• Evaluation of a multi-disciplinary back pain rehabilitation programme—individual and group perspectives

      Baird, Andrew; Worral, Lisa; Haslam, Cheryl; Haslam, Roger A.; Loughborough University (2008-02-16)
      To evaluate the impact of a multi-disciplinary back pain rehabilitation programme using a combination of individual and group change data. A total of 261 consecutive patients attending an assessment session for the back pain rehabilitation programme completed the SF-36 health survey questionnaire. The patients were requested to complete the questionnaires again at programme completion and at the 6-month follow-up. The Reliable Change Index was used to define 'clinical significance' in terms of the assessment of individual change. Half of those patients considered to be suitable for the programme subsequently completed it. In group terms, non-completers scored lower than completers on all SF-36 scales. Statistically significant improvements were evident for those completing the programme (all scales at P < 0.000), with improvement maintained at follow-up. In individual terms, 'clinical significance' was exceeded most frequently in the Physical Functioning and Role Physical scales. Whilst some participants lost previous improvements between completion and follow-up, others improved over this same time period. The majority of those completing the programme showed improvement in at least one scale. Adding assessment of individual change to traditional group change measures provides greater insight into the impact a rehabilitation programme has upon participants' quality of life. Whilst the programme is clearly effective for those who complete it, work is required to limit post-programme deterioration and improve uptake
    • Exploring Differences in Pain Beliefs Within and Between a Large Nonclinical (Workplace) Population and a Clinical (Chronic Low Back Pain) Population Using the Pain Beliefs Questionnaire

      Baird, Andrew; Haslam, Roger A.; University of Derby (2013-07-25)
      BACKGROUND: Beliefs, cognitions, and behaviors relating to pain can be associated with a range of negative outcomes. In patients, certain beliefs are associated with increased levels of pain and related disability. There are few data, however, showing the extent to which beliefs of patients differ from those of the general population. OBJECTIVE: This study explored pain beliefs in a large nonclinical population and a chronic low back pain (CLBP) sample using the Pain Beliefs Questionnaire (PBQ) to identify differences in scores and factor structures between and within the samples. DESIGN: This was a cross-sectional study. METHODS: The samples comprised patients attending a rehabilitation program and respondents to a workplace survey. Pain beliefs were assessed using the PBQ, which incorporates 2 scales: organic and psychological. Exploratory factor analysis was used to explore variations in factor structure within and between samples. The relationship between the 2 scales also was examined. RESULTS: Patients reported higher organic scores and lower psychological scores than the nonclinical sample. Within the nonclinical sample, those who reported frequent pain scored higher on the organic scale than those who did not. Factor analysis showed variations in relation to the presence of pain. The relationship between scales was stronger in those not reporting frequent pain. LIMITATIONS: This was a cross-sectional study; therefore, no causal inferences can be made. CONCLUSIONS: Patients experiencing CLBP adopt a more biomedical perspective on pain than nonpatients. The presence of pain is also associated with increased biomedical thinking in a nonclinical sample. However, the impact is not only on the strength of beliefs, but also on the relationship between elements of belief and the underlying belief structure
    • Influence of different stool types on muscle activity and lumbar posture among dentists during a simulated dental screening task

      De Bruyne, Mieke A.A.; Van Renterghem, Benedikt; Palmans, Tanneke; Danneels, Lieven; Dolphens, Mieke; Baird, Andrew; University of Derby (Elsevier, 2016-03-11)
      Whereas in the past dental stools typically facilitated a 90° hip angle, a number of currently available alternative designs allow for a more extended hip posture. The present study investigated the influence of different stool types on muscle activity and lumbar posture. Twenty five participants completed a simulated dental procedure on a standard stool, a saddle and the Ghopec. The latter stool comprises a seat pan consisting of a horizontal rear part for the pelvis and an inclinable sloping down front part for the upper legs, with a vertically and horizontally adjustable back rest. Lumbar posture was most close to neutral on the Ghopec, whereas sitting on a standard/saddle stool resulted in more flexed/extended postures respectively. Sitting with a 90° angle (standard stool) resulted in higher activation of back muscles while sitting with a 125° angle (saddle and Ghopec) activated abdominal muscles more, although less in the presence of a backrest (Ghopec). To maintain neutral posture during dental screening, the Ghopec is considered the most suitable design for the tasks undertaken.
    • A longitudinal exploration of pain tolerance and participation in contact sports

      Thornton, Claire; Sheffield, David; Baird, Andrew; Northumbria University; University of Derby (Elsevier, 2017-03-22)
      Background/aims Athletes who choose to engage in contact sports do so with the knowledge that participation will bring pain in the form of contact with others, injury, and from exertion. Whilst athletes who play contact sports have been shown to have higher pain tolerance than those who do not, it is unclear whether this is a result of habituation over time, or as a result of individual differences at the outset. The aim was to compare pain responses over an athletic season in athletes who participated in contact sport and those who disengaged from it. Methods One hundred and two new contact athletes completed measures of cold and ischaemic pain tolerance, perceived pain intensity, pain bothersomeness, pain coping styles and attendance at the start, middle (4 months) and end (8 months) of their season. The athletes were drawn from martial arts, rugby and American football. Cluster analysis placed 47 athletes into a participating category and 55 into a non-participating cluster. Results Participating athletes had higher ischaemic pain tolerance at the start (r = 0.27, p = 0.05), middle (r = 0.41, p < 0.0001) and end of the season (r = 0.57, p < 0.0001) compared to non-participating athletes. In addition participating athletes were more tolerant to cold pain at the end of the season (r = 0.39, p < 0.0001), compared to non-participating athletes. Participating athletes also exhibited higher direct coping, catastrophized less about injury pain and also found contact pain to be less bothersome physically and psychologically compared to non-participating athletes. Participating athletes were more tolerant of ischaemic pain at the end of the season compared to the start (r = 0.28, p = 0.04). Conversely non-participating athletes became significantly less tolerant to both pain stimuli by the end of the season (cold pressor; r = 0.54, p < 0.0001; ischaemia; r = 0.43, p = 0.006). Pain intensity as measured by a visual analogue scale did not change over the season for both groups. Conclusions Those who cease participation in contact sports become less pain tolerant of experimental pain, possibly a result of catastrophizing. The results suggest that athletes who commit to contact sports find pain less bothersome over time, possibly as a result of experience and learning to cope with pain. Athletes who continue to participate in contact sports have a higher pain tolerance, report less bothersomeness and have higher direct coping than those who drop out. In addition, tolerance to ischaemic pain increased over the season for participating athletes. Implications Having a low pain tolerance should not prevent athletes from taking part in contact sports, as pain becomes less bothersome in athletes who adhere to such activities. Participating in contact sports may result in maintained cold pain tolerance, increased ischaemic pain tolerance, reduced catastrophizing and better coping skills. Coaches can therefore work with athletes to develop pain coping strategies to aid adherence to contact sports.
    • Motor performance during experimental pain: The influence of exposure to contact sports

