Back Pain: Reis S

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, Anonymous00003. · No affiliation provided · Eur Spine J. · Pubmed #16550448 No free full text.

This publication has no abstract.

Reis S, Borkan J, Vanraalte R, Tamir A, Dahan R, Hermoni D, Anonymous00093. · The R & B Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel. · Patient Educ Couns. · Pubmed #17451910 No free full text.

Abstract: OBJECTIVE: To describe a new tool designed to capture patients' perception of their low back pain (LBP) episodes-the patient perception scale (PPS) and test its ability to predict episode outcomes. METHODS: Thirty-two family physicians recruited 526 low back pain patients during an office visit. Physicians completed a short questionnaire at the index visit, which included both their assessments of patients' patient perception scale (PPS-doc) and contact information. Patients were then interviewed by telephone within 2 weeks after the index visit, with follow-up telephone contacts at 2, 4, 8 and 12 months. The patient perception scale as reported by the physician (PPS-doc) and patient (PPS-pt), each constituent question, and different combinations were analyzed for their ability to predict patient outcomes. RESULTS: Patients' responses (PPS-pt) proved predictive for all outcome items. PPS-doc was much less predictive. Measures of patient centeredness did not perform well in this study. CONCLUSION: By using a short scale based on the patient's perception of pain (PPS-pt), it is possible to predict adverse outcomes of a low back pain episode. The patient perception scale should be evaluated further and perhaps combined with other instruments for targeting care and chronicity prevention efforts in low back pain. PRACTICE IMPLICATIONS: The PPS-pt could potentially be used as part of the standard initial patient evaluation of new LBP patients, as a proxy for "yellow flags" (markers of psychosocial risk) where a positive score might be the equivalent to high-risk identification. The apparent advantage of this scale is its brevity and simplicity of administration. The separation, through this scale of pain episodes into simple and complex LBP might be a useful tool for helping direct resources and avoiding chronicity.

Reis S, Lahad A. · Department of Family Medicine, The R& B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Clalit Health Services. · Harefuah. · Pubmed #18935766 No free full text.

Abstract: The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. Guidelines for Chronic Low Back Pain (CLBP) care were never published in Israel previously, contrary to the Acute Low Back Pain (ALBP) guidelinges. This year, such guidelines are disseminated sponsored by the IMA. In the present paper a summary of the new CLBP care guideline is reported. To each recommendation an evidence level is attached, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will stay valid with periodic updating. Clinical practice guidelines are not intended to replace careful clinical judgment and personal acquaintance with the patient in. They may support decisions by bringing a summary of the existing evidence in the domain.

Dahan R, Reis S, Borkan J, Brown JB, Hermoni D, Mansor N, Harris S. · Department of Family Medicine, The B. RAppaport Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel. · J Eval Clin Pract. · Pubmed #18373587 No free full text.

Abstract: OBJECTIVES: To measure knowledge of Israeli low back pain (LBP) clinical practice guidelines among different subgroups of primary care doctors, prior to designing an intervention programme to enhance guideline adherence in practice. STUDY DESIGN: Confidential mailed survey questionnaire. SETTING: Family practices in the Haifa and western Galilee district, Israel. PARTICIPANTS: Random sample of 163 primary care doctors. A total of 134 doctors (82%) completed the questionnaire. MAIN OUTCOME MEASURES: A Multiple Choice Questionnaire measuring knowledge of the LBP guidelines. Instrument reliability and inter-item reliability were tested in a pilot phase. Content validity was assured by having the Israeli LBP guideline authors involved in a consensus procedure. RESULTS: Distribution of test scores significantly differentiated professional levels and background variables, demonstrating the instrument reliability. Cronbach's alpha was above 0.91. The average test score was 67.7 [standard deviation (SD) 16.2], family doctors had average scores of 75.2 (SD 9.8), general practitioners (GPs) 57.9 (SD 19) and family practice residents 67.4 (SD 13.2). The difference between the test average scores of family doctors, GPs and residents was significant (P < 0.001). Significant differences were also found for specific variables including the doctor's age, country of medical training and self-report familiarity with the LBP guidelines. CONCLUSIONS: Striking differences exist between subgroups of primary care doctors regarding their knowledge of LBP guidelines. These differences will require the design of multiple interventions tailored to each subgroup.

Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M. · Population Health Research Unit, (URESP) Research Centre of the Laval University Affiliated Hospital, Québec, QC, Canada. · Spine (Phila Pa 1976). · Pubmed #18165754 No free full text.

Abstract: STUDY DESIGN: A modified Delphi study conducted with 28 experts in back pain research from 12 countries. OBJECTIVE: To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. SUMMARY OF BACKGROUND DATA: Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. METHODS: Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. RESULTS: Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. CONCLUSION: These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.

