Article

Chronic musculoskeletal pain disorders are highly prevalent and have
high personal and societal cost. Hence, early detection and care of patients at
risk of developing chronic pain is important. Risk factors are well known and
screening tools exist, but much less is known about the care of at-risk patients.
The aim of this study was to investigate the effectiveness of secondary
prevention strategies for musculoskeletal pain.
METHODS: We performed a
systematic review of clinical trials in which treatments were adjusted to the
risk of chronicity in adults with acute or subacute musculoskeletal pain.
Clinical trials, systematic reviews and meta-analyses published after January 1,
2000 were searched in PubMed and PEDro databases and in the reference list of
relevant papers. The risk of bias was assessed by the PEDro score. RESULTS: We
identified 4807 potentially eligible articles; 13, corresponding to 9 studies,
met the inclusion criteria. Most studies investigated low back pain. The overall
risk of bias was moderate, mainly because of the difficulty of blinding in
physiotherapy studies. As compared with a "one-size-fits-all" treatment,
stratified programmes showed significant improvements in several domains of the
International Classification of Functioning, Disability and Health: body
structures and functions (pain, mood), activities (functional capacity),
participation (return to work, quality of life), as well as environmental factors
(healthcare consumption). Effect sizes were moderate. Overall, simple educational
messages seemed sufficient for low-risk patients. Medium- and high-risk patients
benefited from a physical reactivation programme combined with education. In
high-risk patients, an additional cognitive-behavioural intervention further
improved the outcome. CONCLUSIONS: A stratified approach seems effective in
reducing long-term disability in patients with musculoskeletal pain. However,
more research is necessary to confirm these results.
CI - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.
- Prévention secondaire

Langue : ANGLAIS