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PURPOSE To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care. METHODS We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). RESULTS We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability ([beta], -2.94; 95% CI, -3.63 to -2.24; P[less than or equal to].001), pain ([beta], -0.88; 95% CI, -1.18 to -0.57; P[less than or equal to].001), perceived effect of treatment ([beta], 1.40; 95% CI, 0.97 to 1.82; P[less than or equal to].001), and health-related quality of life ([beta], 0.11; 95% CI, 0.08 to 0.14; P[less than or equal to].001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC. https://doi.org/10.1370/afm.3104, INTRODUCTION Low back pain (LBP) is a high-burden health problem worldwide, and its management represents a serious challenge for health systems. (1-4) The burden caused by LBP is mainly explained [...]

Introduction: Despite growing research, the relationship between social determinants of health (SDoH) and low back pain (LBP) remains inconsistent. This study aimed to investigate the associations between SDoH and self‐reported LBP in the Portuguese population in 2019 and explore potential differences between rural and urban areas. Methods: This is a cross‐sectional study that includes 13,230 participants from the 2019 Portuguese National Health Interview Survey. Multivariable logistic regression models were used to assess the associations between SDoH and LBP. Interaction effects were examined to determine whether these relationships are modified by the degree of urbanisation/rurality. Results: The regression model for demographic and economic determinants showed associations between LBP and sex, age, marital status, education and financial capacity, with older rural residents having a higher likelihood of reporting LBP. The psychosocial model revealed that poor health status, sleep disturbances, fatigue, and dissatisfaction with life course were positively associated with LBP. In the behavioural model, obesity and history of smoking increased the probability of reporting LBP, whereas exercise behaviours reduced it and significantly varied across urban and rural regions. Health‐system factors, including hospital visits, medication use, consultations with rehabilitation professionals, delayed healthcare access, and unmet health needs due to financial constraints, were associated with LBP. Rural residents were more likely to seek outpatient care at hospitals. Discussion: These findings emphasise the importance of integrating the evaluation of SDoH into healthcare settings to develop tailored interventions for LBP management. Conclusion: LBP was influenced by several SDoH, but differences between rural and urban areas were limited. [ABSTRACT FROM AUTHOR]

Purpose: To culturally adapt the Musculoskeletal Health Questionnaire (MSK-HQ) to European Portuguese and evaluate its reliability in individuals with musculoskeletal conditions. Materials and methods: The study was carried out in two phases. In the first phase, the MSK-HQ was translated and culturally adapted. In the second phase, a longitudinal observational study was carried out with a convenience sample of participants with musculoskeletal conditions. Data collection began at the start of physiotherapy treatments by filling in the MSK-HQ and Numeric Pain Rating Scale (NPRS). After 4–7 days, the participants were asked to fill out the MSK-HQ once again, as well as the Patient Global Improvement Change (PGIC) scale. The data collected was used to study internal consistency, test-retest reliability, and measurement error. Floor and ceiling effects were also analysed. Results: The MSK-HQ was successfully translated and adapted into European Portuguese. The second phase of the study had a sample of 191 participants. This study demonstrated high internal consistency (Cronbach's α = 0.885) and excellent test-retest reliability (ICC(2,1) = 0.908). The analysis of measurement error resulted in an SEM of 2.818 and an SDC at 7.811. No floor or ceiling effect was observed. Conclusions: The MSK-HQ-PT is a reliable instrument for measuring musculoskeletal health. Further studies on its validity and responsiveness are needed. [ABSTRACT FROM AUTHOR]

