Risultati per: Low Back Pain: raccomandazioni

A randomized study demonstrated similar rates of death and stroke with the two interventions.

Introduction
Chronic non-specific low back pain (CNLBP) stands as a predominant factor contributing to disability worldwide. In the recent past, the sphere of medical research has witnessed a burgeoning interest in exploring the therapeutic potential of dynamic neuromuscular stabilisation (DNS) techniques for this condition. Despite the growing body of evidence, a comprehensive synthesis evaluating the effectiveness and safety of these interventions remains absent. This study, therefore, seeks to rigorously assess the therapeutic value and safety profile of DNS techniques in the management of CNLBP.

Methods and analysis
We will explicitly follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting the systematic review. Our search strategy will encompass both English and Chinese databases, extending from their inception through March 2024. Specifically, we will explore the Web of Science, PubMed, Embase and the Cochrane Library for English literature, while for Chinese studies, we will delve into the Chinese National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database (VIP), the Wan Fang Database and the China Biology Medicine disc. The outcome metrics we will assess include clinical efficacy, pain (assessed using the Visual Analogue Scale (VAS) and Numerical Pain Rating Scale (NPRS)) and functional disability (evaluated using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ)) and the incidence of adverse reactions. Our focus will be on identifying randomised controlled trials that assess the efficacy of DNS training in the treatment of CNLBP. The data extracted from these trials will be synthesised through a comprehensive meta-analysis to elucidate the effectiveness of this intervention. When applying the Grading of Recommendations Assessment, Development and Evaluation framework to assess the included studies, we may encounter several challenges, for example, the variability in outcome measurements, the sample sizes of the included studies and the heterogeneity of the study populations. We will pay particular attention to these potential limitations to ensure the accuracy and reliability of the evaluation.

Ethical considerations and dissemination
Given that our research does not engage human or animal subjects nor does it handle any personal patient data, the requirement for ethical approval is bypassed. We aim to share the insights gleaned from this study through publication in reputable peer-reviewed journals and presentation at professional conferences, ensuring broad and impactful dissemination of our findings.

Pérez-Porta I, FlórezGarcía MT, García-Pérez F, et al. Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuff-related shoulder pain: protocol for an open-label randomised controlled trial. BMJ Open 2024;14:e085381. doi:10.1136/bmjopen-20240 85 381
This article has been corrected since it was published online. The funding information has been updated. ‘This trial has received funding from the Instituto de Salud Carlos III and the European Union (PI19/01490). The funder has no influence on the study’s design, execution, analysis, or publication of results.’

Time changed without incident in the hospital where everyone worked an extra hour, and anyone born then would be perpetually confused or late all the time, and anyone who died and quietly lay in a room, still waiting for love, still, wheeled down the hall with the photographs on the walls, several of her smiling with a child, or looking intense because her life was falling apart, yet she looked good in her black jeans, not sure what she is wearing now, she went out in a large black plastic bag, hiding all of her continuing to leave through the door, continuing to become time: the seconds, minutes, hours days years, but who’s counting, who knows.

The method of freezing all suitable embryos before transfer to the uterus, known as the “freeze-all strategy,” has become common practice for in vitro fertilization (IVF) over the past decade. But for some individuals, this might not be the best option.

This Special Communication presents the arc of the author’s career as clinical scientist and mentor in old-age psychiatry.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of cancer treatment. Although chemotherapy drugs target abnormal cells, they can also damage peripheral nerve cells, disrupting signaling pathways and creating sensations of tingling, numbness, or burning.

Objective
This study aimed to assess the status of infant and young child feeding (IYCF) practices and associated factors among children aged 0–23 months in the low-income regions of Dhaka City, Bangladesh.

Design
A community-based cross-sectional study.

Settings
Low-income regions of Dhaka City, Bangladesh.

Participants
530 children aged 0–23 months and their mothers.

Primary and secondary outcome measures
Prevailing IYCF practices were assessed against the 17 indicators of IYCF recommended by the WHO/UNICEF in 2021. Modified Poisson regression models were built to explore the relation between socio-demographic variables and each of the selected IYCF indicators (early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)).

Results
More than two-thirds of the children were reported to follow appropriate breastfeeding practices (EIBF, 70.4% and EBF, 60.9%). Among the complementary feeding indicators, almost half of the children (48.8%) were reported to meet MMF; however, only about 26% of the children reportedly met the MDD with a consequent low prevalence (22.9%) of the composite indicator MAD. More than half (55%) of the children were reported to consume egg and/or flesh food consumption; still, inappropriate dietary practices were observed among 60% had unhealthy food consumption, and 56% had zero vegetable or fruit consumption). Child age was a significant determinant of IYCF practices. The children of mothers with no pregnancy complications exhibited a greater chance of having EIBF (estimate: 1.21, 95% CI: 1.04, 1.42, p=0.02), MDD (Estimate: 1.67, 95% CI: 1.09, 2.55, p=0.02), and MAD (estimate: 1.70, 95% CI: 1.04, 2.77, p=0.03) compared with the children of mothers with pregnancy complications. The children with a mother having secondary or higher education had a higher chance of having MDD (estimate: 1.93, 95% CI: 1.35, 2.76, p=0.003) and MMF (estimate: 1.27, 95% CI: 1.03, 1.56, p=0.02) than the children of mothers having primary or no education. Similarly, children from higher-income households had a higher chance of getting MDD (estimate: 1.57, 95% CI: 1.07, 2.03, p=0.02), and MAD (estimate: 1.73, 95% CI: 1.14, 2.64, p=0.01) compared with children from lower-income households.

