Introduction

Vertebroplasty helps to restore mechanical function to a fractured vertebra. We investigated how the distribution of injected cement benefits both fractured and neighbouring vertebrae.

Methods

Nine pairs of three-vertebra cadaver spine specimens (aged 67–90 yr) were compressed to induce fracture. One of each pair underwent vertebroplasty with PMMA, the other with a resin (Cortoss). Specimens were then creep-loaded at 1.0kN for 1hr. Before and after vertebroplasty, compressive stiffness was determined, and stress profilometry was performed by pulling a pressure-transducer through each disc whilst under 1.0kN load. Profiles indicated intradiscal pressure (IDP) and compressive load-bearing by the neural arch (F_N) at both disc levels. Micro-CT was used to quantify cement fill in the anterior and posterior halves of each augmented vertebral body, and also in the region immediately adjacent to the fractured endplate

Introduction

Risk factors for disc degeneration depend on how the condition is defined, i.e. on the specific disc degeneration “phenotype”. We present evidence that there are two major and largely-distinct types of disc degeneration.

Methods

The relevant research literature was reviewed and re-interpreted.

Introduction

Delamination of the annulus fibrosus is an early feature of disc degeneration, and it allows individual lamellae to collapse into the nucleus, or to bulge radially outwards. We hypothesise that delamination is driven by high gradients of compressive stress in the annulus.

Methods

102 thoracolumbar motion segments (T8-9 to L5-S1) were dissected from 42 cadavers aged 19–92 yrs. Each specimen was subjected to 1 kN compression, while intradiscal compressive stresses were measured by pulling a pressure transducer along the disc's mid-sagittal diameter. Stress gradients were measured, in the anterior and posterior annulus, as the average rate of increase in compressive stress (MPa/mm) between the nucleus and the region of maximum stress in the annulus. Average nucleus pressure was also recorded. Disc degeneration was assessed macroscopically on a scale of 1–4.

Background

In 2009, the National Institute for Health and Clinical Excellence (NICE) produced the guidance: Low back pain: early management of persistent non-specific low back pain aimed at general practitioners (GPs), consultants, and manual therapists in order to ensure all involved in the care of this complex and often debilitating condition are aware of the options most likely to yield a positive outcome.

Two years since the publication of the clinical guidance, services have had ample time to adapt and overcome early teething issues in order to deliver these guidelines.

Methods

A retrospective audit was carried out at an out-patient physiotherapy department. One-hundred notes were randomly selected from those who meet the NICE criteria, i.e. non-specific low back pain for six weeks to 12 months in duration. A questionnaire was developed to target National Health Service (NHS) musculoskeletal physiotherapists using electronic media, mail shot and professional networking (clinical interest) groups within the Chartered Society of Physiotherapy (CSP). Sixty-one completed questionnaires were returned detailing the barriers for implementation.

The results show that 75% of patients received NICE recommended care, and they improved by numerical rating scale (NRS) −3.89, while those who did not, improved by NRS −1.24 producing a significant difference of 2.654 (95% Confidence Interval 1.008–4.300), p≤0.002.

The main perceived barriers were too few follow-up slots, local policy, managerial demands, and inadequate training.

Aims

1.

To develop a decision aid - Decision Support Package (DSP) - that will provide low back pain (LBP) patients, and their treating physiotherapists with information on the treatment options available to the patients

Method

We developed a DSP informed by existing research and collaboration with physiotherapists, patients and experts in the field of decision aids and LBP. We did six pieces of exploratory work: literature review; 2009 NICE LBP guidelines review; qualitative screening of transcripts of interviews of LBP patients; focus groups (patients); nominal group (physiotherapists), and Delphi study (experts). We collated these data to develop the DSP. We also developed a training package for physiotherapists.

