Article

Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial

Authors:
  • Unidad Kovacs de la Espalda. Hospital Universitario HLA-Moncloa
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Abstract

A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain. In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising. Mattress firmness is rated on a scale developed by the European Committee for Standardisation. The H(s) scale starts at 1.0 (firmest) and stops at 10.0 (softest). We randomly assigned participants firm mattresses (H(s)=2.3) or medium-firm mattresses (H(s)=5.6). We did clinical assessments at baseline and at 90 days. Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability. At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2.36 [95% CI 1.13-4.93]), pain on rising (1.93 [0.97-3.86]), and disability (2.10 [1.24-3.56]) than did patients with firm mattresses. Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0.059), pain while lying in bed (p=0.064), and pain on rising (p=0.008) than did patients with firm mattresses. A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

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... In particular, peak body pressure distribution was described as one of the important variables (Bader and Engdal, 2000). Kovacs et al. (2003) reported spinal part is not heavily bent or does not become gentle, only if peak body pressure is evenly distributed on the main parts of human body (head, body, waist and leg). Lahm and Iaizzo (2002) observed that the discomfort of back and waist muscles increases, if one does not maintain the straight shape of spine, when he/she lies down on a mattress. ...
... The correlation coefficient of back muscle relaxation and peak body pressure concentration was rs=0.581, which is similar to the result of Kovacs et al. (2003); Vanderwee et al. (2005) Kovacs et al. (2003) insisting that comfort increases, and subjective satisfaction increases, as no specific mattress part is hard on one's specific body part, when one lies down on a mattress. ...
... The correlation coefficient of back muscle relaxation and peak body pressure concentration was rs=0.581, which is similar to the result of Kovacs et al. (2003); Vanderwee et al. (2005) Kovacs et al. (2003) insisting that comfort increases, and subjective satisfaction increases, as no specific mattress part is hard on one's specific body part, when one lies down on a mattress. ...
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Objective: The purpose of this study is to find the level of physical relaxation of individual subject by monitoring psychophysiological biofeedback to different types of mattresses. And, the study also aims to find a protocol to make a selection of the best mattress based on the measured information. Background: In Korea, there are an increasing number of people using western style bed. However, they are often fastidious in choosing the right mattress for them. In fact, people use their past experience with their old mattress as well as the spontaneous experience they encounter in a show room to finally decide to buy a bed. Method: Total five mattresses were tested in this study. After measuring the elasticity of the mattresses, they were sorted into five different classes. Physiological and psychological variables including Electromyography (EMG), heart rates (HR), oxygen saturations (SaO2) were used. In addition, the peak body pressure concentration rate was used to find uncomfortably pressured body part. Finally, the personal factors and subjective satisfaction were also examined. A protocol was made to select the best mattress for individual subject. The selection rule for the protocol considered all the variables tested in this study. Results: The result revealing psychological comfort range of 0.68 to 0.95, dermal comfort range of 3.15 to 6.07, back muscle relaxation range of 0.25 to 1.64 and personal habit range of 2.0 to 3.4 was drawn in this study. Also a regression model was developed to predict biofeedback with the minimal use of biofeedback devices. Moreover results from the proposed protocol with the regression equation and subjective satisfaction were compared with each other for validation. Ten out of twenty subjects recorded the same level of relaxation, and eight subjects showed one-level difference while two subjects showed two-levels difference. Conclusion: The psychophysiological variables and suitability selection process used in this study seem to be used for selecting and assessing ergonomic products mechanically or emotionally. Application: This regression model can be applied to the mattress industry to estimate back muscle relaxation using dermal, psychophysiology and personal habit values.
... No systematic reviews on the use of mattresses for the prevention of back pain were found. Twelve published studies were found which reported interventions aiming at reducing back pain by using different mattresses: seven RCTs (Kovacs et al. 2003a;Enck et al. 1999;Dubb & Driver 1993;Scriver et al. 1994;Garfin & Pye 1981;Sulzbach et al. 1995;Atherton et al. 1981) (five of which were either non-blinded or single blind); four cohort studies (Jacobson et al. 2002;Monsein et al. 2000;Haex et al. 1998;Hagino 1997); one survey (Koul et al. 2000). Eight of the 12 studies enrolled patients with chronic back pain, and two others were conducted on hospitalized patients. ...
... Eight of the 12 studies enrolled patients with chronic back pain, and two others were conducted on hospitalized patients. The design of the studies, their methodological quality and the results do not allow any conclusions with respect to prevention in back pain, though one RCT suggests patients may have less pain with a medium-firm rather than hard mattress (Kovacs et al. 2003a). ...
... This was not an RCT, compared sleeping at work to sleeping at home, with no control for the effect of shift pattern, and did not specify and control the amount of hours each resident slept. The only high quality RCT in this area (Kovacs et al. 2003a) enrolled 313 adults from the community who reported persistent non-specific low-back pain. Using double blinding, participants were randomly assigned to use mattresses of two different levels of firmness (medium-firm and hard). ...
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Introduction: Although back pain (BP) is a very common cause for sickness absence, most people stay at work during BP episodes. Existing knowledge on the factors influencing the decision to stay at work despite pain is limited. The aim of this study was to explore challenges for coping with BP at work and decisive factors for work attendance among workers with high physical work demands. Methods: Three focus groups (n = 20) were conducted using an explorative inductive method. Participants were public-employed manual workers with high physical work demands. All had personal BP experience. Thematic analysis was used for interpretation. Results were matched with the Flags system framework to guide future recommendations. Results: Workers with BP were challenged by poor physical work conditions and a lack of supervisor support/trust (i.e. lack of adjustment latitude). Organization of workers into teams created close co-worker relationships, which positively affected BP coping. Workers responded to BP by applying helpful individual adjustments to reduce or prevent pain. Traditional ergonomics was considered inconvenient, but nonetheless ideal. When pain was not decisive, the decision to call in sick was mainly governed by workplace factors (i.e. sick absence policies, job strain, and close co-workers relationships) and to a less degree by personal factors. Conclusion: Factors influencing BP coping at work and the decision to report sick was mainly governed by factors concerning general working conditions. Creating a flexible and inclusive working environment guided by the senior management and overall work environment regulations seems favourable.
... A survey reported that sleep problems could occur due to uncomfortable mattress leading also to physical discomfort (Addison et al. 1986), and it was observed that different mattress or different mattress firmness could affect sleep and pain in a non-athlete population. (Kovacs et al. 2003). Nonetheless, the influence of the hardness of a mattress in sleep quality is subject of controversy (Bader and Engdal 2000). ...
... Previous studies reported that unsuitable and low-quality mattress could determine insomnia complaints and lower sleep quality in non-athlete populations (Addison et al. 1986;Enck et al. 1999) while, Bader and Engdal (2000) did not observe a clear preference in healthy active middle-aged men for any one of the mattresses used in their study, neither firm nor soft. In general, the use of firm or medium-firm new mattress was associated with lower drug treatment and relevant improvements in pain and sleep quality (Kovacs et al. 2003;Tonetti et al. 2011a, 2011b); whereas, on the contrary, foam-made and soft mattress designs can actually create symptoms of pain in individuals with back problems (Jacobson et al. 2010). It is however important to highlight that specific categories of people are more sensitive to the firmness of mattresses than others: young subjects usually sleep well, regardless the sleep surfaces; on the other hand, sleep in the elderly can be affected by too hard or too soft mattress (Kovacs et al. 2003). ...
