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(321) Physiotherapists’ Attitudes and Beliefs Towards Chronic Non-Specific Low Back Pain in Saudi Arabia
The Journal of Pain
Late Breaking Abstracts Diagnosis, Assessment, & Reviews (319) Prevalence and Associated Factors of Musculoskeletal Pain among Adult Pilgrims: Cross-Sectional Results from 59 Nationalities M. Alshehri, and J. Alzaidi; Umm Al-Qura Univeristy Musculoskeletal pain is a primary burden on individuals, social and health care systems. Annually, two-to-three million Muslims pilgrims perform Hajj as a religious duty in the holy city of Mecca, Saudi Arabia. Hajj involves high physical demands as pilgrims move, generally by foot, between a series of religious sites over 5-7 days with distances of an average of 5-15 km/day. This is likely to exceed the typical physical activity exposure for most individuals and is further complicated by overcrowding, extreme heat and fatigue. The aim of this study was to estimate the point prevalence of musculoskeletal pain by anatomical sites among adult pilgrims and to study potential associations with individual characteristics, history of major medical conditions, beliefs about Hajj, and falls during the Hajj. A cross-sectional survey was conducted during the period of Hajj. Data were collected after completion of the 2nd day of Hajj (21-31 August 2018) by volunteers who approach individuals at different sites of Mecca city using an online application or paper form. The main inclusion criteria were adult pilgrims aged 18 or older. Participants were allowed reporting more than one site of pain. A total of 2,110 responses was received, of which 1,715 were complete. The overall prevalence of musculoskeletal complaints was high (82.3%). For both sexes, foot/ankle pain was the most frequent musculoskeletal symptom (39.1%), followed by leg pain (30.4%), low back pain (28.4%), knee pain (23.0%), and shoulder pain (16.1%). Multinomial logistic regression analyses indicated that musculoskeletal complaints were more likely in females, older individuals, individuals who smoke, had diabetes and hypertension, those who believed that Hajj was physically exhausted, and those who had experienced a fall during Hajj. These data provide guidance for the potential nature of preventative programs and the allocation of resources to optimise individual’s experience and capacity to complete Hajj.
(320) The Association between Sedentary Behavior and Low Back Pain: A Systematic Review and Meta-Analysis of Longitudinal Studies H. Alzahrani, M. Alshehri, W. Al Attar, and M. Alzhrani; University of Sydney The aim of this review was to investigate the association between sedentary behaviour and low back pain (LBP) in adults. The following databases were searched for longitudinal studies from inception to July 2018: Medline, Scopus, CINAHL, EMBASE, and Web of Science. Pooled estimates of the association between sedentary behaviour (≥2 hours/day and ≥4 hours/day) and LBP, using the generic inverse-variance method with fixed- and randomeffects models were calculated. Fourteen longitudinal studies were included, with 48,750 participants. Greater sedentary time (≥2 hours/day and ≥4 hours/day) was associated with lower prevalence of LBP (The pooled fully adjusted odds ratio (OR) = 0.91 (95%CI 0.86 to 0.98) and 0.92 (95%CI 0.86 to 0.99), respectively, compared with lower sedentary time (<2 hours/day). The sedentary time of ≥2 hours/day compared with <2 hours/day was associated with a 19% increase in LBP intensity and disability (OR = 1.19; 95%CI 1.05 to 1.36). The present meta-analysis of longitudinal studies indicates that sedentary behaviour is associated with lower prevalence of LBP. However, the results showed that sedentary behaviour was associated with higher LBP intensity and disability.
