Article

Back Pain Exacerbations and Lost Productive Time Costs in United States Workers

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Abstract

Cross-sectional with follow-up case-control component. To measure the prevalence of back pain (BP) and back pain exacerbations, describe BP features and functional impairment, estimate BP-related lost productive time (LPT) and costs, and assess the relation between pain exacerbations and lost productive time. BP is associated with substantial lost work time. However, little is known about the extent to which BP with or without exacerbation explains lost work time. A national telephone survey of the U.S. workforce identified 320 workers 40 to 65 years of age with BP defined by NHANES I criteria and 91 matched non-BP controls. Participants self-reported pain characteristics, lost productive time (absenteeism and presenteeism) in the previous 2 weeks, activity limitations, and demographics. A population-weighting adjustment was applied to estimates to account for selection bias and ensure that estimates of certain sample demographic subgroups' totals conformed to the Current Population Survey. The 2-week period prevalence of BP was 15.1%; 42% of workers with BP experienced pain exacerbations. BP prevalence was associated with demographic factors, but BP exacerbations were not. BP was reported by 42.6% of all workers. Workers with exacerbations reported more days with BP than those without exacerbations. Workers with exacerbations were significantly more likely than those without such exacerbations to report activity limitation (88.4% vs. 60.7%; P < 0.0001) and BP-related LPT (22.1% vs. 13.0%; P = 0.0259). BP in workers 40 to 65 years of age costs employers an estimated $7.4 billion/year. Workers with BP exacerbations account for 71.6% of this cost. Workers with BP exacerbations account for a disproportionate share of the cost of BP-related lost productive time.

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... However, the majority of these costs are associated with disability compensation, lost productivity, and lost tax revenue. Disability secondary to spinal pain is enormous (35,203,(486)(487)(488)(489)(490)(491)496,508,509). In the United Kingdom, low back pain was the largest single cause of absence from work in 1988 and 1989 and accounted for 12.5% of all sick days and over £11 billion in direct and indirect costs in 2000 (507). ...
... However, these estimates do not capture other costs associated with the work force "ripple effect," such as the potential hiring and training of replacement workers, impact of coworkers' productivity, and forfeiture of leisure time (492). In an evaluation of back pain exacerbations and LPT costs in United States workers (486), it was shown that the 2week period prevalence of back pain was 15.1%; 42% of workers with back pain experienced pain exacerbations. Back pain prevalence was associated with demographic factors, but back pain exacerbations were not. ...
... Frequent use of opioids in managing chronic noncancer pain has been a major strain on U.S. health care (23,24,(483)(484)(485)(486)493,512,. With the majority of patients receiving opioids for chronic pain combined with increased production of opioids, the costs of opioid use have been much higher even when patients were not abusing. ...
Article
Persistent pain interfering with daily activities is common. Chronic pain has been defined in many ways. Chronic pain syndrome is a separate entity from chronic pain. Chronic pain is defined as, “pain that persists 6 months after an injury and beyond the usual course of an acute disease or a reasonable time for a comparable injury to heal, that is associated with chronic pathologic processes that cause continuous or intermittent pain for months or years, that may continue in the presence or absence of demonstrable pathologies; may not be amenable to routine pain control methods; and healing may never occur.” In contrast, chronic pain syndrome has been defined as a complex condition with physical, psychological, emotional, and social components. The prevalence of chronic pain in the adult population ranges from 2% to 40%, with a median point prevalence of 15%. Among chronic pain disorders, pain arising from various structures of the spine constitutes the majority of the problems. The lifetime prevalence of spinal pain has been reported as 54% to 80%. Studies of the prevalence of low back pain and neck pain and its impact in general have shown 23% of patients reporting Grade II to IV low back pain (high pain intensity with disability) versus 15% with neck pain. Further, age related prevalence of persistent pain appears to be much more common in the elderly associated with functional limitations and difficulty in performing daily life activities. Chronic persistent low back and neck pain is seen in 25% to 60% of patients, one-year or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Estimates and patterns of productivity losses and direct health care expenditures among individuals with back and neck pain in the United States continue to escalate. Recent studies have shown significant increases in the prevalence of various pain problems including low back pain. Frequent use of opioids in managing chronic non-cancer pain has been a major issue for health care in the United States placing a significant strain on the economy with the majority of patients receiving opioids for chronic pain necessitating an increased production of opioids, and escalating costs of opioid use, even with normal intake. The additional costs of misuse, abuse, and addiction are enormous. Comorbidities including psychological and physical conditions and numerous other risk factors are common in spinal pain and add significant complexities to the interventionalist’s clinical task. This section of the American Society of Interventional Pain Physicians (ASIPP)/EvidenceBased Medicine (EBM) guidelines evaluates the epidemiology, scope, and impact of spinal pain and its relevance to health care interventions. Key words: Chronic pain, chronic spinal pain, chronic low back pain, chronic neck pain, chronic thoracic pain, prevalence, health care utilization, loss of productivity, interventional techniques, surgery, comorbid factors, socioeconomic effects, health care impact
... In the USA alone, the direct and indirect costs of LBP were estimated to range from $84.1 billion to $624.8 billion (Dagenais et al., 2008). Due to the productivity lost alone, the annual costs to employers were estimated to be $7.4 billion, of which 71.6% was due to recurrent LBP (Ricci et al., 2006). An earlier Australian study (Walker et al., 2003) (Melloh et al., 2008). ...
... The findings of a recent study in the USA also showed that deviation from the management options endorsed in the clinical guidelines was common, and was associated with unnecessarily increased costs of care (Kim et al., 2019). Given that the health care costs for LBP are high and increasing all over the world (Martin et al., 2008), the cost-effectiveness of treatment for low back and other spinal pain, such as neck pain, has become a matter of global concern (Ricci et al., 2006;Babu et al., 2016). Thus, evidence-based clinical decisions support provision of appropriate diagnostic and treatment services for LBP patients seeking health care. ...
Thesis
Introduction Low back pain (LBP) is a global public health problem. It is a highly prevalent and significant source of negative social, psychological, and economic burden. In Ethiopia, LBP ranked in the top ten causes of age standardised disability-adjusted life years (DALYs) in 2015. From 1990 to 2015, while DALYs caused by all other top 30 contributors (such as measles, malaria, and protein energy malnutrition) were shown to decrease, DALYs caused by LBP and sense organ diseases continued to increase (Misganaw et al., 2017b). This shows that combined with neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia, which are the common causes of DALYs in sub-Saharan Africa (Vos et al., 2013), LBP may pose a serious burden in Ethiopia. Primary prevention strategies have limited potential while timely and appropriate diagnosis and tailored treatment plans can reduce the burden of pain and improve patient outcomes. A better understanding of the epidemiology of health care utilisation for LBP in resource-limited communities like Ethiopia is therefore significantly important for future health care pathways development (Lentz et al., 2018). Objectives The aims of this study were 1) to develop and validate a measurement instrument used to measure determinants of health care utilisation for LBP, and 2) to investigate the epidemiology of health care utilisation for low back pain in Ethiopia. Methods To develop and validate the measurement instrument, a comprehensive review of the literature was undertaken and the relevant domains of potential determinants of health care utilisation for LBP were identified. Items relating to each domain were then generated, translated, and reviewed by an expert panel for content validity, clarity, and to suggest other items which may have been omitted. Factorial validity and internal consistency reliability were assessed by conducting principal component and parallel analyses, and Cronbach's alpha calculation, respectively, using a data from 1303 completed questions. The intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate the temporal stability of the instrument. The investigation of health care utilisation and hospital admission for LBP included a total of 1981 people with LBP. The calculation involved a single population proportion formula, with an expected prevalence of health care utilisation for LBP (p = 50%), 95% level of confidence, 4% margin of error, 3 design effect, and a 10% non-response. The study was conducted in June-November 2018 in South-West Shewa zone of Oromia regional state, Ethiopia. The study participants were selected using a multistage sampling technique with a systematic random sampling method. Data were collected using the Oromo language version of the instrument using the interview technique. Data entry was made using Epi-Info version 7.0, where it was exported to SPSS 23.0 and checked for accuracy. Finally, data analyses were carried out using R version 3.5.1. Health care utilisation and hospital admission for LBP were estimated as prevalence rates with 95% confidence intervals (CIs). The log-binomial regression model was fitted to determine prevalence ratios (PR) with 95% CIs in identifying factors associated with health care utilisation and hospital admission for LBP. Estimates of population parameters were also presented with 95% CIs and p-values. For all applications of inferential statistics, a p-value of < 0.05 was taken as the significance level. Results The content validity index of the items forming the newly developed measurement instrument ranged between 0.80 and 1.00 with the modified Kappa coefficient ranged between 0.79 and 1.00. The parallel analysis showed that there were six components with Eigenvalues exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00. The lifetime prevalence of health care utilisation for LBP was 36.1%, 95% CI: 33.9-38.1 and the annual prevalence was 30%, 95% CI: 27.9-32.2. Of the total 543 individuals with a one-year history of presentation to health care facilities for LBP, 78 (14.4%, 95% CI: 11.6-17.3) were hospitalised for the pain, with an average length of stay (LOS) 7.4 days, 95% CI: 6.4-8.8. Several socio-demographic variables, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors, such as beliefs about the pain, depressive symptoms, and sleeping problem/insomnia were independently associated with health care utilisation for LBP. Hospital admission for LBP was also found to be associated with gender, age, living conditions, residential environment, alcohol consumption status, intensity of pain, and presence of additional spinal pain. Conclusions The newly developed measurement instrument has an overall good level of psychometric properties measured as content and factorial validity, internal consistency reliability, and temporal stability. The most decisive factors explaining variations in health care utilisation and hospital admission for LBP were also determined. There were potential inequalities between urban and rural populations in accessing the Ethiopian health care system with relatively better services. This study also highlighted the burden of LBP to individuals and the already overloaded and fragile Ethiopian health care system. It may be prudent that the Ethiopian health care policy makers develop the necessary strategies to meet the health needs of both urban and rural populations with LBP. Further research evidence is also needed on LBP patient referral procedures in the Ethiopian health care system to inform the health policy makers regarding appropriate management strategies capable of dealing with the increasing epidemiology of LBP and associated health needs of people experiencing the pain.
... The 45 studies included 17 studies (39%) from the United States [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], five (11%) from Sweden [34][35][36][37][38], four (9%) from The Netherlands [39][40][41][42], and three (7%) each from the UK [9,43,44], Germany [45][46][47], and Japan [48][49][50] (Table 2). The studies were published from 1995 to 2020, and the data collection spanned from 1987 to 2017. ...
... No significant methodological differences were observed between studies that assessed both direct, and indirect costs (n = 23) and those that reported on direct costs only [17, 21-23, 25, 27, 29, 31, 43, 46, 48, 51, 56] or indirect costs only [18,20,26,28,30,40,44]. This review examined the cost components reported with the aim of identifying the most important cost drivers. ...
Article
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Background Back pain is a common and costly health problem worldwide. There is yet a lack of consistent methodologies to estimate the economic burden of back pain to society. Objective To systematically evaluate the methodologies used in the published cost of illness (COI) literature for estimating the direct and indirect costs attributed to back pain, and to present a summary of the estimated cost burden. Methods Six electronic databases were searched to identify COI studies of back pain published in English up to February 2021. A total of 1,588 abstracts were screened, and 55 full-text studies were subsequently reviewed. After applying the inclusion criteria, 45 studies pertaining to the direct and indirect costs of back pain were analysed. Results The studies reported data on 15 industrialised countries. The national cost estimates of back pain in 2015 USD ranged from $259 million ($29.1 per capita) in Sweden to $71.6 billion ($868.4 per capita) in Germany. There was high heterogeneity among the studies in terms of the methodologies used for analysis and the resulting costs reported. Most of the studies assessed costs from a societal perspective (n = 29). The magnitude and accuracy of the reported costs were influenced by the case definition of back pain, the source of data used, the cost components included and the analysis method. Among the studies that provided both direct and indirect cost estimates (n = 15), indirect costs resulting from lost or reduced work productivity far outweighed the direct costs. Conclusion Back pain imposes substantial economic burden on society. This review demonstrated that existing published COI studies of back pain used heterogeneous approaches reflecting a lack of consensus on methodology. A standardised methodological approach is required to increase credibility of the findings of COI studies and improve comparison of estimates across studies.