... In general, the use of firm or medium-firm new mattress was associated with lower drug treatment and relevant improvements in pain and sleep quality (Kovacs et al. 2003;Tonetti et al. 2011a, 2011b); whereas, on the contrary, foam-made and soft mattress designs can actually create symptoms of pain in individuals with back problems (Jacobson et al. 2010). It is however important to highlight that specific categories of people are more sensitive to the firmness of mattresses than others: young subjects usually sleep well, regardless the sleep surfaces; on the other hand, sleep in the elderly can be affected by too hard or too soft mattress (Kovacs et al. 2003). ...
Article
This study aimed to evaluate the effect of a new mattress on sleep quality, perceived pain and recovery, and physical performance in top-level athletes. Twenty-five volleyball players were randomized to either an intervention group (INT, n = 13) or a control group (CON, n = 12). Sleep data were collected by actigraphy and Pittsburgh Sleep Quality Index (PSQI), perceived pain was evaluated by the Numeric Rating Scale (NRS), perceived recovery with the Total Quality Recovery scale (TQR), and physical performance with the Counter Movement Jump (CMJ) and Reaction Time (RT) tests. All evaluations were carried out during the competitive season at baseline condition (PRE) and four weeks later (POST). All actigraph parameters, PSQI, and NRS values improved for INT but not for CON while no differences were observed in CMJ and RT for both groups. TQR was higher for INT at POST compared to CON. A 4-weeks use of high-quality mattress could be beneficial for players’ sleep, pain, and recovery.
... This study was approved by the Ethics Committee of the Faculty of Health and Sports Sciences at the University of Tsukuba (approval no. [27][28][29][30][31][32]. Written informed consent was obtained from all participants. ...
... The participants scored the functional mattress as softer and greater comfort for the lower back than the control mattress in the following morning. According to the previous study, medium-firm mattress had better outcome in patients with lower-back pain than with firm mattress [32]. The functional mattress with better body pressure distribution might be effective in providing comfort for the lower back and contributing to the feeling of improvement in "Refreshness" in the morning. ...
Article
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Background and Objective This study evaluated the effects of a mattress with better body pressure dispersal in comparison to a control mattress on sleep quality. Methods In this randomized crossover study, 10 healthy young men slept in an experimental sleep room on either a functional mattress made from polyurethane, with a special four-layer three-dimensional structure, or a control mattress made from solid polyester wadding, which is a mattress commercially available in Japan. Polysomnography recordings were used to characterize sleep architecture, and the length of slow wave sleep (SWS) episodes and delta power density were calculated from the electroencephalography data and subjective sleep quality was evaluated by questionnaire they answered after waking. Results There were no significant differences in sleep latency, the total duration of each sleep stages, total sleep time, or sleep efficiency. Although the difference was subtle, delta power density significantly increased with the functional mattress. There was no difference in the total duration of SWS, but there were significantly fewer SWS episodes with the functional mattress (10.3 ± 1.8) than with the control mattress (16.9 ± 1.2) and longer SWS episode duration (10.9 ± 1.7 min) with the functional mattress than with the control mattress (5.6 ± 0.5 min). Conclusions It was suggested that the functional mattress lengthened SWS episode duration, and its fragmentation was effective in evaluating the sleep quality of healthy young individuals.
... Some authors declared that a mattress with intermediate firmness might reduce back pain [6][7][8][9][10]. In the literature, some authors recommended mattresses with an air overlay system to reduce pain, while others showed that variation of temperature can promote sleep [11][12][13][14]. ...
... The majority of studies assessed mattress firmness on the basis subjective evaluations, except Kovacs et al., who applied the European Committee Standardization Scale of firmness of mattresses [9]. Subjects from all abovementioned studies used a reproducible grading scale to assess back pain and sleep quality. ...
Article
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Energy spent during daily activities is recuperated by humans through sleep, ensuring optimal performance on the following day. Sleep disturbances are common: a meta-analysis on sleep quality showed that 15-30% of adults report sleep disorders, such as sleep onset latency (SOL), insufficient duration of sleep and frequently waking up at night. Low back pain (LBP) has been identified as one of the main causes of poor sleep quality. Literature findings are discordant on the type of mattress that might prevent onset of back pain, resulting in an improved quality of sleep. We conducted a systematic literature review of articles published until 2019, investigating the association of different mattresses with sleep quality and low back pain. Based on examined studies, mattresses were classified according to the European Committee for Standardization (2000) as: soft, medium-firm, extra-firm or mattresses customized for patients affected by supine decubitus. A total of 39 qualified articles have been included in the current systematic review. Results of this systematic review show that a medium-firm mattress promotes comfort, sleep quality and rachis alignment.
... This result differed from the multicenter trial by Kovacs, where pain and disability amongst patients with chronic, non-specific LBP improved when using the medium firm mattresses. 19 The firmness of the mattress was rated in their study along the European Committee for Standardization scale, with the firmest mattress rated as 1 and the softest rated as 10. 19 Self-assessment of the mattress type was carried out by the respondents in this study, which could have affected the results. ...
... This result differed from the multicenter trial by Kovacs, where pain and disability amongst patients with chronic, non-specific LBP improved when using the medium firm mattresses. 19 The firmness of the mattress was rated in their study along the European Committee for Standardization scale, with the firmest mattress rated as 1 and the softest rated as 10. 19 Self-assessment of the mattress type was carried out by the respondents in this study, which could have affected the results. ...
Article
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Background: Low back pain (LBP) is a common health problem with concomitant disability which has assumed a public health importance in our setting. Objectives: The aim of this study was to determine the prevalence of LBP and associated risk factors amongst adult patients attending the General Outpatients’ Clinic of the UniversityCollege Hospital in Ibadan, Nigeria. Method: This was a cross-sectional study of 485 respondents. A semi-structured questionnaire was used to obtain information on socio-demography, lifestyle, occupation and other riskfactors associated with LBP. Results: There were 288 (59.4%) female and 197 (40.6%) male respondents. The point prevalence of LBP was 46.8%. Occupational activities, previous back injury and tobacco smoking were significant associated factors for the total population. For the female respondents, logisticregression analysis showed that a waist circumference of 88 cm or more, dysmenorrhea,previous back injury and being engaged in an occupation were the most significant factors associated with LBP. However, previous back injury was the most significant factor associatedwith LBP for the male respondents. Conclusion: The prevalence of LBP amongst adult patients in our setting is high, with preventable and treatable predisposing factors. Public health efforts should be directed at educating people on occupational activities and lifestyle habits.
... Vanderwee et al. (2005) indicated that fewer patients developed heel pressure ulcers on a commercial air mattress than those in the control group who slept on a foam mattress. Jacobsin et al. (2002) and Kovacs et al. (2003) reported that medium-firm mattresses reduced clinically diagnosed back pain of patients with chronic lower back pain compared to a firm mattress. The degree of pressure relief mattresses affected the level of skin blood perfusion in the heel supported by an air cell (Mayrovitz and Sims, 2002). ...
... (2) All the subjects were healthy young males. Much sleep research on the firmness of mattresses was conducted using patients with pain (Chai and Bader, 2013;Garfin and Pye, 1981;Kovacs et al., 2003;Vanderwee et al., 2005Vanderwee et al., , 2008 or the elderly (Lopez-Torres et al., 2008;Lozano-Montoya et al., 2016) to discern Relationships between shoulder and hip cushioning sensation of mattress regions during sleep at night (Score: À3 Very uncomfortable, À2 Uncomfortable, À1 A little uncomfortable, 0 Neither, 1 A little comfortable, 2 Comfortable, 3 Very comfortable). The number in figure was the corresponding number of subjects any beneficial effects of soft mattresses, but the present subjects were young and had no such pain. ...
