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Low Back Pain in Australian Adults: The Economic Burden
Abstract
This paper reports the results of a "cost-of-illness" study of low back pain (LBP) in Australian adults. It estimates the direct cost of LBP in 2001 to be AU dollars 1.02 billion. Approximately 71% of this amount is for treatment by chiropractors, general practitioners, massage therapists, physiotherapists and acupuncturists. However, the direct costs are minor compared to the indirect costs of AU dollars 8.15 billion giving a total cost of AU dollars 9.17 billion. LBP in Australian adults represents a massive health problem with a significant economic burden. This burden is so great that it has compelling and urgent ramifications for health policy, planning and research. This study identifies that research should concentrate on both direct but particularly the indirect costs including cost-effective management regimes that encourage an early return to duties.
... LBP is also responsible for over 60 million years lived with a disability annually (Buchbinder et al., 2018;James et al., 2018;Maher et al., 2017;Walker, 2000), placing it as the leading cause of disability globally (Collaborators GDaIIaP., 2016;James et al., 2018). In Australia, the direct costs associated with the management of LBP are approximately $5 billion per annum (Martin et al., 2013), with prescription and overthe-counter analgesics accounting for a significant proportion of this cost (Becker et al., 2010;Gore et al., 2012;Martin et al., 2013;Walker et al., 2003). Furthermore, when additional costs such as loss of wages, disability subsidy and decreased productivity are considered, the economic burden almost doubles (Walker et al., 2003). ...
... In Australia, the direct costs associated with the management of LBP are approximately $5 billion per annum (Martin et al., 2013), with prescription and overthe-counter analgesics accounting for a significant proportion of this cost (Becker et al., 2010;Gore et al., 2012;Martin et al., 2013;Walker et al., 2003). Furthermore, when additional costs such as loss of wages, disability subsidy and decreased productivity are considered, the economic burden almost doubles (Walker et al., 2003). The individual and economic burden of LBP can be attributed to the recurrent nature of the condition (da Silva et al., 2019;Foster, 2011;Hartvigsen et al., 2018;Walker et al., 2003), with over 60% of people experiencing at least one reoccurrence of LBP within 12 months following an episode (da Silva et al., 2019) and more than 50% also reporting limitations when performing daily activities or having to seek care due to their LBP (da Silva et al., 2019). ...
... Furthermore, when additional costs such as loss of wages, disability subsidy and decreased productivity are considered, the economic burden almost doubles (Walker et al., 2003). The individual and economic burden of LBP can be attributed to the recurrent nature of the condition (da Silva et al., 2019;Foster, 2011;Hartvigsen et al., 2018;Walker et al., 2003), with over 60% of people experiencing at least one reoccurrence of LBP within 12 months following an episode (da Silva et al., 2019) and more than 50% also reporting limitations when performing daily activities or having to seek care due to their LBP (da Silva et al., 2019). ...
Background:
Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation.
Methods:
This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI).
Results:
From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99).
Conclusions:
Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.
... 1 The Australian Burden of Disease study highlights back pain as a leading cause of nonfatal burden. 2 With an estimated 3.7 million Australians suffering from chronic back problems, the economic toll exceeds AU$4.8 billion annually, and this figure is expected to rise. 2 Such data underscore the importance of finding practical solutions for CLBP. 3 debates persist regarding the clinical efficacy of fusion procedures, highlighting the need for a nuanced understanding and optimization of fusion techniques. 10,11 Reliable bony fusion, governed by intricate physiological and biomechanical principles, is central to this effort. ...
... 1 The Australian Burden of Disease study highlights back pain as a leading cause of nonfatal burden. 2 With an estimated 3.7 million Australians suffering from chronic back problems, the economic toll exceeds AU$4.8 billion annually, and this figure is expected to rise. 2 Such data underscore the importance of finding practical solutions for CLBP. 3 debates persist regarding the clinical efficacy of fusion procedures, highlighting the need for a nuanced understanding and optimization of fusion techniques. 10,11 Reliable bony fusion, governed by intricate physiological and biomechanical principles, is central to this effort. ...
Background:
Chronic low back pain secondary to degenerative disc disease is a significant public health issue worldwide, contributing to substantial health care burdens and patient disability. Anterior lumbar interbody fusion (ALIF) has emerged as a promising surgical solution, offering benefits such as disc height restoration, reduced neural compression, and improved spinal alignment. This study evaluates the efficacy of stand-alone ALIF using polyetheretherketone (PEEK) cages, structural femoral head allografts, and recombinant human bone morphogenetic protein-2 (rhBMP-2) in treating discogenic low back pain caused by degenerative disc disease.
Methods:
This prospective case series study included 1335 patients who underwent stand-alone ALIF by a single surgeon. The surgical construct involved PEEK cages with structural femoral allograft dowels and rhBMP-2, supplemented by anterior fixation. Patient-reported outcome measures, including the visual analog scale for back and leg pain, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were monitored over 12 months.
Results:
The overall fusion rate was 99.6%, with pseudoarthrosis occurring in 0.2% of patients. Lower fusion rates were observed in patients older than 65 years and those using the Brantigan cage. Significant improvements were seen in visual analog scale for back and leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores from baseline, with most scores exceeding the substantial clinical benefit thresholds. More than 85% of patients reported "Excellent" or "Good" outcomes.
Conclusions:
Stand-alone ALIF, augmented with rhBMP-2 and structural femoral head allografts, can enhance mechanical stability, fusion rates, and radiographic assessment. This integrated approach achieves successful spinal fusion and positive clinical outcomes for patients with refractory discogenic low back pain.
Clinical relevance:
Stand-alone ALIF with PEEK cages, structural femoral head allografts, and rhBMP-2 demonstrates high fusion rates and significant clinical improvements in patients with discogenic low back pain. This approach enhances spinal stability and promotes biological healing, making it a reliable and effective surgical option.
... In 90 % of cases there is no pathoanatomical diagnosis available and these cases are deemed non-specific LBP (NSLBP) [4]. Annual LBP-related healthcare financial costs in the United States of America in 2004 was in excess of US$100 billion [5] and in Australia in 2001 was greater than A$9.15 billion [6]. From 2016-2018, 3.4 % of Australian emergency presentations were for LBP [7], which resulted in 181,000 hospitalisations [8]. ...
... Patient charts indicating a primary discharge diagnosis consistent with NSLBP (pain localised below the costal margin and above the inferior gluteal folds, with or without leg pain) [6] were included. Exclusion criteria were: (1) diagnosis with a primary condition other than NSLBP (including specific LBP pathologies and presence of red flags); (2) presentation due to trauma (including fall-related injuries); (3) pregnancy; or (4) voluntarily discharges from the ED against medical advice (which may prevent guideline adherence from the treating clinician given incomplete data). ...
... In health care, NLP systems are used, for example, for analyzing unstructured clinical notes on patients, preparing reports, transcribing patient interactions, and conducting conversational AI. 19 Various machine learning (ML) models have been developed for different decision support purposes. These models include choosing appropriate musculoskeletal management 138 , predicting ventilator admission in the ICU 139 , and making patient stratification easier in organ transplantation 140 . In addition, genome and biomarker interpretation using ML methods can identify certain types of components related to clinical phenotypes, which can, in turn, predict the status of several diseases. ...
... 68 In 2015, LBP was responsible for approximately 60.1 million years lived in disabilities, an increase of 54% since 1990. 39 For industrialized countries, LBP is a very costly illness 21,138 and indirect costs (work absenteeism, productivity loss) account for more than half of the total costs. 9 In many patients, the specific nociceptive source of LBP cannot be identified and those affected are often classified as having so-called "nonspecific low back pain." ...
... Low back pain (LBP) is a common risk that affects approximately 80% of the population at least once in lifetime [1,2]. It is the second most common issue seen in general practitioners' clinic each year [3]. ...
... The purpose of this study is to (1) evaluate the ASWE on the oxygen consumption when lifting lightweight, (2) assess the effects of the ASWE on the muscles of lower back during repetitive lifting tasks and (3) evaluate the discomfort and effectiveness of the ASWE. ...
This study is to determine how a lightweight active soft waist exoskeleton (ASWE) reduces the oxygen consumption and activity of lower back muscles of the wearer performing the repetitive lifting tasks. The heavy and frequent manual lifting operations are usually associated with an increased risk of injury in the industry. An ASWE is designed to assist workers' spine for lifting weights. The structural composition and operation principle were described for the ASWE. Twelve men were recruited in the experiments as the test subjects. Oxygen consumption and electromyography of the thoracic erector spinae (TES) at the T9 level and lumbar erector spinae (LES) at the L3 level were recorded during 90 lifts in 15 min. Subjects' discomfort and effectiveness evaluation were collected after lifting trials. The average value of oxygen consumption was decreased from form 15.9 ml/kg/min (Without-ASWE condition) to 13.7 ml/kg/min (With-ASWE condition). The increase in electromyography root mean square amplitude from the start until the end of the lifting trial was significantly lower when the ASWE was in use for the TES (162.79 vs. 82.08%) and the LES (122.48 vs. 83.87%). The use of the ASWE showed less oxygen consumption and back muscle contraction compared to the nonuse, which might reduce metabolic consumption or slow down the muscle fatigue level of the wearer's back across the lifting trial. Therefore, wearing the ASWE can reduce the discomfort of body parts, lumbar regions that exercise for a long time.
... 34,35 As previously documented, the majority of LBP costs are generated by the public rather than private hospitals. 36 Thus, we analyzed the direct cost of the public healthcare system as most of the authors. 13,[37][38][39][40] However, other studies confirmed that the direct cost of the LBP covered only a fraction of the total sum, eg approximately 10% of both direct and indirect LBP costs. ...
Purpose
Recent redefinitions of pain emphasize the importance of the previously overlooked recurrent low back pain (LBP). Understanding the direct medical cost for recurrent LBP cases based on the cost per visit is crucial economically. We aimed to compare the cost per visit for LBP and recurrent LBP, including the impact of gender and type of medical service, estimating the approximate annual cost of recurrent LBP.
