718 Journal Reports / The Spine Journal 13 (2013) 717–720

might provide a useful alternative in reducing pain catastrophizing as an

extremely relevant target in pain treatment.

Copyright � 2012 International Association for the Study of Pain. Pub-

lished by Elsevier B.V. All rights reserved.

PMID: 23084002 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23084002].

Reprinted from: Hanssen MM, Peters ML, Vlaeyen JW, Meevissen YM,

Vancleef LM. Optimism lowers pain: evidence of the causal status and un-

derlying mechanisms. Pain 2013;154(1):53–8. Epub 2012 Oct 18. This ab-

stract has been reproduced with permission of the International

Association for the Study of Pain� (IASP�). The abstract may not be re-

produced for any other purpose without permission.

http://dx.doi.org/10.1016/j.spinee.2013.04.014

Effectiveness of PhysioDirect telephone assessment and advice

services for patients with musculoskeletal problems: pragmatic

randomised controlled trial. Salisbury C, Montgomery AA,

Hollinghurst S, et al. BMJ 2013;346:f43

OBJECTIVES: To assess the clinical effectiveness, effect on waiting

times, and patient acceptability of PhysioDirect services in patients with

musculoskeletal problems, compared with usual care.

DESIGN: Pragmatic randomised controlled trial to assess equivalence in

clinical effectiveness. Patients were individually randomised in a 2:1 ratio

to PhysioDirect or usual care.

SETTING: Four physiotherapy services in England.

PARTICIPANTS: Adults (aged $ 18 years) referred by general practi-

tioners or self referred for musculoskeletal physiotherapy.

INTERVENTIONS: PhysioDirect services invited patients to telephone

a physiotherapist for initial assessment and advice, followed by face-to-

face physiotherapy if necessary. Usual care involved patients joining

a waiting list for face-to-face treatment.

MAIN OUTCOME MEASURES: Numbers of appointments, waiting

time for treatment, and non-attendance rates. Primary outcome was phys-

ical health (SF-36v2 physical component score) at six months. Secondary

outcomes included four other measures of health outcome, mental compo-

nent score and scales from the SF-36v2, time lost from work, and patient

satisfaction and preference. Participants were not blind to allocation, but

outcome data were collected blind to allocation.

RESULTS: Of 1506 patients allocated to PhysioDirect and 743 to usual

care, 85% provided primary outcome data at six months (1283 and 629

patients, respectively). PhysioDirect patients had fewer face-to-face ap-

pointments than usual care patients (mean 1.91 v 3.11; incidence rate ra-

tio 0.59 (95% confidence interval 0.53 to 0.65)), a shorter waiting time

(median 7 days v 34 days; arm time ratio 0.32 (0.29 to 0.35)), and lower

rates of non-attendance (incidence rate ratio 0.55 (0.41 to 0.73)). After

six months’ follow-up, the SF-36v2 physical component score was equiv-

alent between groups (adjusted difference in means �0.01 (�0.80 to

0.79)). Health outcome measures suggested a trend towards slightly

greater improvement in the PhysioDirect arm at six week follow-up

and no difference at six months. There was no difference in time lost

from work. PhysioDirect patients were no more satisfied with access to

physiotherapy than usual care patients, but had slightly lower satisfaction

overall at six months (difference in satisfaction �3.8% (�7.3% to

�0.3%); p5.031). PhysioDirect patients were more likely than usual care

patients to prefer PhysioDirect in future. No adverse events were

detected.

CONCLUSIONS: PhysioDirect is equally clinically effective compared

with usual care, provides faster access to physiotherapy, and seems to be

safe. However, it could be associated with slightly lower patient

satisfaction.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN55666618.

PMID: 23360891 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/23360891].

Reproduced from: Salisbury C, Montgomery AA, Hollinghurst S, et al. Ef-

fectiveness of PhysioDirect telephone assessment and advice services for

patients with musculoskeletal problems: pragmatic randomised controlled

trial. BMJ 2013;346:f43, with permission from BMJ Publishing Group Ltd.

http://dx.doi.org/10.1016/j.spinee.2013.04.015

US spending on complementary and alternative medicine during

2002–08 plateaued, suggesting role in reformed health system. Davis

MA, Martin BI, Coulter ID, Weeks WB. Health Aff (Millwood)

2013;32(1):45–52

Complementary and alternative medicine services in the United States are an

approximately $9 billion market each year, equal to 3 percent of national

ambulatory health care expenditures. Unlike conventional allopathic health

care, complementary and alternative medicine is primarily paid for out of

pocket, although some services are covered by most health insurance. Exam-

ining trends in demand for complementary and alternativemedicine services in

the United States reported in the Medical Expenditure Panel Survey during

2002–08, we found that use of and spending on these services, previously on

the rise, have largely plateaued.Thehigherproportionof out-of-pocket respon-

sibility for payment for services may explain the lack of growth. Our findings

suggest that any attempt to reduce national health care spending by eliminating

coverage for complementary and alternativemedicinewould have little impact

at best. Should some forms of complementary and alternative medicine-for

example, chiropractic care for back pain-be proven more efficient than allo-

pathic and specialtymedicine, the inclusion of complementary and alternative

medicine providers in new delivery systems such as accountable care organi-

zations could help slow growth in national health care spending.

