Lack of consensus across clinical guidelines regarding the role of psychosocial factors within low back pain care: a systematic review

Australia (NSW Agency for Clinical Innovation (ACI)
Management of people with acute low back pain model of care.)Prognostic risk stratification tools, such as the STarT Back Screening tool and Örebro questionnaire, stratify patients into low, medium or high risk groups, determining the amount and type of treatment that they require.not providedCognitive behavioral therapy is to ensure the patient is supported to understand the relationship between beliefs and behaviors, and to develop a goal-oriented plan of care (even for those without yellow flags).not providedWhen yellow flags are identified or when pain persists past the 14-week review (or earlier if needed), a more complex psychological intervention may be needed.not providedIf there are significant fears or anxieties, earlier application of psychological strategies may be requirednot providedAustria (Update der evidenz- und konsensusbasierten Osterreichischen Leitlinien fur das Management akuter und chronischer unspezifischer Kreuzschmerzen.)Psychosocial and work-related risk factors should be incorporated in treatmentnot providedA multimodal treatment should be provided in patient with chronic LBP and with pain-related psychological comorbidity, if a less intensive evidence-based treatment was ineffectivenot providedIn case of suspicion of psychosocial risk factors, other disciplines like clinical psychologist and psychotherapist can be considered for further diagnosis and managementnot providedIn case of psychiatric comorbidities, provide treatment according to the relevant guidelinenot providedTake into account the occupational setting and consider performing a work place visitnot providedBelgium (Van Wambeke P Desomer A Ailiet L Berquin A Dumoulin C Depreitere B Dewachter B Dolphens M Forget P Fraselle V Hans G Hoste D Mahieu G Michielsen J Nielens H Orban T Parlevliet T Simons E Tobbackx Y Van Zundert J Vanderstraeten J Vanschaeybroeck P Vlaeyen J Jonckheer P. Low Back Pain and radicular pain: assessment and management – Supplement. Good Clinical Practice (GCP) Brussels: Belgian Health Care Knowledge Centre (KCE).)Consider, based on risk stratification, a simple intervention with minimal supervision in patients with high chance of fast recovery and good outcome, and a more complex intervention with intensive supervision in patients with moderate to high risk of poor outcomelow to very lowOnly consider a psychological intervention with cognitive behavioral therapy (in patients with moderate to high risk) as a component of a multimodal treatment including a supervised exercise program, depending on risk profilemoderate to very lowConsider a multidisciplinary rehabilitation program (including cognitive behavioral therapy) that takes into account the specific needs and possibilities of a patients with persisting LBP, in case of psychosocial barriers of recovery and/or failure of previously applied evidence-based treatmentsmoderate to very lowCanada (Toward Optimized Practice (TOP) Low Back Pain Working Group
Evidence-Informed Primary Care Management of Low Back Pain.)Check yellow flags and if present, follow good practice, as follows:○

educate and consider referral to active rehab including cognitive behavioral therapy, in presence of belief that pain and activity are harmful

educate and consider pain clinic referral, in presence of ‘sickness behaviors’ (like extended rest)

assess for psychopathology and treat, in presence of low or negative moods, social withdrawal

educate, in presence of treatment beliefs not fitting best practice

connect with stakeholders and case manage, in presence of problems with claim and compensation

follow-up regularly and refer if recovering slowly, in presence of history of back pain, time-off, other claims

engage case management through disability carrier, in presence of problems at work, poor job satisfaction

follow-up regularly and refer if recovering slowly, in presence of heavy work, unsociable hours (shifts)

educate patient and family, in presence of overprotective family or lack of support

not providedThere is insufficient evidence to recommend for or against modified work duties for facilitating return to work1 RCTDenmark (Stochkendahl MJ Kjaer P Hartvigsen J Kongsted A Aaboe J Andersen M Andersen MØ Fournier G Højgaard B Jensen MB Jensen LD Karbo T Kirkeskov L Melbye M Morsel-Carlsen L Nordsteen J Palsson TS Rasti Z Silbye PF Steiness MZ Tarp S Vaagholt M. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy.)Individual patient education should be offered specifically to patients who are worried about their LBP, show signs of fear-avoidance or passive behavior, and only in those patients who are motivated, are able to change their level of self-efficacy, and be based on a patient-centered dialogueexpert opinionEurope (Airaksinen O Brox JI Cedraschi C Hildebrandt J Klaber-Moffett J Kovacs F Mannion AF Reis S Staal JB Ursin H Zanoli G. On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain.,Becker A Niehus W Breen A Breen A Gil del Real MT Hutchinson A Koes B Laerum E Malmivaara A On behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care.)Manage psychosocial factors appropriatelyexpert opinionIdentification of yellow flags should lead to appropriate cognitive and behavioral management. However, there is no evidence on the effectiveness of psychosocial assessment or intervention in acute LBPlevel AFrance (Agence Nationale d'Accréditation et d'Évaluation en Santé
Diagnosis and management of patients with acute low back pain (,Agence Nationale d'Accréditation et d'Évaluation en Santé
Diagnosis, management and follow-up of patients with chronic low back pain.)Not providedn/aGermany (Chenot JF Greitemann B Kladny B Petzke F Pfingsten M Schorr SG. On behalf of the National Care Guideline development group for non-specific back pain.)Care requirements in special situations:-patients with persistent chronification factors and/or psychosocial consequences of the painful condition:○

basis psychosomatic care

regular screening for chronification factors

initiation and coordination of further psychotherapeutic care, if necessary

possibly social counseling with respect to disability and compensation, or initiation of such counseling

