G Waddell

University of Leeds, Leeds, ENG, United Kingdom

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Publications (81)180.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Quasi-experimental before-and-after design with control group. We evaluated a back pain mass media campaign's impact on population back pain beliefs, work disability, and health utilization outcomes. Building on previous campaigns in Australia and Scotland, a back pain mass media campaign (Don't Take it Lying Down) was implemented in Alberta, Canada. A variety of media formats were used with radio ads predominating because of budget constraints. Changes in back pain beliefs were studied using telephone surveys of random samples from intervention and control provinces before campaign onset and afterward. The Back Beliefs Questionnaire (BBQ) was used along with specific questions about the importance of staying active. For evaluating behaviors, we extracted data from governmental and workers' compensation databases between January 1999 and July 2008. Outcomes included indicators of number of visits to health care providers, use of diagnostic imaging, and compensation claim incidence and duration. Analysis included time series analysis and ANOVA testing of the interaction between province and time. Belief surveys were conducted with a total of 8566 subjects over the 4-year period. Changes on BBQ scores were not statistically significant, however, the proportion of subjects agreeing with the statement, "If you have back pain you should try to stay active" increased in Alberta from 56% to 63% (P = 0.008) with no change in the control group (consistently approximately 60%). No meaningful or statistically significant effects were seen on the behavioral outcomes. A Canadian media campaign appears to have had a small impact on public beliefs specifically related to campaign messaging to stay active, but no impact was observed on health utilization or work disability outcomes. Results are likely because of the modest level of awareness achieved by the campaign and future campaigns will likely require more extensive media coverage.
    Spine 03/2010; 35(8):906-13. · 2.16 Impact Factor
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    ABSTRACT: A modified Delphi study conducted with 28 experts in back pain research from 12 countries. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.
    Spine 02/2008; 33(1):95-103. · 2.16 Impact Factor
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    ABSTRACT: Literature review, expert panel, and a workshop during the "VIII International Forum on Primary Care Research on Low Back Pain" (Amsterdam, June 2006). To develop practical guidance regarding the minimal important change (MIC) on frequently used measures of pain and functional status for low back pain. Empirical studies have tried to determine meaningful changes for back pain, using different methodologies. This has led to confusion about what change is clinically important for commonly used back pain outcome measures. This study covered the Visual Analogue Scale (0-100) and the Numerical Rating Scale (0-10) for pain and for function, the Roland Disability Questionnaire (0-24), the Oswestry Disability Index (0-100), and the Quebec Back Pain Disability Questionnaire (0-100). The literature was reviewed for empirical evidence. Additionally, experts and participants of the VIII International Forum on Primary Care Research on Low Back Pain were consulted to develop international consensus on clinical interpretation. There was wide variation in study design and the methods used to estimate MICs, and in values found for MIC, where MIC is the improvement in clinical status of an individual patient. However, after discussion among experts and workshop participants a reasonable consensus was achieved. Proposed MIC values are: 15 for the Visual Analogue Scale, 2 for the Numerical Rating Scale, 5 for the Roland Disability Questionnaire, 10 for the Oswestry Disability Index, and 20 for the QBDQ. When the baseline score is taken into account, a 30% improvement was considered a useful threshold for identifying clinically meaningful improvement on each of these measures. For a range of commonly used back pain outcome measures, a 30% change from baseline may be considered clinically meaningful improvement when comparing before and after measures for individual patients. It is hoped that these proposals facilitate the use of these measures in clinical practice and the comparability of future studies. The proposed MIC values are not the final answer but offer a common starting point for future research.
    Spine 02/2008; 33(1):90-4. · 2.16 Impact Factor
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    ABSTRACT: Public and professional health education campaign. To change public beliefs about the management of back pain. Within the past decade, there has been a reversal in the strategy of management of back pain, from rest to staying active. There is only one previous public health education campaign on back pain, in a workers compensation setting in Australia. A multimedia campaign was based around 1777 radio advertisements, which were heard by 60% of adults. Information leaflets were prepared for people with back pain, for all health professionals who treat back pain, and for employers. A Web site was set up: www.workingbacksscotland.com. Structured monthly samples of 1000 adults were surveyed on their beliefs about rest or staying active, professional help sought and advice received for 2 months before the campaign and over the following 3 years. Royal Mail sickness absence rates and new awards of social security benefits for back pain were compared in Scotland versus the rest of the United Kingdom, before and after the campaign. There was a significant (P < 0.001) change in the balance of beliefs, from about 55% rest versus 40% staying active to about 30% rest versus 60% staying active. This occurred within 1 month of the launch and was maintained over 3 years. There was a comparable change in professional advice. There was no change in advice about work or the number who said they stayed off work. There was no effect on sickness absence or new awards of social security benefits for back pain. There was a major shift in public beliefs and professional advice but no change in work-related outcomes.
