Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial

Christian Longtin, Simon Décary, Chad E Cook, Marc O Martel, Sylvie Lafrenaye, Lisa C Carlesso, Florian Naye, Yannick Tousignant-Laflamme, Christian Longtin, Simon Décary, Chad E Cook, Marc O Martel, Sylvie Lafrenaye, Lisa C Carlesso, Florian Naye, Yannick Tousignant-Laflamme

Abstract

Introduction: Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings.

Methods: This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures.

Results: Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05).

Conclusion: These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness.

Trial registration: Clinicaltrial.gov: NCT03949179.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study flowchart.
Fig 1. Study flowchart.
Fig 2. Percentage of patients categorized in…
Fig 2. Percentage of patients categorized in the different categories of each domain of the PDDM.

References

    1. Donelson R, McIntosh G, Hall H. Is it time to rethink the typical course of low back pain? PM&R J Inj Funct Rehabil. 2012;4: 394–401. 10.1016/j.pmrj.2011.10.015
    1. Driscoll T, Jacklyn G, Orchard J, Passmore E, Vos T, Freedman G, et al. The global burden of occupationally related low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73: 975–981. 10.1136/annrheumdis-2013-204631
    1. Vos T, Allen C, Arora M, Barber RM, Brown A, Carter A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388: 1545–1602. 10.1016/S0140-6736(16)31678-6
    1. Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010;303: 1295–1302. 10.1001/jama.2010.344
    1. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299: 656–664. 10.1001/jama.299.6.656
    1. Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: A systematic review and meta-analysis. Spine J. 2014;14: 2299–2319. 10.1016/j.spinee.2014.01.026
    1. Karayannis N V, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet Disord. 2012;13: 24 10.1186/1471-2474-13-24
    1. Rabey M, Smith A, Beales D, Slater H, O’Sullivan P. Multidimensional Prognostic Modelling in People with Chronic Axial Low Back Pain. Clin J Pain. 2017;33: 877–891. 10.1097/AJP.0000000000000478
    1. Rabey M, Beales D, Slater H, O’Sullivan P. Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems. Man Ther. 2015;20: 138–147. 10.1016/j.math.2014.07.015
    1. World Health Organization. International classification of functioning, disability and health. Geneva, Switzerland; 2001.
    1. Escorpizo R. Defining the principles of musculoskeletal disability and rehabilitation. Best Pract Res Clin Rheumatol. 2014;28: 367–375. 10.1016/j.berh.2014.09.001
    1. Tousignant-Laflamme Y, Martel MO, Joshi A, Cook C. Rehabilitation management of low back pain—it’s time to pull it all together! J Pain Res. 2017;Volume 10: 2373–2385.
    1. Tousignant-Laflamme Y, Cook CE, Mathieu A, Naye F, Wellens F, Wideman T, et al. Operationalization of the new Pain and Disability Drivers Management model: A modified Delphi survey of multidisciplinary pain management experts. J Eval Clin Pract. 10.1111/jep.13190
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: Extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2: 1–32. 10.1186/s40814-015-0043-x
    1. Caetano R. Standards for reporting non-randomized evaluations of behavioral and public health interventions: The TREND statement. Addiction. 2004;99: 1075–1080. 10.1111/j.1360-0443.2004.00785.x
    1. Abbott JH. The Distinction Between Randomized Clinical Trials (RCTs) and Preliminary Feasibility and Pilot Studies: What They Are and Are Not. J Orthop Sports Phys Ther. 2014;44: 555–558. 10.2519/jospt.2014.0110
    1. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17: 1–13. 10.1186/s12913-016-1943-z
    1. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344: 363–70. 10.1056/NEJM200102013440508
    1. Furlan AD, Pennick V, Bombardier C, Van Tulder M. 2009 Updated method guidelines for systematic reviews in the cochrane back review group. Spine (Phila Pa 1976). 2009;34: 1929–1941. 10.1097/BRS.0b013e3181b1c99f
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10: 1–10. 10.1186/1471-2288-10-1
    1. Chiarotto A, Terwee CB, Ostelo RW. Choosing the right outcome measurement instruments for patients with low back pain. Best Pract Res Clin Rheumatol. 2016;30: 1003–1020. 10.1016/j.berh.2017.07.001
    1. Chiarotto A, Boers M, Deyo R, et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain. 2018;159: 481–495. 10.1097/j.pain.0000000000001117
    1. Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the Brief Pain Inventory for chronic nonmalignant pain. J Pain. 2004;5: 133–137. 10.1016/j.jpain.2003.12.005
    1. Freynhagen R, Baron R, Gockel U, Tölle TR. pain DETECT: A new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22: 1911–1920. 10.1185/030079906X132488
    1. Mayer T, Neblett R, Cohen H. The development and psychometric validation of the central sensitization inventory. Pain …. 2012;12: 276–285. 10.1111/j.1533-2500.2011.00493.x
    1. Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement Properties of the Central Sensitization Inventory: A Systematic Review. Pain Pract. 2018;18: 544–554. 10.1111/papr.12636
    1. Beneciuk JM, Bishop MD, Fritz JM, Robinson ME, Asal NR, Nisenzon AN, et al. The STarT Back Screening Tool and Individual Psychological Measures: Evaluation of Prognostic Capabilities for Low Back Pain Clinical Outcomes in Outpatient Physical Therapy Settings. Phys Ther. 2013;93: 321–333. 10.2522/ptj.20120207
    1. Linton SJ, Nicholas M, Macdonald S. Development of a Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire. 2011;36: 1891–1895.
    1. Marin R, Cyhan T, Miklos W. Sleep disturbance in patients with chronic low back pain. Am J Phys Med Rehabil. 2006;85: 430–435. 10.1097/01.phm.0000214259.06380.79
    1. Alsaadi SM, McAuley JH, Hush JM, Lo S, Bartlett DJ, Grunstein RR, et al. The Bidirectional Relationship Between Pain Intensity and Sleep Disturbance/Quality in Patients With Low Back Pain. Clin J Pain. 2014;30: 755–765. 10.1097/AJP.0000000000000055
    1. Dersh J, Gatchel RJ, Mayer T, Polatin P, Temple OR. Prevalence of psychiatric disorders in patients with chronic disabling occupational spinal disorders. Spine (Phila Pa 1976). 2006;31: 1156–1162. 10.1097/01.brs.0000216441.83135.6f
    1. Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10: 1–7. 10.1186/1471-2288-10-1
    1. Décary S, Longtin C, Naye F, Tousignant-laflamme Y. Train on the High-Value Track. J Orthop Sport Phys Ther. 2020;50: 118–120. 10.2519/jospt.2020.0603
    1. Edwards RR, Dworkin RH, Turk DC, Angst MS, Dionne R, Freeman R, et al. Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations. Pain. 2016;157: 1851–1871 10.1097/j.pain.0000000000000602
    1. Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O’Sullivan P, O’Sullivan K. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review. J Physiother. 2015;61: 68–76. 10.1016/j.jphys.2015.02.016
    1. Singla M, Jones M, Edwards I, Kumar S. Physiotherapists’ assessment of patients’ psychosocial status: Are we standing on thin ice? A qualitative descriptive study. Man Ther. 2015;20: 328–334. 10.1016/j.math.2014.10.004
    1. Holopainen MR, Simpson MP, Piirainen DA, Karppinen PJ, Schütze DR, Smith PA, et al. Physiotherapists’ perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. Pain. 2020.
    1. Artus M, van der Windt DA, Jordan KP, Hay EM. Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: A systematic review of randomized clinical trials. Rheumatology. 2010;49: 2346–2356. 10.1093/rheumatology/keq245

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner