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Introduction The COVID-19 pandemic, with associated pressures on healthcare services and workforce, had implications for final year Diagnostic Radiography students completing their training and transitioning into employment. The aim of this study was to explore their experience as novice practitioners starting work and integrating into the workforce during a time of national crisis. Methods Five early career Diagnostic Radiographers, eligible to join the temporary HCPC register, were recruited. One to one interviews were completed online exploring their thoughts, feelings and experiences. Participants had the option of using photographs to aid communication. Results Interviews were transcribed, emerging themes identified and coded. Four main themes emerged specifically related to the COVID-19 pandemic, (i) perceived challenges associated with joining the workforce, (ii) managing expectations and unexpected outcomes during transition, (iii) adapting to changes in systems and structures, (iv) sense of uncertainty relating to professional identity. The impacts were experienced beyond the work environment into social and personal lives. Participants demonstrated resilience as they adapted to their shifting lives and drew on the support of clinical colleagues and University academics for help. They did report feelings of concern and anxiety. The participants all expressed a sense of feeling valued and supported in their new roles. Conclusion The Pandemic was unprecedented and created uncertainty in terms of workforce requirements. This study highlights the personal impact and professional responses of novice practitioners, who felt a sense of duty and care to help support the NHS and others. Implications for practice This will help in the understanding of the transition of student into employment and what wider support needs to be in place prior, during and after this phase.

ObjectiveThe objective of this systematic review was to explore the incidence of lower limb injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players who are under 18 years old. The review sought to identify the mechanisms and types of injury sustained and to compare between sports. DesignThis systematic review of the literature focussed on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball (rugby union, rugby league, soccer, Australian Rules and Gaelic football). A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. Prospective cohort studies, retrospective studies, longitudinal studies and epidemiology studies written in English were included. The Standard Quality Assessment Criteria appraisal tool¹ was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers. ResultsSixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1) and these studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55,882 participants, aged 7 – 19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports. Summary Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury.

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.

Background - Telementored ultrasound (US) connects experts to novices through various types of communication and network technologies with the overall aim to bridge the medical imaging gap between patients’ diagnostic needs and on-site user experience. The recurrent theme in previous research on remote telementored US is the limited access to US machines and experienced users. This study was conducted to determine whether telementored US was feasible in a remote offshore setting. The aim was to assess if an onshore US expert can guide an offshore nurse through focused US scanning protocols by connecting an US machine to existing videoconference units at the offshore hospitals and to evaluate the diagnostic quality of the images and cineloops procured. Results - The diagnostic quality of cineloops was scored on a five-point scale. The percentage of cineloops suitable for interpretation (score 3 ≥) for the FATE and e-FAST protocols was 96.4 and 79.1. Lung sliding and seashore sign could be identified in all volunteers. The scan time for the FAST protocol (n = four scanning positions), FATE protocol (n = six scanning positions) and both lungs (n = two scanning positions) was 1 min 20 s, 4 min 15 s and 32 s, respectively. Conclusion - A novice US user can be guided by a remote expert through focused US protocols within an acceptable time frame and with good diagnostic quality using existing communication and network systems found onboard offshore oil rigs.

Purpose eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions. Methods Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity–based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach. Results Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting. Conclusions Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation. Implications for Cancer Survivors There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.

Background Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor response to treatment. There is little research exploring physical therapists' perspectives on the management of the syndrome. Objectives The study objective was to investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. Design This was a qualitative focus group study. Methods Three 60- to 90-minute focus group sessions containing 6 to 8 experienced musculoskeletal physical therapists (total number=20) were conducted. Thematic content analysis was used to analyze transcripts and develop core themes and categories. Results Exercise was seen as key in the management of SAIS. The overarching theme was the need to “gain buy-in to exercise” at an early stage. The main subtheme was patient education. Therapists identified the need to use education about SAIS etiology to foster buy-in and “sell” self-management through exercise to the patient. They consistently mentioned achieving education and buy-in using visual tools, postural advice, and sometimes a “quick fix” of pain control. Furthermore, experienced practitioners reported including educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises, including: scapular stabilization; rotator cuff, lower trapezius, and serratus anterior muscle strengthening; and anterior shoulder and pectoralis minor muscle stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patients performed. Limitations Expanding the geographical area over which the focus groups were conducted and including therapists with less than 5 years of postgraduate experience may have strengthened the findings of this study. Conclusion Experienced musculoskeletal physical therapists believe that exercise is central in treating patients with SAIS and that gaining patient buy-in to its importance, patient education, promoting self-management, and postural advice are central to the successful treatment of people with SAIS.

