Unique considerations for exercise programs to prevent future low back pain: the patient perspective

Ayre, Julie; Jenkins, Hazel; McCaffery, Kirsten; Maher, C. G.; Hancock, Mark J.

doi:10.1097/j.pain.0000000000002540

Cited by 6 publications

(7 citation statements)

References 41 publications

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“…Most of the time, progress took the form of an improvement in shoulder strength or the experience of less shoulder pain with a particular movement, which aligns with previous qualitative research in the area of non-specific low back pain. 41 Similar to the work of Littlewood et al, 20 a lack of timely symptom improvement was met with suspicion and doubt about the benefit of a particular exercise program, which affected motivation and adherence to the exercise program, ultimately leading to poor clinical outcomes. The recovery from RCRSP with exercise is not usually a quick process, and in some cases, it is recommended that 12 months of exercise therapy be trialed prior to escalating treatment to more invasive treatments 45 ; the desire for a timely improvement in shoulder symptoms by patients with exercise may prove difficult.…”

Section: Discussionmentioning

confidence: 89%

“…A desire for individualized exercise prescription reported in this study is similar to the previous qualitative research evidence for PFP and non-specific low back pain. 33 , 41 The desire for a tailored approach to exercise prescription for RCRSP is supported by empirical data which suggest there is no universal best exercise approach. 42–44 Therefore, rather than decreeing 1 particular exercise approach as superior, clinicians should endeavor to construct an exercise program in close collaboration with the individual in question and with careful consideration of access to equipment, past experiences with exercise, beliefs about exercise, and their individual goals.…”

Section: Discussionmentioning

confidence: 99%

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“Restoring That Faith in My Shoulder”: A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff–Related Shoulder Pain

et al. 2023

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Objective Rotator cuff-related shoulder pain is the most common form of shoulder pain. Exercise therapy is a first-line recommended treatment for rotator cuff-related shoulder pain. However, the causal mechanisms underpinning the beneficial effects of exercise for rotator cuff-related shoulder pain are not well understood. Moreover, how individuals with lived experience of rotator cuff-related shoulder pain believe exercise helped or did not help is unknown. This study aimed to gain insights into how individuals with rotator cuff-related shoulder pain believe exercise influenced their shoulder pain and identify the clinical conditions that promoted or inhibited their beliefs. Methods This qualitative study was underpinned by a critical realist approach to thematic analysis. Participants were recruited using hybrid purposive and convenience sampling techniques. Each participant attended an online semistructured interview. The data were coded by 2 members of the research team (JKP & NC) and verified by a third (BS). Recruitment continued until theoretical sufficiency was achieved. Participants reviewed and validated preliminary causal explanations. Results Three causal explanations were consistently expressed by 11 participants to explain the benefits of exercise therapy: (1) shoulder strength; (2) changes to psycho-emotional status; and (3) exercise has widespread health effects. However, the activation of these causal mechanisms depended on (1) the presence of a strong therapeutic relationship; (2) the provision of a structured and tailored exercise program; and (3) experiencing timely clinical progress. Conclusions Participants believed exercise improved their shoulder pain through associated health benefits, improved shoulder strength, and psychoemotional variables. Whether an exercise program was able to cause a clinical improvement for an individual with rotator cuff-related shoulder pain was contingent on clinical contextual features. Thus, the clinical context that an exercise program is delivered within may be just as important as the exercise program itself. Impact Exercise is a recommended primary, first-line intervention to manage rotator cuff-related shoulder pain. The results of this study suggest that a positive experience and outcome with exercise for rotator cuff-related shoulder pain is contingent on several clinical contextual features, such as a strong therapeutic relationship. The clinical context an exercise program is prescribed and delivered should be considered by clinicians.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“Restoring That Faith in My Shoulder”: A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff–Related Shoulder Pain

et al. 2023

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“…Therefore, the education sector in collaboration with the health sector should design regular physical activity programmes to improve the health of the teachers. Different guidelines for the prevention and management of LBP also emphasised the importance of regular physical activity and exercise 52…”

Section: Discussionmentioning

confidence: 99%

Magnitude and influencing factors of work-related low back pain among high school teachers in West Arsi zone, Southwest Ethiopia: evidenced from multicentred cross-sectional study

