Cyril Bègue

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.

Efficiency of three treatment strategies on occupational and quality of life impairments for chronic low back pain patients: is the multidisciplinary approach the key feature to success?

Objective: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. Methods: A monocentric randomized controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. Results: A total of 159 patients (58.9% men, 41.5 ± 10.3 years old, median duration of sick leave = 221.0 days (127.5–319.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. Conclusion: This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care. Clinical Trial registration: NCT02030171

Factors influencing physiotherapists’ attitudes and beliefs toward chronic low back pain: Impact of a care network belonging

ABSTRACT Objectives: To assess the attitudes and beliefs of physiotherapists (PTs) regarding the management of chronic LBP and to investigate the factors which influence them. Methods: A cross-sectional study conducted in the French Loire Valley region by a questionnaire sent to the private PTs between June and September 2014. Demographic data and modalities of practices were collected in association with the Pain Attitudes and Beliefs Scale (PABS) which is a specific self-administered questionnaire designed to assess the “biomedical” or “behavioral” (i.e., biopsychosocial) management orientation of PTs toward chronic LBP. Results: One hundred and sixty-eight of the 704 PTs entirely completed the questionnaire (63% of men, 58% >40 years of age) of whom 15 were involved in a LBP care network. A higher biomechanical score was observed with a higher age and lower with full-time employment, less than 20 years of length of practice and a recent LBP-specific training (p < 0.005). Belonging to a LBP care network was associated with a lower biomedical score (p < 0.01) and a higher biopsychosocial score (p < 0.005). Conclusions: Belonging to a LBP care network, which implies closer collaboration with multidisciplinary rehabilitation teams, was the most significant factor associated with higher biopsychosocial beliefs in PTs toward chronic LBP management.

Interprofessional Communication Concerning Work-Related Musculoskeletal Disorders: A Qualitative Study

Purpose Understanding and treating musculoskeletal disorders (MSDs) requires coordination between the numerous healthcare professionals involved, including occupational physicians (OPs), general practitioners (GPs) and social insurance physicians (SIPs). The main objective of this study was to assess communication between OPs, GPs and SIPs in the management of MSDs. Methods This is a qualitative study in the form of semi-structured interviews with OPs in the French region of Brittany. The interviews were conducted until data saturation was achieved. The interviews were fully coded and analysed thematically using NVivo® software. Results The interviews were carried out among 17 OPs from companies and external occupational healthcare services who treated employees from various activity sectors. Different communication channels were used depending on the interlocutor, though they were mainly contacted by mail or phone. Most of the communication passed through the patient, either verbally or in writing. No major failure was detected in communication between the various types of practitioners, but instances of communication were influenced by various factors such as differences in perception, representation and objectives, as well as by how well the physicians knew each other. A number of instances of non-communication were found. Conclusion This study showed that patients play a key role in the interactions between different practitioners. It also revealed that different types of professional relationships depend on the objectives of the various interlocutors, which in turn vary according to their roles and competences.