Firefighting remains a dangerous job and those employed face many challenges to health, safety and wellbeing. The risks faced range from immediate threat to life and limb to long term, repeated exposure to hazardous environments and arduous working conditions. Many of these hazards can be mitigated by recording exposure to risks, processing risk data, improving information flow and increasing situational awareness. Cyber-physical systems and interactive smart wearables offer a smart and seamless suite of tools that can help achieve these goals and allow emergency responders to work more efficiently and safely. Here we examine how data from wearable devices can be used to improve health, safety and wellbeing of the firefighter.

Low back pain (LBP) has high lifetime prevalence with nonspecific LBP representing the majority of cases.(1) Relapses in pain (60%) and work absences (33%) are common,(1) making LBP one of the most costly conditions in the United Kingdom (total cost of £STG12,300 million, with the cost of informal care and production losses related to LBP contributing £STG10,668 million of this total figure).(2) Current research evidence supports the use of exercise- based treatment approaches for chronic low back pain (CLBP; pain persisting for at least 12 wk); in the United Kingdom, supervised group-based exercise programs are recommended, along with advice to stay physically active.(3) There is no specific guidance on how to self-direct participants to maintain or increase their physical activity (PA), although Savigny et al(3) refer to the National Institute for Clinical Health and Excellence (NICE) guidance on methods to increase PA.(4) One of the interventions identified in this review (NICE, 2006), was pedometer-driven walking, which can incorporate features considered important for increasing PA, that is, professional guidance, self-direction, and on-going professional support.(5) The evidence to support walking in people with CLBP is promising(6,7); however, it is not yet clear what approach works best. Hartvigsen et al(8) showed that supervised Nordic walking was as effective as unsupervised Nordic walking, and a trial by some of the current research team(9) is currently investigating the effects of a structured walking program according to ACSM guidelines (30 min, 5 times/ wk). Other approaches for promoting PA have advocated the use of step targets driven by a pedometer, for example, 10,000 steps, which can be accumulated throughout the day in bouts of at least 10 minutes, and where 3000 steps approximates to 30 minutes of walking.(10) It is not clear whether such an approach would be suitable for people with LBP, for example, in terms of how many steps they should or could accumulate, and what risks might be associated with this approach for this clinical population. No trial to date has investigated the use of a pedometer driven walking program in people with CLBP.(7) Therefore as a first step, before implementing a main RCT, we designed a preliminary study to test the feasibility of delivering a pedometer-driven walking program as an adjunct to a standard education/advice session in people with CLBP.(11) Our specific objectives were to: Assess recruitment and adherence rates in education/ advice (E) and education/advice plus pedometer-driven walking program (EWP) groups. Determine the incidence of adverse events (AEs), including musculoskeletal injuries, and level of overall satisfaction in both groups. Make between and within group comparisons and estimate effect sizes for changes in functional disability, PA levels, stage of change, fear avoidance, self-efficacy, health-related quality of life, psychosocial beliefs, general health, and participant satisfaction.

OBJECTIVE:To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS).METHODS:A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)).RESULTS:Sixteen studies were included (n = 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD -0.46 (-0.76, 0.16); P = 0.003) and a small positive effect on long-term function (SMD -0.31 (-0.57, 0.04); P = 0.02).CONCLUSIONS:Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes.

Purpose: People with a stoma believe that there is a link between their surgery and low back pain (LBP). Aim: To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP. Methods: Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA).Results: The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5–13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87–5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity. Discussion: Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of backpain. These results should be viewed with caution due to the small sample size.

