Articles: low-back-pain.
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Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. ⋯ For assessing change, prospective measurements are preferable to retrospective reports. Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions should complement the assessment of pain, especially in patients with chronic symptoms. Clinicians should be aware of the psychometric properties of the tool to be used, including its level of imprecision (random measurement error) and its minimum clinically important difference (score difference indicating meaningful change in clinical status).
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Cognitive-behavioral models of chronic low back pain (CLBP) predict that dysfunctional assumptions about the harmfulness of activities may maintain pain-related fear and disability levels. The Photograph Series of Daily Activities (PHODA) is an instrument to determine the perceived harmfulness of daily activities in patients with CLBP. This study examined the psychometric properties of a short electronic version of the PHODA (PHODA-SeV). The results show that the PHODA-SeV measures a single factor and has a high internal consistency. The test-retest reliability and stability of the PHODA-SeV over a 2-week time interval are good, with discrepancies between 2 measurements over 20 points suggesting true change. The construct validity is supported by the finding that both self-reported pain severity and fear of movement/(re)injury were uniquely related to the PHODA-SeV. Validity is further corroborated by the finding that patients who have received exposure in vivo, that aimed to systematically reduce the perceived harmfulness of activities, had significantly lower PHODA-SeV scores after treatment than patients receiving graded activity that did not address these assumptions. The findings support the PHODA-SeV as a valid and reliable measure of the perceived harmfulness of activities in patients with CLBP. Preliminary normative data of the PHODA-SeV are presented. ⋯ This article describes a pictorial measurement tool (PHODA-SeV) for the assessment of the perceived harmfulness of activities in patients with chronic low back pain. The PHODA-SeV has good psychometric properties and can be used to elaborate on the contribution of beliefs about harmful consequences of activities to pain and disability.
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Randomized Controlled Trial
Interferential and horizontal therapies in chronic low back pain due to multiple vertebral fractures: a randomized, double blind, clinical study.
Chronic low back pain due to multiple vertebral fractures is of difficult management. Electrical nerve stimulation is frequently used, but its efficacy has never been properly evaluated. In a randomized placebo-controlled clinical trial, we have shown that both interferential currents and horizontal therapy are more effective than placebo for functional. ⋯ This randomized double-blind controlled study provides the first evidence that IFT and HT therapy are significantly effective in alleviating both pain and disability in patients with CBPMF.
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J Orthop Sports Phys Ther · Nov 2007
Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain.
Prospective series of consecutive cases. ⋯ In this study we observed that kinesiophobia decreased during an intensive physical therapy program in which exercises were performed in a quota-based manner. Following the successful performance of non-pain-contingent, quota-based exercise, patients' fears of injury lessened, and this may have had a positive influence on disability.
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J Am Osteopath Assoc · Nov 2007
Case ReportsUsing image-guided techniques for chronic low back pain.
Image-guided spine intervention is used primarily for its precise diagnostic capabilities. This article reviews basic principles of the more common image-guided diagnostic techniques specifically as they relate to patients with low back pain. It also includes discussion of advanced modes of therapy, including spinal cord stimulation and intrathecal therapy, providing primary care physicians with an understanding of the primary indications for these therapeutic modalities. Two illustrative case presentations have been added to "refresh" this article, which was originally published in a supplement to the September 2005 issue of the JAOA and to further enhance primary care physicians' understanding of spinal intervention.