Factors Influencing the Use of Outcome Measures for Patients with Low Back Pain: A Survey of Nigerian Physiotherapists

Background: Low back pain is one of the important patients’ presenting complain that requires expert management from the physiotherapists. Yet no work was available for reference on the use of outcome measures for its evaluation by Nigeria physiotherapists. Objective: This study, therefore, investigated the outcome measures used by Nigerian physiotherapists to evaluate patients with Low Back Pain and the factors that influenced their use. Methods: A survey questionnaire was posted to 306 randomly selected mem- bers of the Nigeria Society of Physiotherapy (NSP). Data were analyzed using frequency, percentages, mean, ANOVA, and Pearson’s Chi-square. P-value was placed at 0.05. Results: 52.9% of the respondents (221) used a pain visual analog scale. Only 36.1% used LBP-specific clinical outcome measures. The factors that influenced their use were belief, attitude, knowledge, and choice. There was no significant difference between the majority of the factors and the use of clinical outcome measures. The P-values were 0.960, 0.648, 0.760 for belief, attitude and knowledge respectively. The only factor that had a significant difference (P = 0.029) with the use of clinical outcome measures was choice. Gender and postgraduate qualification had no significant influ- ence on the use of clinical outcome measures at the P-value of 0.117 and 0.510 respectively. Conclusion: Pain visual analog scale is the outcome measure frequently used by Nigeria Physiotherapists to evaluate patients with Low Back Pain. Belief, attitude, knowledge, and choice are the factors that influ- enced the use. There is a need to incorporate the use of LBP-specific outcome measures by Nigerian physiotherapists while treating patients with LBP.

Regional anesthesia for acute pain management in elderly patients

Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.

Influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in elderly patients operated under general anesthesia

BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.

Ultrasound-guided,direct suprainguinal injection for fascia iliaca block for total hip arthroplasty:A retrospective study

BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.

腰痹通胶囊联合脉冲射频治疗老年慢性腰腿痛的临床研究

目的:探讨应用腰痹通胶囊联合脉冲射频治疗老年慢性腰腿痛,观察其临床效果,并检测相关炎性因子水平,分析作用机制。方法: 120例老年慢性腰腿痛患者,数表法随机分为对照组和研究组,两组各60例,对照组应用脉冲射频治疗,研究组同时应用腰痹通胶囊进行治疗。评估两组患者临床疗效、应用改良日本骨科学会腰痛功能评价表(M-JOA)评估患者腰腿部功能、采用视觉模拟评分法(VAS)、ODI量表评估患者的疼痛、功能障碍和生活状况,并检测白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子(TNF-α)水平。结果:研究组总有效率为98.33%,高于对照组96.67%,差异有统计学意义( P <0.05);研究组治疗后M-JOA总评分为(22.85±1.73)分,高于对照组的(20.31±1.56)分;研究组VAS评分和ODI评分分别为(2.33±0.48)分和(25.24±2.70)分,低于对照组的(3.54±0.51)分和(30.18±2.93)分,差异均具有统计学意义( P <0.05)。研究组治疗后血清IL-6、IL-8、和TNF-α分别为(32.31±4.58)pg/mL、(64.62±7.08)pg/mL和(25.02±3.65)pg/mL,均低于对照组(38.65±4.46)pg/mL、(72.38±6.90)pg/mL和(31.62±3.74)pg/mL,差异均具有统计学意义( P <0.05)。结论:应用腰痹通胶囊联合脉冲射频治疗老年慢性腰腿痛,能够显著改善患者症状或体征,减轻腰腿痛疼痛程度,下调炎性因子水平。

不同方式有氧运动对中老年女性非特异性腰痛的缓解作用

目的:探讨不同方式有氧运动对中、老年女性非特异性腰痛的缓解作用。方法:选120名非特异性腰痛患者随机分为4组。B、C、D组分别参加为期9个月的健身走、太极拳、健身瑜伽训练,A组为对照组无训练计划。训练前、后分别对各组骶棘肌肌电进行测试。对结果进行疗效判定。结果:B、C、D3组腰背肌肌电图波幅均高于训练前(P<0.05),时程均低于训练前(P<0.05),D组在各时段的变化均具有非常显著性差异(P<0.01);组间疗效比较D组优于其他组别(P<0.01)。结论:健身走、太极拳锻炼均能增加患者腰背肌肌肉力,对中老年女性非特异性腰痛具有一定的缓解作用,健身瑜伽练习作用优于健身走和太极拳锻炼,疗效显著。

