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
To read the full-text of this research, you can request a copy directly from the authors.

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.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Their research study revealed that the mattress with 720 springs and water types had high scores (based on the European Committee for Rank Satisfaction) given by users [11]. According to the mattress firmness standardization, Kovacs et al. (2003) applied a flexibility scale (called Hs) with a value between 1 (as the hardest) and 10 (as the softest). Despite being a prototype design, it was observed that mattresses with medium hardness can enhance patients' recovery periods [12]. ...
... According to the mattress firmness standardization, Kovacs et al. (2003) applied a flexibility scale (called Hs) with a value between 1 (as the hardest) and 10 (as the softest). Despite being a prototype design, it was observed that mattresses with medium hardness can enhance patients' recovery periods [12]. In 2004, Giesecke et al. designed a system to inspect the pain threshold and its resultant effect on different parts of the brain. ...
... These are the most important areas to test for mattresses and pillows [3,5,12]. The test procedure in the supine position of volunteers is followed as stated below. ...
Article
Full-text available
Getting proper rest is an essential issue, but it is neglected as the major component of every person’s overall health and well-being. Enough proper rest has a lot of proven health benefits. This paper aims at proposing a systematic framework to find the suitable pillows and mattresses for individuals to have proper rest and sleep. The proposed system includes a set of force-sensing resistors (FSR), thermal sensors, humidity-thermal sensors, and a central unit to process the acquired data. Customized software in LabVIEW is developed to monitor the results and ultimately identify the proper ergonomic mattresses and pillows for users. Initial experiments were performed based on zonal performance and multitasking to design, construct, and test each system as a novel hypothesis. The studies and tests were carried out in two steps. The first step included hardware testing and sensor arrangement, and the second step involved processing the acquired data to identify a good product. In this study, we propose a feasible framework to select convenient mattresses and pillows for each person.
... 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.
... 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
Full-text available
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.
... Non-mechanical back pain can be caused by a specific pathophysiological mechanism, such as inflammatory diseases, tumours or infiltrative lesions, metabolic and acquired disorders. 6,7 Mechanical back pain is originated from the spine, intervertebral discs or surrounding soft tissues which can be caused without any specific pathology, and is also called non-specific LBP. There are certain factors involved in the causation of mechanical back pain, including abnormal lifting motions, inappropriate stress on back and maintaining incorrect posture while resting using inappropriate mattresses. ...
... In a randomised, double-blind, controlled, multicentre trial, the effect of different firmness of mattresses on the clinical course of patients with chronic non-specific LBP showed that patients who usually used medium firm mattresses got improvement in their pain-related disability, while the disability was more prevalent in users of firm mattresses. 7 The possible reason is the greater pressure on bony prominences, like hips and shoulders. 14 Firm mattresses are not always damaging for the lower back, but in older ages these mattresses provide overall comfort and ease of rolling. ...
Article
Full-text available
Objective: To find out the frequency of low back pain in young adults and its relationship with the mattresses being used. Methods: The cross-sectional study was conducted from September 2019 to February 2020 in Rawalpindi and Islamabad, Pakistan, and comprised young adults aged 18-35 years who were using the same kind of mattress for more than 3 months. Data was collected using a self-structured questionnaire along with the Modified Oswestry Scale and the Numeric Pain Rating Scale. Data was analysed using SPSS 24. Results: Of the 366 subjects, 266(72.7%) were women and 100(27.3%) were men. The overall mean age was 22.06±3.74 years. Of the total, 208(56.4%) participants were feeling low back pain, and, of them, pain was most prevalent in 30(14.4%) who were using firm mattress, and by 128(61.5%) who were using foam mattress. The pain was more frequent in those not having changed their mattresses for more than three years 105(50.4%). Conclusions: Low back pain was found to be a frequent occurrence in young adults and it was more prevalent in those using firm or foam mattresses for more than three years.
... 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.
... 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
Full-text available
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.
... 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. ...