Gemedo,

Andualem,

Hailu Tesfaye

et al. 2023

BMJ Open

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ObjectiveThis study aimed to investigate the prevalence of low back pain and its associated factors among high school teachers in the West Arsi zone, Southwest Ethiopia.DesignA school-based cross-sectional study was conducted from February to March 2020. A self-administered structured Nordic Musculoskeletal questionnaire was used to assess low back pain during the past 12 months. Bivariate and multivariable binary logistic regression analysis was carried out using Stata V.14. The degree of significance was obtained at a 95% CI and p<0.05.SettingThe study was conducted in the West Arsi zone, Ethiopia.ParticipantsA total of 602 teachers participated in this study.Outcome measuresThe primary outcome is the prevalence of low back pain.ResultsThe prevalence of low back pain during the last 12 months was found to be 63.73% (95% CI 59.77% to 67.70%). About 225 (39.61%) teachers experienced moderate pain, and (89.79%) of them had a minimal disability. Being unmarried (adjusted OR (AOR) 0.47, 95% CI 0.28 to 0.79), prolonged standing (AOR 2.31, 95% CI 1.16 to 4.60), sleeping disturbance (AOR 3.22, 95% CI 1.41 to 7.36), regular physical activity (AOR 0.52, 95% CI 0.33 to 0.84), current smoker (AOR 2.83, 95% CI 1.04 to 7.67), lifting heavy load (AOR 1.96, 95% CI 1.17 to 3.28), psychological job demand (AOR 2.86, 95% CI 1.69 to 4.84) and job satisfaction (AOR 0.46, 95% CI 0.27 to 0.79) were associated with low back pain.ConclusionThe prevalence of low back pain was high in this study. Prolonged standing, sleep disruption, heavy load lifting, cigarette smoking and psychological job demand were risk factors for low back pain. Physical exercise and workplace satisfaction were effective interventions. Emphasis should now be put on ergonomics, regular physical activity and psychosocial factors to lessen the problem.

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“…23,24 Interestingly, individuals with LBP may feel uncertain about exercise. Qualitative research has suggested that although people with LBP often believe that exercise can prevent or reduce future LBP, some experience uncertainty about undertaking exercise that is unfamiliar 1 or exercising while in pain. 14 Although the uncertainties surrounding diagnosis, prognosis, and management have been discussed in the LBP literature, the uncertainty clinicians experience when working with individuals with LBP is not limited to these biomedical aspects.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“I felt uncertain about my whole future”—a qualitative investigation of people's experiences of navigating uncertainty when seeking care for their low back pain

Costa

Butler

Dillon

et al. 2023

Pain

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Uncertainty pervades low back pain (LBP). This study aimed to explore individuals' experiences of navigating uncertainty when seeking care for their LBP, with a view to better understanding the contexts in which they experience uncertainty and gaining insight into how uncertainty may be better navigated during clinical encounters. We conducted 15 semistructured interviews with people who have experienced LBP. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Analysis produced 4 themes. To reflect the unsettled nature of participants' discussions of navigating uncertainty, themes are framed as questions: (1) What will happen over time?; (2) Can clinicians help me? Are they willing to?; (3) What are clinicians talking about?; and (4) Am I being taken seriously? Participants also discussed how clinicians could better navigate these uncertainties. Suggestions included making time to (actively) listen to, and acknowledge, patients' concerns; asking open-ended questions; being honest about uncertainty; creating management plans and returning to them; challenging assumptions; remaining curious about patients' context; and providing guidance on how to manage LBP rather than simply giving certainty that symptoms will worsen, lessen, or continue. These findings indicate that many of the uncertainties individuals with LBP experience are intertwined with relational aspects of their interactions with clinicians. Clinicians therefore may need to consider these broader and relational aspects of care when navigating uncertainty with people who experience LBP, bringing attention to the importance of drawing from knowledge produced outside of the usual hierarchy of evidence (eg, systematic reviews and randomised controlled trials).

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Unique considerations for exercise programs to prevent future low back pain: the patient perspective

Abstract: Supplemental Digital Content is Available in the Text. Patients want highly individualised exercise programs for low back pain prevention that provide meaningful explanations of exercises and help them maintain exercise in the long-term.

Cited by 6 publications

References 41 publications

“Restoring That Faith in My Shoulder”: A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff–Related Shoulder Pain

“Restoring That Faith in My Shoulder”: A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff–Related Shoulder Pain

Magnitude and influencing factors of work-related low back pain among high school teachers in West Arsi zone, Southwest Ethiopia: evidenced from multicentred cross-sectional study

“I felt uncertain about my whole future”—a qualitative investigation of people's experiences of navigating uncertainty when seeking care for their low back pain

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