Christian Longtin1, Simon Décary2, Chad E Cook3, Marc O Martel4, Sylvie Lafrenaye5, Lisa C Carlesso6, Florian Naye1, Yannick Tousignant-Laflamme1,7. 1. School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada. 2. Faculty of Medecine, Laval University, Quebec, Quebec, Canada. 3. Department of Orthopaedics, Duke University, Durham, North Carolina, United States of America. 4. Faculty of Dentistry & Departmet of Anesthesia, McGill University, Montreal, Quebec, Canada. 5. Faculty of Medecine, University of Sherbrooke, Quebec, Quebec, Canada. 6. School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 7. Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada.
Abstract
INTRODUCTION: Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings. METHODS: This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures. RESULTS: Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05). CONCLUSION: These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness. TRIAL REGISTRATION: Clinicaltrial.gov: NCT03949179.
INTRODUCTION: Self-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings. METHODS: This study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures. RESULTS: Applicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (p<0.05). CONCLUSION: These findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness. TRIAL REGISTRATION: Clinicaltrial.gov: NCT03949179.
Authors: Saad M Alsaadi; James H McAuley; Julia M Hush; Serigne Lo; Delwyn J Bartlett; Roland R Grunstein; Chris G Maher Journal: Clin J Pain Date: 2014-09 Impact factor: 3.442
Authors: Brook I Martin; Richard A Deyo; Sohail K Mirza; Judith A Turner; Bryan A Comstock; William Hollingworth; Sean D Sullivan Journal: JAMA Date: 2008-02-13 Impact factor: 56.272
Authors: Riikka Holopainen; Phoebe Simpson; Arja Piirainen; Jaro Karppinen; Rob Schütze; Anne Smith; Peter O'Sullivan; Peter Kent Journal: Pain Date: 2020-06 Impact factor: 6.961
Authors: Lehana Thabane; Jinhui Ma; Rong Chu; Ji Cheng; Afisi Ismaila; Lorena P Rios; Reid Robson; Marroon Thabane; Lora Giangregorio; Charles H Goldsmith Journal: BMC Med Res Methodol Date: 2010-01-06 Impact factor: 4.615