Patients and Methods
Data on LBP categorized according to ICD-10 codes (G54, G55, M45, M46, M47, M48, M49, M51, M53, and M54) from the Polish National Health Fund (NHF) and Opolskie Rehabilitation Center (OCR) were analyzed based on the recurrent state as outlined in the new chronic pain definition.
Results
In OCR, a recurrent LBP was confirmed for 22.78% of patients, of which 59.72% were female (p<0.001). The mean value of a single procedure for recurrent LBP was 110.56 EUR, it was significantly higher for males (135.35 EUR) than for females (92.94 EUR) (p=0.008). Recurrent LBP generated a higher cost per visit for medical services than LBP (p<0.001), except for physiotherapy. Notably, males had a higher cost per visit in inpatient admissions, while females had a significantly higher cost per visit in physiotherapy services for both LBP and recurrent LBP. Moreover, recurrent LBP generated a statistically higher cost per visit for medical services than non-recurrent cases, except for physiotherapy. The average annual cost of LBP-related medical services in Poland was €243,861,639.
Conclusion
Recurrent LBP accounts for 5% of total direct LBP costs and has a higher cost per visit than LBP, excluding physiotherapy services. Gender significantly affected per-visit costs, with males having more inpatient admissions and females utilizing more physiotherapy services for both LBP and recurrent LBP.
... Public health implications: LBP has been costed in the UK at GBP 12.3 billion [18] and AUD 9.17 billion in Australia [19]. The American Academy of Pain Medicine published annual costs in 2006 for chronic pain of USD 560 to 635 billion, noting that 53% of all chronic pain patients in the USA were affected by LBP [20]. ...
Intervertebral disc degeneration, which leads to low back pain, is the most prevalent musculoskeletal condition worldwide, significantly impairing quality of life and imposing substantial socioeconomic burdens on affected individuals. A major impediment to the development of any prospective cell-driven recovery of functional properties in degenerate IVDs is the diminishing IVD cell numbers and viability with ageing which cannot sustain such a recovery process. However, if IVD proteoglycan levels, a major functional component, can be replenished through an orthobiological process which does not rely on cellular or nutritional input, then this may be an effective strategy for the re-attainment of IVD mechanical properties. Furthermore, biomimetic proteoglycans (PGs) represent an established polymer that strengthens osteoarthritis cartilage and improves its biomechanical properties, actively promoting biological repair processes. Biomimetic PGs have superior water imbibing properties compared to native aggrecan and are more resistant to proteolytic degradation, increasing their biological half-life in cartilaginous tissues. Methods have also now been developed to chemically edit the structure of biomimetic proteoglycans, allowing for the incorporation of bioactive peptide modules and equipping biomimetic proteoglycans as delivery vehicles for drugs and growth factors, further improving their biotherapeutic credentials. This article aims to provide a comprehensive overview of prospective orthobiological strategies that leverage engineered proteoglycans, paving the way for novel therapeutic interventions in IVD degeneration and ultimately enhancing patient outcomes.
... [9,10] In developed countries, the direct and indirect costs of low back pain range from 1 billion to 28 billion. [2,11] Of all low back pain, 90% of patients are with nonspecific low back pain (NSLBP). [12] The diagnosis of NSLBP means that there is no definite pathoanatomical cause of low back pain, and the source of his pain may be multifaceted. ...
Background
This prospective randomized controlled trial was designed to evaluate the clinical efficacy and safety of Bu Shen Tong Luo herbal compound as a complementary treatment for nonspecific low back pain (NSLBP).
Methods
A total of 76 patients with NSLBP included from January 2022 to June 2023 according to the criteria were randomly divided into Bushen Tongluo formula (BSTL) group (n = 38) and celecoxib group (n = 38). According to Traditional Chinese Medicine principles, patients of 2 groups were divided into 5 syndrome types. Celecoxib or BSTL herbal compound were used to treat NSLBP of each group for 3 weeks, every week the Visual Analog Scale (VAS), Oswestry Disability Index, and Japanese Orthopaedic Association scores of each patient was record and compared to evaluate the clinical efficacy, and adverse reaction was reported to evaluate the safety of 2 interventions.
Results
A total of 71 patients finished the follow-up, including 36 patients in BSTL group and 35 patients in celecoxib group. The result showed that within 3 weeks, both BSTL and celecoxib interventions were able to treat NSLBP, with improvements in VAS scores and waist function index. However, there were no significant differences in clinical outcomes between these 2 interventions. Then we divided the patients into 5 syndromes on the basis of traditional Chinese medicine principles and observed their clinical outcomes. We found that celecoxib had similar improvements in VAS score and waist function index for each syndrome type and most of the syndromes in the BSTL group, except for the SRBZ syndrome. In the treatment of SRBZ syndrome, BSTL prescription showed no statistically significant clinical improvement. Meanwhile, in the treatment of HSBZ syndrome of NSLBP, BSTL prescription showed better clinical results than celecoxib, although there was no difference in VAS scores between the 2 groups, patients in BSXL group had better waist function than those in celecoxib group.
Conclusion
Both BSTL herbal compound and celecoxib are effective and safe in the clinical treatment of NSLBP, and BSTL herbal compound had unique advantages in the treatment of HSBZ syndrome type of NSLBP especially in waist function improvement.
... Low back pain (LBP) is the leading cause of years lived with disability globally [1] and is regarded as a longlasting condition with high rates of recurrence [1]. LBP is associated with a significant public health burden [2], with direct and indirect health costs exceeding $9 billion annually in Australia [3]. The high cost is in part, associated with a small proportion of people who seek ongoing care for their LBP [4]. ...
Background
Global policy and guidelines for low back pain (LBP) management promote physical activity and self-management yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching is effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP.
Aim
This qualitative study aimed to understand which aspects of a community over-the-phone health-coaching program, were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment.
Methods
A purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi-structured interviews were conducted, and a general inductive thematic analysis approach was taken.
Results
The main themes uncovered regarding the intervention included the positive and negative aspects of the health coaching service and the relationship between the participant and health coach. Specifically, the participants spoke of the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP-specific knowledge. They also reported the health coach and the coaching relationship to be the primary factors influencing the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. The sub-themes uncovered regarding the outcomes of the intervention included positive impacts (a greater capacity to cope, increased confidence, increased motivation and increased satisfaction) and negative impacts (receiving no personal benefit).
Clinical implications
In an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment.
Trial Registration
The GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.
... Low back pain (LBP) is one of the most prevalent and burdensome health conditions, and the leading cause of global disability. 1 In Australia, LBP contributes significantly to health care costs associated with diagnostics, treatment and prevention. 2 Recent research has shown that LBP is a complex, multifactorial condition with physical, psychosocial and lifestyle risk factors. 3 However, many of the commonly used and recommended interventions fail to address the range of factors contributing to each person's pain and associated disability. ...
Objective
The objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention.
Methods
A systematic review with meta-analyses was conducted. Four databases were searched from inception to October 12th 2023. Randomized controlled trials investigating CFT compared to any control group in patients with nonspecific LBP were included. Mean difference and 95% CIs were calculated for pain, disability, and pain self-efficacy. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results
Seven trials were included. Low to moderate certainty of evidence was found that CFT was effective for disability at short, medium, and long term time points compared to alternate treatments, including usual care. Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term. There was high certainty evidence CFT was effective in increasing pain self-efficacy in the medium and long terms. A single study found CFT was cost-effective compared to usual care. Variability was found in the training and implementation of CFT across the included trials, which may contribute to some heterogeneity in the results.
Conclusion
The results show promise in the use of CFT as an intervention likely to effectively manage disability, pain, and self-efficacy in people with chronic nonspecific LBP. The number of clinicians trained, their experience, and quality of training (including competency assessment) may be important in achieving optimal effectiveness.
Impact Statement
This is the most comprehensive review of CFT to date and included investigation of between-trial differences. CFT is a promising intervention for chronic LBP and high-quality synthesis of evidence of its effectiveness is important for its clinical application.
... Low back pain (LBP) has been recognized as a common phenomenon that affects public health and it is a common problem presented to both physicians and physiotherapists (Maniakis and Gray, 2000;Walker et al, 2004). Although LBP is a less globally recognized problem in children, it has been reported (Olsen et al, 1992). ...
... 8 Some studies have reported that around 60-90% of adults will experience LBP at some point in their lifetime. 9,10,11 Another study showed that it was the most common type of pain reported by patients, with 25% of U.S. adults reporting LBP in the prior three months. 12 Low back pain has multiple risk factors, including physical and psychosocial risk factors. ...
Objective: To ascertain the determinants of chronic lower back pain among patients presenting in primary care clinics. Methods: 300 participants from 18 to 75 years of age were enrolled from Primary Care Clinics, Primary Health Center, Sikanderabad and Family Medicine Health Center, Clifton, for a Cross-sectional study that was done from December 1, 2020, to June 30, 2021. Consultant family physicians took informed consent and then asked relevant history questions and performed a relevant physical examination, such as a straight leg raise on the patients. Results: The frequency of chronic lower back pain came out to be 16.7%(50). The median age was 31.99+15.7 years. For those who had chronic back pain, the majority were regularly taking Cholecalciferol supplements ( 20.8% p-value 0.05). The effect of depression increases the chances (0.688) of chronic lower back pain. (p-value 0.006) Conclusion: In our study, we concluded that lower back pain, especially chronic in duration, is very rampant in the community with male predominance. The majority reported a dull type of pain. Depressed people are more vulnerable to developing chronic back pain. Keywords: LBP (lower back pain), magnitude, restricted mobility, S.I. joint (Sacroiliac joint), community..
