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At least 253 records · Page 14Linked to original sources
PubMed2006

Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain.

STUDY DESIGN: Longitudinal masked, double-controlled cohort study. OBJECTIVES: To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA: The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS: Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS: Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION: Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

Aged↗
PubMed2003

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain.

AIM: To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities. METHODS: The study comprised 620 adolescents. A questionnaire was used to elicit the characteristics of LBP. Perceived social support and affect were investigated using the Personal Resource Questionnaire (PRQ) and the Positive Affect Negative Affect Scale (PANAS), respectively. Comparisons were made between adolescents with LBP and adolescents without LBP. Within the LBP group, answers from adolescents appealing for medical advice were compared with those who did not seek advice. Another comparison was done between adolescents who reduced their activities and those who did not. Descriptive statistics, the median test for two samples, a chi2 test or Fisher's exact probability test and logistic regression analysis were used for data analysis. RESULTS: Month prevalence of LBP was 24.7%. Thirteen adolescents visited a physician or received treatment, pain severity being the sole factor associated with the decision. Fifteen adolescents reduced their sports activities and 11 reduced or stopped other leisure activities. Pain severity and negative affect were the main associated factors. CONCLUSION: The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.

Adolescent↗
PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Adult↗
PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure]. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

Adult↗
PubMed1988

Psychological factors in the treatment of chronic low back pain. Follow-up study of a back school intervention.

The aim of the study was to investigate the role of certain psychological factors (e.g. neurotic features, alexithymia, and hostility) as intervening variables modifying the outcome of the back school intervention or correlating with spontaneous recovery. The results indicated that those patients who reacted favorably to the back school intervention could be described as emotionally well adjusted and controlled showing relatively good cognitive capacity with undisturbed reality testing. The poor responders in the treatment group were less capable cognitively and not so well balanced emotionally. Patients showing spontaneous recovery in the control group were characterized by a more lively and less controlled way of expressing emotions and affects. In contrast to these, patients who showed increasing disability during the 1-year follow-up were characterized by restricted expression of emotions and affects indicating alexithymia.

Adult↗
PubMed1991

Personality traits in patients with acute low-back pain. A comparison with chronic low-back pain patients.

This study investigates the possibilities to identify, within a group of acute low-back pain patients, individuals with psychogenic etiology to pain. 26 acute back pain patients and 25 healthy control subjects were tested with the Minnesota Multiphasic Personality Inventory Hysteria: (Hs), Hypochondria (Hy), Depression (D); Cesarek-Marke Personality Scale: Aggression (Agg), Defence of status (Dst), Guilt (Gui); Mood Adjective Check List: (Hedonism, Activity, Calmness = Hed, Act, Clm) and a 'pain questionnaire' including 'pain drawing'. Differences between groups and correlation patterns between test variables indicate that a combination of Hs, Hy, D, Dst, Gui, Hed, Act, Clm as well as predisposition to somatization, Som (a quantification of pain drawing) provides a useful predictive screening instrument.

Acute Disease↗
PubMed1998

Avoidance and confrontation of painful, back-straining movements in chronic back pain patients.

Avoidance of painful activities has been proposed to be an important risk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants were first classified as avoiders or confronters. In comparison with confronters, avoiders reported greater frequency and duration of pain, higher fear of pain and injury, more disability in daily living, and more attention to back sensations. Finally, avoiders reported more fear of (re)injury during the behavioral test and had a worse performance than confronters. The results suggest a close link between the fear of pain/(re)injury on one hand and avoidance behavior and physical deconditioning on the other hand.

Activities of Daily Living↗
PubMed2002

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.

OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.

