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PubMed2005

Effects of a media campaign on back beliefs is sustained 3 years after its cessation.

STUDY DESIGN: Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population. OBJECTIVE: To measure the magnitude of any sustained change in population beliefs about back pain 3 years after cessation of a population-based intervention designed to alter beliefs about back pain. SUMMARY OF BACKGROUND DATA: A media campaign, which ran between September 1997 and December 1999 in Victoria, Australia, provided simple evidence-based advice about back pain. Following the campaign, there were significant improvements in both community and physicians' beliefs about back pain, as well as a decline in number of workers' compensation back claims. METHODS: The campaign's impact on population beliefs about back pain and fear-avoidance beliefs was measured using telephone surveys. Demographically identical population groups in Victoria and the adjacent control state, New South Wales, were surveyed at 4 times: before, during, immediately after, and 3 years after the media campaign in Victoria (surveys 1-4, respectively). Back beliefs were measured using the Back Beliefs Questionnaire (BBQ) (possible score 9-45, for which a higher score indicates a more positive belief about low back trouble). Fear-avoidance beliefs were measured using the Fear-Avoidance Beliefs Questionnaire consisting of 2 subscales for physical activity and work activity (possible scores 0-24 and 0-36, respectively), for which a lower score indicates fewer fear-avoidance beliefs. RESULTS: A total of 6230 individuals in the general population completed the surveys. Large statistically significant improvements in population beliefs about back pain were still observed in Victoria 3 years after cessation of the campaign (mean scores on the BBQ were 26.5, 28.4, 29.7, and 28.8 for surveys 1-4, respectively). No changes were observed in New South Wales (mean scores on the BBQ were 26.3, 26.2, 26.3, and 26.1 for surveys 1-4, respectively). Of those individuals who reported back pain during the previous year, fear-avoidance beliefs about physical activity in Victoria were also significantly better than at baseline (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity were 14.0, 12.5, 11.6, and 12.3 for surveys 1-4, respectively). CONCLUSIONS: Significant sustained improvements in population beliefs about back pain were observed 3 years after cessation of a media campaign of provision of positive messages about back pain. This result provides further evidence that a primary preventive strategy of altering population beliefs about back pain may be a highly effective way for reducing back-related disability.

Adolescent↗
PubMedDate not supplied

Is low-back pain prevalent among Kuwaiti children and adolescents? A governorate-based study.

OBJECTIVE: To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. SUBJECTS AND METHODS: A cross-sectional multistage stratified random sample of 400 schoolchildren (199 males and 201 females) of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. RESULTS: According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% (50.8% in male and 64.7% in female students), while the point prevalence was 35% (20.6% in male and 39.3% in female students). More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students (92.1% in males, 84.6% in females) reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students (58.4%, compared to females 36.2%) reported low-back pain caused by accident or with duration of recovery less than a week (21.8% for males as compared to 16.2% for female students). Female students reported more recurrent or continual low-back pain. CONCLUSION: Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students.

Adolescent↗
PubMed2005

Seat inclination, use of lumbar support and low-back pain of taxi drivers.

