Risultati per: Epidemiologia e classificazione del Low Back Pain

Annals of Internal Medicine, Volume 178, Issue 5, Page 760-761, May 2025.

Introduction
There are no validated paediatric-specific diagnostic criteria for complex regional pain syndrome (CRPS). As a result, diagnostic tools developed for adults (eg, Budapest Criteria, Japanese Diagnostic Criteria, Veldman Criteria) are frequently applied in the paediatric population. However, the clinical presentations and trajectories of children can differ from adults. Given that treatment outcomes are linked to early diagnosis and intervention, the lack of paediatric-specific screening or diagnostic tools is an important knowledge gap. We aim to identify the frequency of individual criteria used in diagnosing CRPS in children and adolescents in existing literature, summarise assessment methods used to establish the diagnosis, and provide recommendations for research and clinical application.

Methods
The following databases and platforms will be searched for articles published from 2003 (year the Budapest Criteria was developed) onward: CINAHL, CENTRAL, Embase, Ovid MEDLINE, PubMed, PsycINFO and Web of Science. Our search strategy will use subject headings and text words related to the concepts of CRPS in paediatric populations, with study inclusion criteria from birth up to 18 years old, and a diagnosis of CRPS. Data will be extracted by our multidisciplinary team and findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Ethics and dissemination
This study does not involve human participants or unpublished data; therefore, approval from a human research ethics committee is not required. The findings of this scoping review will be disseminated through academic conferences and peer-reviewed publications.

Objective
Valid and reliable measurement of early childhood development (ECD) is critical for monitoring and evaluating ECD-related policies and programmes. Although ECD tools developed in high-income countries may be applicable to low- and middle-income countries (LMICs), directly applying them in LMICs can be problematic without psychometric evidence for new cultures and contexts. Our objective was to systematically appraise available evidence on the psychometric properties of tools used to measure ECD in LMIC.

Design
A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Data sources
MEDLINE, Embase, PubMed, PsycInfo, SciELO and BVS were searched from inception to February 2025.

Eligibility criteria
We included studies that examined the reliability, validity, and measurement invariance of tools assessing ECD in children 0–6 years of age living in LMICs.

Data extraction and synthesis
Each study was independently screened by two researchers and data extracted by one randomly assigned researcher. Risk of bias was assessed using a checklist developed by the study team assessing bias due to training/administration, selective reporting and missing data. Results were synthesised narratively by country, location, age group at assessment and developmental domain.

Results
A total of 160 articles covering 117 tools met inclusion criteria. Most reported psychometric properties were internal consistency reliability (n=117, 64%), concurrent validity (n=81, 45%), convergent validity (n=74, 41%), test–retest reliability (n=73, 40%) and structural validity (n=72, 40%). Measurement invariance was least commonly reported (n=16, 9%). Most articles came from Brazil, China, India and South Africa. Most psychometric evidence was from urban (n=92, 51%) or urban–rural (n=41, 23%) contexts. Study samples focused on children aged 6–17.9 or 48–59.9 months. The most assessed developmental domains were language (n=111, 61%), motor (n=104, 57%) and cognitive (n=82, 45%). Bias due to missing data was most common.

Conclusions
Psychometric evidence is fragmented, limited and heterogeneous. More rigorous psychometric analyses, especially on measurement invariance, are needed to establish the quality and accuracy of ECD tools for use in LMICs.

PROSPERO registration number
CRD42022372305.

Objectives
This article aimed to explore patients’ experiences of attending the emergency department (ED) for low back pain (LBP) and provides a theoretically informed analysis of the ED cultures perceived by patients to inform their experiences of care.

Design
Multisite, cross-sectional qualitative interview study.

Setting
Four NHS Emergency Departments located in the UK.

Participants
47 adults (aged 23–79 years) who, in the past 6 weeks, had attended the ED for LBP (all types and durations). Purposive sampling was used to gain variation in the recruiting sites, and participants’ LBP and demographic characteristics.

Interventions
Data were collected using individual, semistructured, telephone interviews (median 45 min duration) which were audio-recorded and transcribed verbatim. Analysis was informed using reflexive thematic analysis and ideal type analysis. Cycles of inductive and deductive analysis were undertaken, with Bourdieu’s concepts of field and habitus employed to help explain the findings.

Results
We present three contrasting cultures of ED care for LBP, comprising (1) emergency screening only, (2) ‘cynicism and neglect’ and (3) appropriate and kind care. Taking each culture (field) in turn, we explore important differences in the content and delivery of care. Drawing on Bourdieu’s concepts of field and habitus, we consider the social and institutional norms and misrepresentations likely to underpin the thoughts and behaviours of ED staff (their habitus), and why these tended to vary based on where and by whom the patient was managed in the ED.

Conclusions
Strategies to improve patients’ experience need to review the social and institutional norms that underpin staff habitus, the assumptions informing these norms and the voices that validate and reproduce them.

ISRCTN registration number
ISRCTN77522923.

Objective
Recognising and managing pain was considered an essential clinical skill for nurses. This study aimed to assess nurses’ knowledge of pain management and the factors associated with it.