Article
Purpose The purpose of the present study was to evaluate the effect of air mattress pressure on sleep quality. Design/methodology/approach Ten young healthy males participated in all hard surface [AH], shoulder soft [SS] and shoulder and hip soft mattress [SHS] conditions. The surface pressure for SS and SHS were set at their preferred levels. Findings The results showed that sleep efficiencies were over 95% for all the three conditions; there were no significant differences in individual sleep variables among the three conditions, but overall sleep quality was better for SS than AH ( p = 0.065); heart rates during sleep was greater for AH than the other two conditions ( p < 0.1); and a stronger relationship between clothing and bed microclimate humidity were found for SS and SHS than that for AH. Research limitations/implications These results indicated that the both pressure relief air mattresses that were set at their own preferred levels provided high quality sleep with no marked differences. Practical implications Air pressure relief mattresses can improve sleep quality of healthy individuals during sleep at night. The results can be used to understand appropriate pressure distribution on surface mattress according to body region, and also to develop algorithms to provide optimum sleep using mattresses with surface pressure control by body region. Originality/value The present study found that the shoulder and/or hip pressure relief air mattresses that were set at their own preferred levels provided high quality sleep with no marked differences.
... anxiety and depression, have also been found to influence sleep quality (Morin et al., 1998; Dixon et al., 2001; Kovacs et al., 2003; Vorona et al., 2005; Bergholdt et al., 2008; Griefahn et al., 2008; Spira et al., 2008). For comprehensive sleep evaluation it is recommended to utilise both subjective and objective measures as they do not typically concur, particularly in people with chronic pain (Wilson et al., 1998; Cole et al., 2006; Buysse et al., 2008). ...
... bed, chair), environmental noise (e.g. trains, airport, motorway) (Griefahn et al., 2008), mattress firmness and age (Monsein et al., 2000; Kovacs et al., 2003; Bergholdt et al., 2008; Jacobson et al., 2008), bed sharing (Troxel et al., 2007), smoking (Colrain et al., 2004), alcohol and caffeine consumption. Anxiety and depression were assessed by the 14-statement Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983), generating a total score (0e42) and two sub-scores 'Anxiety' and 'Depression' (range 0e21). ...
... Kovacs et al. [16] examined the effects of mattress stiffness on low back pain. They reported that patients who lay on mattresses with normal stiffness experience less pain in their back than the ones with high stiffness mattress. ...
... The parameter is the stiffness level of mattress where (N.mm) is the work demanded to compress the core with a maximal force of 450 , and (N/mm) is the average differential firmness. The value of the tested surface was measured to be 1250 mm2, which is close to the normal stiffness level of mattress according to the standards provided in the literature [16,26] . The E values was obtained by measurement of the total area under the loading curve ranging from 0 to 450 N, and the parameter C was obtained using the mean slope of loading curve tangents at points of 210, 275 and 340 N in consistent with the standard method ISO 2430; 2001. ...
... Some studies evaluate the association between sleep surface, sleep quality and pain (back and shoulder) [8,9]. Bader et al. [10] concluded that mattress differences did not significantly affect sleep quality, whereas others consider that those with different firmness or construction can affect quality of sleep [11]. ...
... However, a significant reduction in low back pain with a MFM was observed. Moreover, several studies have concluded that medium-firm sleep surfaces may be the most beneficial for people with chronic low back pain [7,8,11,21]. Although there is scarce evidence and lack of agreement regarding the role of the mattress in musculoskeletal pain, guidelines for prevention of low back pain, state that "there is no robust evidence for or against recommending any specific chair or mattress for prevention in low back pain, though persisting symptoms may be reduced with a medium-firm rather than a hard mattress", [22]. ...
Article
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We aimed to evaluate the impact in sleep quality and musculoskeletal pain of a Medium-Firm Mattress (MFM), and their relationship with objective sleep parameters in a group of institutionalized elders. The sample size included forty older adults with musculoskeletal pain. We did a clinical assessment at baseline and weekly trough the study period of four weeks. We employed the Pittsburgh Sleep Quality Index (PSQI) and Pain Visual Analog Scale (P-VAS). Additionally a sub-group of good sleepers, selected from PSQI baseline evaluation, were studied with actigraphy and randomized to MFM or High Firm Mattress (HFM), in two consecutive nights. We found a significant reduction of cervical, dorsal and lumbar pain. PSQI results did not change. The actigraphy evaluation found a significant shorter sleep onset latency with MFM, and a slightly better, but not statistically significant, sleep efficiency. The medium firmness mattress improved musculoskeletal pain and modified the sleep latency.
... ple le choix d'un matelas doivent être considérés. Contrairement à la croyance générale, une étude très sérieuse conclut ainsi qu'un matelas mi-dur est meilleur qu'un matelas dur[19].Les LLS influencent les activités physiques du patient, et inversement. Bien qu'il soit difficile de quantifier exactement à partir de quelle durée d'inactivité l'effet thérapeutique devient délétère pour l'évolution du patient, il n'y a pas de doute que plus la période d'inactivité est longue, plus le risque de chronicité est grand. ...
... Auch die Einrichtung am Arbeitsplatz und zu Hause -beispielsweise die Wahl einer neuen Matratze -gilt es mit einzubeziehen. Ent- gegen einer landläufigen Meinung hat eine sehr gute Studie gezeigt, dass eine mässig harte Ma- tratze besser ist als eine ganz harte [19]. ...
... Several studies have found that sleeping on a medium to firm mattress can help alleviate back pain and improve sleep quality (Kovacs et al. 2003;Jacobson et al. 2008). Sleeping surfaces that promote a neutral spine can reduce LBP possibly by decreasing tensile stresses in spinal structures (Haex 2004). ...
Article
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Purpose To determine the efficacy of decreasing spinal curvature – when sleeping laterally – in reducing low-back pain (LBP) and improving sleep quality in people with chronic LBP. Secondly, to investigate whether sleeping positions, nocturnal movements, and skin temperature are related to pain in people with chronic LBP. Methods Sixteen subjects with chronic LBP (50% female, mean age 45.6 ± 13.1 years) slept for one night on their own mattress, followed by three nights on an experimental mattress – designed to reduce spinal curvature in lateral sleeping positions – and then a final night again on their own mattress. Sleep positions, nocturnal movements, skin temperature, and room temperature were measured throughout the five nights. Numerical pain ratings for pain while lying, pain on rising, stiffness on rising, sleep quality, and mattress comfort were recorded for both mattresses. Results The experimental mattress was associated with 18% (p<.05) lower pain scores while lying and a 25% (p<.01) higher comfort rating. Pain on rising, stiffness on rising, and sleep quality were not different between own and experimental mattress. The relationship between sleep positions and pain scores was non-significant, but pain when rising was positively correlated with nocturnal movement (p<.05) and skin temperature was negatively correlated with pain while lying (p<0.05). Conclusion Pain while lying in bed decreased and comfort was higher for the experimental mattress compared to the participants’ own mattresses.
... At baseline, sociodemographic data (ie, age, sex, work status, medical history, LBP history), blood pressure, body mass index (kg/m 2 ), and cardiorespiratory fitness using the Shuttle Walk Test, 22 were recorded. Participants were questioned about sleep-influencing variables, that is, sleeping place (eg, bed, chair), environmental noise (eg, trains, airport, motorway), mattress firmness and age, bed sharing, smoking, alcohol/ caffeine consumption, analgesic/sleeping medication usage, [23][24][25][26][27][28][29][30] and the primary reason for their sleep disturbance. ...
... Mimicking previous studies, the current study employed a mediumfirm [37,41,42] innerspring mattress as the experimental bedding system. However, no universal standards presently define the firmness of mattresses. ...