... * Correspondence: william.shaw@libertymutual.com 1 Liberty Mutual Research Institute for Safety, 71 Frankland Rd., Hopkinton, MA 01748, USA Background One dramatic workforce trend in the US and elsewhere is the advancing median age of workers and the growing prevalence of chronic health conditions that contribute to workplace pain, fatigue, task limitations, and reduced productivity. Approximately 40 percent of working U.S. adults report persistent or recurrent musculoskeletal pain conditions or other chronic physical health conditions that limit their ability to work in measures of point prevalence [1,2]. ...
... * Correspondence: william.shaw@libertymutual.com 1 Liberty Mutual Research Institute for Safety, 71 Frankland Rd., Hopkinton, MA 01748, USA Background One dramatic workforce trend in the US and elsewhere is the advancing median age of workers and the growing prevalence of chronic health conditions that contribute to workplace pain, fatigue, task limitations, and reduced productivity. Approximately 40 percent of working U.S. adults report persistent or recurrent musculoskeletal pain conditions or other chronic physical health conditions that limit their ability to work in measures of point prevalence [1,2]. Because of aging trends in the workforce, the prevalence of chronic diseases will increase in coming years, especially musculoskeletal conditions [3]. ...
Article
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Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program (“Manage at Work”) (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20–69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability. Clinical trial registration: Clinicaltrials.gov #NCT01978392.
... 1 In this robotic era, the culture of sedentary work is becoming a fashion and thus the prevalence of musculoskeletal disorders is increasing with every passing day, which is negatively affecting not only the mental health but also the physical health and productivity of the patients. 2,3 The population that is most likely to be affected by these issues is those who spend most of the time sitting and working on computers, abnormal posture for a long-time which may cause back pain. 2 A Swedish study concluded that the sitting time is directly proportional to low back pain among the blue-collar workers in this context. 4 Moreover, having a dull routine without any physical activities being part of the daily schedule can make a person more susceptible to lumbar pain and discal issues. ...
... 2,3 The population that is most likely to be affected by these issues is those who spend most of the time sitting and working on computers, abnormal posture for a long-time which may cause back pain. 2 A Swedish study concluded that the sitting time is directly proportional to low back pain among the blue-collar workers in this context. 4 Moreover, having a dull routine without any physical activities being part of the daily schedule can make a person more susceptible to lumbar pain and discal issues. ...
Article
Full-text available
Lumbar disc herniation is one of the key factors in radiculopathy. Various physical therapy interventions are being used to address this increasing complaint. This study was design to find out the effects of spinal decompression and ELDOA exercises on back, leg pain, and disability in patients with lumbar disc protrusion. Material & Methods: This study was a randomized control trial. There were one hundred and twenty participants enrolled in this study. The inclusion criteria were age 30 to 60 years, lumbar disc protrusion confirms through MRI, and pain in the back and leg. Patients were randomly allocated into two groups Decompression and ELDOA, 60 in each, through the sealed envelope method. Participants were assessed at baseline and after the 8th visit. The primary outcome measuring tools were NPRS, and MODI. The data analysis was done through SPSS version 21. Results: Among 120 participants, 56 were male and 64 were female with a mean age of 44.47±11.89. After 8th visit pain and disability show significant result. The back pain score for the decompression group was 1.75 ± 0.57 and ELDOA group was 1.13 ± 0.72 having P< 0.001, leg pain score for the decompression group was 1.90 ± 0.630 while the ELDOA group was 0.58 ± 0.99 having P< 0.001 and the MODI score of the decompression group was 72.12 ± 8.17 and the ELDOA group was 17.53 ± 4.27 having P< 0.001. Conclusion: Decompression and ELDOA exercises are beneficial for improving back pain, leg pain as well as the quality of life of patients with disc protrusion. However, ELDOA exercise has shown significant results compared to the decompression and control group.
... Chronic pain is a leading contributor to years lived with disability, and it places an immense burden on individuals and their families. 1 -3 Its economic impact is significant because of its effects on health care costs, 4 missed work, 5,6 and reduced productivity at work. 5,6 It has become increasingly clear that primary health care (PHC) systems are struggling to address the needs of people living with chronic pain. ...
... 1 -3 Its economic impact is significant because of its effects on health care costs, 4 missed work, 5,6 and reduced productivity at work. 5,6 It has become increasingly clear that primary health care (PHC) systems are struggling to address the needs of people living with chronic pain. 7,8 Despite a rise in PHC of the rate of opioid prescriptions to manage chronic pain over the past three decades, 9 function and return-to-work outcomes have not improved for this population. ...
Article
Purpose: Evidence suggests that a physiotherapist-led chronic pain self-management programme in primary health care (PHC) improves function for people living with chronic pain; however, implementing a new approach to care can be difficult. In this study, we sought to understand the experiences of physiotherapists who had implemented the ChrOnic pain self-ManageMent support with pain science EducatioN and exerCisE (COMMENCE) programme; its perceived barriers, facilitators, benefits, and drawbacks; and how the physiotherapists tailored the programme to their own clinical contexts. Method: This interpretive description qualitative study used semi-structured interviews with physiotherapists who had implemented the COMMENCE programme in PHC. Results: Themes from 11 interviews included experiences of personal and professional growth, increasing confidence with experience, and changing the culture of pain management. Barriers and drawbacks to implementation included resource intensiveness, balancing programme demands with other clinical work, and challenges with patient attendance and participation. Facilitators included training, programme design and materials, supportive teams, and previous knowledge. Benefits included offering group and individualized support, evidence-based content, and sparking interest in learning more about pain management. The participants made small changes to tailor the programme content and delivery to their context. Conclusions: This study provides a rich understanding of the experiences, barriers, facilitators, benefits, drawbacks, and tailoring related to the COMMENCE programme in PHC. The results will facilitate future implementation of this intervention in PHC settings.
... Among these, LBP is one of the most common diseases occurring amongst VDTs, suffice it to say that in Europe about 44 million workers suffer from lumbar ache [6,7]. Causing a loss of 149 million working days per year in the US alone [8], LBP is considered to be one of the main reasons for absenteeism in workplaces, as well as a relevant socio-economic burden, since it leads to reduced work productivity, high insurance costs and the exploitation of the National Health Service [9,10]. Studies show that the occurrence of LBP is attributable to multiple factors that take into account both the workers' physical features (i.e., age, gender, and body mass index-BMI) and the working environment [11]. ...
Article
Full-text available
Low back pain (LBP) is one of the musculoskeletal disorders that most affects workers. Among others, one of the working categories which mainly experiences such disease are video terminal workers. As it causes exploitation of the National Health Service and absenteeism in workplaces, LBP constitutes a relevant socio-economic burden. In such a scenario, a prompt detection of wrong seating postures can be useful to prevent the occurrence of this disorder. To date, many tools capable of monitoring the spinal range of motions (ROMs) are marketed, but most of them are unusable in working environments due to their bulkiness, discomfort and invasiveness. In the last decades, fiber optic sensors have made their mark allowing the creation of light and compact wearable systems. In this study, a novel wearable device embedding a Fiber Bragg Grating sensor for the detection of lumbar flexion-extensions (F/E) in seated subjects is proposed. At first, the manufacturing process of the sensing element was shown together with its mechanical characterization, that shows linear response to strain with a high correlation coefficient (R2 > 0.99) and a sensitivity value (Sε) of 0.20 nm∙mε−1. Then, the capability of the wearable device in measuring F/E in the sagittal body plane was experimentally assessed on a small population of volunteers, using a Motion Capture system (MoCap) as gold standard showing good ability of the system to match the lumbar F/E trend in time. Additionally, the lumbar ROMs were evaluated in terms of intervertebral lumbar distances (Δ d L 3 − L 1 ) and angles, exhibiting moderate to good agreement with the MoCap outputs (the maximum Mean Absolute Error obtained is ~16% in detecting Δ d L 3 − L 1 ). The proposed wearable device is the first attempt for the development of FBG-based wearable systems for workers’ safety monitoring.
... 5 Parallel to this, in 2004 indirect cost of US$ 7,400,000,000 due to LBP was spent at national level in United States of America. 6 Musculoskeletal problems with complaints of back pain were also one in seven of all the recorded consultations in the United Kingdom in 2006. 7 Therefore, LBP is not only a health problem but also a socioeconomic problem. ...
Article
Full-text available
Background Low-back pain (LBP) is a major public health problem globally and its direct and indirect healthcare costs are growing rapidly. Virtual reality involving the use of video games or non-game applications are alternatives to conventional face-to-face physical therapy for LBP. The purpose of this study was to assess the cost-effectiveness of Back Extension-Virtual Reality Game (BE-VRG) compared to Clinic-based McKenzie therapy (CBMT) for chronic non-specific LBP in Nigeria. Methods Patients with chronic non-specific LBP were randomised into either BE-VRG or CBMT group. Patients’ level of disability was assessed using Oswestry Disability Index (ODI) at week 4 and week 8. ODI was mapped to SF-6D to generate quality adjusted life years (QALYs) used for cost-effectiveness analysis. Resource use and costs were assessed based on rehabilitation services from a healthcare perspective. Cost-effectiveness analysis which included direct healthcare costs was conducted. Incremental cost per QALY was also calculated. Results Forty-six patients (BE-VRG, n = 22; CBMT, n = 24) with the mean (±SD) age of 32.6 ± (11.5) years for BE-VRG and 48.8 ± (10.2) years for CBMT intervention completed in this study. The mean direct health costs per patient were USD100.67 and USD106.3 for BE-VRG and CBMT, respectively. The mean quality adjusted life years at week 4 and week 8 were (BE-VRG, 0.0574 ± (0.002); CBMT, 0.0548 ± (0.002)); and (BE-VRG; 0.116 ± (0.002); CBMT; 0.114 ± (0.004)), respectively. Incremental cost-effectiveness ratio showed that BE-VRG arm was less costly and more effective than CBMT. Conclusion The findings of this study suggest that BE-VRG was cost saving for chronic non-specific LBP compared to CBMT. This evidence could guide policy makers, payers and clinicians in evaluating BE-VRG as a treatment option for people with chronic non-specific LBP.
... Employees who experience exacerbations in LBP incur high costs and account for most loss of productivity [11]. ...
Article
Objective: The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF. Materials and methods: Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application. Results: Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days. Discussion: These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
... While painful IVD degeneration is not a lethal disease, it has been recognized as a major social burden with a high socioeconomic impact, with many people not being able to return to work. Low back pain has been reported as the leading cause of disability worldwide, with a total cost of more than $100 billion annually in the United States alone [1,2]. ...
Article
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Background: Acute trauma on intervertebral discs (IVDs) is thought to be one of the risk factors for IVD degeneration. The pathophysiology of IVD degeneration induced by single high impact mechanical injury is not very well understood. The aim of this study was using a post-traumatic IVD model in a whole organ culture system to analyze the biological and biomechanical consequences of the single high-impact loading event on the cultured IVDs. Methods: Isolated healthy bovine IVDs were loaded with a physiological loading protocol in the control group or with injurious loading (compression at 50% of IVD height) in the one strike loading (OSL) group. After another 1 day (short term) or 8 days (long term) of whole organ culture within a bioreactor, the samples were collected to analyze the cell viability, histological morphology and gene expression. The conditioned medium was collected daily to analyze the release of glycosaminoglycan (GAG) and nitric oxide (NO). Results: The OSL IVD injury group showed signs of early degeneration including reduction of dynamic compressive stiffness, annulus fibrosus (AF) fissures and extracellular matrix degradation. Compared to the control group, the OSL model group showed more severe cell death (P < 0.01) and higher GAG release in the culture medium (P < 0.05). The MMP and ADAMTS families were up-regulated in both nucleus pulposus (NP) and AF tissues from the OSL model group (P < 0.05). The OSL injury model induced a traumatic degenerative cascade in the whole organ cultured IVD. Conclusions: The present study shows a single hyperphysiological mechanical compression applied to healthy bovine IVDs caused significant drop of cell viability, altered the mRNA expression in the IVD, and increased ECM degradation. The OSL IVD model could provide new insights into the mechanism of mechanical injury induced early IVD degeneration. The translational potential of this article: This model has a high potential for investigation of the degeneration mechanism in post-traumatic IVD disease, identification of novel biomarkers and therapeutic targets, as well as screening of treatment therapies.
... Back pain is the single leading cause of disability globally and is rising (9,10). Financial costs from back pain are estimated to be in the order of billions of US dollars (USD) (10,11), while the economic burden of members of the workforce suffering from back pain is estimated in the USA alone to be USD 7.4 billion/year (12). Traditionally conceptualised as solely secondary to mechanical injury, back pain is now described within a bio-psychosocial model, resulting from an interaction of physical, psychological and social in uences (13). ...