... Furthermore, the risk-reward factor of the intervention should be established, given the delicate nature of the areas treated and the associated risk. If QMRG is found to be a safe and effective long-term treatment option for LR, it could significantly improve the quality of life of patients who suffer from this condition as well as decrease its economic burden and societal impact on patients, their families, and the community as a whole [40,[55][56][57][58][59][60][61][62][63][64][65][66][67][68]. ...
Objectives
Low back pain is a common musculoskeletal complaint and while prognosis is usually favorable, some patients experience persistent pain despite conservative treatment and invasive treatment to target the root cause of the pain may be necessary. The aim of this study is to evaluate patient outcomes after treatment of lumbar radiculopathy (LR) with quantum molecular resonance radiofrequency coblation disc decompression and percutaneous microdiscectomy with grasper forceps (QMRG).
Methods
This prospective cohort study was carried out in two Spanish hospitals on 58 patients with LR secondary to a contained hydrated lumbar disc hernia or lumbar disc protrusion of more than 6 months of evolution, which persisted despite conservative treatment with analgesia, rehabilitation, and physiotherapy, and/or epidural block, in the previous 2 years. Patients were treated with QMRG and the outcomes were measured mainly using the Douleur Neuropathique en 4 Questions, Numeric Rating Scale, Oswestry Disability Index, SF12: Short Form 12 Health Survey, Patient Global Impression of Improvement, Clinical Global Impression of Improvement, and Medical Outcomes Study Sleep Scale.
Results
Patients who received QMRG showed significant improvement in their baseline scores at 6 months post-treatment. The minimal clinically important difference (MCID) threshold was met by 26–98% of patients, depending on the outcome measure, for non-sleep-related outcomes, and between 17 and 62% for sleep-related outcome measures. Of the 14 outcome measures studied, at least 50% of the patients met the MCID threshold in 8 of them.
Conclusion
Treatment of LR with QMRG appears to be effective at 6 months post-intervention.
... (1) LBP is the biggest contributor to disability-adjusted life years among musculoskeletal disorders (2) and is also a substantial cause of socioeconomic burden. Costs related to LBP have reached up to US$ 118.8 billion in the United States (US), (3) AU$ 9.17 billion in Australia (4) and approximately £ 11 billion in the United Kingdom (UK). (5) Although LBP has several possible causes (e.g. ...
... Low back pain (LBP) is a common musculoskeletal condition that is often accompanied by decreased sensory, cognitive, and mobility function, presenting an economic health burden worldwide (Chiarotto and Koes, 2022). The direct and indirect economic burden for LBP ranged from US$19.6 to $118.8 billion in the USA in 2008 (Dagenais et al., 2008), and the number was approximately US$ 4.7 billion (AU$ 9.17 billion) in Australia (Walker et al., 2003). It is estimated that the burden from LBP-related costs and disability will expand further in the future (GBD, 2021). ...
Introduction
Low back pain (LBP) is associated with altered somatosensory perception, which is involved in both involuntary and voluntary control of posture. Currently, there is a lack of methods and tools for assessing somatosensory acuity in patients with LBP. The purpose of this study was (1) to assess the reliability of the sway discrimination apparatus (SwayDA) (2) to evaluate the differences in somatosensory acuity between patients with LBP and pain-free individuals, and (3) to examine relationships between somatosensory acuity, severity of LBP, and mobility in patients with LBP.
Methods
Twenty participants (10 patients with LBP and 10 matched asymptomatic controls) were recruited in a test–retest reliability test. Another 56 participants were recruited for this study with 28 individuals presenting with LBP and a further twenty-eight being asymptomatic. The SwayDA was custom-built to measure somatosensory perception during voluntary anterior–posterior (SwayDA-AP), medial-lateral to the dominant side (SwayDA-ML-D), and non-dominant side (SwayDA-ML-ND) postural sway control. Participants also completed mobility tests, including 10 times and 1-min sit-to-stand tests (10-STS, 1 m-STS). The area under the receiver operating characteristic curve (AUC) was calculated to quantify somatosensory acuity in discriminating different voluntary postural sway extents.
Results
The ICC (2.1) for the SwayDA-AP, SwayDA-ML-D, and SwayDA-ML-ND were 0.741, 0.717, and 0.805 with MDC95 0.071, 0.043, and 0.050. Patients with LBP demonstrated significantly lower SwayDA scores (tSwayDA-AP = −2.142, p = 0.037; tSwayDA-ML-D = -2.266, p = 0.027) than asymptomatic controls. The AUC values of the SwayDA-AP test were significantly correlated with ODI (rSwayDA-AP-ODI = −0.391, p = 0.039). Performances on the 1 m-STS and the 10-STS were significantly correlated with the AUC scores from all the SwayDA tests (−0.513 ≤ r ≤ 0.441, all p < 0.05).
Discussion
The SwayDA tests evaluated showed acceptable reliability in assessing somatosensory acuity during voluntary postural sway. Somatosensory acuity was diminished in patients with LBP compared to asymptomatic controls. In patients with LBP, lower somatosensory acuity was associated with increased LBP-related disability. Future research could focus on investigating the factors contributing to the decreased somatosensory perception and mobility in individuals with LBP.
... Conservative epidemiological data reveals that, per year, over 1.5 million Australians suffered from Chronic Low Back Pain symptoms (a significantly greater number in the millions have relapsing and remitting back pain in their journey to chronicity). Recent Australian Hospital Health Registry figures reveal less than 1000 patients receive Lumbar Stabilisation surgery without decompression or purely "Back Pain Surgery" annually [16][17][18]. This raises serious questions about a growing anti-spinal surgery message being delivered on a number of fronts and unilaterally by organisations and individuals unqualified to comment on the role of spinal surgery in the management of structural deficits relating to the lumbar spine. ...
... Musculoskeletal conditions affect about 1.71 billion people worldwide, with low back pain (LBP) being the single leading cause of disability in 160 countries [1,2]. It has a significant detrimental impact on work absenteeism and relapses in pain, causing substantial economic burden [3,4]. Given the upward trend in sedentary lifestyles and the rapid ageing of Western societies [5], a crescent demand for rehabilitation care is expected [6]. ...
Purpose: Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. Methods: The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. Results: Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. Conclusions: Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists. h IMPLICATIONS FOR REHABILITATION • This work makes three important contributions, in which it extends existing research: • Presents insights into the requirements of effective remote physiotherapy sessions; • Highlights the challenges and concerns of patients and physiotherapists regarding telerehabilitation; • Provides guidance for developing telerehabilitation platforms.
... In Great Britain, it was estimated that direct and indirect spending related to LBP reached GBP 11 billion in 2000, one of the highest levels in the healthcare sector [11]. Similarly, in Australia, LBP was proven to be one of the costliest conditions, with direct and indirect expenses totaling AUD 9.14 billion in 2001 [12]. The hospitalization rates caused by LBP vary between 13.4% and 18.7%. ...
Low back pain (LBP) is a leading cause of disability and work absenteeism. The cause of LBP may be degeneration of the intervertebral disc. LBP is characterized by considerable variability and tends to develop into chronic pain. Treatment of LBP includes conservative and rehabilitative treatments, surgery, and so-called minimally invasive treatment. One of the most commonly performed procedures is interspinous stabilization using a dynamic interspinous DIAM (device for intervertebral assisted motion) stabilizer. There is still no clear, strong evidence for the effectiveness and superiority of surgical treatment over conservative treatment. This study aimed to compare the early and long-term outcomes of patients with LBP using the DIAM interspinous stabilizer in relation to patients treated conservatively. A group of 86 patients was prospectively randomized into two comparison groups: A (n = 43), treated with the DIAM dynamic stabilizer for degenerative lumbar spine disease (mean age = 43.4 years ± SD = 10.8 years), and B (n = 43), treated conservatively. Pain severity was assessed using the visual analog scale (VAS), whereas disability was assessed using the Oswestry disability index (ODI). The difference in preoperative and postoperative ODI scores ≥ 15 points was used as a criterion for treatment effectiveness, and the difference in VAS scores ≥ 1 point was used as a criterion for pain reduction. In patients under general anesthesia, the procedure only included implantation of the DIAM system. Patients in the control group underwent conservative treatment, which included rehabilitation, a bed regimen, analgesic drug treatment and periarticular spinal injections of anti-inflammatory drugs. It was found that all patients (n = 43) continued to experience LBP after DIAM implantation (mean VAS score of 4.2). Of the 36 patients who experienced LBP with sciatica before the procedure, 80.5% (n = 29) experienced a reduction in pain. As for the level of fitness, the average ODI score was 19.3 ± 10.3 points. As for the difference in ODI scores in the pre-treatment results vs. after treatment, the average score was 9.1 ± 10.6. None of the patients required reoperation at 12 months after surgery. There were no statistically significant differences between the two groups in either early (p = 0.45) or long-term outcomes (p = 0.37). In conclusion, neurosurgical treatment with the DIAM interspinous stabilizer was as effective as conservative treatment and rehabilitation during the one-year follow-up period.
... In the USA, expenditures on healthcare related to musculoskeletal disorders reached $380.9 billion [3]. In Australia, they impose a substantial health and economic burden, surpassing costs associated with cardiovascular disease and cancer [4], particularly when accounting for indirect expenses [5]. Several validated decision rules exist to guide the appropriate use of imaging for patients with musculoskeletal injuries. ...
Background
Several validated decision rules are available for clinicians to guide the appropriate use of imaging for patients with musculoskeletal injuries, including the Canadian CT Head Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study (NEXUS) guideline, Ottawa Ankle Rules and Ottawa Knee Rules. However, it is unclear to what extent clinicians are aware of the rules and are using these five rules in practice.
Objective
To determine the proportion of clinicians that are aware of five imaging decision rules and the proportion that use them in practice.
Design
Systematic review.
Methods
This was a systematic review conducted in accordance with the ‘Preferred reporting items for systematic reviews and meta-analyses’ (PRISMA) statement. We performed searches in MEDLINE (via Ovid), CINAHL (via EBSCO), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus databases to identify observational and experimental studies with data on the following outcomes among clinicians related to five validated imaging decision rules: awareness, use, attitudes, knowledge, and barriers and facilitators to implementation. Where possible, we pooled data using medians to summarise these outcomes.