Article
Background: It has been long assumed that stress interferes with sleep, but less has been attributed to the converse of poor sleep contributing to stress. Study question: Can an older sleep surface contribute to poor sleep and thus, stress and will a new sleep surface provide better sleep, thus less stress. Methods: Forty-six participants rated physical and psychological signs of stress and sleep efficiency for three weeks while sleeping in their own beds. Following baseline measures participants’ beds were replaced by new, unmarked beds and they again rated their stress and sleep efficiency. Results: Average age of participants’ bed was 11.27 yrs. Physical and psychological signs of stress were reduced significantly (p<0.01) from pre- to post-assessments. Similarly, sleep efficiency improved significantly (p<0.01) between pre- and post-assessments. Conclusions: Replacing an older mattress that may have lost adequate support and comfort may result in a better night’s sleep thereby reducing stress brought on by a lack of sleep. It was suggested that a simple principal step in acquiring better sleep is to consider a new sleep surface rather than to opt for pharmaceuticals to achieve better sleep.
... The latter is one of the less common positions chosen by LBP patients during sleep. 5 In addition, clinical tests have been developed to assess pain or patient's symptoms during passive extension movements. 6,7 One likely reason for this may be the anatomical alterations during lumbar extension. ...
Article
A prospective study was performed on the assessment of both thoracic and lumbar spine sagittal profiles (from C7 to S1). To propose a new non-invasive method for measuring the spine curvatures in standing and lying prone positions and to analyse their relationship with various biometric characteristics. Modifications of spine curvatures (i.e. lordosis or kyphosis) are of importance in the development of spinal disorders. Studies have emphasized the development of new devices to measure the spine sagittal profiles using a non-invasive and low-cost method. To date, it has not been applied for analysing both lumbar lordosis and thoracic alterations for various positioning. Seventy-five healthy subjects (mean 22.6 ± 4.3 years) were recruited to participate in this study. Thoracic and lumbar sagittal profiles were assessed in standing and lying prone positions using a 3D digitizer. In addition, several biometric data were collected including maximal trunk isometric strength for flexion and extension movement. Statistical analysis consisted in data comparisons of spine profiles and a multivariate analysis including biometric features, to classify individuals considering low within- and high between-variability. Kyphosis and lordosis angles decreased significantly from standing to lying prone position by an average of 13.4° and 16.6°, respectively. Multivariate analysis showed a sample clustering of three homogenous subgroups. The first group displayed larger lordosis and flexibility, and had low data values for height, weight and strength. The second group had lower values than the overall trend of the whole sample, while the third group had larger score values for the torques, height, weight, waist, BMI and kyphosis angle but a reduced flexibility. The present results demonstrate a significant effect of the positioning on both thoracic and lumbar spine sagittal profiles and highlights the use of cluster analysis to categorize subgroups following biometric characteristics including curvature measurement.
... Bed systems (i.e. mattress and supporting structure) are not only related to sleep quality, but also associated with the appearance of backache (Denninger et al., 2011;DeVocht et al., 2006;Kovacs et al., 2003;Verhaert et al., 2012) and pressure ulcer (Shelton et al., 1998). Epidemiological studies from all over the world reported that a lifetime prevalence rate of low back pain ranged from 49% to 80% (Verhaert et al., 2013). ...
Article
Mechanical interaction behavior between human body and mattress is one of the crucial physical factors affecting the sleep comfort and quality. This paper proposes a novel method for sleep (dis)comfort level assessment in a supine posture without interfering with sleep in an attempt to improve mattress design. Three-dimensional (3D) back surface model is constructed by scanning human body in an upright standing position. Based on the mechanical property of mattress and body pressure distribution measured by Tactilus system, finite element (FE) models are established to numerically calculate mattress upper surface indentation. Finally, Pearson correlation coefficient similarity measure is used to evaluate sleep (dis)comfort by compared back surface with mattress upper surface indentation. The experimental process is validated with two distinct types of mattress, namely palm fiber mattress and latex foam/palm fiber mattress. Results show that all the participants feel more comfortable when lying on latex foam/palm fiber mattress, which are in excellent agreement with the results obtained by body pressure distribution and spinal alignment.
... In >85% of cases, the pain is not specific and cannot be attributed to 1 definite disease or pathology. 4 The goal of treatment in these patients is not only to gain complete recovery, which can be very difficult in most cases, but also to control the pain, preserve the function, and prevent any associated disability. ...
Article
Introduction: Chronic pain is one of the most debilitating complaints, which can often cause functional impairment, disability, and psychological distress to the patient. The costs of treatment and days off from work are expensive. Although some studies have resulted in significant progress in both pain management and the quality of life, for patients with persistent pain the evaluation and treatment of back pain remain suboptimal. Methods: This study was conducted as a prospective clinical trial. Sixty patients with chronic low-back pain were recruited from the outpatient department of neurosurgery in 1 center. The patients were randomly allocated into 2 groups. The first group received amitriptyline and the second group was instructed to take bupropione slow-release tablets for 8 weeks. All patients were asked to fill up the questioners of basic demographic data, pain rating scale, and the quality of life. Patients were also assessed for possible adverse effects and the change in the quality of life at the end of 4, 6, and 8 weeks. Results: There was a statistically significant reduction in the intensity of pain and a subsequent improvement in the quality of life in both groups (P<0.001). Pain relief started in 4 weeks and continued until the end of the study. Forty-three percent of patients in the amitriptyline group reported side effects compared with 30% of patients receiving bupropione SR. Conclusions: For patients with chronic low-back pain, bupropione is as effective as amitriptyline with regard to the reduction in the intensity of pain and the improvement in the quality of life and can be tolerated well.
... [21,24] The relation of LBP to the type of mattress was studied by Kovacs et al. using a randomized double-blind controlled design. [25] They found medium-firmness mattresses to be associated with reduced LBP compared with firm mattresses. Our finding that sleeping without a mattress is associated with increased LBP is similar because a floor or mat is much harder than a firm mattress, though our study found that the type of mattress is not a risk factor. ...
Article
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Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%-45%]). Profession was a significant predictor of LBP (P = 0.001) - nurses (53% [95% CI 43%-63%]), administrative officers (49% [95% CI 40%-59%]), engineers (50% [95% CI 24%-76%]), and health information staff (50% [95% CI 26%-75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.
... [21,24] The relation of LBP to the type of mattress was studied by Kovacs et al. using a randomized double-blind controlled design. [25] They found medium-firmness mattresses to be associated with reduced LBP compared with firm mattresses. Our finding that sleeping without a mattress is associated with increased LBP is similar because a floor or mat is much harder than a firm mattress, though our study found that the type of mattress is not a risk factor. ...
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Original Article Background: Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital. Materials and Methods: The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained. Results: Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%-45%]). Profession was a significant predictor of LBP (P = 0.001)-nurses (53% [95% CI 43%-63%]), administrative officers (49% [95% CI 40%-59%]), engineers (50% [95% CI 24%-76%]), and health information staff (50% [95% CI 26%-75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m 2 , and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor. Conclusion: The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.
... Finally, authors have concluded that medium firm mattresses could improve the pain and disability in patients with chronic lower back pain. 26 Further, it was also believed that mattresses with soft surfaces increase LBP due to incorrect support to the vertebral column and decrease the quality of sleep. 27 It is believed that loading of the intervertebral disc is an important factor which determines LDHD and LDH. ...