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BACKGROUND: The World Health Organisation highlights back pain as a leading and growing cause of disability worldwide. In the field of chronic pain, higher health literacy is linked to lower pain intensity and better pain control. However, there remains a paucity of evidence, with a recent systematic review finding only three studies meeting its inclusion criteria. OBJECTIVES: This scoping review had two objectives in exploring research in chronic pain, which were to identify: 1) The health literacy measures currently employed. 2) The back-pain health outcomes included in such work and the extent to which these reflect the core outcome set for clinical trials in non-specific low back pain. METHODS: The search broadened the search strategy used in the systematic review. It was conducted using thirteen bibliographic databases, employing medical subject heading (MeSH) terms for back pain and health literacy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A thematic framework approach was used for analysis. RESULTS: The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most outcome measures employed (36 out of 50) were not directly relevant to addressing the core outcome set for clinical trials in non-specific low back pain. CONCLUSIONS: A dearth of studies in this field of research was noted, especially in Asia and low-middle income countries. Methodological limitations were identified, including in study design and outcome measures. To allow for comparison across findings and the development of a rigorous evidence base, future work should include the core outcome set for clinical trials in non-specific low back pain. Furthermore, research thus far has focused on a narrow range of populations and there is an urgent need to broaden the evidence-base to include those with characteristics known to be moderators in health outcomes. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.
... According to Ricci et al. [4] approximately 39% of patients suffer from herniated disc and do not describe any subjective complaints, and during radiculography protrusion of the intervertebral disc was found in 50% of cases and herniation of the disc in 24% of cases, data in a study on workers in the USA [4]. ...
Article
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Background and purpose: The purpose of this case report is to describe the outcome of a exercise protocol-based intervention plan combined with K-Taping for a patient with non-specific chronic low back pain.
... El dolor lumbar es una de las afecciones más debilitantes que inflige malestar y discapacidad a su portador. En las personas, la presencia de dolor afecta el bienestar mental, así como la eficiencia en el desempeño de las tareas del día a día, incluso, disminuye la productividad y, en consecuencia, el debilitamiento de la economía 6 . Al categorizar las estrategias terapéuticas de intervención para el dolor lumbar inespecífico, los kinesiólogos señalan la realización de termoterapia, fortalecimiento muscular, ejercicios aeróbicos y que siempre se implementa terapia manual 7 . ...
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Resumen Introducción. El dolor lumbar es una de las causas mas comunes de discapacidad en el mundo, existen diferentes tratamientos conservadores dentro de la kinesiología para el manejo de este. La presente investigación describe los efectos de la aplicación de técnicas de liberación miofascial instrumental y, cómo éstas modifican parámetros mecánicos y la expresión de parámetros séricos, tales como: Leucocitos, Bilirrubina y Fierro en estudiantes sedentarios que presenten dolor lumbar inespecífico de la Universidad de las Américas. Objetivo. Describir el efecto de la técnica de liberación miofascial instrumental en la modificación de parámetros mecánicos y séricos en usuarios sedentarios con dolor lumbar inespecífico. Métodos. Analítico experimental. Resultado. Fueron intervenidos 14 participantes sedentarios con dolor lumbar inespecífico, los resultados no fueron significativos en los cambios serios, por el contrario, fueron significativo en los cambios mecánicos. Conclusión. Las técnicas de liberación miofascial instrumental pueden ser una herramienta eficaz para el manejo del dolor lumbar inespecífico, pero faltan mas estudios para demostrar sus efectos a nivel sérico. Palabras claves: Dolor Lumbar inespecífico; Terapia miofascial; Terapia Instrumental. Introducción La evidencia actual sobre el comportamiento sedentario y la inactividad física del ser humano ha demostrado un aumento en el dolor musculo-esquelético que se ha vuelto cada vez más frecuente en los últimos 40 años 1. El comportamiento sedentario se caracteriza por poco movimiento físico y actividades que implican un bajo gasto de energía menor a 1.5 unidades metabólicas equivalentes 2. Las reducciones dramáticas en el movimiento y la actividad no solo resultan en el desarrollo de diversas enfermedades crónicas como enfermedades cardiovasculares 3 y obesidad 4 , sino que también pueden conducir al aumento de los trastornos musculo-esqueléticos, incluidos el dolor y la discapacidad 5. El dolor lumbar es una de las afecciones más debilitantes que inflige malestar y discapacidad a su portador. En las personas, la presencia de dolor afecta el bienestar mental, así como la eficiencia en el desempeño de las tareas del día a día, incluso, disminuye la productividad y, en consecuencia, el debilitamiento de la economía 6. Al categorizar las estrategias terapéuticas de intervención para el dolor lumbar inespecífico, los kinesiólogos señalan la realización de termoterapia, fortalecimiento muscular, ejercicios aeróbicos y que siempre se implementa terapia manual 7. Dentro de la terapia manual ortopédica, las técnicas instrumentales han tenido una gran explosión estos últimos años, aunque su origen proviene de técnicas milenarias como son gua sha 8 , y se han occidentalizado en técnicas como Graston 9. Chile también tiene una variante de esta técnica 10 , llamada KineticXer ®. Las técnicas de liberación miofascial instrumental se basan en que, a través de instrumentos de piedra, carbono o acero, se realiza
... 12 Forty percent of US workers report chronic or recurrent musculoskeletal pain, 13,14 15% of workers report pain most days or every day, 15 and work-related exacerbations of back pain account for $5.3 billion per year in lost work productivity. 13 Workrelated factors may also influence access to opioids as well as OUD treatments, as many US workers depend on employer-sponsored health insurance or workers' compensation insurance. 16 Attending to conditions of work may have significant potential for effective public health action to combat the opioid crisis. ...
Article
Opioid use disorder (OUD) and opioid overdose deaths (OODs) are prevalent among US workers, but work-related factors have not received adequate attention as either risk factors or opportunities for OOD prevention. Higher prevalence of OOD in those with heavy physical jobs, more precarious work, and limited health care benefits suggest work environment and organizational factors may predispose workers to the development of OUD. Organizational policies that reduce ergonomic risk factors, respond effectively to employee health and safety concerns, provide access to nonpharmacologic pain management, and encourage early substance use treatment are important opportunities to improve outcomes. Organizational barriers can limit disclosure of pain and help-seeking behavior, and opioid education is not effectively integrated with workplace safety training and health promotion programs. Policy development at the employer, government, and association levels could improve the workplace response to workers with OUD and reduce occupational risks that may be contributing factors. (Am J Public Health. Published online ahead of print June 18, 2020: e1–e7. doi:10.2105/AJPH.2020.305716)
... 5 Parallel to this, in 2004 indirect cost of US$ 7,400,000,000 due to LBP was spent at national level in United States of America. 6 Musculoskeletal problems with complaints of back pain were also one in seven of all the recorded consultations in the United Kingdom in 2006. 7 Therefore, LBP is not only a health problem but also a socioeconomic problem. ...
... L ow back pain (LBP) is a very occurring medical condition with a great impact on health and social services and a patient's quality of life. [1] It is a health problem that is present everywhere and is considered to be one of the leading causes of work absenteeism and disability worldwide. [2] High expenses attributed to LBP and its socioeconomic effect have made this condition a significant health-care policy challenge not only in the industrialized world but also in the rural communities. ...
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Introduction: Measuring outcomes in the health-care system has been very well understood among health-care specialists for the past few decades and has been widely acknowledged by various authors. Roland-Morris Disability Questionnaire (RMDQ) is one of the most commonly used measures of disability in patients with low back pain (LBP) and has been translated and validated into many different languages around the world. However, Hausa version of the questionnaire is yet to be established. This study developed and assessed the validity of RMDQ in Hausa-speaking patients with LBP. Materials and Methods: Eligible participants (n = 375; age = 37.5; standard deviation = 7.48) with either acute or chronic LBP completed both the original version of the RMDQ (RMDQ-O) and the Hausa version of the RMDQ (RMDQ-H). In addition, other outcome measures including the Oswestry Disability Index and the Berg Balance Scale were also completed by the participants to enable equivalence of data. Pearson's product-moment correlation was used to establish the validity of the RMDQ-H. Results: The result of this study revealed that the concurrent validity of the RMDQ-H produced a significant value of 0.786 (n = 375; P = 0.001). The convergent validity and the divergent validity of the RMDQ-H were 0.692 (n = 375; P = 0.001) and 0.013 (n = 375; P = 0.671), respectively. Conclusion: The developed RMDQ-H is a valid outcome measure of disability among Hausa-speaking patients with LBP.
... L ow back pain (LBP) is a very occurring medical condition with a great impact on health and social services and a patient's quality of life. [1] It is a health problem that is present everywhere and is considered to be one of the leading causes of work absenteeism and disability worldwide. [2] High expenses attributed to LBP and its socioeconomic effect have made this condition a significant health-care policy challenge not only in the industrialized world but also in the rural communities. ...
... Back pain's indirect economic impacts are also high. It has been estimated that in the USA alone companies lose as much as $7.4 billion per year due to back pain-related issues among workers [7]. Given its substantial individual and societal costs, investigating the causes of back pain is an important endeavour. ...
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Background and objectives: The study reported here focused on the aetiology of spondylolysis, a vertebral pathology usually caused by a fatigue fracture. The goal was to test the ‘Overshoot Hypothesis’, which proposes that people develop spondylolysis because their vertebral shape is at the highly derived end of the range of variation within Homo sapiens. Methodology: We recorded 3D data on the final lumbar vertebrae of H. sapiens and three great ape species, and performed three analyses. First, we compared H. sapiens vertebrae with and without spondylolysis. Second, we compared H. sapiens vertebrae with and without spondylolysis to great ape vertebrae. Lastly, we compared H. sapiens vertebrae with and without spondylolysis to great ape vertebrae and to vertebrae of H. sapiens with Schmorl’s nodes, which previous studies have shown tend to be located at the ancestral end of the range of H. sapiens shape variation. Results: We found that H. sapiens vertebrae with spondylolysis are significantly different in shape from healthy H. sapiens vertebrae. We also found that H. sapiens vertebrae with spondylolysis are more distant from great ape vertebrae than are healthy H. sapiens vertebrae. Lastly, we found that H. sapiens vertebrae with spondylolysis are at the opposite end of the range of shape variation than vertebrae with Schmorl’s nodes. Conclusions: Our findings indicate that H. sapiens vertebrae with spondylolysis tend to exhibit highly derived traits and therefore support the Overshoot Hypothesis. Spondylolysis, it appears, is linked to our lineage’s evolutionary history, especially its shift from quadrupedalism to bipedalism. Lay summary: Spondylolysis is a relatively common vertebral pathology usually caused by a fatigue fracture. There is reason to think that it might be connected with our lineage’s evolutionary shift from walking on all fours to walking on two legs. We tested this idea by comparing human vertebrae with and without spondylolysis to the vertebrae of great apes. Our results support the hypothesis. They suggest that people who experience spondylolysis have vertebrae with what are effectively exaggerated adaptations for bipedalism.
... Low back pain (LBP) is one of the most common causes of disability in US adults younger than 45 years [1], with 10 to 20% of American workers reporting persistent back pain [2]. LBP impacts one's ability to work and affects the quality of life. ...
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Background: Acute and chronic low back pain (LBP) are different conditions with different treatments. However, they are coded in electronic health records with the same International Classification of Diseases, 10th revision (ICD-10) code (M54.5) and can be differentiated only by retrospective chart reviews. This prevents an efficient definition of data-driven guidelines for billing and therapy recommendations, such as return-to-work options. Objective: The objective of this study was to evaluate the feasibility of automatically distinguishing acute LBP episodes by analyzing free-text clinical notes. Methods: We used a dataset of 17,409 clinical notes from different primary care practices; of these, 891 documents were manually annotated as acute LBP and 2973 were generally associated with LBP via the recorded ICD-10 code. We compared different supervised and unsupervised strategies for automated identification: keyword search, topic modeling, logistic regression with bag of n-grams and manual features, and deep learning (a convolutional neural network-based architecture [ConvNet]). We trained the supervised models using either manual annotations or ICD-10 codes as positive labels. Results: ConvNet trained using manual annotations obtained the best results with an area under the receiver operating characteristic curve of 0.98 and an F score of 0.70. ConvNet's results were also robust to reduction of the number of manually annotated documents. In the absence of manual annotations, topic models performed better than methods trained using ICD-10 codes, which were unsatisfactory for identifying LBP acuity. Conclusions: This study uses clinical notes to delineate a potential path toward systematic learning of therapeutic strategies, billing guidelines, and management options for acute LBP at the point of care.
