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At least 199 records · Page 11Linked to original sources
PubMed2001

Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group.

STUDY DESIGN: A systematic review of randomized and nonrandomized controlled trials. SUMMARY OF BACKGROUND DATA: Lumbar supports are used in the treatment of low back pain, but also to prevent the onset (primary prevention) or recurrences of a low back pain episode (secondary prevention). OBJECTIVES: To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain. METHODS: The Medline, Cinahl, and Current Contents databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers independently. A quantitative analysis was performed in which the strength of evidence was classified as strong, moderate, limited or conflicting, and no evidence. RESULTS: Five randomized and two nonrandomized preventive trials and six randomized therapeutic trials were included in the review. Only 4 of the 13 studies were of high quality. There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain. CONCLUSIONS: There continues to be a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance.

Braces↗
PubMed2001

Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain.

STUDY DESIGN: Randomized controlled factorial trial. OBJECTIVE: To assess the effectiveness of a booklet and of physician advice to take regular exercise. SUMMARY OF BACKGROUND DATA: Educational booklets are one of the simplest interventions for back pain but have not been shown to alter pain and function. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise-but there is no evidence that such advice alone improves outcomes. METHOD: Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a detailed self-management booklet, advice to take regular exercise, both, or neither. All groups were advised to mobilize and to use simple analgesia. Patients were telephoned during the first week after entry into the study, and after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patients also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction scale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied). RESULTS: Pain/function scores were obtained in 239 (77%) patients. There were interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findings (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (-8.7, 95% CI -17.4 to -0.03) or advice to exercise (-7.9; -16.7 to 0.8) but much less effect with both together (-0.08, -9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (-3.8, -7.7 to 0.07) and in the exercise advice group (-5.3; -9.3 to -1.38) but much less with both combined (-1.9, -5.8 to 2.1). There was no significant difference between groups in pain/function scores by week 3, when 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet also increased knowledge (Kruskal-Wallis chi2 27.2, P = 0.001). CONCLUSION: Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.

Activities of Daily Living↗
PubMed2005

A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain.

STUDY DESIGN: A systematic review. OBJECTIVE: To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. METHODS: Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. RESULTS: Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain--> worse outcome), several work-related parameters (e.g., high satisfaction--> better outcome), and coping style (less active coping--> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. CONCLUSIONS: It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.

Chronic Disease↗
PubMed1993

The axial torque of the lumbar back muscles: torsion strength of the back muscles.

The maximal, axial torque generated by the lumbar back muscles was determined by modelling the action of the 49 fascicles of longissimus thoracis, iliocostalis lumborum and the lumbar multifidus on radiographs of the lumbar spine of nine young male subjects in upright standing and in full lumbar flexion. No single fascicle exerted more than 2 Nm of axial torque in the upright posture, and the collective torque of all muscles acting a segment did not exceed 5 Nm. All torques were considerably less in full flexion. The lumbar back muscles exert very little torque on the lumbar spine, and contribute only about 5% of the total torque involved in trunk rotation. None of the lumbar back muscles can be considered a rotator. The oblique abdominal muscles are the principal rotators of the trunk. Preventative and rehabilitation programmes concerned with torsion injuries should focus on the abdominal muscles rather than the back muscles for stability in axial rotation.

Back↗
PubMed1999

Toward a better prescription of the prone back extension exercise to strengthen the back muscles.

This study investigated the level of resistance and the level of muscle activation of the prone back exercise. Fifteen male subjects with no previous history of low back injury performed two repetitions of seven exercises. These consisted of four maximal isometric voluntary contractions (MVC) and three prone back extension (PBE) exercises. The subject was lying prone on a table, the upper body was suspended off the end of the table and the legs and thighs were secured to the table with straps. Three starting positions from the horizontal were investigated, 0 degree, 30 degrees and 60 degrees, and were compared with MVC to quantify the level of effort needed to perform the task. The results showed that the three PBE exercises require a level of resistance and a level of muscle activation generally under 40% of the maximum capacity of healthy subjects. Muscle activity of the erector spinae (ES) was slightly greater when the exercise started at 60 degrees, compared to 0 degree and 30 degrees. During the static phase of the PBE exercises, the level of resistance remained at 40% relative to the peak reaction moment of the MVC, but muscular activity of ES tended to work at a lower activity level. In conclusion, since for healthy subjects PBE exercises are low resistance exercises, they seem to be more specifically designed to develop muscular endurance of the back muscles.

