FLEX CEUs: New CEU Courses

LOW BACK PAIN: THE ROLE OF FEAR

Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, and evidence suggests that psychosocial factors, especially fear-avoidance beliefs are important in predicting patients who will progress from an acute to a chronic stage, as well as failure of interventions.  The goals of this CEU course are to evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP, determine whether balance response of LBP patients is different from healthy controls under various conditions, and find out whether body sway is related to the fear of fall in LBP individuals.  Fear and psychological distress in regards to pain and disability is also discussed.

LOW LEVEL LASER THERAPY EFFECTS ON INFLAMMATION

Inflammation of the synovial membrane plays an important role in the pathophysiology of osteoarthritis (OA).  The goal of this CEU course is to evaluate the effects of low-level laser therapy (LLLT) on joint inflammation.

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Early physical therapy benefits low-back pain patients

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit—but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at Medical Xpress

Patients with low-back pain benefit from early physical therapy

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit – but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at news-medical.net

Rocker bottom shoes help reduce chronic low back pain

A new study confirms that rocker bottom shoes helps strengthen back muscles, improving the spine’s curvature and thus reducing low back pain.

Researchers of the Sports Physiotherapy master’s degree at Valencia’s CEU Cardenal Herrera university have confirmed, in a new study of their research work into back pain, that unstable shoes improve the strength of back muscles in order to maintain balance and stability when walking. This muscular strengthening contributes to reducing low-intensity chronic low back pain, which can be disabling for those who suffer it. The results of this new study, headed by CEU UCH teachers Juan Francisco Lisón and Pablo Salvador, co-authors of the first international study on this matter, have been published in the Q1 edition of scientific magazine Clinical Rehabilitation.

As the coordinator of the CEU UCH master’s degree, Pablo Salvador, explains, “patients with chronic low back pain are usually advised to perform exercises to strengthen the muscles in their back, which improve stability of the spine in the lower back area, although it is always hard to make sure they comply with this type of exercises. What this new study shows is that the use of unstable shoes for several hours during a patient’s day-to-day life, without any other specific exercises, effectively contributes to the muscular strengthening of their back and improves the degree of curvature of the spine in the lumbar area, thus helping to reduce chronic pain.”

Full story at Science Daily

LBP in children and adolescents

Is back pain a problem for kids?

One of the things that some universities do to help out new researchers is have senior academics look over their grant applications before they are submitted. Recently we had a proposal for a study on back pain in adolescents assessed in this way. One of the comments was that back pain is not a problem for teenagers; it doesn’t happen very often and if it does it goes away by itself quickly anyway. It is worth noting that this feedback came from researchers outside the field of musculoskeletal pain, and seemed to be on the basis of personal experience.

This appears to be a common view, and was reflected in our study looking at how well pain reports from children match up with their parents. The answer; not very well, parents frequently reported that their child did not have pain over the past week when the child reported that they did[1]. To dig a bit further into the issue, we collected all the systematic reviews that addressed prevalence, risk factors, prognosis, and treatment effectiveness relevant to back pain in children and adolescents. Here’s what we found.

Full story at bodyinmind.org

How should you sleep if you have lower back pain?

Lower back pain not only affects a person’s daily life but can also disturb their sleep. Furthermore, poor bed posture can worsen or even cause backache. So, what are the best sleeping positions for lower back pain?

This article provides a guide to the six best sleeping positions for lower back pain, as well as offering advice on pillows and mattresses, sleep hygiene, and when to see a doctor.

The best sleeping positions

Not only can lower back pain get in the way of a good night’s rest, but poor sleeping posture may make the existing pain worse.

A poor sleeping position may even be the underlying cause of lower back pain. This is because certain positions can place unnecessary pressure on the neck, hips, and back.

Full story at Medical News Today

Study: Referral to Physical Therapy for LBP Reduces Odds of Later Opioid Prescription—Even When Patients Don’t Follow Up on the Referral

There’s solid evidence that physical therapy as a first-line approach for low back pain (LBP) improves outcomes, but not many studies have focused on the factors that are associated with referral to physical therapy in the first place, regardless of later participation in treatment. Now authors of a recent study believe they’ve found associations indicating that the very act of referral for physical therapy may point to the ways a primary care provider’s approach to LBP can affect patient perceptions and reduce odds of later opioid use, even when the patient doesn’t follow through with the referral.

The study, published in the Journal of the American Board of Family Medicine looked at data from 454 Medicaid enrollees who were initially treated by a primary care provider for LBP, of which 215 received a referral for physical therapy. While researchers were interested in differences between the referral and nonreferral groups, the target of their study was something they believe is missing in current research: an examination of the entire referral population, regardless of whether those patients followed up with actual physical therapy.

Full story at APTA

JAMA: Equipment Ownership, Prior Imaging Behavior Predict High Rates of Low-Value Imaging for LBP, Headache

Despite evidence showing that imaging for low back pain (LBP) and uncomplicated headache is not necessary, too many health care providers still order these services for their patients, who incur greater financial costs. In a new study published in JAMA Internal Medicine, researchers identified several factors associated with higher rates of low-value imaging—including whether the providers owned the imaging equipment.

Using 4 years’ worth of claims data from 1 insurer, authors analyzed clinician characteristics as predictors for imaging for uncomplicated back pain and headache—2 low-value services identified by the Choosing Wisely campaign guidelines as inappropriate for imaging.

Full story at APTA

Study Says Cost Savings of Physical Therapy for LBP Are Significant

When it comes to physical therapy for treatment of low back pain (LBP), Medicare is getting a bargain, according to authors of a new study. Researchers say that not only is physical therapy cheaper than injections or surgery in the short-term, it’s an approach that is likely to save on treatment costs for at least a year after initial diagnosis, with average savings of 18% over treatments that begin with injections and 50% over treatments that begin with surgery.

The study, commissioned by the Alliance for Physical Therapy Quality and Innovation (APTQI), focused on Medicare A and B claims data from 472,000 beneficiaries who received a diagnosis of LBP and began treatment between February and October of 2014. Researchers from the Moran Company tracked 3 treatment paths—physical therapy, injections, and surgery—and compared total costs of initial treatment as well as total costs for 12 months after diagnosis. The study also included an analysis of cost differences associated with how soon physical therapy was initiated after diagnosis, the physical therapist interventions used, and relationships between the use of physical therapy and the referring health care provider.

Full story at APTA

Managing low back pain in secondary care: Should we screen to target those ‘at risk’ or treat them all?

This study arose out of a clinical aspiration to do things better.  Daily practice in secondary care spinal clinics at a large metropolitan hospital saw distressed and disabled patients with low back pain (LBP) come and go.  Many had waited months or years for ‘surgical’ consultation, only to be promptly discharged – with “community-based conservative management” the mainstay of advice on offer.

In this government-funded setting with limited resources it was enticing to consider that early patient screening to identify those most at risk of a poor outcome, could offer potential for the timely delivery of care to those most in need.  This made intuitive sense as an approach likely to both optimise patient outcomes and have cost benefits.  For this approach to work, however, screening needed to be able to provide accurate prognostic information.

Full story of managing LBP in secondary care at BodyInMind.org