[Back pain and LBP and muscle relaxants].
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Back Pain↗
Biomedical subjects
Claus Manniche
Publications and source records attributed to Claus Manniche.
Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain.
Most patients referred to physiotherapy with low back pain are without a precise medical diagnosis. Identification of subgroups of non-specific low back pain patients may improve clinical outcomes and research efficiency. A pathoanatomic classification system has been developed, classifying patients with non-specific low back pain into 12 different syndromes and three subcategories based on history and physical examination. The purpose of this study was to estimate the inter-tester reliability of clinical tests used as criteria for classifying patients. Ninety patients with chronic low back pain were each examined by two physiotherapists. A total of four physiotherapists conducted the assessments. Examination findings were recorded independently by the two examiners. Percentage of agreement and kappa coefficients were calculated for each category. The overall rate of agreement was 72% and the kappa coefficient was 0.62 for the mutually exclusive syndromes in the classification system. Agreement rates for each of the syndromes ranged from 74% to 100% and kappa coefficients ranged from 0.44 to 1.00. The findings suggest the inter-tester reliability of the system is acceptable. The relatively modest level of total agreement (39%) for the system as a whole might indicate that the utility of the system for general screening purposes is limited, compared with the utility in identification of particular syndromes. Due to low prevalence of positive findings in some of the syndromes, future work should focus on testing reliability on a larger sample of patients, and testing of validity and feasibility of the system.
Adult↗
Heredity of low back pain in a young population: a classical twin study.
Important genetic influence on intervertebral disc degeneration has been shown previously. However, the role of the disc in pain production is not clear and the genetic influence on the development of the symptoms of low back pain is largely unknown. Therefore, data on lifetime prevalence of low back pain from the young cohort in The Danish Twin Registry (aged 12-41) were analyzed with respect to heredity. Casewise concordance rates, odds ratios, tetrachoric correlation coefficients and biometric liability models were estimated in relation to gender and age. Finally, age-adjusted heritability of liability estimates were obtained. Both concordance rates and odds ratios show significant genetic influence on the liability to develop low back pain. Also, tetrachoric correlation coefficients show genetic influence, but this is not statistically significant for all age groups. The biometric modeling demonstrates shared environment to be a strong component in the youngest age group (12-15), but not above age 15, and it also demonstrates some non-additive genetic effects in the older age groups. Age-adjusted heritability of liability is estimated to 44% (37-50) for males and 40% (34-46) for females aged 16 to 41. Thus, the various analyses all demonstrate significant genetic influence on the liability to low back pain. The shared environment is an important component until age 15. After age 15, this component is unimportant. As people grow older, the effect of the non-shared environment increases and non-additive genetic effects become more evident, indicating an increasing degree of genetic interaction as age increases.
Adolescent↗
[Examination of the lumbar region].
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Humans↗
Low back pain: what is the long-term course? A review of studies of general patient populations.
It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim--attractive as it might be to some--may not reflect reality. In order to investigate the long-term course of incident and prevalent cases of LBP, a systematic and critical literature review was undertaken. A comprehensive search of the topic was carried out utilizing both Medline and EMBASE databases. The Cochrane Library and the Danish Article Base were also screened. Journal articles following the course of LBP without any known intervention were included, regardless of study type. However, the population had to be representative of the general patient population and a follow-up of at least 12 months was a requirement. Data were extracted independently by two reviewers using a standard check list. The included articles were also independently assessed for quality by the same two reviewers before they were studied in relation to the course of LBP using various definitions of recovery. Thirty-six articles were included. The results of the review showed that the reported proportion of patients who still experienced pain after 12 months was 62% on average (range 42-75%), the percentage of patients sick-listed 6 months after inclusion into the study was 16% (range 3-40%), the percentage who experienced relapses of pain was 60% (range 44-78%), and the percentage who had relapses of work absence was 33% (range 26-37%). The mean reported prevalence of LBP in cases with previous episodes was 56% (range 14-93%), which compared with 22% (range 7-39%) for those without a prior history of LBP. The risk of LBP was consistently about twice as high for those with a history of LBP. The results of the review show that, despite the methodological variations and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored. Future research should include subgroup analyses and strive for a consensus regarding the precise definitions of LBP.
Adolescent↗
Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back pain.