Introduction

The STarT Back trial demonstrated that targeting back pain treatment according to patient prognosis (low, medium or high-risk subgroups) is effective. However, the mechanisms leading to these improved treatment outcomes remain unknown. This study aimed to identify which psychological variables included in the study were mediating treatment outcome for all patients and within the low, medium and high-risk subgroups.

Methods

Secondary analysis was conducted on 466 patients randomised to the active treatment arm with 4-month follow-up available. Psychological variables included depression (HADs), fear (TSK), catastrophising (PCS), bothersomeness and illness perception constructs (IPQ brief) e.g. personal control. Treatment outcome was characterised using change in disability score (RMDQ) at 4-months. Residualised change scores were calculated for each variable and Pearson's correlations were calculated overall and at the subgroup level to determine potential mediating variables for disability improvement.

Background

Percutaneous vertebroplasty (PVP) is a well established procedure with respect to improved pain and function following vertebral compression fracture. Currently, there is no consensus on the optimal cement distribution within a treated vertebral body. The aim of this study was to determine the influence of two distinct patterns of cement distribution following PVP on patient reported outcome measures up to 1 year post procedure.

Methods

A retrospective study was undertaken of 42 patients consecutively undergoing PVP of up to 3 levels by a sole operator. Immediate post-procedural CT scans were analysed with VOXAR MPR software to determine cement distribution in each treated vertebrae as one of two defined patterns -“anterolateral” or “diffuse”. Patients completed an EQ-5D questionnaire pre-procedure and at 1, 2, 6 and 12 months from the procedure.

Background and Aims

Transforaminal epidurals (TFEs) have been widely used as a treatment for lumbar radicular pain since its introduction by Krempen and Smith in 1974¹. Originally used as a diagnostic tool, it is now becoming increasingly recognised as a definitive treatment². This study investigates the use of TFEs by a single surgeon over 4 years. We hoped that the study would add to our understanding and the discussion of the actual benefit of therapeutic steroid and local anaesthetic injections by this route³.

Methods and Results

A total of 181 patients were identified. At injection 10mls 0.25% Marcaine and 40mg Depomedrone was injected under fluoroscopic guidance. Clinic notes and MRI reports for all patients were reviewed.

Of the 176 patients included in the study, 127 showed a symptomatic improvement. Of these patients, 59 proceeded to surgical decompression. For 50 patients, TFE was the definitive treatment. 13 patients were offered but declined surgery. 5 patients were too frail to proceed to surgery.

49 patients showed no symptomatic improvement. Of this group, 34 were deemed unsuitable for surgical intervention. 15 patients did proceed to surgery.

Aims

A systematic review of the available literature comparing the outcomes of radiofrequency denervation to sham procedure in treating chronic low back pain caused by lumber zygapophysial joint pathology.

Methods

Medline and EMBASE databases were searched for English language articles from 2005 to July 2010. Articles were considered for review if they satisfied the inclusion criteria: Randomised Controlled Trials(RCT) comparing radiofrequency neurotomy(RFN) to a ‘placebo’ procedure in patients with chronic low back pain caused by facet joint osteoarthritis. Adult patients of both sexes above 17 years of age who complained of continuous low back pain for more than 6 months with focal tenderness over the facet joints. Outcome measures of interest are pain improvement, physical activity, analgesic use, quality of life variables, range of motion of the lumbar spine and hip movement.

Critical appraisal of the selected studies was carried out using the CASP appraisal tool for RCT.

Aims

To capture the views of various members of the healthcare system with regards to whiplash injuries and in particular, the cumulative effects of whiplash on a patient seeking compensation.

Method

A questionnaire was set up on “Surveymonkey” which consisted of three scenarios outlining 1. single whiplash injury 2. Past history of neck pain with new whiplash injury 3. Chronic history of neck pain with a new whiplash injury seeking long term compensation and early retirement. The respondents were asked whether or not they agreed or disagreed with fictional expert opinions for each scenario. The questionnaire was distributed to orthopaedic surgeons, accident & emergency doctors, general practitioners and physiotherapists.