... Low back pain (LBP) mentioned as 2 nd most communal disability in United States (Ricci 2006) but in a survey of 54 countries researchers suggested that LBP has become foremost worldwide problem which is seen more in females of 40-80 years with 11.9±2.0% mean ± SEM prevalence (Hoy et al., 2012). ...
Article
Lumbar spine osteoarthritis with 40-85% prevalence, degeneration of spine with remarkable narrowing of disc space and osteophytes formation trigger pain in lower back. Pain in lower portion of back is now considered to be the second most commonly treated health issue in primary health care setups. This pain causes disability, functional loss and job absentees. Commonly pain is managed pharmacologically by NSAIDS but resulted in severe gastric side effects. The purpose of this trial was to appraise the properties of bromelain and papain, the vegetal proteolytic enzymes, in comparison with standard drug on LBP patients. Forty men and women with lumbar spine osteoarthritis were recruited and divided into group 1, received aceclofenac 100mg tablet b.i.d as standard treatment, group 2, patients treated with aceclofenac 100 mg tablet b.i.d and enzyme supplements 250 mg b.i.d for 6 weeks. All the participants were evaluated for their body mass index, vital signs and liver/kidney enzymes before and after treatment. Moreover intensity of pain were also measured through visual analogue scale (VAS) and oswestry low back pain questionnaire (ODI) before treatment (0 week), 3rd week and 6th week of treatment. The enzyme group patients showed significantly diminished pain scores VAS from 7.10±1.29 to 5.85±1.531*** (P=0.001), ODI score from 56.2±8.70 to 51.6±8.125*** (P=0.000), significantly diminished enzymes; ALP from 210.00±55.24 to 196.90±51.02 (P=0.054*) and serum creatinine from 0.97±0.153 to 0.87±0.139 (P=0.035*) and improved quality of life. Hence, this study suggested that the enzyme supplements for 6 weeks have prolonged beneficial carry-over effects in comparison to standard treatment without producing any change in BMI (P>0.05) and vital signs (P> 0.05).
... [2] CLBP is associated with increased medical expenditure, work absence, and loss of quality of life. [3,4] In fact, the direct costs of medical expenditures and loss of work productivity related to back pain have been estimated to be as high as $635 billion annually in the United States alone. [5] Nonetheless, 85% of CLBP disorders are categorized as nonspecific chronic low back pain (NSCLBP) due to unknown source. ...
Article
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Most research on sedentary lifestyle has focused on pain and disability, while neuromuscular outcomes (postural control and strength) have received less attention. The objective of the study was to determine whether low level of physical activity is negatively associated with measures of lower body muscular strength and postural control in individuals with and without non-specific chronic low back pain (NSCLBP).Twenty-four subjects with NSCLBP (28.8 ± 5.9 years) and 24 age, gender, and body mass index matched healthy controls participated in the study. Subjects were sub-classified into 4 subgroups based on their physical activity level: Non-active NSCLBP; Active NSCLBP; Non-active healthy control; and Active healthy control. Each subgroup consisted of 12 subjects. Peak force of hip muscles strength was assessed using a handheld dynamometer. Postural control was assessed using computerized posturography and the Y Balance Test.There was no significant group by physical activity interaction for strength and static and dynamic postural control, except for static control during left single leg stance with eyes closed (P = .029). However, there was a significant difference in strength and postural control by physical activity (P < .05). Postural control and peak force of hip muscles strength were significantly associated with physical activity (r ranged from 0.50 to 0.66, P < .001 and r ranged from 0.40 to 0.59, P < .05, respectively).Postural control and hip strength were independently related to physical activity behavior. A sedentary behavior may be an important risk factor for impaired postural control and hip muscles strength, and that physical fitness is vital to neuromuscular outcomes.
... Studies have proven that OLBP is a common reason for lost workdays, which means that how to treat OLBP and make the patient recover and return to work (#3) become the hot spot of research. 54 Evidence has confirmed that return to work extends beyond concerns about managing physical therapists to the complexities related to beliefs, roles, and perceptions of many participants, which requires that not only physiotherapy but also psychological treatment is needed when performing recovery therapy. 55 However, potential difficulties may arise when attempting to implement such strategies without a clearer understanding. ...
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This study aimed to explore the evolution tracks of occupational low back pain (OLBP) studies during 2000 ∼ 2020 through strict and systematic bibliometric analysis. The analysis began with data retrieval in Web of Science using defined search terms associated with OLBP. Bibliometric tools, including BibExcel and CiteSpace, were employed to conduct performance analysis and co-citation network analysis. Totally, 4,127 documents were identified from 2000 to 2020. The United States contributed the most publications. The leading journals mainly focused on medicine and ergonomics. The co-citation analysis illuminated the development of OLBP studies and the top three published keywords were musculoskeletal disorder, risk factors, and fear avoidance. This paper can help researchers have a broader and deeper understanding of OLBP studies, provide a general insight into aggregate performance in the OLBP field, and find further research directions.
... LBP is a major health concern and an increasing cause of disability. Its socio-economic impact related to treatments and loss of productive time is clear (Ricci et al., 2006). 40 % of LBP is due to IVD degeneration (Johnson et al., 2015). ...
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Appropriate cell sources, bioactive factors and biomaterials for generation of functional and integrated annulus fibrosus (AF) tissue analogues are still an unmet need. In the present study, the AF cell markers, collagen type I, cluster of differentiation 146 (CD146), mohawk (MKX) and smooth muscle protein 22α (SM22α) were found to be suitable indicators of functional AF cell induction. In vitro 2D culture of human AF cells showed that transforming growth factor β1 (TGF-β1) upregulated the expression of the functional AF markers and increased cell contractility, indicating that TGF-β1-pre-treated AF cells were an appropriate cell source for AF tissue regeneration. Furthermore, a tissue engineered construct, composed of polyurethane (PU) scaffold with a TGF-β1-supplemented collagen type I hydrogel and human AF cells, was evaluated with in vitro 3D culture and ex vivo preclinical bioreactor-loaded organ culture models. The collagen type I hydrogel helped maintaining the AF functional phenotype. TGF-β1 supplement within the collagen I hydrogel further promoted cell proliferation and matrix production of AF cells within in vitro 3D culture. In the ex vivo IVD organ culture model with physiologically relevant mechanical loading, TGF-β1 supplement in the transplanted constructs induced the functional AF cell phenotype and enhanced collagen matrix synthesis. In conclusion, TGF-β1-containing collagen-PU constructs can induce the functional cell phenotype of human AF cells in vitro and in situ. This combined cellular, biomaterial and bioactive agent therapy has a great potential for AF tissue regeneration and rupture repair.
... Low back pain (LBP) is the single leading cause of disability globally and is rising (9,10). Financial costs from LBP are estimated to be in the order of billions of US dollars (USD) (10,11), while the economic burden of members of the workforce suffering from LBP is estimated in the USA alone to be USD 7.4 billion/year (12). Traditionally conceptualised as solely secondary to mechanical injury, LBP is now described within a bio-psychosocial model, resulting from an interaction of physical, psychological and social in uences (13). ...
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BACKGROUND: The World Health Organisation highlights low back pain as a leading and growing cause of disability worldwide. In the field of chronic pain, higher health literacy is linked to lower pain intensity and better pain control. However, there remains a paucity of evidence, with a recent systematic review finding only three studies meeting its inclusion criteria. OBJECTIVES: This scoping review had two objectives in exploring research in chronic back pain, which were to identify: 1) The health literacy measures currently employed for back pain and the aspects of health literacy they include. 2) The back-pain health outcomes included in such work and the extent to which these reflect the core outcome set for clinical trials in non-specific low back pain. METHODS: The search broadened the search strategy used in the systematic review, with the eligibility criteria defined by the Joanna Briggs Institute PCC mnemonic, namely: · Population – Patients with LBP (≥ 10% of study population), of any age, gender, or race · Concept – Relationship of LBP health outcomes to HL · Context – Any healthcare setting, in any geographical setting It was conducted using thirteen bibliographic databases, employing medical subject heading (MeSH) terms for low back pain and health literacy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A thematic framework approach was used for analysis. RESULTS: The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most outcome measures employed (36 out of 50) were not directly relevant to addressing the core outcome set for clinical trials in non-specific low back pain. CONCLUSIONS: A dearth of studies in this field of research was noted, especially in Asia and low-middle income countries. Methodological limitations were identified, including in study design and outcome measures. To allow for comparison across findings and the development of a rigorous evidence base, future work should include the core outcome set for clinical trials in non-specific low back pain. Furthermore, research thus far has focused on a narrow range of populations and there is an urgent need to broaden the evidence-base to include those with characteristics known to be moderators in health outcomes. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.
... of billions of US dollars (USD) [2,4], while the economic burden of members of the workforce suffering from LBP is estimated in the USA alone to be USD 7.4 billion/ year [5]. Traditionally conceptualised as solely secondary to mechanical injury, LBP is now described within a bio-psychosocial model, resulting from an interaction of physical, psychological and social influences [6]. ...
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Background Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed. Objectives The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. Methods The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis. Results The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. Conclusions To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.
... Chronic low back pain (CLBP) is dened as a pain that persists for more than 3 months, or longer than the expected healing period. It is associated with increased medical expenditure, work absence, and loss of quality 8,9 of life. While the effect of low levels of physical activity on pain and disability is becoming clear, the possible effect on postural control outcomes has received less attention to date. ...
Article
Background: Low back pain (LBP) is a major health issue that causes more disability and global burden than any other conditions. It is one of the most common musculoskeletal disorders. Chronic low back pain (CLBP) is dened as a pain that persists for more than 3 months, or longer than the expected healing period. It is associated with increased medical expenditure, work absence, and loss of quality of life. This study aims to ascertain efcacy of 5% dextrose (D5W) in chronic non-specic low back pain. Material and Methods: This study is conducted on patient suffering from chronic low back pain presenting in Department of PM&R, SMS Hospital, Jaipur. It is a Single blind randomized control trial study. We include 34 patients of non-specic chronic LBPin each group as sample size which is further enhanced and rounded off to 40 patients in each group as nal sample size expecting 10% attrition/drop out. Results: We found that mean age of our study group is 49 years. This is female dominant study with 56.25% patients. Dextrose participants reported greater Numerical Rating scale pain score change at baseline (6.4 vs 6.25 points, p=0.59), but there is signicant reduction of mean NRS st nd rd st pain score at 1 week (4.9 vs 5.4 points, p=01), 2 week (4 vs 5.45 points, p=0.0001), 3 week (3.15 vs 5.32 points, p=0.<0.0001), 1 month (2.95 vs nd rd 5.32 points, p=<0.0001), 2 month (2.9 vs 5.32 points, p=<0.0001) and 3 month (2.82 vs 5.32 points, p=<0.0001). CONCLUSION: Serial caudal epidural injection of D5W resulted in consistent post injection analgesia and clinically signicant improvement in pain through 3 months among participants with non-specic CLBP. Patients with CLBPcan be treated effectively by using 5% dextrose.
... The significant amount of debility brought about by low back pain makes it the single biggest contributor to musculoskeletal disordersrelated disabilities globally. A multitude of risk factors influence the etiology of low back pain, including age, gender, physical demands at place of employment, psychosocial profile, and social support (Borkan et al. 1995;Ricci et al. 2006). ...
... A global review of prevalence in a general adult population showed point prevalence of 12% to 33% and 1 year prevalence of 22% to 65% and lifetime prevalence ranged from 11% to 84% [5]. A study done in the US indicated that it was the second most common cause of disability in adults and a common reason for absenteeism, work lost and economic burden to the nation [6]. In the context of Nepal, the annual prevalence of back pain in Eastern Nepal has been reported as 71%, with prevalence of 67.9% in males and of 74.3% in females [7]. ...
Article
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Background Low back pain (LBP) is a common musculoskeletal problem, associated with disability and high societal costs. The Oswestry Disability Index (ODI) is among the most commonly used patient reported outcome measures to measure disability due to LBP. Evidence supporting the reliability and validity of the Nepali Version of Oswestry Disability Index (NODI) exists, but its responsiveness is yet to be assessed. Objective We aimed to assess the responsiveness of NODI in participants with non-specific low back pain. Methods The study included 102 (Male 41, Female 61) participants with non-specific low back pain, attending the physiotherapy outpatient department of a tertiary care hospital and nearby community. The NODI was administered to the patients at baseline and again 2 weeks later along with a 7-item Nepali Version of Global Rating of Change (GROC-NP). Responsiveness of NODI was assessed by plotting Receivers Operating Characteristics (ROC) curve. Results The area under curve (AUC) of NODI was 0.88. The best cut-off point on the NODI for improvement on the GROC-NP or the minimal clinical important change (MIC) was 4.22 and ranged from 3.11 to 6.34. The sensitivity and specificity was 77.4% and 84.2% respectively. Conclusion NODI is a responsive scale which can discriminate between participants whose level of disability due to LBP is stable or improving. The result for minimal clinically important change, sensitivity and specificity are consistent with other cross culturally adopted versions.