Adolescent↗
PubMed1996

Scientific application of sports medicine principles for acute low back problems. The Agency for Health Care Policy and Research Low Back Guideline Panel (AHCPR, Guideline #14)

The Agency for Health Care Policy and Research Low Back Guideline Panel (AHCPR, Guideline #14) truly brought to life sports medicine principles in the care of the most common and expensive musculoskeletal problem by focusing on the basic activity paradigm of musculoskeletal limitations. Twenty-three experts and seven international consultants led a review of over 10,000 abstracts and evaluation of over 4,600 articles. This effort was to establish scientifically how any clinician can: 1) safely be sure that the patient only has a back problem, 2) offer safe options for comfort, and 3) concentrate on the real treatment for an activity intolerance with sports medicine principles: activity, not rest, begets activity tolerance. Evidence tables and their subsequent derivation as "Finding and Recommendation Statements" provide an understanding of what medical science can and cannot presently support as predictable.

Clinical Trials as Topic↗
PubMed2004

Differences in back extensor strength between smokers and nonsmokers with and without low back pain.

STUDY DESIGN: Cross-sectional study comparing isometric lumbar extensor strength (ILES) in individuals who smoke and nonsmokers with and without low back pain (LBP). OBJECTIVES: To examine the differences in ILES between individuals who smoke and nonsmokers with and without LBP. BACKGROUND: Given the evidence for general muscle weakness in individuals who smoke and in individuals with LBP, we were interested in examining the interrelationships between back strength, in particular ILES, and LBP in individuals who smoke and nonsmokers. METHODS AND MEASURES: The study involved 76 men (age range, 30-50 years) in 4 groups, namely, nonsmokers with LBP (NS-LBP), a control group of nonsmokers without LBP (NS-C), smokers with LBP (S-LBP), and a control group of smokers without LBP (S-C). ILES was measured at 7 angles of lumbar flexion, specifically 72 degrees, 60 degrees, 48 degrees, 36 degrees, 24 degrees, 12 degrees, and 0 degrees. ANOVA and Scheffe post hoc comparison tests were used to analyze the data. RESULTS: Nonsmokers with LBP had less muscle strength than those without LBP (P<.01). However, the strength of smokers with and without LBP was comparable (P>.05). Both groups of individuals who did not smoke were stronger than the 2 groups comprised of smokers. CONCLUSIONS: Individuals who smoke were weaker than those who did not smoke, but no difference in strength was noted between smokers with and without LBP. Although smoking appears to be an important cofactor in the etiology of LBP, the degree to which smoking is a primary, secondary, or a component of a combined etiology warrants further study.

Adult↗
PubMed2003

Rigorously assessing whether the data backs the back school.

A rigorous between-subjects methodology employing independent random samples and having broad clinical applicability was designed and implemented to evaluate the effectiveness of back safety and patient transfer training interventions for both hospital nurses and nursing assistants. Effects upon self-efficacy, cognitive, and affective measures are assessed for each of three back safety procedures. The design solves the problem of obtaining randomly assigned independent controls where all experimental subjects must participate in the training interventions.

Back Injuries↗
PubMed2005

Getting your back back to work: pain relief--where to start?

Dental health care workers are vulnerable to back and neck pain resulting from poor occupational posture. While numerous choices exist for treatment, this article will provide them with a practical approach to seeking out appropriate care for this common malady. The McKenzie treatment approach is discussed and recommendations for its application are presented to provide the reader with a starting point for treatment. For the dental health care worker experiencing pain and dysfunction of the back and/or neck, as more than half will during their careers, this article will seek to provide an overview of potential causes while creating a roadmap for seeking the most appropriate conservative "antidote" for their care.

Back Pain↗
PubMed2006

[Low back pain in 2006: back to the root].

Low back pain is a major burden for health care. According to the International Classification of Function, it is a disability of complex origin. Risk factors for chronification are of psychosocial and not physical nature. Primary targets of treatment should be physical fitness and the self-management of problem by the patient. Awareness of the psychosocial factors (yellow, blue and black flags) which can disturb occupational reintegration should be developed. Rehabilitation is based on measures to modify patient's beliefs and fitness. The prescribed treatment should aim to relieve pain, correct disability, prevent relapses, inform and educate the patient. Every low back pain sufferer which does not improve in 1 month should be sent to a team skilled in handling this kind of problem.

