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102. Mediators of Treatment Effect in the Back In Action Trial:Using Latent Growth Modeling to Take Change Over Time Into Account

Author

Mansell, Gemma, Hill, Jonathan C., Main, Chris J., Von Korff, Michael, and Van Der Windt, Daniëlle

Abstract

Objectives: To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome, and to test an analytical approach, latent growth modeling, not often applied to mediation analysis. Methods: Secondary analysis was carried out on a randomized controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n=119) with treatment as usual (n=121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fear-avoidance beliefs on disability outcome. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect. Results: A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardized indirect effect −0.35; bias-corrected 95% CI, −0.47 to −0.24). Poor fit of the model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway. Discussion: Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could use this approach.

Published
2017

103. Effects of Biopsychosocial Education on the Clinical Judgments of Medical Students and GP Trainees Regarding Future Risk of Disability in Chronic Lower Back Pain: A Randomized Control Trial.

Author

Dwyer, Christopher P, MacNeela, Pádraig, Durand, Hannah, O'Connor, Laura L, Main, Chris J, McKenna-Plumley, Phoebe E, Hamm, Robert M, Reynolds, Bronagh, Conneely, Sinéad, Slattery, Brian W, Taheny, Darragh, NicGabhainn, Saoirse, Murphy, Andrew W, Kropmans, Thomas, and McGuire, Brian E

Subjects
ACADEMIC medical centers, ATTITUDE (Psychology), CHRONIC diseases, COMPARATIVE studies, EMPATHY, FAMILY medicine, HEALTH attitudes, HOSPITAL medical staff, INTELLECT, JUDGMENT (Psychology), MEDICAL education, MEDICAL personnel, PSYCHOLOGY of medical students, PEOPLE with disabilities, RISK assessment, STATISTICAL sampling, SCHOOL environment, STUDENT attitudes, DECISION making in clinical medicine, RANDOMIZED controlled trials, PRE-tests & post-tests, PATIENTS' attitudes, LUMBAR pain, DISEASE complications
Abstract

Background Chronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians' adherence to biopsychosocial guidelines is low. Objective The current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients. Design Randomized controlled trial (trial registration number: ISRCTN53670726). Setting University classroom. Subjects Medical students and GP trainees. Methods Using 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31). Results Results revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research. Conclusions Short flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues. [ABSTRACT FROM AUTHOR]

Published
2020
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108. In memoriam: Professor Stephen J. Morley (1950-2017)

Author

Vlaeyen, Johan W, Vlaeyen, Johan W, Keefe, Francis J, Main, Chris J, Eccleston, Christopher, de C Williams, Amanda C, Vlaeyen, Johan W, Vlaeyen, Johan W, Keefe, Francis J, Main, Chris J, Eccleston, Christopher, and de C Williams, Amanda C

Published
2017

110. Early Patient Screening and Intervention to Address Individual-Level Occupational Factors ('Blue Flags') in Back Disability

Author

Shaw, William S, van der Windt, Danielle A, Main, Chris J, Loisel, Patrick, Linton, Steven J, 'Decade of the Flags\\' Working Group, and Vlaeyen, Johan

Subjects
business.industry, Rehabilitation, Psychological intervention, Prognosis, Occupational safety and health, Scientific evidence, Occupational Diseases, Social support, Health psychology, Occupational Therapy, Nursing, Conceptual framework, Back Pain, Risk Factors, Humans, Mass Screening, Medicine, Disabled Persons, Job satisfaction, Workplace, business, Occupational Health, Mass screening, Clinical psychology
Abstract

Objective To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability. Methods A 3-day conference workshop including 21 leading researchers and clinicians (the “Decade of the Flags Working Group”) was held to review the scientific evidence concerning clinical, occupational, and policy factors in back disability and the development of feasible assessment and intervention strategies. Results The Working Group identified seven workplace variables to include in early screening by clinicians: physical job demands, ability to modify work, job stress, workplace social support or dysfunction, job satisfaction, expectation for resuming work, and fear of re-injury. Five evaluation criteria for screening methods were established: reliability, predictive performance, feasibility, acceptability, and congruence with plausible interventions. An optimal screening method might include a stepped combination of questionnaire, interview, and worksite visit. Future research directions include improving available assessment methods, adopting simpler and more uniform conceptual frameworks, and tying screening results to plausible interventions. Discussion There is a clear indication that occupational factors influence back disability, but to expand clinician practices in this area will require that patient screening methods show greater conceptual clarity, feasibility, and linkages to viable options for intervention.