Results
We included 39 studies. Studies were conducted in 15 countries (e.g. the USA, Canada, the UK, Australasia, New Zealand) and included various clinician types (e.g. emergency physicians, emergency nurses and nurse practitioners). Among the five decision rules, clinicians’ awareness was highest for the Canadian C-Spine Rule (84%, n = 3 studies) and lowest for the Ottawa Knee Rules (18%, n = 2). Clinicians’ use was highest for NEXUS (median percentage ranging from 7 to 77%, n = 4) followed by Canadian C-Spine Rule (56–71%, n = 7 studies) and lowest for the Ottawa Knee Rules which ranged from 18 to 58% (n = 4).
Conclusion
Our results suggest that awareness of the five imaging decision rules is low. Changing clinicians’ attitudes and knowledge towards these decision rules and addressing barriers to their implementation could increase use.
... Low back pain, back pain that arises internally from the spine, intervertebral discs, and adjacent soft tissues (Patrick et al., 2014), is considered the leading cause of years lost due to physical disability (60.1 million disability-adjusted life years in 2015) and its burden is increasing (54% between 1990 and 2015) concomitant with the increase and ageing of the population (GBD 2015 Disease andInjury Incidence andPrevalence Collaborators, 2016). Each year, the cost of low back pain is estimated to be $100 billion in the US (Dieleman et al., 2016), from €3.5 billion to €19.4 billion in European countries (i.e., Netherlands, Switzerland and Germany) (Bolten et al., 1998;Lambeek et al., 2011;Wieser et al., 2011) and AUD $9.17 billion in Australia (Walker et al., 2003). ...
To investigate the relationship between low back pain and cardiorespiratory fitness (CRF) among participants with and without self-report anxiety. Participants were 13,080 individuals (86.6% men; 44.7 ± 9.3 years). CRF was quantified as maximal treadmill test duration and was grouped for analysis as low (lowest 20% of treadmill test duration), moderate (middle 40%), and high (upper 40%). Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between low back pain and CRF according to the presence/absence of self-report anxiety. During an average of 5.7 ± 5.1 years of follow-up, 2,965 cases of low back pain were identified. Participants with self-report anxiety and low CRF had 3.7 times (HR: 3.7; 95%CI: 1.7-8.2) more risk for having low back pain when compared with participants with self-report anxiety and high CRF. Additionally, among participants with self-reported anxiety, moderate CRF was associated with an 70% greater risk of having low back pain than those with high CRF (HR: 1.7; 95%CI: 1.1-3.2). For participants without self-reported anxiety, no association was found between the risk of having low back pain and CRF. According to the results identified in the present study, participants with self-reported anxiety who had low and moderate CRF had higher risks of low back pain than those with high CRF.
... Background Low back pain is a widespread musculoskeletal condition that is considered the primary cause of years lived with disability [1]. It carries a substantial economic burden, resulting from healthcare expenses, reduced productivity, insurance costs, and sick leave [2][3][4]. Non-specific low back pain (NSLBP) is the most common type of low back pain and is characterized by the absence of identifiable underlying diseases or anatomical abnormalities [5]. NSLBP typically occurs between the last rib and the iliac crest, although it can also radiate to the gluteus or legs [5]. ...
Background
Non-specific low back pain is a common condition with significant global prevalence and socio-economic impact. Back School programs, which combine exercise and educational interventions, have been used to address back pain. This study aimed to investigate the effects of a Back School-based intervention on non-specific low back pain in adults. Secondary objectives included evaluating the impact of the program on disability, quality of life, and kinesiophobia.
Methods
A randomized controlled trial was conducted involving 40 participants with non-specific low back pain, who were divided into two groups. The experimental group underwent an 8-week Back School-based program. The program comprised 14 practical sessions focusing on strengthening and flexibility exercises, along with two theoretical sessions covering anatomy and concepts related to a healthy lifestyle. The control group maintained their usual lifestyle. Assessment instruments included the Visual Analogue Scale, Roland Morris disability questionnaire, Short-Form Health Survey-36, and Tampa Scale of Kinesiophobia.
Results
The experimental group showed significant improvements in the Visual Analogue Scale, Roland Morris disability questionnaire, physical components of the Short-Form Health Survey-36, and Tampa Scale of Kinesiophobia. However, there were no significant improvements in the psychosocial components of the Short-Form Health Survey-36. In contrast, the control group did not show significant results in any of the study variables.
Conclusions
The Back School-based program has positive effects on pain, low back disability, physical components of quality of life, and kinesiophobia in adults with non-specific low back pain. However, it does not appear to improve the participants' psychosocial components of quality of life. Healthcare professionals can consider implementing this program to help reduce the significant socio-economic impact of non-specific low back pain worldwide.
Trial registration
NCT05391165 (registered prospectively in ClinicalTrials.gov: 25/05/2022).
... 4 The economic burden is even greater when the indirect costs are also considered. 5 Clinical guidelines recommend opioid analgesics for people with acute low back or neck pain only when other pharmacological treatments are contraindicated or have not worked. 6 Despite these guidelines, as high as twothirds of people in Australia receive an opioid as first-line treatment when presenting for care with low back pain and neck pain. ...
Background:
Opioid analgesics are commonly used for acute low back pain and neck pain, but supporting efficacy data are scarce. We aimed to investigate the efficacy and safety of a judicious short course of an opioid analgesic for acute low back pain and neck pain.
Methods:
OPAL was a triple-blinded, placebo-controlled randomised trial that recruited adults (aged ≥18 years) presenting to one of 157 primary care or emergency department sites in Sydney, NSW, Australia, with 12 weeks or less of low back or neck pain (or both) of at least moderate pain severity. Participants were randomly assigned (1:1) using statistician-generated randomly permuted blocks to guideline-recommended care plus an opioid (oxycodone-naloxone, up to 20 mg oxycodone per day orally) or guideline-recommended care and an identical placebo, for up to 6 weeks. The primary outcome was pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory (10-point scale), analysed in all eligible participants who provided at least one post-randomisation pain score, by use of a repeated measures linear mixed model. Safety was analysed in all randomly assigned eligible participants. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000775516).
Findings:
Between Feb 29, 2016, and March 10, 2022, 347 participants were recruited (174 to the opioid group and 173 to the placebo group). 170 (49%) of 346 participants were female and 176 (51%) were male. 33 (19%) of 174 participants in the opioid group and 25 (15%) of 172 in the placebo group had discontinued from the trial by week 6, due to loss to follow-up and participant withdrawals. 151 participants in the opioid group and 159 in the placebo group were included in the primary analysis. Mean pain score at 6 weeks was 2·78 (SE 0·20) in the opioid group versus 2·25 (0·19) in the placebo group (adjusted mean difference 0·53, 95% CI -0·00 to 1·07, p=0·051). 61 (35%) of 174 participants in the opioid group reported at least one adverse event versus 51 (30%) of 172 in the placebo group (p=0·30), but more people in the opioid group reported opioid-related adverse events (eg, 13 [7·5%] of 174 participants in the opioid group reported constipation vs six [3·5%] of 173 in the placebo group).
Interpretation:
Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions.
Funding:
National Health and Medical Research Council, University of Sydney Faculty of Medicine and Health, and SafeWork SA.
... According to Alonso-García and Sarría-Santamera (24) the contributing factor to the high indirect costs of LBP was absenteeism and presenteeism. On the other hand, a cost-of-illness study in Australia reported that the costs of LBP in public hospitals was higher than in private hospitals (36). The high costs of LBP in public hospitals in Australia . ...
Introduction
Low back pain (LBP) is a common health problem, and the leading cause of activity limitation and work absence among people of all ages and socioeconomic strata. This study aimed to analyse the clinical and economic burden of LBP in high income countries (HICs) via systematic review and meta-analysis.
Methods
A literature search was carried out on PubMed, Medline, CINAHL, PsycINFO, AMED, and Scopus databases was from inception to March 15th, 2023. Studies that assessed the clinical and economic burden of LBP in HICs and published in English language were reviewed. The methodological quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale (NOS) for cohort studies. Two reviewers, using a predefined data extraction form, independently extracted data. Meta-analyses were conducted for clinical and economic outcomes.
Results
The search identified 4,081 potentially relevant articles. Twenty-one studies that met the eligibility criteria were included and reviewed in this systematic review and meta-analysis. The included studies were from the regions of America (n = 5); Europe (n = 12), and the Western Pacific (n = 4). The average annual direct and indirect costs estimate per population for LBP ranged from € 2.3 billion to € 2.6 billion; and € 0.24 billion to $8.15 billion, respectively. In the random effects meta-analysis, the pooled annual rate of hospitalization for LBP was 3.2% (95% confidence interval 0.6%–5.7%). The pooled direct costs and total costs of LBP per patients were USD 9,231 (95% confidence interval −7,126.71–25,588.9) and USD 10,143.1 (95% confidence interval 6,083.59–14,202.6), respectively.
Discussion
Low back pain led to high clinical and economic burden in HICs that varied significantly across the geographical contexts. The results of our analysis can be used by clinicians, and policymakers to better allocate resources for prevention and management strategies for LBP to improve health outcomes and reduce the substantial burden associated with the condition.
Systematic review registration
https://www.crd.york.ac.uk/prospero/#recordDetails?, PROSPERO [CRD42020196335].
... Lower back pain is one of the leading global causes of disabilities associated with increased healthcare costs and healthcare facility turnover rates [5,6,7]. This disease triggers an annual health expenditure of US$9.17 billion on direct medical expenditure in Australia and up to US$105.4 billion in the United States [8,9]. Most individuals with low back pain do not require surgical, pharmacological, or physical therapy intervention, but 10 to 20% of individuals experience severe symptoms resulting in functional limitations in daily life activities and are at risk of poor recovery [10]. ...
