Stated versus observed performance levels in patients with chronic low back pain

This study examined the relationship between chronic low back pain (CLBP) patients' perceived (stated) levels of function and their measured (observed) performance in squatting and stair climbing activities as compared to healthy volunteers. Twenty patients with CLBP and 20 healthy subjects were asked through an interview to self-assess their ability to comfortably perform stair climbing and squatting as well as other tolerances. The subjects were then asked to perform the activities and their performance levels were recorded. Results of the t-tests and Analysis of Variance (ANOVA) procedures revealed that patients' estimate of squatting and stair climbing abilities as well as their demonstrated levels were significantly lower (p < 0.001) than those of the healthy subjects. There was a significant difference between groups in terms of the time required to perform squatting but not stair climbing. Both healthy subjects and patients with CLBP underestimated their physical capabilities. Findings indicate that the use of actual performance measurement combined with self-report of functional abilities is needed when assessing performance levels of both healthy as well as patients with CLBP.

Effect of conflicting advice on return to work in patients with low back pain

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Effect of conflicting advice on return to work in patients with low back pain

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Pain, Disability, and Art: A Response to Verpaelst

Réponse à - travail créatif / Response to - Creative work

IMPLEMENTING BACK PAIN TREATMENT PATHWAYS IN CLINICAL PRACTICE: QUALITATATIVE ANALYSIS OF STAKEHOLDER PERCEPTIONS

Background
Evidence-based practice advocates utilising best current research evidence, while reflecting patient preference and clinical expertise in decision making. Successfully incorporating this evidence into practice is a complex process. Based on recommendations of existing guidelines and systematic evidence reviews conducted using the GRADE approach, treatment pathways for common spinal pain disorders were developed.

Aims
The aim of this study was to identify important potential facilitators to the integration of these pathways into routine clinical practice.

Methods
A 22 person stakeholder group consisting of patient representatives, clinicians, researchers and members of relevant clinical interest groups took part in a series of moderated focus groups, followed up with individual, semi-structured interviews. Data were analysed using content analysis.

Results
Participants identified a number of issues which were categorized into broad themes. Common facilitators to implementation included continual education and synthesis of research evidence which is reflective of everyday practice; as well as the use of clear, unambiguous messages in recommendations. Meeting additional training needs in new or extended areas of practice was also recognized as an important factor. Different stakeholders identified specific areas which could be associated with successful uptake. Patients frequently defined early involvement in a shared decision making process as important. Clinicians identified case based examples and information on important prognostic indicators as useful tools to aiding decisions.

Conclusion
A number of potential implementation strategies were identified. Further work will examine the impact of these and other important factors on the integration of evidence-based treatment recommendations into clinical practice.

Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Study of Patients' Experiences in Decision Making

Background The culture of current clinical practice calls for collaboration between therapists and patients, sharing power and responsibility. This paper reports on the findings of a qualitative study of exercise prescription for patients with NSCLBP, taking into account issues such as decision making and how this accords with patient preferences and experiences. Objective To understand the treatment decision making experiences, information and decision support needs of patients with NSCLBP who have been offered exercise as part of their management plan. Design A qualitative study using a philosophical hermeneutic approach. Methods Semi-structured interviews with eight patients (including use of brief patient vignettes) was undertaken to explore their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their care. Findings The findings provide a detailed insight into patients’ perceptions and experiences of receiving exercise-based management strategies. Four themes were formed from the texts: (1) patients’ expectations and patients’ needs are not synonymous, (2) information is necessary but often not sufficient, (3) not all decisions need to be shared, and (4) wanting to be treated as an individual. Conclusions Shared decision making did not appear to happen in physiotherapy clinical practice, but equally may not be what every patient wants. The overall feeling of the patients was that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute to the decision making.