: Robust evidence links maladaptive (negative) responses to low back pain (LBP)... more BACKGROUND CONTEXT: Robust evidence links maladaptive (negative) responses to low back pain (LBP) with the development of persistent LBP and disability. Emerging evidence demonstrates the importance of adaptive (positive) responses in determining good outcomes in patients with LBP. However, the relative importance of negative and positive beliefs is unclear. PURPOSE: The aim of this study was to assess the predictive validity of negative and positive pain beliefs in patients with LBP. STUDY DESIGN/SETTING: Retrospective cross-sectional and longitudinal analyses of patient data at baseline and during treatment from an outpatient physical therapy registry. PATIENT SAMPLE: All patients with LBP undergoing baseline and during treatment assessment between January 2012 and July 2016 were included. OUTCOME MEASURES: The outcomes were the baseline Oswestry Disability Index (ODI) score (range: 0-100, cross-sectional analysis) and the meaningful clinical important difference (MCID) for the ODI (>30% decrease from baseline, longitudinal analysis). METHODS: Demographic variables were also collected. Negative beliefs were assessed with the distress subscale of the STarT Back Screening Tool (SBST, five items, range: 0 to 5 points). Positive beliefs were assessed using two questions: positive outcome expectations "I believe that my condition is going to get better" and self-efficacy "I am confident I can cope with my condition" (10 point Likert scale: strongly disagree to strongly agree). The prediction models were fitted to the outcome. Predictor variables were selected using the AIC. RESULTS: Overall, 1733 patients (57% women, median age 53 years) were included in the cross-sectional analysis; 665 (38%) completed a follow-up assessment and were included in the longitudinal analysis. SBST scores were associated with higher disability scores at baseline (Beta 2.36, 95% CI 1.86-2.86) but did not predict a MCID. The association between baseline positive beliefs questions and baseline ODI was minimal but both positive beliefs questions were associated with outcome in longitudinal analysis. Only the self-efficacy question predicted a MCID at follow up (OR 1.095, 95% CI 1.01-1.18 per one point increase). Results from the multiple analysis on treatment outcome (MCID ODI >30%) using AIC selection of variables: Pos
Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a... more Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders. Methods Recommendations were developed through two Delphi methods with international and multi-professional panels. Results In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-ba...
Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 coun... more Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. Methods On September 17–18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. Results In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitatio...
Background In the midst of the coronavirus pandemic, the International Chiropractors Association ... more Background In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory aut...
Discussion. Subjects who received PiPT were more likely to report learning PiPT concepts than tho... more Discussion. Subjects who received PiPT were more likely to report learning PiPT concepts than those who did not. is indicates that the transfer of PiPT knowledge from the PT to the patient was successful. is paper is limited; in that, subjects included only ADSM, and the generalizability of the findings is unknown.
This study assesses the feasibility of training U.S. Navy Physical Therapy staff members (PT staf... more This study assesses the feasibility of training U.S. Navy Physical Therapy staff members (PT staff) aboard a U.S. Navy Aircraft Carrier in psychologically informed physical therapy (PiPT). Training was conducted prior to deployment over 3 d and included background information, skills development, and application in the form of role playing and case studies. During deployment, nine phone conferences were conducted to reinforce training, assess skills, and discuss implementation. PiPT knowledge was assessed by a written test and role-playing skills. The adoption of the training was determined by analysis of clinical notes and verbal responses of the PT staff during phone conferences. There were two PT staff members on the carrier. Both received passing knowledge test scores and demonstrated role-playing proficiency. Clinical note assessment and discussions during conference calls also indicated successful implementation. The feasibility of training Navy PT staff to implement PiPT was demonstrated. PT staff successfully translated training into practice. This is significant, since PiPT has the potential to limit attrition due to musculoskeletal injuries in Navy personnel. Factors believed to be associated with the success of the training include adoption of the PiPT model by PT staff and reinforcement of changes in clinical practice during deployment.
Background Context: Negative beliefs are known to influence treatment outcome in patients with sp... more Background Context: Negative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. Purpose: Assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. Study Design/Setting: Retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). Patient Sample: Patients with SP with a baseline assessment and follow-up assessment. Outcome Measure: Perceived disability (oswestry disability index (ODI) or neck disability index (NDI). A clinical meaningful change (MCID) was defined as decrease in ODI / NDI of ≥30%. Methods: We used the Akaike Information Criterion (AIC) from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. This study was not funded and the authors have no conflict of interest to declare. Results: In the cross-sectional analysis 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. SBST-distress was positively associated with perceived disability in both LBP and NP; LBP (Beta 2.31, 95% CI 1.75-2.88) and NP (Beta 2.57, 95% CI 1.47-3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (Beta 0.50, 0.29-0.72) but not for NP while less positive expectations was associated with more perceived disability in Page 2 of 37 3 NP (Beta 0.57, 0.02-1.12) but not in LBP. In the longitudinal analysis LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience a MCID in perceived disability (OR per point increase 0.89, 95% CI 0.83-0.96) and there was a similar trend in NP (0.90, 0.79-1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 1.01-1.19). In NP, self-efficacy was not included in the final model. Conclusions: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability however, in this study only positive beliefs were associated with treatment outcome.