Purpose and background

Effective reassurance is an essential element of treatment for conditions that do not require further investigations, referrals and on-going monitoring. However, research defining what reassurance should consist of and how to deliver it is scarce. The aim of this review was to identify consultation-related processes that improved patients' outcomes, in order to build an evidence-based model of effective reassurance in primary care.

Method and results

A literature search identified prospective observational studies that explicitly measured consultation-related factors in appropriate primary care patient groups. The findings from empirical studies were combined with theoretical and systematic reviews to develop a model of effective reassurance. Scrutiny of 8193 Abstracts yielded 29 empirical studies fitting inclusion criteria, and 64 reviews. The majority of studies measured patient satisfaction. Clinical outcomes (e.g. health status / symptom reduction) appear to improve with patients' active participation in the consultation. Behavioural outcomes (e.g. adherence/ health care utilization) were only measured in a handful of studies, but may improve when information was given in the final stage of the consultation. Psychological outcomes (e.g. health concerns) were consistently improved by patient-centred approaches.

Background

Back pain has become a worldwide problem and excessive, repetitive rotation has been shown to cause tissue damage. A sleeping posture similar to that of the foetal position has been suggested to limit unnecessary rotation of the lumbar spine. The Rophi™ cushion, utilises this theory to provide spinal alignment and improved sleeping posture. This study aims to assess the subjective experience and biomechanical effects of the Rophi™ cushion in participants with simple mechanical lower back pain (LBP).

Methods & Results

Fifteen participants (aged 44 ± 9.7 years) with simple mechanical LBP were recruited using the Red Flags screening form. The kinematics of the pelvis, lower limbs, lumbar and thoracic spine were analysed in six degrees of freedom whilst the participants lay in a semi-foetal position. Visual analogue scales were used to measure participant pain and discomfort levels during sleep pre and post a one week cushion intervention.

Kinematic results show the main significant difference in joint angles occurred at the hip in all three planes, and between the lower lumbar region and the pelvis in the coronal plane. Subjective experience showed a reduction in the number of days with poor sleep quality and a significant reduction in frequency and intensity of lower back pain and stiffness when waking.

Background

Nerve Root compression can lead to severe back pain. Different risk factors like high BMI, smoking, alcohol and psychological history have been identified. The aim of our study was to identify if the incidence of these risk factors was higher in patients with nerve root compression.

Patients and methods

We collected data prospectively for 26 consecutive patients admitted between January and March 2011 with severe back pain and had an MRI scan. Demographic details were recorded along with occupation, BMI, smoking status, alcohol intake and psychological history. 12 patients had nerve root compression (Group A) on MRI scan and 14 had normal MRI scan (Group B).

Background

Recent years have witnessed a paradigm shift in the assessment of outcome in spine surgery, with patient-centred questionnaires replacing traditional surgeon-based assessments. The assessment of “complications” — loosely defined as new/unexpected problems arising as a result of surgery — has not enjoyed this same enlightened approach.

Methods

Patients with lumbar degenerative disorders operated with the goal of pain relief, completed a questionnaire 1 year post-operatively enquiring about complications arising as a consequence of their operation. They rated the bothersomeness of any such complications on a 5-point adjectival scale. Global outcome of surgery and satisfaction were rated on 5-point Likert scales.

Background

The majority of studies assessing minimal clinical important difference in outcome do so for management of chronic low back pain. Those that identify MCID following spinal surgical intervention fail to differentiate between the different pathologies and treatments or use variable methods and anchors in the calculation.

Aim

To identify the MCID in scores across the most common spinal surgical procedures using standardised methods of calculation.

Study purpose and background

There is growing concern that current outcome measures of back pain trials do not comprehensively capture what is important to patients. Some researchers believe we need to incorporate patients in the development of ‘next-generation’ outcomes. As a preliminary step to patient-interviews, we aimed to articulate ‘important change’ from the patients' perspective, as represented in reports of qualitative investigations inadvertently or directly exploring this.