Humans↗
PubMed1991

A comparison of the characteristics of preferred low-back motion of normal subjects and low-back-pain patients.

The purpose of this study was to compare the preferred low-back motion of normal subjects and low-back-pain patients. Each subject performed a maximum isometric flexion trial followed by repeated flexion and extension against a relative resistance set at 50% of the recorded maximum flexion isometric torque. The subjects were instructed to move at their own pace through their preferred movement range until either exhaustion or for 120s. The results showed that the groups differed significantly in their preferred motion characteristics, although the performances were equally consistent.

Adult↗
PubMed1988

A comparison between the Minnesota Multiphasic Personality Inventory and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain.

Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain have been equivocal. The Mensana Clinic Back Pain Test (MPT) was able to predict, with some degree of success, patients who had a definite organic pathologic condition. However, the MMPI measures personality traits, whereas the MPT measures the impact of pain on a patient's life. To determine which of the two tests would be a better predictor of actual physical abnormalities, and hence valid pain complaints, a comparison was undertaken between the two tests. The charts of 83 patients admitted to the Neurosurgery Service of Johns Hopkins Hospital with complaints of back pain were assessed. MMPI test results, as well as test results for the MPT, were compared to the presence or absence of pathologic conditions on electromyography, nerve conduction velocity studies, thermography, myelogram, or computerized axial tomography scan. The MPT had a correlation factor of -.59700, that was significant as P = .000005. Of the 52 patients scoring 17 points or less on the MPT, 85% had objective physical abnormalities, considered moderate or severe by blind review. Of the 31 patients scoring 18 points or greater on the MPT, only 26% had objective physical findings that were considered moderate or severe. Only the F scale (faking badly) of the MMPI correlated with objective physical abnormalities (r = .21340, P less than .033). However, 60% of the patients with T scores of less than 70 on the F scale had objective findings, whereas 75% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗
PubMed1988

Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients.

Mobility of hips and lumbar spine were measured in 301 men and 175 women who were in employment but suffered from chronic or recurrent low-back pain. The degree of low-back pain (LBP) was assessed with a questionnaire. Hip flexion, extension, internal rotation, and hamstring flexibility in the men, and hip flexion and extension in the women had statistically significant negative correlations with LBP. Among the correlations between hip and lumbar spinal mobility, hip flexion and extension with lumbar rotation were strongest.

Adult↗
PubMed1993

Trunk strength testing with iso-machines. Part 2: Experimental evaluation of the Cybex II Back Testing System in normal subjects and patients with chronic low back pain.

This experimental evaluation of Cybex II isokinetic measurement was based on 70 normal subjects and 120 patients with chronic low back pain. It considered: reliability and learning effect; discrimination of individual patients versus normal subjects; relationship to clinical measures; assessment of effort; and a prospective 2-year follow-up of normal subjects to predict future low back pain.

Adult↗
PubMed1996

[Guidelines for treating low back pain in primary care. The Israeli Low Back Pain Guideline Group].

Low back pain (LBP) is a common problem in primary care, the successful management of which poses special challenges for patients and practitioners alike. It has been estimated that all adults will suffer LBP sometime during their lifetimes. It is one of the most frequent reasons for visiting a primary care physician, yet practitioners often find it difficult and frustrating to treat. This medical protocol is concerned with the diagnosis, treatment, and follow-up of low back pain in adults. It was developed for community-based, primary care physicians (general practitioners, family physicians, and internists) to serve as a general outline, to be adjusted in accord with the individual's circumstances. The protocol provides a "Ten Commandments" for the care of LBP, outlines the background of the problem, presents an overall algorithm and deals with issues of diagnosis, imaging, and treatment. In general, LBP in primary care is conceived of as a benign ailment, and emphasis is placed on reducing pain, resuming functioning and returning to work. The main task of the physician is to distinguish the less than 10% of cases with serious, specific causes of LBP from the more than 90% with nonspecific etiologies. In the great majority of patients, imaging studies such as X-ray, CT, MRI, and bone scan, and also EEG are unnecessary.

Family Practice↗