ABSTRACT The purpose of this chapter is to promote a model to prevent chronicity and disability f... more ABSTRACT The purpose of this chapter is to promote a model to prevent chronicity and disability from non-specific low back pain (NSLBP). Delayed recovery is defined in this chapter as the period between 4 and 8 weeks after onset of NSLBP during which a patient has not yet returned to work. The recognition of predictors associated with delayed recovery at onset of the problem helps health care providers in their treatment plan. An algorithm can be useful for health care providers and employers in guiding the employee back to work. A multidisciplinary return to work programme is an essential part of the algorithm.
Scandinavian journal of medicine & science in sports, 1996
Health care providers often prescribe exercises as treatment for nonspecific low back pain. Howev... more Health care providers often prescribe exercises as treatment for nonspecific low back pain. However, the effectiveness of this treatment is poorly documented in the literature. While the evidence suggests that exercise in general is beneficial, there is a lack of knowledge about the types, frequency and duration of exercises that should be prescribed and at what stage of injury they are most helpful. In addition, few studies have dealt with exercise treatment alone rather than in combination with other treatments, making it hard to decipher the unique contribution of exercise. Inadequate study designs also make conclusions difficult. Conversely, the literature clearly shows that inactivity has detrimental effects (i.e. delayed return to normal activity, and negative physiological and psychological effects) for low back pain patients.
The process of rehabilitation, accommodation and return-to-work entails an assessment of a patien... more The process of rehabilitation, accommodation and return-to-work entails an assessment of a patient's ability to engage in work activities, an analysis of job demands and the matching of these elements to determine whether the individual and the job are compatible. The process involves numerous stakeholders, whereby ergonomists may analyze the demands of the job, clinicians may assess the individual's abilities and the matching is conducted as a joint effort. The success of the joint effort depends on the communication between several professional disciplines. To improve the communication we need tools that advance the decision making. The process of ‘ergonomics for one’ requires tools and methodologies of sufficient resolution to address the individual's needs. From the ergo-nomist's perspective, do we have tools that support clinical decision making regarding the ability of an individual patient to return to work? Similarly, does the ergonomist have tools to assist in adapting the job to the individual's abilities? The session is aimed for practitioners involved in industrial ergonomics as well as rehabilitation. The panel will examine several attempts to address these questions conceptually or practically, limiting the scope of the discussion to rehabilitation and accommodations of physical impairments. The goal of the session is to identify areas and directions that need further research and development.
BACKGROUND CONTEXT: Musculoskeletal disorders of the spine in the US military account for the sin... more BACKGROUND CONTEXT: Musculoskeletal disorders of the spine in the US military account for the single largest proportion of the absence of sickness causes leading to early termination. We explored if selected psychological and physical factors were associated with poor outcome after episodes of low back pain (LBP). PURPOSE: To identify clinical, demographic, and psychological factors predictive of work duty status after a complaint of LBP. STUDY DESIGN: A prospective clinical cohort of US Navy personnel treated for LBP. PATIENT SAMPLE: Eligible cases were active duty US Navy or Marine Corps personnel presenting to an emergency clinic or primary care clinic with a complaint of LBP, where the index episode of LBP was no more than 12 weeks duration before enrollment. OUTCOME MEASURES: The subject's work status (full duty, light duty, sick in quarters [SIQ], limited duty, or medically released to full duty) was abstracted from the subject's electronic medical record at approximately 4 weeks and then again 12 weeks after study enrollment. Work status in this study population is assigned by a Navy health-care provider at the time of a clinical visit and based on the health-care provider's determination of medical fitness for duty. This study collapsed work status into two groups, ''full duty'' (consisting of ''full duty'' and ''medically released to full duty'') and ''not at full duty'' (consisting of ''light duty,'' ''SIQ,'' and ''limited duty''). METHODS: Volunteers completed a baseline questionnaire consisting of recommended wellvalidated measures, including attitudes and beliefs about LBP and work (Fear-Avoidance Beliefs Questionnaire [FABQ] and the Tampa Scale of Kinesiophobia), distress (the Pain Catastrophizing Scale), clinical depression (The Center for Epidemiologic Studies Depression scale), a numeric pain intensity scale, self-perceived disability (Oswestry Disability Index), and general health status (12-Item Short Form Health Survey). Navy health-care providers conducted a back pain-specific medical evaluation. Associations are expressed as multivariate-adjusted prevalence ratios (PRs) estimated using Poisson regression. RESULTS: Two hundred fifty-three participants were enrolled. Work status outcome was collected for 239 participants. Predictors of ''not at full duty'' at 4 weeks after enrollment included having back pain for 4 weeks or less before study enrollment (PR, 2.69; 95% CI, 1.21-5.97) and increased FDA device/drug status: Not applicable.