... The use of a medium-firm mattress has been associated with more frequent discontinuation of drug treatment and relevant improvements in pain and disability for chronic low-back pain patients [10]. The firmness of a mattress also affects pressure distribution and muscular function when lying in bed, which can contribute to overall sleep quality [18]. ...
Article
Full-text available
Mattress comfort, often associated with firmness, is a complex construct influenced by factors such as material composition, construction, and personal preference. In this short communication paper, we indirectly investigated the effects of long-term mattress use on its hardness and sleep quality by observing the changes in the mattress. A mechanical durability test was performed on two structurally different mattress samples (with polyurethane core and pocket spring core) using a modified method based on the EN 1957 standard, aiming to understand the long-term effects of mattress characteristics on sleep quality. Preliminary results confirm that the mattress samples can maintain firmness and support during long-term use. The polyurethane foam mattress experienced initial compression but quickly stabilized, while the pocket spring mattress showed slight softening, maintaining overall firmness. For the polyurethane mattress, after the initial drop, the hardness value stabilized, varying between 7.53 and 9.03 N/mm, and at the end of the test, it stopped at 8.60 N/mm. The firmness rating stabilized at 4.3, showing minimal fluctuation between 4.0 and 4.6 throughout the process, while the total height loss was 3.79 mm. The hardness value of pocket spring mattresses generally decreased with increasing test cycles (it started at 5.86 N/mm and ended at 5.21 N/mm). The firmness remained relatively stable, varying between 7.3 and 7.1, and the total height loss was only 2.86 mm. The findings suggest that the firmness of a mattress can be changed with its use, highlighting the need for further research on a larger number of samples in the direction of the long-term implications of these changes on sleep comfort.
... The data were collected via a questionnaire derived from an extensive review of the literature using validated scales such as the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Index (MODI) [10,17,18,19]. The MODI for assessing LBP demonstrates robust reliability, with our study reporting Cronbach's alpha of α = 0.940, significantly supporting the previously established reliability (α = 0.754) [20]. ...
Article
Full-text available
Low back pain (LBP) is a prevalent global health issue that causes significant discomfort and disability. Previous research highlights the crucial role of mattress quality, particularly firmness and usage duration, in LBP management. This study aimed to examine sociodemographic and mattress usage characteristics, assessing LBP severity, comparing pain across different mattress firmness levels, and analyzing the correlation between mattress usage duration and LBP severity. This exploratory study was conducted at Hussain Memorial Hospital, Lahore, over two months in 2023. Using the purposive sampling method, this study recruited 130 male and female patients, aged 18 to 60 years, diagnosed with mechanical back pain through a positive Kemp test and who have been using the same mattress for over a year. The data were collected through face-to-face interviews using a questionnaire that incorporated the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Index (MODI). Analysis was performed using SPSS 25.00, with significance set at p-value ≤ 0.05. Most of the patients reported moderate disability (78.46%) and preferred medium mattress firmness (29.23%), with an average mattress usage of 7.18 ± 3.49 years. Kruskal‒Wallis tests revealed significant differences in LBP severity across mattress firmness levels (p < 0.001), with medium firmness associated with less pain. A positive correlation was found between mattress use duration and LBP severity, with r = 0.250 (p = 0.004). This study established a link between mattress firmness and LBP severity, with medium firmness potentially offering optimal relief. Additionally, a correlation exists between extended mattress usage and heightened LBP symptoms, suggesting that the age of a mattress may aggravate LBP. These insights highlight the importance of selecting a mattress by carefully considering both its firmness and usage duration as key factors in effective LBP management.
... Namely, L1-L5 and SS increased when participants were on the mattress, indicating that the mattress significantly influenced some of the lumbar angles, ultimately contributing to an increased sense of comfort. The underlying mechanisms explaining these differences are likely related to effect of mattress firmness on muscular stiffness and pressure distribution when lying supine [28]. Noteworthy is that we observed a different trend in superior and inferior lumbar angles: upper lordosis (i.e., L1-L5) increased whereas lumbosacral lordosis (i.e., L5-S1) decreased when subjects were laying down on the mattress compared to the control condition. ...
