ABSTRACT Introduction Despite advances in physiotherapy care for Low Back Pain (LBP) worldwide, studies suggest that physiotherapists in Nigeria do not adhere to international guidelines, and it is not known whether recent treatment approaches developed for LBP are recognized or applied by physiotherapists in Nigeria. Objectives To evaluate the current assessment and treatment practices used by physiotherapists in Nigeria for people with recent onset, recurrent and chronic LBP. Design A descriptive cross‐sectional electronic national survey. Participants Two hundred and sixty‐seven registered physiotherapists who treat LBP across all 36 states of Nigeria completed the survey anonymously via REDCap. Results Two hundred and sixty‐seven physiotherapists (mean age = 37.6 years, SD = 9.1; 53.6% female) completed the survey in full. Although most physiotherapists (> 95%) regularly applied traditional assessment methods (e.g., history of presenting complaint, observation for spinal deformity, palpation), only approximately 30% screened for red flag pathology. Very few physiotherapists assessed patients with LBP for psychological distress (< 8%) or risk stratification/prognostic factors (< 4%). For treatment, electrophysical agents and muscle techniques (e.g., massage) predominated (> 95%), while few physiotherapists used cognitive‐behavioural strategies (< 2%), individualised multimodal treatment programs (e.g., cognitive functional therapy, StarT Back or STOPS, < 1.5%), validated outcome measures (< 15%), clinical practice guidelines (< 10%) or a clinical reasoning strategy/framework (< 20%). Most Nigerian physiotherapists (> 99%) expressed interest in learning evidence‐based LBP assessment and treatment methods from international experts. Conclusion There is very limited application of contemporary assessment and treatment practices for LBP by Nigerian physiotherapists; however, they are very interested in learning these methods from international experts.
Purpose. To report the outcomes and adverse events of people diagnosed with lumbar disc herniation with associated radiculopathy (LDHR) who were treated with a physiotherapy functional restoration programme.Method. Data on functional outcome (Oswestry score), work status, global rating of change, and adverse events were extracted from the files of all people with LDHR treated by three physiotherapists using functional restoration principles from 2001 to 2009.Results. Ninety-five participants were included. The Oswestry score reduced by a mean of 15.9 (95%% CI, 11.8–20.1) points between baseline and discharge following a mean (SD) of 8.7 (9.4) months of treatment. The proportion of participants working full-time increased from 37%% to 67%% between baseline and discharge (p < 0.001). Eighty per cent of participants reported overall improvement between baseline and discharge on the global rating of change scale (p < 0.001). Minor adverse events were reported by eight (8%%) participants, while one (1%%) participant developed adhesive capsulitis.Conclusion. People with LDHR who undertook a physiotherapy functional restoration programme achieved significant improvements in Oswestry disability scores, work status, and global rating of change, with few adverse events reported. A randomised controlled trial is warranted to determine the efficacy of functional restoration for people with this condition.
The International Association for the Study of Pain defines three pain types presumed to involve different mechanisms - nociceptive, neuropathic and nociplastic. Based on the hypothesis that these pain types should guide matching of patients with treatments, work has been undertaken to identify features to discriminate between them for clinical use. This study aimed to evaluate the validity of these features to discriminate between pain types. Subjective and physical features were evaluated in a cohort of 350 individuals with chronic musculoskeletal pain attending a chronic pain management program. Analysis tested the hypothesis that, if the features nominated for each pain type represent 3 different groups, then (i) cluster analysis should identify 3 main clusters of patients, (ii) these clusters should align with the pain type allocated by an experienced clinician, (iii) patients within a cluster should have high expression of the candidate features proposed to assist identification of that pain type. Supervised machine learning interrogated features with the greatest and least importance for discrimination; and probabilistic analysis probed the potential for coexistence of multiple pain types. Results confirmed that data could be best explained by 3 clusters, clusters were characterized by a priori specified features, and agreed with the designation of the experienced clinical with 82% accuracy. Supervised analysis highlighted features that contributed most and least to the classification of pain type and probabilistic analysis reinforced the presence of mixed pain types. These findings support the foundation for further refinement of a clinical tool to discriminate between pain types.
A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial.To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice.Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders.The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0-10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up.Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis.These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores.2.
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