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A Collaborative Modeling Approach to Understand the Perspective of Patients with Low Back Pain Referred for Osteopathic Manipulative Medicine Management

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A78-A79. doi: Subito , type of study: qualitative study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

chronic pain [204]
low back pain [413]
patients [80]
qualitative study [209]

Abstract:

Statement of Significance: Chronic low back pain (CLBP) is widely accepted as a multifaceted issue with many biopsychosocial factors. Previous research emphasizes biomechanical, psychological, and behavioral/lifestyle factors in patient perspectives of CLBP1,2,3,4. Clinicians are trained to identify such factors, but the relative importance of factors may differ from patients to clinicians. There remains no clear consensus regarding the most prominent factors contributing to the patient populations’ perspective of CLBP5. Research Methods: The patient population were those seen by a physician for their CLBP and referred to a large Midwestern university’s Osteopathic Manipulative Medicine (OMM) outpatient clinic for treatment, but had not yet been seen there. Participants were recruited based on referrals to the clinic. Prior to participation, each participant underwent an IRB-approved informed consent process. After completing a questionnaire recording demographic and self-reported health information, each participant underwent a semi-structured virtual interview to create a fuzzy cognitive map (FCM) representing their understanding of how numerous factors are related to CLBP6. This process involved nomination of Factors relating to patients’ outcomes (i.e., pain, disability, and quality of life) and assigning weight/strength to connections between these factors. Each FCM’s Factors were then categorized into eight Domains: 1) Behavioral/Lifestyle, 2) Biomechanical, 3) Comorbidities, 4) Individual Factors, 5) Nociceptive detection and processing, 6) Psychological, 7) Social/Work/Contextual Factors, and 8) Tissue injury or pathology. To determine the importance of each factor in each FCM, centrality (Ci) was computed. Ci measures the weighted contribution of each Factor i in each FCM: Ci = (sigma)n sub k=1 |a sub k|. n is a total number of Connections going to and from a Factor and a is the weight of each Connection. Thus, centrality of a factor increases with the number of connections to and from that factor and by the weighting of these connections6. Centrality of each domain (sum of centrality for each factor within the designated domain) was expressed as a percentage of the eight domains. Individual FCMs and metamodels were analyzed with descriptive statistics. This study is in line with the osteopathic tenets, as understanding how patients view their CLBP will enable physicians to treat patients more holistically and take on a whole person/patient-centered approach to managing patients with CLBP. Data Analysis/Results: 30 patients with CLBP (n=18 female, n=11 male, and n=1 unknown), averaging 13.1±14 years of LBP history with Oswestry Disability Index of 11.0±6.5% and 3.8±2.3 pain intensity rating out of 10, participated in this study. Based on these 30 participants’ interviews, a total of 639 factors were identified, with a total of 88 unique factors. On average, individual FCMs contained 21±4.7 factors and 40.2±27.8 connections. Of the 8 domains, Biomechanical (23.8%), Behavioral/Lifestyle (22.4%), and Psychological (21.9%) were the most prominent in the aggregated model, followed by Social/Work/Contextual Factors (15.7%), Tissue injury or pathology (7.8%), Comorbidities (4.7%), Individual Factors (2.4%), and Nociceptive detection and processing (1.3%). Furthermore, for the domains of Biomechanical, Behavioral/Lifestyle, and Psychological, each shared an equal number of participants (9 participants each) that expressed these domains as being most “central” to their understanding of CLBP. Conclusion: Similar to our previous report of individuals with LBP4, the aggregated model of patients with CLBP referred to the OMM outpatient clinic demonstrated Biomechanical factors as being most central to the perspective of CLBP patients, with Behavioral/Lifestyle and Psychological being the next most prominent factors in the aggregate model. These findings speak to the perceived importance of the numerous factors in patients with CLBP and highlight the unique perceptions in this patient population. The study has osteopathic significance as understanding how patients view their CLBP will enable osteopathic physicians to consider patients more holistically, thereby taking on a whole person/patient-centered approach to managing patients with CLBP, which is in line with the osteopathic tenets. Post-OMM interviews aimed at investigating potential changes in patient perspectives following participant visits to the OMM clinic as well how patient perspectives may diverge or converge with the perspectives of treating osteopathic physicians are currently underway.


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