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Psychosocial Factors and Low Back Pain Among College Students
Journal of American College Health
Abstract
The authors evaluated psychosocial factors of stress and their effects on the prevalence of low back pain (LBP) among a population of college students in a major university in Colorado.
This was a nested cross-sectional study of 973 respondents who completed the National College Health Assessment survey. The authors evaluated a subset of questions pertaining to psychosocial stressors against the presence of LBP.
The annual prevalence of LBP among the population studied was 42.8%. The stressful psychosocial variables of feeling very sad, exhausted, and overwhelmed were associated with the prevalence of LBP.
The prevalence of LBP among this younger population is significant and understudied.
... For example, prevalence of mental health problems is significantly higher in university students than the general population, and psychological distress in students is associated with disability and poorer academic attainment [1]. The existing literature suggests that pain too is a common experience among university students [2,3]; however, to our knowledge this research is rather limited. In China, research has mainly focused on pre-university students. ...
... For example, in a sample of Chinese high school students aged 16 to 18 (n=2849), the incident rates of low back pain (LBP), headache, abdominal pain, neck and shoulder pain were 41. 1, 30.3, 20.9, and 32.8% respectively [4]. Similar findings were found in American university students, where the annual prevalence of LBP was found to be 42.8% (n=973) in one study [2] and 38% (n=963) in another study [3]. ...
... Finally, all participants were Chinese nationals studying at Chinese universities and recruited online. This reduces the generalizability of our results, although the prevalence of chronic pain in adolescents in China [2] is comparable to the prevalence rates in other countries such as the United States [3]. ...
Objectives
University students with pain face unique physical, psychological, social and academic challenges, but research on this is limited. The main aim of this study was to examine how pain, disability and perceived social support relate to psychological and academic outcomes in students with pain. It also compared students with pain and students without pain on measures of depression, anxiety and perceived social support.
Methods
Three hundred and eleven students enrolled in Chinese universities took part in the study, 198 with pain (102 reported acute pain and 96 chronic pain) and 113 without pain. They completed measures of perceived social support, depression, anxiety, pain (intensity, frequency, duration), disability and pain interference with academic functioning.
Results
Students with chronic pain reported higher levels of anxiety and depression and lower levels of perceived social support than students without pain. There were no significant differences between students with acute and chronic pain, and between students with acute pain and those without pain. In the pain sample (containing both acute and chronic pain group), greater interference with academic functioning was predicted by higher levels of pain and disability, and disability also predicted higher levels of depression. After controlling for effects of pain and disability, lower levels of perceived social support predicted higher levels of both anxiety and depression.
Conclusions
These results highlight the role of pain and disability in academic functioning and the role of perceived social support in psychological functioning of students with pain.
... The results support the study of Gonge et al., [7] who found that only stress, but not physical exertion or any of the psychosocial factors, such as time pressure was associated with LBP. In the United States, Kennedy et al., [8] investigated psychosocial factors of stress and their effects on the prevalence of LBP among college students. They found that the stressful psychosocial variables of feeling very sad, exhausted, and overwhelmed were associated with the prevalence of LBP. ...
... Previous studies found negative psychological aspects associated with LBP in a population with similar age. Kennedy et al., [8] investigated the underlying reason regarding incidence of pain related to the lower back in college students studying in a major university in Colorado. The authors determined the psychosocial effects like stress on the pervasiveness of LBP in this population. ...
... Among the five psychosocial stress and strain aspects examined (feeling overwhelmed, feeling of hopelessness, feeling very sad, feeling depressed, as well as feeling exhausted), three of them were considerably correlated to LBP: Feeling very sad, feeling fatigued and feeling overwhelmed. [8] Generalization of the finding of this study has to be considered with caution because the sampling method was not random (convenience sampling). However, the appropriate sample size used based on the sampling calculation and involvement of the matched control group strengthens the external validity of this study. ...
Context: Low back pain (LBP) is a common public health problem, and has a multifactorial etiology that includes not only physical risk factors, but also psychosocial factors. There were several studies that investigated physical and psychosocial factors and their relationship with LBP. However, up to the researchers′ knowledge, no studies have been conducted in Saudi Arabia.
Aims: To investigate physical and psychological factors in Saudi population with LBP.
Settings and Design: A case-control study using self-report measures.
Materials and Methods: Arabic versions of the following self-report measures were applied: A 10-cm Visual Analogue Scale (VAS) to measure pain intensity; the International Physical Activity Questionnaire (IPAQ) to record average physical activity levels over the last 7 days; and Depression, Anxiety and Stress Scale (DASS) to measure the negative emotional states of depression, anxiety and stress. The above self-report measures were handed to the participants and were collected immediately. Thirty-one patients with LBP and thirty-one control participants matched in body mass index and age participated.
Statistical analysis used: Independent t-tests and Pearson Correlation Analysis were used to calculate differences in VAS, IPAQ and DASS between the two groups.
Results: Patients with LBP had moderate stress compared to control participants (19.8 and 4.4 respectively, P = 0.0013). Both groups did not present with anxiety or depression. No significant difference was found in any level of activity between the groups.
Conclusions: Stress was present in this group of Saudi patients with LBP. Targeting psychological factors associated with LBP, not only physical factors may help improve the management of patients with LBP.
... There were 180 (58.4%) females and 128 (41.6%) males. The ages of the participants were ≤21 years in 175 (56.8%), 22 Of a total of 209 students who reported LBP during the last 12 months, 119 (56.94%) mentioned that their pain duration was between one and seven days, 28 (13.4%) between eight and 30 days, and 27 (12.92%) more than 30 days, and 19 (9.09%) reported that their pain was every day, and 16 (7.66%) ...
... The prevalence of LBP during the last 12 months in our study (67.9%) was similar to the prevalence reported in previous studies conducted in Saudi Arabia (67%) [16] and (61.4%) [17], Bangladesh (63.3%) [14], Jordan (63.1%) [18], Brazil (59.9%) [19], and Serbia (59.5%) [20]. On the other hand, the lower prevalence was reported in studies conducted in India (47.5%) [21], Malaysia (46.1%) [13], the USA (42.8%) [22], China (40.1%) [23], and Pakistan (38.6%) [24]. ...
Background
Low back pain (LBP) is a common problem encountered in medical practice, leading to limitations in daily activities and causing social and economic hardships.
Objectives
This study aimed to assess the prevalence of LBP and its associated factors among medical students at Nineveh University in Iraq.
Methods
Between December 2022 and January 2023, a cross-sectional study was conducted among medical students at Nineveh University. A modified version of the Standard Nordic Questionnaire was used for data collection.
Results
Out of 308 students, 229 (74.4%) experienced LBP at some point in their lives. In addition, 209 (67.9%) reported having LBP during the last 12 months, 148 (48.1%) during the previous seven days, and 126 (40.9%) at the time of answering the survey. Factors significantly associated with LBP during the last 12 months were being in the fifth-stage academic year (p=0.047), family history of LBP (p=0.003), and history of trauma (p=0.006). On the multivariable logistic regression analysis, factors significantly associated with LBP during the last 12 months were family history of LBP (p=0.02) and history of trauma (p=0.01).
Conclusions
The prevalence of LBP among medical students at Nineveh University was comparatively high. A family history of LBP and a history of trauma were factors significantly associated with LBP during the last 12 months. Managing this health concern should be a priority for the administration of medical schools.
... In 2019, an estimated 8.5% of 18-29-year-olds in the United States reported chronic pain, i.e. pain occurring on every day or most days in the past 3 months, and 2.2% experienced chronic pain that resulted in activity restrictions (Zelaya et al., 2020), i.e. functional disability. Limited evidence about the causes of chronic pain among youth suggests that musculoskeletal injuries (Reuter & Fichthorn, 2019), lower back pain (Kennedy et al., 2008;Nyland & Grimmer, 2003), and headaches (Kennedy et al., 2008) could be sources of chronic and recurrent pain in this age group. Those findings are corroborated by studies that documented back/musculoskeletal pain (19%) and injury (12%) to be primary reasons for prescribing opioid pain relievers to youth aged 15-29 (Fortuna et al., 2010), and back pain to be the most cannabis patients compared to non-patients (Lankenau et al., 2018). ...
... In 2019, an estimated 8.5% of 18-29-year-olds in the United States reported chronic pain, i.e. pain occurring on every day or most days in the past 3 months, and 2.2% experienced chronic pain that resulted in activity restrictions (Zelaya et al., 2020), i.e. functional disability. Limited evidence about the causes of chronic pain among youth suggests that musculoskeletal injuries (Reuter & Fichthorn, 2019), lower back pain (Kennedy et al., 2008;Nyland & Grimmer, 2003), and headaches (Kennedy et al., 2008) could be sources of chronic and recurrent pain in this age group. Those findings are corroborated by studies that documented back/musculoskeletal pain (19%) and injury (12%) to be primary reasons for prescribing opioid pain relievers to youth aged 15-29 (Fortuna et al., 2010), and back pain to be the most cannabis patients compared to non-patients (Lankenau et al., 2018). ...
Background:
Pain is a primary reason for medical cannabis use among young adults, however little is known about the patterns of pain in this group. This study identified pain profiles among young adult cannabis users and examined related antecedents and distal outcomes.
Methods:
Past 30-day cannabis users aged 18-26, both medical cannabis patients and non-patients, were enrolled in Los Angeles in 2014-2015. A latent class analysis was used to identify pain classes based on history of chronic pain conditions and recent non-minor pain. The study assessed the predictors of membership in pain classes and examined the association of classes with recent mental health characteristics, cannabis use motives and practices.
Results:
Three classes were identified: Low pain (56.3%), Multiple pain (27.3%), and Nonspecific pain (16.4%). In adjusted models, lifetime insomnia was associated with membership in Multiple pain and Nonspecific pain classes versus the Low pain class. Medical cannabis patients and Hispanics/Latinos were more likely to belong to the Multiple pain class than the other classes. Regarding recent outcomes, the Multiple pain and Nonspecific pain classes were more likely than the Low pain class to use cannabis to relieve physical pain. Additionally, the Multiple pain class had a higher probability of psychological distress, self-reported medical cannabis use, consuming edibles, and using cannabis to sleep compared to one or both other classes.
Conclusion:
Findings suggest that young adult cannabis users can be separated into distinct groups with different pain profiles. The Multiple pain profile was associated with medically-oriented cannabis use motives and practices.
... All over the world, back pain imposes a large amount of direct and indirect costs to health care and treatment systems and is one of the main reasons for the absence of people from the workplace [1][2][3]. Over 80% of people have experienced at least one back pain during their life [4,5]. Several studies have reported various general factors such as obesity, smoking, and long-term sedation as risk factors for back pain [6,7]. ...
... Several studies have reported various general factors such as obesity, smoking, and long-term sedation as risk factors for back pain [6,7]. Also, hamstring shortness is known as a risk factor for back pain [4,5]. So that having a short hamstring muscle is usually reported in patients with back pain. ...
Background
Both universal goniometer and electro-goniometer are used for measuring joint range of motion in physiotherapy. Active knee extension test is a way to assess hamstring shortness in patients with chronic low back pain. The aim of this study was to assess universal goniometer and electro-goniometer reliability in measuring knee angle during active knee extension test.
