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The Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific)
Abstract
Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP. Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level Ia being the best level with evidence from meta-analysis of randomised controlled trials. Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.
... According to epidemiological reports, approximately 80% of individuals will experience LBP at some point in their lives [5]. Most LBP cases are nonspecific, meaning they have an unknown cause or no identifiable pathology [6]. Only a small percentage of cases (5%-10%) have a specific cause [6]. ...
... Most LBP cases are nonspecific, meaning they have an unknown cause or no identifiable pathology [6]. Only a small percentage of cases (5%-10%) have a specific cause [6]. In more than 50% of affected individuals, LBP becomes chronic, lasting more than 12 weeks, and is less amenable to therapeutic intervention [6]. ...
... Only a small percentage of cases (5%-10%) have a specific cause [6]. In more than 50% of affected individuals, LBP becomes chronic, lasting more than 12 weeks, and is less amenable to therapeutic intervention [6]. ...
Background
Studies comparing the effectiveness of telerehabilitation and spinal manual therapy (SMT) for chronic non-specific low-back pain (NSLBP) are limited. This study aimed to compare the efficacy of the telerehabilitation-based McKenzie therapy (TBMT) and SMT among patients with NSLBP.
Methods
Forty-nine consenting patients randomised into either TBMT ( n = 28) or SMT ( n = 21) group completed the study. TBMT is a mobile phone-based telerehabilitation involving the ‘McKenzie extension protocol’. SMT is a grade II (10 oscillations) posterior-anterior central vertebral pressure on the offending spinous process. Both interventions were applied thrice weekly for eight weeks, and outcomes were assessed on Pain Intensity (PI), Activity Limitation (AL), Participation Restriction (PR), and Health-related Quality of Life (HRQoL) in the fourth and eighth weeks.
Results
Within-group comparison across baseline, 4th and 8th week indicate that SMT had a significant effect on PI (F = 132.804, p = 0.001), AL (F = 75.984, p = 0.001), PR (F = 99.428, p = 0.001) and for all the scales of SF-12 except for mental health domain ( p > 0.05). Similarly, TBMT had a significant effect on PI (F = 243.631; p = 0.001), AL (F = 85.930; p = 0.001), PR (F = 48.425; p = 0.001), and for all the scales except also for mental health domain ( p > 0.05). However, there were no significant differences ( p > 0.05) in the treatment effects between SMT and TBMT, except for the ‘health perception’ ( p = 0.045) scale at week four and the ‘mental health’ scale ( p = 0.023) at week eight.
Conclusion
Telerehabilitation-based McKenzie method and SMT are effective in chronic NSLBP, with TBMT leading to significantly higher long-term health perception improvement.
Trial Registration
Pan African Clinical Trial Registry (PACTR202010667228786), Registered 27 October 2020-Retrospectively registered.
... Low Back Pain is defined as pain localized below the margin of the last ribs (costal margin) and above the inferior gluteal lines, with or without lower limb pain (Van Middelkoop M, Rubinstein SM, Verhagen AP et al (2010). The prevalence of low back pain is 60-85% during an individual's lifetime (Krismer M, van Tulder, M. (2007). At some point in life, between 15% and 20% of adults have this syndrome (Krismer M, van Tulder M. (2007), (Fernández-de-las-Peñas C, Hernández-Barrera V, Alonso-Blanco C et al (1976). ...
... The prevalence of low back pain is 60-85% during an individual's lifetime (Krismer M, van Tulder, M. (2007). At some point in life, between 15% and 20% of adults have this syndrome (Krismer M, van Tulder M. (2007), (Fernández-de-las-Peñas C, Hernández-Barrera V, Alonso-Blanco C et al (1976). Most of the cases (approximately 90%) are nonspecific and occur in all age groups 1. Local sources of LBP are intervertebral discs, facet joints, sacroiliac joints, muscles, fascia, bones, nerves, ...
... Only 10% of LBP has a specific cause due to a particular disease (Deyo RA, Rainville J, Kent DL (1992). Despite the lack of structural change in nonspecific LBP, it can limit daily activities and cause temporary or permanent inability to work, being one of the main causes of absence at work in the Western world (Krismer M, van Tulder M (2007). ...
Neurotherapy deals with the whole body/mind system in totality. The therapy uses the by-now well-established knowledge, that our body, like all other living beings in the universe, has the vital energy to cure itself, without any interference from external sources. Present study intended to the impact of neurotherapy in pain relief among patients of low back pain. To conduct the present study 92 samples selected by the author conveniently and treated with the planned treatment package of neurotherapy, 30 minutes daily for 3 months regularly. Before starting the treatment pre test had been conducted on VAS and after the treatment patients had been recorded again as post test on VAS. In results found that t value is 45.307 at .01 level. This is highly significant. Hence it is concluded that neurotherapy treatment is very effective on the pain relief among low back pain patients. In totality 96% patients had recorded improvement in their low back pain after the regular neurotherapy treatment.
... In den Studien erfolgte der Vergleich von WBVT vs. keine Maßnahme, WBVT vs. Bewegungstherapie mit allgemeinen körperlichen Übungen, WBVT vs. rumpfstabilisierende Übungen mit und ohne Atemwegswiderstand, WBVT vs. lumbale Extensionsübungen und WBVT vs. Ganzkörper-Elektromyostimulation. Die Behandlungsansätze variierten in Bezug auf die Dauer (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), Häufigkeit (2-bis 3-mal/Woche, 2 Anwendungen mit einer 2-wöchigen Pause), Vibrationsfrequenz , Art der Übungen (WBVT mit oder ohne statische oder dynamische Übungen), und Vibrationsrichtung (horizontal und vertikal). In allen 10 Studien, die die Schmerzintensität untersuchten, wurde eine signifikante Schmerzreduktion festgestellt. ...
... The lifetime prevalence of low back pain (LBP) is estimated to reach up to 84% and the prevalence of chronic low back pain (CLBP) is approximately 23%, with a notable 11-12% of the population experiencing disability due to LBP [3]. After an initial episode of LBP, 44-78% of individuals experience recurrence of pain and 26-37% experience a recurrence of work disability [3]. ...
... The lifetime prevalence of low back pain (LBP) is estimated to reach up to 84% and the prevalence of chronic low back pain (CLBP) is approximately 23%, with a notable 11-12% of the population experiencing disability due to LBP [3]. After an initial episode of LBP, 44-78% of individuals experience recurrence of pain and 26-37% experience a recurrence of work disability [3]. ...
Introduction
Non-specific low back pain (NLBP) is a common and clinically significant condition with substantial socioeconomic implications. Whole-body vibration therapy (WBVT) has shown effectiveness in improving pain and sensorimotor function (e.g., in osteoporosis) in previous studies. However, studies had heterogeneous settings. The aim of this study was to assess the effects of WBVT on pain, function, proprioception, and postural stability in patients with subacute and chronic NLBP.
Methods
A systematic literature search was conducted in the scientific databases PubMed, EMBASE, and PEDro (from inception until 17.05.2023). Only prospective controlled and uncontrolled studies were included. Outcome measures assessed were pain intensity, function (activities of daily living and physical function), proprioception, and postural stability.
Results
A total of 12 original articles ( n = 821) were included in the analysis. Ten of the studies were randomized controlled trials, one study had a crossover design, and one study had a one-group pre–post study design. The studies compared WBVT vs. no intervention, WBVT vs. basic physical therapy, WBVT vs. core stabilization exercises with and without respiratory resistance, WBVT vs. lumbar extension exercises, and WBVT vs. whole body electromyostimulation training. The treatment approaches varied in terms of duration (2–18 weeks), frequency (2–3 times per week, two applications with a 2-week break), vibration frequency (5–30 Hz), type of exercises (WBVT with or without static or dynamic exercises), and vibration direction (horizontal and vertical). Significant pain reduction was observed in all 10 studies that investigated pain levels. Significant improvement in daily activity function was reported in five of the six studies that investigated daily function, while improvement in physical function was observed in all four studies that investigated physical function. Improvement in proprioception was reported in all three studies that investigated proprioception, and significant improvement in postural stability was observed in four out of six studies that investigated postural stability. No adverse events or side effects related to WBVT were reported.
Conclusion
The majority of the included studies demonstrated significant pain reduction, improvement in physical and daily functioning, and enhanced proprioception. Improvement in postural stability was less consistent. WBVT appears to be a safe and effective treatment modality for subacute and chronic NLBP when used within a multimodal approach. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.
... LBP could be differentiated into two main types: non-specific and specific. Nonspecific LBP accounts for 90% of the cases, whereas only 5 to 10% of the cases are due to a specific cause [7]. The most common causes of LBP include vertebral fractures and their sequelae, axial spondylarthritis, tumors, infections, and intra-abdominal causes [7]. ...
... Nonspecific LBP accounts for 90% of the cases, whereas only 5 to 10% of the cases are due to a specific cause [7]. The most common causes of LBP include vertebral fractures and their sequelae, axial spondylarthritis, tumors, infections, and intra-abdominal causes [7]. ...
... LBP can be differentiated, from a chronological point of view, into three main subtypes (acute, sub-acute, and chronic) based on symptoms duration and onset [6,7]. Acute LBP lasts less than 4 weeks, subacute back pain lasts 4 to 12 weeks, and chronic back pain lasts more than 12 weeks [6,7]. ...
Background: Low back pain (LBP) is an emerging disease. This review aims to investigate the role of gender-related factors in the diagnosis, clinical, and surgical management of LBP. Methods: From January 2002 to March 2023, EMBASE, SCOPUS, OVID-MEDLINE, Google Scholar, PubMed, and Web of Science were searched to identify relevant papers for further analysis. Results: Fifteen papers were included in this review. Sex- and gender-related differences were analyzed regarding the following points: (1) LBP epidemiology; (2) LBP physiopathology; (3) conservative management of LBP; (4) major vertebral surgery for LBP. The conservative treatment of LBP highlights that women claim services later in terms of poorer health status than men. In the postoperative phase, female patients show worse LBP, quality of life, and disability, but equal or greater interval change, compared with male patients complaining of lumbar degenerative disease. Conclusions: LBP epidemiology and clinical outcomes, following conservative and surgical management of patients complaining of back pain, might depend on both sex- and gender-related factors. It is mandatory to assess gender-related indicators in patients referred to LBP and address them to improve their clinical outcomes and quality of life.
... These conditions further intensified health issues could have arisen among people susceptible to the effects of anxiety and stress induced by isolation and facing an unknown future. [28][29][30][31][32] In our study, we investigated the prevalence of nonspecific BP and NP, using these as a proxy to explore the correlations among health impacts attributable to stress-laden environments. Linked to a sedentary lifestyle and heightened anxiety, nonspecific pain in the neck and back manifests as discomfort in the lumbar spine without an identifiable cause. ...
... Linked to a sedentary lifestyle and heightened anxiety, nonspecific pain in the neck and back manifests as discomfort in the lumbar spine without an identifiable cause. 31 This contrasts starkly with specific spinal pain, which is attributable to identifiable pathological conditions such as disc herniation, spinal stenosis, vertebral infection, or neoplasm. A public health crisis like the COVID-19 pandemic can have significant effects on pain perception, which in turn affects both physical and mental health, 4-7 especially among certain groups such as health care workers. ...
Objective
We examined fluctuations in emergency department (ED) visits for nonspecific back and neck pain during the COVID-19 pandemic and explored potential contributing factors.