(321) Physiotherapists’ Attitudes and Beliefs Towards Chronic Non-Specific Low Back Pain in Saudi Arabia M. Alshehri, H. Alzahrani, M. Alotaibi, A. Alhowimel, and O. Khoja; Umm Al-Qura University Chronic non-specific low back pain (CNSLBP) is one of the most widespread conditions affecting the population indiscriminately
S55
across the world. It is a considerable health problem and the main causes of disability and pain. It is a complex, multifactorial disorder and one of the most controversial conditions for clinicians, patients, and policy makers. Physiotherapists’ (PTs) attitudes and beliefs towards CNSLBP still unknown in Saudi Arabia (SA). The aim of this study was to identify PTs attitudes and beliefs towards NSLBP in SA. A cross sectional study was conducted using a convenience sample. An online survey was distributed from April to September 2018. Only participants working as physiotherapists in SA whether in clinical or academic settings were included. Data were collected regarding demographics, beliefs and attitudes towards NSLBP using the short form of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). The short form of PABS-PT consisted of 19 items on a 6-point scale evaluating ‘biomedical’ and ‘biopsychosocial treatment orientation’ factors. Higher scores indicate a higher level of orientation. The data analysis was performed using IBM SPSS (v.24). A total of 299 PTs participated in this study. The majority of the participants were males (61.5%) and most of them had completed their bachelor’s degree (54.5%). Most participants worked as a full time (79.9%) and more than half of them had experience less than 5 years (53.8%). The overall mean score for biomedical factor was 34.4 (SD 7.7) and overall mean score for biopsychosocial factor was 31.7 (SD 5.5). Overall mean score of both factors was mean 66.2 (SD 9.6). Among the 19 items of PABSPT, the lowest three mean scores items were related to biopsychosocial orientation. Physiotherapists were found to have similar biomedical and biopsychosocial orientations in their attitudes and beliefs but both orientation scores were not high.
(322) Worsening Depressive Symptoms after an Emergency Department Visit for Low Back Pain are Associated with Persistent Pain and Disability E. Eucker, S. Peskoe, J. Ring, C. Zhao, B. Friedman, and S. George; Duke University More than 2.5 million U.S. emergency department (ED) visits each year are for low back pain (LBP). Nearly half of these patients report persistent pain and functional disability 3 months later. While baseline depression has been shown to predict these poor outcomes, little is known about whether persistent pain and disability correlate with worsening depression. This is a secondary analysis of 362 patients seen at an urban ED with LBP who completed the Roland-Morris Disability Questionnaire (RMDQ), a 0-10 pain numeric rating scale (NRS), and Patient Health Questionnaire depression subscale (PHQ-9) at their ED visit and 3 months later. Linear regression analysis was used to determine the association between changes in depression severity from index ED visit to 3-month follow-up, and changes in RMDQ and pain scores over the same period. Models were adjusted for age, gender, race, ethnicity, education, and depression severity at baseline. At the index ED visit, median PHQ score was 0 (IQR 0,4) and median RMDQ score was 22 (IQR 17,24). At one week, median pain score was 6 (IQR 2,8). At 3 months, median change in PHQ from baseline was 0 (IQR -24,23), change in RMDQ was -8 (IQR -20,0), and change in pain score was -1 (IQR -3,0). After adjusting for potential confounders, worsening depression score between the ED visit and 3 month follow-up was associated with worsening function (B=0.85, 95% CI=0.68-1.03) and pain scores (B=0.11, 95%CI=0.05-0.17). The 3-month disability and pain intensity outcomes were more strongly correlated with change in depression than with baseline depression scores. Future work among ED patients with LBP should consider progressive depressive symptoms as a potentially modifiable risk factor for persistent pain and disability.