possibly suggestion of measures for occupational reintegration and/or retraining

-patients with symptom-maintaining or symptom-reinforcing comorbidities (such as anxiety and depression):-patients with continued inability to work:○

screening for workplace-related risk factors

contact with company physician and, if necessary, with employer or pension insurance company

consider and, if necessary, initiate measures to support occupational reintegration

not providedItaly (Negrini S Giovannoni S Minozzi S Barneschi G Bonaiuti D Bussotti A D'Arienzo M Di Lorenzo N Mannoni A Mattioli S Modena V Padua L Serafini F Violante FS Diagnostic therapeutic flow-charts for low back pain patients: The Italian clinical guidelines.)In patients at high risk of chronicity, the main aim of treatment is early, specific intervention on bio-psycho-social risk factors of chronicitylevel AMultidisciplinary approach is not recommended in case of low-disability and if (i) complex treatment is difficult because of cognitive, psychological or motivational factors, and/or (ii) patient does not believe a solution is possiblelevel CMalaysia (Hussein MMA Singh D Mansor M Kamil OIM Choy CY Cardosa MS Hasnan N Vijayan R. The Malaysian low back pain management guidelines.)If the patient does not improve within 4-6 weeks, yellow flags should be addressednot providedIdentify and address specifically the patient's worries and anxiety about health matters that they suspect is related to their back pain.multiple studiesRefer to a pain specialist if yellow flags still persist and activity has not returned to normal after 3 monthsmultiple studiesIdentification of yellow flags leads to (i) decision whether more detailed assessment is needed, (ii) identification of factors that can be addressed by specific interventions, and (iii) secondary prevention of chronic back painnot providedNetherlands (Van Tulder MW Custers JWH Bie RA Hammelburg R Hulshof CTJ Kolnaar BGM Kuijpers T Ostelo RWJG van Royen BJ Sluiter A. Ketenzorgrichtlijn Aspecifieke Lage Rugklachten.)Cognitive behavioral therapy is recommended in presence of cognitive behavioral problemsnot providedIdentification of yellow flags should lead to appropriate cognitive and behavioral managementnot providedIf needed, the health care professional should refer the patient to a primary care psychologist for diagnostics or treatment (if no improvement in 2-3 weeks and presence of any psychosocial risk factor for chronicity)not providedPatient in sick leave because of LBP and their supervisor should be advised to perform a workplace assessment to analyze any barriers for return to work and if so, apply necessary adaptations in work(place)level B (moderate evidence)New Zealand (New Zealand acute low back pain guide
ACC.)Address any barrier to recovery such as excessively heavy or prolonged work, problems with treatment, rehabilitation or compensation, or psychosocial yellow flags.not providedSuggested steps to better early behavioral management of low back pain problems, in the presence of yellow flags:○

Provide a positive expectation that the individual will return to work and normal activity, aid if the problem persists beyond 2-4 weeks, provide a reality-based warning of what is going to be the likely outcome

Be directive in scheduling regular reviews of progress

Keep the individual active and at work if at all possible, even for a small part of the day. Consider reasonable requests for selected duties and modifications to the workplace. After 4-6 weeks, if there has been little improvement, review vocational options, job satisfaction, any barriers to return to work, including psychosocial distress

Acknowledge difficulties with activities of daily living, but avoid making the assumption that these indicate all activity or any work must be avoided

Help to maintain positive cooperation between the individual, an employer, the compensation system, and health professionals, and encourage collaboration wherever possible

Make a concerted effort to communicate that having more time off work will reduce the likelihood of a successful return to work

Be alert for the presence of individual beliefs that he or she should stay off work until treatment has provided a ‘total cure’

Promote self-management and self-responsibility, and encourage the development of self-efficacy to return to work

Be prepared to ask for a second opinion, especially if it may help clarify that further diagnostics are unnecessary

Avoid confusing the report of symptoms with the presence of emotional distress

Avoid suggesting (even inadvertently) that the person from a regular job may be able to work at home, or in their own business because it will be under their own control

Encourage people to recognize, from the earliest point, that pain can be controlled and managed so that a normal, active or working life can be maintained

If barriers to return to work are identified and the problem is too complex to manage, referral to a multidisciplinary team as described in the New Zealand Acute Low Back Pain Guide is recommended

not providedProvide your patient, and their employer, with advice on monitoring and managing work activities that cause painnot providedIf the physical demands of the patient's job are high, workplace modifications may be needed. You may be able to advise the employer on how to seek specialist occupational health advice about this.not providedPhilippine (Philippine Academy of Rehabilitation Medicine (PARM)
Clinical Practice Guidelines on the Diagnosis and Management of Low Back Pain (Updated version).)Nonen/aUK (National Institute for Health and Care Excellence
Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). Full guideline.)Based on risk stratification, consider (i) simpler and less intensive support for people with low back pain with or without sciatica likely to improve quickly and have a good outcome, and (ii) more complex and intensive support for people with low back pain with or without sciatica at higher risk of a poor outcomenot providedConsider a combined physical and psychological program, incorporating a cognitive behavioral approach (preferably in a group context that takes into account a person's specific needs and capabilities), for people with persistent low back pain or sciatica when (i) they have significant psychosocial obstacles to recovery or (ii) previous treatments have not been effectivenot providedUSA (Qaseem A Wilt TJ McLean RM Forciea MA Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatment for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians.)Nonen/a

留言 (0)

沒有登入
gif