Methods
This retrospective cohort study included patients who presented to the ED with nonspecific back and neck pain between January 2019 and December 2021. Demographic data, visit frequencies, and clinical outcomes were analyzed to assess the impact of the pandemic on visit patterns.
Results
A total of 1245 ED visits were recorded. Visits decreased by 30% during the peak of the pandemic, with a gradual return to baseline by mid-2021. No significant changes in patient demographics or clinical outcomes were noted during the pandemic. However, a proportional increase in neck pain visits was observed.
Conclusions
The observed decline in visits may be linked to pandemic-related concerns, such as fear of exposure in the hospital and reduced activities. The increased neck pain visits highlights the potential influence of pandemic-related stress and lifestyle changes. Visit patterns rebounded as the pandemic eased, indicating a temporary decrease unrelated to condition severity. The COVID-19 pandemic temporarily affected ED visits for nonspecific back and neck pain. Further research is needed to explore the long-term effects of the pandemic on health care utilization.
... Low back pain is defined as pain localized between the 12th rib and the inferior edge of the gluteal groove, with or without pain in the lower extremities 3) . Almost all people who complain of low back pain have no identifiable cause for their pain and are classified as having so-called nonspecific low back pain. ...
... Almost all people who complain of low back pain have no identifiable cause for their pain and are classified as having so-called nonspecific low back pain. There are serious causes of persistent low back pain (malignancy, vertebral fracture, infection, inflammatory disease) that need to be identified and treated, but these causes are known to be responsible for only a small percentage of persistent low back pain [3][4][5] . Under such circumstance, a recent review by Gartenberg has shown that sacroiliac dysfunction is an unrecognized cause of low back pain worldwide. ...
Purpose] This study aimed to determine the effectiveness of the Arthrokinematic Approach (AKA)-Hakata method for patients with low back pain (LBP). [Participants and Methods] The participants were 39 patients with LBP who visited a medical facility between June 1, 2022, and November 30, 2022. The intervention period was 8 weeks, with five treatment sessions, and the patient assessments were performed using patient self-reported measures of LBP and motor function assessment. [Results] The AKA-Hakata method showed significant differences in all of the items evaluated in the longitudinal comparison of patients. Additionally, an interaction was observed only in the Roland-Morris Disability Questionnaire between the two groups classified using the Subgrouping for Targeted Treatment Back Screening Tool. [Conclusion] The results of this study showed that treatment with the AKA-Hakata method may have an early therapeutic effect on the physical and psychosocial risks in daily life. The results of this study indicated that the AKA-Hakata method is effective for the treatment of LBP. However, this study only evaluated a relatively short treatment period of five sessions. Further research on the long-term treatment effect is needed in order to optimize the treatment duration in detail and investigate the effectiveness of the AKA-Hakata method.
... In almost all cases presenting with low back pain, the precise nociceptive source cannot be located, leading to the diagnosis of "non-specific low back pain. " However, specific causes of LBP include malignancy, vertebral fractures, infections, or inflammatory illnesses such axial spondyloarthritis that necessitate detection and targeted treatment, but they only make up a very tiny number of cases [2,3]. When low back pain lasts for less than 6 weeks, it is considered acute low back pain; when it lasts between 6 and 12 weeks, it is sub-acute low back pain; and when it lasts for twelve weeks or longer, it is chronic low back pain [1]. ...
... Risk factors for low back pain[2] ...
People all around the world suffer from low back pain (LBP), which frequently results in disability and a lower quality of life. Myths and misconceptions around LBP are still prevalent in both the general public and hospital settings, despite its ubiquitous prevalence. Through dispelling these myths and advocating for evidence-based knowledge, medical professionals can enhance patient education, lessen stigma, and anxiety related to life with post-traumatic stress disorder and enable more successful management techniques. Furthermore, dispelling myths regarding low back pain in the broader public can enable people to actively participate in their own care and support improved outcomes for those who have this crippling illness. The purpose of this evaluation of the literature is to identify and dispel prevalent misconceptions about LBP by examining the available data.
... Low back pain (LBP), defined as perceived discomfort between the twelfth rib and the lower folds of the gluteal region with or without leg pain (Krismer and van Tulder 2007), has emerged as one of the most common musculoskeletal complications that affect road cyclists. Indeed, previous studies report a yearly prevalence rate of LBP approximately ranging from 30 to 58% among road cyclists of all experiences (Clarsen et al. 2010;Battista et al. 2021). ...
... Specific inclusion criteria for LBPG were (1) non-specific low back pain episodes within the last six months but symptom-free during the last 6 weeks and (2) no pharmacologic interventions for the relief of LBP in the last six months prior to the test. Non-specific LBP refers to symptomatology without an identifiable etiology linked to pathology or trauma (Krismer and van Tulder 2007) and identified by excluding other spinal disorders. The specific inclusion criterion for the CG was no history of acute or chronic LBP within the last year. ...
Purpose
While cycling offers several health benefits, repetitive loading and maintenance of static postures for prolonged periods expose cyclists to low back pain (LBP). Despite high LBP prevalence in cyclists, underlying pathomechanics and specific lumbar region muscle activation patterns during cycling are unclear. Here, we compared lumbar erector spinae (ES) muscles activation and spatial distribution activity in cyclists with and without recent LBP history.
Methods
Ten cyclists with recent LBP history (LBPG; Oswestry Disability Index score ~ 17.8%) and 11 healthy cyclists (CG) were recruited. After assessing the Functional Threshold Power (FTP), participants underwent an incremental cycling test with 4 × 3 min steps at 70%, 80%, 90%, and 100% of their FTP. High-density surface electromyography (HDsEMG) signals were recorded from both lumbar ES using two 64-channel grids. Information about ES activation levels (root-mean-square, RMS), degree of homogeneity (entropy), and cranio-caudal displacement of muscle activity (Y-axis coordinate of the barycenter of RMS maps) was extracted from each grid separately and then grand-averaged across both grids.
Results
Repeated-measure 2-way ANOVAs showed a significant intensity by group interaction for RMS amplitude (p = 0.003), entropy (p = 0.038), and Y-bar displacement (p = 0.033). LBPG increased RMS amplitude between 70–100% (+ 19%, p = 0.010) and 80–100% FTP (+ 21%, p = 0.004) and decreased entropy between 70–100% FTP (− 8.4%, p = 0.003) and 80–100% FTP (− 8.5%, p = 0.002). Between-group differences emerged only at 100% FTP (+ 9.6%, p = 0.049) for RMS amplitude.
Conclusion
Our findings suggest that cyclists with recent LBP history exhibit higher ES muscles activation and less homogeneous activity compared to healthy controls, suggesting potential inefficient muscle recruitment strategy.
Trial registration number
HEC-DSB/09-2023.
... Because of the inconsistent definitions of chronic non-specific LBP and different self-administration questionnaires, the reported results between studies turn out to be heterogeneous and inconclusive. LBP is commonly characterized as discomfort, muscle strain, or tension situated above the inferior gluteal folds and below the costal border [31]; it may or may not be accompanied by leg pain [32]. The persistent nature of this problem does not improve with time and consumes the majority of resources, making it a significant issue [31], and psychological components become crucial to explain how people respond to back pain [33]. ...
... LBP is commonly characterized as discomfort, muscle strain, or tension situated above the inferior gluteal folds and below the costal border [31]; it may or may not be accompanied by leg pain [32]. The persistent nature of this problem does not improve with time and consumes the majority of resources, making it a significant issue [31], and psychological components become crucial to explain how people respond to back pain [33]. However, chronic LBP is characterized by an extensive variety of physical [34], as well as psychosocial [35] aspects, which we considered in our study. ...
Chronic non-specific low back pain (LBP) is a serious public health issue that impairs the functional abilities of working men and women. The burden and experience of chronic non-specific LBP are largely influenced by psychological and psychosocial aspects. The objective was to investigate the association between the severity of chronic non-specific LBP disability and depressive symptoms in a sample of Croatian working active men and women with an age distribution from 35 to 65 years. The Roland Morris Disability Questionnaire (RMDQ) assessed disability, whereas the Beck Depression Inventory-II assessed depressive symptoms. During the routine outpatient visit self-reported RMDQ and BDI-II were completed from 203 recruited patients, divided into categories concerning disability scores. The median (IQR) age of 48.59 ± 6.48 was in the lower and the median (IQR) age of 50.65 ± 7.68 in the higher disability category. Disability was significantly associated (p < 0.05) with higher age (r = 0.177), working experience (r = 0.161), LBP duration (r = 0.195), greater pain intensity (r = 0.474 during activity, r = 0.227 at rest), and BDI-II score (r = 0.466). Higher BDI-II scores were associated with confirmatory answers on the 15th, 19th, and 22nd questions in RMDQ (p < 0.05). In patients with chronic non-specific LBP, higher degrees of disability were linked to severe depressive symptoms, aging, longer working experience, and increased pain intensity. These findings support pretreatment screening for depressive symptoms in order to develop individually customized and efficient multidisciplinary therapies.
... Low back pain is pain in the region between the 12th rib and the inferior gluteal fold and is a musculoskeletal system problem that is common in society, mostly caused by nonspecific causes and leads to disability [1]. The most common form of low back pain is nonspecific low back pain that cannot be attributed to a pathoanatomic cause [1]. ...
... Low back pain is pain in the region between the 12th rib and the inferior gluteal fold and is a musculoskeletal system problem that is common in society, mostly caused by nonspecific causes and leads to disability [1]. The most common form of low back pain is nonspecific low back pain that cannot be attributed to a pathoanatomic cause [1]. Low back pain is categorized into three groups according to symptom duration: acute (< four weeks), subacute (4-12 weeks), and chronic (>12 weeks) [2]. ...
Introduction: Lumbar strain originating from the quadratus lumborum (QL) is an important cause of low back pain; however, its diagnosis is often missed, and treatment is often inadequate. This leads to unnecessary diagnostic investigations and chronicization of pain. Therefore, it is important to treat it effectively and safely. In this study, we aimed to find out the effect of ultrasound (US)-guided QL block in acute-subacute low back pain caused by a strain of QL.
Materials and methods: Our study was retrospective, and the changes in the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores within one week in 50 patients with acute-subacute localized low back pain, unilateral lumbar strain, palpation tenderness, paravertebral spasm, and decreased lumbar range of motion in the QL muscle, in whom we applied US-guided block to the QL muscle, were analyzed.
Results: There was a significant decrease in the mean VAS and ODI scores of the patients after the procedure. There was a negative correlation between improvement rates in VAS and ODI scores and age and body mass index (BMI). Recovery rates were higher in female patients than in male patients.
Conclusion: It can be said that US-guided QL block is an effective treatment method for QL-induced lumbar strains, and younger age, female gender, and lower BMI are associated with better responses after injection.
... Specific causes for back pain, such as infections, tumors, osteoporosis, spondyloarthropathies, and trauma, actually represent a minority of such pain syndromes, qualifying for specific therapeutic approaches [5]. Specific causes of back pain are some degenerative conditions, inflammatory conditions, infective and neoplastic causes, metabolic bone disease, referred pain, psychogenic pain, trauma, and congenital disorders [6]. ...
... Chronic low back pain often manifests as localized pain and a considerable proportion of widespread pain, which may indicate a worse prognosis. However, exercise therapy can help reduce pain and improve or maintain function in patients with chronic low back pain [6]. Furthermore, evidence suggests that exercise modulation training in individuals with recurrent low back pain reduces pain intensity [33]. ...
Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70–80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland–Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.
