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- Grunnesjö, Marie
(författare)
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Low Back Pain : With Special Reference to Manual Therapy, Outcome and its Prognosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work. Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work. Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56). Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.
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| 2. |
- Abbott, Allan, 1978-
(författare)
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Physiotherapeutic rehabilitation and lumbar fusion surgery
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Over the last two decades, the economic costs and rates of lumbar fusion surgery for chronic low back pain has risen dramatically in western industrialized countries. Data from the Swedish National Spine Register suggest that 25% of patients experience unimproved pain and up to 40% are not satisfied with the outcome of lumbar fusion surgery. Thus, there is a definite need to optimize the selection and management of patients to improve lumbar fusion outcomes. Aim: To investigate the role of biopsychosocial factors in explaining disability and health related quality of life in chronic low back pain patients before and after lumbar fusion surgery and to evaluate the effectiveness of post-operative rehabilitation regimes. Methods: At total of 107 patients were recruited, aged 18 to 65 years, selected for lumbar fusion due to 12 months of symptomatic back and/or leg pain due to spinal stenosis, degenerative/isthmic spondylolisthesis or degenerative disc disease. Measures of disability, health related quality of life, pain, mental health, fear of movement/(re)injury, self-efficacy, outcome expectancy, pain coping styles, work status, health care use, analgesic use and sickness leave were collected with self-rated questionnaires at baseline (Studies I-IV), 3, 6, 12 months (Study II) and 2-3 years after surgery (Studies II-III). In Studies II-IV, patients were randomised to psychomotor therapy (N=53) or exercise therapy (N=54) implemented during the first 3 post-operative months. Semi-structured interviews were conducted 3-6 months after surgery on 20 patients including 10 from each rehabilitation group to investigate experiences of back problems before and after surgery, post-operative recovery and expectations of rehabilitation analysed in terms of the International Classification of Functioning, Disability and Health (Study IV). Results: Approximately 50% of the variability in baseline disability and 40% of the variability in baseline health related quality of life could be explained by psychological variables. In particular, catastrophizing, control over pain, self-efficacy and outcome expectancy had significant mediation roles (Study I). For the short and long term outcome of lumbar fusion surgery, post-operative psychomotor therapy is significantly more effective than exercise therapy with approximately 10-20% better outcome in measures of disability, fear of movement/(re)injury, pain catastrophizing, self-efficacy, outcome expectancy sickness leave, health care utilization and return to work (Study II). A model with good outcome predictive performance which significantly predicts disability, back pain and health related quality of life outcomes 2-3 year after lumbar fusion surgery, was shown to involve pre-operative screening of disability, leg pain intensity, mental health, fear of movement/(re)injury, outcome expectations, catastrophizing, control over pain and the implementation of post-operative psychomotor therapy (Study III). Lumbar fusion patient s experiences of back problems before and after the operation as well as experiences of recovery and outcome expectations correspond well with the content of outcomes measures used in the study suggesting good content validity (Study IV). Conclusion: Psychological factors strongly influence levels of disability and health related quality of life in lumbar fusion candidates as well as predicts post-operative outcomes. Early post-operative rehabilitation focusing on cognition, behaviour and motor control is recommended for improved lumbar fusion outcomes.
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