Summary of methods used and results

We adopted a multi-strand search of electronic databases, and citation and reference tracking. Two researchers identified qualitative investigations relating to low back pain. Data were abstracted and synthesised using meta-ethnographic processes. Provisional results, based on 41 studies, indicate few studies have directly addressed this issue, but that data regarding experience and expectations may be useful. Whilst results suggest that practically, patients are concerned with (re-)engagement in meaningful activities, the more experientially focused literature suggests that patients want to be believed and have validated their experiences and identity as someone ‘doing battle’ with pain. Patients seek not only diagnoses, treatment and cure, but simultaneously reassurance of the absence of pathology. In the absence of tenable diagnoses, some feel they must not adopt a ‘sick role’. Some struggle, but manage to meet others' expectations; thereby undermining the credibility of their pain/disability claims. Others withdraw, fearful of disapprobation and unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain healthy, and emotionally robust state.

Background

Individual illness perceptions have been shown to be important influences on clinical outcomes for low back, yet significant others' illness perceptions are rarely explored, particularly in relation to work disability.

Method

Semi-structured interviews based on the Illness Perceptions Questionnaire were conducted with a purposive sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis.

Background

Doubt has been cast over the accuracy of dermatome charts. This study investigated a large group of patients with known lumbar nerve root compression (NRC), and identified whether their radicular pain corresponded with the predicted distribution on a dermatome chart.

Methods

The study included 209 patients that presented with lumbar radiculopathy. 106 were confirmed as L5 NRC and 103 as S1 NRC, by MRI. Each patient used an interactive computer assessment program to record their pain on a body map image. The coordinates were then used to compare the sensory distribution to a standard dermatome chart.

Study Purpose

To examine the presence of radicular pain and its relationship to the degree of lumbar nerve root compression in patients with a degenerative lumbar spine condition about to undergo surgery for either lumbar disc prolapse or lumbar canal stenosis.

Background

The pathophysiology underlying radicular pain is not completely understood but it is thought that nerve root compression is a key factor and from a surgical perspective, decompressing the nerve root is considered to be the key therapeutic step. However, despite often severe root compression in patients with lumbar stenosis, radicular pain is not a typical feature.

Statement of Purposes

Functional Restoration (FR) and spinal fusion are both used as treatment for patients with chronic low back pain however opinions are divided over their long term efficacy. This study examines the 18 month to 8 year outcomes of stand-alone lumbar fusion (STALIF) at L5/S1 and FR in similar groups of patients.

Methods

A prospective audit was undertaken using data routinely collected from the practice of the senior author. Pain (VAS), disability (ODI) and patients' subjective appraisals were used as comparable outcome measures. SPSS was used for statistical analysis.

Background

Self-rated disability scores in patients with chronic LBP (cLBP) do not always relate well to performance in traditional physical tests (e.g. back strength, fatigability, etc.). Therefore tests using “functional activities” that challenge for example trunk mobility and movement speed have been suggested as alternative “objective” outcome measures. We examined the relationship between self-reported disability and a battery of such functional tests.

Methods

37 patients with cLBP took part (45±12y; 23f, 14m); 32 completed 9 weeks' physiotherapy. Before and after therapy, the patients completed the Roland Morris disability questionnaire (RM) and performed a battery of 8 simple tests (stair climb, prolonged flexion, stand to floor, lift test, sock test, roll-up test, pick-up test, fingertip-to-floor test).

Background

Active therapeutic exercises during unstable and unilateral conditions using body weight for resistance are often used in the rehabilitation of low back pain (LBP). In LBP patient's unilateral atrophy of the spinal muscles is reported. To address these deficits understanding side to side muscle activity using surface Electromyography (SEMG) can help clinicians design exercises that specifically address these deficits. Aim: To identify the effects of unilateral and unstable bridging exercises on trunk muscle activity.