Adult↗
PubMed1975

Symposium on back problems in the horse. Backs-clinical signs.

Diseases of the back of horse and man are not comparable owing to the great difference in anatomy and posture. Veterinary surgeons, particularly in the United Kingdom, are often requested to account for a poor performance due to suspected "back trouble" but a complete examination of the horse's back is most difficult and care must be taken first to exclude any limb or foot lesions. Diseases of the bones, nerves and muscles are briefly discussed. Diagnosis must be improved by new radiographic and biochemical tests before the significance of back lesions can be assessed or even treated.

Aging↗
PubMed1992

Controlled trial of a back support ('Lumbotrain') in patients with non-specific low back pain.

A randomized, controlled, parallel-group clinical trial was carried out in general practice to assess the clinical efficacy of a new back support ('Lumbotrain') compared with 'standard therapy' of advice on rest and lifestyle in the treatment of patients with non-specific low back pain. A total of 216 patients entered this study (111 'Lumbotrain' group, 105 control group). All patients were allowed to take 1 g paracetamol up to 4-times daily if necessary for control of pain. Self-assessments were made daily by patients, over a period of 21 days, of pain levels at rest, on activity, at night, and limitation of activity using visual analogue scales. Details were also recorded of their ability to work or not, and the number of doses of paracetamol taken. At the end of the study period, patients assessed their overall response to treatment and those in the 'Lumbotrain' group were questioned on the comfort and ease of use of the back support. A clinical examination was carried out by the doctor at the start and end of the study period and an assessment made of the total range of active and passive back movement. Analysis of the daily diary records showed there were progressive, significant reductions in mean scores for all the pain and activity criteria in both groups and these were significantly greater in the 'Lumbotrain' group from Day 7 onwards. The times taken for reduction of symptom scores to 10% of initial values were significantly less in the 'Lumbotrain' group, such a degree of recovery occurring 2 to 4 days more rapidly than in the control group. A significantly higher proportion of patients in the 'Lumbotrain' group became able to work normally. After 3 weeks, 85% of patients in the 'Lumbotrain' group could work normally, as compared with 67% in the control group (p less than 0.02). Total analgesic consumption during the trial was significantly lower (p less than 0.0001) in the 'Lumbotrain' group (median 24.5 doses) than in the control group (median 51 doses). Overall clinical assessment scores were significantly superior in the 'Lumbotrain' group (p less than 0.002). Improvement was seen in 106 (95%) of 111 patients in the 'Lumbotrain' group, as compared with 79 (77%) of 103 of those in the control group (p less than 0.0002).(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

Back basics: general information for back school participants.

Back schools have been proved to be one of the most effective methods of treatment for patients with chronic back pain and disability, and almost every physical therapy clinic now offers some form of education to their back patients. This chapter has attempted to establish what basic information should be available to a person dealing with a back injury, and to offer a logical manner of presenting this information.

Back Pain↗
PubMed1992

Trunk muscle strength and back muscle endurance in construction workers with and without low back disorders.

The aim of this study was to test the hypothesis that male workers exposed to heavy work and with no lifetime history of a low back disorder (group A) have better trunk muscle strength and back muscle endurance compared to male workers with the same work exposure but with a probable (group B) or definite low back disorder (group C). Group A (n = 42) was clinically negative on physical examination. Group B (n = 75) was clinically negative or uncertain and group C (n = 86) was clinically positive, with current or previous low back disorders occurring in both groups. Group A had a significantly higher mean intraindividual extension/flexion ratio, namely 1.29 versus 1.19, in group C. The mean values for maximum isometric trunk extension and flexion strength did not differ between the groups. The isometric trunk extensor endurance was significantly lower in group C than in both group A and group B.

Adult↗
PubMed1990

Conservative treatment of acute low-back pain. A prospective randomized trial: McKenzie method of treatment versus patient education in "mini back school".

