The clinical and cultural factors in classifying low back pain patients within Greece: a qualitative exploration of Greek health professionals

Billis, Evdokia; McCarthy, Christopher J.; Stathopoulos, Ioannis; Kapreli, Eleni; Pantzou, Paulina; Oldham, Jacqueline

doi:10.1111/j.1365-2753.2006.00698.x

Cited by 17 publications

(12 citation statements)

References 58 publications

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“…This was a two-round modified Delphi survey. Initial data included in the first-round Delphi were generated by focus groups involving Greek PTs and doctors and is described elsewhere [31]. Ethical approval was obtained from the Ethical Committees of Technological Educational Institute of Lamia, Greece and University of Manchester, UK.…”

Section: Methodsmentioning

confidence: 99%

Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals

Billis¹,

McCarthy

Gliatis

et al. 2010

Evaluation Clinical Practice

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Section: Methodsmentioning

confidence: 99%

Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals

Billis¹,

McCarthy

Gliatis

et al. 2010

Evaluation Clinical Practice

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“…In all except two European studies [57,74] the profession involved in developing the classification systems was the medical profession; which could indicate the dominance of the 'medical' model throughout Europe [9]. Also most classification systems were diagnostic [5,[19][20]74], and psychosocial questionnaires were one of the most commonly used discriminatory criteria for subgroup classification.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Greek physiotherapists are only covered by health insurances for treating their patients and not for assessing them, or for deciding on treatment; these procedures are legally considered as medical ones [9]. Thus, 'cultural' issues have an impact on how LBP is managed.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, treatment decisions are not always based on an evidence-based clinical reasoning model, but quite often, are dictated by each country's health system [9,34,83]. For example, Greek physiotherapists are only covered by health insurances for treating their patients and not for assessing them, or for deciding on treatment; these procedures are legally considered as medical ones [9].…”

Section: Introductionmentioning

confidence: 99%

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Subclassification of low back pain: a cross-country comparison

2007

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Various health professionals have attempted to classify low back pain (LBP) subgroups and have developed several LBP classification systems. Knowing that culture has an effect on LBP symptomatology, assessment findings and clinical decision making, the aim of this review is to perform a cross-country comparative review amongst the published classification systems, addressing each country's similarities and differences as well as exploring whether cultural factors have been incorporated into the subclassification process. A systematic search of databases limited to human adults was undertaken by Medline, Cinahl, AMED and PEDro databases between January 1980 and October 2005. Classification systems from nine countries were identified. Most studies were classified according to pathoanatomic and/or clinical features, whereas fewer studies utilized a psychosocial and even less, a biopsychosocial approach. Most studies were limited in use to the country of the system's developer. Very few studies addressed cultural issues, highlighting the lack of information on the impact of specific cultural factors on LBP classification procedures. However, there seem to be certain 'cultural trends' in classification systems within each country, which are discussed. Despite the plethora of classification studies, there is still no system which is internationally established, effective, reliable and valid. Future research should aim to develop a LBP classification system within a well identified cultural setting, addressing the multi-dimensional features of the LBP presentation.

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“…The first study accompanying this publication (10) reports the intertester reliability of a suggested discriminatory list, derived from the consensus of a large number of health professionals (11,12). This reliability study enabled the identification of items that presented with a kappa value of 0.41 or more, corresponding to moderate and substantial/excellent agreement (13).…”

Section: Testing Proceduresmentioning

confidence: 99%

Sub-grouping patients with non-specific low back pain based on cluster analysis of discriminatory clinical items

Billis¹,

McCarthy²,

Roberts³

et al. 2013

J Rehabil Med

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Objective: To identify potential subgroups amongst patients with non-specific low back pain based on a consensus list of potentially discriminatory examination items. Design: Exploratory study. Participants: A convenience sample of 106 patients with nonspecific low back pain (43 males, 63 females, mean age 36 years, standard deviation 15.9 years) and 7 physiotherapists. Methods: Based on 3 focus groups and a two-round Delphi involving 23 health professionals and a random stratified sample of 150 physiotherapists, respectively, a comprehensive examination list comprising the most "discriminatory" items was compiled. Following reliability analysis, the most reliable clinical items were assessed with a sample of patients with non-specific low back pain. K-means cluster analysis was conducted for 2-, 3-and 4-cluster options to explore for meaningful homogenous subgroups. Results: The most clinically meaningful cluster was a twosubgroup option, comprising a small group (n = 24) with more severe clinical presentation (i.e. more widespread pain, functional and sleeping problems, other symptoms, increased investigations undertaken, more severe clinical signs, etc.) and a larger less dysfunctional group (n = 80). Conclusion: A number of potentially discriminatory clinical items were identified by health professionals and sub-classified, based on a sample of patients with non-specific low back pain, into two subgroups. However, further work is needed to validate this classification process.

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The clinical and cultural factors in classifying low back pain patients within Greece: a qualitative exploration of Greek health professionals

Abstract: An extensive Greek 'list' of clinical and cultural features was developed from the groups' analysis. Although similarities existed in most categories, there were several differences across the three focus groups which will be discussed.

Cited by 17 publications

References 58 publications

Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals

Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals

Subclassification of low back pain: a cross-country comparison

Sub-grouping patients with non-specific low back pain based on cluster analysis of discriminatory clinical items

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