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      The myth of patient centrality in integrated care: the case of back pain services

      research-article
      , RGN, MSc, PGCHE, , RN, PhD.
      International Journal of Integrated Care
      Igitur, Utrecht Publishing & Archiving
      integrated care, back pain, patient centrality

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          Abstract

          Purpose

          The purpose of this paper is to critically examine the extent of patient centrality within integrated chronic back pain management services and compare policy rhetoric with practice reality.

          Context

          Integrated chronic back pain management services.

          Data sources

          We have drawn on theories of integration and context specific journals related to integration and pain management between 1966 and 2006 to identify evidence of patient centrality within integrated chronic pain management services.

          Discussions

          Despite policy rhetoric and guidelines which promote ‘patient centrality’ within multidisciplinary services, we argue that evaluations of these services are scant. Many papers have focussed on the assessment of pain in multidisciplinary services as opposed to the patients' experience of these services.

          Conclusions

          A latent measure of the reality of its magnitude needs to be captured through analysis of the patient's perspectives. Capturing patients' thoughts about integrated services will promote patient centrality and support the reality rather than endorse the rhetoric.

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          Most cited references36

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          Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.

          Sixty-five studies that evaluated the efficacy of multidisciplinary treatments for chronic back pain were included in a meta-analysis. Within- and between-group effect sizes revealed that multidisciplinary treatments for chronic pain are superior to no treatment, waiting list, as well as single-discipline treatments such as medical treatment or physical therapy. Moreover, the effects appeared to be stable over time. The beneficial effects of multidisciplinary treatment were not limited to improvements in pain, mood and interference but also extended to behavioral variables such as return to work or use of the health care system. These results tend to support the efficacy of multidisciplinary pain treatment; however, these results must be interpreted cautiously as the quality of the study designs and study descriptions is marginal. Suggestions for improvement in research designs as well as appropriate reports of research completed are provided.
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            Multidisciplinary rehabilitation for chronic low back pain: systematic review.

            To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain. Systematic literature review of randomised controlled trials. A total of 1964 patients with disabling low back pain for more than three months. Pain, function, employment, quality of life, and global assessments. Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments. The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.
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              Is Open Access

              Low back pain

              Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies.
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                Author and article information

                Contributors
                Role: Lecturer,
                Salford Centre for Nursing, Midwifery and Collaborative Research, School of Nursing, University of Salford, Frederick Rd Campus, Manchester, M6 6PU, UK
                Role: Senior Lecturer in Research,
                Salford Centre for Nursing, Midwifery and Collaborative Research, School of Nursing, University of Salford, Frederick Rd Campus, Manchester, M6 6PU, UK
                Journal
                Int J Integr Care
                IJIC
                International Journal of Integrated Care
                Igitur, Utrecht Publishing & Archiving (Utrecht, The Netherlands )
                1568-4156
                Jul-Sep 2007
                11 July 2007
                : 7
                : e27
                Affiliations
                Salford Centre for Nursing, Midwifery and Collaborative Research, School of Nursing, University of Salford, Frederick Rd Campus, Manchester, M6 6PU, UK
                Salford Centre for Nursing, Midwifery and Collaborative Research, School of Nursing, University of Salford, Frederick Rd Campus, Manchester, M6 6PU, UK
                Author notes
                Corresponding author: Michelle Howarth, Frederick Rd Campus, Manchester, M6 6PU; Phone: +0161 295 2873 E-mail: m.l.howarth2@ 123456Salford.ac.uk
                Article
                ijic200727
                1919416
                17786176
                20cdd2d2-5193-4550-a0db-2b41ccb59b3a
                Copyright 2007, International Journal of Integrated Care (IJIC)
                History
                : 15 November 2006
                : 15 March 2007
                : 25 April 2007
                Categories
                Research and Theory

                Health & Social care
                integrated care,back pain,patient centrality
                Health & Social care
                integrated care, back pain, patient centrality

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