Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]

Campos, Tarcisio F de

doi:10.1016/j.jphys.2017.02.012

Cited by 171 publications

(134 citation statements)

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“…The fine‐wire percutaneous PNS leads were designed to reduce invasiveness, adverse events, and some of the technical challenges that were previously associated with traditional systems and applications for PNS. Because this PNS system was designed purposely for use as a percutaneous therapy, it has an excellent safety profile and fewer complications than permanently implanted neurostimulation systems . Studies suggest that use of neurostimulation earlier in the treatment continuum could also improve patient outcomes, for example, by reducing the number of hospitalizations and clinic visits, or reducing opioid usage .…”

Section: Discussionmentioning

confidence: 99%

“…Despite changes in recent years to LBP treatment guidelines, which suggest that opioids should not be offered for the treatment of chronic LBP, opioids continue to be commonly prescribed and a diagnosis of chronic LBP is associated with an increased likelihood of opioid use and abuse . Because there is little evidence supporting the efficacy of opioids in treating chronic LBP, improving the patient’s ability to return to work, or reducing the need for other pain therapies, it is widely accepted that an effective, non‐opioid treatment is needed to treat chronic back pain and limit opioid use to prevent dependence and addiction.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant

et al. 2019

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Introduction Percutaneous peripheral nerve stimulation (PNS) provides an opportunity to relieve chronic low back pain and reduce opioid analgesic consumption as an alternative to radiofrequency ablation and permanently implanted neurostimulation systems. Traditionally, the use of neurostimulation earlier in the treatment continuum has been limited by its associated risk, invasiveness, and cost. Methods Percutaneous PNS leads (SPRINT MicroLead) were placed bilaterally to target the medial branches of the dorsal rami nerves under image guidance. The percutaneous leads were connected to miniature wearable stimulators (SPRINT PNS System) for the 1‐month therapy period, after which the leads were removed. Pain and disability were assessed long‐term up to 12 months after lead removal. Results Substantial, clinically significant reductions in average pain intensity (≥50% reduction as measured by the Brief Pain Inventory Short Form) were experienced by a majority of subjects (67%) at end of treatment compared to baseline (average 80% reduction among responders; P < 0.05, analysis of variance; n = 9). Twelve months after the end of PNS treatment, a majority of subjects who completed the long‐term follow‐up visits experienced sustained, clinically significant reductions in pain and/or disability (67%, n = 6; average 63% reduction in pain intensity and 32‐point reduction in disability among responders). No serious or unanticipated adverse events were reported. Conclusions This study challenges the long‐held notion that a positive trial of PNS should be followed by a permanent implant in responders. Percutaneous PNS may serve as an effective neurostimulation therapy for patients with chronic low back pain and should be considered earlier in the treatment continuum as a motor‐sparing means of avoiding opioids, denervation, and permanently implanted neurostimulation systems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant

et al. 2019

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“…It has thereby the potential to optimize (cost‐)effectiveness of exercise therapy for a very large and strongly increasing patient group. Even more important, due to the simplicity of the stratification algorithm, our model, if proven to be (cost‐)effective, can easily be implemented in daily practice and quickly adopted in current guidelines, similar as for the STarT Back Screening Tool (de Campos, ).…”

Section: Discussionmentioning

confidence: 99%

Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study)

Knoop

Dekker

Leeden

et al. 2019

Physiotherapy Res Intl

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Objectives Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup‐specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost‐)effectiveness of stratified exercise therapy compared with usual, “nonstratified” exercise therapy. Methods A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a “high muscle strength subgroup,” “low muscle strength subgroup,” or “obesity subgroup” and (b) subgroup‐specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3‐month (primary endpoint), 6‐month (questionnaires only), and 12‐month follow‐up, with an additional cost questionnaire at 9 months. Intention‐to‐treat, multilevel, regression analysis comparing stratified versus usual care will be performed. Conclusion This study will demonstrate whether stratified care provided by primary care PTs is effective and cost‐effective compared with usual best practice from PTs.

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“…For instance, the Orebro Musculoskeletal Pain Questionnaire (OMPQ) [17] and the STarT Back Screening Tool (SBT) [18,19] have been developed and validated to estimate risk in LBP. Their use is recommended in physiotherapy guidelines from New Zealand [20] and England [21]. The Dutch physiotherapy guideline [13] does not recommend any specific screening tool, but physiotherapists are generally advised to consider all prognostic (psychosocial) patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

Use and perceived added value of patient-reported measurement instruments by physiotherapists treating acute low back pain: a survey study among Dutch physiotherapists

Knoop

Lankveld

Geerdink

et al. 2020

BMC Musculoskelet Disord

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Background: This study aims to explore (i) physiotherapists' current use in daily practice of patient-reported measurement instruments (screening tools and questionnaires) for patients with acute low back pain (LBP), (ii) the underlying reasons for using these instruments, (iii) their perceived influence on clinical decision-making, and (iv) the association with physiotherapist characteristics (gender, physiotherapy experience, LBP experience, overall ehealth affinity). Methods: Survey study among Dutch physiotherapists in a primary care setting. A sample of 650 physiotherapists recruited from LBP-related and regional primary care networks received the survey between November 2018 and January 2019, of which 85 (13%) completed it. Results: Nearly all responding physiotherapists (98%) reported using screening tools or other measurement instruments in cases of acute LBP; the Quebec Back Pain Disability Scale (64%) and the STarT Back Screening Tool (61%) are used most frequently. These instruments are primarily used to evaluate treatment effect (53%) or assess symptoms (51%); only 35% of the respondents mentioned a prognostic purpose. Almost three-quarters (72%) reported that the instrument only minimally impacted their clinical decision-making in cases of acute LBP. Conclusions: Our survey indicates that physiotherapists frequently use patient-reported measurement instruments in cases of acute LBP, but mostly for non-prognostic reasons. Moreover, physiotherapists seem to feel that current instruments have limited added value for clinical decision-making. Possibly, a new measurement instrument (e.g., screening tool) needs to be developed that does fit the physiotherapist's needs and preferences. Our findings also suggest that physiotherapist may need to be more critical about which measurement instrument they use and for which purpose.

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Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]

Cited by 171 publications

References 0 publications

Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant

Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant

Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study)

Use and perceived added value of patient-reported measurement instruments by physiotherapists treating acute low back pain: a survey study among Dutch physiotherapists

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