Surgeries were considered the only effective treatment method for patients suffering from chronic low back pain with lumbar radiculopathy for a while. However, in the contemporary world, it is not regarded as the primary treatment method until other conventional pharmacological and physical therapy interventions have not proven effective. Therefore, this study compares the outcomes in terms of pain relief and perceived level of mobility in patients with chronic low back pain with lumbar radiculopathy, regardless of whether the butler neural mobilization technique or manual therapy is used. This comparative cross-sectional study was conducted in Lahore, recruiting 100 patients by rendering a purposive sampling technique undergoing any treatment method mentioned above. Observations were recorded pre- and postintervention with a follow-up of 7 days to assess the response to both techniques using a questionnaire. Face-to-face interviews were conducted to assess pain levels using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Descriptive statistics, chi-square test, Mann‒Whitney U test, independent t test, and the Wilcoxon signed-rank test were used to analyze the data. The medical characteristics of patients who had opted for manual therapy and butler neural mobilization were not different (p > 0.05), except for the quality of pain (p < 0.05). However, pre- and postintervention NPRS scores, pain intensity during the last 24 hours using NPRS scores, and MODQ scores were significantly different among the groups, indicating postintervention pain reduction for both groups comprising patients who had opted for manual therapy (p = 0.001) and butler neural mobilization technique (p = 0.001). Moreover, patients who had opted for either technique had improved their disability levels compared with the preintervention disability levels (p = 0.001). The study concluded that both techniques significantly reduce pain and disability levels, including butler neural mobilization and manual therapy, among patients suffering from chronic low back pain with lumbar radiculopathy.
... L ow back pain is the most common musculoskeletal condition globally. 27 People with chronic low back pain (CLBP) account for the largest health care costs, greatest loss of work productivity, 27,62 and the most significant proportion of years lived with disability among all health conditions. 15 The burden of CLBP has increased in the last few decades 15 despite substantial healthcare investments 19 and the widespread availability of evidence based guidelines. ...
A new wave of treatments has emerged to target the altered nervous system and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators/barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n=20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behaviour change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behaviour change techniques to maintain the improvements after the cessation of formal care. Perspective: This article presents the experiences of people with chronic low back pain toward a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.
... 4 UK costings for LBP of £12.3 billion, 6 and $9.17 billion for Australia have been published. 7 The American Academy of Pain Medicine published annual costs in 2006 for chronic pain of $560 to 635 billion, and noted that 53% of all chronic pain patients in the USA were affected by LBP with 31 million people estimated to have LBP at any one time. 8 In 2015, the global point prevalence of activity limiting LBP of 7.3% indicated that 540 million people were affected globally. ...
The purpose of this review was to evaluate data generated by animal models of intervertebral disc (IVD) degeneration published in the last decade and show how this has made invaluable contributions to the identification of molecular events occurring in and contributing to pain generation. IVD degeneration and associated spinal pain is a complex multifactorial process, its complexity poses difficulties in the selection of the most appropriate therapeutic target to focus on of many potential candidates in the formulation of strategies to alleviate pain perception and to effect disc repair and regeneration and the prevention of associated neuropathic and nociceptive pain. Nerve ingrowth and increased numbers of nociceptors and mechanoreceptors in the degenerate IVD are mechanically stimulated in the biomechanically incompetent abnormally loaded degenerate IVD leading to increased generation of low back pain. Maintenance of a healthy IVD is, thus, an important preventative measure that warrants further investigation to preclude the generation of low back pain. Recent studies with growth and differentiation factor 6 in IVD puncture and multi-level IVD degeneration models and a rat xenograft radiculopathy pain model have shown it has considerable potential in the prevention of further deterioration in degenerate IVDs, has regenerative properties that promote recovery of normal IVD architectural functional organization and inhibits the generation of inflammatory mediators that lead to disc degeneration and the generation of low back pain. Human clinical trials are warranted and eagerly anticipated with this compound to assess its efficacy in the treatment of IVD degeneration and the prevention of the generation of low back pain. © 2022 The Authors. JOR Spine published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.
... Another cross-sectional Switzerland study by Wieser et al. reported the direct costs of CLBP to be €2.3 billion and indirect costs were estimated at €4.1 billion using the human capital approach and €2.2 billion using the friction cost method, representing 2.3% of the total gross domestic production [12]. Walker et al. estimated the direct cost of LBP at AU$1.02 billion and indirect cost at AU$8.15 billion among the Australian adults [13]. In the Netherlands, van Tulder et al. reported that the total annual direct costs of LBP were estimated at US$367.6 million, while the total annual indirect costs were estimated at US$4.6 billion [14]. ...
Background
Low back pain (LBP) is a multifactorial and the most prevalent musculoskeletal disorder, whose economic burden is of global concern. Evidence suggests that the burden of LBP in increasing and will continue rising with the greatest burden occurring in low-and-middle-income-countries (LMICs). This study sought to determine the economic burden of LBP in KwaZulu-Natal, South Africa from the providers perspective.
Methods
We used a retrospective prevalence-based cost-of-illness methodology to estimate the direct medical cost of LBP. Direct medical costs constituted costs associated with healthcare utilisation in inpatient care, outpatient care, investigations, consultations, and cost of auxiliary devices. We used diagnostic-specific data obtained from hospital clinical reports. All identifiable direct medical costs were estimated using a top-down approach for costs associated with healthcare and a bottom-up approach for costs associated with inpatient and outpatient care.
Results
The prevalence of chronic low back pain CLBP was 24.3% (95% CI: 23.5–25.1). The total annual average direct medical costs associated with LBP was US0.92 million) and 83% (US99.43 and US2.10 million) of the total annual average direct medical cost, 54.9% (US831,595.40, which formed 15.4% of the average total cost.
Conclusion
The economic burden of LBP is high in South Africa. Majority of costs were attributed to CLBP. The outpatient care costs contributed the largest share percent of the total cost. Pain medication was the main intervention strategy, contributing more than half of the total outpatient costs. Measures should be taken to ensure guideline adherence. Focus should also be placed towards development of prevention measures to minimise the cost.
... The total annual cost of lost productivity due to work-related MSD is estimated to be 2% of the GDP in Europe alone [10]. Treatment of MSD imposes significant costs on public health systems in various countries, e.g., Germany's Federal Statistical Office reports a cost of 420 € per citizen per year (year 2015) [11,12]. ...
Background
Despite advancing automation, employees in many industrial and service occupations still have to perform physically intensive work that may have negative effects on the health of the musculoskeletal system. For targeted preventive measures, precise knowledge of the work postures and movements performed is necessary.
Methods
Prototype smart work clothes equipped with 15 inertial sensors were used to record reference body postures of 20 subjects. These reference postures were used to create a software-based posture classifier according to the Ovako Working Posture Analysing System (OWAS) by means of an evolutionary training algorithm.
Results
A total of 111,275 posture shots were recorded and used for training the classifier. The results show that smart workwear, with the help of evolutionary trained software classifiers, is in principle capable of detecting harmful postures of its wearer. The detection rate of the evolutionary trained classifier ( a ¯ ccr = 0.35 for the postures of the back, a ¯ ccr = 0.64 for the arms, and a ¯ ccr = 0.25 for the legs) outperforms that of a TensorFlow trained classifying neural network.
Conclusions
In principle, smart workwear – as prototypically shown in this paper – can be a helpful tool for assessing an individual’s risk for work-related musculoskeletal disorders. Numerous potential sources of error have been identified that can affect the detection accuracy of software classifiers required for this purpose.
... Au Royaume-Uni le coût est de 12,3 milliards de livres (1,6 milliard pour les coûts directs et 10,7 milliards pour les coûts indirects), voir figure 9 [267]. En Australie, les coûts sont similaires (10,19 milliards de dollars Australien) [469]. ...
Les affections de la colonne sont la principale source de handicap mondiale. Leur impact sur les systèmes de santé et sociaux est monumental dans les pays occidentaux et sans doute négligé dans les pays en voie de développement. Bien que traditionnellement considéré comme non spécifique, il est possible dans certains cas de définir des sources anatomo-pathologiques responsables de la douleur des patients. Parmi elles, se trouve les fissures radiales de l’annulus fibrosus du disque intervertébral. Cette lésion structurelle à de nombreuses conséquences sur la biologie et la mécanique du disque intervertébral, pouvant conduire à une dégénérescence de la structure. Dans cette thèse nous nous intéressons aux déplacements et aux déformations du Nucleus Pulposus rendu plus importantes du fait de la brèche de l’annulus. McKenzie a émis l’hypothèse d’un nucleus mobile dans la fissure. Ces déformations / déplacements sont dépendants des forces imposées sur l’unité fonctionnelle par les mouvements physiologiques du rachis. Ainsi une flexion déplace / déforme le nucleus vers l’arrière, une extension vers l’avant et ainsi de suite. Afin de tester la pertinence de cette hypothèse, nous utilisons une approche quadruple, incluant :- Une revue systématique de la littérature avec une méta-analyse.- Une approche ex vivo, combinant IRM quantitative et analyse photomécanique.- Une approche in vivo d’analyse quantifié de mouvement.- Une approche in silico de modélisation par éléments finis.Nos résultats, quoique préliminaires, semblent confirmer cette hypothèse. Mais, nous sommes encore loin d’une validation ferme et définitive. D’autres recherches seront nécessaires pour finaliser cet objectif.
... It is estimated that up to 90% of people will suffer from LBP during their lifetime [2]. The societal cost of LBP is reported to be in excess of $USD100 billion per year in the USA [3], more than $AUD9 billion per year in Australia [4] and approximately €50 billion per year in Germany [5]. The development and resultant adoption of evidence-based clinical guidelines has been shown to reduce costs and may lead to improved patient outcomes: randomised controlled trials have reported either significant [6][7][8] or non-significant [9][10][11] reductions in costs favouring guideline adherent approaches. ...
