Bagnoli C1, Bonetti F1, Daugenti A1
1University of Rome, Tor Vergata, Department of Medicine and Surgery, Master in Manual Therapy Applied to Physiotherapy, Rome, Italy
Background: Spondylolisthesis is a specific kind of Low Back Pain (LBP) with a prevalance of 6-9% into general population[1]. Its management provides both conservative treatment, based on corset use and physiotherapy[2], inclunding manual therapy[3] and therapeutic exercise, or surgery. Therefore, these patients experience persistent pain, so they could also develop maladaptive attitudes, as fear avoidance, kinesiophobia etc.., having a negative influence on their prognosis, so recent studies have proposed to integrate conservative approach with management strategies for yellow flags (YF), that we already know being effective in non-specific LBP.
Purpose: The aim of this study is to investigate the efficacy of a YF[4] screening/management program, in spondylolisthesis subjects, on disability, pain, quality of life (QOL), psycho-social factors and physical skills.
Methods:
Sources: We carried out an Electronic databases research on Pubmed, Physiotherapy Evidence Database (PEDro), CINAHL, and Web of Science, between October 2017 and May 2018, using keywords and a research string.
Selection and evaluation of studies: We included just Randomized controlled trials (RCT) including spondylolisthesis subjects, (males/females, without age limits), undergoing to YF management interventions, excluding trials with non-specific LBP subjects, mental impairments, systemic/bone´s metabolic diseases, or patients undergoing experimental interventions before surgery.
Two authors selected studies excluding duplicates, and evaluating titles, abstracts and full texts.
We methodologically evaluated included studies using Consort checklist (administered by three blinded authors), looking for their quality assessment on PEDro, and evaluating Risk of bias[5].
Two authors extracted data, using a table to summarize “Population-Interventions-Comparison-Outcome model (P.I.C.O.)” and the Cochrane Consumers and Communication Review Group´s format[6].
Synthesis methods: All results were evaluated like differences between mean values between groups, including a metanalysis investigating outcomes modification trends over time, between studies.
Results: We identified 5 studies for qualitative analysis, excluding 2 of them from metanalysis: a study had uncertain risk of BIAS, low methodological scores, and heterogeneous outcomes; another study provided different kinds of measurements, so we´re waiting for raw data to present precise analysis. From metanalysis, we found favorable results in disability and QOL in short time, and on pain, mental QOL, kinesiophobia and physical skills in long time. Heterogeneous outcomes, like catastrophizing (p 0.01), coping strategies (subscale-cop: p = 0.02; subscale-cat: p 0.01), and beliefs (p 0.01) also became better from other analysis in subjects in the YF management program.
Conclusion(s):
Limits: A study had an uncertain risk of BIAS, low methodological scores and heterogeneous outcomes and another study provided different kinds of measurements (excluded from metanalysis).
All included studies had mixed population.
Strengths: We focused on spondylolisthesis subjects, including in metanalysis studies with good methodological scores and low risk of BIAS.
Conclusions: Despite of the limitations of the study, these results, together with literature[7] , seem to support YF screening/management strategies in spondylolisthesis patients, but further studies are needed to reinforce this evidence.
Implications: Our results are not so strong, but given the importance of YF on pain mechanisms, and the efficacy of their management in non-specific LBP maybe we should integrate our clinical practice with YF management interventions also in spondylolisthesis subjects.
Keywords: Spondylolisthesis, Cognitive-therapy, Physiotherapy
Funding acknowledgements: The study is unfunded. We didn´t provide ethical consent because the present study is a review.
Purpose: The aim of this study is to investigate the efficacy of a YF[4] screening/management program, in spondylolisthesis subjects, on disability, pain, quality of life (QOL), psycho-social factors and physical skills.
Methods:
Sources: We carried out an Electronic databases research on Pubmed, Physiotherapy Evidence Database (PEDro), CINAHL, and Web of Science, between October 2017 and May 2018, using keywords and a research string.
Selection and evaluation of studies: We included just Randomized controlled trials (RCT) including spondylolisthesis subjects, (males/females, without age limits), undergoing to YF management interventions, excluding trials with non-specific LBP subjects, mental impairments, systemic/bone´s metabolic diseases, or patients undergoing experimental interventions before surgery.
Two authors selected studies excluding duplicates, and evaluating titles, abstracts and full texts.
We methodologically evaluated included studies using Consort checklist (administered by three blinded authors), looking for their quality assessment on PEDro, and evaluating Risk of bias[5].
Two authors extracted data, using a table to summarize “Population-Interventions-Comparison-Outcome model (P.I.C.O.)” and the Cochrane Consumers and Communication Review Group´s format[6].
Synthesis methods: All results were evaluated like differences between mean values between groups, including a metanalysis investigating outcomes modification trends over time, between studies.
Results: We identified 5 studies for qualitative analysis, excluding 2 of them from metanalysis: a study had uncertain risk of BIAS, low methodological scores, and heterogeneous outcomes; another study provided different kinds of measurements, so we´re waiting for raw data to present precise analysis. From metanalysis, we found favorable results in disability and QOL in short time, and on pain, mental QOL, kinesiophobia and physical skills in long time. Heterogeneous outcomes, like catastrophizing (p 0.01), coping strategies (subscale-cop: p = 0.02; subscale-cat: p 0.01), and beliefs (p 0.01) also became better from other analysis in subjects in the YF management program.
Conclusion(s):
Limits: A study had an uncertain risk of BIAS, low methodological scores and heterogeneous outcomes and another study provided different kinds of measurements (excluded from metanalysis).
All included studies had mixed population.
Strengths: We focused on spondylolisthesis subjects, including in metanalysis studies with good methodological scores and low risk of BIAS.
Conclusions: Despite of the limitations of the study, these results, together with literature[7] , seem to support YF screening/management strategies in spondylolisthesis patients, but further studies are needed to reinforce this evidence.
Implications: Our results are not so strong, but given the importance of YF on pain mechanisms, and the efficacy of their management in non-specific LBP maybe we should integrate our clinical practice with YF management interventions also in spondylolisthesis subjects.
Keywords: Spondylolisthesis, Cognitive-therapy, Physiotherapy
Funding acknowledgements: The study is unfunded. We didn´t provide ethical consent because the present study is a review.
Topic: Musculoskeletal: spine; Musculoskeletal; Disability & rehabilitation
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: We didn't provide ethical consent because the present study is a review.
All authors, affiliations and abstracts have been published as submitted.