Background: pain is a problem in society as a whole. Previous work has shown that people with a stoma also develop back pain, but it was not known how this back pain was managed. Aim: To investigate how adults in Northern Ireland with either an ileostomy or colostomy managed their back pain at home. Methods: A postal questionnaire survey was sent to people with either an ileostomy or colostomy in Northern Ireland (n?=?1322). The questionnaire included questions regarding the back pain experience (frequency and severity of pain), related disability and the strategies used in managing back pain, which is the focus of this paper. The questions regarding the management of low back pain were in one of three 5-point Likert scale formats depending on the question. Results: Of the 1322 people approached, 895 (67.7%) questionnaires were returned. One hundred and sixty (17.9%) were either blank or incomplete and were, therefore, not included in the analysis. Analysis was carried out on 735 completed questionnaires. There were no statistically significant differences between men and women in whether they managed their back pain by themselves, or sought help from various healthcare professionals. Women more than men, and those with a colostomy rather than an ileostomy, were more likely to have issues regarding back pain. Neither stoma group believed that changing their posture or activities would help the back pain. This has implications for back care education. Conclusion: Many people with a stoma have back pain, and this is managed in a variety of ways. There is no clear evidence regarding the best or most effective method of managing back pain in this group of people, and further research is ongoing into this important and novel area of research.

Purpose. To investigate whether low back pain (LBP) is a problem for people with a stoma.Method. Following ethical approval, a postal questionnaire was sent to the Ileostomy Association of Northern Ireland (n¼402).Results. The response rate was 81.6%. Two hundred ninety three (72.8%) were included in the analysis. The participants fell into three groups: those who never had LBP (n=102, 34.8%), those who had LBP but not within the last 6 months (n=26, 8.9%) and those who had LBP within the last 6 months (n¼165, 56.3%). Participants with LBP (n=165)compared the ease with which they could carry out everyday tasks: ‘before’ and ‘since’ surgery. There was a mean increased difficulty of between 1.75 and 2.26 points across all tasks. The Roland Morris Disability Questionnaire scores ranged from 0 to 24 with 50% having a score of 8/24 or higher. Some participants (n=76, 46.1%) believed that the stoma surgery was the reason for their back pain, followed by 27.9% (n=46) blaming weak muscles. Others (53.3%) thought their back pain was worsening. There was a significant rise in the incidence of first episode back pain within a year of surgery.Conclusions. These results suggest that LBP is a problem for people with a stoma.

A systematic review of randomized controlled trials (RCTs).To explore the evidence for the effectiveness of acupuncture for nonspecific low back pain (LBP).Since the most recent systematic reviews on RCTs on acupuncture for LBP, 6 RCTs have been published, which may impact on the previous conclusions.Searches were completed for RCTs on all types of acupuncture for patients with nonspecific LBP published in English. Methodologic quality was scored using the Van Tulder scale. Trials were deemed to be high quality if they scored more than 6/11 on the Van Tulder scale, carried out appropriate statistical analysis, with at least 40 patients per group, and did not exceed 20% and 30% dropouts at short/intermediate and long-term follow-up, respectively. High quality trials were given more weight when conducting the best evidence synthesis. Studies were grouped according to the control interventions, i.e., no treatment, sham intervention, conventional therapy, acupuncture in addition to conventional therapy. Treatment effect size and clinical significance were also determined. The adequacy of acupuncture treatment was judged by comparison of recommendations made in textbooks, surveys, and reviews.Twenty-three trials (n = 6359) were included and classified into 5 types of comparisons, 6 of which were of high quality. There is moderate evidence that acupuncture is more effective than no treatment, and strong evidence of no significant difference between acupuncture and sham acupuncture, for short-term pain relief. There is strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy for nonspecific LBP, but the effectiveness of acupuncture compared with other forms of conventional therapies still requires further investigation.Acupuncture versus no treatment, and as an adjunct to conventional care, should be advocated in the European Guidelines for the treatment of chronic LBP.

Stoma surgery is very often a life−saving procedure that allows the recipient to experience greatly improved quality of life and there are many specific issues that the recipient learns to deal with, such as the management and care of a stoma. However, to date, there seems to be little research in the wider quality of life issues, particularly low back pain. This is somewhat surprising, as it is well known (from the work of Hodges, Lee, McGill, O′Sullivan and others), that abdominal muscles play a vital role in maintaining a healthy and strong back (Hodges, 1999), and these are the very muscles that are (arguably) most affected by the stoma surgery.