关注老年癌症止痛

虽然肿瘤的发病率在老年人并不低,但社会对老年人的关注度并不高。几乎所有肿瘤药物临床试验都把老年人排除在外,因此,不少药品说明书特别注明"缺乏老年人资料"。老年癌痛治疗领域也存在同样的问题。老年癌痛的病理生理及心理特点很独特,加之对老年癌痛重视不够及缺乏正确评价,所以老年癌痛的研究相当复杂,因而癌痛的处理犹如癌症一样也需要综合治疗。癌痛治疗药物可分成两大类:非阿片类及阿片类药物。非阿片类药物中首选对乙酰氨基酚治疗轻度癌痛,非甾体类抗炎药,特别是选择性COX2抑制剂可在对乙酰氨基酚无效时应用。阿片类药物则广泛应用于中度到重度的癌痛治疗。辅助治疗药物包括三环抗抑郁药、抗惊厥药、苯二氮艹卓类药物等。可用于癌痛三阶梯治疗的任一阶段,能够治疗特殊类型疼痛,改善癌痛以外的症状,增加主要药物镇痛效果,减轻副作用,但不推荐常规使用。总而言之,对于老年癌症患者更要强调以镇痛为主的姑息治疗,特别在重症老年患者,可能成为最重要的治疗,有时甚至是唯一有效的治疗。

老年髋部骨折围手术期镇痛治疗探讨

目的探讨老年髋部骨折的镇痛治疗的经验。方法从2000年8月～2004年8月,对123例老年髋部骨折手术内固定,其中男性62例,女性61例,平均年龄72岁(63～85岁)。结果本组病例切口均顺利愈合,术后3～15天出院;全部获得随访,平均随访时间6个月;无一例死亡,骨愈合时间3～10月。所有病例术后骨折均愈合,髋关节优良满意率为98.4%。结论髋部骨折围手术期良好的镇痛治疗能够保证老年病人增强信心、骨折快速愈合、恢复良好关节功能、降低并发症、病残率,提高生存质量,延长寿命。

不同镇痛模式对老年病人术后血糖代谢的影响

目的:观察术后不同镇痛模式对老年病人术后血糖、血浆胰岛素、皮质醇的影响来研究糖代谢。方法:30例行上腹部手术的老年病人,按术后不同镇痛模式,随机分成三组,每组10例。PCEA组:硬膜外腔给少量吗啡和低浓度（0.1％）布比卡因进行自控镇痛;PCIA组;静脉应用吗啡进行自控镇痛;对照组:术后应用哌替啶肌注。检测围术期血糖、血浆胰岛素、皮质醇。结果:对照组VAS明显高于PCEA组和PCIA组（P<0.05）,对照组和PCIA组在术毕、术后4h、24h时点血糖、血浆胰岛素水平较麻醉前明显增高,有显著差异;PCEA组术毕各时点与麻醉前比较血糖、血浆胰岛素、皮质醇无显著差异。结论:有效镇痛不一定能降低老年病人术后高血糖反应发生,应用PCEA能有助于抑制高血糖反应发生。

老年直肠癌低位直肠前切除术后肛门功能初探

目的探讨低位直肠前切除术在老年患者直肠癌中的应用和临床疗效。方法随访1999年3月—2005年5月行低位直肠前切除术治疗直肠癌73例,按年龄分为70岁以上组(A)和70岁以下组(B),分别对两组患者6个月、12个月时的肛门功能按徐忠法肛门功能评价方法进行评分。结果6个月时肛门功能A组优(0/38)、良(17/38)、一般(10/38)、差(11/38),B组优(0/35)、良(6/35)、一般(19/35)、差(10/35);12个月时肛门功能A组优(9/38)、良(16/38)、一般(6/38)、差(7/38),B组优(5/35)、良(16/35)、一般(9/35)、差(5/35),运用卡方拟合优度检验,6个月时,A、B两组肛门功能恢复程度有差异;12个月时,A、B两组肛门功能恢复程度无差异。结论随着时间的推移,老年患者低位直肠吻合术后肛门功能同一般低位直肠吻合术后患者肛门功能无差异。

鲑鱼降钙素对老年骨质疏松患者腰背疼痛及骨代谢的影响

目的探讨鲑鱼降钙素注射液治疗老年骨质疏松的疗效,以及对患者腰背疼痛及骨代谢的影响。方法选取湖北省枣阳市第一人民医院2018年6月至2019年6月收治的老年骨质疏松患者100例,按随机数字表法分为观察组和对照组,各50例。两组患者均采用常规口服药物治疗,观察组增加肌肉注射鲑鱼降钙素治疗,均治疗6周。结果与治疗前比较,两组患者治疗后的视觉模拟评分(VAS)均降低,骨代谢指标甲状旁腺激素(PTH)水平均下降,1,25-二羟维生素D3[1,25-(OH)2D3]水平均升高,股骨颈、腰椎L2~L4骨密度均升高,观察组均优于对照组(P<0.05);治疗总有效率观察组高于对照组(92.00%比76.00%,P<0.05);两组患者不良反应发生率相当(28.00%比16.00%,P>0.05)。结论鲑鱼降钙素注射液治疗老年骨质疏松,可缓解患者腰背疼痛,提高骨密度,改善骨代谢,疗效较好,且安全性高。