OBJECTIVES: Epidemiologic evidence supporting optimal seating is limited and inconsistent. This cross-sectional study was conducted to examine the association between seat inclination, use of lumbar support, and the prevalence of clinically significant low-back pain among taxi drivers METHODS: A digital inclinometer was used to measure inclinations of seat surfaces (theta(seat)) and backrests (theta(back)), and calculate the back-to-thigh angle (theta(back-thigh)). Structured interviews were conducted to gather information on the use of lumbar support and the prevalence of low-back pain that had led to medical attention or absence from driving in the past month. A multiple logistic regression analysis was used to estimate the prevalence odds ratio (OR) with adjustment for age, body mass index, professional seniority, monthly driving hours, and the intensity of exposure to whole-body vibration. RESULTS: Among 224 drivers, the mean theta(seat), and theta(backrest) were 14.5 (SD 9.6) and 95.1 (SD 2.7) degrees, respectively, resulting in theta(back-thigh) of 80.6 (SD 9.3) degrees. Fifty-five percent used a lumbar support regularly, but 25% reportedly had significant low-back pain. The prevalence of low-back pain was 23% among those with theta(back-thigh) <86 degrees, 37% for those with a theta(back-thigh) of 86 approximately 91 degrees, and 9% for a theta(back-thigh) of >91 degrees. The adjusted OR comparing those with a theta(back-thigh) of < or = 91 degrees to those with a theta(back-thigh) of >91 degrees was 5.11 [95% confidence interval (95% CI) 1.07 approximately 24.4]. For regularly using drivers versus those not using lumbar support, the prevalence of low-back pain was 18% versus 34%, with an adjusted OR of 0.33 (95% CI 0.16 approximately 0.68). Neither theta(seat) nor theta(backrest) alone was significantly associated with low-back pain. CONCLUSIONS: The epidemiologic observation of this study was consistent with the results of prior biomechanical studies on appropriate seat inclinations and the use of lumbar support. Prospective studies are needed to confirm the true beneficial effects of these seating parameters.

Automobile Driving↗
PubMed1998

The association of radiographically detected vertebral fractures with back pain and function: a prospective study.

BACKGROUND: Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of these fractures remains uncertain. OBJECTIVE: To determine the association of new vertebral fractures with back pain and back-related functional limitation in older women. DESIGN: Prospective observational study. SETTING: Multicenter Study of Osteoporotic Fractures. PARTICIPANTS: 7223 white women aged 65 years and older. MEASUREMENTS: Lateral spine radiographs were obtained at baseline and at a follow-up examination an average of 3.7 years later. Prevalent and incident radiographic vertebral fractures were assessed by quantitative morphometry. Frequency and severity of back pain, disability in doing six activities involving the back, and days of bed rest and days of limited activity due to back pain were assessed annually by questionnaire during follow-up. RESULTS: Among women without a vertebral fracture at baseline, those with at least one incident vertebral fracture were more likely to have increased back pain (odds ratio [OR], 2.4 [95% CI, 1.7 to 3.3]) and back disability (OR, 2.6 [CI, 1.9 to 3.7]) and at least 1 day of bed rest due to back pain (OR, 6.7 [CI, 4.4 to 10.2]) and 7 days of limited activity due to back pain per year (OR, 3.8 [CI, 2.7 to 5.0]). Among women with a fracture at baseline, those with an incident vertebral fracture also had a greater risk for increased back pain (OR, 2.0 [CI, 1.4 to 2.8]) and back disability (OR, 2.2 [CI, 1.5 to 3.1]) and at least 1 day of bed rest (OR, 7.9 [CI, 4.9 to 12.9]) and 7 days of limited activity per year (OR, 3.5 [CI, 2.4 to 5.0]). Women with incident fracture had about 10 additional limited-activity days and 1 to 2 days of bed rest per year. New vertebral fractures that did not come to medical attention were associated with increased back pain and functional limitation. CONCLUSION: New vertebral fractures, even those not recognized clinically, are associated with substantial increases in back pain and functional limitation due to back pain in older white women. Prevention of new vertebral fractures should reduce the burden of back pain and functional limitation in women with vertebral osteoporosis.

Activities of Daily Living↗
PubMed2006

Prevalence and characteristics of upper or mid-back pain in Finnish men.

STUDY DESIGN: Descriptive epidemiologic study. OBJECTIVES: To examine the 1-year prevalence, severity, and frequency of mid-back pain in a general population sample of men, with comparisons to neck and low back pain. SUMMARY OF BACKGROUND DATA: No previous studies reporting the characteristics of mid-back pain in a general population were found. METHODS: A total of 600 Finnish men 35 to 70 years of age were drawn from a population-based twin sample and interviewed with standardized pain questions. RESULTS: The 1-year prevalence of mid-back pain was 17.0% (95% confidence interval, 14.3-19.7) compared to 64.0% (95% confidence interval, 60.6-67.5) for neck and 66.8% (95% confidence interval, 63.4-70.3) for low back pain. The frequency of pain over the previous year among those with mid- and low back pain was less than for neck pain. The mean severity of the worst pain episode was highest for low back pain followed by mid-back and neck pain, which were similar. Associated disability tended to be less frequent from mid-back pain (23.5% vs. 30.3%-41.1%). Odds ratios for neck and low back pain when mid-back pain was reported were 2.32 and 2.86, respectively. CONCLUSION: The prevalence of mid-back pain was approximately one fourth that of neck and low back pain and was somewhat less likely to be disabling. In cases of mid-back pain, spinal comorbidity was nearly always reported.