Purpose
Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis.
Methods
Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung–Knapp–Sidik–Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively.
Results
Of 886 records, 6 studies were included ( N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction ( p = 0.021, Fisher’s method, risk of bias: low). This did not persist with sensitivity analysis ( p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I ² = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low).
Conclusion
Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions.
PROSPERO registration
CRD42020215137.
... Back pain is a public health issue affecting up to 80% of the adult population and generates both social and economic impacts [1,2]. Back pain is the biggest cost to the health system [2,3]. Moreover, it causes an individual economic impact because it withdraws people from labor prematurely, becoming the fourth cause of disability in 2015 [2,4]. ...
Risk factors associated with back pain vary in different countries. Given the lack of studies in Latin America, our study aimed to assess back pain and its associated factors for six years in Southern Brazilian school children. All children attending the fifth grade of Teutônia, Brazil, were invited to participate in the study. Only schoolchildren who did not report back pain were included in the first assessment. The schoolchildren completed the Back Pain and Body Posture Evaluation Instrument (BackPEI) during three assessments (2011, 2014, and 2017). BackPEI assesses the presence of back pain and possible associated risk factors (postural, behavioral, and sociodemographic). Generalized estimated equations (GEE) were used to perform a Poisson regression model with robust variance for longitudinal analysis. After six years of follow-up, 75 schoolchildren completed all the assessments. The risk factors associated with back pain were spending more than six hours daily watching television, lifting objects from the ground adopting an inadequate posture, using another backpack type different from those with two straps, and carrying a backpack in an asymmetric way. These results are important in guiding the planning of public policies to minimize this public health problem.
... For instance, it has been estimated to cost the US as much as $90 billion in direct and indirect costs (Davis 2012). The equivalent figures for Australia and the UK are >$9 billion per year and £12 billion per year, respectively (Maniadakis and Gray 2000; Walker et al. 2003;Donaldson 2008). To take a fourth example, the direct and indirect costs of back pain in Canada have been estimated to exceed $12 billion per annum (Bone and Joint Canada 2014). ...
In 1923, Sir Arthur Keith proposed that many common back problems are due to the stresses caused by our evolutionarily novel form of locomotion, bipedalism. In this article, we introduce an updated version of Keith’s hypothesis with a focus on acquired spinal conditions. We begin by outlining the main ways in which the human spine differs from those of our closest living relatives, the great apes. We then review evidence suggesting there is a link between spinal and vertebral shape on the one hand and acquired spinal conditions on the other. Next, we discuss recent studies that not only indicate that two common acquired spinal conditions—intervertebral disc herniation and spondylolysis—are associated with vertebral shape, but also suggest that the pathology-prone vertebral shapes can be understood in terms of the shift from quadrupedalism to bipedalism in the course of human evolution. Subsequently, we place the aforementioned findings under an umbrella hypothesis, which we call the “Evolutionary Shape Hypothesis.” This hypothesis contends that individuals differ in their propensity to develop different acquired spinal conditions because of differences in vertebral shape that relate to the evolutionary history of our species. We end the article with some possible directions for future research.
... 53 LBP imposes high direct costs due to medical consultations, examinations (ie, x-rays, magnetic resonance imaging), and drugs as well as indirect costs from work compensation and absence. 20,54 Acute LBP refers to symptoms lasting up to 4 weeks, subacute LBP refers to symptoms lasting 4 to 12 weeks, and chronic LBP refers to symptoms lasting more than 3 months. 26 While approximately 40% of patients with an acute LBP episode recover within 2 to 4 weeks, the rest tend to develop a chronic disorder with long-lasting symptoms. ...
Objective:
To evaluate the effects of individual patient education for managing acute and/or subacute low back pain (LBP), compared to no intervention/placebo education, non-educational interventions, or other type of education.
Design:
Systematic review with meta-analysis of randomised trials.
Literature search:
PubMed, CINAHL, PEDro, Embase, Scopus and CENTRAL (up to 30 September 2020); reference lists of previous systematic reviews.
Study selection criteria:
Randomized controlled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP.
Data synthesis:
Random effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the GRADE approach.
Results:
We included 13 RCTs. There was moderate certainty of evidence that individual patient education was more effective than placebo education for pain at medium term (MD=-0.79; 95%CI =-1.52 to -0.07), and physical function at short- (SMD=-0.25; 95%CI =-0.47 to -0.02) and medium term (SMD=-0.26; 95%CI =-0.48 to -0.04), but with no clinically relevant effects. There was low-to-moderate certainty of evidence that individual patient education was superior to non-educational interventions on short-term quality of life (MD -12,00, 95%CI -20.05 to -3.95) and medium-term sick leave (OR 0.32, 95%CI 0.11 to 0.88). We found no clinically relevant between-group effects for any other comparison (low-to-high certainty of evidence) at any follow up.
Conclusion:
One or two hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute/subacute LBP. Considering its effects on other outcomes (e.g. reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP. J Orthop Sports Phys Ther, Epub 18 May 2022. doi:10.2519/jospt.2022.10698.
... 5 Devido à alta prevalência de dor lombar crônica, os gastos com cuidados relacionados à essa condição são altos, gerando um problema de ordem econômica. [6][7][8][9] Por causa da natureza não específica da dor lombar, vários tratamentos têm sido utilizados para seu manejo, dentre os quais estão os exercícios físicos. 10,11 O exercício físico é recomendado por diretrizes clínicas como uma medida efetiva no tratamento da dor lombar crônica inespecífica. ...
Low back pain is a major health and socioeconomic problem. Exercises and patient awareness are among the possible positive strategies for treating nonspecific chronic low back pain. Objective: The objective of this study was to determine the effectiveness of the Pilates Method and the "Back School" program in the treatment of nonspecific chronic low back pain. Method: A randomized controlled trial with blinded assessors. Eighty-four individuals with chronic nonspecific low back pain. Interventions: Participants were randomly allocated into two groups: Pilates Group (n= 43) or Control Group - “Back School” (n= 41). The primary outcomes were: pain (Numeric Rating Scale), quality of life (SF-36), and disability (Roland-Morris Disability Questionnaire - RMDQ). The secondary outcomes were: Flexibility (Fingertip-to-Floor Test – FTF) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). Results: The Pilates Group was superior to the Control Group (p<0.05) in outcomes of pain intensity, disability, flexibility, and in five domains of SF-36 (physical functioning, role limitations due to physical health, pain, vitality, and general health). There was no significant difference between groups for sleep quality. Conclusion: The Pilates protocol provided significant improvements and can be considered an option for treating nonspecific chronic low back pain. The Pilates Group was superior to the "Back School" program for pain reduction, improved functional capacity, flexibility, and five quality of life domains. Due to the considerable low adhesion to both interventions, alternatives to improve adherence should be proposed in future studies.
... The total annual cost of lost productivity due to work-related MSD is estimated to be 2% of GDP in Europe alone [10]. Treatment of MSD imposes significant costs on public health systems in various countries, e.g., Germany's Federal Statistical Office reports a cost of 420 e per citizen per year (year 2015) [11,12]. ...
Background: Despite advancing automation, employees in many industrial and service occupations still have to perform physically intensive work that may have negative effects on the health of the musculoskeletal system. For targeted preventive measures, precise knowledge of the work postures and movements performed is necessary.
Methods: Prototype smart work clothes equipped with 15 inertial sensors were used to record reference body postures of 20 subjects. These reference postures were used to create a software-based posture classifier according to the Ovako Working Posture Analysing System (OWAS) by means of an evolutionary training algorithm.
Results: A total of 111,275 posture shots were recorded and used for training the classifier. The results show that smart workwear, with the help of evolutionary trained software classifiers, is in principle capable of detecting harmful postures of its wearer. The detection rate of the evolutionary trained classifier (a_ccr = 0.35 for the postures of the back, a_ccr = 0.64 for the arms, and a_ccr = 0.25 for the legs) outperforms that of a TensorFlow trained classifying neural network.
Conclusions: In principle, smart workwear – as prototypically shown in this paper – can be a helpful tool for assessing an individual’s risk for work-related musculoskeletal disorders. Numerous potential sources of error have been identified that can affect the detection accuracy of software classifiers required for this purpose.
Background
This study investigated the impact of Chronic Low Back Pain (CLBP) on individuals' physical activity (PA) behaviours, specifically, how they modify, cease, or continue PA when experiencing CLBP. The primary aim was to explore the relationship between CLBP and PA and how this is influenced in different contexts (e.g., necessity of a task).
Methods
A mixed‐methods survey was administered to 220 participants, including self‐reported outcomes, and capturing responses to three distinct questions related to PA and CLBP. The data was analysed via a content analysis.
Results
The findings revealed that individuals with CLBP are most likely to modify PA in work‐related contexts and least likely to cease it in the same setting. Housework emerged as the most common domain for cessation of PA, while work/study activities were predominantly continued. Reasons for these trends were typically task‐based rather than health or enjoyment based and influenced by the perceived necessity of the task in question.
Conclusion
The study highlights the role of occupational and educational settings in individual responses to CLBP. The findings also highlight a gap in public awareness regarding effective CLBP management strategies, emphasising the need for increased education and awareness programs.
Background
Global policy and guidelines for low back pain (LBP) management promote physical activity and self-management and yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching has been found to be effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP.
Aim
This qualitative study aimed to understand the aspects of a community over-the-phone health-coaching program, that were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment.
Methods
A purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi structured interviews were conducted, and a general inductive content analysis approach was taken to create a framework from the data.
Results
Participants discussed positive and negative aspects of the health coaching that they found to be empowering and confidence building or disappointing and frustrating. The main themes uncovered from the interviews included the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP specific knowledge. The participants reported the health coach and the coaching relationship to be the primary factor that influenced the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence.
Clinical Implications
In an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment.
Trial Registration
The GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.