INTRODUCTION: Research concerning the development of low back pain (LBP) has traditionally focused on risk factors in search of explanations. This review focuses on comorbidity as a first step in identifying a frail subpopulation with a higher risk of developing low back pain, in particular persistent low back pain. Research into comorbidity might yield a greater understanding of the underlying mechanism for low back pain. Data sources Medline was searched from the beginning of the data base to December 2000, followed by a search through the authors' personal collections of epidemiologic literature regarding low back pain. All articles written in English were included if they related LBP to at least one other physical disorder. Articles were excluded if the prevalence of such disorders could not be compared to that of a control group or to the expected prevalence in a normal population. Data extraction The retrieved articles were evaluated for quality based on predefined methodological criteria, whereupon information about associations between low back pain and other physical disorders was extracted. RESULTS: Twenty-three articles were included. They showed positive associations to all disorders investigated (headache/migraine, respiratory disorders, cardiovascular disease, general health, and others) with the exception of diabetes. There was very little information regarding temporality, therefore there are no clues as to causal mechanisms. CONCLUSION: The literature leaves no doubt that diseases cluster in some individuals and that low back pain is part of this pattern. However, the nature of the relationship between low back pain and other disorders is still unclear.
Adult↗
The course of low back pain in a general population. Results from a 5-year prospective study.
OBJECTIVES: To investigate the course of low back pain (LBP) in a general population over 5 years. DESIGN: Prospective population-based survey by postal questionnaires in 1991, 1992, and 1996. SETTING: The municipal of Ebeltoft, Denmark. SUBJECTS: Two thousand people aged 30 to 50 years, representative of the Danish population. Main outcome measure Number of days with low back pain during the past year. RESULTS: One thousand three hundred seventy were recruited of whom 813 (59%) were followed to 5 years. The responders could be divided into 3 groups with regard to LBP: no pain, short-term pain, and long-lasting/recurring pain. More than one third of people who experienced LBP in the previous year did so for >30 days. Forty percent of people with LBP >30 days at baseline remained in that group 1 and 5 years later, and 9% with LBP >30 days in year 0 were pain free in year 5. People with LBP in year 0 were 4 times more likely to have LBP in year 1, and 2 times more likely to be affected in year 5. CONCLUSIONS: Low back pain should not be considered transient and therefore neglected, since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions. On the other hand, chronicity as defined solely by the duration of symptoms should not be considered chronic.
Adult↗
Palpation for muscular tenderness in the anterior chest wall: an observer reliability study.
OBJECTIVE: To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall. DESIGN: A repeated measures designs was used. SETTING: Department of Nuclear Medicine, Odense University Hospital, Denmark. PARTICIPANTS: Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Palpation for muscular tenderness was done in 14 predetermined areas of the anterior chest wall with all subjects sitting. Each dimension was rated as absent or present for tenderness or pain for each location. All examinations were carried out according to a standard written procedure. RESULTS: Based on a pooled analysis of data from palpation of the anterior chest wall, we found kappa values of 0.22 to 0.31 for the interobserver reliability. For the intraobserver reliability, we found kappa values of 0.21 to 0.28 for the day-to-day reliability and 0.44 to 0.49 for the hour-to-hour reliability. CONCLUSION: Our results indicated great variations between experienced chiropractors palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior chest wall.
Case-Control Studies↗
Is low back pain in youth associated with weight at birth? A cohort study of 8000 Danish adolescents.
INTRODUCTION: Low back pain has been associated with an increased risk of several diseases and with poor general health. Also low birth weight has been associated with an increased susceptibility to various diseases as well as with poor general health. Thus, low birth weight could be a common factor--indicating a general frailty with an increased risk of both low back pain and overall morbidity. To our knowledge, the association between low back pain and birth weight has not previously been investigated. This study investigates the correlation between birth characteristics and low back pain in adolescence. MATERIAL AND METHODS: Analyses are based on data from The Danish Twin Registry. Information about low back pain is from a postal survey, and information about birth characteristics are from The Danish Medical Birth Register. Analyses include 8278 individuals aged 12-22 years--an age at which they are still largely unaffected by the influence of working life. Possible associations between low back pain, birth weight, birth length, ponderal index, gestational age and Apgar scores are investigated by the use of logistic regression analysis. RESULTS: The odds ratio for the lifetime prevalence of low back pain increases from 1.21 (0.94-1.56) for a birth weight of 2000-2500 g to 1.97 (1.35-2.88) for a birth weight of > 3500 g compared to the smallest weight group (< 2000 g) in males, whereas there is a small statistically insignificant, positive association for females. The same pattern is seen for the one-year prevalence of low back pain. No associations are documented between low back pain and other birth factors. The positive association between low back pain and birth weight is independent of other birth factors and of anthropometric measures in adolescence. CONCLUSION: There is a statistically significant association between high birth weight and the risk of developing low back pain in males but not in females. Our results do not indicate that frailty at birth increases the risk of low back pain in adolescence.
Adolescent↗
[Training of back and neck in the year of 2002].
The aim of this review was to determine the relevance of exercise therapy in the total treatment strategy of low back pain (LBP). The review is based on the results of randomised clinical trials, meta-analysis, consensus reports, and medical technology assessments. There is strong evidence for the effectiveness of exercise therapy for subacute and chronic LBP. There is some evidence that exercise is not effective for acute LBP. The most effective exercise programme and the optimal combination of exercise and other effective treatment modalities for different subgroups of LBP patients remain to be determined. Insights regarding the biological mechanisms of the positive effect of exercise are not yet established.
