Aim:

To determine the efficacy and safety of the Magec system in early onset scoliosis (EOS).

Aim:

To measure truncal parameters for patients treated with growing rod systems for early onset scoliosis (EOS).

Aims/background

Current treatment recommendations advocate various exercise modalities for people with chronic Low Back Pain (cLBP)1. Walking appears to represent an inexpensive and readily accessible activity for a range of individuals, including those who were previously sedentary. However, the effectiveness of such interventions are uncertain in cLBP.

Background and Purpose: Current clinical guidelines recommend supervised exercise as a first-line treatment in the management of low back pain (LBP). To date studies have not used objective forms of measuring changes in free-living physical activity (FLPA). The aim of this study was to compare FLPA between two groups who received either supervised exercise and auricular acupuncture (EAA) or exercise alone (E).

Methods: 51 patients with non-specific LBP [mean±SD=42.8±12.4 years] wore an accelerometer for 7 days at baseline, end of the intervention (week 8) and follow up (week 25). FLPA variables were extracted: % time (hours) spent in postures; daily step count and cadence. Data were analysed using SPSS (v15). Repeated measures ANCOVA were performed using a mixed linear model.

Results: There was no difference in daily step count between the two groups at any time point (E, mean±SD, week 1, 8197±2187; week 8, 8563±2438, week 25, 8149±2800; EAA, mean±SD, week 1, 8103±1942; week 8, 8010±2845, week 25, 8139±1480, p=0.9) or cadence. No differences in postures were noted, apart from time sitting/lying which was shorter at week 25 in the E group (p=0.006).

Conclusions & Implications: Supervised exercise classes, with or without acupuncture, do not produce changes in FLPA in the short term or longer term in people with LBP. This suggests more effective ways should be sought to encourage the patient to incorporate activity into their daily lives. These findings have informed the design of two walking intervention trials for LBP patients.

Conflict of Interest: None

Sources of Funding: Research and Development Office, Northern Ireland, Strategic Priority Fund, Department of Employment and Learning, Northern Ireland.

Background & Purpose: Current clinical guidelines support physical activity programmes for people with low back pain (LBP), but a major factor limiting their efficacy is the patient’s level of adherence, difficult to assess using self-report, and the lack of objective data on activity levels in this population. This study investigated differences in the self-report and objective activity levels of LBP patients and age-matched controls.

Methods: 20 patients with non-specific LBP [5 male, 15 female; mean (SD) age = 43.2 (12.1) years] and 20 healthy controls [10 male, 10 female; mean (SD) age = 39.6 (10.9) years] wore the activPAL™ uniaxial accelerometer on the anterior thigh during waking hours for 7 days, and completed the 7-Day Physical Activity Recall Questionnaire (7DRQ). Data were analysed using SPSS (v12).

Results: There was no difference between groups in energy expenditure as measured by the 7DRQ (p> 0.05), but the activPAL™ data showed LBP subjects expended significantly less energy than controls (p=0.004) over the 7-day period, and failed to reach the recommended 10,000 steps per day [mean (SD) = 8067.9 steps (2581.7)] compared to controls [mean (SD)= 10,864 (3,570.3); t = 2.84, p=0.007)]. The LBP subjects also had a significantly lower mean cadence (p=0.004), a lower walking index (p=0.001), and took significantly more short walks (0–100 steps) and less long walks (> 100 steps) than controls (p< 0.05).

Conclusions & Implications: People with LBP are less physically active than age-matched controls, and this is more evident with objective than subjective evaluation. These findings have informed the design of a targeted walking programme for LBP patients.

Background: General practitioners (GPs), orthopaedic surgeons, neurosurgeons, rheumatologists and pain consultants manage the majority of patients with chronic low back pain (CLBP) in the Republic of Ireland. However, little is known about their attitudes and beliefs and the factors that influenced them. This study aimed to investigate factors that influenced doctors’ attitudes and beliefs to CLBP.

