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Abstract: Identifying nonspecific low back pain (LBP) in medico-administrative databases is a major challenge because of the number and heterogeneity of existing diagnostic codes and the absence of standard definitions to use as reference. The objective of this study was to evaluate the sensitivity and specificity of algorithms for the identification of nonspecific LBP from medico-administrative data using self-report information as the reference standard. Self-report data came from the PROspective Québec Study on Work and Health , a 24-year prospective cohort study of white-collar workers. All diagnostic codes that could be associated with nonspecific LBP were identified from the International Classification of Diseases, Ninth and Tenth Revisions ( ICD-9 and ICD-10 ) in physician and hospital claims. Seven algorithms for identifying nonspecific LBP were built and compared with self-report information. Sensitivity analyses were also conducted using more stringent definitions of LBP. There were 5980 study participants with (n = 2847) and without (n = 3133) LBP included in the analyses. An algorithm that included at least 1 diagnostic code for nonspecific LBP was best to identify cases of LBP in medico-administrative data with sensitivity varying between 8.9% (95% confidence interval [CI] 7.9-10.0) for a 1-year window and 21.5% (95% CI 20.0-23.0) for a 3-year window. Specificity varied from 97.1% (95% CI 96.5-97.7) for a 1-year window to 90.4% (95% CI 89.4-91.5) for a 3-year window. The low sensitivity we found reveals that the identification of nonspecific cases of LBP in administrative data is limited, possibly due to the lack of traditional medical consultation., (Copyright © 2023 International Association for the Study of Pain.)

Study Design: The 16th meeting of the International Forum for Back and Neck Pain Research in Primary Care was held in Québec City in July 2019 under the theme of innovation. This paper addresses the state of research in the field., Objective: To ascertain the evolution of knowledge and clinical application in back and neck pain and identify shifting research priorities., Materials and Methods: After a brief presentation of the Forum and its history, the current state of the field was depicted from the scientific program and the recordings of the plenary and parallel oral and poster communications of Forum XVI. Research agendas established in 1995 and 1997 were updated from a survey of a multidisciplinary group of experts in the field. A discussion of the progress made and challenges ahead follows., Results: While much progress has been made at improving knowledge at managing back pain in the past 25 years, most research priorities from earlier decades are still pertinent. The need for integration of physical and psychological interventions represents a key challenge, as is the need to better understand the biological mechanisms underlying back and neck pain to develop more effective interventions. Stemming the tide of back and neck pain in low and middle-income countries and avoiding the adoption of low-value interventions appear particularly important. The Lancet Low Back Pain Series initiative, arising from the previous fora, and thoughts on implementing best practices were extensively discussed, recognizing the challenges to evidence-based knowledge and practice given competing interests and incentives., Conclusion: With the quantity and quality of research on back and neck pain increasing over the years, an update of research priorities helped to identify key issues in primary care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding., Methods: Secondary analyses of population-based cross-sectional data pertaining to 4470 adults were conducted. In multivariate analyses examining the associations of self-reported smoking with several spinal pain outcomes (neck pain, low back pain, low back pain with pain below knee, self-reported diagnosis of arthritis/rheumatism, and related limitations), further adjustment for serum cotinine concentrations was made., Results: Self-reported cigarette smoking was associated with neck pain (adjusted Odds Ratio ( a OR) Regular smokers vs. Non-smokers: 1.44; 95% Confidence Interval (CI): 1.14-1.82), low back pain ( a OR: 1.48; 95% CI: 1.24-1.78), low back pain with pain below knee ( a OR: 1.98; 95% CI: 1.42-2.76), as well as arthritis/rheumatism ( a OR: 1.33; 95% CI: 1.03-1.71), and related functional limitations (P < .05). Further adjustment for serum cotinine concentrations brought about little change in the ORs or beta coefficients., Conclusions: These results do not support the hypothesis that serum cotinine concentrations explain the well-known relationship between cigarette smoking and spinal pain., (Copyright © 2021. Published by Elsevier Inc.)