Article
Full-text available
Background Humans should sleep for about a third of their lifetime and the choice of the mattress is very important from a quality-of-life perspective. Therefore, the primary aim of this study was to assess the changes of lumbar angles, evaluated in a supine position using magnetic resonance imaging (MRI), on a mattress versus a rigid surface. Methods Twenty healthy subjects (10 females, 10 males), aged 32.3 ± 6.5 (mean ± standard deviation), with body mass index 22.4 ± 2.9, completed three evaluations: (i) spine MRI in supine position on a mattress (MAT); (ii) spine MRI in supine position on rigid surface (CON); and (iii) biplanar radiographic imaging in standing position. The following indexes were calculated for both MAT and CON: lumbar lordosis angles L1–L5, L1–S1, L5–S1, and the sacral slope (SS). Further, pelvic incidence (PI) was calculated from the biplanar radiographic images. Results Main findings were (i) L1–L5 and SS were greater in MAT than CON (L1:L5: +2.9°; SS: +2.0°); (ii) L5–S1 was lower in MAT than CON (−1.6°); (iii) L1–S1 was greater in MAT than CON only for male subjects (+2.0°); (iv) significant and positive correlations between PI and L1–L5, L1–S1 and SS were observed in both CON and MAT. Conclusions The use of a mattress determined small but statistically significant changes in lumbar angles. Relevance statement The use of a mattress determines small but statistically significant changes in radiological angles describing the sagittal alignment of the lumbar spine when lying in the supine position. Key points • Lordosis angle L1–L5 was greater in MAT than in CON condition (+2.9°). • Sacral slope was greater in MAT than in CON condition (+2.0°). • Lordosis angle L5–S1 was lower in MAT than in CON condition (−1.6°). Graphical Abstract
... Kuo et al. (2013) reported that a strong bedding system would decrease cardiovascular sympathetic modulation and increase cardiac vagal activity and baroreceptor reflex sensitivity during sleep. Some studies have also revealed that medium-firm bedding provides benefits for patients with chronic low back pain (Kovacs et al., 2003;Jacobson et al., 2006Jacobson et al., , 2009. ...
Article
Full-text available
Introduction A comfortable mattress should improve sleep quality. In this study, we sought to investigate the specific sleep parameters that could be affected by a mattress and explore any potential differences between the effects felt by each sex. Methods A total of 20 healthy young adults (10 females and 20 males; 22.10 ± 1.25 years) participated in the experiments. A smart adjustable zoned air mattress was designed to maintain comfortable support, and an ordinary mattress was used for comparison. The participants individually spent four nights on these two mattresses in four orders for polysomnography (PSG) scoring. Sleep architecture, electroencephalogram (EEG) spectrum, and heart rate variability (HRV), which reflect the central and autonomic nervous activities, were used to compare the difference between the two mattresses. Results An individual difference exited in sleep performance. The modes of influence of the mattresses were different between the sexes. The adjustable air mattress and the increase in experimental nights improved female participants' sleep efficiency, while male participants exhibited a smaller response to different mattresses. With an increasing number of experiment nights, both sexes showed increased REM and decreased N2 proportions; the N3 sleep proportion decreased in the male participants, and the heart rate decreased in both sexes. The performance of the EEG spectrum supports the above results. In addition, the adjustable air mattress weakened automatic nerve activity during N3 sleep in most participants. The female participants appeared to be more sensitive to mattresses. Experiment night was associated with psychological factors. There were differences in the results for this influence between the sexes. Conclusion This study may shed some light on the differences between the ideal sleep environment of each sex.
... In short, our results may indicate that a bubble wrap may not be a satisfactory substitute for air mattresses. Several studies have indicated that a mid-firm mattress is useful for avoiding musculoskeletal pain and improving sleep quality (Kovacs et al., 2003;Normand et al., 2005;López-Torres et al., 2008;Jacobson et al., 2010). An ideal mattress can push back against weight and hold the spine's alignment in a neutral position. ...
