The global burden of low back pain is the highest ranked condition contributing to years of living with disability. Exercise is moderately effective, and adherence to exercise may improve if participants are engaged. Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions. The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain.Two independent reviewers conducted a structured review and metasynthesis informed by Cochrane and Campbell Collaboration guidelines and the PRISMA statement. Fifteen papers were included for data extraction, method quality assessment, and thematic analysis.Four key themes emerged: (1) perceptions and classification of exercise; (2) role and impact of the health professional; (3) exercise and activity enablers/facilitators; (4) exercise and activity barriers. Participants believed that there were distinctions between general activity, real/fitness exercise, and medical exercise. Levels of acquired skills and capability and participant experience with exercise culture require consideration in program design. People participating in exercise classes and group work may be more comfortable when matched for abilities and experience. When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement, people make a reasoned decision to discontinue.People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences.
To determine participant experience of exercise programs for nonspecific chronic low back pain (NSCLBP). Systematic reviews have concluded that exercise is effective for decreasing pain and improving function in adults with NSCLBP. Participation is a key ingredient in exercise and patient's experiences during these programs may be important in influencing outcomes.Qualitative methods with three focus groups facilitated by an independent, experienced facilitator.Eighteen people aged over 18 years were included. They had to speak, read and understand English and participated in an exercise program for NSCLBP. Each group was guided with a series of predetermined questions to elicit their experience of participation in exercise programs. Participants were encouraged to give personal opinions freely. Transcribed data were read independently by two researchers and analysed thematically with grounded theory.Stigma emerged as a significant theme in all focus group transcripts. The results demonstrate that people with NSCLBP experience both subtle and overt stigmatization. The following subthemes emerged: stigma perpetrated by health care providers; stigma facilitated by the "sickness versus wellness" model; stigma applied by friends, family, the community, the workplace, and the low back pain subgroup; stigma-associated diagnostic uncertainty and the need for pathology driven validation.The ramifications of stigma and discrimination are enduring, potentially disabling and appear to interfere with care-seeking, rehabilitation participation, and potentially, rehabilitation outcomes. Public and health professional education, low back pain-specific support groups and dissemination of success stories may help to alleviate stigma.
Introduction Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. Objectives To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. Methods and analysis A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two independent reviewers will conduct a structured review and meta-synthesis, and a third reviewer will arbitrate where there is disagreement. This protocol has been registered on PROSPERO 2014. Ethics and dissemination Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically, in print and at conferences. Updates of the review will be conducted to inform and guide healthcare translation into practice. Trial registration number PROSPERO 2014:CRD42014012961. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014012961
This study was an investigation of the association of attitudes toward guns with self-reports of alcohol/drug use, and impulsivity.Participants included 160 male and female high school students, who completed five questions regarding attitudes toward guns, in addition to questions about alcohol/drug use.Data were analyzed using t-tests.Males were more likely to feel that a home was safer with a gun.Feeling positively about a gun was associated with alcohol use in males and impulsive, aggressive behavior in males and females.A greater understanding of attitudes toward guns must take into account gender, alcohol use, and impulsive and aggressive tendencies.
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