Objective: To investigate up-to-date evidence of the effectiveness of neural mobilisation techniques compared with any type of comparator in improving pain, function, and physical performance in people with musculoskeletal pain. Data sources: The following sources were consulted: PubMed, Web of Science, CENTRAL, CINAHL, Scopus, and PEDro databases; scientific repositories; and clinical trial registers. The last search was performed on 01/06/2023. Methods: Two reviewers independently assessed the studies for inclusion. We included randomised, quasi-randomised, and crossover trials on musculoskeletal pain in which at least one group received neural mobilisation (alone or as part of multimodal interventions). Meta-analyses were performed where possible. The RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation tools were used to assess risk of bias and to rate the certainty of evidence, respectively. Results: Thirty-nine trials were identified. There was a significant effect favouring neural mobilisation for pain and function in people with low back pain, but not for flexibility. For neck pain, there was a significant effect favouring neural mobilisation as part of multimodal interventions for pain, but not for function and range of motion. Regarding other musculoskeletal conditions, it was not possible to conclude whether neural mobilisation is effective in improving pain and function. There was very low confidence for all effect estimates. Conclusions: Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain. For the other musculoskeletal conditions, results are inconclusive. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to explore relevant outcome domains for patients with chronic low back pain (CLBP) undergoing physiotherapy. A secondary aim was to examine potential discrepancies between meaningful changes in pain and disability and the global perception of improvement. An explanatory mixed methods design was employed. Twenty-two patients with CLBP completed self-reported measures before and after a physiotherapy programme. After the intervention, three focus groups were conducted with patients who perceived an overall improvement. Discussions were recorded, transcribed and analysed using thematic analysis. Quantitative analysis showed an inconsistent relationship between changes in pain and disability measures and global improvements as perceived by patients. Two main themes emerged from the thematic analysis: "pain relief" (subthemes: reducing pain intensity and other symptoms; reducing medication intake; improving sleep quality) and "gaining control over the LBP condition" (subthemes: ability to self-manage; return to function; and sense of well-being and normality). Patients with CLBP perceived multiple outcomes from physiotherapy treatment that cover the domains of global, physical, mental and social health. These study findings suggest that the targets of measurement for physiotherapy need to be expanded in order to reflect outcome domains valued by patients. Minimum important changes in pain intensity and disability were not valid indicators of global improvements as perceived by patients. Patients with chronic low back pain undergoing physiotherapy perceived gains in multiple health domains that ranged beyond pain and disability domains. Physiotherapy outcome assessment needs to integrate other patient-relevant outcomes such as medication intake, sleep quality, ability to self-manage and sense of well-being. [ABSTRACT FROM AUTHOR]

To cross-culturally adapt the Global Perceived Effect Scale (GPES) into Portuguese and investigate its psychometric properties in patients with chronic low back pain. Cross-cultural adaptation was carried out according to published guidelines. Along with measures for pain and disability, GPES was administered at baseline, 48-h later and post-intervention. To estimate test-retest reliability, the intraclass correlation coefficient was used. The validity was examined through the correlation between the GPES and the Patient Global Improvement Change Scale and the contribution of baseline status to GPES scores. Responsiveness was assessed by analyzing hypotheses regarding areas under the curve and correlations with changes in other measures. The test-retest reliability, the convergent validity and the contribution of the baseline status to GPES scores were demonstrated. The EPES correlated strongly with global perception of change (r = 0.677), and moderately with pain and disability changes (r = 0.457 and r = 0.452, respectively). Areas under the curve values of 0.71(95% CI = 0.607–0.825) and 0.83 (95% CI = 0.749–922) were found. The GPES demonstrated adequate psychometric properties. This study's findings supported its use in clinical and research studies with patients with chronic low back pain. The European Portuguese version of the Global Perceived Effect Scale demonstrated adequate reliability, validity and responsiveness. This instrument is suitable to evaluate meaningful changes in patients with chronic low back pain. The contribution of baseline status to GPES scores was confirmed by specific and recommended methods. The use of the GPES as external criterion of change in clinimetric studies was supported. The minimum important change was 2.5 points out of 11 of the GPES. Only improvements above this point should be considered as relevant to patients with chronic low back pain undergoing physiotherapy. [ABSTRACT FROM AUTHOR]