老年癌症患者疼痛程度及其对生活质量的影响

目的探讨老年癌症疼痛(以下简称癌痛)患者疼痛程度对生活质量的影响,分析其影响因素,为提高老年癌痛病人生活质量(qualityoflife,QOL)提供依据。方法采用长海痛尺、CPQOL评分表对84例老年住院癌痛病人进行疼痛程度及生活质量评估,并分析癌症疼痛主要影响生活质量的哪些方面。结果老年癌痛患者中、重度疼痛发生率为50%,随着疼痛程度的加重,癌症患者生活质量下降,有统计学意义(F=45.567,P<0.0001),主要表现在睡眠、精神、疲劳、日常生活、食欲方面。经三阶梯止痛法积极治疗及健康宣传教育后,95%患者疼痛缓解,生活质量明显改善,治疗前后比较有显著性差异(P<0.0001)。结论应高度重视对老年癌症患者疼痛的评估,根据中、重度疼痛对患者躯体、精神、心理等方面的影响,尽早给予有效的药物治疗、心理护理、疾病宣教,努力减轻患者的疼痛,提高老年癌症患者的生存质量。

丁丙诺啡透皮贴剂治疗老年椎间盘源性腰痛患者的疗效与安全性研究

背景:椎间盘源性腰痛(DLBP)是公认的最重要和最常见的腰背部疼痛的病因。非甾体抗炎药是治疗DLBP的一线药物,但副作用大。而阿片类药物因其镇痛效果显著已逐渐得到广泛应用。目的:与非甾体抗炎药塞来昔布胶囊对比,评价阿片类药物丁丙诺啡透皮贴剂治疗老年DLBP患者(年龄≥65岁)的有效性及安全性。方法:前瞻性选择2015年12月至2018年12月收治的老年DLBP患者160例。按照随机数字表法随机均分为丁丙诺啡透皮贴剂组和塞来昔布胶囊组两组,每组各80例,分别予以丁丙诺啡透皮贴剂或塞来昔布胶囊治疗。分别记录两组患者治疗后3 d、7 d、14 d的腰背痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),以及不良反应发生情况。结果:两组患者治疗前、治疗后3 d腰背痛VAS评分、ODI差异均无统计学意义;丁丙诺啡贴剂组患者治疗后7 d、14 d腰背痛VAS评分、ODI均低于塞来昔布胶囊组患者,且差异均有统计学意义(P<0.05)。丁丙诺啡贴剂组4例患者(5.0%)发生消化道不良反应,无嗜睡等不良反应。而塞来昔布胶囊组7例患者(8.7%)发生消化道不良反应,3例患者(3.7%)出现嗜睡。两组患者均无尿潴留、呼吸抑制和头晕等不良反应出现。结论:丁丙诺啡透皮贴剂可明显降低老年DLBP患者腰背痛VAS评分及ODI,不良反应发生率低。

疼痛护理方案对老年女性骨质疏松腰背痛患者的影响

目的:观察对老年女性骨质疏松腰背痛患者实施疼痛护理方案的临床效果。方法:收治老年女性骨质疏松腰背痛患者80例,随机平分为两组。均实施药物治疗,对照组采用一般护理,观察组给予疼痛护理方案。对比两组患者护理后疼痛评分及心理、生活改善情况。结果:两组护理3个月后,观察组疼痛评分低于对照组;观察组护理后日常生活能力评分高于对照组,差异均有统计学意义(P<0.05)。观察组总有效率95%,高于对照组的70%。结论:对老年女性骨质疏松腰背痛患者给予治疗后疼痛护理,可降低患者疼痛率,改善患者日常生活能力,提高治疗效果。

唑来膦酸注射液治疗60例老年骨质疏松性腰背痛患者的临床疗效

目的探析老年骨质疏松性腰背痛患者采用唑来膦酸注射液进行治疗的安全性。方法随机选取该院2012年1月—2017年1月收治的骨质疏松性腰背痛60例老年患者,按照治疗方法的区别分成对照组(常规治疗+口服抗骨质疏松药物)与观察组(唑来膦酸注射液治疗),每组各30例,对比观察组与对照组的临床治疗效果。结果数据显示,观察组用药后3个月翻身痛、前驱后伸痛、静息痛分别为(0.91±1.41)分、(0.81±0.56)分、(1.71±2.11)分;用药后6个月翻身痛、前驱后伸痛、静息痛分别为(1.30±1.21)分、(1.09±0.72)分、(1.92±2.01)分;明显低于对照组,组间数据对比,差异有统计学意义(P<0.05);观察组用药后前Ward三角、L1~4骨密度分别为(0.215±0.011)g/cm2、(0.441±0.024);观察组与对照组用药后Ward三角、L1~4骨密度对比有明显区别,差异有统计学意义(P<0.05)。结论唑来膦酸注射液用于老年骨质疏松症腰背痛患者临床治疗中可获得较为理想的效果,能明显改善患者疼痛症状,值得临床推广应用。