Adult↗
PubMed1999

Back pain and agricultural work among farmers: an analysis of the Colorado Farm Family Health and Hazard Surveillance Survey.

BACKGROUND: Back pain is the most prevalent occupational health problem experienced by much of the world's workforce. However, agricultural work-related back pain occurring among US farmers working on small operations or family farms is usually not included in surveillance. With data collected by Colorado Farm Family Health and Hazard Surveillance Survey, this study reports characteristics of and risk factors for back pain among adult farmers living in eight Colorado counties. METHODS: A stratified probability sample of 500 farms was selected in proportion to the number of farms in study areas. During the 4-year period from 1993 through 1996, 458 farms were enrolled in the study and 759 farmers were interviewed using a questionnaire. Information on self-reported back pain and potential risk factors among 742 white farmers was evaluated and reported here. RESULTS: A total of 194 farmers (26.2%) reported to have had at least one episode of back pain lasting for 1 week or more. Males had a slightly higher prevalence of back pain than females (28.6% vs. 22.5%) and the lower back was the predominantly affected part of body among both males and females. In 45.4% of males and 43.9% of females back pain was brought on by repeated activities. Males' activities at work were more likely to cause back pain while females' activities at home were more likely to cause back pain. Three factors were found to be significantly associated with back pain: being depressed (odds ratio (OR) = 3.68, 95% confidence interval (CI) = 2.23-6.09), farming/ranching as main activities (OR = 1.66, CI = 1.17-2.36), and worked in agriculture for 10 to 29 years (OR = 1.62, CI = 1.14-2.30). CONCLUSIONS: Our analyses indicate that back pain is an occupational health problem among farmers on small operations or family farms and that back pain affected males and females differently. The finding of significant positive associations between depression, farming activities, and back pain warrants further attention.

Adult↗
PubMed2006

Back posture education in elementary schoolchildren: a 2-year follow-up study.

Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13-14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters' lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 +/- 0.8 years) and 101 controls (mean age 13.2 +/- 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential.

Back↗
PubMed1996

The relation of self-reported back pain to psychosocial, behavioral, and health-related factors in a working population in Switzerland.

Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. We studied the simultaneous association of various factors representing psychosocial, behavioral, and health-related dimensions to self-reported back pain. Data from the Berne Workplace Health Project on 850 employed men and women was analyzed. Back pain was operationalized by a dichotomized variable (having suffered moderately to severely from back pain in the preceding four weeks). The theoretical model guiding the underlying project was a general demand-resource model. Variables that--according to that model--were hypothesized to be related to back pain as well as more specific factors--like physical work load--were analyzed by stepwise logistic regression analysis. In men, there was a statistical trend (P < 0.1) for several work-related factors (low job discretion, high job demands, low job satisfaction). In women, dissatisfaction with salary was the only work-related factor associated with back pain. There was no significant association between private context factors, like poor social network or high demands/low control, and back pain. Only in men, the likelihood of back pain increased with age, while only in women, back pain was associated with emotional problems (individual factors). Among the behavioral factors, smoking was associated to back pain in men, while in women none of the behavioral factors was significant. In both men and women reporting more than two functional symptoms and a history of intestinal problems were associated to back pain. All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.

Adult↗
PubMed1998

Risk factors for back pain incidence in industry: a prospective study.