Article
Full-text available
Background It has been pointed out that the poor environment of evacuation shelters causes health problems and disaster-related deaths among evacuees, and we are concerned that their environment will deteriorate, particularly during a large-scale disaster due to a shortage of daily necessities. In Japan, evacuees usually slept on floors with futons until the Great East Japan Earthquake, but cardboard beds were installed in evacuation shelters. Previous studies have suggested that cardboard beds can reduce cold air transmission from the floor. We have reported that a cardboard bed can have a low-contact pressure dispersion capacity and cannot reduce musculoskeletal strain, unlike a futon or mattress. In the Great East Japan Earthquake, 33% of disaster-related deaths were reported to have been caused by physical or mental fatigue due to living in evacuation shelters. When a large-scale disaster such as the Nankai Trough Earthquake generates huge numbers of evacuees, the supply of mattresses for evacuees will be very difficult. Therefore, we considered potential alternatives that could be produced in large quantities over a short period. Bubble wrap, with very lightweight and waterproofing, could be a good candidate for mattress replacement. This study aimed to investigate the improvement in body pressure distribution and pressure-sensing area when using bubble wrap. Methods Twenty-seven healthy subjects allocated to sequences A and B with different intervention order were laid in supine and lateral positions on a cardboard bed without a mattress, bubble wrap, or air mattress: the mattress-body contact pressure and contour areas were measured, and subjective firmness and comfort during these conditions were also investigated using the visual analog scale (VAS). Acquired data were analyzed using a linear mixed-effects model and Bonferroni’s post-hoc test, and P < 0.05 was considered statistically significant. Results The mattress-body contact pressure and contour area showed significant differences with and without air mattresses. With the air mattresses, the pressure in the supine position decreased by 34%, and that in the lateral position decreased by 13%. However, the four-fold bubble wrap did not improve the mattress-body contact pressure and contour area; the change ratios were within 5% compared to the cardboard bed. However, there were significant differences in subjective firmness and comfort using the VAS among all experimental positions. Conclusion Our study showed that bubble wrap could not significantly improve body pressure concentration and may not be a satisfactory substitute for air mattresses. Because of the improvement in subjective firmness and comfort with the bubble wrap, using it for an extended period may affect the incidence of back pain in evacuees. Finally, we hypothesize that the body pressure dispersion of the bubble wrap may be improved by changing the air-filling rate and the size of the air bubbles.
... Many authors and researchers have devoted considerable research efforts to predict sleep comfort and contact pressure between the human body and a mattress cushion. Some of these are limited by the mechanical geometry of the model, whereas others are limited by the material models used [2,4,[14][15][16][17][18][19][20][21][22]. ...
Article
Full-text available
Body pressure dispersion mattresses are useful tools for preventing pressure ulcers in patients with limited mobility who experience prolonged body weight-related compression loads at their body contact areas over time. The objective of this study is to propose and optimize a multicell finite element (FE) model of foam mattress to prevent patients from developing pressure ulcers (bed sores), by improving the contact pressure distribution on the upper mattress surface and immersion in the mattress. The NSGA-II multi-objective genetic algorithm was used to predict different configurations of cell materials to provide a more comfortable sleep. Our mattress model contains many cells (50 × 50 × 50), each of which can contain one of the nine different foam firmnesses. The NSGA-II algorithm attempts to combine the properties of soft and firm foams into a single mattress. however, the complexity and intersection of the fitness function objectives and the high number of possible chances forced the optimal solutions set to extend into the area under the result of foams that have a compressive strength between soft and firm. Based on the overall optimization results, the standard deviation ranged from 0.00325 to 0.00175 MPa and the maximum mattress immersion ranged from 50 mm to less than 20 mm. Mattresses with optimal configurations disperse body pressure smoothly to fit the patient's body shape.
... 8,19,[22][23][24][25] These patients usually do not present with any warning signs to suggest other pathology. The most common factors associated with non-specific LBP include older age and sports participation, 6,20 soft mattress usage, 26 sports equipment such as poorly cushioned running shoes or improper bicycle seat position, 27 increased thoracic kyphosis 28 and underlying mental health issues and psychosocial stressors. 29,30 A large systematic review looked at whether LBP was associated with heavy shoulder backpack usage and there was no correlation. ...