    Spine 10/2007; 32(19):2139-43. · 2.16 Impact Factor
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    J N Alastair Gibson, Gordon Waddell
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    ABSTRACT: An updated Cochrane Review. To assess the effects of surgical interventions for the treatment of lumbar disc prolapse. Disc prolapse accounts for 5% of low back disorders yet is one of the most common reasons for surgery. There is still little scientific evidence supporting some interventions. Use of standard Cochrane review methods to analyze all randomized controlled trials published up to January 1, 2007. Forty randomized controlled trials (RCTs) and 2 quasi-RCTs were identified. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Four trials directly compared discectomy with conservative management, and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis, and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an interposition gel covering the dura (5 trials) and of fat (4 trials) show that they can reduce scar formation, although there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy. There are no published RCTs of coblation therapy or transforaminal endoscopic discectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. The evidence for other minimally invasive techniques remains unclear except for chemonucleolysis using chymopapain, which is no longer widely available.
    Spine 08/2007; 32(16):1735-47. · 2.16 Impact Factor
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    ABSTRACT: Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients about post-operative restrictions, reactivation, and return to work. This study aimed to review the evidence on post-operative management, with a view to developing evidence-based messages for a patient booklet on post-operative management after lumbar discectomy or un-instrumented decompression. A systematic literature search produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. Evidence statements were extracted and developed into patient-centred messages for an educational booklet. The draft text was evaluated by peer and patient review. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to post-operative management. The booklet was built around key messages derived from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management. Feedback from the evaluations were favourable from both review groups, suggesting that this evidence-based approach to management is acceptable and it has clinical potential.
    European Spine Journal 04/2007; 16(3):339-46. · 2.47 Impact Factor
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    ABSTRACT: In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain. A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ) and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted) to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice. 335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD) BBQ score for the pharmacists was 31.37 (5.75), which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision) in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most respondents said they would benefit from more education about back pain. Those sampled generally expressed positive attitudes about back pain and were able to offer evidence based advice. Pharmacists may benefit from training to increase their ability and confidence to offer support for self-care in back pain. Further research would be useful to clarify the representativeness of the sample.
    BMC Musculoskeletal Disorders 02/2007; 8:10. · 1.88 Impact Factor
  • Gordon Waddell, Kim Burton, Mansel Aylward
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    ABSTRACT: This paper reviews the evidence on the relationship between work and health. It concludes that, overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term worklessness. That contrasts with increasing trends of sickness absence, long-term incapacity and ill-health retirement attributed to common health problems. It suggests that there needs to be a fundamental shift in how we think about common health problems and work--in health care, the workplace and society.
    Journal of insurance medicine (New York, N.Y.) 02/2007; 39(2):109-20.
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    J N A Gibson, G Waddell
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    ABSTRACT: Disc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery. The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Spine and abstracts of the main spine society meetings within the last five years. We also checked the reference lists of each retrieved articles and corresponded with experts. All data found up to 1 January 2007 are included. Randomized trials (RCT) and quasi-randomized trials (QRCT) of the surgical management of lumbar disc prolapse. Two review authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. Forty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).