The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back p... more The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back pain (NSLBP) at a major U.S. Navy base. In this single blinded randomized clinical trial, subjects were drawn from a larger, prospective cohort of active duty service members seeking care for NSLBP pain at a U.S. Navy Branch Medical Clinic. Outcome measures included return to work, self-reported pain, function, and psychological distress. Subjects were randomly allocated to one of two study arms: a multidisciplinary reconditioning program or the current standard of care for low back pain. The intervention lasted 4 weeks with a 12-week follow-up. Thirty-three subjects were enrolled. Subjects allocated to multidisciplinary care reported significantly lower perceived disability (p = 0.014) and less pain than those allocated to usual care at the end of the intervention period. All subjects returned to their usual duty following the conclusion of the intervention. The implementation of the intervention program was successful. Subjects in the multidisciplinary program showed a clinically significant improvement in the perception of disability compared to the usual care group. This is an important finding since perception of disability is associated with longterm functional outcome.
... the physician completed the standardized medical forms. The initially low compliance rate [13... more ... the physician completed the standardized medical forms. The initially low compliance rate [13% in January 1994] rose to 98% by the end of the instruction period [January 1995] (27). Procedures at First and Subsequent Visits ...
A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidis... more A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidisciplinary rehabilitation program. To identify factors that predict work retention 24 months after treatment in patients with nonspecific LBP. There is evidence that select physical, psychologic, and psychosocial factors are related to positive outcome for work-related nonspecific LBP. However, there is very little information related to work retention following an episode of nonspecific LBP. This is an exploratory study to identify select physical and psychosocial factors related to work retention. Patients who returned to work after treatment (n = 67) were followed for 2 years. Physical baseline measures included tests of flexibility, strength, and functional capacity. Psychosocial baseline measures were The Symptoms Checklist 90-R, The Pain Beliefs and Perceptions Inventory, The Oswestry Scale of perceived disability, The Work Stress Inventory, and The Quality of Life Scale. All physical parameters, perceived disability, and quality of life were tested before and after treatment. The dependent variable, work retention, was defined as the number of days that the subject worked during the 2-year follow-up period. Survival analysis was used to establish the predictive model. The average time out of work before treatment was 9 months (standard deviation 12.8) for 67 subjects (mean age 40 years [standard deviation 9.6]), including 18 females and 49 males. There were 18 participants (25%) that had interruption of work retention at follow-up. Average work retention was 362 days (range 47-682). Variables that reached a P value of <0.10 in the bivariate analysis were included in the multivariate analysis. They were trunk flexion (hazard ratio [HR = 2.4], 95% confidence interval [CI] 1.24-4.38; P = 0.01), trunk extension (HR = 2.1, 95% CI 1.02-4.16; P = 0.04), the somatization scale from the Symptom Checklist 90 revised (HR = 2.0, 95% CI 1.03-4.05; P = 0.04), and the obsessive-compulsiveness scale from the Symptom Checklist 90 revised (HR = 0.4, 95% CI 0.12-1.15; P = 0.09). Results showed that post-test trunk flexion, somatization, and obsessive compulsiveness predicted work retention (final trunk flexion HR = 2.5 [95% CI 1.26-4.79; P = 0.01], somatization scale HR = 2.5 [95% CI 1.25-4.93; P = 0.01], and obsessive compulsion HR = 0.2 [95% CI 0.07-0.77; P = 0.02]). Psychosocial and physical factors are associated with work retention for patients with nonspecific LBP. The predictive value of certain constructs may vary with the time when they are assessed and how outcome is operationalized. Further studies are needed to confirm these findings.
Introduction This brief report describes the number and nature of cases of musculoskeletal pain a... more Introduction This brief report describes the number and nature of cases of musculoskeletal pain and injury among sailors and marines presenting to the ship’s physical therapist during recent, respective deployments of two U.S. Navy aircraft carriers. Materials and Methods The case definition for this study was cases of work-limiting medical complaints involving the musculoskeletal system presenting, or referred, to the ship’s physical therapy services for evaluation and treatment. The population for this study was drawn from ship’s company from two Nimitz class carriers on their respective deployments. Potential subjects were recruited at their index visit for their complaint. Participants completed a survey of their symptoms while at the ship’s medical department. Data for analysis consist of counts of cases, body part affected, self-reported mechanism of injury, age, and gender of the subject. Data were analyzed by generating descriptive tables. Results One hundred ninety-seven ca...
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Papers by Marco Campello