Aline Ramond-Roquin

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review.

BACKGROUND Low back pain (LBP) is a problem that is frequently encountered in primary care, and current guidelines encourage care providers to take into account psychosocial risk factors in order to avoid transition from acute to chronic LBP. OBJECTIVE To review the effectiveness of interventions focusing on psychosocial risk factors for patients with non-chronic LBP in primary care. METHODS A systematic search was undertaken for controlled trials focusing on psychosocial factors in adult patients with non-chronic, non-specific LBP in primary care by exploring Medline, Embase, PsycInfo, Francis, Web of Sciences and The Cochrane Library. The methodological quality of the studies included was assessed before analysing their findings. RESULTS Thirteen studies were selected, seven being considered as having a low risk of bias. Information strategies were assessed by eight trials, with high-quality evidence of no effectiveness for pain, function, work issues and health care use, low-quality evidence of no effectiveness for self-rated overall improvement, satisfaction and pain beliefs and lack of evidence in terms of quality of life. Cognitive behavioural therapy was assessed by three trials, with very low-quality evidence of moderate effectiveness for pain, function, quality of life, work issues and health care use. There was lack of evidence concerning the effectiveness of individual and group education intervention or work coordination. CONCLUSION Among the wide range of psychosocial risk factors, research has focused mainly on pain beliefs and coping skills, with disappointing results. Extended theoretical models integrating several psychosocial factors and multicomponent interventions are probably required to meet the challenge of LBP.

Psychosocial risk factors, interventions, and comorbidity in patients with non-specific low back pain in primary care: need for comprehensive and patient-centered care

Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients’ or HCPs’ overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.

Different Multimorbidity Measures Result in Varying Estimated Levels of Physical Quality of Life in Individuals with Multimorbidity: A Cross-Sectional Study in the General Population.

Introduction. Multimorbidity adversely affects health-related quality of life. Methodological factors may impact the magnitude of this relationship. Objective. To evaluate how physical health-related quality of life varies in individuals with multimorbidity depending on the length of the list of candidate conditions considered. Methods. Secondary analysis from PRECISE, a cohort study of the general adult population of Quebec, Canada. Multimorbidity was measured using the 21-chronic condition list from the Disease Burden Morbidity Assessment, and physical health-related quality of life was measured using the physical component summary (PCS) of SF-12v2. The PCS was calculated, (a) using 2 or more conditions from the 21-condition list (MM2+, 21) and then from a reduced 6-condition list (MM2+, 6) and (b) using three or more conditions from each list (MM3+, 21, and MM3+, 6). Results. The analysis included 1,710 individuals (mean age 51.3, 40.5% men). Multimorbidity prevalence ranged from 63.8% (MM2+, 21 conditions) to 3.8% (MM3+, 6 conditions). The mean [95% CI] PCS dropped from 45.7 [CI: 45.0–46.3] (MM2+, 21) to 40.2 [CI: 38.7–41.8] (MM2+, 6) and from 44.2 [CI: 43.4–44.9] (MM3+, 21) to 34.8 [CI: 31.9–37.6] (MM3+, 6). Conclusion. The length of the list of candidate conditions considered has a great impact on the estimations of physical health-related quality of life.

Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees

BACKGROUND CONTEXT Low back pain (LBP) is a major public health problem, with a considerable impact on workers. PURPOSE To model the risk of LBP in the male general working population. STUDY DESIGN/SETTING Repeated cross-sectional surveys in a wide occupational setting. PATIENT SAMPLE A random sample of 2,161 men working in various occupations in a French region participated in a first survey in 2002, and 1,313 of these (60.8%) participated in a second survey in 2007. OUTCOME MEASURE The self-reported prevalence of LBP during the previous week in the second survey. METHODS Twenty-one biomechanical, organizational, psychosocial, and individual factors were assessed in the first survey. The association between these potential risk factors and the prevalence of later LBP (in the second survey) was studied, using multistep logistic regression models. RESULTS Three hundred ninety-four men reported LBP in the second survey (prevalence 30.0%). The final multivariate model highlighted four risk factors: frequent bending (odds ratio [OR], 1.45, 95% confidence interval [CI], 1.07-1.97 for bending forward only; and OR, 2.13, 95% CI, 1.52-3.00 for bending both forward and sideways), driving industrial vehicles (OR, 1.35; 95% CI, 1.00-1.81), working more hours than officially planned (OR, 1.38; 95% CI, 1.05-1.81), and reported low support from supervisors (OR, 1.35; 95% CI, 1.02-1.79). CONCLUSIONS These results emphasize that biomechanical factors remain worth considering, even when psychosocial factors are taken into account, and provide a significant contribution to preventive strategies.

Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study.

To examine the incidence and risk factors for incident thoracic spine pain (TSP) in workers representative of a French regions working population.

Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project

BACKGROUND Better insight into frequent comorbidities in patients with chronic (≥ 3 months) low back pain (LBP) may help general practitioners when planning comprehensive care for these patients. OBJECTIVE To prospectively study the prevalence of psychological, social, musculoskeletal and somatoform disorders in patients presenting with chronic non-specific LBP to general practitioners, in comparison to a contrast group of patients consulting in the same setting. METHODS This case-control study is embedded in a historical cohort, based on a primary care practice-based research network. All the health problems presented by the patients were prospectively coded according to the international classification of primary care between 1996 and 2013. The prevalence of psychological, social, musculoskeletal and somatoform disorders presented by the adult patients from 1 year before the onset of chronic LBP to 2 years after onset was compared to that of matched patients consulting without LBP, using conditional logistic regressions. RESULTS The 1511 patients with chronic LBP more often presented musculoskeletal disorders than the contrast group during the year before the onset of LBP and during the second year after it, with odds ratios (95%confidence intervals) of 1.39 (1.20-1.61) and 1.56 (1.35-1.81), respectively. They did not more often present psychological, social or non-musculoskeletal somatoform disorders. CONCLUSIONS General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning.