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Objective: Present study was aimed to develop a regression model for selected sociodemographic, behavioural and occupational factors with lumbar disc herniation (LDH) and lumbar disc hearniation and degeneration (LDHD) in a selected population in comparison to healthy individuals.Materials & Methods: The study was conducted using 104 cases with disc herniation and controls (n=104) without LDH. Analysis was conducted in sub groups of patients with LDH (n=67) and LDHD (n=37) in comparison to control subjects. Pre-tested questionnaire was administered to all participants to gather information.Results & Discussion: Among the cases 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characters, body mass index <25 kgm-2 was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have a significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD.Conclusion: In regression model BMI, smoking and daily physical activities with moderate and heavy strain to back were found to be the significant risk factors for development of LDH or LDHD.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 424-434
... hypertension) [32]; rheumatic diseases; neoplasms [33]; and drug abuse. We also excluded pregnant [32,34] or lactating women; victims of recent vehicle accidents or with sequelae from such accidents; those using analgesics, anti-inflammatories or psychotropic medication [35]; and patients with herniated discs, spine fractures, spondylolisthesis [36], kidney calculi or any other diagnosis which proved to be the cause of low back pain. The exclusion criteria were chosen to minimize the confusion variables. ...
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Objective: To compare the short-term effects of pulsed laser and pulsed and continuous ultrasound on pain and functional disability in women with chronic non-specific low back pain. Methods: The sample was composed of 100 volunteers randomly allocated into four groups: The Pulsed Laser Group (n = 26) was treated with 3 J/cm2; the Pulsed Ultrasound Group (n = 24; 3 MHz) was treated with 1 W/cm2; the Continuous Ultrasound Group (n = 26; 1 MHz) was treated with 1 W/cm2; and a Control Group (n = 24), where the patients were still waiting for treatment. Before and after 10 sessions of treatment, the intensity of pain was assessed using the visual analogue scale (VAS), the quality of pain was evaluated using the McGill pain questionnaire and functional disability was investigated using the Roland-Morris questionnaire. Results: The three treated groups exhibited a decrease in pain (p < 0.001); the Pulsed Laser Group showed the greater relative gain (91.2%), Meanwhile, the Control Group exhibited a worsening of - 5.8%. The three treated groups demonstrated improvement in the quality of pain (McGill) in the total, sensory and affective dimensions (p < 0.005; p < 0.002; p < 0.013, respectively). All treated groups showed a decrease in functional disability (p < 0.001), but the Pulsed Ultrasound Group showed the highest relative gain (83.3%). Conclusions: The three modalities have significant effects to decreasing low back pain and improving functional disability in women with non-specific chronic low back pain, but the pulsed low-level laser had the best results on pain while the pulsed ultrasound had the best results on improve the functional disability. Trial registration: ClinicalTrials.gov: NCT02150096.
... than in patients using rm mattresses. Finally, authors have concluded that medium rm mattresses could improve the pain and disability in patients with chronic lower back pain [26]. Further, it was also believed that mattresses with soft surfaces increase LBP due to incorrect support to the vertebral column and decrease the quality of sleep [27]. ...
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Background: Although many studies have been conducted on risk factors associated with lumbar disc herniation (LDH), only few studies reported on the association of these factors in comparison to LDH and lumbar disc herniation and degeneration (LDHD). There are no reported studies on a regression model incorporating these factors. As the risk factors are better described in regression models, present study aimed to develop a regression model associated with LDH and LDHD in relation to socio-demographic, behavioural and occupational factors. Methods: A case control study conducted using 104 cases with LDH and controls (n=104) without LDH. Pre-tested questionnaire was administered to all participants to gather information. Results: Among the cases with LDH, 35.6 % presented with LDHD while 64.4 % had only LDH. Among the socio-demographic characteristics, body mass index <25 kgm⁻² was a significant protective factor for both LDHD (OR=0.31; 95% CI=0.13-0.72) and LDH (OR=0.39; 95% CI=0.20-0.77). Involvement in daily activities with heavy (OR=5.1; 95 % CI=2.1-11.8) and moderate strain (OR=3.1; 95 % CI=1.5-6.6) to back, sitting more than eight hours per day (OR=5.1; 95 % CI=1.0-25.7), smoking (OR=5.0; 95 % CI=1.5-16.4) and sleeping in supine position (OR=2.09; 95% CI=1.09-4.06) were significant risk factors for LDH. Only daily physical activities with heavy strain act as a significant risk factor (OR=3.1; 95 % CI=1.1-8.5) for the development of LDHD. Types of mattresses used did not have significant difference among cases and controls. Majority of cases (56.7 %) did not know the causative factor that led to LDH. According to the regression model, BMI, smoking and involvement in physical activities with moderate and heavy strain to back were considered as significant risk factors for the development of LDH or LDHD. Conclusion: BMI, smoking and daily physical activities with moderate and heavy strain to back are significant risk factors for development of LDH or LDHD in regression model.
... To improve sleep quality, various mattresses have been designed in existing studies [25][26][27]. In a few studies, a thermal controlling device was applied to the developed mattress to improve the sleep quality of the users [28][29][30][31]; others studies have determined the relation between sleep quality and the rigidity of a mattress [27,32,33]. Furthermore, several studies have varied the materials used to design the mattress and have modified its structure [34][35][36]. ...
Article
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Several studies, wherein the structure or rigidity of a mattress was varied, have been conducted to improve sleep quality. These studies investigated the effect of variation in the surface characteristics of mattresses on sleep quality. The present study developed a mattress whose rigidity can be varied by controlling the amount of air in its air cells. To investigate the effect of the variable rigidity of the air mattress on sleep quality, participants (Male, Age: 23.9 ± 2.74, BMI: 23.3 ± 1.60) were instructed to sleep on the air mattress under different conditions, and their sleep quality was subjectively and objectively investigated. Subjectively, sleep quality is assessed based on the participants’ evaluations of the depth and length of their sleep. Objectively, sleep is estimated using the sleep stage information obtained by analysing the movements and brain waves of the participants during their sleep. A subjective assessment of the sleep quality demonstrates that the participants’ sleep was worse with the adjustment of the air mattress than that without; however, the objective sleep quality results demonstrates an improvement in the sleep quality when the rigidity of the air mattress is varied based on the participant’s preference. This paper proposes a design for mattresses that can result in more efficient sleep than that provided by traditional mattresses.
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Background: The Spanish Back Pain Research Network (REIDE) brings together teams of researchers and clinicians who are interested in nonspecific neck and back pain (BP). Its objective is to improve the efficacy, safety, effectiveness, and efficiency of the clinical management of BP. Method: The Network welcomes clinicians and researchers interested in BP. The only requirement to become a member of REIDE is to take part in one of its research projects, and any member can propose a new one. The Network supports those projects that are of interest to two or more groups by assuming their administration and management, which allows the researchers to focus on their task. Its working method ensures methodological quality, a multidisciplinary approach, and the clinical relevance of those projects that are carried out. Results: 179 researchers from 11 areas in Spain are involved in REIDE, including experts in all of the relevant fields of BP research. Most Spanish studies on BP that have been published in international scientific journals come from the teams involved in REIDE, and it currently has 13 ongoing research projects. Conclusions: The Network can help to enhance research among rehabilitation specialists who are interested in BP, and can contribute to the development of research projects which are of interest to the specialty. © 2005 Sociedad Española de Rehabilitación y Medicina Física (SERMEF) y Elsevier España, S.L.