Method: A cross-sectional questionnaire was mailed to a random sample of GPs (n=750; 35%), and all orthopaedic surgeons (n=81), neurosurgeons (n=9), rheumatologists (n=26), and pain consultants (n=24) in the republic of Ireland. The questionnaire pack contained a demographic data form, two clinical vignettes, and an attitudes measure, the Pain Attitudes and Beliefs Scale (PABS.PT). Approval was obtained from the UCD Human Research Ethics Committee.

Results: The response rate was 58% (n=523). Doctors were qualified 23.4±9.4 years. Analysis of the vignettes showed there was no significant difference (p> 0.05) between those who had undertaken postgraduate education (PGE) regarding referral rates to physiotherapy, investigations, or secondary care. Prescription rates were significantly lower for those who had undertaken PGE (88% v 94%, χ² =4.95, p< 0.05), as was their biomedical score on the PABS.PT (41.3 v 43.1, df=507, p=0.03). The number of years since qualification was dichotomised (1–23 yrs, > 23 yrs), and there was no significant difference in the management of the vignettes, except referral rates for investigations which was greater for doctors qualified > 23 years (3% v 52%, χ² =10.71, p=0.001).

Conclusion: Demographic factors (PGE and the number of years since qualification) did not significantly influence doctors’ practice behaviour.

Background: General practitioners (GPs), orthopaedic surgeons, rheumatologists and pain consultants manage the majority of patients with chronic low back pain (CLBP) in primary and secondary care settings in the Republic of Ireland. Little is known about their attitudes and beliefs to CLBP, although the existing literature highlights a range of factors influencing such beliefs including: past experience, education, time and resources¹. This study aimed to investigate factors influencing attitudes and beliefs of Irish doctors to the management of CLBP patients.

Method: A multiple case studies design of semi-structured audiotaped interviews (30 minutes) was conducted on a purposeful sample of GPs (n=7) and Consultants (n=7: orthopaedic surgeons, n=2; Pain consultants, n=2; Rheumatologists n=2 Neurosurgeon, n=1) in July 2006. Questions were devised based on the results of a systematic review of the literature of the topic. All interviews were subsequently transcribed, coded and a cross case analysis was constructed. Approval was obtained from the UCD Human Research Ethics Committee.

Results: The main emerging themes included Doctors current holistic management (referral for physical and mental health treatment), the negative impact of lack of resources on treatment options (lack of multidisciplinary services and prolonged waiting times for Consultant appointments), the influence of the medicolegal system on patients (increased stress) and Doctors (increased referral rates for investigations and procedures).

Conclusion: Doctors’ attitudes and beliefs regarding CLBP management may have important influences on both patient outcomes and resource utilization within the health service. These findings will inform a national postal survey of Doctors attitudes to CLBP.

Background and purpose: Lumbar traction is a common treatment for LBP with radiculopathy. Despite this, its benefits remain to be established. This paradox has significant economic and therapeutic consequences as 3–10% of patients with LBP in the UK have radiculopathy and over 40% of UK physiotherapists use this approach (Harte et al 2005). The purpose of this pragmatic randomised clinical trial was to assess the benefit of lumbar traction in addition to a manipulation package with these patients in a manner that reflects clinical practice.

Methods: 30 patients meeting the inclusion criteria for lumbosacral radiculopathy were recruited from the NHS and randomly assigned to one of two treatment groups: Group 1 received manipulation, advice and exercises; Group 2 received traction, manipulation, advice and exercises. Outcome measures were recorded at baseline, completion of treatment and at 3 and 6 months post completion of treatment (MPQ, RMDQ, SF36, and the ALBPSQ). In addition VAS scores for back and leg pain and the percentage of overall improvement (patients perception) were recorded after each treatment.

Results: 30 patients were recruited over an 11-month period: 40% male, mean age 44 years, mean duration of current episode 7 weeks. Post treatment results (n = 27) showed a significant improvement in all outcomes for both groups (paired t-test, p > .01) but there was no significant difference demonstrated between groups (ANCOVA).

Conclusion: This pilot study demonstrates the feasibility of a trial with this sub-group of LBP patients and a large multi-centred trial would need to be conducted to fully address this research question.