Methods
This was an intra-examiner reliability study between three measurements of knee extension angle that conducted on 45 patients with chronic low back pain having short hamstring muscle that referring to Kermanshah University of Medical Sciences clinic from 2016 to 2017. Knee extension angle was measured three times during active knee extension test with both universal goniometer and electro-goniometer.
The measurement of knee extension angle was done at the beginning, middle and the end of one single session by one experienced physiotherapist.
The intra-class correlation coefficient (ICC) and standard error of measurements (SEM) were used to quantify intra-examiner reliability.
Results
For both methods, the reliability test values were found to be greater than 0.7 in the range of 0.92 to 0.99 (CI 95% ranged over = 0.94 to 0.99), which are classified as good reliability. The SEMs ranged from 1.04° to 2.16° for both scales.
Conclusion
Universal goniometer in clinical evaluations of patients (as they are easy to be employed) and electro-goniometer in laboratory studies (as they are more accurate) are reliable.
... 6,7 Depression has been shown quite consistently to be associated with back pain in the general adult population 8,9 , although research looking specifically at the association between back pain and depression in emerging adults is limited and equivocal, and to our knowledge, this association has not been in-vestigated in a Canadian context. For example, in a study of 973 male and female college students in the United States by Kennedy et al. 10 , psychological factors like feeling sad, exhausted, and overwhelmed were directly associated with the prevalence of low back pain. Similarly, Unalan et al. 11 found that scores on the Zung Depression Index were associated with back pain in their study of 250 Turkish vocational students. ...
... This observation suggests that, in a young emerging adult population, depression is a risk factor for low back pain and is consistent with the findings across later adulthood. These findings align with previous research by Kennedy et al. 10 and Unalan et al. 11 , who reported similar associations between low back pain and depressive symptoms. Only one study did not observe a difference in depression scores between low back pain and control students 12 , however, this study was limited D Robertson, D Kumbhare, P Nolet, J Srbely, G Newton by small sample size of subjects reporting depression. ...
Introduction: The association between depression, somatization and low back pain has been minimally investigated in a Canadian emerging adult population.
Methods: 1013 first year Canadian university students completed the Modified Zung Depression Index, the Modified Somatic Perception Questionnaire, and a survey about low back pain frequency and intensity. Multinomial logistic regression was used to measure associations between low back pain and depression and somatization, both independently and co-occurring.
Results: Over 50% of subjects reported low back pain across grades, and both depression and somatization were significantly positively associated with low back pain. Several positive associations between the cooccurrence of somatization and depression with various grades of low back pain were observed.
Discussion: These results suggest that low back pain, depression and somatization are relatively common at the onset of adulthood, and should be considered an important focus of public health.
... En Colombia, un estudio de la Universidad de Antioquia mostró que el dolor de espalda de origen funcional en universitarios, es una de las cinco primeras causas de consulta médica 16 . En Bucaramanga, un estudio de corte transversal realizado por Camargo DM. et al 14 , con un muestra de 237 estudiantes de la Facultad de Salud de la UIS, encontró prevalencias de dolor musculoesqueletico el día de la encuesta de 34,2% (IC 95% 28,1-40,2), dolor agudo de 18,3% (IC 95% 12,8-23,9) y dolor crónico de 22,8% (IC 95% 16,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]6). Además, según la localización se reportó dolor de cuello en el 60% (IC 95% 49-71) y en la región dorsal del 57,5% (IC 95% 46,4 -68,6). ...
... Variables como el estrés, sentirse triste, exhausto y agobiado también se han asociado con la presencia de dolor de espalda en la región lumbar en estudiantes. Kennedy C et al 27 ; reportaron una fuerte asociación entre factores psicosociales como la fatiga y estar emocionalmente afectado con el dolor de espalda 28 . ...
The back pain is a public health problem due to lifetime prevalence that increases the health system costs and affect of the quality of life of people. In university students high prevalence rates between 30-70% is related to functional limitation in activities of daily living. Intrinsic and extrinsic factors such as age, gender, physical activity practice and time spent using a computer are associated to neck and lumbar pain. The studies reported positive and significant association between the ages older than 20 or 21 years with lumbar pain. The female gender, academic years and hours per week in computer were associated to back pain in several locations. Conflicting evidence was found for the association between physical activity and back pain. The practice of some sports as well as suspend sport practice is associated with an increased risk of lumbar pain. Additionally, psychological factors should be considered also to understand the problem of neck and back pain. In university students, research on association between sitting and back pain are few, but in general population have been described the biomechanical aspects related to body alignment, muscle activation, the relationship between posture and intradiscal pressure, as well as ergonomic factors and contextual factors affecting the adoption and maintenance of the sitting. Salud UIS 2012; 44 (2):45-55
... Etiologically, LBP is caused by several independent factors [19] and involves various structures such as facet joints, intervertebral discs, and muscles. Although LBP increases in the elderly, its prevalence among adolescents (18-24 years) is higher (up to 40%) [20,21]. Undergraduate students, particularly in the health sciences, are at high risk for developing low back pain due to the demanding nature of the curriculum, physical exposure at clinical practice, and prolonged sitting [22][23][24]. ...
Background/Objectives: Hip muscle lengthening is commonly associated with the normal function of the lumbar spine and lower extremities. Some evidence correlates hamstring and iliopsoas tightness with low back pain (LBP). Undergraduates are more prone to LBP as they are involved in prolonged sitting and poor posture. This study aims to assess the impact of hip muscle lengthening on LBP. Methods: This article involves a descriptive study of 70 students who were recruited from Zefat Academic College. Measurement of hamstrings and iliopsoas muscle lengthening, as well as a constructive questionnaire, were used. Results: The majority of participants (80% for hamstrings and 96% for iliopsoas) manifested normal muscle lengthening. Muscle flexibility was significantly higher among females. Logistic regression analyses revealed that hamstring lengthening (right) and stress-related study are significantly associated with LBP. Conclusions: The current study indicates that muscle length is female-dependent and right–left muscle length is symmetrical. Increased hamstring length could be related to LBP.
... Additionally, a study by Kennedy et al. 21 28 . The prevalence and prognosis of LBP in college students have not been extensively studied. ...
INTRODUCTION: One of the most prevalent musculoskeletal issues is low back pain (LBP). It has been discovered that 39.8% of adolescents also experience LBP, proving that the condition is no longer limited to adults. College students are not exempt from this health issue; further study is needed to determine how common it is and how it impacts day-today functioning. Methods and Materials: A cross sectional study was conducted in 402 college students for the prevalence of LBP. The degree of functional disability in students with back pain, including demographic factors, was evaluated using the Quebec Back Pain Disability Scale. Results: It was found that there was no significant association with Pain Disability Scale scores (p-value = 0.6093) across different age groups (25-30 years). There is a significant association between gender and Pain Disability Scale scores (p-value = 0.00266). Females have higher severity in all other categories and males have mild disability. Bed-bound or exaggerating symptoms (0.25%), crippling back pain (2.99%), severe disability (5.47%), moderate disability (18.66%), mild disability (72.64%). Conclusion: Prevalence of LBP in students is 73% which is quite high and its effects can aid in developing prevention strategies and treatment programs for college students.
... It has been found that depression is constantly present in adult patients with back pain, although research in this regard is limited. Associations between low back pain and depression and somatization in a Canadian emerging adult population David Robertson, Kennedy et al published, in 2008, the results of a study conducted on 973 students, in which they show the presence of sadness, exhaustion and overwhelmed is directly associated with lumbar pain [30]. ...
Low back pain, is an important symptom that reduces the individual's quality of life. Lumbar disc hernias are first in the identifiable etiology of low back pain. Physiotherapy and rehabilitation modalities are important in treating lumbar disc hernias, so they can often be treated without surgery. Background: This study aimed to evaluate the contribution of hydrokine to therapy performed in oligo-mineral thermal water in the modification of pain, depression and self-esteem in patients with lumbar disc herniation. Methods: 80 patients with lumbar disc herniation were included in the study. 40 patients took thermal therapy, hydro-kinetotherapy and physical therapy named study group, and 40 patients did only physical therapy named control group. Pre and post-evaluations were conducted. Pain was assessed with visual analog scale, depression levels were assessed with the Hamilton Scale, and self-esteem was evaluated with the Morris-Rosenberg scale. Also, differences between groups are evaluated. Effect size is calculated. Results: The pain score, the depression score and the score for self-esteem evaluation improve significantly in both groups. Self-esteem increases significantly more in the study group, after the 10 days of treatment. Conclusions: Hydrokinetotherapy is a useful physiotherapy modality to reduce pain and increase psychological status in patients with lumbar disc hernias. The combination of hydrokinetotherapy is beneficial for increasing the self-esteem of patients with lumbar disc herniation.
... Our study did insignificant relationships between the other psychological factors such as stress, fatigue, and musculoskeletal disorders. On the other hand, some other reports found an association between fatigue and LBP [38,39]. ...
Background
Rheumatoid Arthritis (RA) is a disease with a heavy functional, psychological, and socioeconomic impact. The management of Quality of Life (QoL) as a therapeutic objective is a fairly recent notion, especially in Tunisia. We aimed to evaluate QoL in RA patients and to identify its affecting factors.
Methods
This was a cross-sectional study in a Tunisian rheumatology center. To assess QoL, we used the Short Form Health Survey (SF-36) and the Arthritis Impact Measurement Scales Short Form (AIMS2-SF). Health Assessment Questionnaire Disability Index (HAQ), the Hospital Anxiety and Depression Scale (HAD) for psychological disorders, Visual Analog Scale for Pain (VAS Pain), and for fatigue (VAS Fatigue) were also used. Disease activity was assessed by the Disease Activity Score (DAS28 CRP).
Results
We enrolled 120 established RA, the mean age of our patients was 56.9±11.4 years, with a predominance of women (83.3%). The mean disease duration was 10.97±7.7 years. According to the HAD scale, 27% of our patients presented anxiety, and 26.7% had depressive disorders. There was significantly impaired QoL in patients with low educational level, dependent financial situation, long disease duration, high disease activity, high pain and fatigue levels, poor therapeutic education, functional disability, and psychological disorders (p<0.001). A strong negative correlation was detected between inflammatory markers, structural damage, and the scores of QoL. Patients under biologics scored significantly higher in the SF36 mental health domain (p<0.001).
Conclusion
QoL is significantly poor in Tunisian RA. These patients should be managed using a multidisciplinary approach involving the patients themselves.
... Our study did insignificant relationships between the other psychological factors such as stress, fatigue, and musculoskeletal disorders. On the other hand, some other reports found an association between fatigue and LBP [38,39]. ...
Objective
Low Back Pain (LBP) is the most common musculoskeletal disorder, particularly among working adults It is one of the most prevalent complaints among students. Medical students, are among those who are most exposed to this condition; due to stress, numerous hours of studying , and the sedentary lifestyle. The aim of our study was to determine the prevalence and the associated factors of LBP among the students of Tunis Faculty of Medicine and to assess its impact on student life.
Methods
This was a cross-sectional study carried out on the students of Tunis Faculty of Medicine. Data were collected through an online self-administered questionnaire. Sociodemographic, personal, and lifestyle characteristics were collected. LBP was assessed using the Nordic Musculoskeletal Health Questionnaire and Its impact using the Oswestry Disability Index (ODI).
