Luciana Gazzi Macedo

Core domains recommended for assessing low back pain (LBP) include pain, function, and health-related quality-of-life. The 9-item questionnaire, derived from PROMIS-29 Impact score, was proposed by the National Institute of Health task force as a comprehensive yet concise measure of LBP impact. However, its psychometric properties have not been widely evaluated. The objectives were to evaluate convergent validity, responsiveness and minimal clinically important difference of the Impact score (total and domains) compared with established measures: Oswestry Disability Index, Numerical Rating Scale, EuroQol 5-Dimension 5-Level, the Patient-Specific Functional Scale, and the Global Perceived Effect Scale (GPE). A secondary analysis was conducted using data of WELBack RCT of 372 participants with chronic non-specific LBP. Outcomes were collected at baseline and 2-months follow-up. Convergent validity was assessed via correlations between the Impact score and legacy measures and one-tailed hypothesis testing. Responsiveness was analyzed using distribution-, construct-, and criterion-based approaches. The MCID estimate was derived using the GPE as an anchor. The questionnaire demonstrated high convergent validity, meeting 80% of predefined hypotheses. Our analyses demonstrated moderate responsiveness, with a large effect size (0.8), 60% of hypotheses were met in construct-based approach, and an acceptable area under the curve (0.73) in criterion-based evaluation. MCID was estimated at 6 points. In conclusion, the Impact score, which captures a construct of LBP impact, reflecting multiple health domains, demonstrated high convergent validity and acceptable responsiveness in patients with chronic LBP. Its brevity and psychometric robustness support its use in clinical practice and research. PERSPECTIVES: This article evaluated the convergent validity, responsiveness and minimal clinical important difference of the Impact score to evaluate low back pain impact. The results demonstrate good validity, responsiveness and an MCID of 6 which supports the use of this short and easy to apply questionnaire.

Background: Technology-based solutions to support the mental health needs of workers are on the rise, as evidenced by the growing body of research related to e–mental health apps implemented with workers or within the context of workplaces. This expanding landscape of evidence related to mental health apps underscores the necessity of summarizing and consolidating the different ways in which studies are evaluating real-world technology-based interventions in a complex setting such as a workplace. Objective: The aim of this scoping review is to summarize the growing body of evidence evaluating mental health apps with workers. Specific research questions include “What types of mental health apps are studied?” “With whom are they being evaluated?” and “What outcomes are being tracked with what tools?” Methods: The scoping review followed 5 stages: specifying the research question, identifying relevant literature, selecting studies, extracting data, and synthesizing the findings. The search strategy was applied across 6 databases (PsycINFO, Embase, MEDLINE, Cochrane Database, OVID Healthstar, and OVID Emcare) to identify relevant studies from January 2000 to August 2023. Results: From the 288 abstracts screened, 54 studies met the inclusion criteria for this review. Over two-thirds of the studies were randomized controlled trials. The studies included 44 different apps, comprising 23 structured self-guided apps, 15 unstructured self-guided apps, and 6 apps designed as adjuncts to other interventions. Evaluation approaches included examining user engagement and utilization, investigating the impact on users, and evaluating the implementation process. Most studies evaluated the impact on individual mental health–related outcomes as well as workplace-related outcomes. Conclusions: This scoping review provides a comprehensive overview of the ways in which studies are currently evaluating workplace mental health apps. The review highlights key trends and gaps in the existing research, noting that most studies focus on the effects of mental health apps on individual users, while only a limited number of studies explore how implementing such dynamic interventions within complex real-world settings (eg, workplaces) may influence their overall effectiveness. Future research should explore the implementation process to identify factors that promote and/or hinder the optimal use and impact of mental health apps for workers.