... LOW back pain (LBP)is a very common health problem; it is considered the second most common type of pain after headache [1,2] . It is believed that two thirds of the population by the age of 40 years would have experienced at least one episode of LBP and 60% of them would suffer from recurrent LBP during the same year [3][4][5] . ...
... Video sources were cataloged into the following categories: (1) academic (authors/uploaders with research or university/college F I G U R E 1 Flowchart for video selection [Color figure can be viewed at wileyonlinelibrary.com] affiliations), (2) physician (physicians or physician groups without research or university/college affiliations), (3) nonphysicians (health professionals other than licensed medical doctors), (4) medical sources (content or animations from health-focused websites), and (5) patients. ...
Article
The aim of this study was to characterize the educational quality and reliability of YouTube videos related to LBP as well as to identify factors associated with the overall video quality. A review of YouTube was performed using two separate search strings. Video specific characteristics were analyzed for the first 50 videos of each string. Seventy-seven eligible videos were identified as a result. The mean Journal of the American Medical Association (JAMA) score was 2.25 ± 1.09 (range 0 – 4) out of 4. The mean Global Quality Score (GQS) score was 2.29 ± 1.37 (range 1 – 4) out of 5. The mean low back pain score (LPS) score was 3.83 ± 2.23 (range 0 – 11) out of 15. Video power index (VPI) was a predictor of GQS score (β = 55.78, p = 0.048), whereas the number of likes (β = -2.49, p = 0.047) and view ratio (β = -55.62, p = 0.049) were associated with lower quality scores. Days since initial upload (β = 0.32, p = 0.042) as well as like ratio (β = 0.37, p = 0.019) were independent predictors of higher LPS scores. The results of this study suggest that the overall reliability and educational quality of videos uploaded to YouTube concerning LBP are unsatisfactory. More popular videos demonstrated poorer educational quality than their less popular counterparts. As the prevalence of low back pain rises, more accurate and thorough educational videos are necessary to ensure accurate information is available to patients. This article is protected by copyright. All rights reserved.
... These changes in the clinical setting lead to detrimental effects, including loss of spinal range of motion and low back pain. Low back pain is currently an extremely common pathology and one of the most expensive health care issues with major socioeconomic burden [2,3]. The total cost of lower back disabilities is in the range of $50 billion per year in the United States [1,4]. ...
Article
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Polyethylene glycol diacrylate (PEGDA) is an important class of photosensitive polymer with many tissue engineering applications. This study compared polyethylene glycol diacrylate (PEGDA) and polycaprolactone (PCL) nanofiber matrix (NFM) coated PEGDA, referred to as PCL-PEGDA, scaffolds for their application in multiple tissue repair such as articular cartilage, nucleus pulposus of the intervertebral disc. We examined each scaffold morphology, porosity, swelling ratio, degradation, mechanical strength, and in vitro cytocompatibility properties. A defect was created in Sprague Dawley rat tail intervertebral disc by scraping native cartilage tissue and disc space, then implanting the scaffolds in the disc space for four weeks to evaluate in vivo efficacy of multi-tissue repair. Maintenance of disc height and creation of a new cell matrix was assessed to evaluate each scaffold's ability to repair the tissue defect. Although both PEGDA and PCL-PEGDA scaffolds showed similar porosity ~73%, we observed distinct topographical characteristics and a higher effect of degradation on the water-absorbing capacity for PEGDA compared to PCL-PEGDA. Mechanical tests showed higher compressive strength and modulus of PCL-PEGDA compared to PEGDA. In vitro cell studies show that the PCL NFM layer covering PEGDA improved osteoblast cell adhesion, proliferation, and migration into the PEGDA layer. In vivo studies concluded that the PEGDA scaffold alone was not ideal for implantation in rat caudal disc space without PCL nanofiber coating due to low compressive strength and modulus. In vivo results confirm that the PCL-PEGDA scaffold-maintained disc space and created a proteoglycan and collagen-rich new tissue matrix in the defect site after four weeks of scaffold implantation. We concluded that our developed PCL-PEGDA has the potential to be used in multi-tissue defect site repair.
... This is important as preexisting anxiety and depression disorders are common and could represent early prognostic factors for both return to work (from lost-time) and lost-time recurrence after initial return to work. The occupational low back pain literature suggests that lost-time recurrence episodes are common as well as longer and costlier than first episodes [17][18][19][20]. Given this, promotion of return to work and prevention of lost-time recurrence may reduce a significant amount of work-disability burden for work-related musculoskeletal strain or sprain. ...
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Purpose To examine the impact of pre-existing anxiety and depression disorders on return to work (RTW) using a phase-based approach. Methods Accepted lost-time workers’ compensation claims for upper limb or spine strain or sprain from 2009 to 2013 were extracted for workers in the Canadian province of British Columbia (n = 78,186). Pre-existing anxiety and depression disorders were identified using health claims data. Probability of RTW following a first or second work lost-time episode was analyzed using Prentice, Williams and Peterson models for recurrent events (common hazards ratios (cHR)). Probability of a first lost-time recurrence was analyzed using Cox models (HR). All models included two years of follow up and were stratified by gender. Results For men, anxiety alone (cHR = 0.90, 95% CI: 0.85 to 0.94) or comorbid with depression (cHR = 0.95, 95% CI: 0.92 to 0.99) was significantly associated with a lower probability of RTW, and comorbid anxiety and depression with a higher probability of recurrence (HR = 1.29, 95% CI: 1.13 to 1.48). In women, comorbid anxiety and depression was significantly associated with a lower probability of RTW (cHR = 0.96, 95% CI: 0.93 to 0.99) and a higher probability of recurrence (HR = 1.15, 95% CI: 1.04 to 1.28); and anxiety alone with a higher probability of recurrence (HR = 1.25, 95% CI: 1.09 to 1.43). There was little evidence that depression alone was associated with RTW or recurrence. Conclusions Workers with a pre-existing anxiety disorder may require additional supports both during lost-time and after initial RTW.
... The significant amount of debility brought about by low back pain makes it the single biggest contributor to musculoskeletal disordersrelated disabilities globally. A multitude of risk factors influence the etiology of low back pain, including age, gender, physical demands at place of employment, psychosocial profile, and social support (Borkan et al. 1995;Ricci et al. 2006). ...
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Musculoskeletal health is an integral component of human health. Robustness in musculoskeletal health is vital for dexterity and mobility. These functions are essential for the ability to work and to actively participate in various activities. Musculoskeletal disorders hamper the functional, social, and economic independence of an individual. Multiple physical and psychosocial stresses make healthcare workers more vulnerable to musculoskeletal disorders. The prevalence of musculoskeletal disorders among hospital staff is estimated to range from 43% to 78%. Musculoskeletal disorders impair the quality of life of healthcare workers and adversely affect the quality of patient care. Moreover, musculoskeletal disorders among healthcare workers present a significant added economic burden to the healthcare industry. The other burdens of musculoskeletal disorders can be loss of productive life years and societal burden due to functional limitations. There is a considerable burden of musculoskeletal disorders in the Eastern Mediterranean Region. This chapter reviews the prevalence and risk factors of musculoskeletal disorders among healthcare workers in the Arab world.
... Additionally, the age of the LBP onset ranges from 20 to 50 years, impacting approximately 15% of the workforce during years that coincide with the highest economic contribution (Collin et al., 2011, Ricci et al., 2006. ...
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Introduction: Intervertebral disc degeneration is a multifaceted pathology that is the main morphological cause of lower back pain. This study aimed to determine the link between the vitamin D receptor gene single nucleotide polymorphisms (SNPs) and degenerative processes of the lumbar spine. Materials and methods: The complete lumbar spinal columns were collected from 100 Caucasian cadavers via ventral dissection. The specimens for the histological analysis were harvested from the L5/S1 intervertebral discs and endplates. Then, the tissues were cut into slices, inserted into paraffin blocks, and stained. The histology was evaluated according to the Boos' protocol. Moreover, TaqI(rs731236), FokI(rs2228570), and ApaI(rs7975232) genotyping were performed. Lastly, the histological scores for different genotypes were analyzed. Results: The overall Boos' score in the study group was 12.49. It consisted of a mean intervertebral disc score of 7.46 and endplate score of 5.39. The determination of the SNPs was successful in 99 specimens and had a distribution of all alleles in accordance with the Hardy-Weinberg equilibrium. No significant differences in overall histological degeneration scores were found between samples from donors with different genotypes. However, in subgroup analysis of specific regions on the IVD, the significant difference was found in posterior inner anulus fibrosus for ApaI. Conclusions: The results of this study suggest that one must be careful when interpreting the results of the clinical and/or radiological studies on vitamin D receptor gene polymorphisms and lumbar spine degeneration risk, because such a relationship, if present, is likely to be very subtle. This article is protected by copyright. All rights reserved.
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Risk factors for low back pain (LBP) flares have been considered with respect to self-reported measures. This case-crossover study aimed to investigate whether: i) objective measures of physical activity and sleep were associated with risk of experiencing LBP flares; and ii) these associations differed for flares defined as pain 2 or more points greater than average pain over the period using an 11-point Numerical Rating Scale (NRS; 0-no pain, 10-worst pain imaginable)(pain-defined flare: PDF) and flares identified by participants according to a broader definition that considered emotions/coping (self-reported flare: SRF). We included 126 participants who had experienced LBP for >3 months. Physical activity and sleep were monitored for 28 days using wearable sensors. Occurrence of flares (PDF/SRF) were assessed daily using a smartphone application. Data on exposure to risk factors one, two and three days preceding PDF/SRF were compared to non-flare control periods. Conditional logistic regression determined association between each factor and flares. Data show that day-to-day variation in physical activity and in-bed time are associated with risk of LBP flares, but associations differ depending on how flare is defined. Longer in-bed time increased the risk of PDF, but not SRF. Although physical activity was not associated with risk of PDF, greater sedentary behaviour increased risk of SRF and being more physically active decreased risk for SRF. These results highlight the potential role of targeting sleep and physical activity in interventions to prevent LBP flares, and indicate that risk factors differ depending on how LBP flares are defined.
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Low back pain is the most common health problem with a prevalence of over 80% worldwide and an estimated annual cost of $100 billion in the United States. Intervertebral disc degeneration accounts for a major cause of low back pain. However, there is still a lack of safe and effective treatment to tackle this devastating condition. In this study, we synthesized four functionalized trimetallic nitride endohedral metallofullerenes (carboxyl-f-Sc3N@C80, carboxyl-f-Gd3N@C80, amino-f-Sc3N@C80, and amino-f-Gd3N@C80) and characterized them with X-ray photoelectron spectroscopy, matrix-assisted laser desorption/ionization-time of flight mass spectrometry, and UV-vis. Via electron paramagnetic resonance, all four metallofullerene derivatives possessed dose-dependent radical scavenging capabilities (hydroxyl radicals and superoxide anions), with the most promising radical scavenging properties shown in the amine functionalized C80 metallofullerenes. Both amino-f-Sc3N@C80 and amino-f-Gd3N@C80 at 1 μM significantly reduced lipopolysaccharide induced reactive oxygen species production and mRNA expressions of pro-inflammatory mediators (inos, tnf-α, il-1, and cox-2) in macrophages without apparent cytotoxicity through regulating activity of p38 MAPK, p65, and nuclear translocation of NF-κB. Furthermore, in an established mouse model of lumbar radiculopathy, amino-f-Sc3N@C80 and amino-f-Gd3N@C80 effectively alleviated ipsilateral mechanical hyperalgesia for up to 2 weeks. In dorsal root ganglia explant culture, we also showed that amino-f-Sc3N@C80 and amino-f-Gd3N@C80 ameliorated TNF-α elicited neuroinflammation. In summary, we presented results for a potent radical scavenging, anti-inflammatory and analgesic nanoparticle, amino-functionalized eighty-carbon metallofullerenes in vitro and in vivo. Our study provides important assets for developing pleiotropic treatment strategies to tackle the inflammation, a significant pathological hallmark in the intervertebral disc degeneration and associated pain.
