Narrow Results

Acupuncture has been used as a therapeutic intervention for the treatment of numerous diseases and symptoms for thousands of years, and low back pain has been studied and treated the most in acupuncture clinics. Traditional theory strongly suggests that the selection of acupoints will influence their clinical effects and combinations (e.g., the clinical effects of a particular acupoint or combination on reducing pain), but this idea was not considered in earlier systematic reviews and meta-analyses. We performed a systematic review, meta-analysis, and network analysis to evaluate the magnitude of the effects of acupoints used to treat low back pain in randomized controlled clinical trials. We found that acupuncture significantly reduced pain in patients with low back pain compared with the control group. The most frequently prescribed acupoints were BL23, GV3, BL20, BL40, and BL25, whereas the acupoints with the highest average effect size scores were BL20, GV3, GB30, GB34, and BL25. Further, the combinations of BL23-BL40, BL23-B25, and BL23-BL60 were the most frequently prescribed, while BL23-GV3, BL40-GV4, and BL23-BL25 showed the largest average effect size. By calculating clinical outcomes based on average effect sizes, we found that the most popular acupoints might not always be associated with the best results. Although a more thorough investigation is necessary to determine the clinical effects of each acupoint and combination on patients, we suggest that our approach may offer a fresh perspective that will be useful for future research.

Purpose: The Core Outcome Measures Index (COMI) is a multidimensional tool designed to assess the changes in health status of individuals with low back pain (LBP) over time as reported by them. It has been validated and translated into several languages. The objective of this study was to translate COMI into traditional Chinese and test its reliability and validity among the Cantonese-speaking people with LBP in Hong Kong. Methods: The COMI was translated into traditional Chinese following standard procedures and avoiding region-specific terminology. A total of 120 Cantonese-speaking individuals with LBP from The Hong Kong Polytechnic University were recruited. Participants completed a baseline translated COMI questionnaire online. After two–three days, a second set of online questionnaires, including the translated COMI, the traditional Chinese version of the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ), and the EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L), were administered to assess the reliability and validity of the translated COMI. Results: The standard Chinese version of COMI was successfully back-translated. There were low floor and ceiling effects, except for symptom-based well-being (floor effect) and disability (ceiling effect). In two rounds of surveys, the Cronbach’s alpha values were 0.79 and 0.80, respectively, indicating sufficient internal consistency. The intraclass correlation coefficient [ICC(2,1)] for the overall score of the COMI was 0.91 (95% CI: 0.86–0.94), and for each item, it ranged from 0.7 to 0.88, demonstrating good test–retest reliability. The HK-COMI was confirmed to be a valid measure. Spearman’s rho correlation tests showed a high correlation with ODI ($rho=0.60$) and EQ-5D-5L ($rho=0.73$), and a moderate correlation with RMDQ ($rho=0.53$). Conclusion: The traditional Chinese version of COMI is a valid and reliable tool for measuring the effectiveness of treatment for LBP among the Cantonese-speaking people in Hong Kong. Future studies should focus on assessing the sensitivity of this measure among the people with LBP in Hong Kong.

Although mechanical diagnosis and therapy (MDT) is generally used for its accurate “hands-on manual or face-to-face diagnostic” classification and therapeutic efficacy in treating low back pain (LBP), the validity and test–retest reliability of an AI-based MDT platform (“Dr. AI”) for chronic LBP diagnosis remain unestablished. This research aimed to assess the validity and reliability of Dr. AI compared to the conventional face-to-face diagnosis by physical therapists (“Dr. PT”). Fifty participants ($36.84\pm 9.62$ years, eight females) with chronic LBP were classified into postural, derangement, and other syndromes using MDT guidelines based on the signs, posture, and repeated movement tests. Convolutional neural networks (CNNs) were employed to compare the classification accuracies of Dr. PT and Dr. AI. The significance value for linear regression and intraclass correlation coefficient (ICC) analyses was set at $p<0.05$. Linear regression analysis demonstrated excellent validity ($R^2=0.98$, $p<0.05$), indicating the outstanding accuracy of Dr. AI. The test–retest reliability data demonstrated good-to-excellent ICC (0.82–0.94; $p<0.05$), indicating consistent measurements by Dr. AI. These findings highlight the important clinical application of the Dr. AI MDT system, which accurately and consistently identifies and classifies syndromes in chronic LBP in a remote or ecological environment. Our novel study has demonstrated more than 10% higher reliability and validity than previous studies.

Background: Low back pain (LBP) with facet joint origin is a common diagnosis of patients referred to physical therapy clinic. An expert consensus of diagnostic criteria has been proposed. However, the reliability of the assessment has not been proved.

Objective: To test the degrees of agreement between two physical therapists for nine physical examination items and the diagnosis of facet joint origin.

Methods: The examination according to diagnostic criteria was performed independently by two physical therapists in 45 patients with chronic LBP. The percent agreements and Kappa coefficients of each examination item and diagnostic conclusion were calculated.

Results: The percent agreements of nine examined items ranged from 73.3–91.1%. The Kappa coefficients, widely ranged from 0.250–0.690 ($p=0.48$ to $<0.001$), showed statistically significant agreements for all examination items. The low level of agreements was partly due to improper distributions of test results. The agreement of conclusion was 86.7% and Kappa coefficient was 0.492 ($p=0.001$) which reflected good agreement of facet diagnosis.