The purpose of this study was to compare the effect of the McKenzie method of treatment with patient education in "mini back school" in patients with acute low-back pain. The study included 100 patients, 23 women and 77 men with the average age 34.4 +/- 9.7 (range 18-61) years. The study included only those who were employed. The patients were randomly allocated to two groups, one group receiving treatment according to the McKenzie technique and the other group receiving education in a "mini back school." Assessments were made after 3 weeks by an independent observer and after 52 weeks they were seen by one of the authors. Patients were assessed on seven variables: return to work, sick-leave during the initial episode, sick-leave during recurrences, recurrences of pain during the year of observation, patients' ability to self-help, pain and movement. Although the effect of attention placebo cannot be ruled out, the results demonstrated that the McKenzie method of treatment for patients with acute low-back pain was superior for five out of seven variables studied. The only variables that did not show any statistically significant differences were sick-leave during recurring episodes of pain and patients' ability to self-help.

Absenteeism↗
PubMed1989

The Swedish back school in chronic low back pain. Part II. Factors predicting the outcome.

The aim of the study was to analyse the factors predicting the outcome of the Swedish back school and spontaneous recovery in chronic low back pain. The predicting variables describing the treatment group (n = 95) and the control group (n = 93) at the initiation of study included sociodemographic factors, variables related to work, severity of low back pain, and a number of clinical measurements and evaluations. The Oswestry Low Back Pain Disability Questionnaire was used for judging recovery factors. It was found that the best predictor for the outcome of the treatment and for spontaneous recovery was work satisfaction.

Back Pain↗
PubMed1983

Back school. An overview with specific reference to the Canadian Back Education Units.

The Canadian Back Education Units (CBEU) in a review of 6418 participants found a significant subjective improvement in 69% of the participants. This figure improved to 80% when only patients who experienced back pain for six months or less were considered. Ninety-seven percent of the participants considered the back education program helpful. Patients who had completed their high school education, who believed that they understood the mechanism of the pain, and who recognized an emotional component to the problem had the best results. Functional improvement was most pronounced in the activities most often performed. Patients with pain persistently radiating below the knee and patients receiving workmen's compensation did not fare as well. Using a computer analysis of the variation in test scores from pretest to the review class, a statistically valid positive correlation was established between the patient's subjective improvement and the amount of information retained. The CBEU are an efficient, effective, well received, and cost-effective therapeutic modality in the conservative treatment of chronic low back pain.

Adult↗
PubMed1995

Ewings sarcoma as an etiology for persistent back pain in a 17-year-old girl after trauma to the back.

Back pain--a common complaint familiar to all physicians--can be either a manifestation of musculoskeletal dysfunction or a symptom of a more serious underlying disease. Unfortunately, the diagnosis can be difficult, and back pain that is not resolved by conservative treatment requires aggressive investigation. The author presents the case history of a 17-year-old patient whose back pain had been extensively evaluated by a series of specialists to no avail until further workup revealed the problem to be Ewing's sarcoma. The steps required to diagnose elusive back pain are presented, together with a brief discussion of cauda equina syndrome and conus medullaris syndrome, components of both of which were found in this patient.

Adolescent↗
PubMed1994

Back pain, sciatica and disability following first-time conventional haemilaminectomy for lumbar disc herniation. Use of "Low Back Pain Rating Scale" as a postal questionnaire.

To determine the value of "Low Back Pain Rating Scale" as a postal questionnaire, a retrospective study was undertaken of patients who had undergone first-time lumbar disc surgery 14-72 months previously. Rate of response was 86% (261/304). From the results, it was concluded that 87% of the patients felt that a satisfactory surgical outcome was obtained; 67% had minor or major functional restrictions of their daily activities; 65% experienced significant low-back symptoms in the period prior to follow-up examination; and 57% experienced sciatica. Thirty-seven patients were receiving pensions in the postoperative period due to continued back pain. "Low Back Pain Rating Scale" used as a postal questionnaire was found to be useful in determining general overall assessment status in patients who had undergone lumbar surgery. This evaluation method could be used as a quality control in future studies regarding this patient group.

Adult↗
PubMed1992

The effect of polymerization of methylmethacrylate on metal-backed and non-metal-backed acetabular components.

