INTRODUCTION: Functional capacity tests are standardized instruments to evaluate patients' capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain.METHODS: A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies.RESULTS: Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury.CONCLUSIONS: Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.
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QUESTION: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain?DESIGN: Systematic review with meta-analysis of prospective inception cohort studies.PARTICIPANTS: Adults with acute or subacute non-specific low back pain.OUTCOME MEASURE: Absence from usual work at a given time point greater than 12 weeks after the onset of pain due to ongoing pain.RESULTS: Ten studies involving 4683 participants were included in the review. Participants with acute or subacute pain and negative expectations about their recovery had significantly greater odds of being absent from usual work at a given time point more than 12 weeks after the onset of pain: OR 2.17 (95% CI 1.61 to 2.91). The exclusion of five studies with the greatest risk of bias showed that the result was similar when more rigorous quality criteria were applied: OR 2.52 (95% CI 1.47 to 4.31).CONCLUSION: The odds that adults with acute or subacute non-specific low back pain and negative recovery expectations will remain absent from work due to progression to chronic low back pain are two times greater than for those with more positive expectations. These results were consistent across the included studies despite variations in the risk of bias.
Background: Self-management support is considered an important component in the physiotherapeutic treatment of people with chronic low back pain. The stratified blended physiotherapy intervention e-Exercise Low Back Pain is an example of a self-management intervention. More insight may contribute to improving blended interventions to stimulate self-management after treatment and thus hopefully prevent chronicity and/or relapses in patients with chronic low back pain. Objectives: The aim of this study was to gain an in-depth understanding of the self-management behaviour after a physiotherapist guided blended self-management intervention in people with chronic low back pain. Design: A qualitative study with semi-structured interviews nested within a randomized controlled trial on the (cost-)effectiveness of e-Exercise Low Back Pain was conducted. Method: Thematic analysis was used to analyse the transcriptions. A hybrid process of both deductive and inductive approaches was used. Results: After 12 interviews, data saturation was reached. Analysis of the data yielded six themes related to self-management behaviour: illness beliefs, coping, cognitions, social support and resource utilization, physiotherapeutic involvement and motivation. Conclusions: In our study the majority of the participants seemed to show adequate self-management behaviour when experiencing low back pain. Most participants first try to gain control over their low back pain themselves when experiencing a relapse before contacting the physiotherapist. Participants struggle in continuing health behaviour in pain free periods between relapses of low back pain. Physiotherapists are recommended to encourage long-term behaviour change. Additionally, better facilitation by the physiotherapist or additional functionalities in the app to stimulate social support might have a useful contribution.
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