Theses and Dissertations at Montana State University (MSU)
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Item The progression from acute to chronic low back pain: a systematic review of risk factors and practice recommendations(Montana State University - Bozeman, College of Nursing, 2018) Sheehan, Willow Anne; Chairperson, Graduate Committee: Jennifer SofieAcute low back pain (LBP) is common and can lead to chronic LBP. Chronic LBP carries the risk of significant financial burden and reduced quality of life. If low back pain persists beyond six weeks, the likelihood of recovery is limited. Therefore, it would be beneficial to identify those acute LBP patients most at risk of progressing to chronic LBP early in the disease process. This project seeks to identify acute LBP risk factors (RFs) that are most predictive of chronic LBP in primary care populations. A systematic review of literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Article review resulted in the inclusion of 13 studies with 3,641 subjects, evaluating 104 RFs. Data extraction and analysis based on the review protocol resulted in clinical practice and future research recommendations. Coping by catastrophizing and the patient's perspective of risk of chronicity are the most well-supported RFs identified and can be safely assessed in clinical practice for the purpose of recognizing those acute LBP patients most at risk of chronicity and in need of early intervention. An additional 82 RFs are discussed for their value in future research and potential implications for future clinical practice.Item Improving adherence among primary-care providers to clinical-practice guidelines for the diagnosis and treatment of acute low-back pain(Montana State University - Bozeman, College of Nursing, 2017) Briggs, Katelyn Rose; Chairperson, Graduate Committee: Alice RunningBack pain is a condition primary-care providers will inevitably see among their patients. It is one of the most prevalent medical conditions, affecting between 50% and 90% of the general adult population in developed countries. Nonspecific low-back pain accounts for approximately 85% of all low-back-pain incidents in primary care, and the majority of these episodes will resolve within two weeks of onset. Care for low-back pain is often fragmented and results in a very heavy economic burden from both direct and indirect costs. Clinical-practice guidelines have been developed to improve patient care and outcomes, and decreased healthcare costs have been demonstrated when clinical-practice guidelines are followed. However, despite the wide availability of clinical-practice guidelines, adherence by primary-care providers is less than optimal. Therefore, the purpose of this project is to evaluate the effectiveness of an educational program for primary-care providers in a rural clinic regarding the proper management of acute low-back pain following available clinical-practice guidelines. A quasi-experimental project design with retrospective chart reviews was conducted. Data from the first review, along with current evidence-based protocols for back-pain management, were used to develop an educational presentation for the primary-care providers of a family-medicine clinic in a rural, southwest Montana town. A second chart review was performed after the educational presentation to evaluate utilization of the evidence-based protocol of the primary-care providers. Results indicated a significant improvement in the prescription of methylprednisolone by primary-care providers, decreasing from 40% during the initial retrospective chart review to 0% during the second retrospective chart review. Other areas of the outcomes data, although not significant, showed improvement related to adherence to the clinical-practice guidelines by the primary-care providers. This indicates the educational intervention was overall successful in fulfilling the purpose of this project.