Background
Low back pain (LBP) is the leading cause of disability worldwide. Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in the emergency department (ED) setting. Whether adherence differs between public and private settings is unknown. This study compared adherence to LBP clinical guidelines between a private and public Australian hospital ED.
Methods
A retrospective audit of 86 private patients were matched to 86 public patients by age (± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS).
Results
Management GAS was lower in private patients compared to public patients (d [95%CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95%CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95%CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95%CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95%CI]: 2.2 [1.2, 4.2], P = 0.013).
Conclusion
Findings suggest that differences exist in public and private hospital ED guideline adherence. Exploring barriers and facilitators underpinning differences in guideline implementation will assist in guiding future implementation science approaches.
Introduction: Capitellar fractures in adults are not only rare injuries but also a challenging one to manage. Very few
studies have been published in literature, in view of which we present our study done in our institute with a purpose to
evaluate the functional outcome of open reduction & internal fixation (ORIF) of capitellar fractures in adults.
Materials and method: 10 patients (two males and 8 females) of capitullam fracture were studied retrospectively from
April 2013 to March 2016. All cases were operated by open reduction & internal fixation (ORIF) within 7-11 days of injuries.
Fixation was done by Herbert screws in 7 cases, cannulated cancellous screw (CCS) in 2 cases and by K- wires only in 1
case. 1 case of Herbert screw & similar number of CCS was supplemented by 1 or 2 k wires. Follow up for a mean period of 31
months was done in all patients and final functional outcome was assessed using Mayo elbow performance index and by
radiology.
Result: The mean Mayo elbow performance index score was 90. As per this evaluation of the functional rating the 7
patients (fixed by Herbert screws) had excellent results, 2 cases (fixed by CCS) showed good result however 1 case (fixed
with K-wire) had fair result. The mean range of elbow flexion/extension was 120 (110 - 130) while range of movement in
supination/pronation was 120-180. None except one had complications like avascular necrosis, myositis osiificans,
osteoarthrosis or fixation failures. One case of capitullam fracture associated with communied fracture of lateral condyle
showed malunion with anterosuperior migration which was excised in due course and the final outcome was good.
Conclusion: Open reduction & internal fixation (ORIF) of capitullam fracture gives good functional outcomes
irrespective of the implants but Herbert screw was found to be superior. In choosing the right surgical approach and
implants, preoperative computed tomography is helpful. Apart from stable internal fixation, early mobilization and
rehabilitation are the keys for optimum functional outcome.
Key words: Capitulum fracture, Fracture fixation, Elbow joint
Background
To explore extraperitoneal approach as an optimal option for reducing peritoneal disruption at a single-level disc in anterior lumbar interbody fusion (ALIF).Methods
First, abdominal axial CT images obtained from 111 patients were observed to evaluate the distribution of extraperitoneal fat at L2-S1 and measure the lateral distances between the midline and the lateral borders of the rectus and the extraperitoneal fat for each disc level. Second, eight embalmed corpses were dissected along the lateral border of the rectus to expose the peritoneum, which was then separated laterally and medially to evaluate the distribution of fat and peritoneum adhesion. Finally, a total of 58 patients were selected for ALIF. For L2-L4 discs and L4-S1, the pararectus approach and the paramedian approach were utilized, respectively.ResultsExtraperitoneal fat was observed behind the rectus at the L5-S1 and the lateral distance between the fat and midline and the lateral border of the rectus gradually decreased on both sides of L2-5. On the cranial side of the arcuate line, it was easier to separate the peritoneum outward along the lateral edge of the rectus. When bluntly dissected medially, the peritoneum was closely adhered to abdominal wall. No complications such as peritoneal damage, retroperitoneal hematoma and neurological complications occurred in 58 patients undergoing the aforementioned surgical methods.Conclusions
For L4-S1, the paramedian approach is the optimal technique to expose the disc, whereas the pararectus approach is the feasible surgical method at L2-4.
Background
Self-efficacy is one of the important factors affecting chronic diseases. In the current epidemiological context of low back pain (LBP), LBP self-efficacy has become a topic of great practical interest for researchers. However, no bibliometric analysis related to LBP self-efficacy has been performed to date. The purpose of this study was to conduct and explore the current state of research in LBP self-efficacy from 1980 to 2021, by using bibliometric analysis and scientific mapping.
Methods
Raw data were selected from the Web of Science (WOS) database, relevant literature on LBP self-efficacy was retrieved, data were de-duplicated and cleaned. Excel was used for data processing. CiteSpace 5.8.R3 was used for bibliometric analysis and scientific mapping in publications and country, institution, journals, authors, references, and key words. Statistical analysis was performed using IBM SPSS 25.0.
Results
There were 822 references included. For this period, the total publication numbers were increased. A total of 103 regions had researchers in this area, the United States was the country with the largest volume of research. There were 94 disciplines, mainly in neuroscience. More research is likely to burst and develop quickly in general & internal medicine in the future. Spine was the most recognized journal. Cognitive behavioral manifestations and older adults with LBP might be the frontiers and trends.
Conclusion
The volume of literature on LBP self-efficacy has increased linearly over the past 41 years and will continue to increase. The field of study has become more refined. This bibliometric analysis provides valuable support for future directions and research trends in LBP self-efficacy.
The role of trunk strength and range of motion (RoM) in low back pain (LBP) risk in athletes is still unclear. The purpose of this study was to compare trunk muscle strength and RoM in adolescent athletes with and without LBP (total n = 381; age = 16.5 ± 2.1 years). The participants included basketball, soccer and tennis players who currently participate in normal training/competition regimen, have regularly participated in training for > 3 years (mean: 7.2 ± 3.2 years) and perform at least 4 training sessions in their sport per week (mean: 6.1 ± 1.2 sessions/week). The participants performed isometric trunk extension, flexion and lateral flexion strength assessments, as well as RoM tests (Schober’s test, lateral flexion RoM) and reported the 1‑year LBP history. Female basketball players with LBP history had lower lateral flexion RoM than their LBP-free counterparts (relative difference = 11.3–12.7%; p = 0.022–0.043), while the opposite was the case in the male tennis subgroup (relative difference = 9.7–14.1%; p = 0.027–0.032). Trunk flexion RoM was 24–28% greater in athletes with LPB cases that required absence from training/competition in female subgroups (p = 0.018–0.23). In male tennis players, absolute and body-mass-normalized trunk extension strength were 51–63% lower in athletes with LPB cases that required absence from the training and competition (p = 0.016–0.027). Further prospective studies are needed, as our study could not clearly elucidate the effect of trunk strength and RoM on LBP risk in adolescent athletes.
Aims: The aim of this study was to determine whether there exists a difference in efficacy in the treatment of lumbar radiculopathy with quantum molecular resonance coablative radiofrequency, and quantum molecular resonance coablative radiofrequency and percutaneous microdiscectomy with grasper forceps (QMRG). Patients & methods: A total of 28 patients from La Fe University and Polytechnic Hospital in Valencia were enrolled in a retrospective cohort. Results: Treatment with QMRG significantly improved non-sleep-related and sleep-related outcome measures. At 6 months post-intervention, treatment with QMRG resulted in significantly better scores in numeric rating scale, Oswestry Disability Index, Short Form 12 Health Survey Physical and Total, Patient Global Impression of Improvement, sleep disturbance and the two sleep problems indexes. Conclusion: Treatment of lumbar radiculopathy with QMRG appears to be more effective at 6 months post-intervention.
Background: Over 70% of people in resource-rich countries will experience LBP at some time in their lives. Back pain and the resulting disability constitute a major public health problem in Western as well as Indian societies. Objective: To study the short-term effect of Maitland's Mobilization on pain and functional ROM in patients with acute mechanical LBP. Methods: 30 participants were divided into 2 groups. Group A underwent Maitland's mobilization with therapeutic exercises and Group B underwent therapeutic exercises. Outcome measures taken were VAS, Pain-Pressure threshold AND functional rating index. Pre and Post treatment and 24-hour post treatment measurements were taken. Results: Results showed that there was significant improvement in VAS, PPT and FRS in group A. Conclusion: It has been concluded that Maitland's Mobilization along with conventional therapy is effective than Conventional exercise therapy alone in improving pain and functional disability in Acute Mechanical LBP.
Background:
Rice farming is considered the most crucial industry in India, where millions of farmers suffer from LBP.
Objectives:
The present study's primary objectives were to evaluate the prevalence of low back pain among India's rice farmers and determine the relationship between low back pain and ergonomic risk factors and psychosocial factors encountered by the farmers.
Methods:
Socio-demographics, ergonomics risk factors and psychosocial factors that cause LBP among rice farmers were examined. Modified Nordic Musculoskeletal Questionnaire and Oswestry LBP Questionnaire were administered among the farmers to evaluate the LBP. Univariate analysis was done to find out the odds ratios and 95% confidence intervals among the farmers.
Results:
The primary findings from this study regarding the psychosocial factors, such as perceived inadequacy of income (84.7% ), job demands (78.1% ), work demand targets specific productivity (76.5% ), rigidity in work methods (75.3% ), monotony at work (73.2 % ), have a relationship with LBP. The results also revealed that the relationship between the low back pain and ergonomic risk factors, such as repetitiveness (OR- 4.215; 95% CI- 2.551-6.965), working in awkward posture (OR- 85.82; 95% CI- 43.134-170.77), lifting loads (OR- 0.281; 95% CI- 0.125-0.324), pulling loads (OR- 0.274; 95% CI- 0.173-0.434), showed significant relationship with LBP in the univariate analysis.
Conclusions:
The prevalence of LBP among rice farmers connected with ergonomic and psychosocial risk factors. The awkward posture, MMH (lifting and carrying) are the main causative factors of LBP.