Background: Low back pain (LBP) is the first cause of years lived with disability worldwide. This is due to the development of chronic pain. Thus, it is necessary to identify the best therapeutic approaches in the acute phase of LBP to limit the transition to chronic pain. Superficial heat presents the highest level of evidence for short-term reduction in pain and disability in acute LBP. Physical activity is also recommended to avoid transition to chronic LBP, but there is a lack of evidence to determine its effect to reduce acute LBP. Also, the long-term effects of these interventions are unknown. This is a protocol for a randomized controlled trial (RCT) to determine the short and long-term effects of wearable continuous low-level thermal therapy, in combination with exercises or not, on disability and pain., Methods/design: Sixty-nine participants with acute LBP will be randomly assigned to one of three intervention programs: 1) thermal therapy, 2) thermal therapy + exercises, and 3) control. The interventions will be applied for 7 continuous days. The primary outcome will be disability and secondary outcomes will be pain intensity, pain-related fear, self-efficacy, number of steps walked and perception of change. The evaluators will be blinded to the interventions, and participants will be blinded to other groups' interventions. Primary and secondary outcomes will be compared between intervention groups., Discussion: This study will provide new evidence about acute LBP treatments, to limit transition to chronicity. This will be the first study to measure the long-term effects of wearable continuous low-level thermal therapy, combined or not to exercises., Trial Registration: This RCT has been retrospectively registered on ClinicalTrials.gov ( NCT03986047 ) on June 14th, 2019.

In the last decades, interactions between health professionals have mostly been discussed in the context of interprofessional teamwork where professionals work closely together and share a team identity. Comparatively, little work has been done to explore interactions that occur between professionals in contexts where traditionally formal structures have been less supporting the implementation of interprofessional teamwork, such as in the private healthcare sector. The objective of this study was to identify private sector physiotherapists' perceptions of interprofessional and intraprofessional work regarding interventions for adults with low back pain. This was a cross-sectional survey of 327 randomly-selected physiotherapists. Data were analysed using descriptive statistics. A majority of physiotherapists reported positive effects of interprofessional work for their clients, themselves and their workplaces. Proximity of physiotherapists with other professionals, clinical workloads, and client's financial situation were perceived as important factors influencing the implementation of interprofessional work. Low back pain is a highly prevalent and disabling condition. The results of this study indicate that integrating interprofessional work in the management of low back pain in the private sector is warranted. Furthermore, the implementation of interprofessional work is viewed by practicing physiotherapists as dependent upon certain client-, professional- and organizational-level factors.

Purpose To identify the characteristics associated with the timing of the first healthcare consultation and to measure the impact of that timing on the duration of the first episode of compensation for occupational back pain following the injury. Methods We analyzed data from a cohort of workers with compensated back pain in 2005 in Ontario obtained from the Workplace Safety and Insurance Board. Cox multivariable survival models were performed to identify factors associated with the time to care and to measure its association with the length of the first episode of 100 % compensation. Results Among the 5520 claims analyzed, 93.7 % of workers accessed care within the first week (average = 2.1 days; median = 1 day). Time to care was shorter for males, for workers who had received previous compensation and for those with access to an early return to work program. Age, number of employees in the company and personal earnings were positively associated with the time to care. More severe nature of injury, employers doubt about the work-relatedness of the injury and consulting a physiotherapist as the first healthcare provider were also associated with longer time to care. Considering potential confounders, longer time to care was significantly associated with a delay in the end of the first episode of compensation (hazard ratio = 0.98; P < 0.001). Conclusion Temporal access to a source of care is not problematic for the vast majority of Ontarian workers who receive compensation for occupational back pain; however, for the minority of workers who do not rapidly access care, the timing of the first healthcare consultation is a significant predictor of the duration of the first episode of compensation.

