Criteria for inclusion in programs of functional restoration for chronic low back pain: Pragmatic Study

Abstract

Introduction: Chronic low back pain (cLBP) patients may benefit from multimodal functional restoration programs (FRPs). The aim of this study was to analyze patients' characteristics, when oriented or not towards such a program. As cLBP is a bio-psycho-social disorder medical and social parameters were analysed. Methods:Observational cross-sectional study in six tertiary centers in France in 2017. Consecutive patients with cLBP visiting a rheumatologist or physical medicine and rehabilitation physician were included. Patients oriented or not towards a FRP were compared for demographic characteristics, duration of sick leave over the past year, self-reported physical activity >1h/week, pain, anxiety/depression (Hospital Anxiety and Depression Scale), disability (Oswestry Disease Index) and kinesiophobia (Tampa Kinesiophobia Scale). Univariate and multivariate logistic regression were performed.Results: 147 patients were analysed: mean ± standard deviation, age 48.8 ± 12.0 years, mean cLBP duration 9.1 ± 9.4 years, 88 (59.9%) women. Overall, 58 (39.5%) patients were oriented towards a FRP: these patients were younger (mean age 46.3 ± 11.2 vs 50.5 ± 12.2 years, p=0.036), had longer sick leave (mean 128.5 ± 140.6) vs 67.6 ± 107.6 days/year, p=0.004), less often self-reported physical activity (35.1% ± 48.1 vs 53.4% ± 50.2, p=0.031), and reported lower pain levels (mean 6.1 ± 2.0 vs 7.1 ± 1.9 on a 0-10 numeric scale, p=0.002) .There was no significant difference regarding functional disability, pain duration, kinesiophobia, psychological status. In multivariate analysis, lower pain (odds ratio, OR: 0.95, 95% CI [0.91;0.99] for an increase of 1 point), absence of physical activity (OR: 0.84, 95% CI [0.72;0.98]) and longer sick leave (OR: 1.03, 95 % CI [1.01;1.05] for 30 more days of sick leave) were independently associated with orientation towards a FRP. Conclusion:Orientation towards FRPs was linked to pain, self-reported physical activity and sick leave. This confirms the biopsychosocial approach of FRPs for cLBP.

Kinesiophobia and physical activity: A systematic review and meta-analysis

“…In 54 of the 74 studies, kinesiophobia was assessed using the 17-item TSK (TSK-17; n = 38) 29,62,64,65,68,72,73,77,84,85,90,91,111–114,117–120,122–125,130,133–135,138–144,146,148,150 shorter versions of the TSK [(TSK-11 152 ; n = 10) 63,81,88,116,121,122,128,131,136,151 , (TSK-14; n = 1) 74 , (TSK-13 153 ; n = 2) 115,137 , (TSK-7; n = 1) 145 ], or its adaptation for patients with coronary artery disease (TSK-Heart 154 ; n = 2) 86,87 . The TSK is a questionnaire that assesses the belief that movements can lead to (re)injury, pain, or aggravation of an underlying and serious medical condition 28 .…”

“…To assess physical activity, the studies used the following outcomes: Score from a questionnaire (e.g., TAS, PAQE, BHPAQ, SGPALS, LTPAQ, n = 24) 63,64,67,68,72,80,81,84,87,89,90,104,107,113,115,119,121,123,125,127,134,137,149 , MET-min/week (n = 23) 31,73,76,77–79,83,85,86,112,114,116,130,131,133,136,138–142,146,147 , steps per day (n = 14) 63,65,75,78,88,113,120,126,128,132,143–145,150 , hours per day or week (n = 12) 62,65,69–71,74,91,113,120,138,143,145 , counts per minute (n = 4) 111,113,117,137 , kilocalories per day (n = 2) 129,144 , or percentage of active time (n = 1) 122 . Nine studies used multiple physical activity outcomes 63,65,78,91,113,120,143–145 .…”

Establishment of quantitative indicators for an efficient treatment on masticatory muscle pain

“…Discrepancies between self-perceived symptoms and biological indicators may reflect symptoms (Assadourian et al, 2020). Subjective symptoms should be considered when diagnosing MMP; however, quantitative indicators that objectify the differences in individual treatment responses should be used as well.…”

“…According to the Diagnostic Criteria for TMD (DC/TMD), practitioners are advised to conduct multidimensional interviews and evaluate patients, to determine specific pain patterns (i.e., acuteness or chronicity; Assadourian et al, 2020 ; Schiffman et al, 2014 ). However, most interviews often depend on patients' memory and cognitive characteristics, limiting the prospects of obtaining reliable and accurate information.…”

“…However, most interviews often depend on patients' memory and cognitive characteristics, limiting the prospects of obtaining reliable and accurate information. Discrepancies between self‐perceived symptoms and biological indicators may reflect symptoms (Assadourian et al, 2020 ). Subjective symptoms should be considered when diagnosing MMP; however, quantitative indicators that objectify the differences in individual treatment responses should be used as well.…”