... Low back pain, which is described as pain felt below the 12 th rib and above the gluteal folds, is a widespread issue affecting 60-85% of the general population at some point in their lives (Krismer et al., 2007). About 85% of LBP cases are non-specific, meaning they cannot be explained by a pathology (van den Berg et al., 2018). ...
... About 85% of LBP cases are non-specific, meaning they cannot be explained by a pathology (van den Berg et al., 2018). Specific LBP accounts for roughly 5-10% of all LBP cases and may be initiated by trauma, psychological factors, or disease (Krismer et al., 2007). PGP is less widespread in the general population, as it is most common during pregnancy (Ando & Ohashi, 2009). ...
Low back and pelvic girdle pain are prevalent during pregnancy, impacting about 50% of pregnant women. Previous studies conducted on the general population have suggested that physical activity has been associated with reductions in pain levels. Purpose: To determine if women with higher levels of physical activity experience less low back and pelvic girdle pain and lower disability scores than women who are less physically active. Methods: Pregnant women (n=24, 32.2 ± 4.1 years) were recruited between 28- and 32-weeks gestation. Participants reported their weekly physical activity, responded to subjective pain surveys, and underwent a battery of objective pain testing. Spearman’s-rho was used to assess correlations between physical activity scores and each subjective pain measure. Results: Tests for correlation between pregnancy physical activity scores and pain domain measures were not significant (ps>0.05), so no relationship could be determined between physical activity levels and low back/pelvic girdle pain based on this study. Conclusion: This study was not able to identify a significant correlation between physical activity levels and low back/pelvic girdle pain during pregnancy.
... Previous studies have reported that the cause of LBP is unknown in approximately 85% of patients, in which case the condition is classified as "non-specific LBP" [8,9]. Non-specific LBP cannot be clearly diagnosed or treated based on radiological findings. ...
... The incidence of specific LBP was 22.7% in older adults included in our study, which is similar to that indicated in previous reports (15.0%-21.2%) [8,9,23]. ...
Introduction
Low back pain (LBP) is a major contributor to decreases in the ability to perform activities of daily living (ADL) in older adults. Paralumbar spine disease (PLSD) is a common cause of LBP. We aimed to investigate the causes of LBP, including PLSD, among older adults.
Methods
Among 744 consecutive patients with LBP, 75 patients (10.1%) aged >80 years (25 males and 50 females) were included. The average patient age was 83.9 years. All patients were evaluated using lumbar magnetic resonance imaging (MRI) and radiography to diagnose the causes of LBP. PLSD was diagnosed based on clinical symptoms, palpation, and the effects of the block.
Results
Eleven patients (11/75, 14.7%) had acute osteoporotic vertebral fractures. Twenty-eight of the remaining 64 patients exhibited decreased LBP with oral medication, and six (6/75, 8.0%) exhibited lumbar spinal canal stenosis on MRI. PLSD was suspected in 19 of the remaining 30 cases based on clinical symptoms and palpation. Blocks were effective in 16 patients with PLSD, which involved superior cluneal nerve entrapment (SCN-E) in eight patients (10.7%), middle cluneal nerve entrapment (MCN-E) in nine patients (12.0%), sacroiliac joint (SIJ) pain in five patients (6.7%), and gluteus medius muscle (GMeM) pain in three patients (4.0%). The average numerical rating scale (NRS) scores for pain changed from 7.5 ± 1.5 before treatment to 1.3 ± 0.9 at discharge (p < 0.05).
Conclusion
Osteoporotic acute vertebral fracture (14.7%) was identified as the cause of LBP in older adults. Block therapy for PLSD may aid in the diagnosis and treatment of non-specific LBP.
... Low back pain is de ned as pain localized between the 12th rib and the inferior edge of the gluteal groove, with or without pain in the lower extremities [2]. Almost all people who complain of low back pain have no identi able cause for their pain and are classi ed as having so-called nonspeci c low back pain. ...
... Almost all people who complain of low back pain have no identi able cause for their pain and are classi ed as having so-called nonspeci c low back pain. There are serious causes of persistent low back pain (malignancy, vertebral fracture, infection, in ammatory disease) that need to be identi ed and treated, but only a small percentage of these causes are known to cause persistent low back pain [2][3][4]. According to a review reported by Gartenberg et al. in 2021, sacroiliac dysfunction is considered an unrecognized cause of low back pain worldwide. ...
Purpose: The purpose of this study was to determine the effectiveness of the Arthrokinematic Approach (AKA)-Hakata method for patients with low back pain (LBP).
Methods: The subjects were 39 patients with LBP who visited a medical facility between June 1, 2022 and November 30, 2022. The intervention period was 8 weeks with 5 treatment sessions, and patient assessments were performed using the patient self-reported majors of LBP and motor function assessment.
Results: The AKA-Hakata method showed significant differences in all items evaluated in the longitudinal comparison of patients. In addition, an interaction was observed only in the Roland-Morris Disability Questionnaire between the two groups classified using the Subgrouping for Targeted Treatment Back Screening Tool.
Conclusions: The results of this study show that treatment with the AKA-Hakata method may have an early therapeutic effect on physical and psychosocial risks in daily life. The results of this study indicate that the AKA-Hakata method is effective in the treatment of LBP. However, this study evaluated a relatively short treatment period of five sessions and did not examine long-term treatment effects. Further research is needed to optimize the treatment duration in detail and to investigate the effectiveness of the AKA-Hakata method.
... Diet, exercise, cognitive behavioral therapy, and pharmacotherapy are some of the ways to help patients lose weight [4]. Today, it is believed that one of the most effective treatments in the fight against obesity is the bariatric surgery [5]. ...
... It can affect people of all ages in the community, but it is common in individuals between the fourth and fifth decades of life [2,3]. Low back pain is divided into 3 subclasses according to the duration of the symptoms as Acute (lasting only a few weeks), Subacute (lasting about 6 to 12 weeks), and chronic (lasting more than 12 weeks) [4,5]. Clinicians cannot make a specific diagnosis in approximately 90% of chronic LBP cases, and for this reason, it is classified as mon-specific chronic LBP [6]. ...
Özet Amaç; Geleneksel mat egzersizleri, Reformer Pilates (RP) ve Hamak Yogası (HY) yaklaşımlarının Kronik bel ağrılı bireylerin ağrı, dayanıklılık, denge, engellilik ve yaşam kalitesi üzerindeki etkilerini incelemek. Yöntem; Kronik bel ağrısı olan 60 birey çalışmaya katıldı ve rastgele RP grubu (n=20, ortalama yaş:31.85±8.89 yıl), HY grubu (n=20, ortalama yaş:29.90±6.70 yıl) ve mat grubu (n=20, ortalama yaş:30.40±8.21 yıl) olmak üzere 3 gruba ayrıldı. Tüm egzersiz eğitimleri 4 hafta boyunca haftada iki kez (45 dakika) uygulandı. Ağrı; VAS ve McGill ile, endurans; plank testi ve tek bacak kalça köprüsü testi ile, statik denge; tek ayak üzerinde durma testi ile ve dinamik denge; yıldız denge testi ile değerlendirildi. Engelilik; Oswestry Özürlülük Anketi ile, yaşam kalitesi ise Dünya Sağlık Örgütü Yaşam Kalitesi (WHOQOL-Bref) ile değerlendirildi. Bulgu; Değerlendirilen tüm parametreler gruplarda iyileşti (p
... Forty-five female athletes (15 NSLBP with high painrelated anxiety, 15 NSLBP with low pain-related anxiety, and 15 healthy (control)) aged between 18 and 40 years [28] were enrolled in this study. Inclusion criteria for NSLBP were persistent pain for more than 12 weeks or at least three self-reported recurrent pain episodes during the year before testing [29] and the location of the pain was between the 12th rib and the lower gluteal fold [30]. Subjects were included when their pain was less than 30 mm on a 100-mm Visual Analogue Scale (VAS) [30] and their score on the State-Trait Anxiety Inventory questionnaire (STAI) was lower than 40 for trait anxiety. ...
... Inclusion criteria for NSLBP were persistent pain for more than 12 weeks or at least three self-reported recurrent pain episodes during the year before testing [29] and the location of the pain was between the 12th rib and the lower gluteal fold [30]. Subjects were included when their pain was less than 30 mm on a 100-mm Visual Analogue Scale (VAS) [30] and their score on the State-Trait Anxiety Inventory questionnaire (STAI) was lower than 40 for trait anxiety. Also, participants' state anxiety score on the STAI, as transient feelings of insecurity at the moment of testing should not be more than 40 [31]. ...
Background
Low back pain is common among athletes and it has been shown that postural control is altered in the general population with nonspecific low back pain (NSLBP). Psychological factors may also predispose individuals to risk of altered postural control. Dynamic postural control is essential to the performance of athletes. This study aimed to compare the dynamic postural control between women athletes with and without NSLBP with high and low pain-related anxiety.
Methods
Forty-five female athletes (15 NSLBP with high pain-related anxiety, 15 NSLBP with low pain-related anxiety, and 15 healthy (control)) were included. Pain-related anxiety was assessed using the Pain Anxiety Symptom Scale-20 (PASS-20). Based on the cut-off score of 30 for the total score of PASS-20, NSLBP patients were classified into two groups of low and high pain-related anxiety. Participants performed double-leg vertical drop jump (DVJ) and single-leg vertical jump (SVJ) tests on a Kistler force plate (type 9260AA6, Kistler Instruments Inc, Switzerland). The total root mean square (RMS) of the center of pressure (COP), COP displacement in the anteroposterior (AP), and mediolateral (ML) directions, COP mean velocity, and time to stabilization (TTS) in vertical, AP, and total directions were extracted from COP and ground reaction force data using MATLAB software. One-way Analysis of variance (ANOVA) and Welch’s ANOVA were employed to compare the groups. In case of significant findings, post hoc tests were performed.
Results
The results showed that during DJV, athletes with high pain-related anxiety had significantly greater TTS in all total, AP, and ML directions than other groups (P < 0.05). Also, the control group showed greater total RMS distance during DJV than either NSLBP group. However, no significant differences in TTS and COP parameters were found between the groups during SVJ (P > 0.05).
Conclusions
The findings suggest that pain-related anxiety may contribute to athletes’ postural control strategies. Therefore, it is important to consider the level of pain-related anxiety during planning postural control exercises for women athletes with NSLBP.
... European guidelines describe nonspecific CLBP as LBP whose pathological causes are unknown, such as osteoporosis, fracture, inflammatory diseases, and infection [3]. Approximately 80% of patients with LBP are diagnosed with nonspecific CLBP [4,5]. ...
Introduction
Capacitive and resistive electric transfer (CRET) therapy is widely used for the treatment of musculoskeletal disorders, including chronic low back pain (CLBP). However, the effects of CRET on nonspecific CLBP remain unexamined. Therefore, this systematic review aimed to investigate the effectiveness of CRET therapy for 3 months nonspecific CLBP.
Material and Methods
Six electronic databases (PubMed, Embase, PEDro, MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature) were systematically searched for relevant literature. The quality of the included studies was assessed using PEDro scores. Furthermore, a risk-of-bias analysis was performed using the Cochrane tool for risk-of-bias assessment.
Results
Seven randomized controlled trials were included in this analysis, with 351 participants aged 18–70 years. CRET was compared with manual therapy, other modalities, or sham CRET (power off). Several devices, including Physio Radio Stim Pro, INDIBA Active Pro recovery HCR 902, and WinBack-TECAR, were used for CRET therapy. These findings indicate that CRET is an effective treatment option for immediate and long-term follow-up of pain reduction and improved physical function in patients with nonspecific CLBP.
