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At least 181 records · Page 10Linked to original sources
PubMed1998

Evaluation of orthopedic testing of the low back for nonspecific lower back pain.

OBJECTIVE: To assess the value of some commonly used orthopedic tests used in evaluating nonspecific lower back pain where there are no demonstrable pathological or neurological deficits. DESIGN: Retrospective analysis of patient files. SETTING: Chiropractic teaching clinic, Royal Melbourne Institute of Technology. SUBJECTS: Five hundred sixty-four files of patients presenting to the above clinic with nonspecific lower back pain were analyzed. DATA ANALYSIS: The data were entered into a spreadsheet, contingency tables were created, and the data were analyzed using chi 2 tests. Statistical significance was set at p < .05. RESULTS: Kemp's and Yeoman's tests were most commonly positive, whereas Bonnet's, supported Adams' and axial compression tests showed relatively low positive results. The factors studied that affected the rate of positive responses were age, gender, pain site, duration and cause. The number of previous episodes of lower back pain had no effect on the positive test rates. CONCLUSION: For cases of nonspecific, mechanical lower back pain, orthopedic testing has limited clinical value once nerve root problems and pathologies have been ruled out. Kemp's and Yeoman's tests were the most frequently positive, and seemed to be the most useful in diagnosing nonspecific lower back pain. When selecting the most appropriate tests to use, one needs to take into account the patient profile and history.

Adolescent↗
PubMed2006

Are localized low back pain and generalized back pain similar entities? Results of a longitudinal community based study.

PURPOSE: To compare subjects with localized low back pain (LBP) and with generalized back pain (BP) with regard to baseline characteristics and long-term outcomes. METHODS: A community-based longitudinal study. All inhabitants aged 22 - 70 of a single town were asked to complete self-administered questionnaires regarding back and neck pain and lifestyle characteristics. Those reporting LBP during the previous month were followed up after one year. Data were stratified by sites of pain with respect to 'localized LBP' and to 'LBP with additional sites of BP'. Among LBP measures were the Roland and Morris Disability scale and Pain symptoms indices. RESULTS: Nearly 30% of the total population (602) experienced LBP during the previous month, of whom more than half (336) reported 'localized LBP' and the rest LBP + neck and or upper back pain (Generalized BP). Both subgroups differed from those free of BP, however, those reported 'Generalized BP' comprised more females, were less educated, smoked more, were less engaged in sporting activities and reported higher level of LBP measures than those reported 'localized LBP'. After one year, both subgroups were similar with regard to lifestyle but remained different with regard to some of the LBP measures. CONCLUSIONS: Subjects with 'localized LBP' presented healthier lifestyle than subjects with 'Generalized BP'. The latter experienced higher degree of pain measures. It seems that 'Generalized BP' is not a different entity than 'localized LBP' but rather a more severe one.

Adult↗
PubMed1975

Symposium on back problems in the horse. (2) The diagnosis of diseases of the horse's back.

A description of some of the clinical features of low back pain in the horse has been given and a number of methods for assisting diagnosis considered. As well as a complete clinical examination both at rest and during exercise, a useful diagnostic aid in some chronic cases was the injection of local anaesthetic into the interspinous spaces. A laboratory examination, including haematological and biochemical profiles, was undertaken in all cases. The serum enzymes GOT and CPK were particularly valuable as an aid to diagnosis in atypical tying-up. A technique for radiography of the vertebral column of the mid back in the standing position and of the pelvic and sacroiliac regions of the anaesthetised horse was described using a Siemens Triplex Optimatic 1023 machine. Some of the radiological features of the vertebral column were considered and a breakdown of the diagnosis of 110 referred back cases. The most important conditions included muscle strain, crowding and overriding of the dorsal spinous processes in the mid back, spondylosis, undue curvature of the spine and vertebral fractures.

Anesthesia, Local↗
PubMed2001

Back fitness and back health assessment considerations for the Canadian Physical Activity, Fitness and Lifestyle Appraisal.

The Canadian Physical Activity, Fitness, and Lifestyle Appraisal (CPAFLA) is used as a measure for the health-related fitness of the general population. The CPAFLA includes an evaluation of back health, which is comprised of abdominal muscular endurance (partial curl-ups) and trunk flexion (sit and reach). This paper reviews the occupational, lifestyle, and physical risks associated with back pain and examines the measurement techniques used to assess health-related fitness components of back health in fitness assessments, such as the CPAFLA. Recommendations for future revisions of the CPACFLA's back health assessment and future research needs are presented.