      Thornton, Claire; Sheffield, David; Baird, Andrew; University of Derby (Wiley, 2019-01-30)
      Athletes who play contact sports are regularly exposed to pain, yet manage to perform complex tasks without significant decrement. Limited research has suggested that superior pain tolerance in contact athletes may be important in this context and this may be altered via experience of pain. Other psychological variables such as challenge states, pain bothersomeness and coping style may also influence skill execution during pain. Forty experienced contact athletes (>3 years experience), 40 novice contact athletes (<6 months experience) and 40 non-contact athletes performed a motor task both in pain and without pain. During the pain condition, pressure pain was induced and half of each group were given challenge instructions and the other half threat based instructions. Measures of cognitive appraisal, heart rate variability, pain bothersomeness, tolerance and intensity and coping styles were taken. Contact athletes, regardless of experience, performed better during pain compared to the non-contact athletes, this relationship was mediated by pain tolerance and physical bothersomeness. During the threat condition, experience of contact sports moderated performance. Contact athletes were challenged by the pain, regardless of the instructions given, had higher direct coping and found pain less psychologically bothersome. Experienced contact athletes had higher pain tolerance and reported pain as less intense than the other groups. Ahletes who play contact sports may have better coping and adjustment to experimental pain, especially during threatening conditions. Performance during experimental pain is mediated by pain tolerance and physical pain bothersomeness. Athletes with even relatively small amounts of contact sport experience perform better during experimental pain than athletes who play non-contact sports. Experienced contact athletes had higher levels of direct coping and were more challenged and less threatened by pain than non-contact athletes.
    • The relationship between pain beliefs and physical and mental health outcome measures in chronic low back pain: direct and indirect effects

      Baird, Andrew; Sheffield, David; University of Derby (2016-08-19)
      Low back pain remains a major health problem with huge societal cost. Biomedical models fail to explain the disability seen in response to reported back pain and therefore patients’ beliefs, cognitions and related behaviours have become a focus for both research and practice. This study used the Pain Beliefs Questionnaire and had two aims: To examine the extent to which pain beliefs are related to disability, anxiety and depression; and to assess whether those relationships are mediated by pain self-efficacy and locus of control. In a sample of 341 chronic low back pain patients, organic and psychological pain beliefs were related to disability, anxiety and depression. However, organic pain beliefs were more strongly related to disability and depression than psychological pain beliefs. Regression analyses revealed that these relationships were in part independent of pain self-efficacy and locus of control. Further, mediation analyses revealed indirect pathways involving self-efficacy and, to a lesser extent chance locus of control, between organic pain beliefs, on the one hand, and disability, anxiety and depression, on the other. In contrast, psychological pain beliefs were only directly related to disability, anxiety and depression. Although longitudinal data are needed to corroborate our findings, this study illustrates the importance of beliefs about the nature of pain and beliefs in one’s ability to cope with pain in determining both physical and mental health outcomes in chronic low back pain patients.
    • The use of an e-learning module on return to work advice for physiotherapists - A prospective cohort study.

      Chance-Larsen, Fiona; Chance-Larsen, Kenneth; Divanoglou, Anestis; Baird, Andrew; Manchester University NHS Foundation Trust; University of Central Lancashire; University of Iceland; University of Derby (Taylor and Francis, 2018-06-20)
      Nonspecific low back pain (LBP) can progress to chronic disability and prolonged absence from work. Despite clinical and professional guidelines, physiotherapists often fail to address return to work outcomes. The aim of this exploratory study was to determine whether an e-learning resource tailored to physiotherapy practice could affect physiotherapists’ attitudes and beliefs regarding return to work advice for their patients. Design: A prospective interventional cohort study (pilot). Methods: Participants were recruited via the Chartered Society of Physiotherapy website. Responses on a clinical vignette, the Health Care Providers’ Pain and Impairment Scale (HC-Pairs), and the Behavioral Constructs Questionnaire (BCQ) were collected online at baseline (Q1) and 2-months post-intervention (Q2). Fifty-four physiotherapists completed Q1 and the response rate for Q2 was 44/54 (81%). Changes in the degree of agreement with guidelines indicated that the intervention made an impact on respondents (kappa 0.345; p = 0.003). HC-Pairs and BCQ results showed a nonstatistically significant trend toward the target behavior. There is a need for interventions to improve adherence with advice for return to work following nonspecific LBP. An e-learning tool for physiotherapists on advising patients regarding return to work has potential to positively affect self-reported clinical behavior.