Quality of life and back pain]

Back pain considering generality of its occurrence became an epidemiological problem. In a significant part the pain is persistent and not corresponds on treatment. An aim of this study was to explore a connection between chronicity of pain and quality of a life. An instrument of study was a questionnaire consisting of 6 groups of questions relating to a character of pain, its origin, and its influence on work, social and family relation. Thirty people (21 women and 9 men) in the age of 49 and 46 years with chronic back pain took part in examination. In relations of patients an origin of pain is strongly connected with character of work and beside of this pain would have a negative influence on life- satisfaction and a results of work. Results confirm a significant influence of pain on a quality of people life in different fields and besides of this they connect chronicity of process and its character with personal, psychological profile of participants.     

Cost-effectiveness of general practice care for low back pain: a systematic review

Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data. Eleven studies were included; the majority of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone. In conclusion, GP care alone did not appear to be the most cost-effective treatment option for low back pain. GPs can improve the cost-effectiveness of their treatment by referring their patients for additional services, such as advice and exercise, or by providing the services themselves.     

Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care

An intervention that can prevent low back pain (LBP) becoming chronic, may not only prevent great discomfort for patients, but also save substantial costs for the society. Psychosocial factors appear to be of importance in the transition of acute to chronic LBP. The aim of this study was to compare the cost-effectiveness of an intervention aimed at psychosocial factors to usual care in patients with (sub)acute LBP. The study design was an economic evaluation alongside a cluster-randomized controlled trial, conducted from a societal perspective with a follow-up of 1 year. Sixty general practitioners in 41 general practices recruited 314 patients with non-specific LBP of less than 12 weeks’ duration. General practitioners in the minimal intervention strategy (MIS) group explored and discussed psychosocial prognostic factors. Usual care (UC) was not protocolized. Clinical outcomes were functional disability (Roland–Morris Disability Questionnaire), perceived recovery and health-related quality of life (EuroQol). Cost data consisted of direct and indirect costs and were measured by patient cost diaries and general practitioner registration forms. Complete cost data were available for 80% of the patients. Differences in clinical outcomes between both the groups were small and not statistically significant. Differences in cost data were in favor of MIS. However, the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data. This study presents conflicting points of view regarding the cost-effectiveness of MIS. We conclude that (Dutch) general practitioners, as yet, should not replace their usual care by this new intervention.     

Implementation barriers for general practice guidelines on low back pain a qualitative study

STUDY DESIGN: Qualitative study design, using semi-structured interviews. OBJECTIVE: To explore factors that determine non-adherence to the guidelines for low back pain. SUMMARY OF BACKGROUND DATA: Guidelines for low back pain have been published in the past decade in various countries. In the Netherlands, general practitioners adhere to them to a fair extent, and it is unclear whether room for improvement remains. METHODS: Forty semistructured, in-depth interviews were conducted with twenty patients who consulted for low back pain, and with their general practitioners. The interviews were fully transcribed and analyzed qualitatively. RESULTS: Patients often had limited expectations of the consultation. They wanted to hear a diagnosis or expected to receive simple advice. The general practitioners said they were well informed about the guideline and mostly agreed with its content. Reasons for non-adherence were mainly related to patients' experiences in the past and general practitioners' interpretations of their preferences. General practitioners stated that they were inclined to give in to patients' demands, for example the request for radiographic films or a referral to a physical therapist. In general, patients and their general practitioners were satisfied with the chosen management. CONCLUSIONS: Improvement of the quality of back pain care may still be possible. Implementation strategies should aim at training physicians in communication skills, especially about subjects for debate, where patients' beliefs and experiences color their expectations.     

Quality of life after intensive care in trauma patients

Published studies and our own preliminary results show that Intensive Care Unit (ICU) patients admitted after severe trauma, all report reduced quality of life (QOL) after discharge. In contrast to other ICU patients, this reduction is decreased by time, but does not seem to reach pre-ICU levels. Interventions to improve this situation have not been documented. This should be a high priority aspect for all health personnel caring for patients surviving severe trauma.     

The economic cost of low back pain in Sweden in 2001

BACKGROUND: Low back pain (LBP) is a common cause of lost work days and disability. In 2001, expenditure for back pain represented 11% of the total costs for short-term sick leave in Sweden, and about 13% of all early retirement pensions were granted for back problems, of which LBP is the most important symptom. The magnitude of LBP as a health problem justifies a closer look at its burden of illness to society. MATERIALS AND METHODS: We assessed the costs of LBP to society in Sweden in 2001. The study was conducted in a cost-of-illness framework, measuring both the direct costs of providing health care to LBP patients, and the indirect costs as the value of the production that is lost because people are too ill to work. The costs were estimated by a prevalence and top-down approach. RESULTS: The total cost of LBP was 1860 million EUR in Sweden in 2001. The indirect costs due to lost productivity accounted for 84% of the total cost. INTERPRETATION: The cost of illness due to low back pain was substantial, but does not appear to have risen during the last 10-15 years.     

The economic cost of low back pain in sweden in 2001

Background Low back pain (LBP) is a common cause of lost work days and disability. In 2001, expenditure for back pain represented 11% of the total costs for short-term sick leave in Sweden, and about 13% of all early retirement pensions were granted for back problems, of which LBP is the most important symptom. The magnitude of LBP as a health problem justifies a closer look at its burden of illness to society.

Materials and methods We assessed the costs of LBP to society in Sweden in 2001. The study was conducted in a cost-of-illness framework, measuring both the direct costs of providing health care to LBP patients, and the indirect costs as the value of the production that is lost because people are too ill to work. The costs were estimated by a prevalence and top-down approach.

Results The total cost of LBP was 1 860 million EUR in Sweden in 2001. The indirect costs due to lost productivity accounted for 84% of the total cost.

Interpretation The cost of illness due to low back pain was substantial, but does not appear to have risen during the last 10-15 years.     

Nonsurgical care of low back pain.

Based on accumulating evidence, an important shift in the nonsurgical treatment paradigm for low back pain is underway. This shift is away from prolonged rest and passive therapy toward earlier patient activation and greater use of exercise therapy. The patient's best interest is often served by encouraging an early return to work and by avoiding adversarial legal proceedings. Patients should be reassured about the good prognosis of acute pain, and the alarming terminology of "injury" or "ruptured disc" should be avoided. Intervention to avoid sedentariness, smoking, and obesity probably offers important therapeutic and preventive opportunities. When surgery is indicated, the patient should have a major role in decision making after being provided an accurate view of risks and benefits of surgical intervention. Surgery should generally be reserved for those cases for which a benefit of surgery has been clearly established, avoiding the liberalization of indications to include imaging findings alone, persistent pain alone, or the failure of other treatments in the absence of clear surgical indications.     

Emergency eye care in general practice

Ocular injuries should receive immediate meticulous care. The majority of such injuries can and should be the responsibility of the physician first seeing the patient. The simplest of ocular trauma may result in loss of eyesight but this can usually be prevented by following a few simple rules of ocular care. Lacerations of the lids cannot be sutured in the same manner as simple lacerations elsewhere on the body surface. The peculiar and complex anatomy of the eyelids must be maintained if function is not to be disturbed.