Article
Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.
... 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
Full-text available
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.
... 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. ...
Article
Full-text available
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
... 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
Full-text available
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.
... 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]. ...
Preprint
Full-text available
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.
... 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. ...
Article
Full-text available
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.
... [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
Full-text available
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.
... [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
Full-text available
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.
... 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.
... 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]. ...
... There is a lot of possible factors to provide comfortable pillows. Many researchers tried to evaluate comfortableness of pillows with those factors such as stiffness [1] [2], shape [3][4] [5][6] [7] and thermal properties [8]. Some researchers reported development of an active air mattresses for controlling thermal condition of bedding [9] or preventing bedsore of a patient [10] [11] by pressurizing or depressurizing air bags with predetermined routine. ...
Chapter
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.
Article
A review of information about musculoskeletal pain in adolescents is presented: the causes of their development, prevalence, classification, clinical manifestations, treatment and prevention. Included are the results of our own research, which showed the peculiarities of the relationship between the frequency of occurrence and the structure of these types of pathology in adolescents with different variants of the course of recurrent cephalalgia – episodic (rare) and chronic (frequent). Frequent dorsalgia in adolescents is significantly more often associated with chronic cephalgia (32.0%), and rare ones – with episodic (46.9%). Girls have a higher incidence of frequent dorsalgia associated with chronic (37.1 and 14.3%) and episodic (22.2 and 16.4%) cephalgia. The authors come to the conclusion about the need for early diagnosis, prevention and timely treatment of dorsalgia associated in adolescents with chronic and episodic cephalgia, and highlight approaches to the treatment and prevention of musculoskeletal pain in children and adolescents.
Article
Full-text available
In this paper we generate finite element (FE) models to predict and analyse the comfort of a flexible polyurethane foam mattress with different mechanical properties (compressive strength). We use the half of a symmetrical three dimensional virtual numerical model of foam mattress and human body in a supine position. Our goal is to analyse the different factors of mattress comfort, as contact pressure peak on the surface between human body and foam mattress, contact pressure distribution on the surface of the mattress, and displacement of mattress in the load direction of body weight. These factors are predicted by numerical simulation.A linear elastic isotropic material model is used for skin, the Mooney-Rivlin material model, which is a mathematical FEM model, is used to simulate hyperelastic behaviour of muscle tissue, and nonlinear hyperelastic materials are used to represent nonlinear compressive strength of flexible polyurethane foam. The results present the effect of compressive strength of FPU foam on the main parameters of mattress comfort. We show the variation of parameters depending on the firmness or softness of mattress foam.
Chapter
In this chapter, we have organized the frequently asked questions about pillows received at the Pillow Clinic and the replies. Some of the answers are based on our clinical experiences. Care was taken to keep the responses as simple as possible and easy for patients to understand. These sample Q&A will help you answer your patients’ questions. However, healthcare and general market conditions may vary from country to country or region to region, so please use this information to tailor your answers to your specific situation.Throughout this chapter, we have compiled answers to questions about improving daily life, such as neck pain, shoulder stiffness, depression, snoring, sleep apnea syndrome (SAS), and insomnia. Symptom relief, such as numbness, cervical disc herniation, lumber disc herniation, low back pain, rheumatoid arthritis, scoliosis, straight neck, headache, etc. are also included in this summary. Issues on sleeping posture, such as prone position, kyphosis, sleep position, lateral position, and turn over are also discussed. There are suggestions for pillow qualities such as commercially available pillow, pillow material, urethane pillow, polyurethane pillow, foam pillow, custom-made pillow, contour pillow, higher pillow, lower pillow, pillow size, pillow for children, without pillows, and beddings such as hard mattress, soft mattress, foam mattress, high density foam mattress, Japanese futon, comforter, pajamas, hag pillow, waterbed, smart pillow, smart Mattress are also reviewed.