Contraindications↗
Palpation of the upper thoracic spine: an observer reliability study.
OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated-measures design was used in all substudies. SETTING: Department of Nuclear Medicine, Odense University Hospital, Denmark. PARTICIPANTS: Two chiropractors examined 29 patients and 27 subjects in the interobserver part and 1 chiropractor examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Three types of palpation were performed: Sitting motion palpation and prone motion palpation for biomechanic dysfunction and paraspinal palpation for tenderness. Each dimension was rated as "absent" or "present" for each segment. All examinations were performed according to a standard written procedure. RESULTS: Using an "expanded" definition of agreement that accepts small inaccuracies (+/-1 segment) in the numbering of spinal segments, we found--based on the pooled data from the thoracic spine--kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability with all 3 palpation procedures. Kappa coefficients were 0.24 and 0.22 for the interobserver reliability with prone and sitting motion palpation and 0.67 and 0.70, respectively, with paraspinal palpation for tenderness. CONCLUSION: With expanded agreement we found good hour-to-hour and day-to-day intraobserver reliability with all 3 palpation procedures and good interobserver reliability for paraspinal tenderness. The interobserver reliability was unacceptably poor with prone and sitting motion palpation.
Adult↗
Low Back Pain Rating scale: validation of a tool for assessment of low back pain.
Low Back Pain Rating scale is an index scale which includes measurements of pain intensity, disability, and physical impairment. The scale was designed to monitor the outcome of clinical trials of low back pain treatment. It has been validated in 58 patients following first-time discectomy. The scale rating can be rapidly carried out and requires no special aids. With slight modification it can be used in office and telephone interviews, as well as postal questionnaires. These modifications only slightly reduce the quantity of information gathered. In the study, a high rater agreement (97.7%) was found without level difference between two observers using the scale. The validation process included: construct validity, criterion-related validity and item bias, relative to Global Assessments pronounced by the patient and an experienced clinician. Low Back Pain Rating scale hs been shown to be valid and reliable in the assessment of low back pain.
Adult↗
Intensive dynamic back exercises for chronic low back pain: a clinical trial.
The effect of intensive dynamic back extensor exercises for patients with chronic low back pain was investigated in a controlled clinical trial in which chronic low back pain patients underwent a 3-month intensive training program with a total of 30 sessions. The 105 patients were divided into 3 groups: a treatment group, an alternative group which underwent 1/5 of the treatment group's exercise program per session, and an alternative group in which treatment consisted of thermotherapy, massage and mild exercise. Regardless of whether the treatment outcome is assessed qualitatively or quantitatively, a statistically significant, favorable difference was found between the results for the treatment group and for the alternative groups at conclusion and at the 3-month follow-up. It appeared from the quantitative assessment that patients in the treatment group who completed the training program at least once a week for the entire 1-year follow-up period were the only patients with a significantly better back status after 1 year compared to the time of inclusion. Irrespective of sex, age, duration and degree of severity of back trouble, or of pre-existing sciatica or pathological findings upon X-ray of the spine, patients obtained a favorable result from the training program. The therapy was found to be without risk, but patients with clinical signs of current lumbar nerve root compression or radiological signs of spondylolysis or halisteresis of the spine were excluded from the study.
Adult↗
Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial.
OBJECTIVE: To examine if participants with chest pain originating from the spine would benefit from manual therapy. METHODS: A nonrandomized, open, prospective trial was performed at a tertiary hospital. Patients who were referred for coronary angiography because of known or suspected stable angina pectoris were invited to participate in this study. A total of 275 took part, 50 were diagnosed as cervicothoracic angina (CTA)-positive (chest pain from the cervicothoracic spine) and 225 as CTA-negative. The intervention performed was manual therapy according to chiropractic standards. Patient self reported questionnaires at baseline and 4-week follow-up, including pain measured with an 11-point box scale, Short Form 36 (quality of life), and perceived improvement. RESULTS: Approximately 75% of CTA-positive patients reported improvement of pain and of general health after treatment, compared with 22% to 25% of CTA-negative patients (P < .0001). Pain intensity decreased in both groups with consistently larger decreases for all measures of pain among CTA-positive patients. Short Form 36 scores increased in the CTA-positive group in 5 of 8 scales and remained unchanged in the CTA-negative group. CONCLUSION: This study suggested that patients with known or suspected angina pectoris and a diagnosis of CTA may benefit from chiropractic manual therapy. Methodologically, sound randomized clinical trials are needed to corroborate our results.
Angina Pectoris↗