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Background: Lower back pain is often evaluated using magnetic resonance imaging (MRI) and conventional imaging, which provide incomplete information about the etiology of pain and lead to less than optimal management. Hypothesis: MR neurography (MRN) of the lumbosacral (LS) plexus renders a more accurate diagnosis, alters the management strategy, and clinical outcomes of radiculopathy or failed back surgery Syndrome (FBSS) patients when compared to the conventional imaging modalities. Study type: Retrospective, cross-sectional. Population: A total of 356 patients (mean age 65.8 ± 12.3; 48.9% female) from single university hospital over 6 years with MRN of LS plexus were included from a cohort of 14,775 total patients with lumbar spine MR imaging. Assessment: Conventional imaging obtained before and after MRN of LS plexus was reevaluated and categorized into three levels based on extent of imaging findings' correlation to presenting clinical symptoms (contributory levels). Clinical notes were reviewed for changes in ordering provider's recommended management and subsequent patients' symptom level pre-MRN to post-MRN. Field strength/sequence: A 5 T and 3.0 T. T1-weighted (T1W), T2-weighted (T2W), short T1 inversion recovery (STIR), T1 turbo spin echo (T1 TSE), T2 spectral attenuated inversion recovery (T2 SPAIR). Statistical tests: Chi-squared test. Statistical significance was set at P < 0.05. Results: A total of 356 total patients (174 females) with mean age ± SD was 65.8 ± 12.3 years, 4.2% of patients imaged with lumbar spine MRI. Definitely contributory studies among X-rays, computed tomography, MRI, and MRN were 3 of the 129 (2.3%), 3 of the 48 (6.2%), 35 of the 184 (19.0%), and 283 of the 356 (79.8%), respectively. Pre-MRN vs. post-MRN led to change in recommendation in 219 of the 356 (61.5%) patients and 71 of the 99 (71.7%) patients had improved symptoms. Conclusion: MRN of the LS plexus can provide more corroborative image findings for symptom correlation compared to other imaging modalities for accurate diagnosis, effects patient management and leads to positive clinical outcomes in a small subset of patients with radiculopathy or FBSS. Evidence level: 4 TECHNICAL EFFICACY: Stage 5.
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Objective The molecules released from cells undergoing necrosis are recognized as alarmins, and S100A8/9, a typical alarmin, is associated with several inflammation-related diseases. This study was to investigate the molecular role of S100A8/A9 on the process of intervertebral disc degeneration (IVDD) and inflammation-related pain. Methods The expression pattern of S100A8/A9 in different degenerated human nucleus pulposus (NP) tissues were measured by RT-qPCR and immunohistochemical (IHC). The effects of S100A8/A9 on matrix production were assessed by RT-qPCR, western blotting, and cell immunofluorescence. Involvement of TLR4 and NF-κB signaling pathways were studied by pharmachemical inhibitors and small interfering RNAs (siRNAs). The development of degenerative and pain features in the IVDD model were examed by IHC and pain-behavior testing. Results The expression of S100A8/A9 was significantly elevated in severely degenerated human NP tissue with similar expression pattern of TNF-α. In NP cells, S100A8/A9 increased MMP-3/13, TNF-α, IL-6 expression and inhibited aggrecan and collagen II expression. RT-qPCR and western blotting showed that the regulatory effects of S100A8/A9 on IVD were TLR4 dependent. Pharmacological inhibition or siRNA knockdown of the NF-κB signaling attenuated S100A8/A9-induced upregulation of MMP-3/13, TNF-α and IL-6. In vivo, S100A9 inhibitor treatment inhibited disc-puncture induced IVDD and inflammation-related pain. Conclusions This study showed that S100A8/A9 bound to TLR4 and increased the expression of MMPs, TNF-α, and IL-6 through NF-κB signaling pathways in NP cells. Furthermore, S100A8/A9 inhibitor could prevent development of IVDD and inflammation-related pain in the rat model.
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Background: Back pain, such as upper and low back pain are among the most common musculoskeletal conditions that can cause major public health and socioeconomic problems. Back pain is one of the leading causes of disability that reduces worker performance and well-being and increases absence from work, which can cause an enormous economic burden. In developing countries, particularly in Ethiopia, there is no adequate evidence on the overall prevalence of occupational-related upper and low back pain, and they remain less prioritized and empirically unrepresented. Therefore, this study aimed to determine the prevalence of occupational-related upper and low back pain among the working population of Ethiopia. Methods: This systematic review and meta-analysis considered studies conducted in Ethiopia, written in English, and published from 2017 to 2020. Articles were searched from 9 electronic databases (Web of Science, SCOPUS, PubMed, Google Scholar, CINAHL, Cochrane Library, African Index Medicus, African Journals Online database, and Science Direct) using a combination of Boolean logic operators, Medical Subject Headings, and main keywords. The quality assessment of the articles was performed using the Joanna Briggs Institute Critical Appraisal tools to determine the relevance of the articles to the study. A random effects model was used to estimate the pooled prevalence, the 95% confidence interval, and the degree of heterogeneity among the included studies. Sensitivity analyses were performed to identify the influence of outliers and to identify sources of heterogeneity. Results: Of the 1114 studies identified from the included databases, 20 studies were included in the systematic review and meta-analysis. The pooled prevalence of occupational-related upper and low back pain in the previous year was (27.1% [95% CI: 18.4, 37.9]) and (54.2% [95% CI: 48.2, 60.0]), respectively. Based on a subgroup analysis by publication year, study population, and regions where the studies were conducted, the prevalence of upper back pain was (43.8% [95% CI: 39.3, 47.7]), (34.7% [95% CI: 33.1, 36.2]), and (36.2% [95% CI: 33.6, 39.0]), respectively, while the prevalence of low back pain was (61.8% [95% CI: 58.9, 64.6], (52.8% [95% CI: 51.3, 54.3]), and (55.2% [95% CI: 51.4, 59.0]), respectively. Conclusions: This systematic review and meta-analysis found that 54.2% of the included study participants experienced low back pain in the previous year, while 27.1% experienced upper back pain. The highest prevalence was reported among pedestrian back-loading women.
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Background: Radiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint-related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing for early reinnervation. Increasing the success rate and duration of relief may require techniques that increase the likelihood of successful nerve ablation over a relevant distance by maximizing lesion size. Objectives: The aim of this technical note is to detail a modification to the current commonly used lumbar medial branch radiofrequency (RF) denervation approach to increase lesion size. Study design: This is a technical report describing a novel two-needle approach to lumbar RF medial branch denervation. Setting: Large private interventional pain management institute. Methods: A dual needle placement of two 10-mm active tip RF cannulas separated by 6 mm is used to optimally contact the superior articular process (SAP) from its ventral to dorsal borders, which encompasses the anticipated course of the medial branch nerves. Results: The described technique creates a lesion that we estimate to be 11.0-mm wide and 11.6-mm long along the course of the medial branch adjacent to the SAP ensuring adequate coverage and treatment. Limitations: This report does not encompass a systematic evaluation of the clinical safety and efficacy of the two-needle RFA approach. Future studies will have to assess the long-term efficacy and safety of the approach. Conclusions: The detailed two-needle approach to lumbar RF medial branch denervation appears to be promising in terms of projected treatment success by coagulating a large volume of tissue, in a cost- and time-efficient manner.
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The goal of this study was to investigate the association of body composition components and to elucidate whether any of these components is a risk factor for Lumbar Disc Herniation (LDH). The group of study consisted of 90 adults involved in a physical activity program due to overweight and obesity. 19 adults with medical diagnostic through Magnetic Resonance Imaging with LDH. Body composition data was obtained with a bioelectrical impedance analyzer. Descriptive statistics and principal components analysis permitted to analyze the information's structure and to visualize information clusters. A logistic regression analysis allowed us to find the association between some of the variables of body composition with LDH. The Degree of Obesity, Body Mass Index, Visceral Fat Area and the Abdominal Circumference resulted associated ( P values of 0.0388, 0.0171, 0.0055 and 0.0032, respectively). The application of Odd Ratio allowed us to declare the Visceral Fat Area and Abdominal Circumference as risk factors to develop Lumbar Disk Herniation. Our results provide a new record for future studies, and support for prescription of physical activity and changes in diet, to correct or prevent the development of LDH in the population of Baja California.
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Pain is an undesirable sensory experience that can induce depression and limit individuals’ activities of daily living, in turn negatively impacting the labor force. Affected people frequently feel pain during activity; however, pain is subjective and difficult to judge objectively, particularly during activity. Here, we developed a system to objectively judge pain levels in walking subjects by recording their quantitative electroencephalography (qEEG) and analyzing data by machine learning. To do so, we enrolled 23 patients who had undergone total hip replacement for pain, and recorded their qEEG during a five-minute walk via a wearable device with a single electrode placed over the Fp1 region, based on the 10–20 Electrode Placement System, before and three months after surgery. We also assessed subject hip pain using a numerical rating scale. Brain wave amplitude differed significantly among subjects with different levels of hip pain at frequencies ranging from 1 to 35 Hz. qEEG data were also analyzed by a support vector machine using the Radial Basis Functional Kernel, a function used in machine learning. That approach showed that an individual’s hip pain during walking can be recognized and subdivided into pain quartiles with 79.6% recognition Accuracy. Overall, we have devised an objective and non-invasive tool to monitor an individual’s pain during walking.
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Lift-to-lift variability occurs in repetitive lifting tasks due to alterations in the lifting techniques used by the lifter, resulting in variability in lower back tissue loading. Understanding how trunk variability changes with time in the initial phases of a lifting bout may provide insights into the risk of injury during work startup. The purpose of this study was to quantify the variation of lifting kinematics and kinetics during the initial phase of a lifting bout. Twenty participants performed a repetitive lifting task continuously for 30 min. The load was equivalent to 10% of each participant's body weight and lifting was done at a rate of six lifts/min. Kinematic variables (three-dimensional range of motion, angular velocity, and angular acceleration) of the trunk were measured using the Lumbar Motion Monitor and a dynamic biomechanical model estimated peak L5/S1 moment and spine compression. The variances of these variables were compared across 10-min intervals: 0-10 min, 10-20 min, and 20-30 min. Results indicate a significant reduction in the variance of the peak sagittal acceleration, the sagittal range of motion, the transverse range of motion, peak sagittal moment, and peak spine compression between the first and second time intervals, followed by no significant change in variance between the second and third intervals. The downward trend in variation of these kinematic and kinetic variables suggests an initial adjustment period as the lifters reach a steady state of their lifting technique. The reduced variance of spinal loading may reduce the probability that a tissue tolerance is exceeded. K E Y W O R D S low back pain, repetitive lifting, trunk kinematics/kinetics, variability
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Context The real-world burden of gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in Japanese patients with osteoarthritis (OA) and/or chronic low back pain (CLBP) remains unreported. Objective To assess the incidence and economic burden of NSAID-induced GI events by using data from large-scale real-world databases. Methods We used the Japanese Medical Data Center database to retrospectively evaluate anonymized claims data of medical insurance beneficiaries employed by middle- to large-size Japanese companies who were prescribed NSAIDs for OA and/or CLBP between 2009 and 2018. Results Overall, 180,371 patients were included in the analysis, of whom 32.9% had OA, 53.8% had CLBP, and 13.4% had both OA and CLBP. NSAIDs were administered as first-line analgesics to 161,152 (89.3%) of the patients in the sample, in oral form to 90.3% and as topical patches to 80.4%. A total of 65.1% used combined oral/topical patches. Of the 21.0% of patients consistently using NSAIDs (percentage of days supplied ≥70%), 54.5% received patches. A total of 51.5% patients used NSAIDs for >1 to ≤6 months. The incidence of GI events was 9.97 per 10,000 person-years (95% confidence interval: 8.92–11.03). The risk of developing GI events was high in elderly patients and patients with comorbidities and remained similar for patients receiving oral vs. topical NSAIDs. Longer treatment duration and consistent NSAID use increased the risk of GI events. The cost (median [interquartile range]) of medications (n = 327) was US$ 80.70 ($14.10, $201.40), that of hospitalization (n = 33) was US$ 2,035.50 ($1,517.80, $2,431.90), and that of endoscopic surgery (n = 52) was US$ 418.20 ($418.20, $418.20). Conclusion NSAID-associated GI toxicity imposes a significant health and economic burden on patients with OA and/or CLBP, irrespective of whether oral or topical NSAIDs are used.