    Cochrane database of systematic reviews (Online) 02/2007; · 5.70 Impact Factor
  • Gordon Waddell
    Pain 10/2006; 124(1-2):7-8. · 5.64 Impact Factor
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    ABSTRACT: Population-based survey. To assess the back pain beliefs in 2 provinces in Canada to inform a population-based educational campaign. Beliefs, attitudes, and recovery expectations appear to influence recovery from back pain, yet prevailing public opinions about the condition have been little studied. Telephone surveys were conducted with 2400 adults in 2 Canadian provinces. Surveys included the Back Beliefs Questionnaire, and additional questions concerning age, gender, recent and lifetime back pain, coping strategies for back pain, and awareness and persuasiveness of media information concerning back pain. A high prevalence of back pain was reported, with a lifetime prevalence of 83.8%, and 1-week prevalence of 34.2%. Generally, a pessimistic view of back pain was held. Most agreed that back pain makes everything in life worse, will eventually stop one from working, and will become progressively worse with age. Mixed opinions were observed regarding the importance of rest and staying active. A significant minority (12.3%) reported taking time off from work for their last back pain episode. Those individuals taking time off from work held more negative back pain beliefs, including the belief that back pain should be rested until it gets better. Public back pain beliefs in the 2 Canadian provinces sampled are not in harmony with current scientific evidence for this highly prevalent condition. Given the mismatch between public beliefs and current evidence, strategies for reeducating the public are needed.
    Spine 09/2006; 31(18):2142-5. · 2.16 Impact Factor
  • Gordon Waddell
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    ABSTRACT: Musculoskeletal disorders are among the most common causes of sickness absence, long-term incapacity for work and ill-health retirement. The number of Incapacity Benefit (IB) recipients in the United Kingdom has trebled since 1979, despite improvement in objective measures of health. Most of the trend is in non-specific conditions (largely subjective complaints, often with little objective pathology or impairment). Understanding incapacity requires a biopsychosocial model that addresses all the physical, psychological and social factors involved in human illness and disability. Rehabilitation should be directed to overcome biopsychosocial obstacles to recovery and return to work. These principles are fundamental to better clinical and occupational management and minimizing incapacity. Sickness absence and incapacity from non-specific musculoskeletal conditions could be reduced by 33-50%, but that depends on getting all stakeholders onside and a fundamental shift in thinking about these conditions-in health care, in the workplace and in society.
    British Medical Bulletin 02/2006; 77-78:55-69. · 4.36 Impact Factor
  • J N Alastair Gibson, Gordon Waddell
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    ABSTRACT: An updated Cochrane review. To review current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis. There is still limited scientific evidence on spinal surgery. Use of standard Cochrane review methods to analyze all randomized controlled trials published to March 31, 2005. A total of 31 randomized controlled trials were identified. Most of the earlier trials reported mainly surgical outcomes; more of the recent trials also reported patient-centered outcomes of pain or disability. There is still very little information on occupational outcomes or long-term outcomes beyond 2-3 years. Seven heterogeneous trials on spondylolisthesis, spinal stenosis, and nerve compression permitted limited conclusions. There were two new trials on fusion that showed conflicting results. One trial showed that fusion gave better clinical outcomes than conventional physiotherapy, and the other showed that fusion was no better than a modern exercise and rehabilitation program. There were 8 trials that showed that instrumented fusion produces a higher fusion rate, but any improvement in clinical outcomes is probably marginal. No conclusions are possible about the relative effectiveness of anterior, posterior, or circumferential fusion. The preliminary results of three small trials of intradiscal electrotherapy suggest it is ineffective, except possibly in highly selected patients. Preliminary data from three trials of disc arthroplasty do not permit firm conclusions.
    Spine 11/2005; 30(20):2312-20. · 2.16 Impact Factor
  • Gordon Waddell, A Kim Burton
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    ABSTRACT: This chapter develops rehabilitation principles for the clinical and occupational management of non-specific low back pain (LBP). Rehabilitation has traditionally been a secondary intervention, which focused on permanent impairment, but this is inappropriate for LBP. Most patients with LBP do not have any irremediable impairment and long-term incapacity is not inevitable: given the right care, support and opportunity, most should be able to return to work. Rehabilitation should then address obstacles to recovery and barriers to (return to) work. Rehabilitation should not be a separate, second stage after 'treatment' is complete: rehabilitation principles should be integral to clinical and occupational management. It should be possible to reduce sickness absence and long-term incapacity due to LBP by at least 30-50%, but this will require a fundamental shift in management culture.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 09/2005; 19(4):655-70. · 3.55 Impact Factor
