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Few Studies Examine the Effect of Health Literacy on LBP Treatment Outcomes

Spine Patient Education, Patient Centered, Education

A review of published research on the implications of patient Healthcare Literacy (HL) in patients with lower back pain (LBP) found that evidence-based studies were minimal and that further research could be beneficial in determining future treatment costs and outcomes. The ability of chronic pain sufferers to access, understand, and apply health information defines HL and can be helpful to practitioners treating LBP patients. The reviewers sought to understand how HL affects LBP patient treatment outcomes.

 

The Review

Researchers performed a data search using lower back pain terms in PubMed, Web of Science, PsychInfo, and CINAHL but found only three studies that directly addressed the issue of HL in patients with LBP. The search parameters were limited to studies conducted between the years of 2000-2017, published in English, and formatted as an article or review. Of the initial 1037 articles that met the initial criteria, only three were empirical research studies related to HL in patients with LBP.

Due to the lack of adequate data, a full, systematic review of the subject in question was not possible. Still, the authors of the review noted that, based on the limited data, patients with chronic LBP may have a more negative attitude towards their health and a more difficult time managing their health than patients without chronic back pain. Since self-health management is a central tenet of HL, this finding could indicate that better HL could assist in determining a better, more satisfying attitude and outcome for LBP patients.

One reviewed study looked at the effect of HL on patient empowerment and found that patients who had lower levels of HL were the most dependent on practitioners and least self-empowered when it came to managing their LBP. This was true of patients who used medication for chronic conditions and those who were treated without medication. This suggests that better HL in LBP patients can empower patients and lead to a more satisfying treatment outcome.

 

Conclusion

Though there are limited published studies about how HL affects LBP patient treatment outcomes, the available data suggests that patients who are better informed about their health are more likely to feel empowered and have a more satisfying treatment outcome. Patients who were being treated with or without medication were more likely to report better self-sufficiency and a sense of empowerment when they were more familiar with their condition and understood the health treatment options available to them. Further evidence-based research should be conducted to fully understand the relationship between improved HL and patient treatment experience and outcomes.

 

KEYWORDS: the effect of health literacy on LBP treatment outcomes. the implications of patient healthcare literacy (HL) in patients with lower back pain (LBP), how HL affects LBP patient treatment outcomes, self-health management, satisfying treatment outcome.

 

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Radiographic Study Indicates Optimal Standing Lordosis Angles Could Help Reduce DJD

lordosis. degenrative joint disease

A radiographic study of the effect of hypo- and hyper-lordosis in the lumbar spine concluded that a lordosis angle of between 65-68 degrees can be considered ‘optimal’ in the reduction of degenerative joint disease (DJD) of the lumbar spine. The results of the study should be helpful in the treatment of spinal pain and rehabilitation.

The Study

Archival standing radiograph images from a single clinic of 301 adult female and male chiropractic patients aged 4 to 79 were analyzed in a blind study using RadiAnt DICOM viewer software. All the images were scored for the severity of DJD by one experienced clinical investigator to ensure consistency using the Kellgren-Lawrence (K-L) criteria—categorizing the results into three groups: 1 and below (no DJD); 2 (mild DJD); 3 (moderate DJD); and 4 (severe DJD). The Cobb angle (CA) was used to measure lumbar lordosis.

Results

In examination of the data, researchers found significant quadratic correlations between the Azari-LeGrande Degenerative Index (ALDI) and the CA values in nearly all study subjects. (No correlation was found in younger men). The correlations were more pronounced in all five spinal motion segments in women under and over the age of 40 than in their male age-counterparts. The findings indicate that too little or too great lordosis can contribute to lumbar spinal degeneration, particularly in women.

 

Conclusion

Though the effects of lumbar lordosis angles on lower DJD was modest—between 17 and 18 percent in women, and roughly 13 percent in older men—the information is significant because, unlike other contributing factors to DJD, such as genetics, lumbar lordosis can be modified to the optimal degree of between 65 and 68 degrees to reduce the risk of DJD (73 degrees in older men). An increased incidence of DJD was found whenever subjects deviated outside of these optimal weight-bearing parameters, either through hypo— or hyper-lordosis. This information may help prevent, treat, or rehabilitate patients with lower back pain.