Conclusions
This review is the first attempt to aggregate and synthesize evidence for the effectiveness of CRET therapy for nonspecific CLBP. The findings reveal that CRET therapy is effective for managing nonspecific CLBP. More randomized controlled trials are expected to be conducted in the future that will strengthen the evidence on the effectiveness of CRET for nonspecific CLBP.
... The chronic condition is the most difficult to manage since it takes up the majority of resources and rarely gets better over time. 3 Pre-diabetes is a hyperglycemic state characterized by glycemic indices that are higher than normal but less than the diabetes threshold. While the criteria for diagnosing pre-diabetes differ among world-wide professional associations, it presents a high risk of developing diabetes, with an annual conversion rate of 5%-1. 4 The association between pre-diabetes, diabetes, and non-specific low back pain is becoming more and more recognized. ...
Background
Pre-diabetes, characterized by elevated glycemic indices, poses a high risk of diabetes development, and is increasingly linked to non-specific low back pain. While mechanisms remain incompletely understood, metabolic, inflammatory, and neurological factors are implicated. Dietary interventions, including low-glycemic and anti-inflammatory diets, alongside weight management, may improve outcomes in this population.
Objectives
In this non-randomized controlled trial, we aim to evaluate the influence of decreasing HbA1c levels on reducing chronic non-specific low back pain in pre-diabetic, non-obese individuals, as well as emphasizing the importance of such a study in supporting the literature.
Methods
A non-randomized controlled single-blind clinical trial was conducted among 82 participants with chronic non-specific low back pain and pre-diabetes at an outpatient clinic in Baghdad from the 30th of January to the 22nd of September. The intervention methods aimed at reducing HbA1c levels to assess the reduction impact on alleviating chronic non-specific low back pain included dietary adjustments, sleep optimization, and correction of vitamins and minerals deficiencies. The follow-up process was conducted individually for each participant, with a monthly assessment over a period of six months.
Results
At 12 weeks a significant decrease in chronic non-specific low back pain severity was observed in patients with lower HbA1C levels yielding a P-value of .021. Similarly, at 24 weeks there was a decline in the number of patients who reported chronic non-specific low back pain, and the association to lower HbA1C levels was significant with a p-value of .005.
Conclusion
This study suggests the presence of a statistically significant association between reduction of HbA1C levels and ensuing improvement in chronic non-specific low back pain symptoms in non-obese prediabetic patients.
... C hronic low back pain (CLBP) with no clear clinical evidence which is known as non-specific is a highly prevalent pain condition and is a leading cause of temporary or permanent physical and even psychological disorders worldwide [1]. Despite alternative therapies such as pharmacological prescriptions, exercise programs, bed rest, acupuncture, spinal manipulation, or even surgery and injection, patients with CLBP still suffer from persistence or recurrence of pain and movement problems as serious difficulties in daily life [2][3][4][5]. ...
Background
Non-specific chronic low back pain (CLBP) is a common painful condition and is responsible for different physical disorders. Despite alternative therapies, patients still suffer from persistent pain. Repetitive transcranial magnetic stimulation (rTMS) has provided much evidence of pain reduction, but results have not been examined deeply in CLBP symptoms.
Objective
The analgesic effect of rTMS in non-specific CLBP patients was evaluated by the amplitude of low-frequency fluctuation (ALFF) analysis in resting-state fMRI.
Material and Methods
In this experimental study, fifteen non-specific CLBP participants (46.87±10.89 years) received 20 Hz rTMS over the motor cortex. The pain intensity and brain functional scan were obtained during pre and post-stimulation for all participants. The ALFF maps of the brain in two scan sessions were identified and the percentage of pain reduction (PPR%) was determined using paired t-test. Also, correlation analysis was used to find a relationship between ALFFs and pain intensity.
Results
Pain intensity was significantly reduced after induced-rTMS in non-specific CLBP (36.22%±13.28, P<0.05). Positive correlation was found between ALFF in the insula (INS) and pain intensity (rpre-rTMS=0.59, rpost-rTMS=0.58) while ALFF in medial prefrontal cortex (mPFC) and pain intensity had negatively correlated (rpre-rTMS=-0.54, rpost-rTMS=-0.56) (P<0.05). ALFF increased in mPFC while INS, thalamus (THA), and supplementary motor area (SMA) showed decremental ALFF followed by rTMS.
Conclusion
This study demonstrated that ALFF in INS, THA, mPFC, and SMA is associated with CLBP symptoms and analgesic effects of rTMS. ALFF potentially seems to be a proper objective neuroimaging parameter to link spontaneous brain activity with pain intensity in non-specific CLBP patients.
... Low back pain is a musculoskeletal problem that is common in society and is known to be mostly caused by nonspecific causes and causes disability [1]. Lumbar disc herniation, spinal stenosis, spondylolysis, spondylolisthesis, facet joint arthropathy, and sacroiliac joint dysfunction are frequently considered in the differential diagnosis. ...
... It affects people of all ages, even young children and the elderly. The costs of medical care for LBP differ between nations and have been affected by societal and healthcare practices (1). There are two categories of LBP: specific LBP and nonspecific LBP (NSLBP), which was defined as LBP without obvious pathologies. ...
... A beautician's everyday activities include cleaning faces, providing skin, nails, and body hydrotherapy and care, treating acne, doing makeup, giving massages, removing facial and body hair, doing manicures and pedicures, hairdressing, threading, waxing, and other typical procedures (1) . Pain, muscle strain, or stiffness in the region between the inferior border of the 12th rib and the inferior gluteal folds, with or without sciatica, is referred to as low back pain (LBP) (2) . There are two types of low back pain: specific and nonspecific LBP. ...
BACKGROUND: In the beauty industry the people who are working are named as cosmetologists, beauticians and beauty therapists. Low back pain is one of the most prevalent musculoskeletal conditions and most common cause of disability. Beauticians were found to be more affected from low back pain due to their altered posture during walking, static postures for prolonged period of time. So the purpose of this study is to correlate quality of life and disability in middle aged beauticians with low back pain. METHODOLOGY: A convenience sampling method was used to administer questionnaires to 30 middle aged (26 to 40 years, 15 female and 15 male) beauticians with low back pain using the short form 12 and modified Oswestry disability index (MODI) and results were analysed. Beauticians were selected according to inclusion criteria which included having work experience of minimum 1-2 years and Numeric pain rating scale ≥4 and exclusion criteria included beauticians with severe spinal pathologies and previous surgeries before 6 months. Quality of life of the beauticians was assessed by SF12 and disability by Modified Oswestry disability index. RESULTS: Spearman correlation test was used to Analyse data and data was analysed by using SPSS 20.00 version. A significant negative strong correlation was found between disability and physical component score (PCS) (r=-0.746 and p<0.05), But no significant correlation was noticed between disability and mental component score (MCS) (r=0.067 and p>0.05) in middle aged beauticians with low back pain. CONCLUSION: Disability and physical component of quality of life was correlated in beauticians with low back pain. Weak correlation was found between mental component of quality of life and disability in beauticians with low back pain. Key words: Disability, Quality of life, low back pain, beauticians, Modified Oswestry disability index
... LBP is a cause of activity limitation and adversely affects quality of life [4]. Additionally, LBP has growing economic burdens due to loss of productivity and the cost of treatment [5]. ...
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.
... Excessive contraction of the global muscles may occur in patients with poor ability to activate the local stabilizers. The result can be low back pain or symptoms elsewhere in the body, depending on the activity of the athlete. is a concept that considers the integrated relationship between the legs, pelvis, trunk and upper extremities.The aims stabilization is as follows: 1. Achieve localized segmental neuromuscular control 2. Ability of the athlete to achieve and hold, isometrically, the position power (neutral pelvis) or optimal stability 3. Improve neuromuscular coordination between the trunk, pelvic and shoulder girdles during changing movement patterns.4. Improve the athlete"s musculoskeletal and cardiovascular fitness and endurance. ...
INTRODUCTION : Low back pain (LBP) is one of the most common complaints seen in primary care, with 60-85% of adults experiencing it at some time in their lives. Athletes are no exception, with the added strain of long training contributing to the problem. Current studies have done to see the effect of core strengthening exercises using Swiss ball, theraband and floor exercises in general population with low back pain, but there are no studies which have compared the effectiveness of Swiss ball, theraband and floor exercises in core strengthening in cricketers with low back pain.
... Low back pain (LBP) stands as the most prevalent musculoskeletal ailment globally [1]. It leads to impaired activity and absenteeism, incurring substantial economic consequences [2]. A matter of concern is the escalating growth of disability related to LBP, with the number of years lived with LBP-associated disability surging from 42.5 million in 1990 to 64.9 million in 2017, making LBP the leading global cause of disability [3]. ...
Background
Low back pain (LBP) is a major global disability contributor with profound health and socio-economic implications. The predominant form is non-specific LBP (NSLBP), lacking treatable pathology. Active physical interventions tailored to individual needs and capabilities are crucial for its management. However, the intricate nature of NSLBP and complexity of clinical classification systems necessitating extensive clinical training, hinder customised treatment access. Recent advancements in machine learning and computer vision demonstrate promise in characterising NSLBP altered movement patters through wearable sensors and optical motion capture. This study aimed to develop and evaluate a machine learning model (i.e., ’BACK-to-MOVE’) for NSLBP classification trained with expert clinical classification, spinal motion data from a standard video alongside patient-reported outcome measures (PROMs).
Methods
Synchronised video and three-dimensional (3D) motion data was collected during forward spinal flexion from 83 NSLBP patients. Two physiotherapists independently classified them as motor control impairment (MCI) or movement impairment (MI), with conflicts resolved by a third expert. The Convolutional Neural Networks (CNNs) architecture, HigherHRNet, was chosen for effective pose estimation from video data. The model was validated against 3D motion data (subset of 62) and trained on the freely available MS-COCO dataset for feature extraction. The Back-to-Move classifier underwent fine-tuning through feed-forward neural networks using labelled examples from the training dataset. Evaluation utilised 5-fold cross-validation to assess accuracy, specificity, sensitivity, and F1 measure.
Results
Pose estimation’s Mean Square Error of 0.35 degrees against 3D motion data demonstrated strong criterion validity. Back-to-Move proficiently differentiated MI and MCI classes, yielding 93.98% accuracy, 96.49% sensitivity (MI detection), 88.46% specificity (MCI detection), and an F1 measure of .957. Incorporating PROMs curtailed classifier performance (accuracy: 68.67%, sensitivity: 91.23%, specificity: 18.52%, F1: .800).
Conclusion
This study is the first to demonstrate automated clinical classification of NSLBP using computer vision and machine learning with standard video data, achieving accuracy comparable to expert consensus. Automated classification of NSLBP based on altered movement patters video-recorded during routine clinical examination could expedite personalised NSLBP rehabilitation management, circumventing existing healthcare constraints. This advancement holds significant promise for patients and healthcare services alike.
... Localised pain between the ribcage and the lower buttocks, with or without leg pain, is commonly known as low back pain (LBP). 1 A recent global study revealed that LBP affects 12-33% of adults worldwide. 2 Various environmental and personal factors influence the onset and progression of LBP. 3 It is estimated that 70-85% of adults experience at least one episode of LBP in their lives, making it a significant health concern. ...
Objectives
This study aims to evaluate the prevalence and associated factors of lower back pain (LBP) among farmers, rickshaw pullers and office workers in Bangladesh, while also investigating potential contributors within these occupational groups.