Objectives: Low Back Pain (LBP) is prevalent in most people of working age. The morbidity it causes cannot be taken lightly, as is its economic burden. Physiotherapy has long been prescribed to LBP patients, but treatment outcome measurements, along with the factors influencing it, have not been widely evaluated. In this study, we aim to assess the correlation between patient’s expectation and LBP physical therapy outcome. Methods: This was a cross sectional study conducted at physical rehabilitation outpatient clinic in September-December 2019. Participants were patients with LBP who were treated with physical therapy. One series of physical therapy consists of 5 sessions of modality only or modality with exercise therapy; one patient underwent 2 sessions per week. Oswestry disability index (ODI) score was used to evaluate treatment outcome and Stanford Expectation of Treatment Scale score was used to evaluate patient’s expectation. Data was collected twice, before and after 1 series of therapy. Results: There were 91 participants included in this study, most of whom were female. Most patients reported a significant decrease in ODI score, irrespective of the LBP chronicity or nutritional status. However, patients who received a combination of physical exercises and modalities reported lower after therapy ODI than those who only received modalities (p=0.009). No correlation was found between positive (p=0.567) or negative (p=0.910) expectations with ODI improvement. Conclusion: Our study did not find any correlation between positive or negative expectations towards ODI score improvement. Keywords: Low back pain; Physical therapy; Treatment outcome; Patient expectation; ODI score
In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One-third of the hospital care costs and one-half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. The total direct medical costs of back pain were estimated at US200 million. The mean costs of hospital care for back pain per case were US199 for an outpatient. The total indirect costs of back pain for the entire labour force in The Netherlands in 1991 were estimated at US3.1 billion was due to absenteeism and US4622 and US$9493, respectively. The indirect costs constituted 93% of the total costs of back pain, the direct medical costs contributed only 7%. It is therefore concluded that back pain is not only a major medical problem but also a major economical problem.
In this study we estimated the indirect costs of back pain in 1991 in The Netherlands on the basis of two approaches: the traditionally used human capital method and the more recently developed friction cost method. The indirect costs of illness were defined as the value of production losses of paid labour and related costs to society due to back pain. The results of this study in 1991 in The Netherlands show that the short-term indirect costs estimated by the human capital method were more than three times as high as the indirect costs estimated by the friction cost method (US$ 4.6 billion vs. USS 1.5 billion, respectively). The lower estimate of indirect costs when using the friction cost method is mainly due to the fact that in this method actual production losses are estimated during a relatively short friction period, which is defined as the period needed to restore the initial production level. In contrast with the human capital method, long-term absenteeism and disability do not induce additional costs when applying the friction cost method. Since the friction cost method takes into account that employees can be replaced, we believe that this method produces a more accurate estimate of indirect costs than the human capital method. Notwithstanding the resulting decrease in indirect costs of back pain, these costs are still impressive, representing 0.28% of the GNP in The Netherlands in 1991. As a consequence, but particularly stimulated by structural changes in the Dutch social security system, policies aimed at reducing indirect costs of back pain, increasingly concentrate on the development and evaluation of interventions early after the onset of disease. This is complemented, on the one hand, by the development of clinical guidelines for the management of back pain in primary care and, on the other hand, by governmental policies aimed at reintegration of chronically ill in the labour force.
This paper reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be pound1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total pound10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area.
This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company (PEPCO) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U.S. Postal Service. The physicians were unbiased, in that they could not take part in the patients' ongoing care. The results in both groups demonstrated significant and continuous reductions in number of incidents, in days lost from work, in low-back surgery, and in financial costs. The number of low-back pain patients at PEPCO decreased 29% the first year and 44% the second; days lost from work decreased 51% the first year and 89% the second; low-back surgery dropped 88% the first year and 76% the second year. Results for the U.S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.
Background
Back pain has become quite a health problem in today’s modern industrial society. Even though an excellent network of doctors and efficient treatments is available and most of the patients need only a few treatments, back pain is a common cause of illness and inability to work. This amounts to a considerable reduction in quality of life for those affected, additionally this also leads to a high economic burden for the national economy and the solidarity of the insured.
□ Cost Analysis
The total costs caused by back pain come up to about 34 billion DM per year according to the present study. Ten billion DM of these amount to direct costs, which are divided into costs for physician visits (including diagnostic procedures) at about 35%, hospital treatment at about 22%, rehabilitation at about 21%, physical therapy at about 17% and medication at about 5%. Regarding total costs, which are composed of around 70% indirect costs, the direct costs relativize immensly.
□ Conclusion
Savings through restrictive prescriptions for medications therefore have no great impact on total costs. Only a more efficient therapy, which reduces sick days, number of recurrences and development of chronic illness as well as a more effective prevention, is able to limit the costs of back pain in the long-run. Therefore, more research on a broader base may result in a significant benefit in this area.
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 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.
This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company ( PEPCO ) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U.S. Postal Service. The physicians were unbiased , in that they could not take part in the patients' ongoing care. The results in both groups demonstrated significant and continuous reductions in number of incidents, in days lost from work, in low-back surgery, and in financial costs. The number of low-back pain patients at PEPCO decreased 29% the first year and 44% the second; days lost from work decreased 51% the first year and 89% the second; low-back surgery dropped 88% the first year and 76% the second year. Results for the U.S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.
This was a survey of 235 individuals with and 132 individuals without documented low back pain.
To approximate the magnitude of potential reporting biases in estimates of prevalence of and medical care use in low back pain.
The use of survey techniques presents several possible biases in the reporting of acute symptoms. These biases are especially pertinent in musculoskeletal symptoms, which often are recurrent and not life-threatening.
Two-hundred-thirty-five patients with acute low back pain were contacted by telephone 4-16 months after their physician visit and surveyed regarding the presence and date of back pain episodes. One-hundred-thirty-two patients who had no functionally disabling back pain on physician interview were interviewed.
Of the patients who had sought care for back pain, 21% indicated they had not had back pain when interviewed 4-16 months later. Episodes of pain that occurred more than 8 months before the interview tended to be recalled as occurring more recently than they actually occurred, confirming "forward telescoping" of the illness episode. Only 3% of the individuals without functionally impairing pain reported such pain on a separate interview.
Lack of recall occurs regarding acute low back pain, usually a self-limited illness. This potential under-estimate of back pain prevalence may be balanced by forward telescoping of the date of illness occurrence.
Cost data were gathered from computerized records of the Liberty Mutual Insurance Company for low back pain workers' compensation claims (N = 119,107) and for all claims (N = 731,087) initiated from 45 jurisdictions (states) during 1989.
This study provided more current, accurate, and additional information to estimate the costs and incidence associated with compensable low back pain compared with all compensation claims.
The first group of data included all compensable low back claims selected by specific codes: body part codes consisted of low back area, sacrum and coccyx, disc, and multiple trunk; injury codes consisted of strain, sprain, inflammation, rupture, hernia, fracture, and contusion. The second sample included all compensable claims, including both occupational injuries and illnesses.
Low back pain cases represented 16% of all claims but 33% of all claims costs; 55.4% of the low back pain cases received medical payments only (i.e., did not receive indemnity payments for lost time). The mean cost per case for low back pain was 396. Medical costs represented 32.4% of the total costs; indemnity costs (i.e., payment for lost time) represented 65.8%.
Since indemnity costs represent the greatest percentage of workers' compensation expenditure, the primary goal of low back pain management should be the prevention or reduction of prolonged disability.
A new approach for estimating the indirect costs of disease, which explicitly considers economic circumstances that limit production losses due to disease, is presented (the friction cost method). For the Netherlands the short-term friction costs in 1990 amount to 1.5-2.5% of net national income (NNI), depending on the extent to which short-term absence from work induces production loss and costs. The medium-term macro-economic consequences of absence from work and disability reduce NNI by an additional 0.8%. These estimates are considerably lower than estimates based on the traditional human capital approach, but they better reflect the economic impact of illness.
The friction cost method has been proposed as an alternative to the human-capital approach of estimating indirect costs. We argue that the friction cost method is based on implausible assumptions not supported by neoclassical economic theory. Furthermore consistently applying the friction cost method would mean that the method should also be applied in the estimation of direct costs, which would mean that the costs of health care programmes are substantially decreased. It is concluded that the friction cost method does not seem to be a useful alternative to the human-capital approach in the estimation of indirect costs.
There may be some discussion about whether indirect costs should be taken into account at all in an economic appraisal, but there is certainly considerable debate about the proper way of estimating these costs.
This reviews offers a practical guide for quantifying and valuing these indirect costs of disease, both at an aggregated level of general cost of illness studies, and in an economic appraisal of specific healthcare programmes.
Two methods of calculating these costs are considered: the traditional human capital approach, and the more recently developed friction cost method. The former method estimates the potential value of lost production as a result of disease, whereas the latter method intends to derive more realistic estimates of indirect costs, taking into account the degree of scarcity of labour in the economy. All necessary steps in the estimation procedure and the data required at various points will be described and discussed in detail.
The objective of this study was to conduct a systematic review of the literature on the prevalence of low back pain in Australian adults. All Australian low back pain prevalence studies published between 1966 and 1998 were identified. General and methodological criteria using current best practice were applied to each prevalence study. Five studies meeting the inclusion criteria were identified. Out of these, three met the minimum current criteria for methodologic acceptance. These studies were Australian Government Health studies conducted over the past 12 years. However, even these studies were flawed, and thus the true prevalence of low back pain in Australia remains uncertain. A methodologically sound study for Australia is recommended as are best practice guidelines for other studies.
A systematic literature review of population prevalence studies of low back pain between 1966 and 1998 was conducted to investigate data homogeneity and appropriateness for pooling. Fifty-six studies were analyzed using methodologic criteria that examined sample representativeness, data quality, and pain definition. Acceptable studies were assessed for homogeneity and appropriateness for pooling. Thirty were methodologically acceptable. Of these there were significant differences in study design, patient age, mode of data collection, potential temporal effects, and prevalence results. Point prevalence ranged from 12% to 33%, 1-year prevalence ranged from 22% to 65%, and lifetime prevalence ranged from 11% to 84%. A limited number of studies were left for analysis, making the pooling of data difficult. A model using uniform best-practice methods is proposed.