Results
One hundred and forty-eight students were included. The mean age was 22.9 ± 2.3 years [19.64-38.21]. The sex ratio was 0.29. According to the Nordic questionnaire, the point, annual and lifetime prevalence of LBP were 37.8%, 80.4%, and 90.5% respectively. The mean ODI score was 10.32± 8.48 % [0-32]. The ODI score was minimal in 87.3% and moderate in 12.7% of cases. The associated factors with LBP were: young age (p = 0.015), spending more than 4 hours in a sitting position (p = 0.059), second cycle of medical studies (p= 0.006), low screen projection in the amphitheater (p= 0.029) and poor layout of the amphitheatres (p= 0.000). The feeling of depression was significantly higher among LBP students (p= 0.018). In the multivariate analysis, the factors that remained statistically significant were the second cycle of medical studies (OR= 3.41), feeling of depression (OR = 3.7) and the belief in the responsibility of the poor layout of the amphitheaters in the genesis or maintenance of LBP (OR = 7.66).
Conclusion
LBP in medical students is multifactorial across both personal and college-life domains.
... However, very few studies 5,10,14,[19][20][21][22][23][24] have been conducted that evaluated the prevalence and potential risk factors associated with LBP among medical students. These studies showed a high prevalence of LBP. ...
Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study determined the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh.
Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant.
Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.4 ± 1.9 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), non-specific (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m ² (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes.
Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.
... [15][16][17] Moreover, Burton et al. 18 addressed the modification of risk factors as the most crucial prevention strategy of LBP. However, very few studies 5,10,14,[19][20][21][22][23][24] have been conducted that evaluated the prevalence and potential risk factors associated with LBP among medical students. These studies showed a high prevalence of LBP. ...
Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study determined the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh.
Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant.
Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.4 ± 1.9 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), non-specific (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m ² (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes.
Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.
... The results were quite similar compared to some previous similar studies [49][50][51]. This large percentage of MSD problems in the Lower Back region may occur due to different factors for instance, prolonged sitting duration, static muscle work, etc. ...
Prolonged static and sitting posture in poorly designed furniture may increase Musculoskeletal Disorders (MSDs). Therefore, the research purposes were to examine the prevalence and severity of MSD problems among the students in different body regions and determine the relationship between furniture dimensions and MSD problems. A total of 400 university students (250 males and 150 females) voluntarily participated in this survey. Standard Nordic Musculoskeletal Questionnaire was used to assess the MSDs. All dimensions of the four types academic furniture were measured and evaluated. A Chi-square test was used to determine the association between furniture dimensions and body measurements. Moreover, lordosis and kyphosis abnormalities were analyzed to determine the relationship between furniture dimensions and MSDs. The results showed a high frequency of MSDs in the Lower Back region (52.25%) among the participants. Moreover, female participants were more affected than male participants in MSDs. A significant positive relationship was found between furniture dimensions and lordosis disorders at p < 0.05. Moreover, Chi-square results showed the dimensions of academic furniture (SW, SH, SD, BH, etc.) were unsuitable relative to body measurements. Students were affected by the MSD problems due to the inappropriate furniture. Therefore, to avoid or reduce the MSD problems, the design of the academic furniture should be changed.
... [13][14][15] For example, the annual prevalence of low back pain in university students, one of the most common pain conditions, was found to be around 40% and it was associated with a variety of psychosocial factors. [16][17][18] University students are also reporting high prevalence of chronic pain, with 54% reporting chronic pain of over 3 months in at least one pain site in a recent study. 19 Among those students, 19.1% reported chronic pain in at least three pain sites. ...
Objective:
Chronic pain is a prevalent health issue among young adults; however, there is limited understanding on how it affects university students. This is the first systematic review of evidence relating to the association between chronic pain and psychological, social and academic functioning in university students. Participants: Four databases were searched for relevant published studies. Data from 18 studies including 10,069 university students, of which 2895 reported having chronic pain, were included in the synthesis. Methods: Due to heterogeneity of data and methodologies, meta-analysis was not possible; therefore, data were synthesized narratively. Results: Our findings showed that students with chronic pain have poorer psychological, social and academic functioning and quality of life, compared to students without chronic pain. Conclusions: These findings suggest that chronic pain presents a challenge in university settings. Research is urgently needed to enable an understanding of how universities can support students who experience chronic pain.
... [11][12][13] Moreover, Burton et al. 14 addressed the modification of risk factors as the most crucial prevention strategy of LBP. However, very few studies 5,6,10,[15][16][17][18][19][20] have been conducted that evaluated the prevalence and potential risk factors associated with LBP among medical students. These studies showed a high prevalence of LBP. ...
Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study evaluated the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh.
Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant.
Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.36 ± 1.915 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), undiagnosed (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m ² (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes.
Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.
... In this study the magnitude of back pain among medicine and nursing student were found to be 54% which is comparable with findings has been done at University of Salzburg, Austria (Moroder et al., 2011). However, the overall magnitude of back pain in this study was higher when compare with other studies between 30 to 48% (Mustafa et al., 2013;Issa et al., 2016;Nupur et al., 2017;Kennedy et al., 2008). ...
Musculoskeletal pain are common problems for nursing and medicine students especially in developing countries. The study aimed to assess the prevalence and associated factors of back and upper body musculoskeletal pain among nursing and medicine students at the University of Gondar. Institution based cross-sectional study was conducted. Stratified simple random sampling technique and structured self-administered questionnaires were used for data collection. All questionnaires were entered into EPI™ version-7 then exported to SPSS™ version-20. Bivariate and multivariate logistic regressions were employed to ensure further significance with subsequent use of odds ratio to show the strength of the association with 95% (CIs). Magnitude of musculoskeletal pain in different body parts was 54% back pain and 36.7% neck pain. Sex difference (AOR: 0.607, 95% CI [0.062, 0.935]), alcohol consumption (AOR: 1.821, 95% CI [1.002, 4.130]), and sufficient rest break (AOR: 0.494, 95% CI [0.044, 4.202]) has significant association to back pain. Also, department (AOR: 3.399, 95% CI [1.340, 3.418]), year of study (AOR: 1.912, 95% CI [1.001, 5.349]) and sleep hours per day (AOR: 1.670, 95% CI [1.507, 4.801]) have significantly associated with neck pain. The overall magnitude of back pain and neck pain in medicine and nursing students were high. Therefore, interventions on organizational factors as well as personal factors should be done to reduce the burden of lower back and upper body musculoskeletal disorders.
... Furthermore, they also suggested to be able to evaluate the quality of life of individuals who have NSLBP as an essential examination. In field of education, Kennedy et al. also reported that students with LBP affect their quality of life by decreasing psychosocial aspects such as experiencing sadness, being overwhelmed and exhausted 48 . ...
Background: Low back pain was the most common case in musculoskeletal disorders. Non-specific low back pain (NSLBP) described as low back pain with no clear causal relationship between the symptoms, physical findings, and imaging findings. This study aimed to briefly review the evidence the evaluation and intervention for NSLBP in physiotherapy practice. Methods: In this study, the library research method was used, which took online and offline data sources referring to books, journals, articles related to the topic of evaluation and physiotherapy intervention in NSLBP conditions as a data source to answer research objective Results: Some researchers commonly assess the pain, range of motion (ROM), functional ability and quality of life. As a regular treatment for non-specific low back pain, some study recommended general therapeutic exercise and manual therapy to reduce the problematic of non-specific low back pain. Conclusion: Physiotherapist can evaluate patients with NSLBP based on the patients complains like pain using VAS or NPRS, Lumbar ROM using schober method, functional disability using ODI or RMDQ and Quality of life. For the physiotherapy intervention of non-specific low back pain, we can summarize that the first-line management of NSLBP is self-management exercise. Furthermore, physiotherapist can use any method of therapeutic exercise and manual therapy to reduce pain, improve lumbar ROM, increase functional ability and quality of life.
... More than 80% of people develop at least once in their lifetime with LBP (3). Several studies have suggested various risk factors for LBP such as obesity, cigarette smoking, longterm sedation (4,5). ...
... [11] Tayland üniversitesinde öğrencilerin bel ağrısı yaşama durumlarının incelendiği bir araştırmada, öğrencilerin %31'i, diğer bir çalışmada %42,8'i son bir yıl içerisinde bel ağrısı yaşadıklarını belirtmişlerdir. [12,13] Diğer araştırmalarda da bizim çalışmamızda olduğu gibi öğrencilerin yaklaşık üçte biri bel ağrısı sorunu yaşamaktadır. Avustralya'da hemşirelik öğrencileri ile yapılan çalışmada öğrencilerin %59,2'sinin, Kore'de yapılan çalışmada ise %39,1'inin bel ağrısı yaşadığı saptanmıştır. ...
Objectives:
This study aimed to determine the pain experience of nursing students and the methods used to cope with it.
Methods:
This descriptive study was conducted at the nursing department. Sampling was not used. The study was completed with 264 students. Data were collected using the questionnaire that was prepared by the researchers. Descriptive statistics and chi-square test were used for data analysis.
Results:
Of all students, 76.1% (84.1%, females; 56.0%, males) who participated in this study had pain. The most experienced pain was headache (52.3%), stomachache (42.4%), and low back pain (33%); these were more prevalent in females than in males. The use of medication (42.9% in males and 47.8% in females) was higher than the other methods for pain treatment. Students who stayed in the dormitory were more likely to use drugs (58.5%), whereas those not staying in the dormitory were more likely to use non-drug methods (47.4%). Students who paid attention to feeding behavior used more medication (80%) than who did not pay attention (44.1%; p<0.05).
Conclusion:
Students were mostly applied to health institutions owing to pain, they used drugs for headache, and the pain affected their daily life activities and resulted in them being absent on school days. In conclusion, considering the adverse effects of medications, it is recommended that students should be informed regarding reliable traditional nonpharmacological methods for coping with pain and should be encouraged to use such methods.
... Even though they are professional only 64 % of the students chose to take treatment while the rest ignored the pain and functioned beyond their physical limits inviting new injuries. This is illustrated in Graph 4 [22][23][24][25][26][27][28]. ...
Physiotherapists serve as role models for practicing healthy life style behaviors. They are desired to have a good level of physical fitness to meet their job demands. Their professional demands require the therapist to engage in activities that demand wholesome amount of strength, endurance and flexibility. The job analysis shows that physiotherapy students are more likely to experience musculoskeletal pain. Occupational musculoskeletal pain relates to workplace hazards and incurs high costs to society as well as individual’s pain and suffering. All physiotherapy students enrolled in a tertiary care public sector hospital were asked to participate in a cross-sectional questionnaire based study. A sample size of 48 was randomly selected at a power of 80% and p<0.05 using STATA 10 software. The sample targeted all students registered from first to fourth year and also post-graduate students. Descriptive statistics were included for quantitative variables. The prevalence of musculoskeletal pain between different year groups was compared using Pearson’s chi square test. Prevalence of low back pain was found among 48 % of students, followed by 16 % reporting neck and upper back pain, 12 % having both neck and low back pain, 8 % showed knee pain while 4 % stated foot pain. We observed that 52 % students had musculoskeletal pain in one form or other. But, only 36 % out of these were taking any precautionary measures or treatments to cure the same.
