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- Grooten, Wilhelmus Johannes Andreas, et al.
(author)
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Summarizing the effects of different exercise types in chronic low back pain : a systematic review of systematic reviews
- 2022
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.METHODS: We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022-01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.RESULTS: Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.CONCLUSIONS: Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.TRIAL REGISTRATION: PROSPERO: Reg no 190409 Registration date 01AUG 2020.
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| 2. |
- Sjöberg, Veronica, et al.
(author)
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Content Validity and Feasibility of the eVISualisation of physical activity and pain (eVIS) intervention in Interdisciplinary Pain Rehabilitation Programs : Valuable steps in a systematical development and evaluation process
- 2022
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Conference paper (peer-reviewed)abstract
- Background and aims: *Low physical health is one consequence that chronic pain encompasses. To improveeffectiveness of Interdisciplinary pain rehabilitation programs (IPRP) theeVISualisation of physical activity and pain (eVIS) intervention was developed. Thepurpose of this study was to evaluate eVIS validity by the aspects of content validityand clinical feasibility in IPRP-context.Methods: *This observational study was performed in 3 phases. Twenty-two field experts (patients,caregivers, researchers) participated, and provided quantitative scores and qualitativecomments on eVIS and its included elements (data collection, visualization,communication). In phase 1, ratings on a four-point Likert scale of each element´scontent validity (relevance, simplicity, safety) were collected through digitalquestionnaires. Three iterative assessment loops were completed, each followed byconsensus panel protocol revisions. Item-level content validity index (I-CVI), averageand overall CVI were calculated, and free-text comments were analyzed. In phase 2,ratings of content validity and elements’ clinical feasibility categorized in 5 focus areas(acceptability, demand, implementation, limited efficacy, practicality), were collectedfrom patients and caregivers after 2-3 weeks test trial. Phase 3 involved follow-up focusgroup interview with caregivers on specific ratings, as well as interviews with expertsin clinical pain management pharmacology.Results: *CVI for relevance, simplicity and safety improved over time and were all rated abovecut-off (0.78). Revisions were mainly made in the visualization element. In phase 2,participants rated eVIS as relevant and feasible to use in clinical IPRP-context.Conclusions: *Patients, caregivers, and researchers found eVIS valid in IPRP-context. Methodicalvalidation was essential to ascertain eVIS’ substantiality before clinical trial.
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| 3. |
- Sjöberg, Veronica, et al.
(author)
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Effectiveness of the eVISualisation of physical activity and pain (eVIS) intervention in Interdisciplinary Pain Rehabilitation Programs : Study Protocol for a Registry-based Randomised Controlled Clinical Trial
- 2022
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Conference paper (peer-reviewed)abstract
- Background and aims: * Interdisciplinary Pain Rehabilitation Programs (IPRPs) are considered to be superior to single-treatment measures in chronic pain treatment. However, the effects of IPRPs are moderate and as many as 30% of patients deteriorate in some outcomes. Although physical activity and exercise are central components in IPRPs, many patients struggle to achieve and maintain the recommended levels. An intervention, entitled eVISualisation of physical activity and pain (eVIS), has now been systematically developed and designed to facilitate patients with chronic pain in achieving and maintaining recommended physical activity levels. The aim of the present study protocol is to transparently report on the methodology, outcomes, and processes for an initiated registry-based randomized controlled trial (R-RCT), which will evaluate the effectiveness of eVIS on the primary outcome physical health and defined secondary outcomes. Methods: * Participants (approximately 400) will be recruited from IPRP units and randomly allocated to either IPRP with an addition of eVIS or to treatment as usual by IPRP. eVIS entails objectively measured physical activity and patient-reported outcomes of pain intensity, effect on daily activities and pharmaceutical consumption. Data is collected and visualized in a web application, PATRON. Pilot analyses evaluating the feasibility of the R-RCT will be performed on data from initial 30 participants. Outcomes will be extracted from PATRON and from six national registries. Multivariate statistics and repeated measures analyses will be performed. Results: * Recruitment will be initiated in late 2021. ClinicalTrials.gov identifier: NCT05009459. Conclusions: * This study protocol describes a R-RCT that is designed to provide robust data on the feasibility and effectiveness of eVIS as an addition to IPRPs.
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| 4. |
- Sjöberg, Veronica, et al.
(author)
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Effectiveness of the eVISualisation of physical activity and pain intervention (eVIS) in Swedish Interdisciplinary Pain Rehabilitation Programmes: study protocol for a registry-based randomised controlled clinical trial
- 2022
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In: BMJ open. - : BMJ. - 2044-6055. ; 12:4, s. e055071-
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Journal article (peer-reviewed)abstract
- Living with chronic pain often involves negative consequences. Interdisciplinary Pain Rehabilitation Programmes (IPRP) is considered superior to single-treatment measures in patients with chronic pain. Despite this, effects emerge suboptimal and more than 20% of patients deteriorate in patient-reported physical health outcomes after IPRP. A novel e-Health intervention, eVISualisation (eVIS) of physical activity and pain, was systematically developed to facilitate individualisation of physical activity levels. By adding elements of data collection, visualisation and communication of objectively measured physical activity and patient-reported outcomes (pain intensity, interference of pain, pharmaceutical consumption) to existing treatment modalities in IPRP, the IPRP team acquires prerequisites to adapt advice and physical activity prescriptions and to evaluate set activity goals. The overall aim is twofold. First, the aim is to evaluate the feasibility of the subsequent registry-based randomised controlled clinical trial (R-RCT). Second, the aim is to prospectively evaluate the effectiveness of the eVIS-intervention as a supplement to IPRP on our defined primary (physical health) and secondary outcomes.Methods and analysisIn the R-RCT, recruitment of 400 patients with chronic pain will be performed at 15 IPRP units. A random allocation to either IPRP + eVIS or to control group that will receive IPRP only will be performed. Data from the initial 30 participants completing the study period (6 months) will be included in a pilot study, where key feasibility outcomes (recruitment, randomisation, implementation, treatment integrity, data collection procedure, preliminary outcome measures) will be evaluated. Outcome variables will be extracted from the web application Pain And TRaining ON-line (PATRON) and from six national registries. Multivariate statistics and repeated measure analyses will be performed. Quality-adjusted life years and incremental cost-effectiveness ratio will be calculated for cost-effectiveness evaluation.Ethics/disseminationThe Swedish Ethics Review Board granted approval (Dnr 2021/02109). Results will be disseminated through peer-reviewed journals.Trial registration numberNCT05009459. Protocol V.1.
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