Background: Few studies have compared the factors that drive patients' decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain. The purpose of this study is to identify characteristics associated with the choice of first healthcare provider seen for acute uncomplicated occupational back pain., Methods: We analyzed data collected by the Workplace Safety and Insurance Board from a cohort of workers with compensated back pain in 2005 in Ontario (Canada). Multivariable logistic regression models were created to identify factors associated with the type of first healthcare provider seen (chiropractor, physician, or physiotherapist). Adjustments to the final models were evaluated using the area under the receiver-operating characteristics curve (ROC)., Results: According to the 5520 analyzed claims, 85.3 % of the patients saw a physician, 11.4 % saw a chiropractor, and 3.2 % saw a physiotherapist. Longer job tenure (odds ratio (OR) = 1.02, P = 0.004), higher gross personal income (OR = 1.06, P = 0.018), mixed-manual job (OR = 1.35, P = 0.004) and previous similar injury (OR = 1.60, P < 0.001) increased the odds of seeing a chiropractor rather than a physician, while the size of the community (>500,000 inhabitants) and the availability of an early return to work program in the workplace (OR = 0.77, P = 0.035) decreased it. The odds of seeing a physiotherapist rather than a physician increased with increasing age (OR = 1.19, P = 0.019), previous similar injury (OR = 1.71, P < 0.001) and severity of injury (OR = 2.03, P = 0.010). Increased age (OR = 1.28, P = 0.008) and size of community (>1,500,000 inhabitants; OR = 2.58, P = 0.002) increased the odds of seeing a physiotherapist rather than a chiropractor, while holding a mixed-manual job significantly decreased those odds (OR = 0.63, P = 0.044). The area under the ROC curve of our multivariable models varied from 0.62 to 0.64., Conclusion: The type of first healthcare provider sought for occupational back pain is influenced by injury-and work-related factors and by the worker's age, income and community size. Contrary to previous studies, the workers who first sought a physician did not have higher odds of having a severe injury.

Interprofessional collaboration is recommended in health systems everywhere, but research on its measurement is needed. This psychometric study assessed the construct validity, internal consistency, and test-retest reliability of the Intensity of Interprofessional Practices Questionnaire for Private-Sector Physiotherapists (IIPQ-PT). A random sample of 303 physiotherapists (PTs) completed the 12-item questionnaire, and a subsample of 103 completed it a second time 2 weeks later. Exploratory factor analyses revealed a one-factor solution for the instrument. IIPQ-PT scores showed respectively fair and moderate relationships with the percentage of low back pain clients for whom PTs reported interactions with other professionals (0.30; 95% CI 0.19-0.40; p<0.001) and perceived degree of interactions (0.58; 95% CI 0.50-0.65; p<0.001). The IIPQ-PT had high internal consistency (Cronbach's a= 0.86; 95% CI 0.83-0.88) and good test-retest reliability (ICC=0.69; 95% CI 0.57-0.78). The minimum detectable difference for a 95% CI was 2.52. Although further study of this instrument is warranted, our results are promising for its future use. The IIPQ-PT may prove useful to evaluate the effectiveness of interventions aiming to improve interprofessional practices and to measure the effects of such practices on service users, providers, and the health system.

Background: Assessed dimensions of low back pain (LBP) vary in prevalence studies. This may explain the heterogeneity in frequency estimates. To standardize definitions of LBP, an English consensus with 28 experts from 12 countries developed the "Delphi Definitions of Low Back Pain Prevalence" (DOLBaPP). The optimal definition and the shorter minimal definition with the related questionnaires for online, paper, and face-to-face use and telephone surveys are suitable for population-based studies. The definitions have to be adapted to different languages and cultures to provide comparable frequency estimates. The objective was to culturally adapt and pre-test the English definitions and corresponding Delphi DOLBaPP questionnaire forms into German., Methods: The German DOLBaPP adaptation was conducted using the systematic approach suggested by Beaton et al. A pre-test of the Delphi DOLBaPP optimal paper questionnaire including an additional evaluation form was conducted in a sample of 121 employees (mainly office workers). In order to evaluate the comprehensibility, usability, applicability, and completeness of the adapted questionnaire, response to the questionnaire and 6 closed evaluation questions were analyzed descriptively. Qualitative methods were used for the 3 open questions of the evaluation form., Results: The cultural adaptation of the DOLBaPP for a German-speaking audience required little linguistic adaptation. Conceptual equivalence was difficult for the expression "low back pain". The expert committee considered the face validity of the pre-final version of the related Delphi DOLBaPP questionnaires as good. In the pre-test, most participants (95%) needed less than 5 minutes to fill in the optimal Delphi DOLBaPP questionnaire. They were generally positive regarding length, wording, diagram, and composition. All subjects with LBP (n=61 out of 121 - 50.4%) answered the questions on functional limitation, sciatic pain, frequency and duration of symptoms as well as pain severity., Conclusion: The results indicate that the cross-cultural German adaptation of the DOLBaPP Definitions and the corresponding questionnaires was successful. The definitions can be used in epidemiological studies to measure the prevalence of LBP. Some critical issues were raised regarding the general features of the Delphi DOLBaPP questionnaires. Future research is needed to evaluate these instruments.