Keywords: physiotherapy students, musculoskeletal pain, occupational injury, ergonomics, postures, low back pain
... [11] Tayland üniversitesinde öğrencilerin bel ağrısı yaşama durumlarının incelendiği bir araştırmada, öğrencilerin %31'i, diğer bir çalışmada %42,8'i son bir yıl içerisinde bel ağrısı yaşadıklarını belirtmişlerdir. [12,13] Diğer araştırmalarda da bizim çalışmamızda olduğu gibi öğrencilerin yaklaşık üçte biri bel ağrısı sorunu yaşamaktadır. Avustralya'da hemşirelik öğrencileri ile yapılan çalışmada öğrencilerin %59,2'sinin, Kore'de yapılan çalışmada ise %39,1'inin bel ağrısı yaşadığı saptanmıştır. ...
Objectives: This study aimed to determine the pain experience of nursing students and the methods used to cope with it. Methods: This descriptive study was conducted at the nursing department. Sampling was not used. The study was completed with 264 students. Data were collected using the questionnaire that was prepared by the researchers. Descriptive statistics and chi-square test were used for data analysis. Results: Of all students, 76.1% (84.1%, females; 56.0%, males) who participated in this study had pain. The most experienced pain was headache (52.3%), stomachache (42.4%), and low back pain (33%); these were more prevalent in females than in males. The use of medication (42.9% in males and 47.8% in females) was higher than the other methods for pain treatment. Students who stayed in the dormitory were more likely to use drugs (58.5%), whereas those not staying in the dormitory were more likely to use non-drug methods (47.4%). Students who paid attention to feeding behavior used more medication (80%) than who did not pay attention (44.1%; p<0.05). Conclusion: Students were mostly applied to health institutions owing to pain, they used drugs for headache, and the pain affected their daily life activities and resulted in them being absent on school days. In conclusion, considering the adverse effects of medications, it is recommended that students should be informed regarding reliable traditional nonpharmacological methods for coping with pain and should be encouraged to use such methods.
... Carrying laptop, tablets and health sciences books might justify the association [5]. Psychological factors were identified to contribute to development of LBP [7,15]. In this study, being overwhelmed and sad is associated significantly with point prevalence of LBP (p < 0.001). ...
AimTo determine the prevalence of low back pain (LBP) among health sciences students and to identify the associated factors. Methods
Cross-sectional study was conducted among 1163 students from five health sciences colleges during the academic year 2016–2017. Self-administered questionnaire was conducted and included 4 sections: demographic characteristics, risk factors, Nordic musculoskeletal questionnaire and Oswestry disability questionnaire. Data were analyzed using SPSS. ResultsMean age was 20.74 ± (1.59 years). 70.9% of students were female. Lifetime prevalence of LBP was 56.6%, 12-month prevalence 48.8%, and point prevalence 21.2%. Dentistry students had highest lifetime prevalence of LBP (67.6%) with significant p value (<0.001). Male were found to have higher lifetime prevalence compared to female (p ≤ 0.001). Spending more than 10 h on computer or tablet was significantly associated with LBP (OR 2.19; 95% CI 1.30–3.70; p = 0.003). Feeling discomfort on bed was associated with LBP (OR 1.81; 95% CI 1.38–2.38; p ≤ 0.001). Uncomfortable college furniture was associated with LBP (OR 1.40; 95% CI 1.09–1.79; p = 0.008). Using heavy backpack was found to be associated with LBP (OR 1.49; 95% CI 1.01–2.03; p = 0.011). Most of students LBP (90.3%) found to cause minimal disability on Oswestry scale. Conclusion
This study has shown high prevalence of LBP among future healthcare provider. These risk factors should be well established to minimize the prevalence of LBP among future health sciences students. Dentistry students at higher risk of developing LBP compared to other students.
... Published by Elsevier España, S.L. All rights reserved.IntroducciónUno de los problemas osteomusculares de mayor relevancia en salud pública es el dolor, por su alta prevalencia en la población, con cifras que oscilan entre el 13,8 y el 63% cuando se analiza un período inferior a 1 mes; entre ellos, el dolor de cuello, de espalda y lumbar son los más frecuentes, con prevalencias de entre el 20 y el 30%, aproximadamente 1,2 .Particularmente, en la población universitaria de áreas de la salud, se han encontrado prevalencias de dolor de espalda de entre el 4,2 y el 64,4%, dependiendo de la localización específi ca (cuello, hombros o espalda lumbar) y el tiempo de evocación del dolor, en el cual factores relacionados con la actividad académica y los derivados de las actividades propias del ejercicio profesional, además de los sociodemográfi cos y psicosociales, interactúan y condicionan su manifestación[3][4][5] .La práctica de actividad física (AF) vigorosa en jóvenes ha mostrado un efecto protector de la salud en varios estudios, al disminuir el riesgo de presentar dolores de cabeza (odds ratio [OR]: 0,74), problemas de sueño (OR: 0,76), insatisfacción con la apariencia física (OR: 0,69), intentos de suicidio (OR: 0,59), tabaquismo (OR: 0,65) y comportamientos de riesgo como ingesta de alcohol varias veces a la se-entre 1,7 y 3,8, el sexo femenino (RP = 2,0) y el estado civil soltero (RP = 0,14), ajustados por la variable AF baja. Conclusiones: Estos hallazgos plantean la necesidad de desarrollar programas de intervención desde la perspectiva de la promoción de la salud, tendentes a modifi car los factores relacionados con la manifestación del dolor de espalda crónico en los estudiantes universitarios, y contribuir a mejorar su salud y calidad de vida. ...
Objective: To determine the level of quality of life in college students health areas and evaluate associated factors. Methods: Cross sectional study. Sociodemographic variables were measured, level of physical activity with the International Physical Activity Questionnaire, pain with Self Registration Form Pain and quality of life with the Quality of Life Enjoyment and Satisfaction Questionnaire. Models of simple and multiple linear regression assessed associations. Results: A total of 237 students, 37.1% male, mean age 20.6 ± 2.2 years. The prevalence of vigorous physical activity was 8.4%, 18.3% acute pain and chronic 22.8%, the average weekly hours of school day 30.9 ± 10.7 hours and quality of life ranged between 33 and 75/100. Acute pain (β:-2.6), chronic pain (β: -3.9) and hours per week of classroom academic day (β:-0.07) were negatively associated with quality of life, only vigorous physical activity was positive (β = 5.3). Conclusions: The factors evaluated are likely to intervene. It requires the implementation of programs aimed at promoting physical activity, recreation and sport, as part of a healthy lifestyle that contributes to improving the quality of life of college students.
... Published by Elsevier España, S.L. All rights reserved.IntroducciónUno de los problemas osteomusculares de mayor relevancia en salud pública es el dolor, por su alta prevalencia en la población, con cifras que oscilan entre el 13,8 y el 63% cuando se analiza un período inferior a 1 mes; entre ellos, el dolor de cuello, de espalda y lumbar son los más frecuentes, con prevalencias de entre el 20 y el 30%, aproximadamente 1,2 .Particularmente, en la población universitaria de áreas de la salud, se han encontrado prevalencias de dolor de espalda de entre el 4,2 y el 64,4%, dependiendo de la localización específi ca (cuello, hombros o espalda lumbar) y el tiempo de evocación del dolor, en el cual factores relacionados con la actividad académica y los derivados de las actividades propias del ejercicio profesional, además de los sociodemográfi cos y psicosociales, interactúan y condicionan su manifestación[3][4][5] .La práctica de actividad física (AF) vigorosa en jóvenes ha mostrado un efecto protector de la salud en varios estudios, al disminuir el riesgo de presentar dolores de cabeza (odds ratio [OR]: 0,74), problemas de sueño (OR: 0,76), insatisfacción con la apariencia física (OR: 0,69), intentos de suicidio (OR: 0,59), tabaquismo (OR: 0,65) y comportamientos de riesgo como ingesta de alcohol varias veces a la se-entre 1,7 y 3,8, el sexo femenino (RP = 2,0) y el estado civil soltero (RP = 0,14), ajustados por la variable AF baja. Conclusiones: Estos hallazgos plantean la necesidad de desarrollar programas de intervención desde la perspectiva de la promoción de la salud, tendentes a modifi car los factores relacionados con la manifestación del dolor de espalda crónico en los estudiantes universitarios, y contribuir a mejorar su salud y calidad de vida. ...
Objective: To explore the association between physical activity and chronic back pain in students of health occupations. Material and methods: A cross-sectional study was performed in university students from the first to tenth semesters, randomly selected and registered in the university between February, 2007 and June, 2008. Sociodemographic variables were gathered and physical activity was quantified through the long form of the International Physical Activity Questionnaire (IPAQ) in leisure time. The amount of time sitting or standing each week, in the hypoactive category, was also measured, using the short-form IPAQ. Pain was characterized using the Self Report of Pain Questionnaire (SRPQ) and the time since onset was registered as acute ( 3 months). Back pain was recorded for one or more of the following locations: neck, dorsal and low back. Simple and multiple log-binomial regression models were used to estimate prevalence ratios (PR) and their 95% confidence intervals; the outcome variable was chronic back pain and the reference category consisted of students without pain (a = 0.05). Results: A total of 237 students, with a mean age of 20.6 ± 2 years (62.9% females), participated in the study. The prevalence of low, moderate and vigorous physical activity was 85.2% (95% CI 80.7-89.8), 6.9% (95% CI 3.5-10.3) and 8.4% (95% CI 4.9-12.0), respectively. The median weekly number of sitting hours was 60.5 h/week. The prevalence of pain on the day of the survey was 34.2%, (95% CI 28.1-40.2), that of acute pain was 18.3% (95% CI 12.8-23.9) and that of chronic pain 22.8% (95% CI 16.9-28.6); pain located in the neck was found in 60% (95% CI 49-71) and pain in the dorsal back in 57.5% (95% CI 46.4-68.6). The multivariate model took account of 190 observations; among the factors associated with chronic back pain were university year (PR = 1.4), sitting hours categorized in PR quartiles between 1.7 and 3.8, female gender (PR = 2.0) and single marital status (PR = 0.14), adjusted by the low physical activity category. Conclusions: These findings support the need to develop intervention programs from the perspective of health promotion to decrease the prevalence of chronic back pain in university students and to help improve their health and quality of life.
... A lombalgia pode ser definida como um processo doloroso da coluna lombar de origens variadas como distensão muscular, pontos-gatilho miofasciais, alterações nas articulações ou discos intervertebrais, além de disfunção das articulações sacroilíacas (HOOKER; PRENTICE, 2002). Não existem dados que relatem a prevalência de lombalgia na população brasileira como um todo, porém estimase que 14,7% da população de Salvador sofra com lombalgia (ALMEIDA et al., 2008), número menor que o encontrado em outros países (KENNEDY et al., 2008;BRACCI et al., 2007). A incidência de dor lombar tem sido associada à sobrecarga ocasionada pelo trabalho e, nesse aspecto, Andrusaitis, Oliveira e Barros Filho (2006) associam a prevalência de dor lombar associada ao número de horas de trabalho, além disso, a mesma relaciona-se ao tabagismo e sobrepeso (ALMEIDA et al., 2008). ...