Reis S, Lahad A. · Department of Family Medicine, The R& B Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology. · Harefuah. · Pubmed #17853562 No free full text.

Abstract: The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. A decade ago, Guidelines for Acute Low Back Pain (ALBP) care were published in Israel. This year, updated and upgraded guidelines were disseminated, sponsored by the IMA. In the present paper a summary of the new ALBP is reported, as well as a comparison with the prior 1996 guidelines. An evidence tag is attached to each recommendation, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will remain valid with periodic updating. Clinical practice guidelines are not intended to replace your careful clinical judgment and personal acquaintance with the patient in front of you. They may support your decisions by bringing you a summary of the existing evidence in the domain.

Dahan R, Borkan J, Brown JB, Reis S, Hermoni D, Harris S. · Department of Family Medicine, The B. Rappaport Faculty of Medicine, The Technion Institute of Technology and Clalit Health Services Haifa and W G, Israel. · J Eval Clin Pract. · Pubmed #17683304 No free full text.

Abstract: PURPOSE: Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. METHODS: A qualitative focus group study of FPs in the north of Israel. Purposeful sampling was used to recruit participants, all of them board-certified FPs. Four focus groups were created, and discussions were taped, transcribed and analysed for major themes. RESULTS: Focus groups findings have expanded the understanding of the intellectual and mental challenges faced by Israeli FPs caring for LBP patients and highlighted the many obstacles to implementing LBP guidelines. Physicians' decision-making, pertaining to LBP, functions on three levels simultaneously: the physicians' agenda based on familiarity with the guidelines; their need to remain grounded in the context of the specific patient-doctor relationship; and the constraints and demands of the physician's workplace, medical system and environment. CONCLUSIONS: Despite an overall positive attitude towards LBP guideline implementation, FPs found it hard to come to terms with the conflicting dimensions of LBP patient care. The patient-doctor interaction determined the outcome of the encounter, whether it complied with the guidelines and whether the encounter leads to a healing process or to a vicious circle of unnecessary utilization of services.

Neher JO, Borkan JM, Wilkinson MJ, Reis S, Hermoni D, Hobbs FD. · Department of Family Medicine, University of Washington School of Medicine, Seattle, USA. · Scand J Prim Health Care. · Pubmed #11822647 No free full text.

Abstract: OBJECTIVE: To document the frequency of conversations about alternative medicine during primary care consultations for back pain in diverse settings. DESIGN: "Exit interview" type patient survey. SETTINGS: General practices in Seattle, Washington; rural Israel; and Birmingham, England. PATIENTS: A convenience sample of 218 adults completing a doctor visit for back pain. MAIN OUTCOME MEASURES: Frequencies of doctor-patient discussions of alternative medicine. RESULTS: Alternative medicine was discussed in a minority of visits (US site 40%, Israel site 37%, UK site 14%, p < 0.05). At each site, patients initiated at least half of the discussions. Users were five to six times more likely to discuss alternative medicine with their doctor than non-users (p < 0.05 for comparison at each site). The percentage of patients who used alternative medicine but left the consultation without discussing it was similar at all sites (US site 17%, Israel site 23%, UK site 15%). CONCLUSIONS: Discussions of alternative medicine occurred in a minority of consultations for back pain although the rate varied considerably by site. Discussions were initiated primarily by patients who use it.

Hermoni D, Borkan JM, Pasternak S, Lahad A, Van-Ralte R, Biderman A, Reis S, Anonymous00043. · Department of Family Medicine, Technion, Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel. · Br J Gen Pract. · Pubmed #11127171 links to  free full text

Abstract: Doctor-patient concordance and patient initiative were examined in a prospective network interview study, with telephone follow-up, of a cohort of 100 patients presenting with low back pain to their family physician. The average overall rate of concordance was 60% (95% CI = 53 to 66), with the highest rates for radiographic imaging studies and sick leave. No correlation was found between concordance and patient parameters. Subjects initiated an average of two (95% CI = 1.7 to 2.3) diagnostic or therapeutic procedures, the most common of which were for medications (40%), followed by bed rest (26%) and back school (22%). One out of every six subjects initiated a referral to a complementary therapist. Positive correlation was found between patient initiatives and pain severity (P = 0.022) and disability (P = 0.02). There was a negative correlation between the subjects' initiatives and their belief that the physician understood the cause of their pain and its influence on their life (P = 0.02). Overall, those patients who described more pain or disability sought more types of diagnostic and therapeutic measures, while those who felt they had been understood sought less.

Reis S, Hermoni D, Borkan JM, Biderman A, Tabenkin C, Porat A. · Department of Family Medicine, Technion, Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel. · J Fam Pract. · Pubmed #10229256 No free full text.