Background: Collaboration and interprofessional practices are highly valued in health systems, because they are thought to improve outcomes of care for persons with complex health problems, such as low back pain. Physiotherapists, like all health providers, are encouraged to take part in interprofessional practices. However, little is known about these practices, especially for private sector physiotherapists. This study aimed to: 1) explore how physiotherapists working in the private sector with adults with low back pain describe their interprofessional practices, 2) identify factors that influence their interprofessional practices, and 3) identify their perceived effects., Methods: Participants were 13 physiotherapists, 10 women/3 men, having between 3 and 21 years of professional experience. For this descriptive qualitative study, we used face-to-face semi-structured interviews and conducted content analysis encompassing data coding and thematic regrouping., Results: Physiotherapists described interprofessional practices heterogeneously, including numerous processes such as sharing information and referring. Factors that influenced physiotherapists' interprofessional practices were related to patients, providers, organizations, and wider systems (e.g. professional system). Physiotherapists mostly viewed positive effects of interprofessional practices, including elements such as gaining new knowledge as a provider and being valued in one's own role, as well as improvements in overall treatment and outcome., Conclusions: This qualitative study offers new insights into the interprofessional practices of physiotherapists working with adults with low back pain, as perceived by the physiotherapists' themselves. Based on the results, the development of strategies aiming to increase interprofessionalism in the management of low back pain would most likely require taking into consideration factors associated with patients, providers, the organizations within which they work, and the wider systems.

Introduction: While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person's life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual's perspective using a validity-driven approach., Methods: To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants' ideas into clusters of ideas that then informed the conceptual model., Results: One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed--Psychosocial, Physical, Treatment and Employment--each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others., Conclusions: Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.

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.

Background: Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later., Methods: Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up., Results: Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes., Conclusion: The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings.

Unlabelled: Agreement between patients' and health professionals' perceptions has been shown to be low to moderate for different aspects of the patients' pain experience. Little is known, however, about patient-physiotherapist agreement in low back pain. The study objectives were to describe patient-physiotherapist agreement for low back pain intensity and functional limitations, and to identify correlates of agreement. A cross-sectional design was used. Seventy-eight patients with acute/subacute nonspecific low back pain and their respective physiotherapists were included in the study. After the initial physiotherapy consultation, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Intraclass correlation coefficients (ICC) were used to measure chance-corrected agreement. Patients' and physiotherapists' mean ratings were also compared using paired t tests. Multiple regression analyses were conducted to identify factors associated with agreement measures. The level of agreement was moderate for pain intensity (ICC = 0.55, 95% confidence interval [CI]: 0.38-0.69) and functional limitations (ICC = 0.56, 95% CI: 0.22-0.74). Both variables were rated significantly (P < .05) lower by the physiotherapists than by the patients. Higher ratings by the patients for pain and functional limitations were related to higher differences in perceptions between patients and physiotherapists. This report shows that physiotherapists' perceptions of their patients' pain intensity and functional limitations often differ from their patients'., Perspective: The findings of this study indicate that there are frequent discrepancies between patients' and physiotherapists' perceptions of the patients' low back pain experience. Gaining a better understanding of the level of patient-physiotherapist agreement and identifying the correlates of agreement may help improve physiotherapists' interventions with people with low back pain.