Back↗
PubMed2000

Continuous assessment of back stress (CABS): a new method to quantify low-back stress in jobs with variable biomechanical demands.

Jobs with a high degree of variability in manual materials handling requirements expose limitations in current low-back injury risk assessment tools and emphasize the need for a probabilistic representation of the biomechanical stress in order to quantify both acute and cumulative trauma risk. We developed a hybrid assessment methodology that employs established assessment tools and then represents their evaluations in a way that emphasizes the distributions of biomechanical stress. Construction work activities in the home building industry were evaluated because of the high degree of variability in the manual material handling requirements. Each task was evaluated using the Revised NIOSH Lifting Equation, The University of Michigan Three-Dimensional Static Strength Prediction Program, and the Ohio State University Lumbar Motion Monitor Model. The output from each model was presented as time-weighted histograms of low-back stress, and the assessments were compared. The results showed considerable differences in what were considered high-risk activities, indicating that these 3 assessment tools consider the risk of low-back injury from different perspectives. The time-weighted distribution aspect of this methodology also contributed vital information toward the identification of high-risk activities. These results illustrate the necessity for more advanced low-back injury risk assessment techniques for jobs with highly variable manual materials handling requirements.

Back↗
PubMed2006

Back injuries--getting injured workers back to work.

BACKGROUND: Back problems are the seventh most common reason for seeking care in general practice in Australia. Despite medical advances, chronic disability from back pain is a major contributor to the burden of disease in society today. OBJECTIVE: This article provides an overview of evidence based management for workers presenting with acute low back pain, with the aim of minimising the risk of chronic disability. DISCUSSION: Approximately 95% of cases of acute low back pain are nonspecific. Serious spinal conditions are rare and can be identified by triaging for 'red flags'. A modern biopsychosocial approach does not require a specific patho-anatomic diagnosis for effective management. It is essential to reassure patients to stay active and to resume normal activities quickly--including return to work. Screening for environmental and psychosocial 'yellow flags' can identify patients at risk of poorer outcomes so that additional early intervention can commence.

Back Injuries↗
PubMed1978

The use of the low back and the dorsal scales in the identification of functional low back patients.

Scores from the Low Back (Lb) and the Dorsal (DOR) scales of 20 patients with functional low back pain, 20 patients with functional gastrointestinal pain, and 20 psychoneurotic patients were compared. Among the various proposed cut-off scores, the Lb score of 11 yielded the highest rate (75%) of correct identification of Low Back patients and a hit rate similar to those reported in previous studies. However, it was noted that this 75% hit rate did not achieve statistical significance. Furthermore, the data indicated that neither the Lb nor the DOR scales could differentiate the Low Back patients from other psychosomatic and psychiatric patients and suggested that these two scales should be used with extreme caution by clinicians.

Adult↗
PubMed1986

Backing out: nurse wastage associated with back pain.

Results from a survey of 1008 National Health Service nurses and nursing auxiliaries leaving their current position are reported. These indicate that 1.3% of nurse leavers are leaving their positions for good solely because of back pain. Further, one nurse leaver in 29 is leaving their position with back pain as a main or contributory cause and 12% of all nurse leavers intending to leave for good cited back pain as either a main or contributory factor. The findings from this survey have implications for Health Authorities in relation to costs and manpower planning, and emphasize the need to provide further education and prompt referral and treatment to prevent long-term back morbidity and wastage, not only for registered nurses but also for nursing auxiliaries and aides.

Adult↗
PubMed1991

Predicting disability time using formal low back pain measurement: the Low Back Pain Simulation Scale.

Objective evaluation of simulation in low back pain is currently not possible. A new simulation scale based on subject response to 103 pain words has shown promise in discriminating patients with low back pain from those simulating low back pain. Administration of this scale to 1679 individuals who were injured at work produced a 10.4% sample with scores in the simulation range. This subsample projected more intense pain and were disabled longer. These findings were replicated in a second study in which treating physicians rated the degree of physical pathology and symptom exaggeration blind to patient classification by the Low Back Pain Simulation Scale. Medical assessment indicated less organic pathology and greater symptom exaggeration among patients classified as simulators providing a measure of support for the validity of the simulation scale.

