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Ahmed S Alhowimel,1 Mazyad A Alotaibi,1 Aqeel M Alenazi,1 Bader A Alqahtani,1 Mansour A Alshehri,2,3 Dalyah Alamam,4 Faris A Alodaibi4 1Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia; 3NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; 4Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed S AlhowimelDepartment of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, AlKharj, 11942, Saudi ArabiaTel +966115886354Email aalhowimel@gmail.com; a.alhowimel@psau.edu.saObjective: Previous evidence has recommended conservative interventions as the best treatment in individuals with chronic low back pain (CLBP). However, the influence of psychosocial factors on the treatment outcomes is unclear. Therefore, this systematic review aimed to address the psychosocial factors that influence changes in pain and disability in patients with CLBP after a guideline-based conservative intervention.Methods: Four electronic databases were systematically searched from inception until September 2020 for prospective studies examining the relationship between psychosocial factors and the outcomes of pain and disability after conservative intervention. All included studies were selected, extracted, and critically evaluated by two independent reviewers.Results: In total, 15 studies were included in this systematic review. The results support the link between the baseline fear of movement, depression, self-efficacy, and catastrophizing with future functional disability outcomes after conservative interventions. However, these factors were less likely to predict changes in pain intensity outcomes after conservative interventions. Self-efficacy seems to mediate between some of the baseline psychosocial factors (eg, fear) and future pain and disability.Conclusion: Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention. This highlights the importance of addressing these factors in conservative management of CLBP.Keywords: chronic low back pain, outcomes, conservative interventions, psychosocial

Ahmed S Alhowimel,1 Mazyad A Alotaibi,1 Dalyah M Alamam,2 Faris A Alodaibi,2 Julie M Fritz3 1Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 2Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia; 3Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USACorrespondence: Ahmed S AlhowimelDepartment of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi ArabiaTel +966 115886354Email aalhowimel@gmail.com; a.alhowimel@psau.edu.saIntroduction: Healthcare professionals’ beliefs and attitudes towards low back pain management play a significant role during treatment. This is a crucial aspect of primary care physicians working as a first point of contact for people seeking healthcare for low back pain.Aim: To identify the beliefs and behaviors of frontline healthcare professionals (primary care physicians) working in the Riyadh region with regard to low back pain management.Methods: A cross-sectional design was implemented, in which the Pain Attitude and Beliefs Scale (PABS) questionnaire was used along with a low back pain clinical vignette with some questions. The PABS assesses healthcare provider orientations toward low back pain with two subscales: biomedical and behavioral. In total, 400 primary care physicians working in the Riyadh region of Saudi Arabia were invited to participate.Results: The responding primary care physicians (n = 72, response rate = 18%) provided an average score on the behavioral subscale (mean = 31.5± 7.1) that was lower than that on the biomedical subscale (36.5± 7.8) of the PABS. The lower scores in the biomedical subscale are associated with the using of clinical guidelines for low back pain management (χ2 (1) = 4.7, p = 0.03). Moreover, providing guideline-based advices regarding activity and work was more likely to come from those scoring above the mean in the behavioral subscale.Conclusion: The results of this study show that Saudi Arabian primary care physicians manage their patients within a biomedical framework; there is some compliance to the current low back pain clinical guidelines among these physicians, with under/post-graduate education being needed for these professionals to adopt a more biopsychosocial framework during low back pain management.Keywords: low back pain, attitude, behavior, primary care physician, biomedical management, biopsychosocial management, primary care, guidelines adherence, pain, healthcare professional

Yazed AlRuthia,1,2 Hawazin Alhazzani,1 Ghaida Alhindi,1 Maryam Alarfaj,1 Lama Almutairi,3 Miteb Alanazi,4 Khaulah Alokili,1 Nouf Alanazi,1 Faris Alodaibi,5 Monira Alwhaibi,1 Adel S Bashatah,6 Yousif Asiri,1 Hisham Alsanawi7 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Pharmacy, King Abdulaziz University Hospital, Riyadh, Saudi Arabia; 4Department of Pharmacy, King Khalid University Hospital, Riyadh, Saudi Arabia; 5Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 6Department of Nursing Education and Administration, College of Nursing, King Saud University, Riyadh, Saudi Arabia; 7Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Yazed AlRuthiaDepartment of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaTel +996 114677483Fax +966 114677480Email yazeed@ksu.edu.saBackground: Musculoskeletal pain is one of the most complex and debilitating types of pain. Although different pharmacologic treatments are available, very few studies have explored the predictors for opioid analgesics prescription to manage this type of pain.Objective: The aim of this study was to explore the predictors for opioid prescription in patients with acute musculoskeletal pain in Saudi Arabia.Methods: This was a single-center, retrospective chart review of adult patients (≥ 18 yrs.) with an acute nociceptive musculoskeletal pain at a university-affiliated medical center in Riyadh, Saudi Arabia. Cancer patients and those with chronic neuropathic pain were excluded. Patients’ age, gender, number of comorbidities, duration of pain management, number of clinic visits for pain, and Numeric Pain Rating Scale (NPRS) scores at rest and with normal activities were collected. Multiple logistic regression was conducted to examine the relationship between the type of musculoskeletal pain and the prescription of opioid analgesics controlling for NPRS score on activity, age, gender, number of comorbidities, duration of pain treatment, and number of clinic visits for pain.Results: The mean age of the 227 patients, who met the inclusion criteria, was 39 years and 68% of them were male. Sixty-three percent of the patients were prescribed opioid analgesics, and 61% of them had shoulder pain, 29% had back pain, and 10% had lower extremity pain (eg, hip, thigh, lower leg, knee, ankle, and foot pain). Tramadol was the most commonly prescribed opioid analgesic (82%), followed by codeine (13%). Ninety-seven percent of patients who were prescribed non-opioid analgesics had shoulder pain. Patients with shoulder pain had lower odds of receiving opioid analgesics (OR=0.019, P< 0.0001, 95% CI=0.004– 0.081) in comparison to their counterparts who had lower extremity or back pains. Moreover, the higher the pain score on activity was, the higher odds of receiving opioid analgesics (OR=1.317, P< 0.0001, 95% CI=1.029– 1.685).Conclusion: Future studies should explore the impact of different opioid prescribing policies to improve the quality of patient care and reduce the unnecessary prescribing of opioids for patients with non-cancer musculoskeletal pain.Keywords: analgesics, opioid, musculoskeletal pain, shoulder pain, Saudi Arabia

The use of active learning strategies in healthcare colleges in the Middle East questionnaire. (DOCX 16 kb)

Table S1. The Revised Neurophysiology of Pain Questionnaire (RNPQ) 12-items. 12 statements on pain neurophysiology that can be answered with “true”, “false”, or “undecided”. (DOCX 18 kb)

Table S2. Participantsâ institutions with percentage participation from each institution. Participantsâ institutions with percentage participation from each institution. (DOCX 18 kb)