Design
This cross-sectional study aimed to determine the prevalence of LBP, associated factors and management procedures among farmers, rickshaw pullers and office workers in Bangladesh through face-to-face interviews.
Setting
The study was conducted in different parts of the Bogura district in Bangladesh.
Participants
A total of 396 participants were included in the final analysis, all the participants were men and adult in age.
Main outcome measurements
Data were collected using a semi-structured questionnaire based on previous research. Bivariate and multivariable logistic regression analyses were performed to identify significant associations.
Results
The prevalence of LBP was found to be 42.7% among the participants. Farmers and rickshaw pullers had approximately four-times and three-times higher odds of experiencing LBP compared with office workers. Other significant factors associated with LBP included living in a nuclear family, having a normal body weight, lacking professional training, having a chronic disease, having a family history of LBP and experiencing numbness in the legs or feet. The majority of respondents sought medical attention and took medication for their LBP.
Conclusion
The study underscores occupational differences in LBP prevalence, emphasising the necessity for tailored interventions and occupational health policies. Identifying specific risk factors and management practices in these professions can aid in developing effective prevention strategies and enhancing healthcare services.
... В офисе и дома необходимо: -оптимизировать эргономику рабочего места; -сидя за столом, опираться на спинку стула, периодически наклоняясь вперед для разгрузки дорсальных отделов МПД (использовать эффект разгрузочного сидения); -во время уборки сгибать ноги в коленях и работать обеими руками; -в положении лежа сгибать ноги в коленных и тазобедренных суставах с той же целью. В отношении физической нагрузки при выборе конкретных упражнений важно выполнять движения в безболевом диапазоне движений, а при выборе видов спорта -отдавать преимущество динамическим прямолинейным упражнениям, таким как езда на велосипеде, плавание, быстрая ходьба и бег [21,43]. ...
Back pain in young people (14–35 years old) may have causes rooted in adolescence or even earlier childhood. Diagnosis in this case can present considerable difficulties for a therapist and general practitioner, since “nonspecific back pain” may hide pathological conditions inherent in childhood. The degree of compensation for scoliosis, hereditary abnormalities in the development of the spine, the severity of early degenerative processes, and metabolic diseases of the skeleton that were not identified during school years determine a non-standard scope of diagnostic and therapeutic measures for the doctor. These include collecting a family history and screening the patient for the presence of inflammatory back pain according to the 2009 ASAS criteria, a survey on the hospital anxiety and depression scale, a morphometric assessment of the stigma of dysembryogenesis and an assessment of hypermobility syndrome, advanced laboratory diagnostics with determination of indicators of mineral-calcium metabolism, X-ray diagnostics with functional tests, the use of magnetic resonance imaging or computed tomography of the spine in the absence of radicular symptoms. The patient’s active involvement in non-drug restorative treatment significantly improves his prognosis, and pharmacological support should have a health-saving direction and consider the presence of low-intensity inflammation in the pathogenesis of the disease. The choice of therapy for a reproductively active cohort of patients is made in favor of drugs with the maximum safety profile, which include, among others, selective non-steroidal anti-inflammatory drugs.
... Inflammatory and degenerative arthropathies, neoplasms, infection, compression fractures, and functional musculoskeletal disorders are all possible causes of LBP (Koes, Van Tulder, and Thomas, 2006). LBP is also caused by functional musculoskeletal problems, which account for 90% of LBP cases in the general population (Cohen, Argoff, and Carragee, 2008;Krismer and Van Tulder, 2007) and are commonly referred to as mechanical low back pain (Al-Eisa, Egan, Deluzio, and Wassersug, 2006). Mechanical LBP is largely thought to be caused by biomechanical abnormalities such as lumbar joint stiffness, dysfunction of muscles specifically the lumbar multifidus (MacDonald, Moseley, and Hodges, 2009), lumbar extension strength deficits (Steele, Bruce-Low, and Smith, 2014), sustained or abnormal postural mechanical loading of the lumbar spine, resulting in joint stress (Diab and Moustafa, 2012) and lower extremity postural changes (Chaléat-Valayer et al., 2011), including those at the feet (Almutairi et al., 2021;Kendall, Bird, and Azari, 2014). ...
Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis, Physiotherapy Theory and Practice, ABSTRACT Background: A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. Objectives: This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. Methods: From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. Results: Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [−2.43 (95% CI −2.73 to −2.13, p < .001)] and disability of −6.69 (95% CI −8.04 to −5.33, p < .001)]. Conclusions: This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.
... Differential diagnosis of back pain in adults is complicated [18] and it can have many causes: lumbosacral muscle strains and sprains, lumbar spondylosis, disk herniation, spondylolysis, spondylolisthesis, repetitive spinal stress [28], vertebral compression fracture, spinal stenosis, and tumors -97% of spinal tumors are metastatic [29] and many patients have infections [30]. ...
Background
This study of 60 patients with low back pain (LBP) aimed to compare outcomes following magnetotherapy, ultrasound therapy, laser therapy, and electrotherapy, with and without lumbosacral kinesiotherapy, and used the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). This was a randomized actively controlled intervention trial of adding kinesiotherapy to a standard physiotherapy for LBP.
Material/Methods
The research included 60 participants with a diagnosis of chronic non-specific lumbar pain syndrome (CNSLPS) (mean±SD age 58.3±15.4 years, 37 women) LBP randomly assigned (1: 1) to 2 treatment groups. In Group 1, 30 patients were treated with magnetotherapy, ultrasound therapy, laser therapy, and electrotherapy. In Group 2, 30 patients received the same treatments as in Group 1, and also performed kinesiotherapy exercises affecting the lumbosacral spine and adjacent muscles. At baseline and at the end of the study, all participants completed the RMDQ and the OLBPDQ.
Results
Both groups had significant improvement after therapy. Repeated-measures ANOVA indicated that at the end of treatment there was significantly greater progress and symptom reduction (P<0.001) in Group 2. Patients in Group 2 had a pain reduction of 52.5%, while Group 1 had 25.4% pain reduction (P=0.009).
Conclusions
For treatment of disability caused by CNSLPS, physical therapy combined with kinesiotherapy should be a treatment of choice.
... Non-specific Low Back Pain (NS-LBP) is defined as pain that arises between the 12th rib and the inferior gluteal, folds with or without leg pain and is not associated with specific underlying pathology (Violante et al., 2015). Sub-acute NS-LBP refers to pain that lasts between six weeks and three months (Krismer and van Tulder 2007). Even though there is not a specific pathological cause, NS-LBP is related to the presence of myofascial trigger points (MTrPs) (Barbero et al., 2019). ...
Background: Limited knowledge exists about the effectiveness of dry needling (DN) concerning the torso kinematics in patients with non-specific low back pain (NS-LBP). Acute effects of DN in NS-LBP patients from a functional perspective were investigated. Methods: Sixteen NS-LBP patients and 11 healthy individuals (HG) were examined. NS-LBP patients received a single session of DN at the lumbar region. Baseline and immediate post-treatment measurements during flexion-extension and lateral bending of the trunk were conducted for the NS-LBP patients. HG were measured only at baseline to be used as a reference of NS-LBP patients' initial condition. Algometry was applied in NS-LBP patients. Centre of pressure, range of motion of the trunk and its’ derivatives were obtained. Findings: HG performed significantly faster, smoother and with greater mobility in the performed tasks compared to the pre intervention measurements of the NS-LBP patients. For the NS-LBP patients, significant greater angular velocity in frontal plane and significant lower jerk in the sagittal plane were demonstrated post intervention. DN alleviated pain tolerance significantly at the L5 level. Regarding the effectiveness of the DN upon spine kinematics, their derivatives were more sensitive. Interpretation: It appeared that the pathological type of torso movement was acutely affected by DN. NS-LBP patients showcased smoother movement immediately after the intervention and better control as imprinted in the higher derivative of motion although range of motion did not improve. This quantitative variable may not be subjected to acute effects of DN but rather need additional time and training to be improved.
... Such a treatment strategy might prevent future recurrences of disabling pain and thus maintain the patient's current work status, considered important for health. 10 Lumbars' flexion exercises have been a cornerstone in the management of LBP patient for many years. 11 However, these exercises were somewhat discredited when Nachemson showed that they significantly raised the intra-discal pressure. ...
... El dolor lumbar per se no constituye riesgo de vida para las personas que lo sufren, estimaciones de prevalencia y carga, realizadas en las últimas décadas, muestran al dolor lumbar como principal responsable de ausentismo laboral, entre los trastornos osteomusculares relacionados al trabajo (Hoy et al., 2010) Se estima que dos tercios de la población adulta sufre dolor lumbar en algún momento de su vida (Krismer & van Tulder, 2007;Luo et al., 2004), afecta a personas de todas las edades y continua siendo la principal causa de discapacidad en la mayoría de los países (YLD) (siglas en inglés, -Años Vividos con Discapacidad) (Chen et al., 2021;Ferreira et al., 2023;Maher et al., 2017;Wu et al., 2020). La mitad de las personas que sufren , continuarán de manera recurrente con dolencias diarias afectando su calidad de vida (Croft et al., 1998). ...
... Muscular Pain: commonly 60% to 85% of the population has had back pain which has a nonspecific muscular source for a few movements in lifetime prevalence) 112 . Chronic muscular pain is still a significant clinical problem which is understood poorly. ...
Tripura is a small hilly state in the northeastern region of India. The state has abundant precious plants with medicinal values, naturally increasing principally in hilly areas. The agro-climatic environment favors miscellaneous medicinal plants and is a hot spot for native medicinal plants. Many of the tribal peoples of the state are living in the deep forest area with adverse communication. From ancient times they have been using plant and their products to treat different body problems as they are familiar with the medicinal properties of locally available medicinal plants. Different parts of those medicinal plants are rich in different compounds and bioactive molecules like flavonoid, alkaloid, sterol, etc.. They use them in aqueous extract, raw, dried, or by preparing in different ways in patients suffering from different complications. The plant products protect against complications like indigestion, constipation, insomnia, chest pain, etc. Laportea interrupta is a plant that belongs to the Urticaceae family and is used by the tribals of Tripura as a therapeutic agent against several diseased conditions. The plant also has the potential to boost pharmaceutical products in the future.
... In India incidence of low back pain(LBP) has been reported to be 23.09% and has a lifetime prevalence of 60-85%. 1,2 Causes of LBP with or without radiating pain are idiopathic, degenerative, traumatic, inflammatory, congenital, neoplastic, metabolic, postural and gynaecological, renal or rectal systemic. Prolapsed intervertebral disc (PIVD) is the most common cause of lumbar radiculopathy. 3 PIVD is collective term, describing a process in which the rupture of annular fibers allow for a displacement of nucleus pulposus within the intervertebral space, most commonly in posterior or postero-lateral direction. ...
Introduction: Disc related disorders of spine are estimated to compromise high percentage of low back pain Indian population with incidence of 23.09% with lifetime prevalence of 60-85%.The significant cost in management often require surgical intervention so study was carried out to find out cost effective physical therapy interventions along with manual therapy. Objective: To study & compare the effect of McKenzie approach and Mulligan's mobilisation (SNAGS) in lumbar disc prolapse with unilateral radiculopathy. Method: 30 participants between 25 to 45 years classified according to Qubec Task Force (QTF) classification & divided into group A & B. Baseline treatment of shortwave diathermy, intermittent lumbar traction & interferential therapy for both groups along with McKenzie approach for Group A & Mulligan's (SNAGS) for Group B. Outcome measures visual analogue scale (VAS), Modified Oswestry Disability Index (MOLBPDI) & lumbar range of motion (ROM) were assessed pre & post treatment. Result: Result showed improvement in VAS, MOLBPDI & ROM except rotation ROM in both groups. But there was better improvement in Group B. Conclusion: McKenzie approach and Mulligan's mobilisation (SNAGS) are effective in improving pain, functional ability & ROM in prolapse intervertebral disc with unilateral radiculopathy, later is more effective.