Conclusion
IYCF practices among a considerable proportion of children aged 0–23 months in the low-income regions of Dhaka City were found to be suboptimal and predicted by children’s age, maternal education and pregnancy complications, and household income.

Objectives
Early evaluation and treatment of patients with acute chest pain pose a massive challenge to the emergency care system worldwide. This study aims to determine the current burden and early management of acute chest pain presenting to the emergency departments (EDs) in China.

Design
The Evaluation and Management of Patients with Acute ChesT pain study is a prospective, multicentre and provincially representative registry of acute chest pain patients in Chinese EDs.

Setting
A stratified random sampling design generated the province representative sample of 21 public hospitals with independent EDs in Shandong, China. Each participating site consecutively enrolled patients for at least 12 months from August 2015 to September 2017.

Participants
A total of 8349 adult patients presenting with acute chest pain or suspected acute coronary syndrome (ACS) were included.

Primary outcome measures
The annual incidence of ED-assessed acute chest pain was estimated. The aetiology, process of care and 30-day major adverse cardiac events (MACE) of included patients were analysed.

Results
The estimated annual incidence of ED-assessed acute chest pain was 96.6 (95% CI 95.9 to 97.3) per 100 000 adults, significantly increasing with age. The mean age of included patients was 63.8 years, with 57.9% males. Prehospital delay was a median of 2.8 (IQR, 1.2–10.3) hours, with 17.9% transported by ambulance. About 75.6% of patients received their first ECG within 10 min. Cardiac troponin was tested in 54.2%, with high-sensitivity cardiac troponin in 24.5% and serial troponins in 5.1% during the ED stay. Most (74.0%) were admitted to the inpatient ward, with a median ED stay of 65.0 (IQR, 27.0–385.0) min. Within 30 days, 6.8% experienced MACE. Among included patients, 62.9% were diagnosed with ACS, with specific management varying by ST-segment elevation status.

Conclusions
China’s first regionally representative registry of acute chest pain revealed a lower incidence of ED-assessed cases but a higher proportion of high-risk patients compared with other countries. Gaps persist in aligning emergency management with guidelines. More programmes and policies are needed to enhance the quality of acute chest pain care in China.

Trial registration number
This study was registered at URL: https://www.clinicaltrials.gov (NCT02536677).

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Objectives
Early evaluation and treatment of patients with acute chest pain pose a massive challenge to the emergency care system worldwide. This study aims to determine the current burden and early management of acute chest pain presenting to the emergency departments (EDs) in China.

Design
The Evaluation and Management of Patients with Acute ChesT pain study is a prospective, multicentre and provincially representative registry of acute chest pain patients in Chinese EDs.

Setting
A stratified random sampling design generated the province representative sample of 21 public hospitals with independent EDs in Shandong, China. Each participating site consecutively enrolled patients for at least 12 months from August 2015 to September 2017.

Participants
A total of 8349 adult patients presenting with acute chest pain or suspected acute coronary syndrome (ACS) were included.

Primary outcome measures
The annual incidence of ED-assessed acute chest pain was estimated. The aetiology, process of care and 30-day major adverse cardiac events (MACE) of included patients were analysed.

Results
The estimated annual incidence of ED-assessed acute chest pain was 96.6 (95% CI 95.9 to 97.3) per 100 000 adults, significantly increasing with age. The mean age of included patients was 63.8 years, with 57.9% males. Prehospital delay was a median of 2.8 (IQR, 1.2–10.3) hours, with 17.9% transported by ambulance. About 75.6% of patients received their first ECG within 10 min. Cardiac troponin was tested in 54.2%, with high-sensitivity cardiac troponin in 24.5% and serial troponins in 5.1% during the ED stay. Most (74.0%) were admitted to the inpatient ward, with a median ED stay of 65.0 (IQR, 27.0–385.0) min. Within 30 days, 6.8% experienced MACE. Among included patients, 62.9% were diagnosed with ACS, with specific management varying by ST-segment elevation status.

Conclusions
China’s first regionally representative registry of acute chest pain revealed a lower incidence of ED-assessed cases but a higher proportion of high-risk patients compared with other countries. Gaps persist in aligning emergency management with guidelines. More programmes and policies are needed to enhance the quality of acute chest pain care in China.

Trial registration number
This study was registered at URL: https://www.clinicaltrials.gov (NCT02536677).

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Introduction
Placental dysfunction is estimated to affect 10% of pregnancies and is associated with adverse perinatal outcomes. Low-dose aspirin (LDA) reduces placental dysfunction risk. However, adherence to LDA is suboptimal in pregnant women and may reduce its effectiveness.

