EFFECTIVE EVIDENCE-BASED TREATMENT FOR BACK PAIN AND SCIATICA

(GREAT) EXPECTATIONS OF RECOVERY FROM LBP ARE ASSOCIATED WITH RECOVERY FROM LBP ‼️ . My suggestions for managing patient expectations 👇🏻 . ✅ Explore patients’ expectations at the first visit (before setting them!) & explore underpinning beliefs. Ask the patient flat out, for example “What are you expecting from seeing me today?” . ✅ Balance the therapeutic benefit of setting positive (‘great’) expectations of recovery with evidence, likelyhood & realism. . ✅ Emphasise & reflect on improvements in pain, disability & function at each visit. . ✅ Frame ALL elements of the clinical encounter in a positive & reassuring way (eg pain experience, clinical findings, diagnosis, treatment explanations). . ✅ Performing patients’ preferred/expected treatment interventions (eg manual therapy) initially (whilst ‘holding your nose’) & then reframing, empowering & educating towards other interventions, can develop trust & a therapeutic alliance necessary for ongoing successful management. . ✅ Incorporating patient preferences, values and expectations is part of evidence-based decision-making and practice. . #lowbackpain #evidencebased #biopsychosocial #backpain #osteopath #physiotherapy #chiropractor #wordsmatter #greatexpectations #patientexpectations ...

Whilst NOT perfect (and continually under evolution and refinement- e.g. Greenhalgh et al 2014), evidence-based practice (EBP) is the OPTIMAL and ETHICAL approach to clinical healthcare practice. . The now familiar definition of EBP is the integration of best research evidence WITH clinical expertise AND patient values & preferences. 🤝 . EBP was developed in the early 1980s, with many medical and health professions responding by emphasising research and critical thinking/appraisal in their educational programmes and professional practice. . Needless to say, the transition AWAY from FAITH-based, BELIEF-based, GURU-based and PRACTITIONER-based practice TOWARDS EVIDENCE-based and PERSON-centred practice has posed a variety of CHALLENGES for ALL healthcare professions. 🤯 . Osteopathy was a little late to the EBP party 🥳, partly due to osteopathic practice being steeped in TRADITIONAL knowledge, GURUISM and ANECDOTE. 😬 . These factors combined with FUNDING challenges to carry out research, LIMITED presence of osteopathy courses in UNIVERSITIES and limited research LEADERSHIP and SKILLS in the osteopathy profession, meant it was always going to make the transition to EBP for osteopathy particularly challenging. 🤕 . In light of these challenges, the findings of our national study UK of osteopaths’ attitudes, skills and usage of EBP is encouraging and offers optimism for the future 🙌🏼 (notwithstanding the limitations of the study of course!). . #osteopathy #evidencebasedpractice #osteopathicmedicine #criticalthinking ...

I’ve been involved with the International Journal of Osteopathic Medicine (IJOM) since 2006, firstly as a reader, then as an author, then as a peer-reviewer and finally since 2016 as Masterclass Section Editor. . I’m lucky to be part of a great Editorial from around the world, lead by @stevevogel5883 of @officialuco . The MASTERCLASS section aims to address the challenges faced by practitioners to RELATE and APPLY research evidence to INDIVIDUAL patients. 🤔 . Masterclass papers INTEGRATE the LATEST research evidence with the EXPERTISE and craft KNOWLEDGE of the author(s). . The papers offer a FRAMEWORK to link the areas of research AND practice, in a PRACTICALLY MEANINGFUL way. 🙌🏼 . Masterclass papers have been published on a VARIETY of topics related to contemporary osteopathic and manual therapy practice. . Here are some screen shots of some of my FAVOURITES, in order of appearance: 📍Editorial on the Masterclass section (Thomson and Evans, 2016). 📍Back pain beliefs (Darlow, 2016). 📍Cervical artery dysfunction and manual therapy (Vaughan et al 2016). 📍Qualitative research and grounded theory (Thomson et al 2014). 📍Osteopathy and the biopsychosocial model Part 1 and 2 (Fryer, 2017). 📍Developing clinical expertise (Petty, 2015). 📍Somatic dysfunction (Fryer, 2015). 📍Clinical reasoning and complex neck pain (Reid et al, 2018). . Many of the papers are open access or accessible via professional associations. They’re relevant and useful to all musculoskeletal and manual therapy professionals. . We’re also alway happy to hear from academic-clinicians who would like CONTRIBUTE a paper to the Masterclass section. 🙏🏼 . Post your comments/thoughts of your favourite IJOM masterclass paper(s) below. 👇🏻👇🏻 ...

Patients with LBP often desire a MRI scan or present to clinic with a scan report. . MRI scans are useful to rule out pathological causes of LBP (~ 1-2%) OR if direction of treatment might change SIGNIFICANTLY due to worsening neurological function (eg surgery). . Unnecessary scanning can have a detrimental effects on patients (eg promote anxiety, fears, avoidance behaviours, choosing more invasive treatments etc) by ‘pathologising of of a benign problem’. . Therefore we need to manage patients’ wishes for a scan with the clinical need, and to communicate the findings of an MRI scan in the most EFFECTIVE and TRUTHFUL way to optimally facilitate patient RECOVERY. . Karen et al (2018) have a developed a framework to frame or /re-framing imaging reports to patients with LBP. 🖼 . The GLITtER framework provides clinicians some useful guidance to provide helpful and accessible messages to LBP who have had a scan. While the effectiveness of the framework-intervention is still being tested (and any results from students will likely modify the framework), it has good face validity so worth taking on key points. . #lowbackpain #evidencebasedpractice #mri #osteopathy #wordsmatter ...

“Because an MRI displays detailed images of the organs and tissues within the body, we are able to visually compare structures before and after [treatment x] to validate the effectiveness of this treatment”. . The above statement is taken from a clinic’s website that employs a well-known form of physical ‘traction’ to ‘treat’ back pain, commonly disc-related pain. . However using MRI to predict the recovery of LBP or an individual’s response to treatment is PROBLEMATIC at best, HARMFUL at worst. See the 10-year longitudinal study my Tonusu et al below: ⬇️ . 1. 91 PAIN FREE people were scanned at baseline. 2. The presence of disc bulging, modic changes and spondylolythesis were recorded. 3. 49 of these individuals returned for a scan 10 YEARS later, and the same imaging findings recorded, PLUS their history of LBP in the preceding 10 year period. 4. When comparing those that DID experience LBP versus those that DIDN’T, there were NO SIGNIFICANT differences in the progression of disc bulging, disc degeneration or spondylolythesis or the occurrence of LBP. 5. Conclusion: the PRESENCE or PROGRESSION of COMMON MRI findings are NOT associated with the development of LBP over a 10 YEAR period. . ➡️ When imaging has primacy in the conservative management of LBP (e.g. central to diagnosis and gauging ‘therapeutic’ response to treatment) it provides patients with ‘ULTRA HIGH DOSAGES’ of FEAR, UNHELPFUL beliefs, behaviours and advice... often in VIVID multimedia format (words, images and spinal models). . . #lowbackpain #mri #spinaltraction #osteopathy #physiotherapy #chiropractic #evidencebasedpractice #slippeddisc #discbulge #sciatica ...