... Those experiencing localized pain from the lower margin of the twelfth rib to the lower gluteal folds for more than three months were included in the NS-CLBP group. 17 Online Questionnaire Survey A web-based questionnaire survey was conducted using Google Form (Google LLC, Mountain View, CA, United States). The survey was distributed to each sports club during meetings, practices, or via representatives. ...
Purpose
This study aimed to determine the psychosocial factors associated with non-specific chronic low back pain (NS-CLBP) among college athletes.
Material and Methods
A cross-sectional study was performed at one university. A non-anonymous, self-administered online questionnaire was collected from each athlete. Participants with a history of orthopaedic spine disease or surgery were excluded. Online responses from 368 college athletes belonging to 18 clubs were collected, among which 263 were included in the analysis. In the 263 responses, 41 individuals were identified as having NS-CLBP. Multivariate logistic regression analyses were performed to determine factors associated with presence of NS-CLBP. Independent variables included the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA) score, Tampa Scale for Kinesiophobia-11 (TSK-11) score, Roland-Morris Disability Questionnaire (RDQ) score, and body mass index (BMI). Additionally, the Mann–Whitney U-test was utilized to compare FABQ-PA, TSK-11, RDQ scores, and BMI between the NS-CLBP and non-NS-CLBP groups.
Results
The FABQ-PA (odd ratio = 1.096, P = 0.003) was significantly associated with NS-CLBP. No significant association was observed between NS-CLBP and TSK-11 (P = 0.776), RDQ (P = 0.074), and BMI (P = 0.296). The scores for FABQ-PA, TSK-11, RDQ, and BMI in the group with NS-CLBP were found to be significantly higher compared to the group without NS-CLBP (P < 0.001, P = 0.034, P < 0.001, and P = 0.022, respectively).
Conclusion
The present study revealed a significant relationship between higher FABQ-PA scores and NS-CLBP among college athletes. Conversely, TSK-11 and BMI values showed no significant association with NS-CLBP presence. The findings suggest that addressing fear-avoidance beliefs may be crucial in managing NS-CLBP among college athletes.
... Non-specific LBP encompasses both acute and chronic cases, with acute pain lasting less than six weeks and chronic pain lasting more than three months. 60 Non-steroidal anti-inflammatory drugs and muscle relaxants have been found effective in treating acute LBP, whereas strong evidence supports the efficacy of manual and exercise therapy ...
Purpose
Low back pain (LBP) is a prevalent musculoskeletal disorder, and manual therapy (MT) is frequently employed as a non-pharmacological treatment for LBP. This study aims to explore the research hotspots and trends in MT for LBP. MT has gained widespread acceptance in clinical practice due to its proven safety and effectiveness. The study aims to analyze the developments in the field of MT for LBP over the past 23 years, including leading countries, institutions, authoritative authors, journals, keywords, and references. It endeavors to provide a comprehensive summary of the existing research foundation and to analyze the current cutting-edge research trends.
Methods
Relevant articles between 2000 and 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. We used the software VOSviewer and CiteSpace to perform the analysis and summarize current research hotspots and emerging trends.
Results
Through screening, we included 1643 papers from 2000 to 2023. In general, the number of articles published each year showed an upward trend. The United States had the highest number of publications and citations. Canadian Memorial Chiropractic College was the most published research institution. The University of Pittsburgh in the United States had the most collaboration with other research institutions. Long, Cynthia R. was the active author. Journal of Manipulative and Physiological Therapeutics was the most prolific journal with 234 publications.
Conclusion
This study provides an overview of the current status and trends of clinical studies on MT for LBP in the past 23 years using the visualization software, which may help researchers identify potential collaborators and collaborating institutions, hot topics, and new perspectives in research frontiers, while providing new clinical practice ideas for the treatment of LBP.
... Low back pain (LBP) is considered a significant and one of the most prevalent musculoskeletal disorders associated with the workplace [1,2]. It is defined as "pain localized between the 12th rib and the inferior gluteal folds, with or without leg pain" [3]. Individuals and their families, communities, healthcare systems, and companies are greatly affected by LBP in multiple aspects [4]. ...
Background and objective
Low back pain (LBP) is a significant and prevalent musculoskeletal disorder associated with the workplace that impacts individuals, families, communities, healthcare systems, and companies. Although LBP prevalence and risk factors have been studied in various professional categories in Saudi Arabia, there is no data on the prevalence of LBP among office workers and related risk factors. This study aimed to determine the prevalence of LBP among office workers in Saudi Arabia and identify major risk factors.
Methodology
This cross-sectional study was conducted among office workers in Saudi Arabia of both genders aged over 18 years living in five geographical regions: Central, Western, Southern, Eastern, or Northern. A self-administered questionnaire was distributed among office workers using an online survey. The questionnaire comprised sociodemographic characteristics, the prevalence of work-related LBP, and work-related characteristics.
Results
Among 604 office workers, 51.7% were males and 43.5% were aged between 18 and 30 years old. The prevalence of work-related LBP in this study was 59.9%. Independent risk factors for LBP include being overweight or obese, sleep disturbance, previous history of back trauma, increasing years of working in the office, changes made to workstation/work habits to reduce the risk of LBP, and frequent work stress. Protective risk factors for LBP include regular physical exercise and satisfaction with the current job.
Conclusions
LBP was widely prevalent among office workers in Saudi Arabia. Office workers with elevated body mass index (BMI) who had a previous history of back trauma and had sleep disturbance or work stress in the past month were at significant risk for LBP. Occupational health and safety programs are vital for building ergonomically safe working conditions, and regular physical exercise promotion could alleviate the risk of LBP at work.
This study examined the erector spinae contractile properties, trunk isokinetic strength, and differences in acute muscle fatigue response after exercise in young females with and without non-specific chronic low back pain (NSCLBP). This study evaluated participants using tensiomyography and isokinetic trunk strength tests. An independent t-test compared the control group and the NSCLBP group, while a two-way mixed ANOVA analyzed differences in the erector spinae’s acute muscle fatigue response before and after exercise within and between groups. The results of the tensiomyography indicated that the NSCLBP group exhibited significantly lower Dm and Vc (p < 0.05) compared to the control group, while Tc showed no significant difference between groups. Significant differences in all variables were observed between the groups in the isokinetic trunk strength test (p < 0.05). Furthermore, the two-way mixed ANOVA revealed significant group main effects in Dm and Vc of the erector spinae (p < 0.05). This study found that non-specific chronic low back pain is linked to a decrease in Dm, Vc, and trunk isokinetic strength in both extensor and flexor muscles. It suggests that future research should further investigate the acute muscle fatigue response in individuals with and without NSCLBP.
During aging, the spine undergoes degenerative changes, particularly with vertebral endplate bone expansion and sclerosis, that is associated with nonspecific low back pain (LBP). We reported that parathyroid hormone (PTH) treatment could reduce vertebral endplate sclerosis and improve pain behaviors in aging, SM/J and young lumbar spine instability (LSI) mice. Aberrant innervation noted in the vertebral body and endplate during spinal degeneration was reduced with PTH treatment in aging and LSI mice as quantified by PGP9.5 ⁺ and CGRP ⁺ nerve fibers, as well as CGRP expression in dorsal root ganglia (DRG). The neuronal repulsion factor Slit3 significantly increased in response to PTH treatment mediated by transcriptional factor FoxA2. PTH type1 receptor (PPR) and Slit3 deletion in osteoblasts prevented PTH-reduction of endplate porosity and improvement in behavior tests, whereas PPR deletion in chondrocytes continued to respond to PTH. Altogether, PTH stimulates Slit3 to repel sensory nerve innervation and provides symptomatic relief of LBP associated with spinal degeneration.
Background:
Low back pain (LBP) is a common public health problem resulting in workforce loss.
Objective:
This study aims to evaluate the LBP status and its affecting factors among drivers in a city in southeast Turkey.
Methods:
This cross-sectional questionnaire survey study was conducted among 323 drivers. The chi-square test and logistic regression analysis were used to analyze the data.
Results:
The mean age of the drivers was 41.7±11.5 years (min: 19, max: 70), and 83.9% were married, and all were men. LBP was found in 59.4% of drivers. It was significantly higher in drivers with poor socioeconomic status, dissatisfied with their life, having a chronic illness, physically inactive, having sleep disorders, exposed to bad road conditions, prolonged vibration, high physical- psychological workload, and a family history of LBP (p < 0.05). There was no significant association between age, education level, and BMI with LBP (p > 0.05).
Conclusion:
There is limited study on this subject in Turkey. Further studies can raise awareness about this issue and create an educational plan.
Background
Work-related musculoskeletal disorders are widespread among workers of informal small-scale enterprises. Specifically, lower back pain is a prevalent occupational health problem across various industries, including weaving factories. Lower back pain significantly impairs the functioning, performance, and productivity of weavers. However, information on the prevalence and associated factors of low back pain among weavers of Bahir Dar City and nationwide is scarce. Therefore, this study aimed to assess the prevalence and associated factors of lower back pain among weavers working in Bahir Dar City.
Method
A multicentered institutional-based cross-sectional study was conducted on 403 weavers in Bahir Dar City, Ethiopia, from April to May 2023 using a structured face-to-face interview questionnaire. Samples were proportionally allocated to each institution, and study participants were selected using a simple random sampling technique. Variables with a P-value < 0.25 in the bivariate logistic regression were adopted for the multivariate logistic regression analysis after verifying the model fitness. In the multivariate logistic regression analysis, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and a P-value < 0.05 were considered to identify the associated factors of lower back pain among weavers.
Result
The results revealed that the overall annual prevalence of lower back pain was 63.5% (95% CI = 58.8–68.5). Longer working hours [AOR = 2.580 (CI = 1.517–4.384)], lack of back support [AOR = 1.938 (CI = 2.089–3.449)], repetitive movement of the back during weaving [AOR = 5.940 (CI = 2.709–13.02)], awkward posture [AOR = 2.915 (CI = 1.677–5.065), static working posture [AOR = 4.505 (CI = 2.298–8.831)], and job stress [AOR = 3.306 (CI = 1.896–5.765)] were significantly associated with lower back pain among weavers.
Conclusions
Lower back pain among weavers was found to be highly prevalent. Working longer hours, lack of back support, repetitive movement of the back, awkward posture, static posture, and job stress were significantly associated with lower back among weavers. The study recommends prompt interventions on weavers to ensure that they use sitting support, weave for <8 h per day, change positions every 2 h, reduce job-related stress, and minimize task repetition, thereby enhancing their working conditions and minimizing the occurrence of lower back pain.