The objective of this study was to examine the relationship between physical and psychological risk factors on the one hand, and the occurrence of new episodes of back pain on the other hand. A prospective study was conducted with 12 months follow-up by means of self-administered questionnaires. The study took place in the Cargo Department of a major Dutch airline company. The subjects for this study were 270 workers involved in heavy physical work. Only workers without back pain at baseline were included. Self-reported back pain and sick leave due to back pain during the follow-up period were measured. Of the 238 workers included in the analysis, 73 (31%) developed a new episode of back pain during the follow-up period, and 27 (11%) subjects reported sick leave due to back pain. Multiple logistic regression analysis showed that the history of back pain was the best predictor for the occurrence of a new episode of back pain during follow-up (OR 9.8; 95% CI 2.8-34.4 for subjects who had back pain more than twice in the past year). Low job satisfaction was also associated with an increased risk for the occurrence of back pain during follow-up (OR 1.2; 95% CI 1.01-1.4). Riding a forklift truck appeared to be a protective factor for the occurrence of back pain (OR 0.7; 95% CI 0.5-0.99). In this study the best predictors for the occurrence of back pain were the history of back complaints and low job satisfaction. Although it needs to be confirmed by future intervention studies, the results indicate that increasing job satisfaction may be a successful (co-)intervention for the prevention of back pain at the workplace.

Adult↗
PubMed1996

Use of back belts in occupational settings.

Studies of the biomechanical and physiological mechanisms of action concerning the prophylactic use of back belts to prevent occupational low back injuries are limited in number and present conflicting findings. The epidemiological data concerning the efficacy of back belts in the prevention of occupational low back injuries are not sufficient to warrant general use of back belts in the occupational setting for uninjured workers. There is actually a potential for increasing the degree of low back injury with general application of back belts in occupational settings. In sum, there are insufficient data in the scientific literature to indicate that general use of back belts in occupational settings is appropriate for uninjured workers. Because the increase in use of soft canvas back belts has been fairly recent, physical and epidemiological studies pertaining specifically to soft canvas back belts are extremely limited. The sample size of many physical investigations also is extremely limited. In many instances, studies concerning the role of back belts in preventing occupational low back injuries have examined conditions that do not apply directly to the use of soft canvas back belts. For these reasons, further studies in both the physical and epidemiological realms are necessary before it is appropriate to use commonly constructed back belts as personal protective equipment in occupational settings.

Biomechanical Phenomena↗
PubMed2005

Outcome of subacute low back pain: influence of patients' and rheumatologists' characteristics.

OBJECTIVES: To assess the outcome of subacute low back pain, to identify the characteristics of patients and physicians which were related to outcome and to evaluate the influence of rheumatologists' beliefs about back pain on their following the guidelines for physical and occupational activity. METHODS DESIGN: a longitudinal descriptive survey. SETTING: a secondary care practice in France. PARTICIPANTS: 266 rheumatologists; 440 patients with subacute low back pain. OUTCOME MEASURES: the main outcome measure was persistence of back pain 3 months after baseline evaluation. A self-administered questionnaire for physicians assessed attitudes and beliefs about back pain [Fear-Avoidance Beliefs Questionnaire (FABQ)], and one for patients assessed pain, perceived handicap and disability (Quebec Scale), anxiety and depression (Hospital Anxiety Depression Questionnaire), and beliefs about back pain (FABQ). RESULTS: Forty per cent of patients had persistent low back pain at 3 months; 5.5% of these had sciatica. A total of 10% of rheumatologists and 68% of patients at baseline had a high FABQ physical score (phys; >14). Determinants of outcomes were work-related back pain [odds ratio (OR) = 3.37; 95% confidence interval (CI) 1.08-5.17], anxiety (OR = 2.41; 95% CI 1.44-4.09), sex (female OR = 2.03; 95% CI 1.30-3.18) and patients' beliefs about back pain at work (OR = 1.02; 95% CI 1.00-1.05). Physicians with high FABQ physical scores were less likely to follow guidelines on prescribing rest and occupational activity for back pain. CONCLUSION: Back pain commonly persists 3 months later in patients with subacute low back pain. Patients and rheumatologists still have negative beliefs about back pain. Rheumatologists' beliefs influence their following guidelines on physical and occupational activities. National education programmes about low back pain are needed in France.

