Publications by authors named "Steven Z George"

Purpose: AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics.

Participants: To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort).

View Article and Find Full Text PDF

Background: Reverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA.

View Article and Find Full Text PDF
Article Synopsis
  • Rotator cuff repair surgery is known for its high pain levels, but postoperative pain management isn't frequently studied; the research aimed to understand how pain outcomes relate to recovery after arthroscopic surgery and how pain coping mechanisms influence this relationship.
  • The study included 83 patients who had the surgery, measuring pain with the Brief Pain Inventory and shoulder function with the Oxford Shoulder Score, while also exploring various coping strategies through the Coping Strategies Questionnaire.
  • Results showed that 24% of patients experienced chronic pain six months post-surgery, and better functional recovery was linked to positive coping strategies, notably self-statements, highlighting the importance of cognitive approaches in enhancing patient outcomes.
View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to assess how COVID-19 impacted pain management clinical trials using the PICOTS framework, focusing on patient demographics, intervention methods, and trial outcomes.
  • Researchers utilized rapid qualitative methods to gather insights from trial leaders across various study designs, uncovering significant disruptions primarily related to the shift from in-person to virtual care.
  • Findings revealed that while patient populations remained stable, the transition created issues with intervention fidelity and posed challenges for ongoing care access, affecting the reliability of research outcomes and the overall conduct of the trials.
View Article and Find Full Text PDF

Objective: This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA).

Design: This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP).

Setting: Ten VHA clinics.

View Article and Find Full Text PDF
Article Synopsis
  • Best practices for clinical trials require that statistical analysis plans (SAPs) be finalized prior to any analysis, but there is little guidance on when and how to make changes to these plans during the research process.
  • A survey of 12 pragmatic clinical trials in pain management found that most included details on SAPs and made changes after trial initiation, often due to COVID-19, affecting aspects like sample size and study design.
  • The study recommends that changes to SAPs are acceptable until data lock/unblinding, emphasizing the importance of transparent documentation, including details and justifications for any modifications, along with approval from oversight bodies.
View Article and Find Full Text PDF
Article Synopsis
  • * A total of 1987 patients were assessed using various pain and function scales, alongside evaluating demographic and surgical characteristics.
  • * Key predictors for CPSP included preoperative negative emotions, existing pain, and shoulder function, emphasizing the need for better pre-surgery evaluations of psychological and social influences on pain outcomes.
View Article and Find Full Text PDF
Article Synopsis
  • * The study will follow 300 participants with chronic low back pain, assessing factors like sleep disturbances and pain, using various methods over 12 months to identify their impact on developing multiple COPCs.
  • * The research aims to analyze how sleep and circadian rhythm issues relate to pain intensity, psychological distress, and the spread of pain across the body, potentially guiding future treatment and prevention approaches for these conditions.
View Article and Find Full Text PDF

The transition from acute to chronic low back pain (LBP) in community settings is not well understood. The purpose of this study was to assess the feasibility of recruitment and estimate the transition and continuation of chronic LBP. We also explored characteristics associated with this transition to chronic LBP.

View Article and Find Full Text PDF
Article Synopsis
  • Pain intensity in knee osteoarthritis (KOA) can vary greatly, with a specific focus on high-impact chronic pain (HICP) among those affected.
  • * A study using data from the Johnston County Health Study found that approximately 15.5% to 21.2% of individuals with KOA are classified as having HICP, based on different measurement tools.
  • * Key findings revealed that increased kinesiophobia (fear of movement) and somatization (physical symptoms with no clear medical cause) are consistently linked to HICP, while other sociodemographic and clinical factors differ depending on the measurement used.
View Article and Find Full Text PDF

Background: The Association of American Medical Colleges suggests an Experiences-Attributes-Metrics framework for holistic review, but there is minimal research on demographic and personal characteristic attributes and the interplay between these Attributes subcategories. Understanding how personal attributes may vary among students considered represented and those considered underrepresented in one or more categories is critical to avoid unintentionally perpetuating practices that favor represented groups. This study explored differences in six personal characteristics either consistently related to academic performance or deemed positive professional traits based on diversity characteristics (categories of underrepresentation), age, and sex.

View Article and Find Full Text PDF

Introduction: Acute low back pain (LBP) is a common experience; however, the associated pain severity, pain frequency, and characteristics of individuals with acute LBP in community settings have yet to be well understood. In this manuscript, two acute-LBP severity categorization definitions were developed: 1) pain impact frequency (impact-based) and 2) pain intensity (intensity-based) severity categories. The purpose of this manuscript is to describe and then compare these acute-LBP severity groups in the following characteristics: 1) sociodemographic, 2) general and physical health, and 3) psychological using a feasibility cohort study.

View Article and Find Full Text PDF
Article Synopsis
  • The study evaluated the cost-effectiveness of risk-stratified care compared to usual care for treating low back pain in a military health setting, focusing on resource use and costs.
  • The findings indicated no significant differences in back-related medical costs, total medical costs, or quality of life outcomes between the two approaches over a one-year period.
  • Despite the theoretical benefits of risk-stratified care, the incremental net monetary benefit was modest and negative at certain thresholds, suggesting it may not be a more cost-effective option.
View Article and Find Full Text PDF

The Fear-Avoidance Components Scale (FACS) and the Fear of Daily Activities Questionnaire (FDAQ) assess fear-avoidance model components. However, the questionnaires are not available in Brazilian Portuguese. This study aimed to translate the original English FACS and FDAQ into Brazilian (Br) Portuguese and assess their measurement properties in patients with Chronic Low Back Pain (CLBP).

View Article and Find Full Text PDF

In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain.

View Article and Find Full Text PDF

Background: Increasing deformity of the lower extremities, as measured by the hip-knee-ankle angle (HKAA), is associated with poor patient outcomes after total hip and knee arthroplasty (THA, TKA). Automated calculation of HKAA is imperative to reduce the burden on orthopaedic surgeons. We proposed a detection-based deep learning (DL) model to calculate HKAA in THA and TKA patients and assessed the agreement between DL-derived HKAAs and manual measurement.

View Article and Find Full Text PDF

The transition from acute to chronic low back pain (LBP) in community settings has yet to be well understood. We recruited n=131 participants with acute LBP from the community and followed them for 3 and 6-month outcomes. Acute LBP was defined by a duration of < 4 weeks, and participants must have reported a 30-day LBP-free period before the current acute episode.

View Article and Find Full Text PDF

Background: The decision to treat shoulder osteoarthritis (OA) definitively with shoulder arthroplasty (SA) is multifactorial, considering objective findings, subjective information, and patient goals. The first goal of this study was to determine if Patient Reported Outcome Measurement Information System (PROMIS) measures correlated with patients with shoulder OA who underwent SA within 1 year. The second goal of this study was to determine if score cut-offs in PROMIS domains could further discriminate which shoulder OA patients underwent SA within 1 year.

View Article and Find Full Text PDF