Objectives
We aimed to explore the barriers and facilitators to LDA adherence in pregnant women with placental dysfunction risk.

Design
Qualitative semi-structured individual interviews were undertaken, and data were inductively thematically analysed.

Setting
A single NHS Trust in South West England, UK.

Participants
Pregnant women aged >18, recommended daily LDA for pregnancy indications. We purposively recruited those with a range of adherence patterns (non-adherent, suboptimally adherent, adherent).

Results
15 women participated (93% white British, 73% university educated). Five were adherent (6–7 doses per week), five suboptimally adherent (4–5 doses per week) and five non-adherent (

Introduction
Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100–US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice.

Methods and analysis
The Implementation of the American College of Physicians Guideline for Low Back Pain trial is a health system-embedded pragmatic cluster-randomised trial that will examine the effect of offering initial contact with a PSP compared with usual primary care for LBP. Twenty-six primary care clinics within three healthcare systems were randomised 1:1 to PSP intervention or usual primary care. Primary outcomes are pain interference and physical function using the Patient-Reported Outcomes Measurement Information System Short Forms collected via patient self-report among a planned sample of 1800 participants at baseline, 1, 3 (primary end point), 6 and 12 months. A subset of participants enrolled early in the trial will also receive a 24-month assessment. An economic analysis and analysis of healthcare utilisation will be conducted as well as an evaluation of the patient, provider and policy-level barriers and facilitators to implementing the PSP model using a mixed-methods process evaluation approach.

Ethics and dissemination
The study received ethics approval from Advarra, Duke University, Dartmouth Health and the University of Iowa Institutional Review Boards. Study data will be made available on completion, in compliance with National Institutes of Health data sharing policies.

Trial registration number
NCT05626049.

Introduction
Non-specific pain (NSP), defined as pain without a clear pathological cause, is a common presentation in the emergency department (ED). There is no universally accepted analgesic strategy, but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed. However, the established efficacy of NSAIDs for NSP is limited. Additionally, NSAIDs are associated with an increased risk of upper gastrointestinal bleeding, acute kidney injury and cardiovascular events, such as myocardial infarction and stroke. There is increasing evidence supporting the analgesic effects of open-label placebo (OLP), defined as placebo administered to patients without deception, in a broad variety of settings. Accordingly, OLP could be a safer, effective analgesic treatment option for NSP. To our knowledge, this is the first study investigating the feasibility of OLP for NSP in the ED. Therefore, our primary objective is to assess whether OLP is a feasible treatment option in this setting.

Methods and analysis
Patients diagnosed with acute NSP will be prospectively recruited at discharge in the ED at the University Hospital of Basel, Switzerland. Patients treated with pain medication for >7 days prior to ED visit or with chronic pain will be excluded. Patients will be randomised to receive either OLP (intervention) or ibuprofen (control). Rescue medication will be ibuprofen in both groups. Daily online self-assessment will take place during the first 7 days after the baseline visit as well as on day 30. A qualitative interview will be conducted on day 30. The primary outcome is feasibility, consisting of acceptability, adherence to the protocol and patient satisfaction. Clinical outcomes will focus on pain intensity and interference according to the Brief Pain Inventory Short Form as well as adverse events.

Ethics and dissemination
The study protocol has received approval from the ethics committee for Northwestern and central Switzerland (EKNZ; project ID 2024-00089). The results will be disseminated in peer-reviewed journals and at scientific conferences.

Trial registration number
Swiss National Clinical Trials Portal (SNCTP000005852); Clinicaltrial.gov (NCT06408519).

Objective
To determine if there is research waste in controlled trials of exercise therapies compared with usual care/no treatment for adults with chronic non-specific lower back pain.

Design and data sources
Secondary analysis of previously published systematic review (Cochrane review).

Eligibility criteria
Randomised controlled trials comparing exercise treatments for chronic low back pain to usual care/no treatment eligible for inclusion in the 2021 Cochrane review of exercise interventions for chronic low back pain.

Data extraction and synthesis
All data were taken from the 2021 Cochrane review of exercise therapy for chronic lower back pain and the UK BEAM trial. We did trial-sequential meta-analysis and cumulative meta-analyses, exploring changes in effect estimates over time and by trial size.

Results
Respective superiority boundaries for pain and disability were crossed in 2004 after four and five trials (n=358/415) were published. A further 43 trials with 2626 participants were included in the Cochrane review. In 2004, the mean effect sizes for pain and disability were –12.85 (95% CI –24.89 to –0.81) and –6.67 (95% CI –11.27 to 3.36), respectively; similar to those reported by Cochrane in 2021. Including small trials substantially affected effect size estimates. When the 33 and 36 trials, respectively, with fewer than 70 participants are excluded, the limits of the 95% CIs for effect size estimates exclude the clinically important differences ((pain; –8.8 (95% CI –11.38 to –5.63): disability –4.27 (95% CI –6.12 to –2.24).

Conclusions
It may be difficult to justify any further trials comparing exercise interventions to usual care/no treatment for chronic low back pain. The inclusion of small studies in meta-analyses has produced biased results in previous meta-analyses. Exercise treatments might not have a clinically important effect on people with chronic low back pain.