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A significant number of US citizens lack appropriate sleep for several reasons. Back pain has been identified as possible cause for inappropriate sleep in adults. Previously, the quality of mattresses and bedding systems has been correlated to the pain perceived by individuals. However, there is controversy in the literature regarding the type and characteristics of a mattress that best serve the purpose of decreasing spinal pain, and improving spinal alignment and quality of sleep. This study gathered the best available evidence in the literature related to this matter through conducting a systematic review of controlled trials that were published since the year of 2000. In those trials, mattresses were subjectively identified as soft, medium firm, firm, or custom inflated. Articles examining the effect of temperature alterations of mattresses on promoting sleep quality and reducing pain were included as well. Twenty-four articles qualified for inclusion into this systematic review. The methodological quality of the reviewed clinical trials was deemed moderate to high according to the PEDro scale. Results of this systematic review show that a mattress that is subjectively identified as a medium-firm mattress and is custom inflated (self-adjusted) is optimal for promoting sleep comfort, quality, and spinal alignment. Evidence is not sufficient yet regarding the appropriate temperature of the optimum mattress; however, warm temperature has been recommended by authors.
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Placing a topper on a sleeping system is common practice to enhance sleeping comfort. The aim of this study was to determine the thickness and hardness effect of a mattress topper by measuring the four physiological measurements from 40 healthy males. The results showed that the use of a thin mattress topper (30 mm) significantly induced lower body pressure and temperature, higher muscle activities in the biceps femoris, and a straighter spinal alignment in the T12–L4 vertebrae. The use of a hard mattress topper significantly induced a higher body pressure, a lower body temperature in the lower extremities, a higher EMG (%MVC) in the trapezius, but a lower EMG (%MVC) in the biceps femoris, and a straighter spinal alignment at T1–T4, T4–T6, and T6–T8. Overall, a soft topper of 30-mm thickness was suggested as the best combination. The findings can provide very useful information for topper design and selection.
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Low back pain is the most occurring body disorder and most important reasons of disability in the advanced states. Numerous structures in the backbone may cause low back pain which includes ligaments that join vertebral column, outer fbers of the annulus fbrosis, facet joints, vertebral periosteum, paravertebral muscu-lature and fascia.
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In this chapter, we will discuss some of the more common factors associated with the development and maintenance of insomnia such as age, physiology, circadian rhythms, and environment.
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Infancy is a developmental stage in an individual's life. As an important part of infant development, sleep greatly influences the physiological and mental development of infants, and the health and comfort of infant sleep is a major public concern. From the viewpoint of ergonomics, this study investigated the effects of mattress firmness on the body pressure distribution of infants aged 0–3 years in the supine posture. Six types of mattresses with different firmness values were tested and 11 healthy infant subjects participated in the experiment. A Tekscan body pressure measurement system was used to record data. The body pressure distribution of infants was analysed using six pressure distribution indices including the maximum pressure, average pressure, contact area, maximum pressure gradient, average pressure gradient, and longitudinal pressure distribution curve. The results revealed that, in the supine posture, there is significant correlation between the body pressure indices and the mattress firmness. The average pressure has the strongest correlation with mattress firmness. The infants' buttocks zone had the highest pressure, while the pressure on the head and leg zones was relatively low. The recommended K value, which represents the mattress firmness, ranges from 267 to 669 mm².
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Mattress, as a sleep platform, its types and physical properties has an important effect on sleep quality and rest efficiency. In this paper, by subjective evaluations, analysis of sleeping behaviors and tests of depth of sleep, the relationship between characteristics of the bedding materials, the structure of mattress, sleep quality and sleep behaviors were studied. The results showed that: (1) Characteristics of the bedding materials and structure of spring mattress had a remarkable effect on sleep behaviors and sleep quality. An optimum combination of the bedding materials, the structure of mattress and its core could improve the overall comfort of mattress, thereby improving the depth of sleep and sleep quality. (2) Sleep behaviors had a close relationship with sleeping postures and sleep habits. The characteristics of sleep behaviors vary from person to person.
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Background and aim: Ergonomic factors in sleep designing system will have direct effects on maintaining the spinal alignment during sleep. Studies show that a mattress with uniform stiffness cannot preserve the spine's natural posture. Using a mattress made of components with different stiffness can be considered as a solution for this problem. In this study, male spinal alignment has been assessed and compared on the hard and soft mattress along with a new type of mattress with different stiffness. The aim of this study was to evaluate the performance of this new type of mattress and determination of specific layout for each volunteer. Materials and Methods: After obtaining the dimensional survey data, 25 male volunteers were asked to take the side sleeping position on soft and very firm surfaces, with specific stiffness based on a predetermined protocol. The location coordinates of markers installed on the spinous process by optical detection methods were obtained in frontal plane. In the next step, spring-foam elements were arranged in a frame for each volunteer so that their spinal frontal plane can be close to their natural alignment. Results: In side sleeping posture a c formed curvature appeared along the spinal frontal plane on stiff surface due to lack of support of the spine, and on the soft mattress, softness caused further sinking in the area of pelvis and loss of natural posture. But the arrangement of elements with different stiffness (custom made mattresses) maintained the natural posture of spine. The specific layouts for each volunteer were extracted. Conclusion: The results of this study showed that use of mattresses with custom arrangement is an appropriate way for maintaining optimum spinal alignment during sleep. Common mattresses with uniform stiffness do not have the ability to maintain the spine in a natural position during sleep. Determination of specific arrangements for side sleeping posture can help predict layout required for every individual in the future studies without performing a test.
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Characteristics of included trials. A table showing the characteristics of included trials and their references. (PDF)
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This study aims to develop an intelligent bedding that automatically provides a comfortable sleep condition for each person. This paper proposes a pillow-type device which actively changes its shape and stiffness. The device is composed of multiple flexible actuators which are driven by air pressure. Each actuator has two types of sensors: an internal pressure sensor and five contact pressure sensors. These sensors are used for monitoring the support condition of user’s head and neck. We developed a pillow system capable of controlling the internal pressure and contact pressure of each actuator in order to realize a comfortable condition for sleep. The pillow system successfully controlled the center of contact pressure to the target position. To elucidate comfortable and uncomfortable support conditions, pressure distributions on the head and neck were measured by the system. The result indicates that accurate control of the center of contact pressure is important for comfortableness.
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A prospective study of patients with chronic low-back pain was made to determine the significance of the patient's own prediction of the outcome of a vocational rehabilitation program. Fifty-two patients were screened, and their work situation determined one and 4 years after the rehabilitation program was started. The patients predicted the outcome correctly in 69%, with a sensitivity of 68% and a specificity of 71%. A statistically significant correlation was found between the patient's prediction and the recommendations given by the rehabilitation unit.
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Associations between back pain, the quality of sleep and the quality of mattress have not yet been investigated systematically. At check-out we asked 265 consecutive guests of a trade fair hotel about the subjective quality of sleep in the previous night. Nine rooms had been equipped with new mattresses of three different qualities and prices, but this was kept blind to the hotel staff and the guests. Sleep quality was assessed on an analog scale between 1 (very good) and 5 (very bad) and was analyzed in comparison to the remaining 8-year old mattresses of the hotel, but also with respect to social (e.g. private vs. professional reason for the stay) as well as personal (e.g. previous experience with low back and sleep complaints) characteristics of the guests. The three qualities of the mattresses correlated significantly and positively with the perceived quality of sleep, but the difference to the "old" mattresses was most pronounced for those guests who were staying overnight for professional reasons, or who frequently were suffering from low back pain or sleep disturbances. At least for chronic sufferers from back pain and sleep problems, the association between sleep quality and quality of the mattress is significant.