A lombalgia, definida como processo doloroso da coluna lombar de origens variadas, pode ser tratada clinicamente por meio de várias técnicas fisioterapêuticas, incluindo o método Isostretching e a cinesioterapia convencional. O objetivo deste estudo foi comparar o método Isostretching e a cinesioterapia convencional no tratamento da dor e incapacidade provocados pela lombalgia. Para tanto, participaram deste estudo seis pacientes, do sexo feminino, com diagnóstico médico de lombalgia mecânica e idade média de 34,33 anos (DP=11,44). Para avaliação da incapacidade, foi utilizado o “Índice de Incapacidade de Oswestry” no início e fim do tratamento, e, para avaliação da dor, a escala visual analógica de dor no início e fim do tratamento. As pacientes foram divididas em dois grupos, composto de três pacientes cada, de tratamento individual durante 10 sessões, duas vezes por semana; o grupo A realizou nove posturas do método Isostretching, e o grupo B, alongamentos dos músculos dos membros inferiores e fortalecimento do músculo transverso abdominal. A análise estatística foi realizada por meio dos testes Komolgorov Smirnov, t de Student e Wilcoxon, com significância de 5%. A análise dos resultados demonstrou que houve diferença em relação a dor apenas no grupo A (p=0,0266), porém não houve diferenças entre os grupos (p=0,5), em relação a incapacidade ambos os grupos apresentaram melhora (p=0,0417 e p=0,0412, respectivamente), contudo não houve diferença entre os mesmos (p=0,25) . Portanto, o presente estudo concluiu que o método Isostretching não foi superior à cinesioterapia convencional no tratamento da lombalgia, sendo necessários novos estudos.
... Therefore, it might be feasible that school pride may have major consequences such as commitment and loyalty, increased con-sumption, and positive word of mouth for both sport consumers and sport marketers in the context of intercollegiate sports (Decrop & Derbaix, 2010). In addition, college life can be an emotionally challenging and stressful time for students (Kennedy, Kassab, Gilkey, Linnel, Morris, 2008). It seems reasonable that football games would be attractive to both groups in need of an escape from their routines (Wann, Grieve, Zapalac, & Pease, 2008). ...
... Although the concern of college students' back health has recently been addressed, research studies are still comparatively sparse (Kennedy et al. 2008). The objective of this study was to investigate the most critical backpack load for male college students by assessing simultaneously the changes in spinal curvature changes along the whole spine. ...
Change in sagittal spinal curvature from the neutral upright stance is an important measure of the heaviness and correctness of backpack use. As current recommendations, with respect to spinal profile, of backpack load thresholds were based on the significant curvature change in individual spinal region only, this study investigated the most critical backpack load by assessing simultaneously the spinal curvature changes along the whole spine. A motion analysis system was used to measure the curvature changes in cervical, upper thoracic, lower thoracic and lumbar regions with backpack load at 0, 5, 10, 15 and 20% of body weight. A multi-objective goal programming model was adopted to determine the global critical load of maximum curvature change of the whole spine in accordance with the maximum curvature changes of the four spinal regions. Results suggested that the most critical backpack load was 13% of body weight for healthy male college students.
Practitioner Summary: As current recommendations of backpack load thresholds were based on the significant curvature change in individual spinal region only, this study investigated the backpack load by considering simultaneously the spinal curvature changes along the whole spine. The recommendation, in terms of the global critical load, was 13% of body weight for healthy male college students.
... Ample research suggests many people today suffer pain without relief, including college students [1]. It is also well established that people in pain may abuse drugs [2][3][4]. ...
... However, the etiology of the majority of these backaches (85% to 88%) in adults has never been identified 8 . Moreover, much of studies related to idiopathic low back pain are focused on the adult population, which leads to a lack of understanding about the causes and beginning of this condition among adolescents and children 9 , although the incidence rates of low back pain in adults are similar to those in adolescents and children 10 . ...
http://dx.doi.org/10.5007/1980-0037.2014v16n6p680
O objetivo do trabalho foi verificar a prevalência de dor associada ao transporte de material escolar por estudantes universitários. Realizou-se pesquisa transversal, quantitativa, descritiva-analítica, na qual foram avaliados 373 estudantes universitários da Universidade Estadual da Paraíba, entre fevereiro e setembro de 2012. As informações foram coletadas através de questionário sobre dados sociodemográficos, acadêmicos, transporte do material escolar e presença de dor, sendo ainda realizada a medição de dados antropométricos e pesagem de todos os volumes transportados pelo indivíduo. Os dados foram analisados de forma descritiva e inferencial através do software SPSSÒ 17.0. Utilizou-se modelo de Regressão Logística Hierárquica Binária, pelo método Backward LR, no qual o poder de influência das variáveis preditoras – divididas em blocos – foi testado na presença de dor musculoesquelética. Constatou-se uma prevalência de dor de 82,84%, com média geral de 5,21 pontos na Escala Visual Analógica (EVA) para avaliação de dor. Nas mulheres, a influência exercida pela massa relativa dos volumes sobre a presença de dor foi 45,1% maior que entre os homens (OR = 0,689; IC95% = 0,503 – 0,942) para cada 1% de incremento. O tempo de carga, por sua vez, aumentou em 22,9% a probabilidade da presença de dor, a cada 15 minutos decorridos (OR = 1,229; IC95% = 1,090 – 1,386). Verificou-se alta prevalência de dor relacionada ao transporte de material escolar e a influência preditora de variáveis como peso relativo da carga transportada e tempo de transporte desse material, especialmente nos indivíduos do sexo feminino.
... Ample research suggests many people today suffer pain without relief, including college students [1]. It is also well established that people in pain may abuse drugs [2][3][4]. ...
Objectives: Substance abuse is widespread among college students. This study strove to: (1) Examine the prevalence of substance abuse among college students; (2) The prevalence of pain among this sample; (3) The relationship between substance abuse and pain among this cohort. Participants: Participants were 244 undergraduate students from a large public Midwestern College. Methods: Subjects completed three surveys: A Demographic Survey, a validated Drug Abuse Screening tool; and Pain Questionnaire. Results: (1) The prevalence of substance abuse was 11.5%; (2) The prevalence of pain was 9.7%; (3) Pain was strongly and positively associated with drug use (<0.01); (4) This association was stronger for women than men, and for Seniors, rather than Freshman (<0.05). Conclusions: In general, the finding that pain and drug use were strongly and positively linked among this cohort of college students, but varied with gender and years in college, may be useful for designing future tailored prevention programs.
Background
Low back pain (LBP) is a leading cause of disability. Recurrent low back pain (rLBP) is defined as two or more episodes of LBP in a 12-month period, each lasting more than 24 hours and separated by at least one pain-free month. Many studies have shown that hip and trunk variables have an influence on LBP. However, most of these are studies of participants with acute or chronic LBP rather than rLBP.
Purpose
To examine the difference between hip and trunk variables of university students with and without rLBP.
Study Design
Cross-Sectional
Methods
Participants with and without rLBP between 18 and 35 years of age not currently undergoing clinical orthopedic care were recruited for this cross-sectional study. Bilateral hip range of motion (ROM) and trunk ROM were measured with a goniometer or measuring tape (hip motions in all planes along with trunk flexion, extension, and lateral flexion). Strength of the hip extensors, abductors, and external rotators was measured using a handheld dynamometer, and a single-leg bridge endurance test was performed to assess differences and correlations between outcomes.
Results
Twenty-six subjects aged 18 to 35 years with rLBP (n=10) and without rLBP (n=16) participated. Statistically significant differences between the two groups were found for right and left hip flexion (p = 0.029 and 0.039, respectively), right hip adduction (p = 0.043), and right hip extension (p = 0.021). No significant differences were found between groups for strength, endurance, or other ROM measures.
Conclusion
The findings of this study show statistically significant although clinically non-meaningful differences in hip flexion, extension, and adduction ROM in the rLBP group compared to the control group. This lack of clinically meaningful difference may be relevant to testing procedures and treatment of patients or athletes with rLBP. This study also suggests that hip strength and endurance may not play a major role in the development or treatment of rLBP. Level of Evidence: 3
Aim: The effects of chiropractic manipulation, muscle energy technique and home exercise program on pain, depression and functional level were compared in patients diagnosed with sacroiliac joint dysfunction (SIJD) in this study. Materials and Methods: Forty-five volunteer patients aged 20-65 years who were diagnosed with SIJD participated in this study. The patients were tested through chiropractic and orthopedic examination methods, and aspects of dysfunction were detected. Patients were randomized into 3 groups: Chiropractic Manipulation Group (CM), Muscle Energy Technique Group (MET), Control Group. All groups were assigned a home exercise program. All treatment groups were evaluated with numerical pain scale (NPS), Oswestry low back pain disability questionnaire (OLBPDQ), Beck depression inventory (BDI) and algometer before and after treatment. Descriptive statistics were used in data analysis, Kruskal-Wallis tests in intergroup comparisons, Mann-Whitney U tests in pairwise comparisons, and Friedman, post-hoc Wilcoxon Rank tests were used for intragroup comparisons. The statistical significance value was set at p
Perceived stress among university students is a prevalent health issue directly correlated with poor academic performance, poor sleep quality, hopelessness, compromised physical and mental health, high risk of substance abuse, and suicidal ideation. Tamarkoz, a Sufi meditation, may reduce the impact of stressors to prevent illness among students. Tamarkoz is the art of self-knowledge through concentration and meditation. It is a method of concentration that can be applied to any task. The method is said to discipline the mind, body, and emotions to avoid unintended distractions. Therefore, it can be used in daily life activities, such as studying, eating, driving, de-stressing or in Sufism, seeking self-knowledge. This study was an 18-week quasi-experimental design with pre-intervention, post-intervention and follow-up assessments in the experimental group, a wait-list control, and a third group that utilized the campus health center’s stress management resources. Participants, university students, had no prior exposure to Tamarkoz, and there were no statistically significant differences among groups on baseline measurements. Using a generalized linear mixed model, significant increases in positive emotions and daily spiritual experiences, and reductions in perceived stress and heart rate were found in the experimental group compared to the other two groups. Tamarkoz seems to show some advantages over the usual stress management resources offered by a student health center.
Trial registration: ClinicalTrials.gov Protocol Registration Date: (03/04/2018); ClinicalTrials.gov ID: NCT03489148.
Objective
The purpose of this pilot study was to examine relationships between perceived stress, coping, and diabetes self-care activities among college students with type 1 diabetes.
Participants
College students, self-reported as diagnosed with type 1 diabetes.
Methods
Students responded to an online self-report questionnaire (Perceived Stress Scale, Brief COPE, Summary of Diabetes Self-Care Activities).
Results
ANOVA analysis showed significant differences between levels of perceived stress for healthy diet and foot care. Simple linear regression analysis showed significant relationships between healthy diet and active coping, positive reframing, and planning; between exercise and humor; between blood glucose testing and active coping, planning, and acceptance; and between foot care and active coping and positive reframing.
Conclusions
Our results indicate that effective stress management and coping skills will positively impact diabetes self-care. Educational programs for college students with type 1 diabetes should address self-care activities as well as psychosocial factors that affect health.