PMID: 23297270 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23297270].

Copyrighted and published by Project HOPE/Health Affairs as: Davis MA,

Martin BI, Coulter ID, Weeks WB. US spending on complementary and

alternative medicine during 2002–08 plateaued, suggesting role in re-

formed health system. Health Aff (Millwood) 2013;32(1):45–52.

http://dx.doi.org/10.1016/j.spinee.2013.04.016

Emergency department treatments and physiotherapy for acute

whiplash: a pragmatic, two-step, randomised controlled trial. Lamb

SE, Gates S, Williams MA, et al. Lancet 2013;381(9866):546–56.

Epub 2012 Dec 19

BACKGROUND: Little is known about the effectiveness of treatments for

acute whiplash injury. We aimed to estimate whether training of staff in

emergency departments to provide active management consultations was

more effective than usual consultations (Step 1) and to estimate whether

a physiotherapy package was more effective than one additional physio-

therapy advice session in patients with persisting symptoms (Step 2).

METHODS: Step 1 was a pragmatic, cluster randomised trial of 12 NHS

Trust hospitals including 15 emergency departments who treated patients

with acute whiplash associated disorder of grades I-III. The hospitals were

randomised by clusters to either active management or usual care consul-

tations. In Step 2, we used a nested individually randomised trial. Patients

were randomly assigned to receive either a package of up to six physiother-

apy sessions or a single advice session. Randomisation in Step 2 was strat-

ified by centre. Investigator-masked outcomes were obtained at 4, 8, and

12 months. Masking of clinicians and patients was not possible in all steps

of the trial. The primary outcome was the Neck Disability Index (NDI).

Analysis was intention to treat, and included an economic evaluation.

The study is registered ISRCTN33302125.

FINDINGS: Recruitment ran fromDec 5, 2005 to Nov 30, 2007. Follow-up

was completed on Dec 19, 2008. In Step 1, 12 NHS Trusts were randomised,

719Journal Reports / The Spine Journal 13 (2013) 717–720

and 3851 of 6952 eligible patients agreed to participate (1598 patients were

assigned to usual care and 2253 patients were assigned to active manage-

ment). 2704 (70%) of 3851 patients provided data at 12 months. NDI score

did not differ between active management and usual care consultations (dif-

ference at 12 months 0$5, 95% CI –1$5 to 2$5). In Step 2, 599 patients wererandomly assigned to receive either advice (299 patients) or a physiotherapy

package (300 patients). 479 (80%) patients provided data at 12 months. The

physiotherapy package at 4months showed amodest benefit compared to ad-

vice (NDI difference –3$7, –6$1 to –1$3), but not at 8 or 12 months. Active

management consultations and the physiotherapy packageweremore expen-

sive than usual care and single advice session. No treatment-related serious

adverse events or deaths were noted.

INTERPRETATION: Provision of active management consultation did

not show additional benefit. A package of physiotherapy gave a modest ac-

celeration to early recovery of persisting symptoms but was not cost effec-

tive from a UK NHS perspective. Usual consultations in emergency

departments and a single physiotherapy advice session for persistent symp-

toms are recommended.

FUNDING: NIHR Health Technology Assessment programme.

Copyright � 2013 Elsevier Ltd. All rights reserved.

PMID: 23260167 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/23260167].

Reprinted from The Lancet: Lamb SE, Gates S, Williams MA, et al. Emer-

gency department treatments and physiotherapy for acute whiplash: a prag-

matic, two-step, randomised controlled trial. Lancet 2013;381(9866):

546–56. Epub 2012 Dec 19, with permission from Elsevier.

http://dx.doi.org/10.1016/j.spinee.2013.04.017

The role of fear of movement in subacute whiplash-associated

disorders grades I and II. Robinson JP, Theodore BR, Dansie EJ,

Wilson HD, Turk DC. Pain 2013;154(3):393–401. Epub 2012 Dec 1

Fear and avoidance of activitymay play a role in fostering disability in whip-

lash-associated disorders (WAD). This study examined the role of fear after

WAD and assessed the effectiveness of 3 treatments targeting fear. People

still symptomatic fromWAD grade I-II injuries approximately 3months pre-

viously (n5191) completed questionnaires (eg, Neck Disability Index

[NDI]) andwere randomized to 1 of the treatments: (1) informational booklet

(IB) describing WAD and the importance of resuming activities, (2) IBþdidactic discussions (DD) with clinicians reinforcing the booklet, and (3)

IBþimaginal and direct exposure desensitization (ET) to feared activities.

