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Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Prevalence of low back pain (LBP) rises rapidly during adolescence, reaching adult levels by the age of 18. It has been suggested that adolescent LBP is benign with minimal impact, despite limited evidence. Methods The aim of this study was to investigate the impact of LBP and the influence of chronicity, gender and presence of other spinal pain comorbidities at age 17. Subjects (n = 1283) were categorised according to experiencing current and chronic LBP, gender and presence of other areas of spinal pain. LBP impact was ascertained via questions regarding seeking professional assistance, using medication, missing school/work, limited normal or recreational physical activity and health related quality of life (HRQOL). Results 12.3% of participants reported current but not chronic LBP, while 19.9% reported current chronic LBP. LBP was more commonly reported by females than males. Other spinal pain comorbidities were common in the LBP groups. Impact was greater in subjects with chronic LBP, in females and in those with other spinal pain comorbidities. Conclusion LBP, and particularly chronic LBP, has a significant negative impact at 17 years. It is commonly associated with care seeking, medication use, school absenteeism, and reduced HRQOL. These findings support that adolescent LBP is an important public health issue that requires attention.

Background: Emerging evidence suggests that although care pathways for people with low back pain (LBP) improve health outcomes, there is a limited adoption/uptake of these pathways in primary care. To help identify and/or explain barriers and facilitators to implementation, research study designs applying a mixed methods approach including robust qualitative methodology may provide a more comprehensive understanding of patient health outcomes and patient perceptions of care. Methods: A systematic search of MEDLINE, OVID EMBASE, Cumulative Index to Nursing and Allied Health Literature and Scopus (1980–2020) was conducted to identify relevant mixed methods, quantitative and qualitative studies. Results: Three hundred and sixteen articles were screened for inclusion, with a total of 12 articles (1 mixed methods and 11 quantitative) included in the review. No solely qualitative studies were found. Broadly, patients reported overall improved health outcomes and higher satisfaction using the care pathway. In the mixed methods study, engaging patients in aspects of care were reported to be challenging. Further, while patient health outcomes (quantitative) and patient experiences of the care pathway (qualitative—free‐text survey responses) were presented separately, a lack of detailed convergence/triangulation of the data limits conclusions that could inform implementation into clinical settings. Conclusion: Data supported the positive effect of care pathways on patient health outcomes, yet investigation of the patient experience was limited. Only one study used a mixed methods design and then only used free‐text survey responses for the qualitative component. Future efforts to integrate LBP care pathways into primary care may benefit from using mixed methods design with an emphasis on robust qualitative methodology. [ABSTRACT FROM AUTHOR]

Background: Associations between inflammatory conditions and low back pain (LBP) have been found frequently in older populations. However, the nature of these relationships in younger populations is unknown. This study aimed to investigate the associations between early life chronic or recurrent inflammatory conditions and impactful LBP in adolescence and young adulthood. Methods: In this longitudinal study, we used data from the Raine Study Gen2 participants at the 1, 2, 3, 5, 8, 10, 14, 17, 20 and 22‐year follow‐ups (N = 2,868). Data were collected on inflammatory conditions from 1 to 22 years of age and occurrences of impactful LBP from 14 to 22 years of age. Longitudinal and cross‐sectional associations between inflammatory conditions and impactful LBP occurrence were examined. Potential dose–response relationships between the number of inflammatory conditions and impactful LBP were also assessed. Logistic regression models were used in the analysis. Results: Participants with respiratory or atopic conditions during childhood had increased odds of future impactful LBP in adolescence and young adulthood (odds ratio (OR) [95% confidence interval (CI)] = 1.29 [1.07, 1.54] and 1.23 [1.02, 1.49], respectively). There were cross‐sectional associations between inflammatory conditions including respiratory, skin, musculoskeletal, autoimmune and atopic conditions, with impactful LBP. Participants with two illnesses and three or more illnesses had an increased odds (OR [95% CI] =1.68 [1.30, 2.18] and OR [95% CI] =2.12 [1.54, 2.89], respectively) of reporting impactful LBP. Conclusions: Overall, longitudinal and cross‐sectional associations of respiratory and atopic conditions with impactful LBP in adolescence and young adulthood were identified. More evidence is needed to determine whether there is a causal relationship between chronic inflammatory conditions and impactful LBP. Significance: Low back pain (LBP) is a prominent and significant health problem and associations between inflammatory conditions and LBP have been found frequently in older populations. We found that children with respiratory or atopic conditions and those with several chronic inflammatory conditions are at increased odds of impactful LBP in adolescence and young adulthood. In clinical practice and future research, there is a need to consider comorbidities also in younger populations. [ABSTRACT FROM AUTHOR]