Background: Hazardous alcohol use among college students is a growing problem. Alcohol is commonly used in the context of pain due to acute analgesic effects, although the role of pain among hazardous drinkers has not been examined. Little is known regarding factors that may moderate pain-alcohol relations. One factor is anxiety sensitivity, which reflects the fear of physiological sensations. Pain severity and anxiety sensitivity may interact such that those with high anxiety sensitivity may have stronger pain-alcohol relations.Objectives: The current study examined interactive associations of pain severity and anxiety sensitivity in relation to hazardous drinking severity, alcohol consumption, and alcohol problems among hazardous drinking college students (n = 370; 78.1% female).Methods: Self report measures of alcohol use, pain severity, and anxiety sensitivity were collected and moderation analyses were conducted.Results: There was a significant interaction of pain severity and anxiety sensitivity in relation to hazardous drinking severity (β = 0.25, p = .037); pain severity was significantly related to hazardous drinking for high (β = 0.28, p < .001) but not low (β = 0.09, p = .202) anxiety sensitivity. There was a similar interaction for alcohol consumption (β = 0.35, p = .008). For alcohol problems, there was no significant interaction, but there were unique main effects of both pain severity (β = 0.23, p < .001) and anxiety sensitivity (β = 0.34, p < .001).Conclusions: These findings suggest that drinkers with high anxiety sensitivity may use alcohol hazardously (and in greater quantities) in the context of pain. If replicated with longitudinal samples, the findings may inform clinical practice in terms of screening for and treatment of anxiety sensitivity.
Segmental instability of the lumbar spine as one possible cause of development of chronic back pain is still a challenge in daily clinical work. For orthopedic rehabilitation, structured treatment programs with a multimodal basis are applied. Psychological interventions comprise part of the interdisciplinary procedure. Different psychological tests and therapeutic aspects are applied in a standardized manner and extended by the use of diagnostic tools and psychological treatment, where necessary. The therapeutic concept applied to treat chronic back pain in the author´s clinic is discussed in the present article.
Objective:
Pain affects a significant proportion of college students in the United States and has been linked to anxiety and depressive symptoms. Rumination and worry, two transdiagnostic factors linked to comorbidity, may explain the relationship between pain and mental health symptoms. Current Study: The current study examined worry and rumination as explanatory factors in the relationship between pain and anxiety and depressive symptoms in a sample of college students with pain (n = 1,577; 79.9% female).
Results:
Results indicated that both rumination and worry explained the relationship between pain and depressive and social anxiety symptoms, while rumination alone explained the relationship between pain and anxious arousal symptoms.
Conclusion:
The current study provides novel empirical evidence that worry and rumination each help explain the relationship between pain and anxiety and depressive symptoms among college students with current pain, and college students in pain may benefit from targeted psychosocial strategies aimed at decreasing worry and ruminative responses.
An understanding of how missed class and work are influenced by psychosocial factors is important. The authors collected data from 303 college students through self-report questionnaires. Moderation analysis indicated that with higher perceived stress, students were more likely to miss class if they were less satisfied with social support and less likely to miss work if they engaged in avoidant coping strategies. College counselors can provide students with skills to enhance academic performance and engagement in academic life.
Low distress tolerance, an important component of emotion regulation, is a risk factor for unhealthy eating. Identifying factors which explain the link between distress tolerance and unhealthy eating can advance the understanding of problematic eating and inform prevention and treatment of obesity and eating disorders. The present study examines pain catastrophizing as a mediator between distress tolerance and unhealthy eating in a nonclinical population, which has received little attention despite being a risk factor for unhealthy eating behaviors. The Distress Tolerance Scale (DTS), Pain Catastrophizing Scale (PCS), and the Dutch Eating Behavior Questionnaire (DEBQ), were administered to 171 college students (62.6% female, 38.6% White, 28.1% Hispanic). There was no evidence of a significant direct effect of distress tolerance on unhealthy eating. However, as hypothesized, there was a significant indirect or mediated effect of pain catastrophizing on the relationship between distress tolerance and unhealthy eating. Individuals low in distress tolerance reported higher pain catastrophizing, and a result, these individuals also reported higher levels of unhealthy eating. These findings introduce pain catastrophizing as an influential variable in the link between distress tolerance and unhealthy eating. Findings suggest that reducing catastrophic thinking about pain may be a worthy target of intervention in reducing unhealthy eating.
Back diseases belong to the most monitored area of locomotor apparatus diseases in clinical occupational medicine. Published papers so far were mostly dealing with diseases of hard workers. Recently, there is a growing amount of white collar workers with sedentary work. This paper presents the analysis of an anonymous study of PC workers. The questionnaire included questions to consider relevant risk factors for back diseases. Economists, computer programmers, high school teachers and students were asked to fill up the questionnaire. The analyses show that back diseases can be caused not only by risk factors typical for hard work, but also by long sedentary work with the neck pain and low back pain as the most usual diseases. The statistically significant influence of age and psychosocial factors like work satisfaction, salary satisfaction or employment relationship satisfaction on back pain presence was also confirmed.
Objective:
To analyze the literature in which researchers have utilized the NCHA I or the NCHA II.
Participants and methods:
The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses.
Results:
The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers.
Conclusions:
Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.
Purpose:
To evaluate the extent of intra-subject difference in hamstring flexibility and its possible relationship to the severity of Low Back Pain (LBP). A secondary purpose was to evaluate the extent of intra-rater reliability using both electrogoniometer and conventional goniometer for measuring hamstring tightness.
Importance:
Potential correlations between muscle impairments and LBP may lead to more effective treatments and prevention strategies.
Methods:
Seventy two participants with mechanical LBP were recruited for this study. The sample included; 41 females, 31 males with a mean age of 33.69 ± (11.04) years, height of 170 ± (9) cm, and weight of 79.5 ± (1.6) kg. Hamstring length was detected indirectly using the Active Knee Extension method in the 90/90 position from supine. The amount of extension was measured using both electro-goniometer (EG)and a standard goniometer (SG).
Results:
Right lower extremities of these patients were significantly more flexible than left ones at α = 0.025 ( t_{72} = 3.14, p=0.002). Similarly, dominant lower extremities of these patients were significantly more flexible than the non dominant ones at α=0.025 ( t _{72} =2.56, p=0.013). Additionally, Oswestry scores of the patients were significantly and positively correlated with the amount of hamstring tightness of the right lower extremities (r=0.244, p=0.039), left lower extremities (r=0.225, p=0.048) and the average of both sides (r=0.24, p=0.039). However, the Oswestry scores were negatively, but insignificantly correlated to the absolute difference between right and left extremities at (r=-0.156, p=0.091). Finally, the extent of intrasubject reliability in measuring hamstring tightness using EG and SG was found to be high (ICC=0.93).CONCLUSION: There is a possible relation between mild mechanical LBP and hamstrings tightness. It was found that the more the tightness, the higher the severity of LBP that patient experienced. Also, these patients had one of their lower extremities significantly tighter than the other. Such tightness was successfully detected utilizing both EG and SG. These findings and their possible pathomechanical consequences should be considered while constructing effective rehabilitation protocols for patients with mechanical LBP.
Despite the increasing number of prescriptions written to adolescents and young adults for opioid analgesics, the rise in non-medical use of such drugs among university students, and the potential role of craving in the misuse of opioids, there have been no published studies assessing craving for prescription opioids in this population. Therefore, the current study was designed to assess the impact of prescription opioid-related cue exposure on craving in university students. Students (n = 277) recruited from a large university in the Midwestern United States were randomly assigned to two conditions to test the impact of cue exposure to either prescription opioid-related stimuli or control stimuli. Relative to the control condition, prescription opioid-related cue exposure significantly increased overall craving, desire and intention to use prescription opioids, relief from negative states by using prescription opioids, and perceived control over prescription opioid use. In addition, when assessing correlates of post-cue exposure craving, negative mood and procurement of prescription opioids from non-medical sources were the only measured variables that were significantly associated with overall craving and/or any of the craving measure’s subscales. Craving may be important aspect of prescription opioid use among university students. Future research assessing craving as a function of non-medical user subtype is warranted.
The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical–environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).
The objectives of this study were to examine the relation between occupational and nonoccupational conditions and both incident
(IBLP) and chronic low back pain (CLBP), aswellasdepression, among women and men. Data from a4-year follow-up of a study group
consisting of 420 participants of both genders from the general Swedish population were analysed. Occupational risk indicators
were predictors for both ILBP and CLBP. Depression was not found to be a predictor for either IBLP or CLBP among women, but
was a predictor for CLBP among men. Among women, depression had some risk indicators in common with ILBP and appeared to be
a concurrent outcome rather than a risk indicator. Low back pain in 1993 was not a predictor for depression in 1997 in either
women or men. Occupational conditions are of relevance in relation to both incident and CLBP. Nonoccupational conditions were
stronger predictors for CLBP than for ILBP but had some predictive value also for ILBP.
We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem.
In 1985, the National Institute for Occupational Safety and Health (NIOSH) convened an ad hoc committee of experts who reviewed the current literature on lifting, recommend criteria for defining lifting capacity, and in 1991 developed a revised lifting equation. Subsequently, NIOSH developed the documentation for the equation and played a prominent role in recommending methods for interpreting the results of the equation. The 1991 equation reflects new findings and provides methods for evaluating asymmetrical lifting tasks, lifts of objects with less than optimal hand-container couplings, and also provides guidelines for a larger range of work durations and lifting frequencies than the 1981 equation. This paper provides the basis for selecting the three criteria (biomechanical, physiological, and psychophysical) that were used to define the 1991 equation, and describes the derivation of the individual components (Putz-Anderson and Waters 1991). The paper also describes the lifting index (LI), an index of relative physical stress, that can be used to identify hazardous lifting tasks. Although the 1991 equation has not been fully validated, the recommended weight limits derived from the revised equation are consistent with or lower than those generally reported in the literature. NIOSH believes that the revised 1991 lifting equation is more likely than the 1981 equation to protect most workers.
In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One-third of the hospital care costs and one-half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. The total direct medical costs of back pain were estimated at US200 million. The mean costs of hospital care for back pain per case were US199 for an outpatient. The total indirect costs of back pain for the entire labour force in The Netherlands in 1991 were estimated at US3.1 billion was due to absenteeism and US4622 and US$9493, respectively. The indirect costs constituted 93% of the total costs of back pain, the direct medical costs contributed only 7%. It is therefore concluded that back pain is not only a major medical problem but also a major economical problem.
To examine the associations of low back pain symptoms with waist circumference, height, waist to hip ratio and body mass index, and to test the interactions between (1) waist circumference and height, and (2) waist to hip ratio and body mass index.
Cross-sectional study set in The Netherlands of a random sample of 5887 men and 7018 women aged 20-60 y.