Objetivo: observar a relação existente entre hábitos de vida e incapacidade física e a relação desses dois fatores com a DLC não específica. Métodos: Tratou-se de um estudo transversal, exploratório e analítico, com uma amostra por conveniência de 50 indivíduos de ambos os sexos, com idade ≥ 18 anos. Os participantes foram avaliados quanto às questões socioeconômicas, demográficas e hábitos de vida; nível de incapacidade física através do questionário Roland-Morris (RM) e Intensidade da dor pela escala visual analógica (EVA). Resultados: A idade média de idade dos participantes foram de 56,9 (DP=8,87) anos, variando entre 34 e 72 anos. Destes, 90% (n=45) dos indivíduos eram do sexo feminino. A percepção de dor se dividiu entre moderada 30% (n=15) e intensa 70% (n=35). Observou-se associação estatisticamente significante entre o nível de dor e incapacidade física (RP 9,86, IC=1,46-66,47). Os indivíduos que não costumavam realizar atividades de lazer apresentaram também maior sensação subjetiva de dor lombar (DL) (RP 0,60, IC=0,37-0,95) e incapacidade física (RP 0,39, IC=0,18-0,88). Também foi observada associação estatisticamente significante entre os ser fumante e DL (RP 1,60, IC=1,25-1,99) e entre a incapacidade física e a DL (RP 1,88, IC=1,13-3,11). Não foi observada associação significativa entre a prática de exercício físico, consumo de bebida alcoólica e alimentação com os níveis de dor e incapacidade física. Conclusão: No presente estudo foi possível observar forte relação entre a dor e a incapacidade física, bem como o hábito de fumar e interferência na realização de atividades de lazer.
Background:
The US National Institutes of Health (NIH) has produced a minimal data set to promote more accurate and consistent reporting of clinical trials, facilitating easier comparison of research on low back pain patients worldwide. The NIH-minimal dataset has not been previously translated into Turkish, and its features are currently unknown. This study aimed to adapt the NIH-Minimal Data Set into Turkish and investigate its validity and reliability in Turkish-speaking patients with chronic low back pain (CLBP).
Methods:
In the study, 245 patients with CLBP were included. Test-retest and internal consistency analyzes were performed to evaluate the reliability of the NIH-minimal dataset. The intraclass correlation coefficient (ICC2,1) value was used to assess test-retest analysis. Cronbach's alpha value was calculated for internal consistency. Total impact scores of the NIH-minimal dataset were compared with total scores of the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to assess construct validity. The minimal detectable change (MDC95) was calculated based on the standard error of measurement (SEM95).
Results:
The NIH-Minimal Data Set was found to have high test-retest reliability (ICC2,1 = 0.928) and high internal consistency (Cronbach α = 0.905). The NIH-minimal dataset correlated well with RMDQ and ODI (r = 0.750 and 0.810, respectively). There were no floor or ceiling effects. Also, SEM95 and MDC95 for the total score were 4.57 and 12.55, respectively.
Conclusion:
Considering all these data, it was concluded that the Turkish version of the NIH-minimal dataset is a valid and reliable outcome measure for evaluating patients with CLBP.
Aim of the Study within the Thesis:
This prospective cohort study aims to gather descriptive information on psychosocial profiles
of patients hospitalized with acute and acute-on-chronic LBP and to evaluate possible
associations between the psychosocial profiles, the therapeutic alliance and hospitalization
outcomes.
Rationale:
The psychosocial profiles of patients admitted to acute care hospitals with acute and acute-
on-chronic LBP may largely determine their needs and are important factors to consider
when delivering stratified care for this patient group. Furthermore, psychosocial profiles and
therapeutic alliance might influence treatment outcomes in this patient group. To date, there
remains an absence in current research regarding associations between patients’ psychosocial
profiles, therapeutic alliance and treatment outcomes of hospitalizations.
Methods:
A Prospective single centre, single cohort observational study with n=29 patients hospitalized
with LBP. While data on psychosocial profiles (depression, anxiety, stress, social support,
loneliness) and clinical data (age, gender, pain intensity, LBP episode duration, country of
birth) at admission was available from all patients, from n=15 patients, data was available for
therapeutic alliance and satisfaction with care collected before discharge. Hospitalization
outcome was defined as better patient satisfaction and shorter hospitalization times.
Conclusion:
The present study demonstrated high involvement of psychosocial factors and associations
between better hospitalization outcomes and stronger alliances and weaker alliances from
those with a lack of social support.
Abstract
Aim: In our study, we aimed to examine the relationships between lumbopelvic core stability level, pain intensity and functional disability level in persons with chronic non-specific low back pain.
Method: This prospective cohort study was conducted with persons with chronic non-specific low back pain. A 10 cm horizontal visual analog scale was used to measure pain intensity, Oswestry Disability Index was used to measure functional disability, and Sahrmann Core Stability Test was used to assess lumbopelvic core stability. In statistical analysis, Spearman’s rank correlation coefficient was used to examine the correlations of the data. The significance value was determined as p<0.05.
Findings: In our study, 36 persons with chronic non-specific low back pain with a median age of 35 years were evaluated. It was determined that there was a high negative correlation between the core stability level and pain intensity (r=-0.781; p<0.001), a moderate negative correlation between functional disability level and core stability level (r=-0.652; p<0.001) and a moderate positive correlation between functional disability level and pain intensity (r=0.656; p<0.001).
Results: According to our study results, the decrease in lumbopelvic core stability in persons with chronic non-specific low back pain leads to an increase in pain intensity and functional disability. Accordingly, improvement of lumbopelvic core stability in persons with nonspecific low back pain may lead to a decrease in pain intensity and functional disability
Low back pain, Sahrmann Core Stability Test, Oswestry
Background
Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.
Aim
This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.
Methods
This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008–2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.
Results
Changes in acceptance (β:0.424–0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177–0.233; all P<0.001) and changes in fear-avoidance (β: −0.152– −0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.
Discussion and Conclusion
Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
Background: Lower back pain (LBP) is a leading cause of disability worldwide. The Roland–Morris Disability Questionnaire (RMDQ) has been widely used to assess functional impairment in patients with LBP. However, its length and redundancy calls for a more concise and optimized version.Methods: We conducted a secondary analysis of data from two randomized controlled trials comparing pharmacopuncture and physical therapy for chronic LBP. We focused on 132 patients with moderate-to-severe symptoms and analyzed their baseline data to evaluate the structural validity of the RMDQ. We used R packages lavaan and semPlot for confirmatory factor analysis (CFA). Model fit were assessed through various indices, including comparative fit index, Tucker–Lewis index, root mean square error of approximation, and standardized root mean squared residual.Results: A total of 18 items were ultimately removed to produce a streamlined 6-item structure. Our model met the fit index criteria, yielding a one-domain, 6-item RMDQ structure. While the relative indices fell slightly short of the ideal values, the RMDQ-6 derived through CFA correlated well with the original version.Conclusion: This study developed a more concise version of RMDQ through CFA to optimize its structural configuration. This concise instrument can be proposed as an efficient tool to assess the functionality of patients with LBP.
Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.
Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and appropriate physiotherapy for low back pain. They aim to improve the efficiency and effectiveness of physiotherapeutic care for patients with low back pain. The guidelines were constructed on the basis of the phases of the physiotherapy process, using the Dutch method of developing physiotherapy guidelines. Scientific evidence of systematic reviews was used as the basis for the recommendations. A computerised literature search of Medline, Cinahl, the Cochrane Database of Systematic Reviews and the Database of the Dutch National Institute of Allied Health Professions was conducted to identify relevant systematic reviews. If no evidence was available, consensus between experts was obtained. The guidelines were pilot tested among one hundred physiotherapists and reviewed by an external multidisciplinary panel. The guidelines recommend that the diagnostic process should focus on disability and participation problems resulting from back pain. The treatment should consist of an active approach, in which the patients learn to take control over their back pain. For patients with a normal course, where activities and participation gradually increase, reassurance, adequate information and advice to stay active are the most important recommendations. For patients with an abnormal course, where activities and participation do not increase, exercise therapy should also be provided, with a behavioural approach if necessary. These are the first national physiotherapy guidelines for low back pain. The recommendations are largely in line with other primary care guidelines for low back pain. Implementation will be a major challenge for the near future.
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.
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.
The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain.
The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective.
We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews.
Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included.
Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model.
Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45).
Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.
A systematic review of randomized and nonrandomized controlled trials.
Lumbar supports are used in the treatment of low back pain, but also to prevent the onset (primary prevention) or recurrences of a low back pain episode (secondary prevention).
To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain.
The Medline, Cinahl, and Current Contents databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers independently. A quantitative analysis was performed in which the strength of evidence was classified as strong, moderate, limited or conflicting, and no evidence.
Five randomized and two nonrandomized preventive trials and six randomized therapeutic trials were included in the review. Only 4 of the 13 studies were of high quality. There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain.
There continues to be a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance.
To estimate the prevalence of chronic regional and widespread musculoskeletal pain in a sample of the general adult population and study the association to age, sex, socioeconomic class, immigration, and housing area.
A cross sectional survey with a postal questionnaire to 3928 inhabitants on the west coast of Sweden.
The age and sex adjusted prevalence of chronic regional pain (CRP) was 23.9% and chronic widespread pain (CWP) 11.4% among 2425 subjects who responded to the complete questionnaire. Odds ratio (OR) for CWP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 6.36, 95% CI 3.85-10.50) vs age group 20-34 yrs. CWP was also associated with female sex (OR 1.91, 95% CI 1.41-2.61), being an immigrant (OR 1.83, 95% CI 1.22-2.77), living in a socially compromised housing area (OR 3.05, 95% CI 1.48-6.27), and being an assistant nonmanual lower level employee (OR 1.92, 95% CI 1.09-3.38) or manual worker (OR 2.72, 95% CI 1.65-4.49) vs being an intermediate/higher nonmanual employee. OR for CRP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 2.22, 95% CI 1.62-3.05) vs age group 20-34 yrs. CRP was also associated with being a manual worker (OR 1.63, 95% CI 1.19-2.23) vs being an intermediate/higher nonmanual employee.
Chronic musculoskeletal pain is common in the general population. Sociodemographic variables were overall more frequently and strongly associated with CWP than with CRP, which indicates different pathophysiology in the development or preservation of pain in the 2 groups.
To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.
Systematic literature review of randomised controlled trials.
A total of 1964 patients with disabling low back pain for more than three months.
Pain, function, employment, quality of life, and global assessments.
Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.
The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.
Back pain is a common problem for which cyclobenzaprine hydrochloride is frequently prescribed.
To perform a systematic review of cyclobenzaprine's effectiveness in the treatment of back pain.
We searched MEDLINE, PsycLIT, CINAHL, EMBASE, AIDSLINE, HEALTHSTAR, CANCERLIT, the Cochrane Library, Micromedex, Federal Research in Progress, and the references of reviewed articles, and contacted Merck, Sharpe and Dohme for English-language, randomized, placebo-controlled trials of cyclobenzaprine in adults with back pain. Outcomes included global improvement and 5 specific domains of back pain (local pain, muscle spasm, range of motion, tenderness to palpation, and activities of daily living). Study quality was assessed using the methods of Jadad. Summary outcomes were obtained using a random-effects model.
Patients treated with cyclobenzaprine were nearly 5 times (odds ratio, 4.7; 95% confidence interval, 2.7-8.1) as likely to report symptom improvement by day 14 as were those treated with placebo. Slightly fewer than 3 individuals (2.7; 95% confidence interval, 2.0-4.2) needed treatment for 1 to improve. The magnitude of this improvement was modest, with an effect size of 0.38 to 0.58 in all 5 outcomes (local pain, muscle spasm, tenderness to palpation, range of motion, and activities of daily living). Treatment efficacy for these 5 outcomes was greatest early, in the first few days of treatment, declining after the first week. Patients receiving cyclobenzaprine also experienced more adverse effects, the most common being drowsiness.
