General practitioners (GPs) manage the majority of patients with chronic low back pain (LBP) in the Republic of Ireland's health system; however, little is known about their attitudes and beliefs, and how these influence their practice behavior. This study aimed to determine the attitudes and beliefs of GPs regarding chronic LBP, the factors that influence these, and their impact on the management of patients with chronic LBP.A cross-sectional questionnaire survey of a random sample of GPs (n = 750) was undertaken. The questionnaire pack contained a demographic questionnaire, an attitudes measure (the Pain Attitudes and Beliefs Scale, which measured "biomedical" and "biopsychosocial" orientations), and 2 LBP clinical vignettes.The response rate was 57% (n = 432). Doctor-related factors (use of LBP clinical guidelines, number of years qualified) had a statistically significant impact on biomedical scores, that is, those who used guidelines, and were qualified a shorter time had significantly lower biomedical scores (P < 0.05); however, they had a limited impact on the consultation outcomes. No doctor-related factor impacted on the biopsychosocial score, and only sex impacted on the consultation outcome, that is, female GPs referred patients more frequently to allied health professionals.The current results show partial adherence to current LBP guidelines: GPs manage patients within a biomedical framework, and postgraduate education is not significantly impacting on chronic LBP management. GPs' beliefs do not correlate with their management, which only reflects partial adherence to LBP guideline recommendations. Further research is needed to explore the role of patient factors in the consultation outcomes.
Objectives: Pain sensitization in knee osteoarthritis (OA) is associated with greater symptom severity and poorer clinical outcomes. Measures that identify pain sensitization and are accessible to use in clinical practice have been suggested to enable more targeted treatments. This merits further investigation. This study examines the relationship between quantitative sensory testing (QST) and clinical measures of pain sensitization in people with knee OA. Methods: A secondary analysis of data from 134 participants with knee OA was performed. Clinical measures included: manual tender point count (MTPC), the Central Sensitization Inventory (CSI) to capture centrally mediated comorbidities, number of painful sites on a body chart, and neuropathic pain-like symptoms assessed using the modified PainDetect Questionnaire. Relationships between clinical measures and QST measures of pressure pain thresholds (PPTs), temporal summation, and conditioned pain modulation were investigated using correlation and multivariable regression analyses. Results: Fair to moderate correlations, ranging from −0.331 to −0.577 ( P <0.05), were identified between MTPC, the CSI, number of painful sites, and PPTs. Fair correlations, ranging from 0.28 to 0.30 ( P <0.01), were identified between MTPC, the CSI, number of painful sites, and conditioned pain modulation. Correlations between the clinical and self-reported measures and temporal summation were weak and inconsistent (0.09 to 0.25). In adjusted regression models, MTPC was the only clinical measure consistently associated with QST and accounted for 11% to 12% of the variance in PPTs. Discussion: MTPC demonstrated the strongest associations with QST measures and may be the most promising proxy measure to detect pain sensitization clinically.
There are currently four Higher Education Institutions offering a 4-year Bachelors of Science Honours degree programme in the Republic of Ireland; three of these are based in the capital city, Dublin, at Trinity College Dublin, University College Dublin and The Royal College of Surgeons in Ireland, and the fourth situated in the south-west of the country at University College Limerick, with approximately 150 students graduating per year from these programmes. Entry to undergraduate physiotherapy education in Ireland is highly competitive and necessitates, for the majority of applicants, the achievement of high grades equivalent to the top 5% of candidates taking the Final Leaving Certificate Examination in a particular year, as well as a number of designated additional places for mature students, those from 'disadvantaged' schools, or those with disabilities. The first School of Physiotherapy in Ireland was established in 1905, the first degree programme in physiotherapy education commenced in 1983, and the first physiotherapist in Ireland was awarded a PhD in 1982. The Irish Society of Chartered Physiotherapists (ISCP), founded in 1983, is the sole body representing the physiotherapy profession in Ireland and, as such, it establishes and maintains educational accreditation standards including that all physiotherapy education should occur in Higher Education Institutions (HEIs). The HEIs maintain close links with clinical providers and all students undertake 1000 hours of supervised clinical practice in a variety of clinical training sites as part of their undergraduate degree training under the supervision of Placement Educators and Practice Tutors. The ISCP is currently designated by the Government as the competent body for the regulation of the physiotherapy profession in Ireland, including the credentialing of graduates from accredited programmes, assessment of applicants from non-accredited overseas programmes, implementation of the Continuing Professional Development Policy and the awarding of Specialist Membership. However, the recent Government-approved Health and Social Care Professions Council is currently being established and will supersede current arrangements. There are also new initiatives underway to develop graduate entry programmes in physiotherapy in Ireland for individuals with a primary degree to gain entry to an accelerated MSc physiotherapy programme, in response to Government policy and public interest.
