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Monthly Archives: May 2016

Long-term Trajectories of Back Pain:
Cohort Study With 7-year Follow-up

By |May 30, 2016|Low Back Pain|

Long-term Trajectories of Back Pain:
Cohort Study With 7-year Follow-up

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SOURCE:   BMJ Open. 2013 (Dec 11); 3 (12): e003838

Kate M Dunn, Paul Campbell, and Kelvin P Jordan

Arthritis Research UK Primary Care Centre,
Institute of Primary Care and Health Sciences,
Keele University,
Newcastle, Staffordshire, UK.


OBJECTIVE:   To describe long-term trajectories of back pain.

DESIGN:   Monthly data collection for 6 months at 7-year follow-up of participants in a prospective cohort study.

SETTING:   Primary care practices in Staffordshire, UK.

PARTICIPANTS:   228 people consulting their general practitioners with back pain, on whom information on 6-month back pain trajectories had been collected during 2001-2003, and who had valid consent and contact details in 2009-2010, were contacted. 155 participants (68% of those contacted) responded and provided sufficient data for primary analyses.

OUTCOME MEASURES:   Trajectories based on patients’ self-reports of back pain were identified using longitudinal latent class analysis. Trajectories were characterised using information on disability, psychological status and presence of other symptoms.

RESULTS:   Four clusters with different back pain trajectories at follow-up were identified:

(1)   no or occasional pain
(2)   persistent mild pain
(3)   fluctuating pain and
(4)   persistent severe pain.

Trajectory clusters differed significantly from each other in terms of disability, psychological status and other symptoms. Most participants remained in a similar trajectory as 7 years previously (weighted κ 0.54; 95% CI 0.42 to 0.65).

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Trajectories of Low Back Pain

By |May 26, 2016|Low Back Pain|

Trajectories of Low Back Pain

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SOURCE:   Best Pract Res Clin Rheumatol. 2013 (Oct); 27 (5): 601–612

Iben Axén, Charlotte Leboeuf-Yde

Unit of Intervention & Implementation Research,
Institute of Environmental Medicine,
Karolinska Institutet,
Nobels väg 13, S-171 77 Stockholm, Sweden


Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories indicates that the low back pain ‘episode’ is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have low back pain, but most have it on and off or persistently. Thus, the low back pain ‘condition’ is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted to understand causality, treatment effect and prognostic factors and to study the possible association of trajectories with pathologies.



From the FULL TEXT Article:

Introduction

Until recently, low back pain (LBP) was believed to be a self-limiting condition, much like the common cold. The European guidelines for the management of acute LBP state that 90% of patients will recover within 6 weeks. [1]

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What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

By |May 25, 2016|Low Back Pain, Research|

What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

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SOURCE:   BMC Musculoskelet Disord. 2016 (May 21); 17 (1): 220

Alice Kongsted, Peter Kent, Iben Axen,
Aron S. Downie, and Kate M. Dunn

The Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
a.kongsted@nikkb.dk


BACKGROUND:   Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management.

DISCUSSION:   LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients.

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Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

By |May 22, 2016|Headache|

Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

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SOURCE:   J Manip Physiol Ther. 2016 (May); 39 (4): 229–239

Eric L. Hurwitz, DC, PhD, Maria Vassilaki, MD, MPH, PhD,
Dongmei Li, PhD, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.

METHODS:   Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.

RESULTS:   The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.

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Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

By |May 21, 2016|Chronic Neck Pain|

Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (May); 39 (4): 240–251

Eric L. Hurwitz, DC, PhD, Dongmei Li, PhD, Jenni Guillen, MS,
Michael J. Schneider, DC, PhD, Joel M. Stevans, DC,
Reed B. Phillips, DC, PhD, Shawn P. Phelan, DC,
Eugene A. Lewis, DC, MPH, Richard C. Armstrong, MS, DC,
Maria Vassilaki, MD, MPH, PhD

Office of Public Health Studies,
University of Hawaii at Manoa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina.

METHODS:   This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP).

RESULTS:   Care patterns with single-provider types and no referrals incurred the least average charges for both uncomplicated neck pain (UNP) and complicated neck pain (CNP). When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers.

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Chronic Neck Pain and Chiropractic Page

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