 

KEYWORDS: the effects of lumbar lordosis angles on lower DJD, hyper-lordosis, optimal standing lordosis angles, degenerative joint disease, lumbar spine

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Hydraulic Recovery with Recumbency

hydraulic recovery of the cervical discs through lying down

The spine undergoes an accordion-like cycle of compression and decompression. This variation occurs not exclusively with the sleep-wake cycle but is influenced by gravity and load orientation of the spine. Researchers have long known that the spine undergoes a diurnal variation with compression changes of water exchange in and out of the intervertebral discs. Much of the attention has been on the discs of the lumbar spine, presumably because of the degree of lower back pain on this planet, but the intervertebral discs are throughout the spine.

In a paper published this month in The Spine Journal, researchers looked at how much the cervical and thoracic discs change with the simple act of lying down. They looked at 101 healthy individuals and found significant volume changes in the cervical and thoracic intervertebral disc heights when the subjects laid down, on average, for 29 minutes. It would seem obvious that this kind of research has been conducted in the past but no.

cervical hydraulic recovery with recumbancy

Research shows how the cervical and thoracic discs fill with the simple act of recumbency.

This basic science research is fundamental if we are to try to figure out the mechanics of optimal load and off-load environments for the spine. Lying down is also a behaviour patients perform when visiting physical therapists, chiropractors, massage therapists, and acupuncturists. Is there a mechanical therapeutic factor of recumbency?


Dynamic Disc Designs develop dynamic spine models to help in the basic understanding of core science in the pursuit of finding the best mechanical strategies for disc height and hydraulic regeneration. Explore.

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Explaining back pain with a spine model – Patient-centered Education

connecting the patient to the anatomy of back pain

Connecting with patients is the future of healthcare.  With low back pain and neck pain as the leading cause of disability and lost work days on this planet, getting to the roots of helping people with these conditions is imperative. These origins are mostly biomechanical in nature. But how a practitioner connects the curious patient with a better understanding of their anatomy can be a challenge.

Much research has talked about how important education is important for better outcomes of low back and neck pain. But how does one execute and teach a patient about their biomechanics? The spine is a complex structure and to help patients understand which movements are good and bad for their condition can be tough.

Patient-centred care is leading the way in healthcare. Engaging with patients in a way they can understand their back condition is helpful. MRI, CT and X-ray findings can be quite intimidating and confusing for the patient, but here at Dynamic Disc Designs Corp., we have made it a lot easier for the professional.

Explaining the intricacies of the annular fibres, for example, and what discogenic back pain means is a lot easier with our dynamic disc model that includes a clear see-through lens. The Professional LxH spine model includes many of the anatomical features that have never been shown in a lumbar model before. Created with the physician in mind who want to communicate effectively the biomechanical origins of back pain, now, with a two-part intervertebral disc that includes an elastomeric annulus fibrosus and nucleus pulposus certain postural changes can be taught to the patient in a dynamic and interactive way.

Below are a few videos that other professionals have created using these detailed spine models.

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Lumbar Disc Herniation and Resorption – What does the literature say?

A professional lumbar spine model with a flexible and totally dynamic herniating (or prolapse) nucleus pulposus.

Lumbar disc herniation is a very common condition which often generates pain and disability. It is a physiological process that starts from the inside out as the nucleus pushes radially into the annulus fibrosus. But not all disc herniations cause pain, and many of them don’t cause long-term disability.

The literature has been quite varied in answering questions surrounding resorption rate. Yes, many disc herniations resorb, and it is believed to be due to the anaerobic and avascular nature of the nucleus pulposus. Once the material extends beyond the annular outskirts, the immune system identifies it as foreign and macrophages begin to chew it up.

But not all lumbar disc herniations are equal while some respond to manual therapy and some do not. Some cases require surgery to remove the offending material.

In a recent meta-analysis titled: ‘Incidence of spontaneous resorption of lumbar disc herniation’ 1 a group of authors looked at 11 cohort studies but found only a very limited number of high-quality papers on the subject. What they found was the phenomenon of lumbar disc herniation resorption to be 66.66% and suggested that conservative treatment may be a first line approach to reduce costs associated with unnecessary surgical bills.


Disc herniations are quite varied in nature, and this is likely why there is such variability in the outcomes reported regarding resorption and pain. As a spine modeling company which continuously invests in the property characteristics of materials, we have found that subtle changes to the nucleus pulposus make-up and annulus fibrosus tensile properties have a significant impact on the biomechanical behaviour of our lumbar disc herniation model.