Introduction: Exercise therapy is the most recommended treatment for chronic low back pain (LBP), with evidence supporting modest effects, likely due to the heterogeneity of patient presentations. Evidence suggests that matching individuals to the most appropriate exercise type could improve outcomes. Systematic reviews also emphasise that effective exercise interventions should be patient centred, target paraspinal muscle health and be of sufficient duration. This study addresses these gaps using a targeted care approach to identify a homogenous sample that is more likely to respond to our interventions. The inclusion of a sample with predominant nociceptive pain profile will be performed with the integration of the Pain and Disability Drivers Management Model (PDDM) and the Lumbar Spine Instability Questionnaire (LSIQ). The primary aim of this two-arm randomised controlled trial is to compare the effectiveness of motor control plus isolated lumbar extension exercises (MC+ILEX, arm 1) to free-weight resistance training (arm 2) in reducing LBP-related disability. Secondary aims include examining whether changes in multifidus composition mediate disability improvements comparing intervention effects on muscle size and quality, strength, mobility, pain, quality of life, sleep, physical activity and satisfaction; exploring baseline LSIQ scores and sex/gender as moderators of treatment response; and investigating participants’ perceptions and experiences of exercise therapy. Methods and analysis: A total of 106 participants will be recruited through primary and secondary care and randomised (1:1) to receive either MC+ILEX or free-weight resistance training. Both groups will complete 48 exercise sessions over 16 weeks. The primary outcome will be disability at 16 weeks, measured by the Oswestry Disability Index. Secondary outcomes include multifidus muscle composition and size, lumbar and gluteal muscle strength, hip range of motion, pain, physical and mental function, satisfaction and recovery, health-related quality of life, sleep quality and physical activity levels. Linear mixed-effects models will be used to assess primary and secondary outcomes. Regression analyses will explore whether baseline LSIQ scores moderate treatment effects on multifidus composition and other outcomes. A subsample of participants will undergo semistructured interviews before and after the intervention to explore their illness perceptions, illness mindsets, perceptions of exercise therapy, as well as their experiences and satisfaction with the two exercise interventions. Reflexive thematic analysis will be used to analyse qualitative data. Ethics and dissemination: This study received ethics approval from the Central Ethics Research Committee of the Quebec Minister of Health and Social Services (CCER-25-26-14). Results will be submitted to peer-reviewed journals and scientific meetings. Trial registration number: ISRCTN14864451 .

Background: Spinal pain is a highly prevalent condition affecting a large part of the population. Chiropractic maintenance care (MC) is a management strategy intended to prevent spinal pain recurrent episodes and deterioration by treating patients at pre-planned intervals. A previous study showed that patients identified as a dysfunctional subgroup by the West Haven-Yale Multidimensional Pain Inventory (MPI) and receiving MC had fewer days with bothersome LBP. This suggests MC may have superior effectiveness in this subgroup of patients. The MPI, however, is not practical for daily clinical practice, prompting the development of the MAINTAIN instrument. This study aims to (1) assess the effectiveness and cost-effectiveness of stratified MC using the MAINTAIN instrument, and (2) assess the fidelity and procedure compliance of implementing the MAINTAIN instrument. Methods: This pragmatic randomized clinical trial will recruit 225 consecutive patients (18–65 years old) with significant (> 30 days in the past 12 months) recurrent spinal pain presenting to chiropractic clinics. After the initial 3 weeks (6 visits) of chiropractic care, patients will be randomized to receive either Stratified MC or Standard Chiropractic Care. Stratified MC: patients will complete the MAINTAIN instrument and be stratified to MC or symptom-guided care (clinicians’ judgment). Patients in the Standard Chiropractic Care arm will receive standard treatment based on the chiropractor’s judgment. The primary outcome is the total number of days with activity-limiting pain measured at 12 months. Secondary outcomes include the number of missed working days and loss of work productivity due to pain, pain intensity, disability, health-related quality of life, perceived improvement, and implementation of MAINTAIN instrument outcomes. An intention-to-treat protocol and generalized estimating equations (GEE) linear regression models will be used for analysis. Discussion: This study investigates the impact of using a clinical instrument to identify patients with recurrent spinal pain to target those who benefit most from a chiropractic MC approach. Strict inclusion criteria should ensure a suitable target group, and frequently collected repeated measures should provide accurate outcome assessment. The study is pragmatic and includes standard clinical procedures facilitating the generalizability and transferability of the results into clinical practice. Trial registration: ClinicalTrials.gov NCT05350254. Prospectively registered on April 22, 2022, last modified on December 08, 2023. The first patient was randomized into the study on December 21, 2023.