  • J N A Gibson, G Waddell
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    ABSTRACT: Surgical investigations and interventions account for large health care utilisation and costs, but the scientific evidence for most procedures is still limited. Degenerative conditions affecting the lumbar spine are variously described as lumbar spondylosis or degenerative disc disease (which we regarded as one entity) and may be associated with back pain and associated leg symptoms, instability, spinal stenosis and/or degenerative spondylolisthesis. The objective of this review was to assess current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis. We searched CENTRAL, MEDLINE, PubMed, Spine and ISSLS abstracts, with citation tracking from the retrieved articles. We also corresponded with experts. All data found up to 31 March 2005 are included. Randomised (RCTs) or quasi-randomised trials of surgical treatment of lumbar spondylosis. Two authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. Thirty-one published RCTs of all forms of surgical treatment for degenerative lumbar spondylosis were identified. The trials varied in quality: only the more recent trials used appropriate methods of randomization, blinding and independent assessment of outcome. Most of the earlier published results were of technical surgical outcomes with some crude ratings of clinical outcome. More of the recent trials also reported patient-centered outcomes of pain or disability, but there is still very little information on occupational outcomes. There was a particular lack of long term outcomes beyond two to three years. Seven heterogeneous trials on spondylolisthesis, spinal stenosis and nerve compression permitted limited conclusions. Two new trials on the effectiveness of fusion showed conflicting results. One showed that fusion gave better clinical outcomes than conventional physiotherapy, while the other showed that fusion was no better than a modern exercise and rehabilitation programme. Eight trials showed that instrumented fusion produced a higher fusion rate (though that needs to be qualified by the difficulty of assessing fusion in the presence of metal-work), but any improvement in clinical outcomes is probably marginal, while there is other evidence that it may be associated with higher complication rates. Three trials with conflicting results did not permit any conclusions about the relative effectiveness of anterior, posterior or circumferential fusion. Preliminary results of two small trials of intra-discal electrotherapy showed conflicting results. Preliminary data from three trials of disc arthroplasty did not permit any firm conclusions. Limited evidence is now available to support some aspects of surgical practice. Surgeons should be encouraged to perform further RCTs in this field.
    Cochrane database of systematic reviews (Online) 02/2005; · 5.70 Impact Factor
  • Mansel Aylward, G. Waddell
    01/2005;
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    T McClune, A K Burton, G Waddell
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    ABSTRACT: This study aimed to develop and evaluate an evidence based educational booklet on whiplash associated disorders. A comprehensive review of the available scientific evidence produced a set of unambiguous patient centred messages that challenge unhelpful beliefs about whiplash and promote an active approach to recovery. These messages were incorporated into a novel booklet, which was then evaluated qualitatively for end user acceptability and its ability to impart the intended messages, and quantitatively for its ability to improve beliefs about whiplash and what to do about it. The subjects comprised people attending accident and emergency or manipulative practice with a whiplash associated disorder, along with a sample of workers without a whiplash associated disorder (n = 142). The qualitative results showed that the booklet was considered easy to read, understandable, believable, and conveyed its key messages. Quantitatively, it produced a substantial statistically significant improvement in beliefs about whiplash among accident and emergency patients (mean 6.5, 95% CI 3.9 to 9.1, p<0.001), and among workers (mean 9.4, 95% CI 7.9 to 10.9, p<0.001), but the shift in the more chronic manipulation patients was substantially smaller (mean 3.3, 95% CI 0.5 to 6.1, p<0.05). A rigorously developed educational booklet on whiplash (The Whiplash Book) was found acceptable to patients, and capable of improving beliefs about whiplash and its management; it seems suitable for use in the accident and emergency environment, and for wider distribution at the population level. A randomised controlled trial would be required to determine whether it exerts an effect on behaviour and clinical outcomes.
    Emergency Medicine Journal 12/2003; 20(6):514-7. · 1.65 Impact Factor
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    ABSTRACT: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries. To compare available international guidelines dealing with the management of low back pain in an occupational health care setting. The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment). and Conclusions: The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for "red flags" and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported.