Cyclobenzaprine is more effective than placebo in the management of back pain; the effect is modest and comes at the price of greater adverse effects. The effect is greatest in the first 4 days of treatment, suggesting that shorter courses may be better. Studies comparing the relative value of acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually and in combination in the treatment of back pain are needed.
In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.
Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain.
To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain.
MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews.
Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain.
Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions.
43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons.
Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias.
Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.
The aim of this Discussion Paper is to estimate the social costs of back pain in the UK and assess the potential for reducing these costs by increasing the appropriateness of management of back pain. 50% to 80% of the population suffer from back pain at some stage of their life. With or without treatment, 90% of back pain problems improve within six weeks, but repeated episodes are very common. Although back pain and its management has been the subject of several thousand research papers over the past three decades, it still remains something of an enigma. Only 15% of cases can be clearly diagnosed. However, the great majority are due to mechanical low back pain which is the focus of this paper. Due to the paucity of data it is only possible to make crude estimates of the costs of back pain to the NHS, and these probably lie between £265 million and £383 million. Most of these costs are generated in 1) General Practice, due to the large number of consultations, and 2) Hospital in-patient management, due to the high treatment cost per person. Between 1986 and 1992 sickness and invalidity benefit claims for back pain alone increased in the UK by about 104%, while claims for other causes of sickness increased by 60%. The intangible costs of back pain and disability affecting the individual are likely to be considerable. When the problem has become chronic and intractable after about six months, the individual’s function and social activities may become severely curtailed. The General Practitioner is the key worker for back pain patients, and recent data suggests that these account for between 5.8 to 8.6 million consultations every year. Most consultations are associated with a prescription for medication, and advice to rest, despite the fact that the evidence is heavily weighted towards early resumption of normal activities. The processes are not well understood and treatment therefore is usually palliative. High quality outcome research is hampered by a number of
Objective
To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.
Design
Systematic literature review of randomised controlled trials.
Participants
A total of 1964 patients with disabling low back pain for more than three months.
Main outcome measures
Pain, function, employment, quality of life, and global assessments.
Results
Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.
Conclusions
The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.
What is already known on this topic
What is already known on this topic
Disabling chronic pain is regarded as the result of interrelating physical, psychological, and social or occupational factors requiring multidisciplinary intervention Two previous systematic reviews of multidisciplinary rehabilitation for chronic pain were open to bias and did not include any of the randomised controlled trials now available
What this study adds
What this study adds
Intensive, daily biopsychosocial rehabilitation with a functional restoration approach improves pain and function in chronic low back pain Less intensive interventions did not show improvements in clinically relevant outcomes
It is unclear whether the improvements are worth the cost of these intensive treatments
This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline version of Acute Low Back Problems in Adults, which was developed by a private-sector panel of health care providers and consumers. The Quick Reference Guide is an example of how a clinician might implement the panel’s findings and recommendations on the management of acute low back problems in working-age adults. Topics covered include the initial assessment of patients presenting with acute low back problems, identification of red flags that may indicate the presence of a serious underlying medical condition, initial management, special studies and diagnostic considerations, and further management considerations. Instructions for clinical testing for sciatic tension, recommendations for sitting and unassisted lifting, tests for identification of clinical pathology, and algorithms for patient management are included.
BACK pain ranks second only to upper respiratory illness as a symptomatic reason for office visits to physicians.¹ About 70% of adults have low back pain at some time, but only 14% have an episode that lasts more than 2 weeks. About 1.5% have such episodes with features of sciatica.2,3 Most causes of back pain respond to symptomatic and physical measures, but some are surgically remediable and some are systemic diseases (cancer or disseminated infection) requiring specific therapy, so careful diagnostic evaluation is important. Features of the clinical history and physical examination influence not only therapeutic choices but also decisions about diagnostic imaging, laboratory testing, and specialist referral.
ANATOMIC/PHYSIOLOGIC ORIGINS OF FINDINGS IN THE LOW BACK Low back pain may arise from several structures in the lumbar spine, including the ligaments that interconnect vertebrae, outer fibers of the annulus fibrosus, facet joints, vertebral periosteum, paravertebral musculature and fascia,
In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice.
To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain.
A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use).
Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems.
A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.
With the emergent concept of evidence-based practice, various countries have produced clinical guidelines for the management of acute low back pain since 1993-94. By and large the evidence-base for these proposals is consistent, though over the last 4 years it has increased considerably, and there has been a slight change of emphasis in several aspects. As all the guidelines are based on the same evidence, the similarity between them is not surprising. The common features are diagnostic triage along with periodic assessment to guide management strategies. There has been progressive reduction in the recommendation of rest as a treatment option, and early activation is increasingly recognized as a potent intervention. There has been a progressive recognition that psychosocial factors are important determinants for the risk of chronicity, and that such factors need to be addressed clinically. Specific therapeutic recommendations vary, but these are probably less important than the overall strategy. It is obviously hoped that clinical management should improve as a result of these initiatives, but effective dissemination and implementation are persisting concerns, and the effectiveness of clinical guidelines in changing clinical practice is still unproven.
Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.
The prevalence of low back pain (LBP) has been reported in the literature for different populations. Methodological differences among studies and lack of methodological rigor have made it difficult to draw conclusions from these studies. A systematic review was done for adult community prevalence studies of LBP published from 1981 to 1998. The technique of capture-recapture was performed to estimate the completeness of the search strategy used. Established guidelines and a methodological scoring system were used to critically appraise the studies. Thirteen studies were deemed methodologically acceptable. Differences in the duration of LBP used in the studies appeared to affect the prevalence rates reported and explain much of the variation seen. It was estimated that the point prevalence rate in North America is 5.6%. Further studies using superior methods are needed, however, before this estimate can be used with confidence to make health care policies and decisions relating to physical therapy.
In this case study, a diverse panel of 6 practitioners of mainstream and/or alternative medicine plus a moderator convened as an experiment in practicing integrative medicine to examine, diagnose, and prescribe for a patient suffering from chronic, severe, treatment-resistant back pain. Although panel members represented a wide range of theories of health and healing, they were able to communicate easily with one another by limiting themselves to the scientific language of biomedicine. From the perspective of medical anthropology, this can be interpreted as an unplanned and unconscious process of cultural imitation in a medical marketplace in which cultural differentiation formerly prevailed. Although the shift from differentiation to imitation was limited in this experiment to the sharing of a single language of discourse and to recommendations of mutually compatible treatment options, it raises an important question. With the institutionalization of integrated medical practice, will alternative medical systems survive only if they are stripped down to being no more than alternative therapeutic modalities?
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.
A systematic review of randomized and double-blind controlled trials was performed.
Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications worldwide and are widely used for patients with low back pain.
To assess the effects of nonsteroidal anti-inflammatory drugs in the treatment of nonspecific low back pain with or without radiation, and to assess which type of nonsteroidal anti-inflammatory drug is most effective.
For this study, the Cochrane Controlled Trials Register, Medline and Embase, and reference lists of articles were searched. Two reviewers blinded with respect to authors, institution, and journal independently extracted data and assessed the methodologic quality of the studies. If data were considered clinically homogeneous, a meta-analysis was performed. If data were considered clinically heterogeneous, a qualitative analysis was performed using a rating system with four levels of evidence: strong, moderate, limited, and no evidence.
This review involved 51 trials and 6057 patients. Of these trials, 16 (31%) were of high quality. The pooled relative risk for global improvement after 1 week was 1.24 (95% confidence interval [CI] = 1.10-1.41), and for additional analgesic use was 1.29 (95% CI = 1.05-1.57), indicating a statistically significant but small effect in favor of nonsteroidal anti-inflammatory drugs as compared with a placebo. The results of the qualitative analysis showed that there is conflicting evidence (Level 3) that nonsteroidal anti-inflammatory drugs are more effective than paracetamol for acute low back pain, and that there is moderate evidence (Level 2) that nonsteroidal anti-inflammatory drugs are not more effective than other drugs for acute low back pain. There is strong evidence (Level 1) that various types of nonsteroidal anti-inflammatory drugs are equally effective for acute low back pain.
The evidence from the 51 trials included in this review suggests that nonsteroidal anti-inflammatory drugs are effective for short-term symptomatic relief in patients with acute low back pain. Furthermore, there does not seem to be a specific type of nonsteroidal anti-inflammatory drug that is clearly more effective than others. Sufficient evidence on chronic low back pain still is lacking.
A systematic review of randomized controlled trials.
To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. They are widely used, despite questionable evidence of their effectiveness.
The reviewed randomized controlled and controlled trials appraising the effectiveness of biopsychosocial rehabilitation for working age patients with neck and shoulder pain were identified by searching electronic bibliographic databases, checking references, and consulting experts in the rehabilitation field. Four blinded reviewers selected the trials. Two specialists on rehabilitation evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results and the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level of scientific evidence.
After 1808 abstracts and the references of 65 reviews were screened, only two relevant studies were found that satisfied the criteria. One of these was considered a methodologically low-quality randomized controlled trial, and the other was a methodologically low-quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain was limited.
There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.
A systematic review of randomized controlled trials was performed.
To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working-age adults.
Multidisciplinary biopsychosocial rehabilitation programs are widely applied for patients with chronic low back pain. The multidisciplinary biopsychosocial approach for prolonged low back pain could be considered to prevent chronicity. Work site visits and a close relationship with occupational health care might produce results in terms of patients working ability.
Reviewed randomized controlled trials as well as controlled trials were identified from electronic bibliographic databases, reference checking, and consultation with experts in the rehabilitation field. Four blinded reviewers selected the trials. Two rehabilitation specialists evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results along with the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level evidence.
Of 1808 references, only 2 relevant studies were included. Both were considered to be methodologically low-quality randomized controlled trials. The clinical relevance of the studies was sufficient. The level of scientific evidence was moderate, showing that multidisciplinary rehabilitation involving work site visit or more comprehensive occupational health care intervention helps patients return to work faster, makes sick leaves less, and alleviates subjective disability.
There is moderate evidence showing that multidisciplinary rehabilitation for subacute low back pain is effective, and that work site visit increases the effectiveness, but because the analyzed studies had some methodologic shortcomings, an obvious need still exists for high-quality trials in this field.
Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial.
The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP.
We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000.
Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors.
Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios.
Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures. Subgroup analysis performed on TENS application and methodological quality did not demonstrate a significant statistical difference. Remaining pre-planned subgroup analysis was not conducted due to the small number of included trials and the variety of outcome measures reported.
The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain. Clinicians and researchers should consistently report the characteristics of the TENS device and the application techniques used. New trials on TENS should make use of standardized outcome measures. This meta-analysis lacked data on how TENS effectiveness is affected by four important factors: type of applications, site of application, treatment duration of TENS, optimal frequencies and intensities.
Descriptive study.
To compare national clinical guidelines on low back pain.
To rationalize the management of low back pain, clinical guidelines have been issued in various countries around the world. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment.
Guidelines were included that met the following criteria: the target group consisted of primary care health professionals, and the guideline was published in English, German, or Dutch. Only one guideline per country was included: the one most recently published.
Clinical guidelines from 11 different countries published from 1994 until 2000 were included in this review. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features were the early and gradual activation of patients, the discouragement of prescribed bed rest, and the recognition of psychosocial factors as risk factors for chronicity. However, there were discrepancies for recommendations regarding exercise therapy, spinal manipulation, muscle relaxants, and patient information.
The comparison of clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations were generally similar. Updates of the guidelines are planned in most countries, although so far produced only in the United Kingdom. However, new evidence may lead to stronger conclusions and enable future guidelines to become even more concordant.