Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis
Abstract
:1. Introduction
- What is the volume, scope and dynamics of the research literature production on physiotherapy in CLBP?
- What is the spatial distribution of physiotherapy in CLBP literature production among the most prolific source titles, institutions, countries and funding institutions?
- What is the most prolific physiotherapy in CLBP research themes, how have they evolved over time and what is their association?
2. Materials and Methods
2.1. Search Procedure
2.2. Data Analysis
2.3. Thematic Analysis
3. Results
3.1. Volume and Prevalence of the Research Literature Production
3.2. The Dynamics of the Research Literature Production
3.3. The Thematic Analysis
3.4. The Chronological Analysis
- Development of pain assessment tools: pain measurement → pain assessment → pain management. These tools first measure and evaluate pain, in order to ultimately contribute to the most functional treatment possible;
- Development of CLBP processing: disease severity → disability evaluation → disease duration → treatment duration → clinical outcomes and effectiveness. The evolution of CLBP processing first began with assessing the severity and then the inability to perform normal bodily functions caused by the pain. The latter affected the duration of the disease, which in turn resulted in the duration of the treatment. Research in this area has continued in the field of studying the clinical outcomes and effectiveness of therapeutic methods of treating CLBP;
- Development of study methodology: follow-up studies → comparative studies → randomized control trials → meta-analysis → cohort analysis. The methodological design first started with follow-up studies, followed by comparative studies and later by randomized control trials. Based on the conclusions of these studies, after further research authors began to summarize the main findings and suggest further possibilities for the development of physiotherapy for CLBP in meta-analysis. They were followed by cohort analyses studying causal factors over time.
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Institution | Number of Funded Publications | Percentage of Funded Information Sources (in %) |
---|---|---|
National Institutes of Health | 84 | 8.97 |
National Center for Complementary and Integrative Health | 67 | 7.15 |
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior | 30 | 3.20 |
National Health and Medical Research Council | 28 | 2.99 |
Fundação de Amparo à Pesquisa do Estado de São Paulo | 23 | 2.46 |
National Natural Science Foundation of China | 23 | 2.46 |
Pfizer | 18 | 1.92 |
U.S. Department of Veterans Affairs | 18 | 1.92 |
National Institute on Aging | 17 | 1.81 |
National Institute of Child Health and Human Development | 16 | 1.71 |
Source Title | Number of Sources | Percentage of All Sources (in %) | IF 2022 1 | H-Index of Journal 2 | Quartiles (Q) 3 |
---|---|---|---|---|---|
Spine | 129 | 6.79 | 3.0 | 292 | Neurology (clinical) (Q1) Orthopedics and Sports Medicine (Q1) Sports Science (Q1) |
BMC Musculoskeletal Disorders | 81 | 4.27 | 2.3 | 122 | Orthopedics and Sports Medicine (Q2) Rheumatology (Q2) |
European Spine Journal | 52 | 2.74 | 2.8 | 164 | Orthopedics and Sports Medicine (Q1) Surgery (Q1) |
Spine Journal | 52 | 2.74 | 4.5 | 136 | Neurology (clinical) (Q1) Orthopedics and Sports Medicine (Q1) Surgery (Q1) |
Pain | 51 | 2.69 | 7.4 | 296 | Anesthesiology and Pain Medicine (Q1) Neurology (Q1) Neurology (clinical) (Q1) Pharmacology (Q1) |
Journal Of Back and Musculoskeletal Rehabilitation | 48 | 2.53 | 1.6 | 39 | Orthopedics and Sports Medicine (Q3) Physical Therapy, Sports Therapy and Rehabilitation (Q2) Rehabilitation (Q2) |
Clinical Journal of Pain | 47 | 2.48 | 2.9 | 145 | Anesthesiology and Pain Medicine (Q1) Neurology (clinical) (Q2) |
Pain Medicine United States | 46 | 2.42 | No data | No data | No data |
Journal of Pain Research | 44 | 2.32 | 2.7 | 71 | Anesthesiology and Pain Medicine (Q2) |
BMJ Open | 34 | 1.79 | 2.9 | 160 | Medicine (miscellaneous) (Q1) |
Theme (Color) | Representative Keywords | Categories | The Newest/Most Cited Papers | Focus of Research |
---|---|---|---|---|
Pathophysiology of CLBP and the assessment tools (yellow) | Oswestry Disability Index, pilot studies, single-blind method, exercise therapy, pathophysiology, range of motion, spine mobility | Pain quantification tools, Muscle physiology, Rehabilitation, Kinesiology |