AbstractAbstractThe purpose of this article is to review the case for the inclusion of a mechanisms-based classification for musculoskeletal pain. In response to perceived limitations of the medical/disease model of pain and illness a mechanisms-based classification system for pain has been advocated. The classification of pain according to the underlying neurophysiological mechanisms responsible for its generation and/or maintenance may better explain the variability and complexities of clinical presentations of musculoskeletal pain and facilitate subsequent decision-making associated with the assessment, treatment and prognosis of patients with musculoskeletal disorders. However, current methods of mechanisms-based classification either lack standardised criteria or propose decision rules whose validity has yet to be substantiated empirically. While the case for a mechanisms-based classification for pain has been well made the onus rests with its advocates to (a) establish its validity for use in clinical practice in defined populations with musculoskeletal disorders, and (b) provide evidence that such a system facilitates improved clinical outcomes.Keywords: PAIN MECHANISMSCLASSIFICATIONMUSCULOSKELETAL PHYSIOTHERAPY
Objectives: Normal efficiency of exercise-induced hypoalgesia (EIH) has been demonstrated in people with knee osteoarthritis (OA), while recent evidence suggests that EIH may be associated with features of pain sensitization such as abnormal conditioned pain modulation (CPM). The aim of this study was to investigate whether people with knee OA with abnormal CPM have dysfunctional EIH compared with those with normal CPM and pain-free controls. Methods: Forty peoples with knee OA were subdivided into groups with abnormal and normal CPM, as determined by a decrease/increase in pressure pain thresholds (PPTs) following the cold pressor test. Abnormal CPM (n=19), normal CPM (n=21), and control participants (n=20) underwent PPT testing before, during, and after aerobic and isometric exercise protocols. Between-group differences were analyzed using repeated-measures analysis of variance and within-group differences were analyzed using Wilcoxon signed-rank tests. Results: Significant differences were demonstrated between groups for changes in PPTs postaerobic ( F 2,55 =4.860; P =0.011) and isometric ( F 2,57 =4.727; P =0.013) exercise, with significant decreases in PPTs demonstrated during and postexercise in the abnormal CPM group ( P <0.05), and significant increases in PPTs shown during and postexercise in the normal CPM and control groups ( P <0.05). Conclusions: Results are suggestive of dysfunctional EIH in response to aerobic and isometric exercise in knee OA patients with abnormal CPM, and normal function of EIH in knee OA patients with an efficient CPM response. Identification of people with knee OA with inefficient endogenous pain modulation may allow for a more individualized and graded approach to exercises in these individuals.
Secondary prevention in ischaemic stroke and transient ischaemic attack (TIA) is dominated by pharmacological interventions with evidence for non-pharmacological interventions being less robust. This systematic review and meta-analysis examines the impact of lifestyle interventions on secondary prevention in stroke or TIA. A systematic literature search was performed. Randomised controlled trials (RCTs) examining the effectiveness of intervention packages incorporating any key component of health education/promotion/counselling on lifestyle and/or aerobic exercise compared to usual care ± a sham intervention in participants with ischaemic stroke or TIA were included. Outcomes of interest were mortality, cardiovascular disease (CVD) event rates, cardiovascular risk factors including blood pressure, lipid profiles and physical activity participation. Methodological quality was assessed. Statistical analyses determining treatment effect were conducted using Cochrane Review Manager Software. Seventeen RCTs were included. Data pooled from eight studies with a total of 2478 patients, demonstrated no effect in favour of lifestyle interventions compared to routine or sham interventions on mortality (risk ratio (RR) = 1.13 (95% confidence interval (CI), 0.85–1.52), I2 = 0%). Data relating to CVD events were pooled from four studies (1013 patients), demonstrated non-significant findings (RR = 1.16 (95% CI, 0.80--1.71), I2 = 0%). Similar results were reported for total cholesterol. Physical activity participation demonstrated significant improvement [SMD 0.24 (95% CI, 0.08–0.41), l2 = 47%]. Blood pressure reductions were noted but were non-significant when corrected for multimodal packages including enhanced pharmacotherapy compliance. There is currently insufficient high quality research to support lifestyle interventions post-stroke or TIA on mortality, CVD event rates and cardio-metabolic risk factor profiles. Promising blood pressure reductions were noted in multimodal interventions which addressed lifestyle.
