ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo test the predictive utility of the Örebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems.DesignProspective, where participants completed the questionnaire and their cases were followed for 6 months to assess outcome with regard to pain, function, and absenteeism due to sickness.ParticipantsOne hundred seven patients, recruited from seven primary care units.ResultsDiscriminant analyses showed that the items on the questionnaire were significantly related to future problems. For absenteeism due to sickness, 68% of the patients were correctly classified into one of three groups, whereas an even distribution would have produced 33%. The analyses for function correctly classified 81%, and for pain 71%, into one of two groups, compared with a chance level of 50%. A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89% and a specificity of 65% for absenteeism due to sickness, and a sensitivity of 74% and a specificity of 79% for functional ability.ConclusionsThe results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Örebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesGiven the individual and economic burden of chronic work disability in low back pain patients, there is a need for effective preventive interventions. The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral graded activity, regarding days of sick leave and work status.DesignRandomized controlled trial.Patients and SettingEmployees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner, occupational physician, or rehabilitation physician. Forty-five employees had been randomly assigned to the experimental treatment condition that included behavioral graded activity and problem-solving therapy (GAPS), and 39 employees had been randomly assigned to behavioral graded activity and group education (GAGE).Outcome MeasuresDays of sick leave and work status. Data were retrieved from occupational health services.ResultsData analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention. Moreover, work status was more favorable for employees in this condition, in that more employees had a 100% return-to-work and fewer patients ended up receiving disability pensions one year after the intervention. Sensitivity analyses confirmed these results.ConclusionsThe addition of problem-solving therapy to behavioral graded activity had supplemental value in employees with nonspecific low back pain.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo describe the development, implementation, and preliminary outcome of the Pain-Disability Prevention (PDP) Program. The PDP Program is a 10-week cognitive–behavioral intervention program that aims to increase daily involvement in goal-directed activity and minimize psychological barriers to activity involvement after occupational injury. Workers' Compensation Board claimants with soft tissue injuries to the back, who were still off work 6 weeks after injury and showed evidence of at least one “yellow flag,” were offered participation in the PDP Program.DesignA single-group, prospective treatment outcome analysis.ParticipantsData from the first 104 claimants who participated in the PDP Program are summarized.ResultsParticipation in the PDP Program was associated with a 60% success rate, where success was defined as return to work (45%) or readiness to return to work (15%). Initial scores on measures of catastrophizing, fear of movement/reinjury, and depression afforded 92% correct classification of treatment outcome. Early treatment changes in catastrophizing and fear of movement/reinjury were also predictive of treatment outcome.ConclusionsThe findings suggest that a psychologically based activity mobilization program can be an effective means of yielding reductions in psychological risk factors for occupational disability. Challenges to program implementation, fidelity to protocol, and issues related to cost efficacy are discussed.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe causes of prolonged disability due to back pain are multiply determined, involving medical, social, and environmental factors. Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence-based programs to large community settings.ObjectiveThis article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec.Methods and ResultsPhase A: Based on literature review and expert knowledge, the Sherbrooke model was developed and assessed through a population-based, randomized clinical trial. Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life; the 6-year follow-up showed the cost-effectiveness of the method.Phase B: Based on the Sherbrooke model experience and recent evidence, a new program addressing the disability paradigm was developed and implemented in the province of Quebec (Canada). Results at 1- and 3-year follow-ups showed that only 24% of workers were not working owing to their musculoskeletal disorder. The program is presently being tested through a population-based, randomized clinical trial in a population of construction workers.Phase C: To implement the program at a provincial level, a network for management, research and education in work rehabilitation was developed. An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various settings.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe potential adherence-related difficulties encountered in the implementation of a secondary prevention, early intervention study with acute low back pain patients. An additional goal is to provide recommendations, based on the authors' experience, on how best to overcome these potential obstacles for future research.DesignThe study used a predictive algorithm, identified through previous research, to identify which patients presenting with acute low back pain were at risk for developing chronic problems. These subjects were then treated prophylactically with an interdisciplinary intervention. Specific difficulties initially encountered during the pilot stage of implementation of this intervention included securing adequate physician referrals to the study and helping patients to progress through treatment in the most efficient manner.ConclusionsPotential difficulties are discussed in the contextual framework of treatment adherence and factors affecting it, including the impact of personality factors, satisfaction, comprehension, side effects, financial issues, length of treatment, type of regimen, social issues, patient beliefs, and biologic factors. It is hoped that the present authors' experience will enable future investigators to anticipate these common problems, and structure their research endeavors accordingly.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo assess the effect of granisetron pretreatment in alleviating propofol injection pain.Study DesignA randomized, controlled, double-blind study, using venous retention with a tourniquet.Materials and MethodsOne hundred fifty adult patients were randomly assigned to one of three groups: group 1 (who received 5 mL of 0.9% saline pretreatment), group 2 (who received 5 mL lidocaine [40 mg in 0.9% saline] pretreatment), and group 3 (who received 5 mL granisetron [2 mg in 0.9% saline] pretreatment). Injections were given in the largest vein on the dorsum of the hand. After 2 minutes, the tourniquet was released and one fourth of the total calculated dose of propofol (2.5 mg/kg body weight) was administered and pain assessment was made.ResultsLidocaine and granisetron significantly reduced the incidence and severity of propofol injection pain more than placebo (P< 0.001). The efficacy of granisetron in alleviating the pain on injection of propofol was no different from lidocaine.ConclusionsGranisetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThe present study examined the relation of pain catastrophizing to the severity of upper respiratory tract illness.Materials and MethodsParticipants included 50 adults (35 female subjects, 15 male) who were self-diagnosed with upper respiratory tract illness and who agreed to complete a diary of symptoms for 7 days. Illness symptoms were grouped into three categories: pain-related, constitutional, and respiratory symptoms.ResultsResults showed that pain catastrophizing was associated with symptom number and symptom severity in all three categories of symptoms. The rumination subscale of the Pain Catastrophizing Scale showed the strongest relations with illness severity. The relation between pain catastrophizing and illness severity remained significant even when controlling for initial symptom severity, duration of the symptoms before the study period, and depression.DiscussionThe results provide the preliminary evidence that the influence of pain catastrophizing may not be restricted to pain-specific domains. The data also provide some support for the view that the excessive focus on bodily sensations may account for more severe symptoms.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and ObjectivesMedial branch blocks are an important tool for the diagnosis of facet joint arthropathy. The most commonly used technique involves multiple needle placements, one for each nerve blocked. This multiple needle technique may require a large amount of local anesthetic for anesthetizing the skin, thereby increasing the rate of false-positive blocks.TechniqueDiagnostic lumbar medial branch blocks are usually performed using multiple needles, one for each branch. The authors describe a different technique using a single needle for all levels. Initially, the needle is directed toward the medial branch located at the level of the affected facet joint in the antero–posterior view. After anesthetizing this nerve with local anesthetic, the same needle is withdrawn to the skin with the tip still in the subcutaneous tissue and repositioned to block the medial branch above, and thereafter below, while continuing to use only the antero–posterior view, thereby using only one entry site.ConclusionsWhen performed correctly, the single needle technique provides accuracy similar to the more conventional multiple needle approach during the performance of diagnostic facet joint nerve blocks. Because only one skin entry point is needed, however, this technique may afford several advantages over the multiple needle approach. These may include less patient discomfort, less time required and less radiation exposure since only one C-arm position is used, a smaller volume of local anesthetic, and possibly a lower incidence of false-positive blocks.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID