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Background: Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of risk factors might contribute to a better understanding of the course of LBP., Objectives: To investigate the association of habitual physical activity (PA) and sedentary behaviour (SB), measured at baseline, with disability trajectories in adults with LBP., Methods: A prospective cohort study where habitual PA levels were measured using the Short QUestionnaire to ASsess Health enhancing physical activity (SQUASH), SB was calculated as average sedentary hours per day, and LBP disability using the Oswestry Disability Index (ODI). Participants completed the questionnaires at one and a half, three, six, and twelve months. Linear mixed models were estimated to describe the association of habitual PA levels SB measured at baseline with disability trajectories. Other predictors were gender, education level, age, pain, number of previous episodes of LBP, and duration of LBP., Results: Habitual SB measured at baseline in adults (n = 347) with LBP were not associated with disability trajectories. For PA, participants with one metabolic equivalent of task (MET) hour per day above average recovered 0.04 [95% CI 0.004 to 0.076] points on the ODI per month faster than participants with an average amount of MET hours per day., Conclusions: Habitual SB was not associated with LBP disability trajectories over a one-year follow-up. High levels of habitual PA at baseline were associated with improved recovery in LBP disability trajectory, but the finding is not clinically relevant., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. No funding received for this received., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain., Methods: This is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up., Results: A medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up., Conclusion: The SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain., Trial Registration: Clinicaltrials.gov: 109,643., (© 2024. The Author(s).)

Rationale: Adherence rates to guidelines show room for improvement, and increase in adherence to guidelines may potentially lead to better outcomes and reduced costs of treatment. To improve adherence, it is essential to understand the considerations of physiotherapists regarding the assessment and management of low back pain (LBP). The purpose of this study is to gain insight in the considerations of Dutch physiotherapists on adherence to the national physiotherapy guideline in the treatment of patients with LBP., Methods: This is a qualitative study, using an interpretive approach of semi-structured interviews with 14 physiotherapists who regularly treat patients with LBP. Thematic analysis was conducted with open coding using an existing framework. This framework distinguishes five components to adherence based on patient factors, provider factors, guideline characteristics, institutional factors and the implementation process., Results: Participating physiotherapists mentioned that the guideline should provide more information about psychosocial prognostic factors and psychosocial treatment options. The participants experienced difficulties in addressing patient expectations that conflict with guideline recommendations. The implementation process of the guideline was considered insufficient. Physiotherapists might rely too much on their experience, and knowledge of evidence-based treatment might be improved. In general, the interviewed physiotherapists thought they were mainly non-adherent to the guidelines. However, when comparing their considerations with the actual guideline recommendations they were mainly adherent., Conclusion: To improve adherence, the guideline should provide more information about addressing psychosocial prognostic factors, and Dutch physiotherapists might be trained in communication skills to better address patient expectations. A more extensive implementation process is warranted for the next guideline to increase the physiotherapists' knowledge of evidence-based treatment., (© 2022 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Purpose: Imaging (X-ray, CT and MRI) provides no health benefits for low back pain (LBP) patients and is not recommended in clinical practice guidelines. Whether imaging leads to increased costs, healthcare utilization or absence from work is unclear. Therefore, this study systematically reviews if imaging in patients with LBP leads to an increase in these outcomes., Methods: We searched PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science until October 2017 for randomized controlled trials (RCTs) and observational studies (OSs), comparing imaging versus no imaging on targeted outcomes. Data extraction and risk of bias assessment was performed independently by two reviewers. The quality of the body of evidence was determined using GRADE methodology., Results: Moderate-quality evidence (1 RCT; n = 421) supports that direct costs increase for patients undergoing X-ray. Low-quality evidence (3 OSs; n = 9535) supports that early MRI may lead to an increase in costs. There is moderate-quality evidence (1 RCT, 2 OSs; n = 3897) that performing MRI or imaging (MRI or CT) is associated with an increase in healthcare utilization (e.g., future injections, surgery, medication, etc.). There is low-quality evidence (5 OSs; n = 15,493) that performing X-ray or MRI is associated with an increase in healthcare utilization. Moderate-quality evidence (2 RCTs; n = 667) showed no significant differences between X-ray or MRI groups compared with non-imaging groups on absence from work. However, low-quality evidence (2 Oss; n = 7765) did show significantly greater mean absence from work in the MRI groups in comparison with the non-imaging groups., Conclusions: Imaging in LBP may be associated with higher medical costs, increased healthcare utilization and more absence from work. These slides can be retrieved under Electronic Supplementary Material.

Background: A cross-sectional observational study of three-dimensional cervical kinematics in 35 non-specific neck pain patients and 100 asymptomatic controls. To compare qualitative and quantitative aspects of cervical kinematics between healthy subjects and subjects with non-specific neck pain and to determine the effect of age on cervical kinematics in healthy subjects., Methods: Three-dimensional kinematics of active lateral bending and flexion-extension of 35 patients and 100 controls were registered by means of an electromagnetic tracking system. The means of several kinematic parameters were compared using t-tests. In addition, we assessed the age-dependency of the three-dimensional kinematic parameters by stratifying the 100 control subjects in 6 age categories., Findings: Comparison of the patient group with the control group reveals no statistically significant differences in qualitative and quantitative parameters. Analysis of the effect of age showed that the range of motion decreases significantly (p < 0.01) with increasing age. In lateral bending, the ratio between axial rotation and lateral bending increases significantly (p < 0.01) among older subjects. Differences in acceleration, jerk and polynomial fit are seen between the age categories, but are not significant., Interpretation: This study demonstrates no significant differences in kinematic parameters between healthy subjects and subjects with non-specific neck pain. Healthy subjects in higher age categories demonstrate higher ratios of coupled movements and lower ranges of motion. Future research should focus on classifying patients with non-specific neck pain in order to gain a better insight on possible subgroup specific differences in kinematics. More studies on this subject are warranted., Level of Evidence: 4., (Copyright © 2018 Elsevier Ltd. All rights reserved.)