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An experimental group of 39 chronic low back pain (CLBP) patients and an equal number of controls, matched for age and sex, completed questionnaires of self-concept and performance motivation. SS were also tested on a standardized back-stress physical test carried out with low external information and feedback. The results revealed a strong tendency for CLBP patients to have a negative self-concept, confirming the findings of previous research. Poorer performance of the CLBP patients on the physical test measure of behavioural persistence and on physiological measures were unrelated to reported pain level or to poor physical condition. Compared to the controls, the chronic low back pain group was less able to estimate their physiological level of exertion, being inclined to overrate their actual individual effort. The interaction of a negative self-concept and negative expectations is discussed.
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Of the various methods for measuring pain the visual analogue scale seems to be the most sensitive. For assessing response to treatment a pain-relief scale has advantages over a pain scale. Pain cannot be said to have been relieved unless pain or pain relief has been directly measured.
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This study examines the effect of 4 different types of beds on chronic low back pain patients' symptoms and signs. The beds employed were an "orthopedic" hard bed with 720 reinforced coils and a built-in bed board, a softer 500 coil bed, a standard 10 in. thick waterbed, and a hybrid bed of foam and water. Subjectively the majority of patients preferred the hard bed and felt that their back pain improved to a greater extent after 2 weeks on the hard bed as compared to the other beds. The next largest group of patients to show improvement used the waterbed. Limitations in performing the straight leg raising test coincided with the subjective complaints. Significantly improved straight leg raising was observed after use of the hard bed or waterbed in 25% of the patients using those beds. No other objective signs were altered. The 500 coil bed and the hybrid bed proved of no benefit to any patient in this study group. This limited study indicates that hard beds should remain the first choice of patients with chronic low back pain. However, if relief is not obtained for these chronic pain patients, a trial on a waterbed may prove beneficial.
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To determine whether an alternating air mattress, a specifically designed exercise program, or both were effective in alleviating back pain in patients after percutaneous transluminal coronary angioplasty (PTCA). 2 by 2 factorial, randomized control trial. Intermediate cardiac care unit in a Canadian regional cardiac referral center. The sample included 100 subjects, X age 57.4 years, undergoing PTCA. 10 cm visual analog and Borg scales, both of which measured subjects' perception of pain. The combination of exercise and alternating air mattress is most effective in pain reduction (p = 0.012). The combination of exercise and alternating air mattress is more effective in alleviating back pain in patients after PTCA than conventional methods or exercise and alternating air mattress alone.
Article
Pilot studies and a literature review suggested that fear-avoidance beliefs about physical activity and work might form specific cognitions intervening between low back pain and disability. A Fear-Avoidance Beliefs Questionnaire (FABQ) was developed, based on theories of fear and avoidance behaviour and focussed specifically on patients' beliefs about how physical activity and work affected their low back pain. Test-retest reproducibility in 26 patients was high. Principal-components analysis of the questionnaire in 210 patients identified 2 factors: fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity with internal consistency (alpha) of 0.88 and 0.77 and accounting for 43.7% and 16.5% of the total variance, respectively. Regression analysis in 184 patients showed that fear-avoidance beliefs about work accounted for 23% of the variance of disability in activities of daily living and 26% of the variance of work loss, even after allowing for severity of pain; fear-avoidance beliefs about physical activity explained an additional 9% of the variance of disability. These results confirm the importance of fear-avoidance beliefs and demonstrate that specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain. These findings are incorporated into a biopsychosocial model of the cognitive, affective and behavioural influences in low back pain and disability. It is recommended that fear-avoidance beliefs should be considered in the medical management of low back pain and disability.
Article
A randomized, double-blind, controlled, multicenter trial was conducted. To assess the efficacy of neuroreflexotherapy in the management of low back pain. Neuroreflexotherapy consists of temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. The rheumatology and rehabilitation departments of three teaching hospitals in Madrid recruited 78 patients with chronic low back pain. These patients were randomly assigned to the control group (37 patients) or to the treatment group (41 patients). Patients in the treatment group underwent one neuroreflexotherapeutic intervention. The control group received sham treatment consisting of placement of the same number of epidermal devices within a 5-cm radius of the target zones. Patients from both groups were allowed to continue drug treatment as previously prescribed. The use of medications during the trial was recorded. Patients underwent clinical evaluations on three occasions: within 5 minutes before intervention, within 5 minutes after intervention, and 45 days later. The preintervention assessment was carried out by the physician from each hospital department who included the patient in the study. Each of the two follow-up assessments were carried out independently by two of three physicians who had no connection with the research team. Patients in the treatment group showed immediate lessening of pain compared with the results in patients in the control group. The pain relief was clinically relevant and statistically significant, and it persisted up to the end of the trial. Neuroreflexotherapy intervention seems to be a simple and effective treatment for rapid amelioration of pain episodes in patients with chronic low back pain. At this time, the duration of pain relief beyond 45 days has not been evaluated.
Article
A previous extensive review of the literature including that from the middle of 1992 concluded that whole-body vibrations may contribute to low back pain, but that the exposure-response relationship had not been clarified. We reviewed the literature of the past 7 years to find out: (i) whether there is evidence in the recent epidemiological literature for a causal association between whole-body vibrations and low back pain, and (ii) if there is evidence in the recent literature for a dose-response relationship between whole-body vibrations and low back pain. All relevant epidemiological articles which were obtained through a search in the databases MEDLINE, OSH-ROM and TOXLINE, and through personal communication, were reviewed independently by the two authors, using a checklist. Twenty-four original articles concerning the association between whole-body vibrations and the lower back were retained for use. The quality of the papers was mostly low, but improved with time. Only seven articles passed our predetermined quality criteria. Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association. Despite the lack of definite evidence, we found sufficient reasons for the reduction of whole-body vibration-exposure to the lowest possible level. If new knowledge is to be produced, good prospective studies with repeated measurements of exposure, analyses of work postures, and clear definitions and subgroupings of low back pain are needed. Other research in this field should be given up, and the resources used for more important issues, as the size of the problem of whole body vibration is probably on the decrease because of the technical prophylactic developments that are already in progress.
Article
To compare SF-36, pain Visual Analog Scale (VAS), and sleep VAS outcomes of an adjustable airbed with innerspring mattresses in a population of chronic back pain sufferers. A-B-A trial, in 3 phases: the patients on their own bed for 1 night, on an adjustable airbed for 28 nights, and on their bed for 14 nights. Outpatient pain rehabilitation, physical therapy, and alternative medicine clinics. Three centers recruited 30 patients each with severe chronic back pain and without sleep apnea or other sleep disorders. SF-36 health status survey and VAS pain and sleep quality scales. On VAS scales, 95% showed pain improvement, and 88% reported better sleep. The average improvements were a 32% pain decrease and a 73% increase in sleep quality, significant at P less than.001 (two-tail t test). Eighty percent improved on the SF-36 physical functioning dimension and 88% improved on the bodily pain dimension. The average score on each dimension improved (P less than.001). Eighty-five percent preferred the adjustable airbed. SF-36 and VAS outcomes measures showed a highly significant benefit for the airbed design in this short-term comparison. The airbed appears to be a useful sleep aid and an adjunct to medical and physical therapies for chronic back pain sufferers.
Article
Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel. Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.