DD and ET participants received three 2-hour treatment sessions. Absolute

improvements in NDI were in predicted direction (ET514.7, DD511.9,

IB59.9). ETs reported significantly less posttreatment pain severity com-

pared with the IB (Mean51.5 vs 2.3, p!.001, d50.6) and DD (M51.5 vs

2.0, p5.039, d50.6) groups. Reduction in fear was the most important pre-

dictor of improvement in NDI (b50.30, p!.001), followed by reductions in

pain (b50.20, p5.003) and depression (b50.18, p5.004). The mediational

analysis confirmed that fear reduction significantly mediated the effect of

treatment group on outcome. Results highlight the importance of fear in in-

dividuals with subacuteWAD and suggest the importance of addressing fear

via exposure therapy and/or educational interventions to improve function.

Copyright � 2012 International Association for the Study of Pain. Pub-

lished by Elsevier B.V. All rights reserved.

PMID: 23318127 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23318127].

Reprinted from: The role of fear of movement in subacute whiplash-asso-

ciated disorders grades I and II. Robinson JP, Theodore BR, Dansie EJ,

Wilson HD, Turk DC. Pain 2013;154(3):393–401. Epub 2012 Dec 1. This

abstract has been reproduced with permission of the International Associ-

ation for the Study of Pain� (IASP�). The abstract may not be reproduced

for any other purpose without permission.

http://dx.doi.org/10.1016/j.spinee.2013.04.018

Neuropsychiatric symptoms and the use of complementary and

alternative medicine. Purohit MP, Wells RE, Zafonte RD, Davis RB,

Phillips RS. PM R 2013;5(1):24–31. Epub 2012 Oct 24

OBJECTIVES: To assess the prevalence of complementary and alter-

native medicine (CAM) use by U.S. adults reporting neuropsychiatric

symptoms and whether this prevalence changes based on the number of

symptoms reported. Additional objectives include identifying patterns of

CAM use, reasons for use, and disclosure of use with conventional pro-

viders in U.S. adults with neuropsychiatric symptoms.

DESIGN: Secondary database analysis of a prospective survey.

PARTICIPANTS: A total of 23,393 U.S. adults from the 2007 National

Health Interview Survey.

METHODS: We compared CAM use between adults with and without neu-

ropsychiatric symptoms. Symptoms included self-reported anxiety, depres-

sion, insomnia, headaches, memory deficits, attention deficits, and excessive

sleepiness. CAM use was defined as use of mind-body therapies (eg, medita-

tion), biological therapies (eg, herbs), ormanipulation therapies (eg,massage)

or alternative medical systems (eg, Ayurveda). Statistical analysis included

bivariable comparisons and multivariable logistical regression analyses.

MAIN OUTCOME MEASURES: The prevalence of CAM use among

adults with neuropsychiatric symptoms within the previous 12 months

and the comparison of CAM use between those with and without neuro-

psychiatric symptoms.

RESULTS: Adults with neuropsychiatric symptoms had a greater preva-

lence of CAM use compared with adults who did not have neuropsychiatric

symptoms (43.8% versus 29.7%, p!.001); this prevalence increased with an

increasing number of symptoms (trend, p!.001). Differences in the likeli-

hood of CAM use as determined by the number of symptoms persisted after

we adjusted for covariates. Twenty percent of patients used CAM because

standard treatments were either too expensive or ineffective, and 25% used

CAM because it was recommended by a conventional provider. Adults with

at least one neuropsychiatric symptomweremore likely to disclose the use of

CAM to a conventional provider (47.9% versus 39.0%, p!.001).

CONCLUSION:More than 40% of adults with neuropsychiatric symptoms

commonly observed in many diagnoses use CAM; an increasing number of

symptoms was associated with an increased likelihood of CAM use.

Copyright � 2013 American Academy of Physical Medicine and Rehabil-

itation. Published by Elsevier Inc. All rights reserved.

PMID: 23098832 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23098832].

Reprinted from: Purohit MP, Wells RE, Zafonte RD, Davis RB, Phillips RS.

Neuropsychiatric symptoms and the use of complementary and alternative

medicine. PM R 2013;5(1):24–31. Epub 2012 Oct 24, with permission from

the American Academy of Physical Medicine and Rehabilitation.

http://dx.doi.org/10.1016/j.spinee.2013.04.019

Animal models for scoliosis research: state of the art, current

concepts and future perspective applications. Ouellet J, Odent T.

Eur Spine J 2013 Mar;22 Suppl 2:81–95. Epub 2012 Oct 26

PURPOSE: The purpose of this study was to provide the readers with a re-

liable source of animal models currently being utilized to perform state-of-

the-art scoliotic research.

MATERIALS AND METHODS: A comprehensive search was under-

taken to review all publications on animal models for the study of scoliosis

within the database from 1946 to January 2011.

RESULTS: The animal models have been grouped under specific headings

reflecting the underlyingpathophysiology behind the development of the spi-

nal deformities produced in the animals: genetics, neuroendocrine, neuro-

muscular, external constraints, internal constraints with or without tissue

injury, vertebral growth modulation and iatrogenic congenital malforma-

tions, in an attempt to organize and classify these multiple scoliotic animal

models. As it stands, there are no animalmodels thatmimic the human spinal