辨证分型联合外治及康复指导干预腰痛

腰痛多因感受寒湿,湿热,气滞血瘀,或肾亏体虚。辨证:血瘀、寒湿、湿热、肾虚。不同证型,辨证施护,使用辅助外治(腰椎牵引、手法治疗、针刺治疗、理疗)等及康复指导,施行积极有效的护理,使患者保持情绪稳定,同时从功能训练、日常生活、情志饮食的方面做好出院康复指导,以防疾病复发。

患者报告结局测量工具选择路径:以中国腰痛患者日常生活活动能力量表的选择为例

患者报告结局测量工具(PROMs)是评价与量化患者报告结局的工具,而良好的测量性能是应用PROMs的基本前提条件,但PROMs数量众多,测量性能评价欠规范、不全面,因此如何选择合适的PROMs成为临床研究中亟待解决的问题之一。基于共识健康测量工具的选择标准(COSMIN)旨在帮助临床研究人员和医务工作者选择最合适的PROMs,本研究参考COSMIN并以中国腰痛患者日常生活活动能力量表的选择为例,探讨PROMs选择路径,发现PROMs选择路径主要包含以下5项主要内容:全面检索判断是否已有工具、研制/译制工具、工具测量性能研究、系统评价、改编工具,其中系统评价是PROMs选择路径中的关键;同时,PROMs的选择并非“一蹴而就”,而是一个循环向前的过程。

低比重0.4%左旋布比卡因腰硬联合麻醉在高龄老人股骨头置换术中的应用

目的探讨低浓度轻比重左旋布比卡因用于老年患者股骨头置换术中的麻醉效能及安全可行性。方法选择拟施该手术的老年患者80例,随机分为两组,一组为左布组(左旋布比卡因组),一组为布比组(布比卡因)。左布组以轻比重的0.4%左旋布比卡因1.5～2 ml实施腰麻而后置管,依手术时间及麻醉情况硬膜外腔适时补充给药,硬膜外用药为2%利多卡因;布比组给轻比重布比卡因1.5～2 ml,两组麻醉平面均调控在T_(10)以下。术中持续监测BP、ECG、RR及SpO_2,比较麻醉诱导时间、维持时间,并据镇痛效果、肌肉松驰程度,短暂性神经综合症来评定麻醉效果。结果两组镇痛效果无显著差异,左旋布比卡因组肌松差于布比组,麻醉时间短于布比组,术后麻醉药毒性明显少于布比组。结论左旋布比卡因在镇痛和最高平面和布比卡因无显著差异,但比布比卡因更可靠、更更安全。

护理专案在提高腰痛患者腰背肌功能锻炼依从性中的应用效果

目的 探讨护理专案在腰痛患者腰背肌功能锻炼中的应用效果。方法 成立护理专案小组,调查2019年5月-8月收治的39例腰痛患者腰背肌功能锻炼依从性现状,对2020年5月-8月收治的38例腰痛患者开展护理专案,比较实施护理专案前(2019年5月-8月)、后(2020年5月-8月)患者出院时及出院后1个月、6个月腰背肌功能锻炼的依从率、Oswestry功能障碍指数(Oswestry Disability Index,ODI)。结果 出院时及出院后1个月、6个月,实施护理专案后患者的腰背肌功能锻炼依从率均高于实施前的患者(P<0.05);ODI组间效应有统计学意义(F=6.365,P=0.016),时间效应有统计学意义(F=125.769,P<0.001),组间与时间无交互效应(F=0.796,P=0.505)。结论 实施护理专案有效提高了腰痛患者腰背肌功能锻炼的依从性,减轻了其功能障碍。

独活寄生汤加减治疗老年原发骨质疏松症腰背疼痛的疗效分析

目的探讨独活寄生汤加减治疗老年原发骨质疏松症腰背疼痛的临床疗效。方法将82例老年原发骨质疏松症腰背疼痛患者随机分为观察组和对照组各41例。对照组患者给予常规西医治疗,观察组患者在此基础上加用独活寄生汤加减治疗,比较两组患者的临床疗效。结果观察组患者治疗总有效率为92.7%,显著高于对照组患者的75.6%,组间差异有统计学意义(P<0.05)。结论采用独活寄生汤加减治疗老年原发骨质疏松症腰背疼痛临床疗效可靠,值得临床进一步推广使用。