Acute Disease↗
PubMed1998

One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up.

STUDY DESIGN: A study of postural control during one-footed and externally disturbed two-footed stance among healthy control subjects and patients with chronic low back pain at the beginning of a functional back restoration program and 6 months later at follow-up examination. OBJECTIVES: To study postural control cross-sectionally among control subjects and patients with low back pain, and to evaluate the effects of functional restoration on the postural control parameters in a follow-up examination. SUMMARY OF BACKGROUND DATA: Deficits of motor skills and coordination have been reported in association with musculoskeletal disorders. It has been found that patients with chronic low back pain have impaired psychomotor control, but the impairment is reversible with successful low back rehabilitation. It is insufficiently known how functional activation and intensive physical training affect postural control. METHODS: Sixty-one healthy volunteers (32 men, 29 women) and altogether 99 patients with low back pain participated in the study. Sixty-eight patients (33 men, 35 women) had moderate and 31 (18 men, 13 women) had severe low back pain. Postural stability was measured with a force platform. In two-footed stance, vibration stimulation on calf and back muscles was used to disturb the balance. Center point of force-velocity (cm/sec), average position shift in anteroposterior direction (cm), and maximal position shift in lateral direction (cm) were used as the parameters. RESULTS: Reliability of all tests was acceptable. Center point of force-velocity was the most sensitive parameter and the one-footed measurement the most sensitivetest for evaluating postural stability. At the beginning, the patients with severe low back pain had poorer one-footed postural control compared with the control subjects (P = 0.0003). The subgroup of patients with moderate low back pain participated in the restoration program. The outcome of the restoration program was considered good if the disability because of low back pain (Oswestry index) decreased during the restoration program and poor if the disability increased or did not change. The one-footed postural stability remained primarily at the same level as the initial results in the control and good outcome groups, but became significantly poorer in the poor outcome group. The difference between poor outcome and control groups was statistically significant (P = 0.04). CONCLUSIONS: Impaired postural stability seems to be one factor in multidimensional symptomatology of patients with chronic low back trouble. Postural stability is easily disturbed in case of impairment in strength, coordination, or effective coupling of muscles in the lumbar and pelvic area. Patients with chronic low back pain seem to experience impairment in these functions, which should be taken into consideration when back rehabilitation programs are planned.

Adult↗
PubMed1999

Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study.

STUDY DESIGN: A 5-year prospective study. OBJECTIVES: To investigate trunk muscle weakness as a risk factor for low back pain in asymptomatic volunteers. SUMMARY OF BACKGROUND DATA: Muscle strength has not been sufficiently studied as a risk factor for low back pain. METHODS: The study participants included 30 male and 37 female volunteers (mean age, 17 +/- 2 years), who neither reported nor had ever been treated for low back pain. Trunk muscle strength was measured isokinetically (60 degrees/sec), using the trunk extension and flexion and torso rotation units. The peak torques of the volunteers' extension, flexion, rightward rotation, and leftward rotation were measured, and the agonist/antagonist ratios were calculated as extension/flexion and left rotation/right rotation ratio. The volunteers then were followed prospectively for 5 years to determine the incidence of low back pain and were classified into a non-low back pain group (volunteers with no low back pain during the 5-year follow-up period) and a low back pain group (volunteers who experienced low back pain during this period). RESULTS: The low back pain group consisted of 8 male and 10 female volunteers. There were no significant differences between the non-low back pain group and the low back pain group regarding age, height, weight, the peak torque values, or the left rotation/right rotation ratio. However, the extension/flexion ratio of the low back pain group (men, 0.96 +/- 0.27; women, 0.77 +/- 0.19) demonstrated significantly lower values than that of the non-low back pain group (1.23 +/- 0.28 and 1.00 +/- 0.16 for men and women, respectively, P < 0.05). CONCLUSIONS: An imbalance in trunk muscle strength, i.e., lower extensor muscle strength than flexor muscle strength, might be one risk factor for low back pain.

Adolescent↗
PubMed1999

Personal risk factors for first-time low back pain.