(323) Determinants of Prescription Opioid Craving and OpioidRelated Hedonic Feelings among Patients with Chronic Pain Prescribed Opioid Therapy; A Longitudinal Study L. Friedman, and M. Martel; McGill University The rise in the use of opioids has been accompanied by escalating rates of prescription opioid misuse and addiction in patients with pain. Research has shown that opioid craving is a robust determinant of prescription opioid misuse. There is reason to believe that hedonic feelings associated with opioid use (e.g., pleasure, satisfaction) could also contribute to opioid misuse. However, this has yet to be examined in patients with pain. In this longitudinal study, the first objective was to examine the association between opioidrelated hedonic feelings and prescription opioid misuse in patients
Late Breaking Abstracts Diagnosis, Assessment, & Reviews (319) Prevalence and Associated Factors of Musculoskeletal Pain among Adult Pilgrims: Cross-Sectional Results from 59 Nationalities M. Alshehri, and J. Alzaidi; Umm Al-Qura Univeristy Musculoskeletal pain is a primary burden on individuals, social and health care systems. Annually, two-to-three million Muslims pilgrims perform Hajj as a religious duty in the holy city of Mecca, Saudi Arabia. Hajj involves high physical demands as pilgrims move, generally by foot, between a series of religious sites over 5-7 days with distances of an average of 5-15 km/day. This is likely to exceed the typical physical activity exposure for most individuals and is further complicated by overcrowding, extreme heat and fatigue. The aim of this study was to estimate the point prevalence of musculoskeletal pain by anatomical sites among adult pilgrims and to study potential associations with individual characteristics, history of major medical conditions, beliefs about Hajj, and falls during the Hajj. A cross-sectional survey was conducted during the period of Hajj. Data were collected after completion of the 2nd day of Hajj (21-31 August 2018) by volunteers who approach individuals at different sites of Mecca city using an online application or paper form. The main inclusion criteria were adult pilgrims aged 18 or older. Participants were allowed reporting more than one site of pain. A total of 2,110 responses was received, of which 1,715 were complete. The overall prevalence of musculoskeletal complaints was high (82.3%). For both sexes, foot/ankle pain was the most frequent musculoskeletal symptom (39.1%), followed by leg pain (30.4%), low back pain (28.4%), knee pain (23.0%), and shoulder pain (16.1%). Multinomial logistic regression analyses indicated that musculoskeletal complaints were more likely in females, older individuals, individuals who smoke, had diabetes and hypertension, those who believed that Hajj was physically exhausted, and those who had experienced a fall during Hajj. These data provide guidance for the potential nature of preventative programs and the allocation of resources to optimise individual’s experience and capacity to complete Hajj.
(320) The Association between Sedentary Behavior and Low Back Pain: A Systematic Review and Meta-Analysis of Longitudinal Studies H. Alzahrani, M. Alshehri, W. Al Attar, and M. Alzhrani; University of Sydney The aim of this review was to investigate the association between sedentary behaviour and low back pain (LBP) in adults. The following databases were searched for longitudinal studies from inception to July 2018: Medline, Scopus, CINAHL, EMBASE, and Web of Science. Pooled estimates of the association between sedentary behaviour (≥2 hours/day and ≥4 hours/day) and LBP, using the generic inverse-variance method with fixed- and randomeffects models were calculated. Fourteen longitudinal studies were included, with 48,750 participants. Greater sedentary time (≥2 hours/day and ≥4 hours/day) was associated with lower prevalence of LBP (The pooled fully adjusted odds ratio (OR) = 0.91 (95%CI 0.86 to 0.98) and 0.92 (95%CI 0.86 to 0.99), respectively, compared with lower sedentary time (<2 hours/day). The sedentary time of ≥2 hours/day compared with <2 hours/day was associated with a 19% increase in LBP intensity and disability (OR = 1.19; 95%CI 1.05 to 1.36). The present meta-analysis of longitudinal studies indicates that sedentary behaviour is associated with lower prevalence of LBP. However, the results showed that sedentary behaviour was associated with higher LBP intensity and disability.
