BACKGROUND: Observation of movement quality (MQ) is an indelible element in the process of clinical reasoning for patients with non-specific low back pain (NS-LBP). However, the observation and evaluation of MQ in common daily activities are not standardized within allied health care. This study aims to describe how Dutch allied health care professionals (AHCPs) observe and assess MQ in patients with NS-LBP and whether AHCPs feel the need to have a specific outcome measure for assessing MQ in patients with NS-LBP.METHODS: In this cross-sectional digital survey study, Dutch primary care AHCPs (n = 114) answered one open and three closed questions about MQ in NS-LBP management. Qualitative and quantitative analyses were applied.RESULTS: Qualitative analyses of the answers to the open questions revealed four main themes: 1) movement pattern features, 2) motor control features, 3) environmental influences and 4) non-verbal expressions of pain and exertion. Quantitative analyses clearly indicated that AHCPs observe MQ in the diagnostic (92%), therapeutic (91%) and evaluation phases (86%), that they do not apply any objective measurement of MQ and that 63% of the AHCPs consider it important to have a specific outcome measure to assess MQ. The AHCPs expressed added benefits and critical notes regarding clinical reasoning and quality of care.CONCLUSION: AHCPs recognize the importance of observing MQ in the assessment and management of LBP in a standardized way. However, there is no consensus amongst AHCPs how MQ should be standardized. Prior to standardization, it will be important to develop a theoretical framework to determine which observable and measurable dimensions of MQ are most valid and relevant for patients with NS-LBP to include in the assessment.
Objective: To develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept. Design: Focus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study. Setting: Dutch primary care physiotherapy practices (n=21 therapists). Participants: Adults with non-specific LBP (n=41). Intervention: e-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals' level of physical activity. The intervention could be tailored to patients' risk of persistent disabling LBP, according to the STarT Back Screening Tool. Main outcome measures: Functional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks. Results: After 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) -12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD -2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5minutes/day; 95% CI -47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD -23.0minutes/day; 95% CI -8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application. Conclusions: The results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.
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OBJECTIVE: Measurement of exercise capacity is essential in patients with non-specific chronic low back pain (CLBP). However, the conventional Astrand bicycle test is not feasible in patients with a very poor aerobic capacity. Therefore the Astrand bicycles test for non-specific CLBP patients based on lean body mass (LBM) was developed as an alternative. The aim of this study was to evaluate reliability and validity of the LBM-based Astrand test.SUBJECTS: Twenty patients with non-specific CLBP and 20 healthy subjects were included for the reliability evaluation, and 19 healthy subjects for the validity evaluation.METHOD: Patients and healthy subjects were assessed twice. Intra class correlation (ICC), repeatability coefficient (RC) and the limits of agreement (LOA) were calculated as a measure of test re-tests reliability. An ICC >or= 0.75 was considered acceptable. Validity was tested by calculating ICC between the LBM-based Astrand test and a maximal bicycle test.RESULTS: The LBM-based Astrand test shows good reliability, reflected by an ICC >or= 0.91 and 95% of the 20 patients could perform the test. However, differences with the estimated true value reflected by the RC and natural variation reflected by the LOA were substantial in patients. Validity was good, reflected by ICC >or= 0.88.CONCLUSION: The present study shows that the LBM-based Astrand test is a reliable, valid, and feasible method for patients with non-specific CLBP. However, a substantial amount of variation should be taken into account in patients when interpreting the test results clinically.