STUDY DESIGN: A prospective study of personal risk factors for first-time low back pain. OBJECTIVES: To construct and validate a multivariate model to predict low back pain. SUMMARY OF BACKGROUND DATA: Various physical and psychological factors have been reported to increase the risk of low back pain, but conflicting results may be attributable to inaccurate "clinical" measures and to poorly validated statistical models. METHODS: A total of 403 health care workers aged 18-40 years volunteered for the study. None had any history of "serious" back pain requiring medical attention or time off work. The volunteers completed the following questionnaires: the modified somatic perception questionnaire, the Zung depression scale, and the Health Locus of Control. Anthropometric factors were quantified using standard techniques. The 3Space Isotrak device (Polhemus, VT) was used to measure lumbar curvature and hip and lumbar spine mobility. Leg and back strength and back muscle fatiguability were measured in functional postures. Postal follow-up questionnaires, sent after 6, 12, 18, 24, 30, and 36 months, inquired about back pain, and multivariate logistic regression was used to identify risk factors at each follow-up. RESULTS: The response rate fell from 99% at 12 months to 90% at 36 months, at which time 90 volunteers reported "serious" back pain and 266 reported "any" back pain. The following were consistent predictors of serious back pain: reduced range of lumbar lateral bending, a long back, reduced lumbar lordosis, increased psychological distress, and previous nonserious low back pain. Only the latter three were consistent predictors of "any" back pain. Physical factors had the most influence in a sub-population of volunteers who were new to the job. CONCLUSIONS: Personal risk factors explained up to 12% of first-time low back pain.

Adolescent↗
PubMed2000

Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain.

STUDY DESIGN: A 22-month prospective cohort study. OBJECTIVES: To describe the course of an inception cohort of patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Chronic low back pain is a debilitating condition with great medical and social cost. METHODS: A cohort of 1246 patients with acute low back pain who sought treatment from 208 North Carolina providers was observed. Patients who developed chronic low back pain were identified. Entry criteria were back pain of less than 10 weeks' duration, no previous care for this episode of low back pain, no previous spine surgery, not pregnant, no nonskin malignancy, and access to a telephone. The providers were of four types: primary care medical doctors, doctors of Chiropractic, orthopedic surgeons, and health maintenance organization-based primary care providers. Patients were contacted by telephone shortly after enrollment and at 2, 4, 8, 12, and 24 weeks, with a final interview at 22 months. Patient functional status, care-seeking, and satisfaction were evaluated. RESULTS: Ninety-six patients had chronic, continuous symptoms for 3 months, forming the inception cohort of chronic low back pain. A valid, reliable measure of back-specific functional disability also was used. Predictors of the development of chronicity were poor baseline functional status and sciatica. A more powerful predictor of chronicity was poor functional status at 4 weeks. Two thirds of patients with chronic low back pain at 3 months had functionally disabling symptoms at 22 months, and a majority of these were employed. Satisfaction with care was low. Forty-six patients (2.6% of the entire cohort) underwent surgery, with no statistically significant difference in surgical rates among initial provider strata. Patients who underwent surgery after 3 months had a Roland disability score at 22 months of 10 (7.7, 12.3). Forty-one percent of patients with chronic low back pain see an orthopedic or neurologic surgeon. Chronic low back pain occurs in 7.7% of patients who seek care for acute low back pain, with unremitting pain for 22 months in 4.7%. CONCLUSION: Once established, chronic low back pain is persistent. Most patients with chronic low back pain seek little care, and a majority are employed. Future research should emphasize maintenance of employment and function.

Adult↗
PubMed2000

Socioeconomic factors and disability retirement from back pain: a 1983-1993 population-based prospective study in Norway.