(321) Physiotherapists’ Attitudes and Beliefs Towards Chronic Non-Specific Low Back Pain in Saudi Arabia M. Alshehri, H. Alzahrani, M. Alotaibi, A. Alhowimel, and O. Khoja; Umm Al-Qura University Chronic non-specific low back pain (CNSLBP) is one of the most widespread conditions affecting the population indiscriminately
S55
across the world. It is a considerable health problem and the main causes of disability and pain. It is a complex, multifactorial disorder and one of the most controversial conditions for clinicians, patients, and policy makers. Physiotherapists’ (PTs) attitudes and beliefs towards CNSLBP still unknown in Saudi Arabia (SA). The aim of this study was to identify PTs attitudes and beliefs towards NSLBP in SA. A cross sectional study was conducted using a convenience sample. An online survey was distributed from April to September 2018. Only participants working as physiotherapists in SA whether in clinical or academic settings were included. Data were collected regarding demographics, beliefs and attitudes towards NSLBP using the short form of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). The short form of PABS-PT consisted of 19 items on a 6-point scale evaluating ‘biomedical’ and ‘biopsychosocial treatment orientation’ factors. Higher scores indicate a higher level of orientation. The data analysis was performed using IBM SPSS (v.24). A total of 299 PTs participated in this study. The majority of the participants were males (61.5%) and most of them had completed their bachelor’s degree (54.5%). Most participants worked as a full time (79.9%) and more than half of them had experience less than 5 years (53.8%). The overall mean score for biomedical factor was 34.4 (SD 7.7) and overall mean score for biopsychosocial factor was 31.7 (SD 5.5). Overall mean score of both factors was mean 66.2 (SD 9.6). Among the 19 items of PABSPT, the lowest three mean scores items were related to biopsychosocial orientation. Physiotherapists were found to have similar biomedical and biopsychosocial orientations in their attitudes and beliefs but both orientation scores were not high.
(322) Worsening Depressive Symptoms after an Emergency Department Visit for Low Back Pain are Associated with Persistent Pain and Disability E. Eucker, S. Peskoe, J. Ring, C. Zhao, B. Friedman, and S. George; Duke University More than 2.5 million U.S. emergency department (ED) visits each year are for low back pain (LBP). Nearly half of these patients report persistent pain and functional disability 3 months later. While baseline depression has been shown to predict these poor outcomes, little is known about whether persistent pain and disability correlate with worsening depression. This is a secondary analysis of 362 patients seen at an urban ED with LBP who completed the Roland-Morris Disability Questionnaire (RMDQ), a 0-10 pain numeric rating scale (NRS), and Patient Health Questionnaire depression subscale (PHQ-9) at their ED visit and 3 months later. Linear regression analysis was used to determine the association between changes in depression severity from index ED visit to 3-month follow-up, and changes in RMDQ and pain scores over the same period. Models were adjusted for age, gender, race, ethnicity, education, and depression severity at baseline. At the index ED visit, median PHQ score was 0 (IQR 0,4) and median RMDQ score was 22 (IQR 17,24). At one week, median pain score was 6 (IQR 2,8). At 3 months, median change in PHQ from baseline was 0 (IQR -24,23), change in RMDQ was -8 (IQR -20,0), and change in pain score was -1 (IQR -3,0). After adjusting for potential confounders, worsening depression score between the ED visit and 3 month follow-up was associated with worsening function (B=0.85, 95% CI=0.68-1.03) and pain scores (B=0.11, 95%CI=0.05-0.17). The 3-month disability and pain intensity outcomes were more strongly correlated with change in depression than with baseline depression scores. Future work among ED patients with LBP should consider progressive depressive symptoms as a potentially modifiable risk factor for persistent pain and disability.
(323) Determinants of Prescription Opioid Craving and OpioidRelated Hedonic Feelings among Patients with Chronic Pain Prescribed Opioid Therapy; A Longitudinal Study L. Friedman, and M. Martel; McGill University The rise in the use of opioids has been accompanied by escalating rates of prescription opioid misuse and addiction in patients with pain. Research has shown that opioid craving is a robust determinant of prescription opioid misuse. There is reason to believe that hedonic feelings associated with opioid use (e.g., pleasure, satisfaction) could also contribute to opioid misuse. However, this has yet to be examined in patients with pain. In this longitudinal study, the first objective was to examine the association between opioidrelated hedonic feelings and prescription opioid misuse in patients