0188 Thoracic spinal pain prevalence in the musculoskeletal disorders surveillance network of the French Pays de la Loire region

Objectives Prevalence studies of thoracic spinal pain (TSP) in the working population are scarce. The epidemiological surveillance of musculoskeletal disorders (MSDs), implemented in 2002 by the French Institute for Public Health Surveillance, allows the study of the prevalence of TSP in a large sample of workers. The aim of this study is to present the prevalence of TSP during the preceding 7 days in the Pays de la Loire region’s workforce according to age, combination with low back pain and neck pain, occupational category and industry sector, separately in men and women. Method A random sample of 3710 workers (58% of men) aged 20–59 years, representative of the regional workforce, was constituted between 2002 and 2005. Medical and occupational data were gathered by questionnaire. Results The prevalence of TSP was higher among women (17.4%) than men (9.2%), without age difference. Only 15.2% of TSP in men and 15.7% in women was declared without low back pain or/and neck pain. Among men, lower-grade white-collar workers were more likely to report TSP (16.6%) than other occupational categories workers (upper white-collar and professionals: 7.2%, technicians/associate professionals: 6.5%, blue-collar workers: 9.7%). Among women, upper white-collar and professionals were more likely to report TSP (25.6%) than the others (technicians/associate professionals: 17.0%, lower-grade white-collar workers: 17.1%, blue-collar workers: 16.7%). The study did not suggest a significant difference in the prevalence of TSP according to sectors in either men or women. Conclusions This study shows that, among workers, TSP is frequent and often combined with low back pain or neck pain.

Facteurs associés à la lombalgie chez les hommes salariés des Pays de la Loire

Objectif : Les lombalgies ont des repercussions majeures sur le monde du travail. Un manque de donnees prospectives et representatives de la diversite des emplois limite l’analyse des facteurs de risque chez les travailleurs. L’objectif de cette etude etait d’estimer, a l’aide d’une modelisation, les facteurs associes a la lombalgie chez les salaries des Pays de la Loire.Methodes : Un echantillon aleatoire de salaries a fait l’objet de deux enquetes successives. La prevalence des lombalgies lors de la deuxieme enquete a ete modelisee, par regression logistique multi-etapes, a partir de facteurs de risque individuels et professionnels recueillis lors de la premiere enquete. Des analyses de sensibilite ont ete realisees. Les analyses ont ete stratifiees par sexe ; seuls les resultats pour les hommes sont presentes.Resultats : Parmi les 3 710 participants a la premiere enquete, 2 332 ont repondu a la deuxieme enquete, dont 1 313 hommes. La prevalence des lombalgies etait de 30 % chez les hommes. Des douleurs du cou ou des membres superieurs, se pencher frequemment et travailler plus que prevu etaient les facteurs de risque principaux de lombalgie ulterieure. L’association observee entre un faible soutien de la hierarchie et des lombalgies ulterieures devenait non significative dans une analyse restreinte aux salaries sans lombalgie lors de la premiere enquete.Conclusions : Le role des facteurs biomecaniques et organisationnels semble predominant sur celui des facteurs psychosociaux. Celui des facteurs individuels est d’interpretation delicate. Quelques limites methodologiques doivent etre discutees, mais l’analyse simultanee de multiples facteurs dans une population diversifiee de travailleurs constitue un apport original et utile pour des actions de prevention.Prat Organ Soins. 2011;42(3):157-68

Biomechanical constraints remain major risk factors for low back pain: results from a prospective cohort study in French male employees

Objectives Low back pain (LBP) has a major impact on work. Prospective data dealing with a wide range of jobs are needed to determine the main risk factors for workers. The objective of this study was to model the risk of LBP in the male general working population. Methods A random sample of 2161 men working in various occupations and industry sectors in the Pays de la Loire (West France) participated in a first survey in 2002. In 2007, 1313 of these (60.8%) participated in a second survey. The association between 21 biomechanical, organisational, psychosocial and individual risk factors (assessed in the first survey) and the prevalence of LBP (during the week preceding the second survey) was studied, using multi-step logistic regression models. Results 394 men reported LBP in the second survey (prevalence: 30.0%). The final multivariate model highlighted four risk factors for subsequent LBP: frequent bending (ORs 1.45; 95% CIs 1.07 to 1.97 for bending forward only, and 2.13; 1.52 to 3.00 for bending both forward and sideways), driving industrial vehicles (1.35; 1.00 to 1.81), working more hours than officially planned (1.38; 1.05 to 1.81), and reported low support from supervisors (1.35; 1.02 to 1.79). Conclusions Whereas current research on LBP mostly focuses on psychosocial issues, these results emphasise that biomechanical factors remain worth considering. Some methodological limitations are discussed, but the prospective analysis of numerous factors in a varied range of workers provides an original contribution to preventive strategies.

Psychosocial risk factors for transition from acute to chronic low back pain in primary care: a systematic review

European General Practice Research Network (EGPRN) Abstracts from the EGPRN meeting in Nice, France, 19-22 May, 2011. Theme: “ Relevant outcome measures in General Practices from the EGPRN meeting in Nice, France, 19-22 May, 2011. Theme: “ Relevant outcome measures in General Practice research into chronic diseases” European Journal of General Practice, 2011; 17: 171–189