The prevalences of low back pain in men and women in the past 12 months were 46% and 52%, of whom 17% and 21% had low back pain for a total of 12 or more weeks, and 13% and 18% had symptoms suggestive of intervertebral disc herniation. After adjustments for age, smoking and education, more women in the highest tertile of waist circumference reported low back pain in the past 12 months (odds ratio = 1.2, 95% confidence interval: 1.1-1.4), low back pain for a total of 12 or more weeks (odds ratio = 1.5, 95% confidence interval: 1.3-1.8), and intervertebral disc herniation symptoms (odds ratio = 1.3, 95% confidence interval: 1.1-1.6) than women in the lowest waist tertile. Corresponding values of low back pain symptoms for women with high body mass index or high waist to hip ratio were similar to those with high waist. There were no significant differences between men in different tertiles of waist, waist to hip ratio or body mass index reporting low back pain symptoms. Tallest subjects did not report low back pain symptoms more often than shortest subjects. There was no significant interactions between waist and height or between waist to hip ratio and body mass index on low back pain symptoms.
Women who are overweight or with a large waist have a significantly increased likelihood of low back pain. There are no significant interactions between waist and height, or waist to hip ratio and body mass index on low back pain symptoms.
The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical-environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).
To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain.
Prospective cohort study.
Two general practices in the south Manchester area.
180 patients, who previously participated in a cross sectional population survey, who consulted because of low back pain during the study period. They were followed at 1 week and 3 and 12 months after consultation.
Persistent disabling low back pain in the 12 months after the consultation.
Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age, among those with a history of low back pain, and in women. Persistence of symptoms was associated with "premorbid" factors (high levels of psychological distress (odds ratio 3.3; 95% confidence interval 1.5 to 7.2), poor self rated health (3.6; 1.9 to 6.8), low levels of physical activity (2.8; 1.4 to 5.6), smoking (2. 1; 1.0 to 4.3), dissatisfaction with employment (2.4; 1.3 to 4.5)) and factors related to the episode of low back pain (duration of symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespread pain (6.4; 2.7 to 15), and restriction in spinal mobility). A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6% to 70%.
The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid state.
Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost.
Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period.
The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied.
This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition on American industry in terms of lost workdays.
This paper reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be pound1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total pound10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area.
To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain.
Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results.
This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes.
The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain.
Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers).
This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.
Low back disorders (LBDs) continue to be the most common musculoskeletal problem in the workplace. It affects many workers, is associated with high costs to industry and the individual, and can negatively influence the quality of life for the workers. Currently there is significant controversy about the work-relatedness of LBD and the ability of ergonomics interventions to control the problem. This paper systematically examines the body of knowledge associated with LBDs and considers how information from different disciplines of study collectively might be used to assess the causality and control of LBD due to physical factors associated with work.
A previous history and earlier onset of low back pain are associated with chronic low back pain in adults, implying that prevention in adolescence may have a positive impact in adulthood. The study objectives were to determine the incidence of low back pain in a cohort of adolescents and to ascertain risk factors. A cohort of 502 high school students in Montreal, Canada, was evaluated during 1995-1996 at three separate times, 6 months apart. The outcome was low back pain occurrence at a frequency of at least once a week in the previous 6 months. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed low back pain over the year (cumulative incidence, 17 percent). Risk factors associated with development of low back pain were high growth (odds ratio = 3.09; 95 percent confidence interval (CI): 1.53, 6.01), smoking (odds ratio = 2.20; 95% CI: 1.38, 3.50), tight quadriceps femoris (odds ratio = 1.02; 95% CI: 1.00, 1.05), tight hamstrings (odds ratio = 1.04; 95% CI: 1.01, 1.06), and working during the school year (odds ratio = 1.33; 95% CI: 1.03, 1.71). Modifying such risk factors as smoking and poor leg flexibility may potentially serve to prevent the development of low back pain in adolescents.
To determine whether physical and psychosocial load at work influence sickness absence due to low back pain.
The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7-44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period.
After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain.
Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.
Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain. Aim: To assess the role of both mechanical and psychosocial factors (including emotional and behavioural problems and other somatic pain complaints) in childhood LBP.
A cross sectional study was carried out in a population of 1446 schoolchildren aged 11-14 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary.
Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong associations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness.
Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren.
Following reports of high prevalence of low back pain (LBP) in young physiotherapists, we investigated whether LBP was a problem for undergraduate physiotherapy students.
Physiotherapy students enrolled in one Australian tertiary institution completed a validated self-administered questionnaire in April 2001, seeking information on LBP prevalence (lifetime, 12 month, one-month, one-week), and its risk factors. The survey incorporated the Nordic back questionnaire, questions on common risks for LBP, and purpose-built questions regarding educational exposures. Univariate logistic regression models were applied to test associations.
72% students responded. LBP prevalence was 69% (lifetime), 63% (12-month), 44% (one-month), 28% (one-week). The risk of LBP increased significantly for students once they completed first year. Being aged 20 or 21 years (final year students) was significantly associated with all measures of LBP, compared with the youngest students. Exposure to tertiary study of greater than two years was associated with lifetime, 12 month and one-month LBP prevalence. Spending more than 20 hours in the past month 'sitting looking down' was significantly associated with one-month LBP prevalence. Similar exposure to 'treating patients' was significantly associated with one-month and one-week LBP prevalence.
Physiotherapy students should be alerted to the likelihood of LBP and is potential causes during their training, so that they enter the workforce with reduced risk of LBP. The potential for other undergraduate students to suffer LBP should also be considered.
Although back disorders are a major occupational problem for nursing staff, few studies distinguish different types. By means of a structured questionnaire, we performed a cross-sectional study on the prevalence of diagnosed lumbar disc hernia, chronic low-back pain (LBP) (at least 90 d in the preceding 12 months) and acute LBP (intense pain for at least 1 d) with respect to physical, individual and psychosocial factors among female nurses (n=587), nursing aides (n=228) and head-nurses (n=43) working in a university hospital (95% of the female workforce). Almost all respondents reported known high-risk occupational activities. Overall prevalence of reported back disorders was 44% (acute LBP 19%, chronic LBP 17%, lumbar hernia 8%). On multinomial logistic regression analysis, scoliosis and commonly stress-related psychosomatic symptoms were associated with all three types of back disorder; trauma/fractures of the spine, pelvis and/or legs and a global work-environment/job-satisfaction score with acute LBP; increasing age with lumbar disc hernia. While confirming the relevance of considering different definitions of back disorder, our data indicate items for investigation in cohort studies. These include: identification of specific risk factors for lumbar hernia; avoidance of possible work-environment risk factors such as hurried execution of different tasks at the same time; and influence on job suitability of underlying spinal pathologies such as scoliosis.
Anthropometric measurements were studied for their prediction of herniated lumbar intervertebral disc in 332 men and women who had been discharged from hospital with this diagnosis during an 11-year follow-up. The patients were compared with 1,205 controls matched individually for sex, age, and place of residence. Men with a height of 180 cm or more showed a relative risk of 2.3 (95% confidence limits, 1.4-3.9) and women with a height of 170 cm or more 3.7 (1.6-8.6), compared with those who were more than 10 cm shorter (1.0). In men, but not in women, increased body mass index proved to be an independent risk factor for herniated lumbar disc, whereas the thickness of triceps skinfold had no predictive significance. Height and heavy body mass may be important contributors to the herniation of lumbar intervertebral disc.
Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain.
Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7–44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period.
Results: After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain.
Conclusions: Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.
In a cross-sectional study, the relationship of low back pain and sedentary work was examined among crane operators (n = 94), straddle-carrier drivers (n = 95), and a reference group of office workers (n = 86), aged 25 to 60 years. Information about history of low back pain, individual characteristics, and working conditions in past and present was obtained by a standardized interview. Assessment of postural load on the back was performed by observation of non-neutral postures of the trunk during normal work activities. Measurements of exposure to whole-body vibration in cranes and straddle-carriers were conducted. The 12-month prevalence of low back pain among crane operators was 50%; among straddle-carrier drivers, 44%; and among office workers, 34%. After adjustment for age and confounders, the odds ratio for newly developed cases of low back pain in the current job among crane operators was 3.29 (95% confidence interval, 1.52 to 7.12), and among straddle-carrier drivers 2.51 (95% confidence interval, 1.17 to 5.38). In both occupations the daily exposure to whole-body vibration was low, and therefore not considered an important risk factor for low back pain in this study. The observations showed that non-neutral postures of the trunk were frequently adopted among all workers. The results of this study suggest that sustained sedentary work in a forced non-neutral trunk posture is a risk factor for low back pain.
A population-based survey of approximately 4000 adults in Belgium, a bi-cultural country with a uniform health care system, explored the relationships of socio-cultural and employment factors to the reported experience of low back pain (LBP). Predictors of 1) history of LBP, 2) first LBP, and 3) daily LBP were examined by multiple logistic regression analysis. Thirty-three percent of the population had current LBP, including 5% experiencing their first episode; 26% had past but not current LBP, and 41% had never had LBP. Increasing age (OR > 2.0, P = .000) and female gender (OR 2.16, P = .000) were associated with history of LBP; only gender (OR 1.40, P = .02) was associated with first episode; neither was associated with daily LBP. Language was associated with history (OR 1.80, P = .000) and first occurrence (OR 1.77, P = .000) but not daily LBP. Among those employed, work dissatisfaction was associated with history of LBP (OR > 2.4, P = .02) and daily LBP (OR 3.85, P = .02), but not with first episode. The results suggest that sociocultural factors influence the expression of LBP, but not the risk of chronicity once LBP is reported, and that work satisfaction may not be causally related to LBP, but may intervene along with type of occupation in the possibility of continuing employment once LBP is present. Prospective studies are needed to confirm these results and elucidate causal relationships.
Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.
Work-related low-back disorders (LBDs) continue to be one of the single largest sources of compensation costs. The relative contributions of personal, workplace, organizational, and environmental variables to the development and severity of LBDs are not completely understood. The inclusion of personal variables in epidemiologic studies of LBDs has been inconsistent, and different authors have different opinions concerning the importance of such variables. Personal variables either known or suspected to influence outcomes are discussed to elucidate the importance of these variables with respect to understanding LBDs and conducting epidemiological studies in industry. The authors suggest that age, gender, injury history, relative strength, smoking, and psychosocial variables be studied further, and that height, weight, pathologies, genetic factors, maximum oxygen uptake, and absolute strength are unlikely to produce significant effects in industrial populations.
A retrospective cohort study.
To describe the incidence and duration of low back pain in patients from the general working population in Norway who take at least 2 weeks of compensated absence from work.
There is a growing concern about the proportion and socioeconomic consequences of work absence resulting from low back pain, and exact figures on incidence and duration of work incapacity from low back pain in the general working population are needed.
Cases were identified from files of the national medical insurance system, covering 90% of all employees in Norway. A total of 89,190 patients with low back pain were identified in 1995 and 1996, based on the International Classification of Primary Care (ICPC codes L02, L03, L84 and L86). Census data were used for the denominators.
The estimated overall 1-year incidence was 2.27%. It was significantly higher for women (2.72%) than for men (1.91%). The incidence increased with increasing age. The median (25th-75th percentile) duration of absence for all claimants was 43 days (25th-75th percentile, 23-103). Approximately 35% of claimants returned to work after 1 month, 70% had returned after 3 months, and 85% had returned after 6 months. Thirty percent of all claimants had low back pain with radiation, and the median duration of absence for these was 59 days (25th-75th percentile, 28-152 days) versus 38 days (25th-75th percentile, 21-86 days) for claimants without radiating pain (P < 0.001).