| The Visual Analogue Scale (VAS) and the Numeric Pain Rating Scale (NPRS) are the most commonly used scales of perceived pain intensity, but otherwise there is no established gold standard for pain measurement in the literature. Physiotherapy interventions through behavioral (teaching the patient about the biology of their pain) or instructional modalities demonstrate better treatment outcomes for CLBP. |
Diagnostics and CLBP treatment (red) | Magnetic resonance imaging (MRI), diagnostic imaging, conservative treatment, risk assessment, radiculopathy, herniation, operation | Diagnostics, Analgesia, Risk assessment, Pathology, Other treatment methods |
| MRI is the most widespread method for researching pain networks in the brain. A newer method is ultra-short echo time (UTE) MRI. Research indirectly suggests a psychoneuroimmunological connection in CLBP. Pain-related fear and avoidance appear to be essential features for the development of chronic pain. The thalamus plays the most important role in regulation of pain-related emotions. Expression of pain-related molecules is mediated by CD14+ cells via inflammatory cytokines. |
CLBP questionnaires and surveys (violet) | Reproducibility, validity, assessment, rating scale, catastrophizing, nerve blockade | Questionnaires and surveys, Pain, Patients’ impact |
| Studies recommend measuring several outcomes to assess the strength of CLBP and the effectiveness of physiotherapy, namely functional (Oswestry Disability Index, Rolland–Morris Disability Index, etc.), pain (NPRS, Pain Disability Index, etc.), psychosocial (Fear Avoidance Beliefs Questionnaire) and other (return to work, complications or adverse effects, etc.) outcomes and quality-of-life assessment (SF-36, etc.). Negative behavioral emotion regulation is reported to result in spiraling negative affect and subsequent CLBP relapse. |
Quality of life (light blue) | Sleep quality, quality of life, functional status, treatment outcome, neuromodulation, balneotherapy | Quality of life, Intermethod comparison, Newer therapeutic methods |
| Depression, anxiety, coping behavior and catastrophizing are the main components of the quality-of-life assessment and influence the strength of CLBP and the success of physiotherapy. The concept of a multidisciplinary approach emphasizes the connection between the psychological and physical components of pain. More recent studies are also focused on investigating the effects of the environment and report that a calmer and green living environment should have a positive effect on the expression of CLBP and pain in general. |
Complementary methods in physiotherapy (dark blue) | Physical therapy modalities, clinical protocol, yoga, cognitive behavioral therapy, coping behavior, interpersonal communication, mindfulness, lifestyle | Physiotherapy, Complementary therapies, Personal relationships, Coping behavior |
| The physiotherapist–patient relationship plays an important role in the success of physiotherapy, as it affects the patient’s trust. The effectiveness of rehabilitation is also influenced by non-verbal communication, the patient’s ability to cope with pain and associated relaxation methods (meditation). |
Psychosocioeconomic aspects (green) | Cost–benefit analysis, healthcare costs, sick leave, social aspects, psychotherapy, depression, prognosis | Economy, Absenteeism, Socioeconomic factors, Disability, Risk factors |
| Research shows an increasing prevalence of CLBP and associated healthcare costs. Early multidisciplinary treatment of CLBP is essential to reduce the rate of sick leave and work disability. |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Šajnović, U.; Kokol, P.; Završnik, J.; Vošner, H.B. Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis. Healthcare 2024, 12, 1676. https://doi.org/10.3390/healthcare12161676
Šajnović U, Kokol P, Završnik J, Vošner HB. Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis. Healthcare. 2024; 12(16):1676. https://doi.org/10.3390/healthcare12161676
Chicago/Turabian StyleŠajnović, Urška, Peter Kokol, Jernej Završnik, and Helena Blažun Vošner. 2024. "Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis" Healthcare 12, no. 16: 1676. https://doi.org/10.3390/healthcare12161676