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Objectives: Driving is one of the most widespread aspects of daily living to people in the United States and is an active process that requires various cognitive functions, such as attention. Chronic low back pain (CLBP) is one of the more prevalent and costly health conditions in the world, with individuals who report CLBP also reporting significant impairment across different domains of daily life both physically and cognitively. However, despite the prevalence of these two constructs, research detailing the experience of driving in pain remains largely underrepresented. This cross-sectional study sought to characterize the driving experience of people who experience CLBP, focusing on the psychological constructs related to chronic pain like pain catastrophizing, affective responses (irritability, anxiety, fear), and self-reported driving behaviors and outcomes. Methods: This study distributed an online questionnaire measuring pain, disability, and other psychological constructs commonly associated with CLBP like pain catastrophizing through M-turk to 307 U.S. participants with recurring CLBP and regular driving activity. Participants also answered questions regarding driving in pain, affective responses to driving in pain (i.e., irritability, anxiety, and fear), driving behaviors and violations, driving avoidance habits as a result of pain, opioid use, using pain medication while driving, and recent vehicle collisions within the past three years. Bivariate correlations were used to compare study variables, and one-way ANOVA's were used to compare means between participants with and without a collision history within the past three years. Results: Findings demonstrated significant positive associations not only between the psychological factors commonly associated with chronic pain, such as pain intensity, pain disability, pain catastrophizing, and the cognitive intrusion by pain, but also statistically significant relationships between these measures and pain intensity while driving, affective responses to driving in pain, driving violations, and driving avoidance habits. Additionally, in comparison to participants with no collision history within the past three years, participants who had been driving during a vehicle collision reported greater pain catastrophizing and cognitive intrusion by pain scores. Conclusions: To our knowledge, the current study is the first to characterize driving experience specifically among individuals with CLBP, with attention to the relationship among key sensory, affective, and cognitive psychological metrics as well as self-reported driving history and behavior. The current findings reinforce multiple associations between pain and cognitive-affective variables that have been observed in literature outside the driving context, including pain intensity, anger, inattention, and behavioral disruption. Given that driving is a pervasive, potentially risky behavior that requires some form of cognitive focus and control, the current findings point to a continued need to examine these associations within this specific life context.We believe we have laid a groundwork for research considering the role of psychological pain variables in a driving performance. However, the nature of our analyses prevents any sort of causality from being inferred, and that future experimental research is warranted to better understand and explain these mechanisms underlying driving in pain while accounting for participant bias and subject interpretation.
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The high percentage of musculoskeletal symptoms (MSS) found in studies of general populations and various occupational groups underlines the need to distinguish between severely and mildly affected individuals. To investigate associations between MSS and quality of life, we examined the frequency of MSS on a five-point scale, health-related quality of life (SF-36) and sickness absence among 5654 workers in the aluminium industry. High frequencies of MSS from all body parts were related to lower scores on the SF-36 and increased sickness absence. This relationship was strongest for MSS from the lower back. Workers who reported low back MSS 'very often' had a mean role—physical score equivalent to that of the 15th percentile of the general population. These results show that workers who reported MSS often or very often were severely affected, and this scale can therefore be used to distinguish individuals at high risk for reduced health-related quality of life and sickness absence.
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This study sought to provide data on the relationship of work exposures to long-term back problems in a population survey. The Ontario Health Survey in 1990 used a representative population sample of the province. It included data on long-term back problems, occupational activity, and physical work exposures. The current study examined relationships between these variables. The prevalence of long-term back problems was 7.8% in working-age adults. It generally increased with age. Long-term back problems were more prevalent in blue-collar occupations and among those not working, as well as among people with less formal education, smokers, and those overweight. Physical work exposures--awkward working position, working with vibrating vehicles or equipment, and bending and lifting--were all associated with a greater risk of back problems. The number of simultaneous physical exposures was monotonically related to increased risk. Within the limitations of the data and assuming the relationship to be causal, about one quarter of the excess back pain morbidity in the working population could be explained by physical work exposures.
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The present study is a 2-year prospective study with repeated measurements. To examine the association of education with back-related disability along with four sets of variables that might explain this relationship: clinical, behavioral, and environmental factors; occupational variables; health care use; and interactions between stressful events and coping strategies. Although education has been found to be associated with back-related disability in previous reports, this relationship remains to be explained. Examination of this association may yield a better understanding of the causes and natural history of disability resulting from back pain. Subjects were 1213 enrollees of a Health Maintenance Organization (HMO) who consulted a primary care physician for back pain in 1989-1990, completed a baseline telephone interview, and had a follow-up evaluation after 1 and 2 years, using a modified version of the Roland-Morris Scale to measure disability. Subjects who completed 13 years or more of schooling had less disability and a greater decline in their disability over time than those who completed less schooling. Occupational characteristics and somatization were among the strongest explanatory factors. Cigarette smoking contributed to the explanation of the cross-sectional association. Education is associated cross-sectionally and longitudinally with disability resulting from back pain. A wide range of variables may mediate the education-back-related disability association, including a propensity to report diffuse physical symptoms (somatization), lifestyle (e.g., cigarette smoking), and occupational factors.
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The high percentage of musculoskeletal symptoms (MSS) found in studies of general populations and various occupational groups underlines the need to distinguish between severely and mildly affected individuals. To investigate associations between MSS and quality of life, we examined the frequency of MSS on a five-point scale, health-related quality of life (SF-36) and sickness absence among 5654 workers in the aluminium industry. High frequencies of MSS from all body parts were related to lower scores on the SF-36 and increased sickness absence. This relationship was strongest for MSS from the lower back. Workers who reported low back MSS 'very often' had a mean role--physical score equivalent to that of the 15th percentile of the general population. These results show that workers who reported MSS often or very often were severely affected, and this scale can therefore be used to distinguish individuals at high risk for reduced health-related quality of life and sickness absence.
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Common pain conditions appear to have an adverse effect on work, but no comprehensive estimates exist on the amount of productive time lost in the US workforce due to pain. To measure lost productive time (absence and reduced performance due to common pain conditions) during a 2-week period. Cross-sectional study using survey data from the American Productivity Audit (a telephone survey that uses the Work and Health Interview) of working adults between August 1, 2001, and July 30, 2002. Random sample of 28 902 working adults in the United States. Lost productive time due to common pain conditions (arthritis, back, headache, and other musculoskeletal) expressed in hours per worker per week and calculated in US dollars. Thirteen percent of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition. Headache was the most common (5.4%) pain condition resulting in lost productive time. It was followed by back pain (3.2%), arthritis pain (2.0%), and other musculoskeletal pain (2.0%). Workers who experienced lost productive time from a pain condition lost a mean (SE) of 4.6 (0.09) h/wk. Workers who had a headache had a mean (SE) loss in productive time of 3.5 (0.1) h/wk. Workers who reported arthritis or back pain had mean (SE) lost productive times of 5.2 (0.25) h/wk. Other common pain conditions resulted in a mean (SE) loss in productive time of 5.5 (0.22) h/wk. Lost productive time from common pain conditions among active workers costs an estimated 61.2 billion dollars per year. The majority (76.6%) of the lost productive time was explained by reduced performance while at work and not work absence. Pain is an inordinately common and disabling condition in the US workforce. Most of the pain-related lost productive time occurs while employees are at work and is in the form of reduced performance.
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In a prospective study of 230 episodes of low-back pain presenting in primary care, the natural history of the symptom of low-back pain has been described. Clinical features predictive of outcome have been identified in order to define groups of patients who were relatively homogeneous with respect to the outcome of the episode. A Disability Questionnaire performed more satisfactorily as an outcome measure than either absence from work or a simple pain-rating scale. Guidelines for future trials of treatment of back pain in primary care are described.
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Study Design. This study is an analysis of national survey data from 5 sample years. Objectives. The authors characterized the frequency of office visits for low back pain, the content of ambulatory care, and how these vary by physician specialty. Summary of Background Data. Few recent data are available regarding ambulatory care for low back pain or how case mix and patient management vary by physician specialty. Methods. Data from the National Ambulatory Medical Care Survey were grouped into three time periods (1980-81, 1985, 1989-90). Frequency of visits for low back pain, referral status, tests, and treatments were tabulated by physician speciatly. Results. There were almost 15 million office visity for "mechanical" low back pain in 1990, ranking this problem fifth as a reason for all physician visits. Low back pain accounted for 2.8 percent of office visity in all three time periods. Nonspecific diagnostic lables were most common, and 56 percent of visits were to primary care physicians. Specialty variations were observed in caseload, diagnostic mix, and management. Conclusion. Back pain remains a major reason for all physician office visity. This study describes visit, referral, and management patterns among specialties providing the most care.
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Study Design: The present study is a 2-year prospective study with repeated measurements. Objectives: To examine the association of education with back-related disability along with four sets of variables that might explain this relationship: clinical, behavioral, and environmental factors; occupational variables; health care use; and interactions between stressful events and coping strategies. Summary of Background Data: Although education has been found to be associated with back-related disability in previous reports, this relationship remains to be explained. Examination of this association may yield a better understanding of the causes and natural history of disability resulting from back pain. Methods: Subjects were 1213 enrollees of a Health Maintenance Organization (HMO) who consulted a primary care physician for back pain in 1989-1990, completed a baseline telephone interview, and had a follow-up evaluation after 1 and 2 years, using a modified version of the Roland-Morris Scale to measure disability. Results: Subjects who completed 13 years or more of schooling had less disability and a greater decline in their disability over time than those who completed less schooling. Occupational characteristics and somatization were among the strongest explanatory factors, Cigarette smoking contributed to the explanation of the cross-sectional association. Conclusions: Education is associated cross-sectionally and longitudinally with disability resulting from back pain. A wide range of variables may mediate the education-back-related disability association, including a propensity to report diffuse physical symptoms (somatization), lifestyle (e, g., cigarette smoking), and occupational factors. (C) Lippincott-Raven Publishers.
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The basic premise of this article is that low back disorders are extremely prevalent in all societies, and probably have not increased substantially over the past two decades. What has increased is the rate of disability, the reasons for which are uncertain. Not only has this phenomenon heightened the awareness of low back pain, but it has led to an explosion in costs. Although a precise estimate is impossible, it is plausible that the direct medical and indirect costs of these conditions are in the range of more than $50 billion per annum, and could be as high as $100 billion at the extreme. Of these costs, 75% or more can be attributed to the 5% of people who become disabled temporarily or permanently from back pain--a phenomenon that seems more rooted in psychosocial rather than disease determinants. Within this overall equation, spinal surgery plays a relatively small role, although the contribution to disability probably has more than passing significance. The future challenge, if costs are to be controlled, appears to lie squarely with prevention and optimum management of disability, rather than perpetrating a myth that low back pain is a serious health disorder.
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In a prospective study of 230 episodes of low-back pain presenting in primary care, the natural history of the symptom of low-back pain has been described. Clinical features predictive of outcome have been identified in order to define groups of patients who were relatively homogeneous with respect to the outcome of the episode. A Disability Questionnaire performed more satisfactorily as an outcome measure than either absence from work or a simple pain-rating scale. Guidelines for future trials of treatment of back pain in primary care are described.
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One of the problems in mounting a trial of treatment of back pain is the lack of suitable outcome measures. This paper describes the development and validation of a questionnaire designed to measure selfrated disability due to back pain. The questionnaire is short, simple, sensitive, and reliable. It would be suitable for use in future trials of treatment. (C) Lippincott-Raven Publishers.
Article
This study is an analysis of national survey data from 5 sample years. The authors characterized the frequency of office visits for low back pain, the content of ambulatory care, and how these vary by physician specialty. Few recent data are available regarding ambulatory care for low back pain or how case mix and patient management vary by physician specialty. Data from the National Ambulatory Medical Care Survey were grouped into three time periods (1980-81, 1985, 1989-90). Frequency of visits for low back pain, referral status, tests, and treatments were tabulated by physician specialty. There were almost 15 million office visits for "mechanical" low back pain in 1990, ranking this problem fifth as a reason for all physician visits. Low back pain accounted for 2.8 percent of office visits in all three time periods. Nonspecific diagnostic labels were most common, and 56 percent of visits were to primary care physicians. Specialty variations were observed in caseload, diagnostic mix, and management. Back pain remains a major reason for all physician office visits. This study describes visit, referral, and management patterns among specialties providing the most care.
Article
Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.
Article
Review paper of outcome studies among primary care back pain patients. To determine the short-term and long-term pain and functional outcomes of patients with back pain who are seeking treatment in primary care settings. Back pain has been viewed as running either an acute or a chronic course, but most patients experience recurrent back pain. This review summarizes outcome studies in light of the episodic course of back pain. Studies reporting pain and functional outcome data for consecutive primary care patients with back pain were reviewed. Back pain among primary care patients typically is a recurrent condition for which definitions of acute and chronic pain based on a single episode are inadequate. Because a majority of patients experience recurrences, describing only the outcome of the initial back pain episode may convey a more favorable picture of long-term outcome than warranted. For the short-term follow-up evaluation, most patients improve considerably during the first 4 weeks after seeking treatment. Sixty-six percent to 75% continue to experience at least mild back pain 1 month after seeking care. At 1 month, approximately 33% report continuing pain of at least moderate intensity, whereas 20-25% report substantial activity limitations. For the long-term follow-up (1 year or more) period, approximately 33% report intermittent or persistent pain of at least moderate intensity, one in seven continue to report back pain of severe intensity, and one in five report substantial activity limitations. Results from existing studies suggest that back pain among primary care patients typically runs a recurrent course characterized by variation and change, rather than an acute, self-limiting course.