Published
2008

119. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care - the Management of OsteoArthritis In Consultations (MOSAICS) study protocol

Author

Dziedzic, Krysia S, primary, Healey, Emma L, additional, Porcheret, Mark, additional, Ong, Bie Nio, additional, Main, Chris J, additional, Jordan, Kelvin P, additional, Lewis, Martyn, additional, Edwards, John J, additional, Jinks, Clare, additional, Morden, Andrew, additional, McHugh, Gretl A, additional, Ryan, Sarah, additional, Finney, Andrew, additional, Jowett, Sue, additional, Oppong, Raymond, additional, Afolabi, Ebenezer, additional, Pushpa-Rajah, Angela, additional, Handy, June, additional, Clarkson, Kris, additional, Mason, Elizabeth, additional, Whitehurst, Tracy, additional, Hughes, Rhian W, additional, Croft, Peter R, additional, and Hay, Elaine M, additional

Published
2014
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121. Effects of workplace, family and cultural influences on low back pain : What opportunities exist to address social factors in general consultations?

Author

Shaw, William S., Campbell, Paul, Nelson, Candace C., Main, Chris J., Linton, Steven J., Shaw, William S., Campbell, Paul, Nelson, Candace C., Main, Chris J., and Linton, Steven J.

Abstract

Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation and disability, especially the effects of organisational support in the workplace, spousal support, family conflict and social disadvantage. A number of barriers exist to address such social factors in routine medical encounters for LBP, but there is emerging evidence that improving social and organisational support may be an effective strategy to reduce the negative lifestyle consequences of LBP. For clinicians to address these factors in LBP treatment requires a clearer psychosocial framework in assessment and screening, more individualised problem-solving efforts, more patient-centred interventions involving family, peers and workplace supports and a less biomechanical and diagnostic approach. (C) 2013 Elsevier Ltd. All rights reserved., Funding Agency:Scan/Design Foundation

Published
2013
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124. Do physical therapists change their beliefs, attitudes,knowledge, skills and behaviour after a biopsychosocially orientated university course?

Author

Overmeer, Thomas, Boersma, Katja, Main, Chris J., Linton, Steven J., Overmeer, Thomas, Boersma, Katja, Main, Chris J., and Linton, Steven J.

Abstract

Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour.MethodWe combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start.ResultsThe results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result.ConclusionA course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.

Published
2009
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132. Rehabilitation for chronic low back pain. (Letters)

Author

Bombardier, Claire, Karjalainen, Kaija, Malmivaara, Antti, Esmail, Rosmin, Guzman, Jaime, Main, Chris J., Williams, Amanda C de C, and Price, Cathy

Subjects
Backache -- Care and treatment, Health, Care and treatment
Abstract

Review was of little help in selecting treatment EDITOR--We have misgivings about the conclusions drawn by Guzman et al on multidisciplinary rehabilitation for chronic low back pain. (1) Low back [...]

Published
2001

134. Behavioural treatment for chronic low-back pain

Author

Henschke, Nicholas, primary, Ostelo, Raymond WJG, additional, van Tulder, Maurits W, additional, Vlaeyen, Johan WS, additional, Morley, Stephen, additional, Assendelft, Willem JJ, additional, and Main, Chris J., additional

Published
2010
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147. A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol

Author

Hay, Elaine M, primary, Dunn, Kate M, additional, Hill, Jonathan C, additional, Lewis, Martyn, additional, Mason, Elizabeth E, additional, Konstantinou, Kika, additional, Sowden, Gail, additional, Somerville, Simon, additional, Vohora, Kanchan, additional, Whitehurst, David, additional, and Main, Chris J, additional

Published
2008
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149. STarT Back Screening Tool

Author

Hill, Jonathan C., primary, Dunn, Kate M., additional, Lewis, Martyn, additional, Mullis, Ricky, additional, Main, Chris J., additional, Foster, Nadine E., additional, and Hay, Elaine M., additional

Published
2008
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