Many mechanically anatomical variations exist which can cause a wide spread of varying symptoms. These symptoms are likely related to the type of herniations with some more central within the spinal canal and others are more lateral. Further to that, Depending on the severity, an astute clinician can be relatively accurate in the anatomical location to help in the mechanical management of lumbar disc herniation.

flexion, lumbar, model, pain, relief

Flexion lumbar loading

 

 

To see how a spine surgeon uses the model to explain a lumbar disc herniation while referencing an MRI, we present Iona Collins of fixmyspine below.

 

 

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Spine Patient Education to Improve Compliance

spine patient education, patient education, spine, models, lumbar, cervical

Improving compliance through spine patient education.

Communication is very important. We all know that. In any relationship, communication seems to be the key element in making sure a common goal is delivered. This is especially important when doctors connect with patients about spinal problems. Spine patient education is imperative in a patient centered model. It also seems helpful in reducing fear avoidance behaviours. 1

Spine Patient Education, Patient Centered, Education

Patient Centered

Doctor-patient communication is critical when relaying information about what the spinal diagnosis is.  Effective communication is also important when relaying the best options for treatment. Doctors and therapists will use their skills to connect with patients. Making reference to the experience they have had with the condition with some offering of favourable outcomes.

What is important is that the patient feels ‘listened to’ and that the doctor can relate their symptoms with the spinal movements that seem to aggravate or miminize the problem.

For example, if a patient exhibits pain bending forward, it can be very helpful to have a dynamic spine model that bulges under flexion load. If a patient can physically see and understand that bending forward can compress the discs (or squeeze on the nerves), this can be very effective in communicating the disc is the likely culprit in the case of sciatica.

spine, education, patient, doctor

Bending forward can cause pain.

Conversely, if a patient demonstrates pain while bending backwards, a dynamic model can show how the facets rub together into extension.

A doctor unequipped for spine patient education is like a mechanic without its tools. Patients are usually very curious about the internal workings of their own bodies. When a doctor or therapist can clearly demonstrate where and why it hurts, often they will be a patient for life.

Spinal pain frequently relates to the spacing of the vertebrae, or lack thereof. Dynamic disc height loss, for example, can now be shown with a model both a doctor and patient can hold and manipulate.

 

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Herniated Lumbar Disk – Review and Modeling

Published May 5th, 2o16 in the New England Journal of Medicine 1 is a review paper on herniated lumbar disk. Dr. Deyo opens the manuscript with a case presentation of  41-yr-old man. He develops progressive increasing lower back and leg pain from doing yard work. This involved pulling out large bushes. With a positive straight leg raise at 40 degrees, the most probable diagnosis is herniated lumbar disk.

About two-thirds of adults experience back pain some time in their life. Sciatica is often used to describe the result of a disk herniation as the sciatic nerve is the downstream nerve effected. A more appropriate term is lumbar radiculopathy. This is due to the proximal origin of the issue and the sensory and motor findings that presents along the sciatic nerve distribution.

Herniated Lumbar Disk

To help with patient education of a herniated lumbar disk, accurate modeling of the nucleus pulposus and annulus fibrosus is developed by Dynamic Disc Designs Corp. Now, a patient can understand the geometry and forces involved to create a disk herniation and may think twice about repeating the activity that causes the problem initially. Accurate patient education of herniated lumbar disk to reveal the mechanism of the injury is very helpful in the management of the condition. This is both in onset and rehabilitation as load with flexion causes the nucleus to push posteriorly.

herniated lumbar disk. lumbar, disk

Herniated lumbar intervertebral disk – important for patients to see how this happened

It is important for patients to understand what caused their symptoms as to change future behaviours. It is known that a herniated lumbar disk is caused by hydraulic compression of overloading the spine into a flexion moment as the posterior annulus is compromised causing radial fissures 2. And now, this never before seen event can be shown with a knowledge transfer to the patient in an easily understandable dynamic model to help improve outcomes.

 

  1. Richard A. Deyo, M.D., M.P.H., and Sohail K. Mirza, M.D., M.P.H. Herniated Lumbar Intervertebral Disk. The New England Journal of Medicine. May 5, 2016 1763-72
  2.  Samuel P. Veres, BEng, Peter A. Robertson, MD, Neil D. Broom, PhD The Morphology of Acute Disc Herniation. A Clinically Relevant Model Defining the Role of Flexion. SPINE 2009 Volume 34, Number 21, pp 2288–2296