Article
To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain). The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020. Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form of arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected. Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.
Article
Back pain afflicts approximately 31 million Americans, and is the number one cause of activity limitation in young adults. Little is known about the labor productivity costs associated with this chronic disease. Such information could provide useful input to employers considering alternative health benefits plans for managing their employees' health care needs. The goals of this study were to generate employee-level as well as national estimates of the labor productivity losses associated with chronic back ache. Multivariate methods were used to isolate the effects of chronic backache on employment status and disability days. These results were combined with information on earnings to generate labor productivity cost estimates associated with chronic backache. The study used data from the National Medical Care Expenditure Survey (NMES), which provides information on health status, health care utilization and cost, work, disability, and sociodemographic characteristics for a nationally representative sample of the noninstitutionalized civilian population of the United States in 1987. Average annual productivity losses per worker due to chronic backache were $1,230 for male workers, measured in 1996 dollars, and $773 per female worker. These figures translated into aggregate annual productivity losses from chronic backache of approximately $28 billion in the United States. The labor productivity losses from chronic backache differed by gender and other sociodemographic characteristics. The aggregate labor productivity losses associated with chronic backache were quite large and comparable to estimates of the direct medical costs associated with treating this chronic illness.
Article
To explore the relationship between type of initial care as well as the likelihood of recurrence and consequent care seeking behavior. Prospective observational cohort recruited from 208 randomly selected North Carolina practices. Cohort study examined the recurrence of low back pain among patients free of back pain 3 months after their index visit to a practitioner for that problem. The following four practitioner strata were examined: primary care providers, chiropractors, orthopedic surgeons, and practitioners in a group model HMO. Patients were interviewed by telephone at 6 and 22 months after the initial visit. Rates of disabling and non-disabling low back pain; functional status using the Roland back disability scale; and care seeking. Rates of recurrence were substantial; functionally disabling recurrence rates varied between 8% and 14% between 3 to 6 months, and 20% to 35% between 6 to 22 months. Differences in rates among practitioner strata were statistically significant only between 6 to 22 months with higher recurrence rates for HMO patients. Functional status, number of bed days, and time off work were very similar among the practitioner strata. Care seeking, however, was greater among those patients who had initially seen a chiropractor for their back pain. Patients with recurrence saw the same practitioner type they had seen for the index episode 88% of the time. Satisfaction was slightly greater for patients who saw chiropractors when compared with patients seeing allopathic physicians. The recurrence of low back pain is common. Severe disability is rare. Patients who had sought care from chiropractors are more likely to return for recurrences than patients who had initially sought care from MDs.
Article
We analyzed data from outpatients with chronic low back pain (LBP) in the Veterans Health Study (n = 563) to examine the relationship between localized LBP intensity and radiating leg pain in assessing patient functional status, low back disability, and use of diagnostic imaging. Based on the localized LBP intensity, the study subjects were divided into tertiles (low, moderate, and high intensity). The study subjects were also stratified by the extent of radiating leg pain. Using analysis of variance and multiple regression analysis, we compared the relative importance of localized LBP intensity and radiating leg pain in explaining the variability in the means of the SF-36 scales and low back disability days, and in the proportion of patients who had used diagnostic imaging. The results of the study indicate that measures of localized LBP intensity and radiating leg pain contribute separately to the assessment of patient functional status, low back disability, and use of diagnostic imaging. These results suggest that localized LBP intensity and radiating leg pain may represent two different approaches in assessing back pain severity. Future epidemiological and health services research should consider both measures in assessing the impact of LBP on patient functional status, low back disability, and use of diagnostic imaging.
Article
A 22-month prospective cohort study. To describe the course of an inception cohort of patients with chronic low back pain. Chronic low back pain is a debilitating condition with great medical and social cost. A cohort of 1246 patients with acute low back pain who sought treatment from 208 North Carolina providers was observed. Patients who developed chronic low back pain were identified. Entry criteria were back pain of less than 10 weeks' duration, no previous care for this episode of low back pain, no previous spine surgery, not pregnant, no nonskin malignancy, and access to a telephone. The providers were of four types: primary care medical doctors, doctors of Chiropractic, orthopedic surgeons, and health maintenance organization-based primary care providers. Patients were contacted by telephone shortly after enrollment and at 2, 4, 8, 12, and 24 weeks, with a final interview at 22 months. Patient functional status, care-seeking, and satisfaction were evaluated. Ninety-six patients had chronic, continuous symptoms for 3 months, forming the inception cohort of chronic low back pain. A valid, reliable measure of back-specific functional disability also was used. Predictors of the development of chronicity were poor baseline functional status and sciatica. A more powerful predictor of chronicity was poor functional status at 4 weeks. Two thirds of patients with chronic low back pain at 3 months had functionally disabling symptoms at 22 months, and a majority of these were employed. Satisfaction with care was low. Forty-six patients (2.6% of the entire cohort) underwent surgery, with no statistically significant difference in surgical rates among initial provider strata. Patients who underwent surgery after 3 months had a Roland disability score at 22 months of 10 (7.7, 12.3). Forty-one percent of patients with chronic low back pain see an orthopedic or neurologic surgeon. Chronic low back pain occurs in 7.7% of patients who seek care for acute low back pain, with unremitting pain for 22 months in 4.7%. Once established, chronic low back pain is persistent. Most patients with chronic low back pain seek little care, and a majority are employed. Future research should emphasize maintenance of employment and function.
Article
An observational study on the course of chronic and recurrent low back pain and its relation to disability and medication use performed on the basis of daily diary recording. To provide a description of daily pain reporting by individuals with self-reported chronic and recurrent low back pain, to study how the intensity and episodic nature of low back pain is related to disability and medication use, and to classify subjects according to Von Korff's categories of chronic low back pain. The natural history of low back pain has been described, and some classification schemes have been proposed, but little has been reported on pain characteristics and their relation to self-report of disability. Daily self-reports of pain intensity, social and work disability, and medication use were collected from 94 participants with self-reported chronic or recurrent low back pain over a 6-month period. A metric for describing the episodic nature of chronic low back pain was developed. A significant effect of pain intensity on disability was found. During an episode, participants had significantly greater disability and medication use. Work-related disability and medication use was significantly greater in the latter half of an episode. Pain intensity can affect disability, but the episodic nature of low back pain also affects the ability to function in both work and personal life. Intermittent increases in pain can markedly alter disability. Chronic low back pain should not be treated as a static phenomenon.
Article
A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later. To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain. Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage. At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants' computerized records. The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1-4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05). Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.
Article
A systematic review of prospective cohort studies in low back pain. To evaluate the evidence implicating psychological factors in the development of chronicity in low back pain. The biopsychosocial model is gaining acceptance in low back pain, and has provided a basis for screening measurements, guidelines and interventions; however, to date, the unique contribution of psychological factors in the transition from an acute presentation to chronicity has not been rigorously assessed. A systematic literature search was followed by the application of three sets of criteria to each study: methodologic quality, quality of measurement of psychological factors, and quality of statistical analysis. Two reviewers blindly coded each study, followed by independent assessment by a statistician. Studies were divided into three environments: primary care settings, pain clinics, and workplace. Twenty-five publications (18 cohorts) included psychological factors at baseline. Six of these met acceptability criteria for methodology, psychological measurement, and statistical analysis. Increased risk of chronicity (persisting symptoms and/or disability) from psychological distress/depressive mood and, to a lesser extent, somatization emerged as the main findings. Acceptable evidence generally was not found for other psychological factors, although weak support emerged for the role of catastrophizing as a coping strategy. Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.
Article
The American Productivity Audit (APA) is a telephone survey of a random sample of 28,902 U.S. workers designed to quantify the impact of health conditions on work. Lost productive time (LPT) was measured for personal and family health reasons and expressed in hours and dollars. Health-related LPT cost employers 225.8 billion US dollars/year (1685 US dollars/employee per year); 71% is explained by reduced performance at work. Personal health LPT was 30% higher in females and twice as high in smokers (> or =1 pack/day) versus nonsmokers. Workers in high-demand, low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-demand, high-control jobs. Family health-related work absence accounted for 6% of all health-related LPT. Health-related LPT costs are substantial but largely invisible to employers. Costs vary significantly by worker characteristics, suggesting that intervention needs vary by specific subgroups.
Article
Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.
Article
It is generally accepted that, in order to appraise from a societal perspective, indirect costs should be included in economic evaluations. What is less generally accepted, however, is the method by which such indirect costs should be calculated. Different methods and assumptions can, in theory, produce different results. Previous studies have commented on this variability, and most suggest a need for consensus. This having been said, no previous study appears to have demonstrated that variability in method is actually a practical problem, in the sense that the use of different costing methods would lead to different policy conclusions. In this paper, we examine this issue with respect to a specific intervention, namely, paediatric cochlear implantation (PCI). Based on questionnaire data, we estimate the indirect costs of PCI using a variety of methods. Thereafter, we integrate these indirect costs into a cost-utility analysis of PCI, and demonstrate that the variability in methods can significantly affect the outcome of a cost-effectiveness study. Therefore, in this case at least, the measurement of indirect cost is indeed a problem.
Article
We examined the effect of interview characteristics (ie, recall interval, interview version) on estimates of health-related lost productive work time (LPT). Three versions of a telephone interview were administered using 7-day and 4-week recall periods. In a population-based survey, 7674 workers randomly were assigned to one of six interviews at contact; 615 participants received a follow-up interview. We found strong evidence of under-reporting using a 4-week recall period and a not significant trend in over-reporting LPT using a 7-day recall period. Of the three interviews, version 3 could be administered most quickly, on average, and yielded the most discriminating estimates of LPT by health condition (ie, headache, allergic rhinitis, and cold/flu). Our data suggest that variation in relatively short recall periods influences estimates of health-related LPT. A 2-week recall period may be optimal for minimizing overall reporting error but requires additional research to verify.
Article
Instruments that measure the impact of illness on work do not usually provide a measure that can be directly translated into lost hours or costs. We describe the validation of the Work and Health Interview (WHI), a questionnaire that provides a measure of lost productive time (LPT) from work absence and reduced performance at work. A sample (n = 67) of inbound phone call agents was recruited for the study. Validity of the WHI was assessed over a 2-week period in reference to workplace data (i.e. absence time, time away from call station and electronic continuous performance) and repeated electronic diary data (n = 48) obtained approximately eight times a day to estimate time not working (i.e. a component of reduced performance). The mean (median) missed work time estimate for any reason was 11 (8.0) and 12.9 (8.0) hours in a 2-week period from the WHI and workplace data, respectively, with a Pearson's (Spearman's) correlation of 0.84 (0.76). The diary-based mean (median) estimate of time not working while at work was 3.9 (2.8) hours compared with the WHI estimate of 5.7 (3.2) hours with a Pearson's (Spearman's) correlation of 0.19 (0.33). The 2-week estimate of total productive time from the diary was 67.2 hours compared with 67.8 hours from the WHI, with a Pearson's (Spearman's) correlation of 0.50 (0.46). At a population level, the WHI provides an accurate estimate of missed time from work and total productive time when compared with workplace and diary estimates. At an individual level, the WHI measure of total missed time, but not reduced performance time, is moderately accurate.
Article
This article reviews some of the advances that have taken place in understanding back disorders, with a particular emphasis on low back pain, as this area has been most represented in the literature in the preceding year (September 2003 to September 2004). Epidemiological studies continue to provide insights into the prevalence of back pain and have identified many individual, psychosocial, and occupational risk factors for its onset. Psychological factors have an important role in the transition from acute to chronic pain and related disability. Recent advances show that there is a significant genetic effect on severe low back pain in the community. Data emerging from candidate gene studies show an association between lumbar disc disease and mutations of genes encoding the alpha-2 and alpha-3 subunits of collagen IX. Back pain is among the most common conditions for which patients seek medical care. Interventions based on behavioral and cognitive principles and exercise programs are effective in improving disability in chronic back pain. Although progress has been made in understanding the role of genetic mutations in disorders such as lumbar disc disease, further investigation of the interaction between genetic and environmental factors such as physical stress is needed.