Article
Objective: The purpose of this study was to compare the firmness of used mattress coil springs from the areas bearing greatest body weight versus areas subjected to little compression. Methods: Weight-bearing springs (WBS) extracted from the center of the mattresses (N = 32), and non-weight-bearing springs (NWBS) extracted from the head/foot were of the same mattresses. To determine spring weakness, a 1296-g ingot was placed on the coil, and the compression distance was measured (cm). In addition, a gauge was used to measure the amount of pressure required to compress the coil springs a distance of 2 cm. Comparison between WBS and NWBS data were statistically treated using independent t tests and a 1-way analysis of variance. Results: There were no significant group differences in weight or height in unloaded coils. However, there were significant (P < .05) differences in coil spring compression distance under load (WBS = 2.78 ± 0.34 cm; NWBS = 1.52 ± 0.39 cm) and force gauge compression (WBS = 1090.51 ± 88.42 g; NWBS = 1213.12 ± 71.38 g) between groups. Conclusion: This study found that WBSs were weaker when compressed than the NWBS from used mattresses, and such characteristics may not be visually apparent in a mattress when not in use. Thus, coil springs in bedding systems may eventually fail to provide the initial structural support after use. Such sagging may compromise sleep posture with accompanying poor sleep quality and quantity.
Article
Full-text available
The use of flexible wearable sensors to monitor the impact of sleeping position and turning frequency on sleep and to study sleep patterns can help bedridden patients heal and recover. The flexible wearable sleeping-position monitoring device was designed and developed using a flexible angle sensor and a six-axis motion sensor to measure the dynamic changes in body posture during sleep. Based on the changes in the output parameters of the flexible angle sensor and the six-axis motion sensor, we determined the change in the subject’s lying position, verifying and analyzing the relationship between lying position preference, turning frequency, and sleep quality in healthy subjects. The sleeping-position monitoring device was worn by 13 subjects (7 males and 6 females) without sleep disorders before the sleep experiment. They performed more than 50 sleeping-position changes to ensure the accuracy of the monitoring device. Subjects slept in their beds for 8 h per night for 15 nights. During that time, they wore the sleeping-position monitoring device and a wristband sleep-monitoring bracelet on their left hand, and gathered the subjective sleep data using questionnaires. The results show that the most critical influencing factors are sleeping-position preference and frequency of turning. Data analysis reveals that subjects with a preference for right-sided lying and a lower frequency of turning had better sleep quality.
Chapter
A healthy spine is of utmost importance when it comes to our quality of life. Many aspects of our lives including posture, exercise, nutrition, smoking, sleep and stress impact the spine. A fundamental understanding of the anatomy of our spine and how various factors affect spine health is important. The tremendous rise in technology has also significantly impacted spine health. The various electronic devices are often used for prolonged periods of time in the same position by adults and children for work, school and entertainment. In addition, the recent global matter of the pandemic and the major shift of the working population from the office to the home has affected our spine health. This mostly revolves around suboptimal work environments and work stations. Maintaining a healthy lifestyle both at work and home is important in keeping our spine and bodies in optimal shape and condition.KeywordsSpineLow back painNeck painText neckLumbar spineCervical spinePostureErgonomicsWork stationSleep positionLifestyleExercise and spineSmoking and spineNutrition and spine
Article
Context Street cleaners assume bending and twisting positions for a long period while on the job, making them to be susceptible to low back pain (LBP). Aims This study was aimed at determining the prevalence of LBP among street cleaners in North-eastern Nigeria. Settings and Design Sample of convenience was to recruit 381 participants who were street cleaners working within Maiduguri Metropolitan Council. Subjects and Methods A conveniently sampled participants ( n = 381) completed sociodemographic form, Nordic LBP Questionnaire and LBP risk factors form. Descriptive statistics were used to summarise the data, and Chi-square statistics were used to explore the differences in LBP prevalence by sociodemographics. Results The present study shows a 12-month LBP prevalence rate of 78.2% and a crude point (7 days) prevalent rate of 55.1% among the workers, and this condition tend to occur more frequently among those in the age group between 58 and 67 years than their counterparts in the lower age groups ( P = 0.001). Male cleaners tend to report LBP more frequently than their female counterparts ( P = 0.011), and those with primary or qur'anic education also reported LBP more frequently than their counterparts with secondary or tertiary education ( P = 0.046). Performing the same task over and over and working in the same position for long periods were the most frequently chosen risk factors pre-disposing the workers to LBP on their job. Conclusions The present study identified the needs for workers ergonomic education and employers' consideration for ergonomically fit tools, as potential solution to addressing LBP as an occupational hazard among the workers.