Adolescent↗
PubMed1994

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↗
PubMed2002

Validity of the French-language version of the Quebec back pain disability scale in low back pain patients in France.

OBJECTIVES: The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. MATERIAL AND METHODS: Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale [DS]), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS). RESULTS: Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r = 0.755) and NHP (r = 0.739) and fair agreement with the impairment score (r = 0.449), the VAS pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed. DISCUSSION: Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.

Adult↗
PubMed1999

Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain.

It is hypothesized that, in a large number of cases of aspecific low back pain, the primary cause of the pain is a fracture of the vertebral endplate caused by compression forces. Clinical studies have shown that, in many low back pain patients, damage of the vertebral bodies and or the intervertebral disc is present. In vitro studies reveal that the most likely type of failure of this anterior part of the spine is a fracture of the endplate as a result of compression. The high incidence of aspecific low back pain concurs with the likeliness of compression fractures of the endplate to occur in everyday life. Furthermore, epidemiological findings and the natural history of low back pain appear to be in line with the proposed hypothesis.

Disease Progression↗
PubMed2005

Injury-induced kinematic compensations within the lower back: impact of non-lower back injuries.

With the number of musculoskeletal disorders increasing in the workplace, the potential exists for multiple injuries due to compensations. The objective of this study was to quantify the impact of non-lower back injuries on the trunk motions adopted by the individual during typical lifting tasks. A total of 32 injured subjects (eight for each injury group--shoulder, hand/wrist, knee and foot/ankle) and 32 matched (gender, height and weight) healthy subjects performed laboratory lifting tasks. The independent variables were task asymmetry (clockwise, sagittally symmetric and counter-clockwise), lift origin (waist, knee and floor) and box weight (2.27 and 6.82 kg). The dependent variables were peak trunk kinematics (as measured by the lumbar motion monitor) and moment arm between the box and lower back. The two injuries that had the greatest impact on the lower back kinematics were foot/ankle and hand/wrist. Individuals who suffered a foot/ankle injury produced greater three-dimensional trunk velocities (up to 10 degrees/s) while individuals with hand/wrist injuries slowed down in the sagittal plane but increased the twisting velocity--specifically when lifting from the asymmetric shelves. Knee and shoulder injuries had limited impact on the trunk motions. Overall, the results indicate workplace design must take into account non-lower back injuries.

Adaptation, Physiological↗
PubMed2001

A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale.

BACKGROUND AND PURPOSE: The quality of a disability scale should dictate when it is used. The purposes of this study were to examine the validity of a global rating of change as a reflection of meaningful change in patient status and to compare the measurement properties of a modified Oswestry Low Back Pain Disability Questionnaire (OSW) and the Quebec Back Pain Disability Scale (QUE). SUBJECTS: Sixty-seven patients with acute, work-related low back pain referred for physical therapy participated in the study. METHODS: The 2 scales were administered initially and after 4 weeks of physical therapy. The Physical Impairment Index, a measure of physical impairment due to low back pain, was measured initially and after 2 and 4 weeks. A global rating of change survey instrument was completed by each subject after 4 weeks. RESULTS: An interaction existed between patients defined as improved or stable based on the global rating using a 2-way analysis of variance for repeated measures on the impairment index. The modified OSW showed higher levels of test-retest reliability and responsiveness compared with the QUE. The minimum clinically important difference, defined as the amount of change that best distinguishes between patients who have improved and those remaining stable, was approximately 6 points for the modified OSW and approximately 15 points for the QUE. CONCLUSION AND DISCUSSION: The construct validity of the global rating of change was supported by the stability of the Physical Impairment Index across the study period in patients defined as stable by the global rating and by the decrease in physical impairment across the study period in patients defined as improved by the global rating. The modified OSW demonstrated superior measurement properties compared with the QUE.

Activities of Daily Living↗
PubMed1986

A controlled, prospective study to evaluate the effectiveness of a back school in the relief of chronic low back pain.

