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Contains fulltext : 49338.pdf (Publisher’s version ) (Closed access) STUDY DESIGN: Prospective inception cohort study. OBJECTIVE: To investigate prospectively whether pain-related fear predicts future perceived disability and participation in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: There are indications that fear of movement/(re)injury, as measured by the Tampa Scale for Kinesiophobia, is present early in an episode of LBP, and that it might be a predictor of future perceived disability and participation. METHODS: A cohort of 555 patients with acute LBP included by general practitioners and physical therapists in primary care settings was followed for 6 months. RESULTS: Results indicate that baseline fear of movement/(re)injury was predictive of future perceived disability and, to a lesser extent (and together with duration and radiation), of participation. CONCLUSIONS: The results suggest that interventions aimed at reducing pain-related fear in the acute stage of LBP might prevent restrictions of activity and participation because of pain, and might be a way of preventing the transition from acute to chronic LBP.

Contains fulltext : 47397.pdf (Publisher’s version ) (Closed access) STUDY DESIGN: Data were derived from a randomized controlled trial on the (cost-) effectiveness of the implementation of the clinical guidelines on physiotherapy for low back pain in primary care. OBJECTIVES: To describe the course of low back pain in patients who are referred to physiotherapy, to identify clinically important prognostic factors on different outcomes, and to evaluate the influence of different statistical techniques in developing a prognostic model. SUMMARY OF BACKGROUND DATA: Several studies have aimed to identify prognostic factors for low back pain in primary care. These studies focused on different outcome measures and used various statistical techniques. METHODS: Primary outcomes were perceived recovery, improvement in pain, improvement in functioning, and presence of disabling low back pain at 3 and 12 months follow-up. Multivariate logistic regression analyses were performed for each outcome variable. Two cut-off points were used to determine significance with respect to the univariate analysis, and two selection methods were used to build the final multivariate models. The resulting prognostic models were compared. RESULTS: A total of 500 patients were included. Pain and disability reduced considerably in the first 3 months, but further reduction was only modest. Prognostic factors varied for different outcomes, but the duration of the current episode was included in all models generated. Varying the statistical techniques also resulted in a different prognostic model with some change to the amount of variance explained. CONCLUSIONS: A substantial proportion of patients still experienced some pain and disability at 12 months follow-up. The most stable predictor of prognosis in low back pain was the duration of the current episode. The choice of statistical method influenced the final model; however, changes in the explained variance were small.

Contains fulltext : 47629.pdf (Publisher’s version ) (Closed access) STUDY DESIGN: Cluster randomized controlled trial for a multifaceted implementation strategy. OBJECTIVES: To assess the effectiveness of tailored interventions (multifaceted implementation strategy) to implement the Dutch low back pain guideline for general practitioners with regard to adherence to guideline recommendations. SUMMARY OF BACKGROUND DATA: Guidelines for the management of low back pain in primary care have been developed in various countries, but little is known about the optimal implementation strategy. A multifaceted implementation strategy was developed to overcome identified barriers to the implementation of the Dutch low back pain guideline for general practitioners. METHODS: General practitioners were randomized to an intervention or a control group. The general practitioners in the intervention group (n = 21) received tailored interventions consisting of the Dutch low back pain guideline for general practitioners, a 2-hour educational and clinical practice workshop; two scientific articles on low back pain management; the guideline for occupational physicians; a tool for patient education; and a tool for reaching agreement on low back care with physical, exercise, and manual therapists. The control group (n = 20) received no intervention. The participating general practitioners were asked to recruit consecutive patients with a new episode of low back pain as the main reason for consultation. General practitioners completed registration forms of each individual consultation with regard to the main outcome measures: advice and information, referral to other health-care providers, and prescription of medication. RESULTS: Forty-one of the 67 randomized general practitioners reported on a total of 616 consultations for 531 patients with nonspecific low back pain. The advice and explanation provided by the general practitioners, the prescription of paracetamol or nonsteroidal anti-inflammatory drugs, and prescription of pain medication on atime contingent or a pain contingent basis showed no statistically significant differences between the intervention and control groups. There were also no differences in overall referral rate. However, in follow-up consultations fewer patients were referred to a physical or exercise therapist by the general practitioners in the intervention group than in the control group. CONCLUSIONS: The multifaceted intervention strategy modestly improved implementation (for parts of the recommendations in) the Dutch low back pain guideline by general practitioners and produced small concomitant changes in patient management. The implementation strategy produced fewer referrals to therapists during follow-up consultations.

Item does not contain fulltext STUDY DESIGN: A clinical practice guideline. OBJECTIVES: To assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with whiplash-associated disorders Grades I and II. SUMMARY OF BACKGROUND DATA: Whiplash constitutes a considerable problem in health care. Many interventions are used in physiotherapy practice, despite increasing evidence for the use of active interventions. There is still no clinical practice guideline for the management of patients with whiplash-associated disorders. METHOD OF DEVELOPMENT: A computerized literature search of Medline, Cinahl, Cochrane Controlled Trial Register, Cochrane Database of Systematic Reviews, and the Database of the Dutch National Institute of Allied Health Professions was performed to search for information about the diagnostic process and the therapeutic process in whiplash patients. When no evidence was available, consensus between experts was achieved to develop the guideline. Practicing physiotherapists reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. RECOMMENDATIONS: The diagnostic process consists of systematic history taking and a physical examination supported by reliable and valid assessment tools to document symptoms and functional disabilities. The primary goals of treatment are a quick return to normal activities and the prevention of chronicity. Active interventions such as education, exercise therapy, training of functions, and activities are recommended according to the length of time since the accident and the rate of recovery. The biopsychosocial model is used to address the consequences of whiplash trauma. CONCLUSIONS: Scientific evidence for the diagnosis and physiotherapeutic management of whiplash is sparse; therefore, consensus is used in different parts of the guideline. The guideline reflects the current state of knowledge of the effective and appropriate physiotherapy in whiplash patients. More and better research is necessary to validate this guideline in the future.

Study design A systematic review of the literature. Objectives To assess the efficacy of conservative treatment in patients with whiplash injuries. Summary of background data Many treatments are available for patients with whiplash injury, but there continues to be no evidence for their accepted use. Methods A computerized literature search of Medline, Embase, Cinahl, Psychlit, and the Cochrane Controlled Trial Register was performed. Studies were selected if the design was a (randomized) clinical trial; if all patients had sustained a whiplash injury; if the type of intervention was a conservative one; if pain, global perceived effect, and participation in daily activities were used as one of the outcome measures, and if the publication was written in English, French, German, or Dutch. The methodologic quality was independently assessed by two reviewers by using the Maastricht-Amsterdam list. Three quality scores were calculated using this criteria list: the Overall Methodologic Quality Score, the Internal Validity Score, and the Delphi Quality Score. The conclusion of the review was based on articles that scored a quality score of at least 50% of the maximum available score on two of three quality scores. Results Eleven studies met the inclusion criteria. Only three studies satisfied at least 50% on two of three ways of calculating a quality score, indicating overall poor methodology. There was a high rank correlation among the three ways of calculating a quality score. No statistical pooling was performed because of the heterogeneity of the interventions. This review indicates that active treatments show a beneficial long-term effect on at least one of the primary outcome measures. Conclusion Caution is needed when drawing a valid conclusion on the efficacy of conservative treatments in patients with whiplash injury. It appears that "rest makes rusty," whereas active interventions have a tendency to be more effective in patients with whiplash injury.