Conclusion: There were adequate agreements for clinical examination of LBP with facet joint origin. The low level of agreement suggested the clinicians to have operational definition and rigorous training sessions although the examinations seemed to be routinely performed.

Background: Low back pain is a common musculoskeletal disorder that can incur high financial burden. A significant proportion of this burden may be incurred from referrals to health services and subsequent healthcare usages. Patients’ overall experience of pain and its related life interferences may also have some relevance to this usage.

Objective: This study aimed to examine the referral practices and subsequent health service utilization of patients with LBP within a tertiary specialist clinic setting. A secondary objective was to explore potential associations between primary independent variables of pain and life interferences with health service utilization.

Methods: Participants were patients with low back pain, who completed a set of self-reported low back pain measures. These included measures for pain intensity, pain interference, disability and quality of life. The participants’ back pain-related referral and health service utilization in the subsequent 12 months were recorded.

Results: A total of 282 patients completed the full measures. Of these, 59.9% were referred for physiotherapy, 26.3% for diagnostic imaging and 9.2% for interventional procedures. Compared to patients who were referred from tertiary care, those from primary care had lower pain intensity ($p=0.001$), pain interference ($p=0.002$), disability ($p=0.001$), but better physical and mental quality of life ($p<0.001$, $p=0.017$). High pain interference was a common factor among patients who were referred on to other services after first consultation. Levels of medical utilization and physiotherapy utilization were both associated with pain intensity ($F=2.39$, $p=0.027$ vs $F=3.87$, $p=0.001$), pain interference ($F=5.56$, $p=0.007$ vs $F=4.12$, 0.01) and disability ($F=5.89$, $p=0.001$ vs $F=3.40$, $p=0.016$). Regression analysis showed that the source of referral contributed to 6% of the variance in medical utilization and 3% of the variance in physiotherapy utilization. After controlling the demographic variables and referral sources, none of the independent variables added any significant variance to medical utilization. Only pain intensity contributed an additional 2% variance to physiotherapy utilization.

Conclusion: Referral patterns and practices appear similar to those reported in other studies. Higher levels of pain intensity, interference, disability and quality of life appear to influence the referral to different health services and subsequent treatment utilization.

Background: Mobile health (M-health) has emerged as a promising solution for enhancing the management of low back pain. However, the feasibility of M-health among the Chinese population and its influencing factors remain unclear.

Objective: This study aimed to assess the acceptance of M-health among people with chronic low back pain (CLBP) and physiotherapists in Shanghai, China, and to explore the influencing factors of its utility in the treatment of CLBP.

Methods: Semi-structured interviews and focus groups were conducted with 25 participants with CLBP and 20 physiotherapists, utilising a combination of group discussion and individual interview. Thematic analysis, supported by NVivo software, was employed to identify and examine the themes regarding the facilitators and barriers to the utility of M-health in Shanghai, China.

Results: The focus group discussions revealed a broad spectrum of factors that drive or hinder participants’ acceptance of M-health. Three main themes related to the feasibility of M-health were identified from the interviews: (1) Reasons for embracing M-health; (2) Reasons for resisting M-health; (3) Recommendations to enhance the feasibility of M-health. In general, participants exhibited enthusiasm towards the prospect of offering M-health as a viable treatment.

Conclusions: The findings of this study indicate that the feasibility of M-health depends on many factors in Shanghai, China. Efforts to promote the establishment of M-health policy or laws, rational integration of M-health and face-to-face model and improvement of the functions of M-health applications may increase its feasibility in Shanghai, China.

This study was to objectively evaluate the treatment effect of acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) on patients with low back pain. Fifty patients suffering from low back pain for at least three months were involved in the study from Chang Gung Memorial Hospital. The subjects were treated with TENS (100 Hz) on acupuncture points (BL23 and BL25). Two electrodes were placed on two right acupoints and two electrodes on the left. Pulse duration of electrical stimulation was fixed at 0.1 ms. The intensity of stimulation was adjusted at a tolerable level for each subject. Patients were treated for twenty minutes per visit, three times a week for two weeks. Visual analog scale (VAS) was used to rank the degree of pain before and two weeks after the treatment. A device, the design of which is based on the Ryodoraku theorem, was used to measure the electrical conductance of 12 meridians and 2 acupoints (BL23 and BL25) on both sides of the subjects. The effect of age difference on the pain score was also evaluated with the electrical conductance. The correlation between the VAS and the electrical conductance in the patients before and after treatment of AL-TENS was determined by linear regression analysis. The results showed that: (1) after the AL-TENS treatment in this study, the electrical conductances of either meridians or acupuncture points increased with the decrease of VAS of the patients; (2) the correlation was higher in the acupoints than that in the meridians; (3) the correlation was higher in the younger group than that in the older group; (4) the effect of AL-TENS on the change of VAS is more related to the change of electrical conductances of acupoints than that of meridians. These findings suggest that electrical conductance of meridian or acupoint can be used to evaluate the degree of pain more objectively, especially in the younger patients.