Ninety-two chronic low back pain patients were randomly allocated to two groups to evaluate the effectiveness of a back school compared with an exercise-only regimen according to specified outcome variables. The data from 78 patients with 7 years mean duration of symptoms was analyzed. Three assessments were made: before treatment and 6 and 16 weeks after treatment. Changes in patients' levels of pain, functional disability, and other related variables were compared in the two groups. Almost all variables showed an improvement at 6 weeks. At 16 weeks, functional disability and pain levels showed a significant difference. Back school patients continued to make an improvement. This method of managing low back pain makes maximal use of limited resources and appears to be effective, especially in the longer term.

Adolescent↗
PubMed1993

Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial.

In a randomized, observer-blind trial, 150 men and women, aged 21-64 years, with chronic/subchronic low-back pain, followed one of these three treatment regimens: 1) intensive, dynamic back-muscle exercises; 2) conventional physiotherapy, including isometric exercises for the trunk and leg muscles; and 3) placebo-control treatment involving semihot packs and light traction. Eight treatment sessions were given during the course of 4 weeks, each session lasting 1 hour. The short-term effect was evaluated at the end of the treatment period and 1 month later, and the long-term effect at 6 and 12 months. The evaluations included recording of changes in pain level and assessment of overall treatment effect, which were indicated on visual interval scales. Subgroups of patients could be identified according to their treatment responses: physiotherapy was the superior treatment for the male participants, whereas the intensive back exercises appeared to be most efficient for the female participants. Patients with moderate or hard physical occupations tended toward a better response with physiotherapy, whereas intensive back exercises seemed most effective for those with sedentary/light job functions.

Adult↗
PubMed1999

Management of chronic disabling low back pain with 360 degrees fusion. Results from pain provocation test and concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation in patients with chronic disabling low back pain.

STUDY DESIGN: A follow-up study conducted by an independent observer was performed on the authors' first 29 consecutive patients treated with concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation, for whom at least 2 years had transpired since the operation. OBJECTIVE: To evaluate the results of concurrent instrumented posterior lumbar interbody fusion and posterolateral fusion used to manage chronic disabling low back pain. SUMMARY OF BACKGROUND DATA: Patients chosen for surgery all had a history of chronic disabling low back pain exceeding 2 years and a sick leave period in excess of 6 months (average, 3.4 years). METHODS: From 1989 to 1993, 29 consecutive patients were surgically treated with fusion. The level of fusion was chosen depending on radiologic changes and results from a intradiscal injection provocation test. Bone union was verified by computed tomography scan with 1-mm-thin slices and sagittal reformation, and by a "second look" in all but three patients. All patients were evaluated subsequently by an independent observer in November 1995, 4.7 years after surgery on the average. RESULTS: Bone fusion was obtained in 27 of the 29 patients (93%). There was a highly significant reduction in back and leg pain measurements. Of the 29 patients, the results were excellent in 9 patients (31%), good in 6 patients (21%), fair in 6 patients (21%), and poor in 8 patients (27%). A total of 18 patients (62%) had returned to work. CONCLUSION: The authors consider posterior lumbar interbody fusion with concurrent posterolateral fusion and pedicle screw instrumentation a possible method for managing chronic disabling low back pain.

Adult↗
PubMed2001

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials was performed. OBJECTIVE: To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working-age adults. SUMMARY OF BACKGROUND DATA: Multidisciplinary biopsychosocial rehabilitation programs are widely applied for patients with chronic low back pain. The multidisciplinary biopsychosocial approach for prolonged low back pain could be considered to prevent chronicity. Work site visits and a close relationship with occupational health care might produce results in terms of patients working ability. METHODS: Reviewed randomized controlled trials as well as controlled trials were identified from electronic bibliographic databases, reference checking, and consultation with experts in the rehabilitation field. Four blinded reviewers selected the trials. Two rehabilitation specialists evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results along with the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level evidence. RESULTS: Of 1808 references, only 2 relevant studies were included. Both were considered to be methodologically low-quality randomized controlled trials. The clinical relevance of the studies was sufficient. The level of scientific evidence was moderate, showing that multidisciplinary rehabilitation involving work site visit or more comprehensive occupational health care intervention helps patients return to work faster, makes sick leaves less, and alleviates subjective disability. CONCLUSIONS: There is moderate evidence showing that multidisciplinary rehabilitation for subacute low back pain is effective, and that work site visit increases the effectiveness, but because the analyzed studies had some methodologic shortcomings, an obvious need still exists for high-quality trials in this field.

Humans↗