Leah Phillips

Workers' perspectives on low back pain recurrence: ''It comes and goes and comes and goes, but it's always there''

&NA; Although various measures of low back pain (LBP) recurrence have been proposed, none have been tested to determine if they are consistent with what those with LBP perceive a “recurrence” to be. To further the understanding of LBP recurrence and how to measure it, we examined how individuals with a history of LBP describe their back pain experiences. A qualitative approach was chosen and six mixed‐gender focus groups were conducted. Discussions were facilitated by two researchers and structured around predetermined questions. All four authors were involved in the data analysis and thematic congruence was achieved through an iterative process of coding and discussion. Participants included 31 individuals (14 female, 17 male), with ages ranging from early 20s to mid 70s. When asked about LBP recurrence, participants had difficulty understanding the concept. There was a sense that, although the pain may disappear, the condition was always there. Three states were defined: “normal,” “flared‐up,” and “attack.” “Normal” could include experiencing pain, but generally represented a tolerable state. “Flared‐up” was associated with increased pain, the use of strategies to overcome difficulties, and modified participation. “Attack” state was described as severely disabled: “I just have to lay there.” Participants described their experiences in a way that is consistent with the idea that LBP is a fluctuating and disabling health condition. Results cast doubt on the validity of currently available measures of LBP recurrence. Focusing on recurrence of pain without consideration of broader contextual factors will result in an incomplete understanding of the meaning of the pain experience.

Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis

IntroductionCentralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA).MethodsPhase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety. Phase 2 involved literature reviews to ensure KPIs were based on best practices and harmonized with existing measures. Phase 3 involved a three-round, online modified Delphi panel to finalize the KPIs. The panel consisted of two rounds of rating and a round of online and in-person discussions. KPIs rated as valid and important (≥7 on a 9-point Likert scale) were included in the final set.ResultsTwenty-five KPIs identified and substantiated during Phases 1 and 2 were submitted to 27 panellists including healthcare providers, managers, researchers, and patients in Phase 3. After the in-person meeting, three KPIs were removed and six were suggested. The final set includes 9 OA KPIs, 10 RA KPIs and 9 relating to centralized intake processes for both conditions. All 28 KPIs were rated as valid and important.ConclusionsArthritis stakeholders have proposed 28 KPIs that should be used in quality improvement efforts when evaluating centralized intake for OA and RA. The KPIs measure five of the six dimensions of quality and are relevant to patients, practitioners and health systems.

Combative Sports Injuries: An Edmonton Retrospective.

Objective:Mixed martial arts (MMA) is an increasingly popular combative sport involving aggressive techniques that present substantial injury risk. We examined the incidence and types of injuries sustained in MMA fights and compared this with injuries sustained in boxing matches. Design:Consecutive Case Series. Setting:We used data from post-fight medical examinations on all bouts in Edmonton, Canada, between 2000 and 2013. Participants:The participants were 1181 MMA competitors and 550 boxers. Main Outcome Measures:The attending physician conducted a mandatory post-fight examination of all fighters and documented the nature of injuries sustained. Results:Boxers were significantly more likely not to experience injury (49.8% vs 59.4%, P < 0.001), whereas MMA fighters were significantly more likely to experience 1 injury (typically contusion/bruising, P < 0.001). Boxers were more likely to experience loss of consciousness (7.1% vs 4.2%, P = 0.01) and serious eye injury (1.1% vs 0.3%, P = 0.02). Conclusions:The overall injury incidence in MMA competitors appears slightly higher than for boxers, but MMA fighters experience more minor contusion/bruising injuries. Boxers are more likely to experience serious injury such as concussion/head trauma involving loss of consciousness or eye injury such as retinal detachment.

Non-pharmacological sleep interventions for youth with chronic health conditions: A critical review of the methodological quality of the evidence

Purpose: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. Method: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. Results: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Conclusions: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research. Implications for Rehabilitation Methodological Quality of Sleep Research Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as bright light therapy, activity, massage and behavioral interventions are promising areas. No studies found reasons that a trail of a NPSI matched to the youth’s context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists’ and parents’ needs is required.

Using genetic programming to discover nonlinear variable interactions

Psychology has to deal with many interacting variables. The analyses usually used to uncover such relationships have many constraints that limit their utility. We briefly discuss these and describe recent work that uses genetic programming to evolve equations to combine variables in nonlinear ways in a number of different domains. We focus on four studies of interactions from lexical access experiments and psychometric problems. In all cases, genetic programming described nonlinear combinations of items in a manner that was subsequently independently verified. We discuss the general implications of genetic programming and related computational methods for multivariate problems in psychology.

Pain coping in injured workers with chronic pain: what's unique about workers?

