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Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial.

ABSTRACT: It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown.Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes.2 center, 2 parallel group, prospective, randomized, clinical trial.Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used.47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05).There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.

SUBMITTER: Van Dillen LR

PROVIDER: S-EPMC4921225 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial.

Van Dillen Linda R LR Norton Barbara J BJ Sahrmann Shirley A SA Evanoff Bradley A BA Harris-Hayes Marcie M Holtzman Gregory W GW Earley Jeanne J Chou Irene I Strube Michael J MJ

Manual therapy 20160419

<h4>Background</h4>It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown.<h4>Objectives</h4>Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes.<h4>Design</h4>2 center, 2 parallel group, prospective, randomize ...[more]

PMID: 27317505

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Project description:Study designProspective cohort study.ObjectiveThe aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.Summary of background dataTreatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making.MethodsAdult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months' follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups.ResultsFollow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics.ConclusionOn average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up.Level of evidence2.

Project description:BackgroundInfectious mononucleosis after primary infection with Epstein-Barr virus (EBV-IM) has been linked to the development of myalgic encephalomyelitis/chronic fatigue-syndrome (ME/CFS) in children, adolescents, and young adults. Here, we present clinical phenotypes and follow-up data from a first German cohort of young people with ME/CFS following EBV-IM.Methods12 adolescents and 13 young adults were diagnosed with IM-triggered ME/CFS at our specialized tertiary outpatient service by clinical criteria requiring post-exertional malaise (PEM) and a history of confirmed EBV primary infection as triggering event. Demographic information, laboratory findings, frequency and severity of symptoms, physical functioning, and health-related quality of life (HRQoL) were assessed and re-evaluated 6 and 12 months later.ResultsYoung adults displayed more severe symptoms as well as worsening of fatigue, physical and mental functioning, and HRQoL throughout the study, compared to adolescents. After one year, 6/12 (54%) adolescents no longer met the diagnostic criteria for ME/CFS while all young adults continued to fulfill the Canadian consensus criteria. Improvement in adolescents was evident in physical functioning, symptom frequency and severity, and HRQoL, while young adults showed little improvement. EBV serology and EBV DNA load did not correlate with distinct clinical features of ME/CFS, and clinical chemistry showed no evidence of inflammation. Remarkably, the median time from symptom onset to ME/CFS diagnosis was 13.8 (IQR: 9.1-34.9) months.ConclusionsME/CFS following EBV-IM is a severely debilitating disease often diagnosed late and with limited responses to conventional medical care, especially in adults. Although adolescents may have a better prognosis, their condition can fluctuate and significantly impact their HRQoL. Our data emphasize that biomarkers and effective therapeutic options are also urgently needed to improve medical care and pave the way to recovery.

Project description:BackgroundVaccine hesitancy is a global public health threat. We present unique data that characterises those who experienced reversals of COVID-19 vaccination hesitancy in Japan.MethodsWe administered a questionnaire on vaccination intention among 30053 Japanese adults aged 20 years or older before the COVID-19 vaccination was available to the general population (first survey) and conducted a follow-up survey on vaccination status one year later in February 2022 (second survey). Those who responded in the first survey that they did not intend to be vaccinated or were unsure and then responded in the second survey that they were vaccinated or intend to be vaccinated were asked about the reasons for their change of heart. Based on previous literature and expert opinion, 31 reasons for changing vaccination intention were compiled and respondents were asked to choose which among them applied to themselves, with multiple responses possible. Based on the results of those responses, each individual was then clustered using the Uniform Manifold Approximation and Projection (UMAP) dimensionality reduction technique and Ordering Points To Identify the Clustering Structure (OPTICS) algorithm. We then identified unique characteristics among each of the sub-populations (clusters).FindingsIn the second survey we received 19195 responses (response rate 63.9%), of which 8077 responded 'no' or 'not sure' in the first survey regarding their intention to be vaccinated. Of these, 5861 responded having received or intending to receive the vaccine (72.6%). We detected six and five sub-populations (clusters) among the 'no' group and 'not sure' group, respectively. The clusters were characterized by perceived benefits of vaccination, including the COVID-19 vaccine, awareness of the COVID-19 vaccination status of those close to them, recognition of the social significance of COVID-19 vaccination for the spread of infection, and dispelled concerns about short-term adverse reactions and the safety of the COVID-19 vaccine. Work and personal relationship reasons were also found to be a unique overarching reason for vaccination changes of heart only among those who did not intend to vaccinate.InterpretationThose who changed their intention to accept COVID-19 vaccination as well as their unique characteristics as detailed in this study will be important entry points when discussing how to promote vaccination to those who are hesitant to vaccinate in the future.FundingThe present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

Dataset Information

Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial.

Publications

Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial.

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