Background: Pain is one of the primary motivations for patients to seek medical advice. Pain location is one element in the process of formulating a diagnosis.Aims: The purpose of the study is to determine if there is a correlation between the location of pain and the location of pathology in the knees of patients with a suspected meniscus tear.MethodsFrom a possible 856 patients referred for arthroscopy, 213 patients consented to be included in the study and 193 (90 %) completed the study. The participating subjects located area of their symptoms on a diagram showing the four aspects of the knee joint. For analysis purposes symptoms were grouped into medial, lateral, posterior, or a combination of these areas. Pathology identified at arthroscopy was recorded on the International Knee Documentation Committee (IKDC) surgical form. The location of knee pathology was divided into medial compartment, lateral compartment or combinations of pathologies. Locations of pain were analysed for an association with the location of pathology found at arthroscopy.ResultsOf the 193 subjects who completed the study, 69 (35.7 %) of the subjects presented with one location of pain i.e. medial, lateral or posterior pain and the remaining 124 (64.3 %) had multiple areas. In correlating locations of reported pain with pathology, there was no significant correlation found (p = 0.98).Conclusions:This study found no direct correlation between the location of pain and the location of pathology in the knee in patients with a suspected meniscus tear.

Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active. Methods/Design The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial. Discussion This paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain. Trial Registration [ISRCTN67030896]

Summary Objectives To investigate the difference in acupuncture treatment regimens for low back pain (LBP) among textbooks, clinical studies and clinical practice, and explore reasons for such differences. Methods A systematic review of textbooks, surveys, clinical studies (randomised controlled trials (RCTs) and case studies) published in English or Chinese, was conducted, plus Chinese expert opinions. Data on detailed acupuncture treatment regimens were extracted. Results 12 textbooks in English, 31 textbooks in Chinese, 3 surveys in English, no surveys in Chinese, 9 Chinese expert opinions, 25 RCTs in English, 29 RCTs in Chinese, and 38 case studies in English were included. For chronic non-specific LBP, the outstanding differences in regimens found were (irrespective of the approach of acupuncture): (i) clinical studies and surveys (9–11 points) reported the use of many more points per session than Chinese experts (5 points); (ii) two extreme frequencies of treatments were used across all sources (1–2 times/week vs. 5–6 times/week). For acute LBP, the notable differences between RCTs and case studies were: (i) a variety of special points were investigated; (ii) case studies reported the use of many more points per session (10 points) than RCTs in Chinese (2 points); (iii) RCTs in Chinese administrated more treatments (6.5 sessions) than RCTs in English (3.5 sessions) and case studies (3 sessions). Conclusion For non-specific LBP, treatment regimens of acupuncture differ by the types of reference sources, in terms of treatment frequency, the points chosen, number of points needled per session, duration and sessions, and co-interventions.

OBJECTIVES: To examine the feasibility of a main RCT to compare the effectiveness of two frequencies (2 versus 5 times/week) of acupuncture treatment for chronic low back pain (LBP). METHODS: Participants (n=30) with chronic LBP were randomised into two groups to receive 10 acupuncture treatments: Low Frequency Group, 2 times/week for five weeks (n=15); High Frequency Group, 5 times/week for two weeks (n=15). The following outcomes were measured blindly at baseline, 2 weeks, 5 weeks, 3 months and 1 year: pain on a VAS, functional disability using the RMDQ, quality of life using the Measure Yourself Medical Outcome Profile (MYMOP-2), psychological impact with the Coping Strategies Questionnaire (CSQ) and Pain Locus of Control (PLC) questionnaire. Two objective outcomes, the Shuttle Walk Test (SWT) and Lateral Trunk Flexibility (LTF), were also measured. RESULTS: The compliance rate was 100% for each group. Some of the measurements were shown to be sensitive (VAS, RMDQ, MYMOP-2 Wellbeing). 66-330 participants would be required for a fully powered non-inferiority trial. The groups were balanced at baseline for LBP and demographic characteristics. There were no significant differences between the groups in terms of any of the outcomes, at each follow-up time point. It was notable however that the clinically important improvement in terms of pain, functional disability, quality of life, and SWT in both groups was achieved within the first two weeks, which was maintained at one year follow-up. CONCLUSIONS: It is feasible to conduct a main RCT, to compare different frequencies of acupuncture for LBP, using sensitive measurements. Also the trend for early clinically important improvement within a minimum of four measurements is worthy of further study.

