Article appraisal
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PICOT QUESTION PAPER
PICOT Question Paper
Laurette Garcia
West Coast University
PICOT Question Paper
This paper aims to address the topic of the effectiveness of treating lower back pain, tackled via PICOT questions. Back pain, especially low back pain, is among the most common causes for patients seeking emergency care (Casiano et al., 2021). The etiologies vary based on the patient population, but it most commonly results from mechanical or non-specific sources. It responds well to activity modification, rest, ice, heat, spinal modulation, and spinal manipulation, among other interventions (Casiano et al., 2021). This paper focuses on spinal manipulation therapy in treating lower back pain.
Background
Low back pain encompasses various types of pain –like nociceptive, neuropathic, nociplastic, or non-specific –that frequently overlap. The components consisting of the lumbar spine are prone to stressors, and each of them alone or in combination can cause low back pain (Knezevic et al., 2021). Due to several factors associated with low back pain and the low specificity of imaging and diagnostic injections, diagnostic techniques, and thus treatment, continue to be subject to controversy (Knezevic et al., 2021, p. P78). Prevention and treatment of low back pain are a substantial challenge in high-risk populations to aid in addressing the high health care cost associated with treatment and rehabilitation. Given its high prevalence and related high burden to society, evidence-based interventions like spinal manipulative therapy must be embraced (Bussieres et al., 2017).
Spinal manipulative therapy applies a high-velocity, low-amplitude force to the spine and is often accompanied by an audible sound from one or more joints (Thomas et al., 2020). Spinal manipulative treatment is widely utilized in the treatment of low back pain and has been investigated in many studies of different methodological quality and sizes, with promising results. For instance, in Bussieres et al.’s study meta-analysis on the effectiveness of spinal manipulation therapy on low back pain, the authors concluded that this therapy leads to modest short-term improvements in pain and function when compared to sham manipulation, usual care, or other interventions. Furthermore, in Coulter et al.’s (2018) systematic review of randomized controlled trials on the effectiveness of spinal manipulative therapy on treating low back pain, it was found that spinal manipulation significantly reduced pain and disability, compared with other active comparators like exercise and physical therapy. Therefore, spinal manipulative therapy is an intervention that can reduce the burden of low back pain to society.
Significance to Nursing
Low back pain is among the most common issues in society and causes substantial disability, work absenteeism, and use of health services (Cruz et al., 2020). Thus, effective management of low back pain patients at the early stage of pain onset can be fundamental for the mitigation of the development of persistent disabling back pain conditions. Casiano et al. (2021) argue that nonpharmacological interventions are more effective in managing low back pain than pharmacological interventions like diazepam and systemic steroids, which have consistently shown no benefits. Additionally, many national clinical guidelines on low back pain management, such as the National Institute for Care Excellence (NICE), Denmark National Guideline, and the American College of Physicians, recommend that clinicians should select nonpharmacological therapy for acute and chronic low back pain (massage, acupuncture, and spinal manipulation) ahead of pharmacological therapeutic alternatives (Bussieres et al., 2017, p. 672). With evidence demonstrating that spinal manipulative therapy is effective in managing low back pain, the nurses can rely on this evidence to address the burden of this condition and consequently improve their ratings and satisfaction.
PICPT Questions
The PICO model is a frequently used tool for structuring clinical study questions in connection with evidence synthesis (Eriksen, 2018). The three PICOT questions that are relevant to the topic in question are presented below.
1. In adults with low back pain of mechanical origin, how can the use of spinal manipulative therapy compared to rest, reduce pain in a span of two weeks?
2. In adults that are 18 and older with spinal pain of mechanical origin, is the use of spinal manipulative treatment superior to ice in reducing pain and disability during one week of intervention?
3. In young patients less than 18 with non-specific low back pain, does spinal manipulation therapy more effective than exercises in reducing pain and disability?
Conclusion
With an increased prevalence of low back pain and associated burden to patients, chiropractic care, especially using spinal manipulation, has shown significant reductions in overall back pain intensity, disability, and satisfaction than usual care (Goertz et al., 2018). From their systematic review focusing on the efficacy of spinal modulation therapy on low back pain, Casiano et al. (2021) found that non-pharmacological interventions are more effective in managing low back pain than pharmacological interventions. If spinal manipulative therapy can be applied early enough in patients, it can prevent the development of persistent disabling back pain condition (Cruz et al., 2020). This paper presented three questions that focus on the effectiveness of spinal manipulative therapy in reducing low back pain compared to other interventions.
References
Casiano, V. E., Dydyk, A. M., & Varacallo, M. (2019). Back pain. StatPearls Publishing.
Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: A systematic review and meta-analysis. The Spine Journal: Official Journal of the North American Spine Society, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013
Cruz, E. B., Canhão, H., Fernandes, R., Caeiro, C., Branco, J. C., Rodrigues, A. M., Pimentel-Santos, F., Gomes, L. A., Paiva, S., Pinto, I., Moniz, R., & Nunes, C. (2020). Prognostic indicators for poor outcomes in low back pain patients consulted in primary care. PloS One, 15(3), e0229265. https://doi.org/10.1371/journal.pone.0229265
Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345
Goertz, C. M., Long, C. R., Vining, R. D., Pohlman, K. A., Walter, J., & Coulter, I. (2018). Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 1(1), e180105. https://doi.org/10.1001/jamanetworkopen.2018.0105
Knezevic, N. N., Candido, K. D., Vlaeyen, J. W. S., Van Zundert, J., & Cohen, S. P. (2021). Low back pain. The Lancet, 398(10294), P78-92. https://doi.org/10.1016/s0140-6736(21)00733.
Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 13. https://doi.org/10.1186/s12913-018-3818-y
Thomas, J. S., Clark, B. C., Russ, D. W., France, C. R., Ploutz-Snyder, R., Corcos, D. M., & RELIEF Study Investigators (2020). Effect of spinal manipulative and mobilization therapies in young adults with mild to moderate chronic low back pain: A randomized clinical trial. JAMA Network Open, 3(8), e2012589. https://doi.org/10.1001/jamanetworkopen.2020.12589