Abstract: BACKGROUND: Low back pain (LBP) is one of the most frequent reasons patients seek consultations in primary care, and it is a major cause of disability. Our research examines the natural history of LBP and the prediction of chronicity in the context of patients presenting to family medicine clinics. METHODS: We performed a prospective cohort study of new episodes of LBP within the framework of a national family practice research network. The setting was 28 primary care family practice clinics located throughout Israel. Of 238 eligible subjects, 219 (92%) completed the study. RESULTS: During the 2-month study period, 2 subjects were referred to the emergency department and discharged, and 2 others were hospitalized. Forty-five percent did not require bed rest, and 38% of the employed were not absent from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, history of back contusion, lack of social support, family delegitimization of patient's pain, dissatisfaction with first office visit, family history of LBP or other chronic pain, coping style, and unemployment. CONCLUSIONS: The cohort patients displayed a relatively benign natural history of LBP, matched by benign clinical behavior from their physicians. In Israeli primary health care, acute LBP is infrequently associated with hospitalization or prolonged work absenteeism. Although most patients have functional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.

Pincus T, Vlaeyen JW, Kendall NA, Von Korff MR, Kalauokalani DA, Reis S. · Royal Holloway, University of London, London, United Kingdom, Maastricht University, Maastricht, The Netherlands. · Spine (Phila Pa 1976). · Pubmed #11880850 No free full text.

Abstract: STUDY DESIGN: An amalgamated review of the current state of knowledge about psychosocial factors in low back pain (LBP), as presented at the plenary session at the Fourth International Forum on LBP Research in Primary Care (March 16-18, 2000, Israel). OBJECTIVES: To outline evidence-based theories that have lead to the identification of yellow flags (psychosocial risk factors for developing long-term disability) for nonspecific LBP. To discuss the role of clinicians in primary care in detecting and addressing these psychosocial factors and to outline future directions for research to clarify this role. SUMMARY OF BACKGROUND DATA: It is widely accepted that psychological and social factors play an important role in LBP; however, it is currently unclear which specific factors merit intervention to reduce the burden of disease. METHOD: The review is an integration based on the plenary session presented at the Fourth International Forum on LBP Research in Primary Care. The presentations included original research studies, a systematic review, and theoretical descriptions of models of risk and treatment. RESULTS: There is good evidence to support the role of psychological risk factors at early stages of LBP in the development of long-term disability. There are evidence-based theories and models that provide directions for future interventions. CONCLUSION: In the treatment of psychological factors, the role of clinicians in primary care remains unclear. Further evidence is needed to identify specific psychological risk factors, primary care tools for their identification need developing, and interventions at different stages of LBP by different professionals need to be tested.

Borkan J, Van Tulder M, Reis S, Schoene ML, Croft P, Hermoni D. · Department of Behavioral Sciences, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Spine (Phila Pa 1976). · Pubmed #11880849 No free full text.

Abstract: STUDY DESIGN: Review of advances in the primary care research on low back pain (LBP) from a unique international forum, and analysis of open-ended questionnaires from participants. SUMMARY OF BACKGROUND DATA: LBP continues to be one of the most common and challenging problems in primary care. It is associated with enormous costs in terms of direct health care expenditures, and indirect work and disability-related losses. OBJECTIVE: To ascertain the current status and state of the art regarding LBP in primary care. METHODS: Four reviewers independently assessed the content and implications of presentations at the Fourth International Forum for Primary Care Research on LBP, pooled the data, and then augmented it with open-ended questionnaires completed by 35 participants. RESULTS: The Fourth Forum documented the field's emergent new paradigm-a transition from thinking about back pain as a biomedical "injury" to viewing LBP as a multifactorial biopsychosocial pain syndrome. The paradigm shift has occurred in the context of increased interest in evidence-based medicine regarding LBP in primary care. The Forum demonstrated the strides taken in moving from research and evidence gathering, through guidelines and policy formulations and finally to the dissemination and implementation imperative. There was an increasing confidence among the Forum researchers that LBP can be managed successfully in primary care settings through a combination of encouraging activity, reassurance, short-term symptom control, and alteration of inappropriate beliefs about the correlations of back pain with impairment and disability. There is also recognition that a wide range of international, evidence-based guidelines now exists that have very similar messages. CONCLUSIONS: The Fourth Forum reflected a major shift in the conceptualization of LBP in primary care and an increased emphasis on implementation and dissemination of LBP research findings and clinical guidelines. Although there is a wide array of challenges ahead, the Fourth Forum provided a clear message regarding the need to focus research energies on changing practitioner behavior.