Methods

Using a repeated measures design, SEMG side to side measurements of lumbar Multifidus (MF), Iliocostalis Thoracis (ICT), Rectus Abdominis (RA) and External Oblique (EO) were conducted on 20 healthy subjects (16 female, age 25.45±3.57 years, height 166±0.8 cm, weight 63.35±12.70 kg. Mean Body Mass Index 23) during 8 supine bridging exercises with stable, unstable and unilateral conditions.

Introduction

ECG contamination of paraspinal EMG measurements is a known issue ^(1,2), with several proposed methods of correction^(3,4). In addition to this some question remains to how much of an effect this contamination actually has on the EMG recordings.

Methods

From a population of 455 previously recorded EMG datasets, 33 severely contaminated sets of data were selected. These 33 datasets were analysed to produce the Half-Width, RMS, RMS Slope, RMS Intercept, MF Slope, and MF Intercept variables.

The Independent Component Analysis method was used to separate the EMG data into a series of additive subcomponents which allowed the removal of ECG contamination whilst preserving underlying EMG. The subcomponents were then reintegrated to produce the original EMG signal, minus the contamination.

The resultant signal data were analysed to produce the same outcome variables so a comparison could be made.

Background

Proteoglycans (PGs) have long been known to be important to the functioning of the intervertebral disc. The most common PG is aggrecan, but there are also small leucine-rich proteoglycans (SLRPs) which constitute only a small percentage of the total PGs. However, they have many important functions, including organising the collagen, protecting it from degradation and attracting growth factors to the disc. We have examined how the core proteins of these molecules vary in intervertebral discs from patients with different pathologies.

Methods

Discs were obtained from patients with scoliosis (n=7, 19–53y), degenerative disc disease (DDD) (n=6, 35–51y) and herniations (n=5, 33–58y). Proteoglycans were extracted and the SLRPs (biglycan, decorin, fibromodulin, keratocan and lumican) were characterised via Western blotting following enzymatic digestion with chondroitinase ABC and keratanase.

Introduction

This study sought to determine whether the functional outcome of two common spinal operations could be improved by a programme of post-operative rehabilitation and/or an educational booklet each compared with usual care.

Methods

This was a multi-centre, factorial, randomised controlled trial on the post operative management of spinal surgery patients, with randomisation stratified by surgeon and operative procedure. The study compared the effectiveness of a rehabilitation programme and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery, each compared with “usual care” using a 2 × 2 factorial design, randomising patient to four groups; rehabilitation-only, booklet-only, rehabilitation-plus-booklet, and usual care only. The primary outcome measure was the Oswestry Disability Index (ODI) at 12 months, with secondary outcomes including visual analogue scale measures of back and leg pain. An economic analysis was also performed.

Purposes of the study and background

Smaller studies indicate that yoga may be an effective treatment for chronic low back pain. We conducted a randomised trial to evaluate if yoga compared to usual care improves back function in patients with chronic or recurrent low back pain.

Summary of the methods used and the results

Outcomes were assessed by postal questionnaires. The setting was 13 non-National Health Service premises. We recruited 313 adults with chronic or recurrent low back pain from primary care. 157 were randomised to usual care. 156 were randomised to a 12-class, gradually-progressing programme of yoga delivered by 12 teachers over three months. All received The Back Book.

Primary outcome was back function (Roland Morris Disability Score) at three months. Secondary outcomes: back function at six and 12 months, back pain, pain self-efficacy and general health.

Back function improved more in the yoga group: mean difference in changes from baseline at three (−2.17, 95% CI −3.31 to −1.03, p<0.001), six (−1.48, 95% CI −2.62 to −0.33, p=0.011) and 12 months (−1.57, −2.71 to −0.42, p=0.007). Improvement in pain self-efficacy at three and six months in the yoga group. No differences in general health and pain reduction.

Two adverse events were reported by controls and 12 by the yoga group – 8 out of 12 reported pain which may have been due to yoga. 63 (40%) were not fully compliant with treatment and 23 (15%) did not attend any yoga classes.