Objective: This systematic review and meta-analysis examined the effectiveness of multidisciplinary-based rehabilitation (MBR) in comparison with active physical interventions for adults with chronic pain. Materials and Methods: The review was conducted in line with the recommendations provided in the Cochrane Handbook for Systematic Reviews and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 8 electronic databases were searched from inception to November 2018. Only randomized controlled trials were eligible for inclusion. In total, 31 trials were identified, and most studies involved patients with chronic low back pain (25 trials). The main outcomes considered were pain intensity and disability at short-term follow-up (≤3 mo after treatment), medium-term follow-up (>3 and <12 mo), and long-term follow-up (≥12 mo). The quality of the evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach Results: A total of 27 studies were included in the meta-analysis. Statistically significant differences in favor of MBR were found for pain intensity and disability at short-term follow-up (standardized mean difference=0.53 and 0.50) and long-term follow-up (standardized mean difference=0.56 and 0.77), but the quality of the evidence was low. There was no significant difference between MBR and active physical interventions in the medium-term follow-up. Conclusions: Overall, the results suggest that MBR may lead to greater improvements in pain intensity and disability compared with active physical interventions, and the effects appear to be sustained in the long term. However, these findings should be interpreted with caution in light of the low quality of the evidence, with all but one trial judged to be at high risk of bias. Further research is required to assess the effectiveness of MBR for people with chronic pain conditions other than low back pain.
Limited studies exist combining mindfulness-based stress reduction (MBSR) and exercise in a pain management programme (PMP), with none thus far delivering a combined intervention as an online PMP. This study aimed to explore the acceptability and feasibility of a combined MBSR and exercise online PMP for adults with chronic pain and to examine the feasibility of conducting a randomized controlled trial (RCT) comparing MBSR and exercise delivered online with an online self-management guide.A feasibility RCT was conducted with participants randomized into the MOVE group (8-wk MBSR and exercise live online) or the self-management (SM) group (8-wk online self-management guide). Primary outcomes included recruitment, attrition, intervention adherence, and satisfaction. Participants wore a Fitbit watch during the study and completed patient-reported outcome measures at baseline, postintervention, and 12-week follow-up.Ninety-six participants were randomized and 80 (83.3%) completed the interventions. Higher mean satisfaction (Client Satisfaction Questionnaire-8) was reported in the MOVE group 26.2 (±5.5) than the SM group 19.4 (±5.6). The Patient Global Impression of Change scale showed favourable changes in both groups; 65.1% of the MOVE group, 42.3% of the SM group reporting improvement. Seventy-three participants (76.3%) adhered to wearing the Fitbit for 8 weeks. Comparable improvements postintervention and at a 12-week follow-up were noted within both groups for Brief Pain Inventory, Pain Self-Efficacy Questionnaire, Pain Disability Index, Pain Catastrophising Scale, Fear Avoidance Belief Questionnaire and Short Form-36 Health Survey.The findings suggest both interventions explored are acceptable and feasible. A fully powered RCT examining the effectiveness of MBSR combined with exercise, delivered live online is warranted.
Background: General practitioners (GPs), orthopaedic surgeons, neurosurgeons, rheumatologists and pain consultants manage the majority of patients with chronic low back pain (CLBP) in the Republic of Ireland. However, little is known about their attitudes and beliefs and the factors that influenced them. This study aimed to investigate factors that influenced doctors’ attitudes and beliefs to CLBP. Method: A cross-sectional questionnaire was mailed to a random sample of GPs (n=750; 35%), and all orthopaedic surgeons (n=81), neurosurgeons (n=9), rheumatologists (n=26), and pain consultants (n=24) in the republic of Ireland. The questionnaire pack contained a demographic data form, two clinical vignettes, and an attitudes measure, the Pain Attitudes and Beliefs Scale (PABS.PT). Approval was obtained from the UCD Human Research Ethics Committee. Results: The response rate was 58% (n=523). Doctors were qualified 23.4±9.4 years. Analysis of the vignettes showed there was no significant difference (p>0.05) between those who had undertaken postgraduate education (PGE) regarding referral rates to physiotherapy, investigations, or secondary care. Prescription rates were significantly lower for those who had undertaken PGE (88% v 94%, χ 2 =4.95, p 23 yrs), and there was no significant difference in the management of the vignettes, except referral rates for investigations which was greater for doctors qualified > 23 years (3% v 52%, χ 2 =10.71, p=0.001). Conclusion: Demographic factors (PGE and the number of years since qualification) did not significantly influence doctors’ practice behaviour.
'/%3e%3cpath d='M200 752.362h200v300H200z' style='fill:%23fff;fill-opacity:1;stroke:none' transform='translate(0 -752.362)'/%3e%3cpath d='M400 752.362h200v300H400z' style='fill:%23ff883e;fill-opacity:1;stroke:none' transform='translate(0 -752.362)'/%3e%3c/svg%3e)