Article
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.
Article
Full-text available
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.
Article
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.
Conference Paper
Full-text available
دف از ارایه این مقاله برر سی و مرور تکنیک هایی پیرامون طراحی و ساخت سی ستمهایی ا ست که با ا ستفاده از سیگنالهای پ سخوراند زیستی 1جهت بدست آوردن الگو و نقشه بدن اشخاص و همچنین انتخاب تشک بهینه بابت افراد مختلف صورت پذیرفته است. بهینه سازی تشک جهت پشتیبانی حداکثری از تمام نقاط بدن، بوجود آوردن شکل صحیح خوابیدن، بالا بردن کیفیت استراحت و پیشگیری از عوارض ناشی از نوع غلط خوابیدن بدلیل پایین بودن و نا مناسب بودن طراحی تشک می باشد. مروری بر فعالیتهای انجام شده در این زمینه بیانگر این است که استفاده از تکنولوژی سیگنالهای پسخوراند زیستی در علوم پزشکی و توانبخشی در ابتدای راه است و قابلیت گسترش بیشتری را در جهت راحتی و آسایش زندگی انسان دارد. با توجه به روشهای بدست آوردن الگوی بدن در کارهای مختلف انجام شده، میتوان روش دقیق تری را انجام داده و الگوهای کاملتری را نمایش داد. مقای سه رو شهای جدید با رو شهای قدیمیتر در این زمینه، بیانگر تاثیرات بی شتر در کیفیت و بهبود استراحت کاربران می باشد
Article
There are limited comparative studies examining physiotherapy performed in various environments and positions. Thus, we conducted a healthy science research, investigating the difference in body pressure-related sensory changes between the floor and mattress while in the static prone position. We used the Body Pressure Measurement System to analyze changes in body pressure. In this measurement system, sensors are attached to existing mattresses and floor surfaces beneath the subjects. The level of pain was evaluated using pain score tools before the static prone position was adopted, at 1, 5, 10, and 15 min, and in total for specific body points. We measured five time points and five body points while placed in the static, prone position. There were no significant differences found in body pressure between floor and mattress placement. However, the pain score values for the arm and abdomen were significantly higher in the floor group compared to the mattress group. In addition, pain score values increased with time for the mattress and floor groups. These results suggest that the properties of time, posture, and environment need to be carefully considered when applying sensory rehabilitation.
Article
Rückenschmerzpatienten wollen häufig wissen, welche Matratze für sie am besten geeignet ist. Eine harte oder weiche, mit Federkern oder mit Memory-Schaum? Was Sie empfehlen und wie Sie Ihre Patienten vor überteuerten Einkäufen bewahren können, erfahren Sie hier.
Conference Paper
This study proposes an intelligent bedding system that actively changes its shape and stiffness with multiple flexible actuators. The proposed system provides mechanical conditions for comfortable sleep by feedback control. The system comprises air bag actuators, feedback control system and an individual body simulator. Authors plan to control the actuators on the basis of the body simulator, which calculates appropriate body support condition. To develop the simulator, this paper discusses a mathematical model of human body to obtain pressure distribution and posture in supine position. Devices of pillow and mattress with flexible actuators are also described.