Design
A cross-sectional survey was conducted in Anhui province, China, using the Knowledge and Attitudes Survey Regarding Pain (KASRP) (2014). Multiple linear regression analysis identified factors associated with nurses’ KASRP Scores.

Setting
The study was carried out in 32 tertiary hospitals in Anhui province, China, from 21 May to 13 July 2023.

Participants
6928 registered nurses.

Outcome measures
The main outcome was the KASRP Score, reflecting nurses’ knowledge and attitudes towards pain management. We assessed the associations between sociodemographic factors, knowledge-sharing behaviours (KSBs) and KASRP Scores.

Results
Among the 6928 nurses analysed, the average KASRP Score was 17.70±3.57, corresponding to a correct response rate of 44.55%. Gender (p=0.003), professional title (p

Introduction
In light of the rising prevalence of sedentary behaviour worldwide, its impact on health has become a subject of growing interest. To clarify whether there is a significant correlation between sedentary behaviour and chronic pelvic pain in women and to explore its potential clinical implications, this study aims to provide a systematic review and meta-analysis of the association between the two. The findings of this study will inform the development of effective prevention and intervention strategies.

Methods and analysis
This study will conduct an exhaustive search across electronic databases, encompassing PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and Scopus, for records published up until 26 June 2024. Two independent researchers will conduct the study selection, data extraction and assessment of bias risks, with any discrepancies resolved through the collaboration of a third reviewer. To accurately discern the underlying sources of heterogeneity, sensitivity, subgroup analyses and meta-regression will be conducted in parallel. Additionally, to ensure the rigour and integrity of our research, Begg’s and Egger’s tests will serve as the primary means of evaluating the potential for publication bias within the studies under consideration.

Ethics and dissemination
Ethical approval will not be required for this study, as it will use publicly accessible, non-identifiable data from the published literature. The research team will ensure data privacy and participant confidentiality through anonymised data processing and strict compliance with relevant regulations. The results of this study will be disseminated through publication in a peer-reviewed journal.

Prospero registration number
CRD42024562443.

Introduction
Musculoskeletal shoulder pain is a common reason for people to be treated in physiotherapy services, but diagnosis can be difficult and often does not guide treatment or predict outcome. People with shoulder pain cite a need for clear information, and timely, tailored consultations for their pain. This trial will evaluate the introduction of a personalised guided consultation to help physiotherapists manage care for individuals with shoulder pain.

Methods and analysis
This is a cluster randomised controlled trial to evaluate the clinical and cost-effectiveness of introducing a personalised guided consultation compared with usual UK NHS physiotherapy care. Physiotherapy services (n=16) will be randomised in a 1:1 ratio to either intervention (physiotherapy training package and personalised guided consultation incorporating a new prognostic tool) or control (usual care); 832 participants (416 in each arm) identified from participating physiotherapy service waiting lists aged 18 years or over with shoulder pain will be enrolled. Follow-up will occur at 3 time points: 6 weeks, 6 months and 12 months. The primary outcome will be the Shoulder Pain and Disability Index (SPADI) score over 12 months. Secondary outcomes include global perceived change of the shoulder condition, sleep, work absence and the impact of shoulder pain on work performance, healthcare utilisation and health-related quality of life (using EuroQol 5 Dimension 5 Level (EQ-5D-5L)). A multimethod process evaluation will investigate views and experiences of participants and physiotherapists, assess uptake, facilitators and barriers to delivery, and changes in factors assumed to explain intervention outcomes. Primary analysis of effectiveness will be by intention-to-treat, and a health economic evaluation will assess cost-utility of introducing the personalised consultation.

Ethics and dissemination
The trial received ethics approval from the Yorkshire & The Humber (South Yorkshire) Research Ethics Committee (REC reference: 23/YH/0070). Findings will be shared through journal publications, media outlets and conference presentations. Supported by patient contributors and clinical advisors, we will communicate findings through a designated website, networks, newsletters, leaflets and in the participating physiotherapy services.

Trial registration number
ISRCTN45377604.

Circulation, Volume 151, Issue 18, Page 1297-1298, May 6, 2025.

Introduction
Kinesiophobia is a significant factor which influences the prognosis of patients with chronic non-specific low back pain (CNLBP). The restriction of functional training can severely impede functional recovery and contribute to negative emotional states (including anxiety and depression) and a heightened risk of insomnia while exacerbating the economic burden on patients. Although several randomised controlled trials have evaluated the effects of various non-pharmacological interventions on kinesiophobia in CNLBP, their relative efficacy and potential adverse effects remain ambiguous. This study will conduct a systematic review and network meta-analysis to identify which non-pharmacological intervention may represent the most effective treatment for kinesiophobia in patients with CNLBP.

Methods and analysis
Comprehensive searches will be conducted across English and Chinese databases (including The Cochrane Library, PubMed, Scopus, Springer, Embase, Wanfang Data, the Chongqing VIP Database and China National Knowledge Infrastructure) from the date of their inception to 20 November 2024. Only Chinese or English studies will be considered for analysis. The primary outcomes will include a significant reduction in secondary movement phobia associated with CNLBP, pain alleviation and enhancement of the functional status of the lumbar muscles. The Cochrane Bias Risk Assessment Tool will be used to conduct a bias risk assessment.
Pairwise meta-analysis will be performed by Review Manager V.5.3 software, Stata V.16.0 and Open BUGS V.3.2.3 software will be used to conduct a network meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation framework will be employed to assess the quality of evidence.