Purpose: Pain caused by a work injury is a complex phenomenon comprising multiple factors, e.g. age, gender, prior health status, occupation, job demands, and severity of injury. Little research has focused on injured workers with chronic pain. This study investigates injured workers’ pain coping. Methods: A descriptive cross-sectional study design was used to measure coping strategies of injured workers in a work rehabilitation program. Differences in coping strategies by demographics, injury-related variables, pain, disability, and depression were measured. Results: n = 479. The coping strategy with the highest mean score was “coping self statements” (Mean = 19.4, SD = 7.6), followed by “praying/hoping” (Mean = 18.2, SD = 9.7), and “catastrophizing” (Mean = 17.5, SD = 8.0). Statistical differences for coping strategies were noted between gender, marital status, depression levels, self-perceived disability levels, and pain (p < 0.01 for all). Conclusions: This study provided relevant information about how injured workers cope with pain. In conditions in which there may be a perceived lack of control (high pain intensity, high self-perceived disability, and high self rated depression), there were significantly higher amounts of both “catastrophizing” and “praying and hoping”. Therefore, workers with high pain and high self-perceived disability are more likely catastrophize their pain, leading to poor recovery outcomes. Implications for Rehabilitation Depression is common in injured workers with chronic pain. Depressed injured workers use more catastrophizing to cope with pain and this may lead to poor recovery. Perceived control over pain could be a mitigating factor in recovery from an occupational injury. Workers with high ratings of pain and high perceived disability often catastrophize their pain and this could lead to poor recovery outcomes.

Focus on pediatric intentional trauma.

BACKGROUND: Based on our previous study, pediatric intentional trauma injuries with Injury Severity Scores (ISS) ≥12 were more commonly observed in the urban than the rural setting (15.2% vs. 5.5%) in Alberta from 1996 to 2006. We wish to understand differences between urban and rural pediatric intentional trauma to plan for prevention and supportive strategies. METHODS: Data were extracted from the Alberta Trauma Registry on pediatric patients (0–17 years) with ISS ≥12, treated from 1996 to 2010 at the Stollery Childrens Hospital. Statistical analysis was made comparing urban versus rural groups using t test and &khgr;2 with p < 0.05 considered significant. RESULTS: There were 170 pediatric patients who suffered intentional injury (urban = 58.3%; rural = 41.8%; not significant), with a majority of males (72.4%). Two groups were predominant: the very young (<1 year) at 17.1% of all injuries and the teens (≥15 years) at 54.1%. The cause of intent injury was child abuse (31.2%), assault with blunt object (24.6%), assault with a sharp object (22.9%), and suicide (18.2%). The mean ISS was 22.9 ± 7.8 standard deviation. Tragically, 29 patients (17.1%) died. There were no differences between urban and rural pediatric trauma in terms of age, gender, cause of injury, ISS, survival, length of stay, pediatric intensive care unit length of stay, number of operations needed, or alcohol. CONCLUSION: An important pattern of intentional injuries can be seen where preventative efforts can be strengthened regardless of urban or rural area: the very young as shaken baby cases and the teens, who unfortunately, accounted for the majority of suicidal attempts. LEVEL OF EVIDENCE: II.

Urban vs rural pediatric trauma in Alberta: where can we focus on prevention?

PURPOSE Understanding differences between rural and urban pediatric trauma is important in establishing preventative strategies specific to each setting. METHODS Data were extracted from a Provincial Pediatric Trauma Registry on pediatric patients (0-17 years) with Injury Severity Scores (ISS) 12 or more, treated from 1996 to 2006 at 5 major trauma centers in the province. Urban and rural patients were compared with respect to demographic data, as well as injury type and severity. Statistical analysis was made using SPSS software (SPSS Inc, Chicago, Ill) by chi(2), Fishers Exact test, or t test with P < .05 considered significant. RESULTS Of n = 2660, 63.3% rural patients predominate; mean ISS was 22.5. However, rural patients had more severe injuries (ISS, 23.2 vs 21.8; P < .0001). Blunt trauma was the most common mechanism overall (urban, 89.6%; rural, 93.2%), with most being motor vehicle accidents (MVAs). Significantly, more penetrating trauma occurred in the urban setting (5.4% vs 2.6%; P < .0001). Intent injuries were more common in the urban setting (15.2% vs 5.5%). Of the patients, 89.2% survived the trauma. However, urban patients had a higher rate of death than rural ones (13.0% vs 10.5%; P < .05). CONCLUSION Despite the finding that rural patients sustained more severe injuries, overall survival was actually better when compared with urban patients. Most injuries were blunt trauma, suggesting road safety should be the main target in prevention strategies. Intent injuries were much higher in the urban group, thus, a need to target violence in urban prevention strategies.

The impact of fatal pediatric trauma on aboriginal children

BACKGROUND/PURPOSE Injuries are the leading cause of death in young people. Our aim is to examine the differences between aboriginal and non-aboriginal pediatric trauma mortality as a means to focus on prevention strategies. METHODS The records for all traumatic pediatric (0-18 years) deaths between 1996 and 2010 were reviewed from the regional Medical Examiners office. RESULTS The majority of the total 932 pediatric deaths were the result of non-intentional injuries (640) followed by suicide (195), homicide (65), child abuse (15), and undetermined (17). Despite being only 3.3% of the provincial population, Aboriginals represented 30.9% of pediatric trauma fatalities. Aboriginal fatalities occurred most commonly in the home, with males and females equally affected. Road related events were the main causes of injury overall. Up to three-quarters of Aboriginal children who died in a non-pedestrian road related event did not wear an indicated protective device. Pedestrian deaths were over-represented in Aboriginal children. The second most common cause of death was suicide for both non-Aboriginal and Aboriginal children. Almost half of all of the suicides were Aboriginal. Homicide and child abuse had similar proportions for both non-Aboriginal and Aboriginal children. CONCLUSION Pediatric Aboriginal injury prevention should be a priority and tailored for Aboriginal communities.

Scope of practice review: providers for triage and assessment of spine-related disorders.

Purpose This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers’ legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals’ scope of practice. Results Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice.