Brona M. Fullen

The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review

It has been suggested that health care professional (HCP) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population.

The association between chronic low back pain and sleep: a systematic review.

ObjectivesChronic low back pain (CLBP) adversely affects many quality of life components, and is reported to impair sleep. The aim of this review was to determine the association between CLBP and sleep. MethodsThis review comprised 3 phases: an electronic database search (PubMed, Cinahl Plus, EMBASE, PsychInfo, Pedro, and Cochrane Library) identified potential articles; these were screened for inclusion criteria by 2 independent reviewers; extraction of data from accepted articles; and rating of internal validity by 2 independent reviewers and strength of the evidence using valid and reliable scales. ResultsThe search generated 17 articles that fulfilled the inclusion criteria (quantitative n=14 and qualitative n=3). CLBP was found to relate to several dimensions of sleep including: sleep disturbance and duration (n=15), sleep affecting day-time function (n=5), sleep quality (n=4), sleep satisfaction and distress (n=4), sleep efficiency (n=4), ability to fall asleep (n=3), and activity during sleep (n=3). Consistent evidence found that CLBP was associated with greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress. Inconsistent evidence was found that sleep efficiency and activity were adversely associated with CLBP. DiscussionMany dimensions of sleep are adversely associated with CLBP. Management strategies for CLBP need to address these to maximize quality of life in this patient cohort.

Prevalence of Musculoskeletal Disorders Among Farmers: A Systematic Review

OBJECTIVE To determine the prevalence of musculoskeletal disorders (MSDs) among farmers and to establish the most common regional MSDs reported. METHODS Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using keywords for MSDs and farmers. Pooled estimates of prevalence with 95% confidence intervals were calculated for overall MSD prevalence and the most common regional MSDs reported. RESULTS Twenty-four studies fulfilled the inclusion criteria and were incorporated into this review. From these studies, life-time prevalence of any form of MSD among farmers was 90.6% while 1-year MSD prevalence was 76.9% (95% CI 69.8-82.7). The majority of studies focused on spinal MSDs with low back pain (LBP) the most frequently investigated. Life-time LBP prevalence was 75% (95% CI 67-81.5) while 1-year LBP prevalence was 47.8% (95% CI 40.2-55.5). The next most common regional MSDs reported were upper (range 3.6-71.4%) and lower extremities (range 10.4-41%). CONCLUSIONS The systematic review identified the prevalence of MSDs by body region in farmers and established that LBP was the most common MSD, followed by upper and then lower extremity MSDs. Reported trends suggest that the prevalence of MSDs in farmers is greater than in non-farmer populations. Case-definition uniformity among MSD researchers is warranted. More studies are needed regarding upper and lower extremity MSDs, gender, workplace, and task context of MSDs.

Doctors' attitudes and beliefs regarding acute low back pain management: A systematic review

&NA; The aim of this systematic review was to determine the attitudes and beliefs of doctors to acute low back pain, and the factors that influence these. The review comprised three phases: a methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified potential papers; these were screened for inclusion criteria by two independent reviewers, the extraction of data and the rating of internal validity and strength of the evidence, using valid and reliable scales from accepted papers. Themes were then identified from the accepted literature. The search generated a total of 15 papers of both qualitative (n = 3) and quantitative (n = 12) methodologies. Themes that emerged included doctors’ attitudes and beliefs, and four factors that influenced attitudes and beliefs: doctors’ specialty, demographic factors, personal beliefs and education. There was consistent evidence that doctors’ specialty impacted their attitudes and beliefs: lack of consensus regarding the natural history of LBP, around treatment options, and issues regarding work. There was inconsistent evidence that demographic factors (age) and level of education impacted doctors’ attitudes and beliefs. Strategies to address/ modify these attitudes and beliefs are required, as in some cases they are at odds with guideline recommendations. Long term, these changes in these areas have the potential to maximise patient‐care, and reduce costs to health services.

Risk factors for musculoskeletal disorders among farm owners and farm workers: A systematic review†

BACKGROUND A systematic review was undertaken to establish risk factors for the development of musculoskeletal disorders (MSDs) among farmers. METHODS Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using a battery of key words for MSDs and farmers. The studies methods quality was assessed using a standardized checklist. RESULTS Thirty-three studies fulfilled the inclusion criteria. The median method score was 65% of the maximum attainable score, resulting in 15 studies of higher methodological. Risks were categorized into: Work characteristics (n = 11), personal characteristics (n = 5), and psychosocial factors (n = 5). Spinal MSD risk factors include exposure to working in tree crops, vibration, postural load, being an owner operator, age, education beyond high school, suffering from asthma or depression, having <8 hr nightly sleep, bad quality sleep, and geographic location. Upper extremity MSD risk factors include being an owner operator, dust with pig workers, numbness and coldness in younger milkers and numbness in milkers >43 years, age, and body height in dairy farmers. Lower extremity MSD risk factors include, duration of farming ≥10 years, working >5 hr daily in animal barns, milking >40 cows, years as a dairy farmer, farm work, age, body mass, and female gender. CONCLUSIONS In exploring risk factors the spine was the most researched body region, followed by lower and upper extremity. Given the variance between studies, it is recommended that future studies focus on specific types of farmers and should explore specific exposures for specific body parts using standardized case definitions.

Adherence of Irish general practitioners to European guidelines for acute low back pain: A prospective pilot study

There are no national low back pain (LBP) clinical guidelines in Ireland, and neither the level of adherence of General Practitioners (GPs) to the European guidelines, nor the cost of LBP to the patient and the state, have been investigated.

Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

Background. Self-management–based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). Methods. The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. Results. An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. Discussion. The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.

Factors impacting on doctors' management of acute low back pain: a systematic review.

The aim of this review was to determine the factors that impact on doctors’ management of patients with acute low back pain. A methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified papers which were screened for inclusion criteria by two independent reviewers. Data were extracted from accepted papers, and the internal validity and strength of the evidence were determined using valid and reliable scales.

The need for a national strategy for chronic pain management in Ireland.

BackgroundChronic pain is defined as pain on a daily basis for more than six months.1 It affects 13% of the Irish population.2 Despite its prevalence and the impact on patient’s quality of life there is no national strategy for this problem.AimTo determine the need for a national strategy for chronic pain in Ireland.MethodsThe cost of low back pain (LBP) (common chronic pain condition), the level of education and research and current chronic pain clinic resources were investigated.ResultsThe cost of LBP in Ireland is enormous: disability payments from the Department of Social and Family Affairs amounted to €348 million and insurance payments cost €10.5 million.The number of teaching hours timetabled for pain education in the schools of Medicine, Physiotherapy Dentistry, Nursing and Psychology in Ireland’s six universities varied significantly (e.g. 11.5-72 hrs in nursing). Research grants awarded from state organisations were limited to one over a four-year period. No current chronic pain clinics comply with recommended International Association for the Study of Pain (IASP) guidelines.3ConclusionA national strategy is needed to reduce costs, standardise teaching and increase pain clinic resources to maximise patient care.

Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis

Following spinal cord injury (SCI), chronic pain is a common secondary complication with neuropathic pain (NP) cited as one of the most distressing and debilitating conditions leading to poor quality of life, depression and sleep disturbances. Neuropathic pain presenting at or below the level of injury is largely refractory to current pharmacological and physical treatments. No consensus on the prevalence of NP post SCI currently exists, hence this systematic review was undertaken. The review comprised three phases: a methodological assessment of databases [PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Physiotherapy Evidence Database (PEDro)] identifying potential papers and screening for inclusion criteria by two independent reviewers; data extraction; and finally rating of internal validity and strength of the evidence, using a published valid and reliable scale. Meta‐analysis estimated pooled point prevalence rates using a random effects model. In total, 17 studies involving 2529 patients were included in the review. Overall point prevalence rates for NP were established at 53% (38.58–67.47); 19% (13.26–26.39) for at‐level NP and 27% (19.89–34.61) for below‐level NP, with high heterogeneity noted (I2 = 84–93%). Prevalence rates for NP following SCI are high. Future studies should include established definitions, classification systems and assessment tools for NP at defined time points post SCI to follow the trajectory of this problem across the lifespan and include indices of sleep, mood and interference to allow for appropriate, optimal and timely NP management for each patient.