Conflicts of interest and sources of funding

CS and MT are employees of Merck Selbstmedikation GmbH, the sponsor of the presented clinical trial. BMG is CEO of CRM Pharmaberatung GmbH, the CRO of the presented clinical trial.

Background

One untested back pain treatment model is to stratify management depending on prognosis (low, medium or high-risk). This 2-arm RCT investigated: (i) overall clinical and cost-effectiveness of stratified primary care (intervention), versus non-stratified current best practice (control); and (ii) whether low-risk patients had non-inferior outcomes, and medium/high-risk groups had superior outcomes.

Methods

1573 adults with back pain (+/− radiculopathy) consulting at 10 general practices in England responded to invitations to attend an assessment clinic, at which 851 eligible participants were randomised (intervention n=568; control n=283). Primary outcome using intention-to-treat analysis was the difference in change in the Roland-Morris Disability Questionnaire (RMDQ) score at 12 months. Secondary outcomes included 4-month RMDQ change between arms overall, and at risk-group level at both time-points. The economic evaluation estimated incremental quality-adjusted life years (QALYs) and back pain-related health care costs.

Background and purpose

The STarT Back trial demonstrated benefits from a stratified primary care model that targets low back pain (LBP) treatment according to patient prognosis (low-, medium-, or high-risk). The current IMPaCT Back study implemented this approach in everyday primary care to investigate; i) changes in GPs' and physiotherapists' attitudes, confidence and behaviours, ii) patients' clinical outcomes, and iii) cost-effectiveness.

Method

This quality improvement study involved 5 GP practices (65 GPs and 34 physiotherapists) with before and after implementation cohorts of consecutive LBP consulters using an intention to treat analysis to compare patient data. Phase 1: Usual care data collection from clinicians and patients (pre-implementation). Phase 2: Introduction of prognostic screening and targeted treatment including a minimal GP intervention (low-risk group), systematic referral to physiotherapy (medium-risk group) and to psychologically informed physiotherapy (high-risk group). Phase 3: Post-implementation data collection from clinicians and patients.

Background and purpose

Over the past decade, it has become apparent that more often than not musculoskeletal pain occurs in more than one site in an individual, and traditional approaches, where pain has been studied as a narrow site-specific problem, are often not feasible. The overall aim of this study is to describe clusters of pain using a large population-based sample. This presentation will focus specifically on musculoskeletal co-complaints in back pain sufferers.

Methods and results

The Danish National Institute of Public Health has since 1987 conducted national representative health interview surveys of the adult Danish population some of which have included questions on musculoskeletal complaints. We used latent class analysis to identify latent classes of musculoskeletal complaints that occurred alongside a primary complaint of back pain. In addition, probabilities that specific sites occurred as co-complaints were determined. Three latent classes were identified and they exhibited quite different patterns of musculoskeletal co-complaints. The most commonly occurring class had a low probability of any co-complaints, the second most commonly occurring class had a high probability of pain in the neck, shoulders and mid-back, while the least commonly occurring class had very high probabilities of pain at all other body sites.

Purpose and background

Private musculoskeletal practitioners treat a large section of people with back pain, and could play an important role in returning and maintaining patients to work. We aimed to examine practitioners perception of their role quantitatively.

methods and results

A postal questionnaire was sent to 300 chiropractors, osteopaths and physiotherapists (n=900). Responses were received from 352 out of 900 (39%). Physiotherapists visited the work place more frequently than either of the other groups, osteopaths were more likely to give out sick leave certificates than chiropractors, who in turn are more likely to give out sick leave certificates than physiotherapists. Physiotherapists had a significantly higher belief in the psychological benefits of work, and in the importance of contacting work than either chiropractors or osteopaths. In addition, physiotherapists held the strongest belief that returning their patients to work was within their remit. There were no differences between the groups in their beliefs that employers could be an obstacle to return to work, that work could be detrimental to recovery, or in their belief that rest from work was necessary for recovery. Almost all practitioners recommended a short break from work sometimes, and more than 10% recommended a break often or always.