Aseptic loosening of the acetabular component has been identified as the main cause of failure of cemented total hip arthroplasty in the long term. Wear of the high-density polyethylene has been implicated as a major contributory factor to loosening. The etiology of wear is multifactorial. The exothermic phase of polymerization of polymethylmethacrylate is associated with a 5.9% volume expansion. Using double-exposure holographic interferometry, the authors examined the influence of polymerization of cement on the internal geometry of a metal-backed cup and two non-metal-backed cups (Charnley 22 mm, Muller 32 mm). The non-metal-backed cups exhibited marked heat concentration points and disrupted fringe patterns, indicating distortion of the internal geometry of the cup. In contradistinction, the metal-backed cup showed good heat dissipation and regular fringe patterns, indicating minimal internal distortion. The differences were not quantified but were visually dramatic. The authors believe this may be an important contributory factor to cup wear in cemented total hip arthroplasty.

Acetabulum↗
PubMedDate not supplied

Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty.

The purpose of this study was to compare the radiographic results of 2 different glenoid component designs. This series consisted of 66 shoulder arthroplasties with primary osteoarthritis divided into 2 groups based on glenoid component type. One group comprised shoulders receiving cemented flat-back polyethylene glenoid implants. The other group comprised shoulders receiving cemented convex-back polyethylene glenoid implants. Immediate postoperative and 2-year postoperative radiographs were evaluated for the presence and progression of periglenoid radiolucencies, and the 2 groups were compared. Radiolucent line scores were calculated and compared for each group. The keeled, convex-back glenoid component was radiographically better than the keeled, flat-back glenoid component.

Adult↗
PubMed1999

Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? Add-Back Consensus Working Group.

OBJECTIVE: To reach a consensus on the role of add-back therapy for patients with endometriosis administered GnRH agonists (GnRH-a). DESIGN: Results of consensus conference reviewing MEDLINE search of English language abstracts of both prospective and retrospective series. SETTING: Consensus conference of 31 specialists in gynecologic surgery and reproductive endocrinology. PATIENT(S): Patients with symptomatic endometriosis who were candidates for GnRH-a therapy in treatment courses ranging in duration from 6 to 12 months. INTERVENTION(S): Oral steroidal and nonsteroidal add-back regimens. MAIN OUTCOME MEASURE(S): Alteration in painful symptoms, extent of disease, vasomotor symptoms, bone mineral density, and serum lipid profile. RESULT(S): When added to GnRH-a for 6 months, both 2.5 mg of norethindrone and 0.625 mg of conjugated equine estrogens with 5 mg/d of medroxyprogesterone acetate provide effective relief of vasomotor symptoms and decrease but do not eliminate bone mineral density loss. During 12 months of GnRH-a therapy, bone mineral density loss is eliminated effectively with an add-back of 5 mg of norethindrone acetate alone or in conjunction with low-dose conjugated equine estrogens. Organic bisphosphonates also may play a role. CONCLUSION(S): In patients with symptomatic endometriosis, the efficacy of GnRH agonists may be preserved and therapy prolonged while overcoming hypoestrogenic side effects with the use of appropriate add-back regimens.

Bone Density↗
PubMed2002

Estimated moments at L5/S1 level and muscular activation of back extensors for six prone back extension exercises in healthy individuals.

The purpose of this study was to identify the prone back extension (PBE) exercises that offer the most resistance to the back extensor muscles. Twenty males with no previous history of low back injury performed two repetitions of eight exercises. These consisted of two maximal isometric voluntary activations (MVA) and six different PBE exercises. The participants, while lying prone on a bench, were asked to raise either their trunk or legs to the horizontal position and hold for one second (static phase) before returning to the original position. The exercises differed according to the particular segments that were raised into extension. To assess the PBE exercises, a biomechanical model was used to estimate the level of load resistance (%MVA) relative to the maximum voluntary activation strength (MVA). In addition, electromyography (EMG) was included to measure the level of muscle activity (%MVE) relative to the maximum voluntary activation EMG (MVE) value reached during the MVA. A significant relationship of 0.86 was found between the mass of the subject and the peak reaction moment during the MVA. Peak level of load resistance averaged around 50% MVA with the exception of exercise no. 5 where the subject had to raise in extension his trunk, legs and arms (65% MVA). The erector spinae (ES) activity level reached a peak value of 61% MVE for exercise no. 5. In the exercises where only the trunk was lifted, the peak level of ES was below 47% MVE and the average activity during the static phase reached approximately 26% MVE. For healthy individuals PBE exercises can be considered low intensity exercises (< 50% MVA; except exercise no. 5) and can be used to improve the endurance of the back muscles.

Adolescent↗