Data
Full-text available
Characteristics of included trials. A table showing the characteristics of included trials and their references. (PDF)
Article
Full-text available
La Sociedad Española de Sueño tiene como uno de sus principales objetivos la promoción de un sueño saludable en la población general y profesionales de la salud. El presente documento pretende realizar una revisión de la literatura científica actual sobre hábitos de sueño que sirva de fundamento para establecer unas recomendaciones generales y útiles para la población general española, en el contexto de un sueño saludable, e identificar aquellos principales retos en la investigación sobre hábitos de sueño. El desarrollo del documento se ha realizado por un equipo multidisciplinar de miembros de la Sociedad Española de Sueño integrado por expertos en medicina pediátrica del sueño, neurofisiología clínica, neumología, neurología, cronobiología, fisiología y psicología. Se ha procedido a una revisión de la bibliografía científica existente sobre hábitos de sueño en población general, y se han abordado los siguientes aspectos: estado actual de los hábitos de sueño en la población española; revisión genérica de la cantidad óptima de horas de sueño; impacto del entorno ambiental (ruido, temperatura, iluminación...), horarios de sueño, alimentación y deporte; y apartados específicos para niños y adolescentes, trabajadores a turnos y conducción de vehículos. De todos los aspectos abordados a lo largo de este documento, se concluyen unas recomendaciones generales finales que servirán de guía a la población general y profesionales de la salud, así como se discuten los principales retos ambientales y futuras direcciones de investigación.
Chapter
Maßnahmen zur Rückengesundheit wie Rückenschule und Rückengymnastik gehören in Unternehmen neben der betrieblichen Sportgruppe zu den am häufigsten angebotenen Programmen und werden als das wichtigste Angebot aller Maßnahmen zur betrieblichen Gesundheitsförderung (BGF) bewertet. Die neue Versorgungsleitlinie »Kreuzschmerz« empfiehlt deshalb zur Prävention von Kreuzschmerz konsequenterweise auch die Maßnahmen am Arbeitsplatz (ergonomische Gestaltung, Verhaltensprävention, Förderung der Arbeitsplatzzufriedenheit).
Chapter
Das vorliegende Kapitel beschäftigt sich mit Beschwerden und Erkrankungen des Rückens. Nach einer Einführung in die anatomischen Grundlagen und der Darstellung wesentlicher Krankheitsbilder kommt den präventiven und rehabilitativen Ansätzen eine besondere Bedeutung zu. Hierbei zeigt sich ein Paradigmenwechsel in den vergangenen Jahren — weg von dem Rat, sich zu schonen, hin zur Empfehlung, sich nach den individuellen Möglichkeiten zu bewegen und weiterhin den Alltagsaktivitäten nachzukommen.
Article
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
Article
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.
Article
Full-text available
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.
Article
Full-text available
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.
Article
Part 1 Statistical methods for sample size determination: the one sample problem the two sample problem sample size for case-control studies sample size determination for cohort studies lot quality assurance sampling the incidence density sample size for continuous response variables sample size for sample surveys. Part 2 Foundations of sampling and statistical theory: the population the sample sampling distribution characteristics of estimates of population parameters hypothesis testing two sample confidence intervals and hypothesis tests epidemiologic study design basis sampling concepts.
Article
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.
Article
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.
Article
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.
Article
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
Tables of random permutations 17 European Committee for Standarization. Domestic Furniture. Beds and mattresses: test method for the determination of functional characteristics
  • Le Moses
  • Ry Oakford
Moses LE, Oakford RY. Tables of random permutations. Standford, CA: Standford University Press, 1963. 17 European Committee for Standarization. Domestic Furniture. Beds and mattresses: test method for the determination of functional characteristics. CEN/TC207/WG1/TG4. Brussels: Comité Européen de Normalisation, 1996. 18 Huskisson EC. Measurement of pain. Lancet 1974; 2: 1127–31.
Le marathon, equilibre energetique, endurance et alimentation du coureur sur route
  • S Pronnett
Pronnett S. Le marathon, equilibre energetique, endurance et alimentation du coureur sur route. Paris: Vigot, 1983.
Associations between back pain, quality of sleep and quality of mattresses: double-blind pilot study with hotel guests
  • Enck
Conservative treatment of chronic low back pain: a meta-analysis of 80 randomized trials of 14 interventions
  • Van Tulder
The epidemiology of spinal disorders
  • Andersson