Purpose Low back pain (LBP) is a major health problem in western society. Stoma surgery, which involves creating a permanent opening in the abdominal wall, may interfere with the function of the abdominal muscles. Therefore people with a stoma may be at greater risk of developing LBP. A literature review revealed no research exploring a possible link between stoma formation and LBP, nor any study involving patients' perceptions. Therefore, the aims of this study were to determine (1) whether people with a stoma have LBP, (2) whether people with LBP and a stoma perceive that the conditions are linked, and (3) what issues regarding LBP should be included in a large survey of persons with a stoma. Methods Members of the Ileostomy Association of Northern Ireland volunteered to participate in a focus group study. Events from this group were recorded, transcribed, and validated. Thematic analysis was performed. Results Three themes were identified: (1) the presence of LBP, (2) a perceived link between LBP and a stoma, and (3) relevant issues for LBP. Ten of the 11 participants had experienced at least one episode of LBP, however 5 (50%) emphasized that they did not have a back problem. Six participants had no LBP prior to their surgery, but have experienced episodes of LBP since. The majority thought that the stoma and their LBP experience were linked. Suggested reasons for this link were changes in muscle strength, posture, and activities. Others included having an epidural or a pouching system that did not optimally suit their needs. Conclusions The results suggest that LBP is a problem for some people with an abdominal stoma and support the need for further study in this population. Two possible areas of future study are an investigation of what the term low back pain means to this population, and further study of the mechanisms that may link stoma surgery to an increased risk of LBP.

A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain (LBP). As part of this, the study was designed to establish the credibility of the placebo control, and to provide data to inform a power analysis to determine numbers for a future trial.A pilot patient and assessor blinded randomized controlled trial.Primary care health centre facility, South and East Belfast Trust, Northern Ireland.Patients from the physiotherapy waiting list (n=48) with LBP of less than 12 weeks duration.Roland and Morris Disability Questionnaire (RMDQ), Visual Analogue Scale (VAS), medication use and an exit questionnaire were completed at baseline, end of treatment, and at 3 months follow up.Ninety-four percent (45/48) of patients completed assigned treatment, 83% (40/48) completed 3 months follow-up. The sham needle used here proved to be credible: 91.7% in the placebo group believed they had received acupuncture, compared to 95.8% in the verum acupuncture group. Differences in baseline characteristics were accounted for using ANCOVA. There was no significant difference between groups on the RMDQ over time. For pain, the only statistically significant difference was at the 3 months follow up (worst VAS, point estimate, 18.7, 95% CI 1.5-36.0, p=0.034). The majority of patients were taking some form of analgesic medication for LBP at the start of treatment (n=44; 92%), and at the end of treatment the verum acupuncture group were taking significantly fewer tablets of pain control medication (mean (S.D.): 1.0+/-0.3) than the placebo group (mean (S.D.): 4.2+/-0.6, p0.05). Based upon these data, power analysis (power=90%, alpha=0.05, minimal clinically important difference (MCID) for RMDQ=2.5 points) indicated that 120 participants (60 per group) would be needed to complete an adequately powered randomized controlled trial.This study has demonstrated the feasibility of a randomized controlled trial of penetrating needle acupuncture compared to a non-penetrating sham for the treatment of acute LBP in primary care; 120 participants would be required in a fully powered trial. The placebo needle used in this study proved to be a credible form of control.

Objectives: This two-phase study was designed to establish the current use of acupuncture within physiotherapy and to determine the opinions of those who received acupuncture therapy. Design: Retrospective study and questionnaire survey. Patients: Patients who attended an outpatient physiotherapy department over a 2-year period (phase 1, retrospective study of clinical records; n =599). Patients who had received acupuncture treatment from outpatient physiotherapy (phase 2, patient survey; n =200). Main outcome measure: Patient records and questionnaire. Results: The patients who attended for outpatient physiotherapy were categorized into three main groups: low back pain, cervical/thoracic spine problems and soft-tissue injuries of peripheral joints. Acupuncture appeared to be used as a secondary form of treatment for these conditions, where other modalities failed rather than being used for best effect. The response rate to the questionnaire was 78%, of whom 60% stated that they had experienced pain relief following their acupuncture therapy, and 31% were still experiencing pain relief. The majority had achieved sufficient relief to carry out daily activities at home (80%) and at work (57%). Ninety-four per cent of respondents were either ‘satisfied' or ‘very satisfied' with their treatment. Conclusion: Further investigation is required to adequately assess the efficacy of acupuncture as a pain-relieving modality.

The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma.To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy.A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy.Over half (56.7%, n = 417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when 'today' was compared with 'before surgery'. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy.Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.