    Occupational and Environmental Medicine 10/2003; 60(9):618-26. · 3.22 Impact Factor
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    ABSTRACT: A systematic review of randomized controlled trials. Although several rehabilitation programs, physical fitness programs, or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy of these treatments, and there are still persistent fears of causing reinjury, reherniation, or instability. The objective of this systematic review was to evaluate the effectiveness of active treatments that are used in the rehabilitation after first-time lumbar disc surgery. The authors searched the MEDLINE, Embase, and Psyclit databases up to April 2000 and the Cochrane Controlled Trials Register 2001, issue 3. Both randomized and nonrandomized controlled trials on any type of active rehabilitation program after first-time disc surgery were included. Two independent reviewers performed the inclusion of studies, and two other reviewers independently performed the methodologic quality assessment. A rating system that consists of four levels of scientific evidence summarizes the results. Thirteen studies were included, six of which were of high quality. There is no strong evidence for the effectiveness for any treatment starting immediately postsurgery, mainly because of the lack of good quality studies. For treatments that start 4 to 6 weeks postsurgery, there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) as compared to mild exercise programs, and there is strong evidence (level 1) that on long-term follow-up there is no difference between intensive exercise programs and mild exercise programs with regard to overall improvement. For all other primary outcome measures for the comparison between intensive and mild exercise programs, there is conflicting evidence (level 3) with regard to long-term follow-up. Furthermore, there is no strong evidence for the effectiveness of supervised training as compared to home exercises. There is also no strong evidence for the effectiveness of multidisciplinary rehabilitation as compared to usual care. There is limited evidence (level 3) that treatments in working populations that aim at return to work are more effective than usual care with regard to return to work. Also, there is limited evidence (level 3) that low-tech and high-tech exercises, started more than 12 months postsurgery, are more effective in improving low-back functional status as compared to physical agents, joint manipulations, or no treatment. Finally, there is no strong evidence for the effectiveness of any specific intervention when added to an exercise program, regardless of whether exercise programs start immediately postsurgery or later. None of the investigated treatments seem harmful with regard to reherniation or reoperation. There is no evidence that patients need to have their activities restricted after first-time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks postoperative) and no evidence they increase the reoperation rate. It is unclear what the exact content of postsurgery rehabilitation should be. Moreover, there are no studies that investigated whether active rehabilitation programs should start immediately postsurgery or possibly 4 to 6 weeks later.
    Spine 03/2003; 28(3):209-18. · 2.16 Impact Factor
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    AK Burton, G Waddell, S Bartys, CJ Main
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    ABSTRACT: Objectives: This project aimed to review the concepts and utility of screening for the risk of long-term incapacity associated with the common, relatively minor, health complaints associated with receipt of social security benefits (predominantly musculoskeletal disorders, mental health problems, and cardio-respiratory symptoms). Methods: A systematic electronic literature search yielded existing reviews concerning clinical and psychosocial data. Alternative search strategies were required to obtain unindexed reports of large individual studies based on socio-demographic and administrative data. From some 1000 retrieved titles, 28 reviews and 31 individual studies met the selection criteria, and provided the material for a structured review. Results: The findings show there is strong evidence that both socio-demographic and clinical psychosocial data contain strong predictors for long-term incapacity, yet they do not combine into a simple, robust, and universal screening tool. Whilst screening is possible and potentially valuable, its utility is strongly dependent on timing and purpose. Socio-demographic data can be strong predictors at an early stage, but may be immutable. Psychosocial predictors are effective somewhat later, yet have the advantage of being suitable for guiding rehabilitation strategies. Conclusions: There is a practical window for screening for long-term incapacity that extends between about one and six months. Socio-demographic and clinical data are interrelated, and their utility may vary over time; both may be combined into a logical and practical sequence in the screening process.
    01/2003;

Publication Stats

7k Citations
180.61 Total Impact Points

Institutions

  • 2007
    • University of Leeds
      • School of Healthcare
      Leeds, ENG, United Kingdom
    • Imperial College London
      • Section of Biosurgery and Surgical Technology
      London, ENG, United Kingdom
  • 2005–2007
    • Cardiff University
      Cardiff, Wales, United Kingdom
  • 1999–2007
    • The University of Edinburgh
      • Department of Orthopaedic Surgery
      Edinburgh, Scotland, United Kingdom
  • 1998–2003
    • University of Huddersfield
      • Spinal Research Unit
      Huddersfield, ENG, United Kingdom
  • 2001
    • Erasmus Universiteit Rotterdam
      • Department of General Practice
      Rotterdam, South Holland, Netherlands
  • 1994–1998
    • University of Washington Seattle
      • • Department of Medicine
      • • Department of Health Services
      Seattle, WA, United States
  • 1987–1992
    • The University of Manchester
      Manchester, England, United Kingdom
  • 1991
    • UK society for behavioural medicine
      Salford, England, United Kingdom
    • University of Glasgow
      Glasgow, Scotland, United Kingdom