Clinician experiences in providing reassurance for patients with low back pain in primary care: a qualitative study.

Questions: What reassurance is being delivered by physiotherapists and chiropractors to people with non-specific low back pain? How is it being delivered? What are the barriers and enablers to delivering reassurance to people with non-specific low back pain?

Design: A qualitative study.

Participants: Thirty-two musculoskeletal clinicians (16 physiotherapists and 16 chiropractors) who manage low back pain in primary care.

Method: Semi-structured interviews were conducted about their experiences delivering reassurance.

Reassurance use and reassurance-related outcomes for low back pain in primary care: A scoping review.

We used a scoping review design to map the available evidence describing the use of reassurance in clinical practice, interventions to increase the delivery of reassurance, and reassurance-related outcome measures. We searched CINAHL, MEDLINE, EMBASE and Cochrane Central from inception to October 2024. Publications were included if they described the use of reassurance or reassurance-related outcome measures in patients with non-specific low back pain (LBP) presenting to primary care.

Why might fears and worries persist after a pain education-grounded multimodal intervention for chronic back pain? A qualitative study.

Introduction: The effect of pain education (PE) on pain intensity and function diminishes after a few months in people with chronic low back pain (CLBP). One possible explanation is the return of underlying fears and worries related to the condition.

Objective: To explore topics related to participants' beliefs and feelings that might explain why fears and worries persist after a PE-grounded intervention for CLBP.

Perceptions of advice for acute low back pain: a content analysis of qualitative data collected in a randomised experiment.

Objectives: To explore how people perceive three different forms of advice for acute low back pain (LBP).

Design: Content analysis of qualitative data collected in a three-arm randomised experiment.

Participants: 2200 participants with acute LBP (ie, pain duration for ≤6 weeks) were randomly assigned to receive three types of advice: guideline advice and guideline advice with the addition of either brief pain science or ergonomics messages.

It's OK to Move! Effect of a Brief Video on Community Confidence in Activity Despite Back Pain: A Randomized Trial.

To estimate the difference in confidence to become active despite low back pain in people who were exposed to one of 2 video interventions delivered on social media, compared to no intervention. A proof-of-concept, 3-group randomized controlled trial, in a 1:1:1 ratio. Participants aged 18 years and over, with and without low back pain, were recruited via the social media channel Facebook, to view either a humorous video, a neutral video, or to no intervention.

Can General Practitioner Opioid Prescribing to Compensated Workers with Low Back Pain Be Detected Using Administrative Payments Data? An Exploratory Study.

Background: Approximately one third of Australians with accepted time loss workers' compensation claims for low back pain (LBP) are dispensed opioid analgesics. Structured administrative payments data is scalable but does not directly link opioids to prescribers. We sought to determine whether opioid prescribing by general practitioners (GPs) to workers with workers' compensation claims for LBP can be detected in structured administrative payments data.

Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial.

Introduction: Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural 'nudge' interventions on low-value care for ED patients with low back pain.

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol).

Introduction: Most simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures.

Awareness and use of five imaging decision rules for musculoskeletal injuries: a systematic review.

Background: Several validated decision rules are available for clinicians to guide the appropriate use of imaging for patients with musculoskeletal injuries, including the Canadian CT Head Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study (NEXUS) guideline, Ottawa Ankle Rules and Ottawa Knee Rules. However, it is unclear to what extent clinicians are aware of the rules and are using these five rules in practice.

Objective: To determine the proportion of clinicians that are aware of five imaging decision rules and the proportion that use them in practice.

Adding Brief Pain Science or Ergonomics Messages to Guideline Advice Did Not Increase Feelings of Reassurance in People With Acute Low Back Pain: A Randomized Experiment.

To investigate the effects of adding pain science or ergonomics messages to guideline advice on feelings of reassurance and management intentions among people with acute low back pain (LBP). Three-arm parallel-group randomized experiment. We recruited people with acute LBP (pain for ≤6 weeks) to participate in an online experiment.

How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment.

Objectives: To explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.

Setting: We performed a content analysis of qualitative data collected in a randomised experiment.

Participants: 2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: plus plus plus and plus included encouragement to stay active and positive prognostic information.

Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review.

Background: The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain.

Methods: Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023.

Spinal cord stimulation for low back pain.

Background: Spinal cord stimulation (SCS) is a surgical intervention used to treat persistent low back pain. SCS is thought to modulate pain by sending electrical signals via implanted electrodes into the spinal cord. The long term benefits and harms of SCS for people with low back pain are uncertain.

Mixed messages: most spinal pain and osteoarthritis observational research is unclear or misaligned.

Objectives: We assessed authors' language and methods to determine alignment between reported aims, methods, intent, and interpretations in observational studies in spinal pain or osteoarthritis.

Study Design And Setting: We searched five databases for observational studies that included people with spinal pain or osteoarthritis published in the last 5 years. We randomized 100 eligible studies, and classified study intent (aims and methods) and interpretations as causal, non-causal, unclear, or misaligned.

Person-centred education and advice for people with low back pain: Making the best of what we know.

Background: The first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care.

"My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain.

A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention.

Content and sentiment analysis of gabapentinoid-related tweets: An infodemiology study.

Introduction: The increasing number of gabapentinoid (pregabalin and gabapentin) harms, including deaths observed across countries is concerning to health-care professionals and policy makers. However, it is unclear if the public shares these concerns. This study aimed to describe posts related to gabapentinoids, conduct a content analysis to identify common themes and describe adverse events or symptoms.

Diagnostic labels and advice for rotator cuff disease influence perceived need for shoulder surgery: an online randomised experiment.

Question: What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease?

Design: 2×2 factorial online randomised experiment.

Participants: People with shoulder pain.

Intervention: Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation.

Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis.

Purpose: An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations.

Methods: In this study we report the results of a content analysis of free-text data collected in our experiment.

Effect of an Individualized Audit and Feedback Intervention on Rates of Musculoskeletal Diagnostic Imaging Requests by Australian General Practitioners: A Randomized Clinical Trial.

Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice.

Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practitioners (GPs).

Design, Setting, And Participants: This factorial cluster-randomized clinical trial included 2271 general practices with at least 1 GP who was in the top 20% of referrers for 11 imaging tests (of the lumbosacral or cervical spine, shoulder, hip, knee, and ankle/hind foot) and for at least 4 individual tests between January and December 2018.

It's safe to move! A protocol for a randomised controlled trial investigating the effect of a video designed to increase people's confidence becoming more active despite back pain.

Introduction: Social media provide promising contemporary platforms for sharing public health information with a broad audience. Before implementation, testing social media campaigns that are intended to engage audiences and initiate behaviour change is necessary. This trial aims to investigate the effectiveness of a public health campaign to increase people's confidence in becoming more active despite low back pain in comparison with no intervention.

Effect of diagnostic labelling on management intentions for non-specific low back pain: A randomized scenario-based experiment.

Background: Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities.

Methods: Six-arm online randomized experiment with blinded participants with and without LBP.