Background

Farming is regarded as a high-risk work sector for LBP.

Purpose

To establish prevalence, risk factors and consequences of LBP among Irish farmers.

Background

Office seating includes a variety of chair styles. There is limited research investigating their effects on spinal angles.

Purpose of Study

Investigate effects of active (Swopper and Vari-Kneeler), and static (Saddle and a Standard Office) chairs on lumbo-pelvic and cervical regions.

Background

The measurement of pelvic kinematics is key to the analysis of aberrant movement patterns of lower back, yet to date technical issues of skin artefacts, body composition and optical motion tracking sensor occlusion [1] are unresolved.

Methods

In this study, an alternative technical pelvic coordinate system to the standard right and left anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) is developed and evaluated in two healthy male subjects (slim and overweight). The alternative system consists of a cluster of 3 retro-reflective markers attached to the Sacrum, thus allowing position and motion of the pelvis to be measured. In order to use these technical markers a static trial must be performed. The ASISs were calibrated relative to the technical frame; and the anatomical frame of the pelvis was defined relative to the technical coordinate frame. Each participant completed 5 walking trials and the angular rotations of the two methods were investigated using Euler angles.

Background

Back pain is a common orthopaedic problem which results in hospital admissions in severe cases. The aim of our study was to identify the reasons for back pain admissions and role of further investigations in the treatment of severe back pain.

Methods

We collected data prospectively for all admissions between January and March 2011. Demographic details were recorded along with the reasons for admissions, time of admission, further investigations and treatment offered.

Introduction

Recently various type of spinal instrumentation was applied, and they are essential in modern spinal fusion surgery. Whereas several authors reported increased possibility of complication and degeneration on adjacent segment. We tried PLIF without instrumentation with box type intervertebral cages.

Method

Forty-one cases of degenerative lumbar diseases were treated by PLIF with carbon cages without spinal instrumentation. There were 17 males and 24 females, and age averaged 71.4 years. Thirty-two cases were degenerative spondylolisthesis, five were spinal stenosis, and four were disc herniation. Single PLIF was performed on forty cases, and double segment in one, with additional decompression on other segment in twenty. Bilateral facet joint were preserved to avoid lateral instability. Two pieces of cage were inserted with local bone graft. Post-op. follow-up period were 12 to 24 months, 15 months on average.

Background

The physiotherapy profession has experienced a paradigm shift in recent years where mounting research evidence, indicating better patient outcomes, has led to an increase in popularity of a biopsychosocial model of care. In turn physiotherapists have begun to address psychosocial ‘obstacles’ to recovery, as means of improving outcomes for patients. To date, research has not examined how this change has affected the perceptions of physiotherapists about delivering care. The aim of this study was to explore these perceptions through exploratory interviews with physiotherapists in the UK.

Methods

A qualitative interview study using a purposive sample of physiotherapists (n=12), nested within a larger study, exploring the attitudes and behaviours of UK general practitioners and physiotherapists about managing patients with low back pain. Interview transcripts were coded by the lead researcher and independently validated by a further team member. Transcripts were coded thematically using the constant comparative method to identify similarities and differences between the data and to determine fit and relevance.

Objective

The STarT Back Screening Tool (STarT) is a 9-item patient self-report questionnaire that classifies low back pain patients into low, medium or high risk of poor prognosis. When assessed by GPs, these subgroups can be used to triage patients into different evidence-based treatment pathways. The objective of this study was to translate the English version of STarT into Danish (STarT-dk) and test its discriminative validity.

Methods

Translation was performed using methods recommended by best practice translation guidelines. Psychometric validation of the discriminative ability was performed using the AUC statistic. The AUC was calculated for seven of the nine items where reference standards were available and compared with the original English version.