This study was a case series design. The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test. The ASLR test is a valid and reliable tool to assist in the assessment of load transference through the pelvis. Irregular respiratory patterns, decreased diaphragmatic excursion and descent of the pelvic floor have been reported in subjects with SIJP during this test. To date the ability to alter these patterns has not been determined. Respiratory patterns, kinematics of the diaphragm and pelvic floor during the ASLR test and the ability to consciously elevate the pelvic floor in conjunction with changes in pain and disability levels were assessed in nine subjects with a clinical diagnosis of SIJP. Each subject then undertook an individualized motor learning intervention. The initial variables were then reassessed. Results showed that abnormal kinematics of the diaphragm and pelvic floor during the ASLR improved following intervention. Respiratory patterns were also influenced in a positive manner. An inability to consciously elevate the pelvic floor pre-treatment was reversed. These changes were associated with improvement in pain and disability scores. This study provides preliminary evidence that aberrant motor control strategies in subjects with SIJP during the ASLR can be enhanced with a motor learning intervention. Positive changes in motor control were associated with improvements in pain and disability. Randomized controlled research is required to validate these results.

The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP disorders have no identified pathoanatomical basis leaving a management vacuum. Diagnostic and treatment paradigms for PGP disorders exist although many of these approaches have limited validity and are uni-dimensional (i.e. biomechanical) in nature. Furthermore single approaches for the management of PGP fail to benefit all. This highlights the possibility that 'non-specific' PGP disorders are represented by a number of sub-groups with different underlying pain mechanisms rather than a single entity. This paper examines the current knowledge and challenges some of the common beliefs regarding the sacroiliac joints and pelvic function. A hypothetical 'mechanism based' classification system for PGP, based within a biopsychosocial framework is proposed. This has developed from a synthesis of the current evidence combined with the clinical observations of the authors. It recognises the presence of both specific and non-specific musculoskeletal PGP disorders. It acknowledges the complex and multifactorial nature of chronic PGP disorders and the potential of both the peripheral and central nervous system to promote and modulate pain. It is proposed that there is a large group of predominantly peripherally mediated PGP disorders which are associated with either 'reduced' or 'excessive' force closure of the pelvis, resulting in abnormal stresses on pain sensitive pelvic structures. It acknowledges that the interaction of psychosocial factors (such as passive coping strategies, faulty beliefs, anxiety and depression) in these pain disorders has the potential to promote pain and disability. It also acknowledges the complex interaction that hormonal factors may play in these pain disorders. This classification model is flexible and helps guide appropriate management of these disorders within a biopsychosocial framework. While the validity of this approach is emerging, further research is required.

Pelvic girdle pain (PGP) disorders are complex and multi-factorial and are likely to be represented by a series of sub-groups with different underlying pain drivers. Both the central and peripheral nervous systems have the potential to mediate PGP disorders. Even in the case of a peripheral pain disorder, the central nervous system can modulate (to promote or diminish) the pain via the forebrain (cognitive factors). It is hypothesised that the motor control system can become dysfunctional in different ways. A change in motor control may simply be a response to a pain disorder (adaptive), or it may in itself promote abnormal tissue strain and therefore be 'mal-adaptive' or provocative of a pain disorder. Where a deficit in motor control is 'mal-adaptive' it is proposed that it could result in reduced force closure (deficit in motor control) or excessive force closure (increased motor activation) resulting in a mechanism for ongoing peripheral pain sensitisation. Three cases are presented which highlight the multi-dimensional nature of PGP. These cases studies outline the practical clinical application of a classification model for PGP and the underlying clinical reasoning processes inherent to the application of this model. The case studies demonstrate the importance of appropriate classification of PGP disorders in determining targeted intervention directed at the underlying pain mechanism of the disorder.