Article
Validation of a translated, culturally adapted questionnaire. To translate and culturally adapt the Spanish version of the Roland-Morris Questionnaire (RMQ), and to validate its use for assessing disability in Spanish patients with low back pain (LBP). The RMQ is a reliable evaluation instrument for disability, but no validated Spanish version is available. Translation/retranslation of the English version of the RMQ was done blindly and independently by four different individuals, and adapted by a team that included five primary care physicians, three back specialists, and two methodologists. The study was done in the primary care setting in Mallorca, with 195 patients who visited their physician for acute or chronic LBP: 50 in the pilot study and 145 in the validation study. Individuals were given the RMQ and three other scales (VAS, Oswestry, and EuroQol) on their first visit and 14 days later. For the pilot study, on the first visit, patients were also given a second RMQ with the questions in a different order and they were subsequently asked for comprehension of each item of the questionnaire. Only 2 questions were partially rephrased after the pilot study, and no request for aid in interpretation was made during the validation study. Scores of the two RMQs on day 1 were 10.04 (SD, 5.01) and 10.9 (SD, 4.8), with an intraclass correlation coefficient of 0.874. The 95% limits of agreement by the Bland-Altman method was 0.340 +/- 4.81. Cronbach's alpha was 0.8375 (day 1) and 0.9140 (day 15) in the validation. Concurrent validity, measured by comparing RMQ responses with the results of VAS, was r = 0.347 (P = 0.0000) for day 1,and r = 0.570 (P = 0.0000) for day 15. Construct validity, tested by determining the correlation between the Spanish RMQ and the Spanish adaptation of the Oswestry Questionnaire, yielded r = 0.197 (P = 0.0061) on day 1 and r = 0.341 (P = 0.0000) on day 15. The Spanish version of the RMQ has good comprehensibility, internal consistency, and reliability, and is an adequate and useful instrument for the assessment of disability caused by LBP.
Article
To determine whether clinical and statistically significant changes in back pain, shoulder pain, spine stiffness, and quality of sleep may be documented after use of a prescribed bedding system. Quasi-experimental field study of single group pretest-posttest design with subjects serving as their own controls. Two chiropractic clinics and the Oklahoma State University Program of Health and Human Performance. Convenience sample of 22 subjects (women, n = 13; men, n = 9) between the ages of 25 and 75 years with documented disturbed sleep, shoulder pain, low back pain, and spine stiffness of a chronic nature. Pretest and posttest 28-day Visual Analog Scales for pain, spine stiffness, and quality of sleep. The experimental bedding system reduced back pain by 57.21% (P =.000001), reduced shoulder pain by 60.83% (P =.000005), reduced back stiffness by 59.12% (P =.000004), and improved quality of sleep by 60.73% (P =.000001). Results suggest that subjects obtain significant improvement in shoulder and back pain, back stiffness, and quality of sleep after 28 days of prescribed bedding system use as compared with 28 days of personal bedding use. Female subjects and those with lower body weight were more likely to significantly improve than heavier and more obese subjects.
Article
A cluster randomized, controlled trial was performed. To assess the clinical effectiveness and cost-effectiveness of adding patients' referral to neuroreflexotherapy intervention to the usual management of subacute and chronic low back pain in routine general practice. Neuroreflexotherapy consists of the temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. The efficacy of this procedure for treating subacute and chronic low back pain has been demonstrated in previous randomized, double-blind, controlled clinical trials. Twenty-one primary care physicians working in seven primary care centers of the Spanish National Health Service in Palma de Mallorca, Spain, were randomly assigned to the intervention group (n = 11) or the control group (n = 10). The physicians recruited patients who had low back pain that had lasted for 14 or more days despite drug treatment and who did not meet criteria for surgery. The 45 patients recruited by physicians from the control group were treated according to the standard protocol, whereas the 59 patients recruited by physicians from the intervention group were, in addition, referred to neuroreflexotherapy intervention. The analysis of variables was performed taking into account that physicians, not patients, were randomly assigned. Patients underwent clinical evaluations at baseline and 15, 60, and 365 days later. At baseline, median intensity of pain was higher in patients undergoing neuroreflexotherapy than in control patients (visual analogue scale, 6.07; range, 4.67-8.80 vs. 5.15, range 4.11-8.00) and median duration of pain was also higher (48.1, range 28.4-211.1 vs. 17.5, range 15.0-91.5 days). At the last follow-up visit, patients treated with neuroreflexotherapy showed greater improvement than did control patients in low back pain (visual analogue scale, 5.5; range, 3.7-8.8 vs. 1.9; range, -1.2-3.0; P < 0.001); referred pain (visual analogue scale, 3.6; range, 2.7-7.3 vs. 0.6; range, -1.5-2.0; P = 0.001); and disability (Roland-Morris scale, 8.7; range, 2.0-13.3 vs. 2.0; range, -1.5-6.7; P = 0.007). Moreover, neuroreflexotherapy intervention was associated with a significantly (P < 0.035) lower number of consultations to private or public specialists, fewer indications of radiographs by primary care physicians, lower cost of drug treatment, and less duration of sick leave throughout the follow-up period. There were also differences in favor of neuroreflexotherapy intervention in the cost-effectiveness ratio for pain, disability, and quality of life that persisted in the most optimistic, the most conservative, and the average (break-even case) assumptions. Referral to neuroreflexotherapy intervention improves the effectiveness and cost-effectiveness of the management of nonspecific low back pain.
Article
A survey of adolescent schoolchildren and their parents through a self-administered questionnaire was conducted to determine the prevalence of low back pain (LBP) in schoolchildren and their parents and to assess its association with exposure to known and presumed risk factors. A previously validated, self-administered questionnaire was used for collecting information on back pain history, anthropometric measures, physical and sports activity, academic problems, hours of leisure sitting, smoking, and alcohol intake. Schoolchildren between the ages of 13 and 15 in schools of the island of Mallorca and their parents (n=16,394) took part in the study. The lifetime prevalence of LBP was 50.9% for boys and 69.3% for girls; point prevalence (7 days) was 17.1% for boys and 33% for girls. There was a significant association with LBP and pain in bed (OR=13.82, 95% CI: 10.47-18.25, P<0.001), reporting scoliosis (OR=2.87, 95% CI: 2.45-3.37, P<0.001), reporting difference in leg length (OR=1.26, 95% CI: 1.02-1.56, P=0.033), practice of any sport more than twice a week (OR=1.23, 95% CI: 1.09-1.39, P=0.001) and being female (OR=1.11, 95% CI: 1.04-1.19, P=0.001). There was no association found between LBP and body mass index, the manner in which books were transported, hours of leisure sitting, alcohol intake or cigarette smoking. Among parents, the lifetime prevalence of LBP was 78.2% for mothers and 62.6% for fathers; point prevalence (7 days) was 41% for mothers and 24.3% for fathers, and there were significant associations with LBP and pain in bed (OR=18.07, 95% CI: 14.72-22.19, P<0.001), report of scoliosis (OR=8.77, 95% CI: 6.44-11.95, P<0.001), report of difference in leg length (OR=2.21, 95% CI: 1.60-3.04, P<0.001), being a university graduate (OR=1.89, 95% CI: 1.21-2.98, P=0.006), being female (OR=1.49, 95% CI: 1.33-1.67, P<0.001), and swimming (OR=1.10, 95% CI: 1.4-1.18, P=0.002). There was no association found between LBP and alcohol intake, cigarette smoking or the practice of other sports. Although there was a positive association in terms of scoliosis between biological parents and their children (P<0.001), there was no association found in familial (biological or not) occurrence of LBP. The prevalence of LBP among adolescents in southern Europe is similar to northern Europe, it is comparable to that in adults, and is associated with several factors. There is a strong association between pain in bed or upon rising in both adolescents and adults. Scoliosis, but not LBP, appears to be related to heredity. Further longitudinal studies are necessary to establish risk factors that are predictive for LBP in adolescents.
Article
This report updates and expands those sections of Biosafety in Microbiological and Biomedical Laboratories (BMBL), published by CDC and the National Institutes of Health, that address precautions that must be taken to manipulate Mycobacterium species safely in the laboratory
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