Ethics and dissemination
All of the data included in this study will be derived from the literature; therefore, ethical approval is not necessary. The findings will be disseminated via peer-reviewed journals and academic conferences.

PROSPERO registration number
CRD42024605343.

Introduction
While recent research suggests that acupuncture may offer benefits to individuals with diarrhoea-predominant irritable bowel syndrome (IBS-D), high-quality studies are scarce in this area. We intend to investigate the efficacy and safety of individualised sensitised acupuncture in IBS-D.

Methods and analysis
The study is designed as a large-scale, multicentre, two-arm, randomised clinical trial involving 326 patients diagnosed with IBS-D. Participants will be randomly allocated into the acupuncture or the sham acupuncture group in a 1:1 ratio. Both groups will undergo 15 sessions over 6 weeks. The primary outcome is the effective response rate at week 6, with secondary outcomes including the effective response rate at alternative time points, percentage of patients with 3 or more effective response weeks throughout the treatment duration, IBS Symptom Severity Scale, IBS-Quality of Life, Patient Health Questionnaire-9, Adequate Relief of IBS Symptoms Scale, Extraintestinal Symptoms Scale and other symptoms.

Ethics and dissemination
The study protocol has been approved by the Medical Ethics Committee of Beijing University of Chinese Medicine (project number: 2023BZYLL0102) and the ethics committees of other participating institutions. Each participant will be required to provide written consent before enrolment. The study results will be submitted for publication in a peer-reviewed journal.

Trial registration number
ChiCTR2300078321.

More than 1 in 5 US adults live with chronic pain, defined as experiencing pain on most days or every day for at least 3 months. Chronic pain takes an immense toll on people’s lives, impacting work, relationships, mental health, and well-being. For those who experience chronic pain and their clinicians, it is evident that flexibility, persistence, and creativity are necessary to create a multimodal care plan that maximizes function and minimizes the interference of chronic pain with daily living. These care plans must be dynamic, as changing life circumstances, pain characteristics, and overall health constantly shift the risk-benefit calculus for various treatment modalities. As a clinician, having options to offer patients is key.

Introduction
Postural neck pain is a prevalent musculoskeletal condition associated with discomfort, disability and impaired quality of life. Osteopathic manipulation has emerged as a potential intervention for managing postural neck pain, but a comprehensive synthesis of the existing evidence is lacking. This systematic review protocol introduces the rationale and objective to evaluate the effectiveness of osteopathic manipulation in alleviating postural neck pain and improving associated outcomes, including pain intensity, disability, range of motion and reposition sense.

Methods
We outline a rigorous methodology for this systematic review. A comprehensive search strategy will be implemented across various databases to identify relevant studies. This systematic review will encompass randomised controlled trials through electronic and manual searches. Electronic searches will be carried out in databases such as PubMed, Medline, Scopus and Web of Science. The search will span articles published from 2004 to December 2024; predefined eligibility criteria involve participants without a history of postural neck pain within the past 6 months. Exposure includes participants diagnosed with postural neck pain, while the comparison group comprises participants without neck pain.

Analysis
Outcome measures focus on pain intensity, range of motion, disability and reposition sense. Two independent reviewers will conduct study selection, data extraction and risk of bias assessment. The primary outcomes encompassing pain intensity, disability, range of motion and reposition sense will be systematically analysed.

Ethics and dissemination
As no primary data will be collected, ethical approval is not required. The findings will be presented at relevant conferences and published in a peer-reviewed journal.

PROSPERO registration number
CRD42023471857.

The global burden of inflammatory bowel disease (IBD) is progressively increasing, with a particularly sharp rise in newly industrialized and resource-limited settings. These regions face unique and pressing challenges in IBD care, including a shortage of trained specialists, delayed or missed diagnoses, financial and geographic barriers to access, and the persistent stigma surrounding the disease. Furthermore, cultural dynamics; especially the prominent role of family in healthcare decisions; profoundly influence patient engagement, treatment adherence, and overall outcomes.

Chronic back pain is the leading cause of disability worldwide, affecting 1 in 5 adults aged 20 to 59 years. But an analysis of randomized trials and observational studies led a panel of experts to strongly advise against the spine interventions commonly used for chronic axial and radicular back pain in a new clinical guideline. The panel found that the treatments offered little or no relief compared with placebos.

Objective
This study aimed to assess the pooled prevalence and factors of low birth weight among newborns in the top 20 countries with the highest infant mortality rates.

Design
We conducted a community-based cross-sectional analysis using data from Demography and Health Surveys across these countries. The final analysis included a weighted sample of 82 430 live births. We employed binary logistic regression to identify predictors of low birth weight, allowing for the interpretation of results as probabilities. This approach enhances the understanding of event likelihood, which is particularly valuable for policymakers. Statistical significance was determined at a 95% CI with p values