The results of this study reaffirm the burden of low back pain to society. The data show that the prognosis for the majority of this group of patients with low back pain, even for those with radiating symptoms, is generally good. From 6 to 20 weeks after onset, however, the return-to-work curve declined steeply among the individuals studied. Approximately 42% of those still off work after 6 months had not returned to work after 12 months, and were switched to permanent disability pension or other compensation forms.
A cross-sectional study of the 1-year prevalence of low back pain was conducted in workers employed in manual lifting jobs.
To provide epidemiologic data to determine the correlation between the prevalence of low back pain and exposure to manual lifting stressors, measured with the lifting index component of the revised lifting equation from the National Institute for Occupational Safety and Health (NIOSH).
The NIOSH lifting equation has been proposed as a practical, yet valid tool for assessing the risks of low back pain caused by manual lifting. To date, however, there have been few studies in which the effectiveness of the equation to identify jobs with elevated rates of low back pain has been evaluated.
Fifty jobs from four industrial sites were evaluated with the NIOSH lifting equation. A symptom and occupational history questionnaire was administered to 204 people employed in lifting jobs and 80 people employed in nonlifting jobs. Regression analysis was used to determine whether there was a correlation between the lifting index and reported low back pain.
As the lifting index increased from 1.0 to 3.0, the odds of low back pain increased, with a peak and statistically significant odds ratio occurring in the 2 < lifting index < or = 3 category (odds ratio = 2.45). For jobs with a lifting index higher than 3.0, however, the odds ratio was lower (odds ratio = 1.45).
Although low back pain is a common disorder, the lifting index appears be a useful indicator for determining the risk of low back pain caused by manual lifting.
A prospective study of personal risk factors for first-time low back pain.
To construct and validate a multivariate model to predict low back pain.
Various physical and psychological factors have been reported to increase the risk of low back pain, but conflicting results may be attributable to inaccurate "clinical" measures and to poorly validated statistical models.
A total of 403 health care workers aged 18-40 years volunteered for the study. None had any history of "serious" back pain requiring medical attention or time off work. The volunteers completed the following questionnaires: the modified somatic perception questionnaire, the Zung depression scale, and the Health Locus of Control. Anthropometric factors were quantified using standard techniques. The 3Space Isotrak device (Polhemus, VT) was used to measure lumbar curvature and hip and lumbar spine mobility. Leg and back strength and back muscle fatiguability were measured in functional postures. Postal follow-up questionnaires, sent after 6, 12, 18, 24, 30, and 36 months, inquired about back pain, and multivariate logistic regression was used to identify risk factors at each follow-up.
The response rate fell from 99% at 12 months to 90% at 36 months, at which time 90 volunteers reported "serious" back pain and 266 reported "any" back pain. The following were consistent predictors of serious back pain: reduced range of lumbar lateral bending, a long back, reduced lumbar lordosis, increased psychological distress, and previous nonserious low back pain. Only the latter three were consistent predictors of "any" back pain. Physical factors had the most influence in a sub-population of volunteers who were new to the job.
Personal risk factors explained up to 12% of first-time low back pain.
A prospective, repeated-measures cohort design with high school students from Montreal, Canada.
To determine whether smoking was a risk factor for the development of low back pain or other musculoskeletal pain in a cohort of adolescents.
Smoking has been associated with low back pain in adults. Many adolescents smoke, and the prevalence of low back pain in this age group is 30%. A history of low back pain is predictive of future problems.
A total of 502 students from grades 7 to 9 were assessed from 3 schools. Data were collected at 3 times: at the beginning of the study, at 6 months, and at the end of a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and life-style factors, which included smoking. Measurements of height, weight, trunk and leg flexibility, and trunk strength were obtained. Low back pain occurring at a frequency of at least once a week in the past 6 months was defined as the outcome. Multivariate methods were used to model the repeated-measures dichotomous outcome as a function of smoking and other covariates.
Smokers experienced low back pain more than nonsmokers (odds ratio, 2.4; 95% confidence interval, 1.3-6.0). There was also a dose-response relationship between amount smoked and development of low back pain. Smokers tended to experience more upper limb or lower limb pain than nonsmokers, although this result was not significant.
Smoking was found to increase the risk for low back pain in this cohort of adolescents.
The literature on psychological factors in neck and back pain was systematically searched and reviewed.
To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain.
Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn.
Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome.
The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor.
Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
A systematic literature review of population prevalence studies of low back pain between 1966 and 1998 was conducted to investigate data homogeneity and appropriateness for pooling. Fifty-six studies were analyzed using methodologic criteria that examined sample representativeness, data quality, and pain definition. Acceptable studies were assessed for homogeneity and appropriateness for pooling. Thirty were methodologically acceptable. Of these there were significant differences in study design, patient age, mode of data collection, potential temporal effects, and prevalence results. Point prevalence ranged from 12% to 33%, 1-year prevalence ranged from 22% to 65%, and lifetime prevalence ranged from 11% to 84%. A limited number of studies were left for analysis, making the pooling of data difficult. A model using uniform best-practice methods is proposed.
Back pain is a major source of lost work time. Occupational physical activity only accounts for a fraction of low back pain; therefore, there is growing interest in investigating other possible causes of back pain including the psychosocial work environment.
Material handlers (N = 6,311) in 160 newly opened stores were interviewed at study entry and approximately 6 months later. Factor analysis was used to reduce the 37 psychosocial questionnaire items to seven distinct factors.
After adjusting for history of back problems and work-related lifting, risk of back pain was moderately increased among employees who reported high job intensity demands (odds ratio (OR) = 1.8), job dissatisfaction (OR = 1.7), and high job scheduling demands (OR = 1.6).
Modification of the psychosocial work environment for material handlers in large retail stores may help reduce back pain among employees.
Back pain is the single most costly work-related injury. Chiropractors and physicians are the main primary care providers for occupational low back pain (OLBP), but there is no consensus regarding the relative cost-effectiveness of these two modes of care.
To critically appraise and synthesize recent literature on the cost-effectiveness of medical and chiropractic care for OLBP, and to propose a cost-effectiveness methodology that integrates epidemiologic and economic methods for future studies.
Literature review. MEDLINE was searched from 1990 through 1999. Nine articles that met the inclusion criteria were reviewed. The methodological quality of the articles was critically appraised independently by two epidemiologists using standardized review criteria. Two health economists reviewed the studies on cost-effectiveness.
The current literature suggests that chiropractors and physicians provide equally effective care for OLBP but that chiropractic patients are more satisfied with their care. Evidence on the relative costs of medical and chiropractic care is conflicting. Several methodological deficiencies limit the validity of the reviewed studies. No studies combine high-quality cost data with adequate sample sizes and controls for confounding factors.
Existing studies fail to clarify whether medical or chiropractic care is more cost effective. We suggest that future studies must combine epidemiologic and economic methods to answer the question adequately.
This paper focuses on the identification and testing of potential psychosocial factors contributing to an integrated multivariate predictive model of occupational low back disability. Psychosocial predictors originate from five traditions of psychosocial research: psychopathological, cognitive, diathesis-stress, human adaptation and organizational psychology. The psychosocial variables chosen for this study reflect a full range of research findings. They were investigated using 253 subacute and chronic pain injured workers. Three outcome measures were utilized: return-to-work status, duration of disability and disability costs. The key psychosocial predictors identified were expectations of recovery and perception of health change. Also implicated, but to a lesser degree, were occupational stability, skill discretion at work, co-worker support, and the response of the workers' compensation system and employer to the disability. All psychosocial models were better at predicting who will return than who will not return to work.
Concerns associated with backpack use among today's schoolchildren and adolescents have recently been raised. The presence of back discomfort, negative postural changes, and potential injury associated with the transport of heavy backpacks is now prevalent in increasing proportions. These problems may be a significant factor in the development of mobility problems during a child's adult years. The purpose of this article is to describe the potential dangers associated with backpack use and to discuss useful strategies that may be helpful in the prevention of injury and the promotion of wellness for today's youth.
The study reported here aims to identify the extent of back pain experienced by 11-14 year old schoolchildren, and establish the intensity, duration and frequency of exposure to physical risk factors present in schools. This paper considers the sitting postures of schoolchildren in the classroom. The sitting postures of 66 children were recorded in normal lessons using the Portable Ergonomic Observation Method (PEO). The study found significant associations between flexed postures and low back pain. Static postures and neck and upper back pain were also associated. This study has implications for schools, designers and people in the field of work related musculoskeletal disorders. Further research is required to examine the association between sitting posture and pain reported at different spinal locations.
Depression is a condition that worsens the prognosis of low back pain (LBP) and is under-recognized and undertreated in primary care. The purpose of this study was to evaluate the accuracy with which physical therapists screen for depressive symptoms among their patients with LBP.
Sixty-eight physical therapists and 232 patients with nonspecific LBP from 40 physical therapy clinics participated.
Patients completed the reference standard (Depression Anxiety Stress Scales [DASS]) and a 2-item screening test for depression taken from the Primary Care Evaluation of Mental Disorders Procedure (PRIME-MD). Treating physical therapists used a 0 to 10 scale to judge whether each patient was depressed. Based on the short-form Depression Anxiety Stress Scales (DASS-21) depression scale score, each patient was categorized as exhibiting normal, mild, moderate, severe, or extremely severe depression symptoms, and receiver operating characteristic (ROC) curves were generated to describe test accuracy.
The 2-item screening test was more accurate in screening for depressive symptoms than the physical therapists' ratings were; for example, in detecting moderate depressive symptoms in the 2 areas under the ROC curve, values were 0.66 versus 0.79.
Because the therapists did not accurately identify symptoms of depression, even symptoms of severe depression, despite the common presentation in their clinics, we recommend that physical therapists managing patients with LBP use the 2-item depression screening test. Administration of this screening test would improve physical therapists' ability to screen for symptoms of depression and would enable referral for appropriate management.
Physical symptoms are common in depression, and, in fact, vague aches and pain are often the presenting symptoms of depression. These symptoms include chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes. A high percentage of patients with depression who seek treatment in a primary care setting report only physical symptoms, which can make depression very difficult to diagnose. Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine. Dysregulation of these transmitters is linked to both depression and pain. Antidepressants that inhibit the reuptake of both serotonin and norepinephrine may be used as first-line treatments in depressed patients who present with physical symptoms. Many physicians consider patients to be in remission when their acute emotional symptoms have abated, but residual symptoms--including physical symptoms--are very common and increase the likelihood of relapse. All symptoms must be measured in order to achieve full remission. There are a number of short yet accurate measurement tools (rating scales) available that effectively measure the remission of physical symptoms as well as emotional symptoms.
Occupational stress The Handbook of Stress. Theoretical and Clinical Aspects
- Rr Holt
Holt RR. Occupational stress. In: Goldberger L, Breznitz S, eds. The Handbook of Stress. Theoretical and Clinical Aspects. 2nd ed. New York, NY: Free Press; 1993:419–444.
Evaluation of the revised NIOSH lifting equation. A cross-sectional epidemiology study Spine
- Waters
- Tr
- Baron
- Sl
- La Piacitelli
Waters TR, Baron SL, Piacitelli LA, et al. Evaluation of the revised NIOSH lifting equation. A cross-sectional epidemiology study Spine. 1999;24:386–394.
The epidemiology of spinal disorders
- Gbj Andersson