STUDY DESIGN: A prospective observational study with an 11-year follow-up period was performed. OBJECTIVE: To investigate the influence of education and socioeconomic position on the incidence of permanent disability retirement from back pain. SUMMARY OF BACKGROUND DATA: Early retirement because of back pain is the extreme end point of a disabling process that is a great burden to the individual and costly for the society. Groups of employees at particular risk for permanent back pain disability need to be identified. METHODS: All employed men and women in Norway between the ages of 20 and 53 years in 1980 were included (n = 1,333,556). Outcome measures were disability retirement from inflammatory back pain (ICD-9 code 720) and noninflammatory back pain (ICD-9 codes 721 to 724). RESULTS: The 11-year cumulative incidence was 0.15% (n = 1990) for disability retirement from inflammatory back pain and 1. 64% (n = 21,829) for noninflammatory back pain and was somewhat higher in women than in men. Each year of formal education was independently associated with decreased risk for disability retirement from noninflammatory back pain (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.77-0.79) and from inflammatory back pain (OR = 0.83; 95% CI = 0.81-0.86). Whereas disability from inflammatory back pain was moderately associated with socioeconomic status, there was a consistent upward trend in the association between disability retirement from noninflammatory back pain and lower socioeconomic position. The OR for unskilled workers was 3.1 (95% CI = 2.6-3.7) for men and 2.1 (95% CI = 1.7-2.5) for women, as compared with that of higher professionals. Stepwise analyses suggest that the effect of education is not mediated by socioeconomic status. CONCLUSIONS: The consistent upward trend in the relation of disability retirement to lower levels of education and socioeconomic position, even for inflammatory back pain, shows that factors related to the occupational and social environment play an important role in the disabling process. The stepwise, monotonic relation between socioeconomic position and disability retirement from back pain, even at the higher end of the socioeconomic scale, suggests that the relation between social class and back pain disability cannot be explained solely in terms of manual versus nonmanual jobs.

Adult↗
PubMed2001

The association between physical workload and low back pain clouded by the "healthy worker" effect: population-based cross-sectional and 5-year prospective questionnaire study.

STUDY DESIGN: A population-based cross-sectional and 5-year prospective questionnaire study. OBJECTIVE: To investigate self-reported physical workload as a risk factor for low back pain. SUMMARY OF BACKGROUND DATA: Both physical and psychosocial workplace factors are considered risk factors for low back pain. However, today no consensus has been reached regarding the exact role of these factors in the genesis of low back pain. METHODS: Questionnaire data were collected at baseline for 1397 (and after 5 years for 1163) men and women aged 31--50 years at baseline. Low back pain ("any low back pain within the past year," "low back pain < or = 30 days in total during the past year," "low back pain > 30 days in total during the past year") was analyzed in relation to physical workload (sedentary, light physical, and heavy physical work) using logistic regression and controlling for age, gender, and social group. The proportions of workers changing between the workload groups over the 5-year period were analyzed in relation to low back pain status. RESULTS: At baseline no statistically significant differences in low back pain outcomes were found for workers exposed to sedentary, light physical, or heavy physical work. This was true for all age, gender, and social groups. At follow-up there was a statistically significant dose-response association between any low back pain and longstanding low back pain within the past year and increasing physical workload at baseline also after controlling for age, gender, and social group. Subjects with heavy physical workload at baseline changed statistically significantly more often to sedentary work if they experienced low back pain for more than 30 days out of the past year. CONCLUSIONS: Having a sedentary job might have a protective or neutral effect in relation to low back pain, whereas having a heavy physical job constitutes a significant risk factor. Because of migration between exposure groups (the "healthy-worker" effect), longitudinal studies are necessary for investigating the associations between physical workload and low back pain.

Cross-Sectional Studies↗
PubMedDate not supplied

Back pain and backpacks in school children.

OBJECTIVE: Back pain in adults is common and well studied. In contrast, back pain in children has received comparatively little scientific study, despite recent media attention. The purpose of this study is to see what factors influence the prevalence of back pain in middle school children, with particular attention to the weight of children's backpacks and the availability of school lockers. METHODS: A population-based sample of 1540 children ages 11-14 years in a large metropolitan area was studied. A questionnaire was used to determine presence and severity of back pain, availability of lockers, backpack use, use of 1 or 2 straps to carry backpack, activity limitations due to back pain, and use of pain medication for back pain. Gender, age, weight of the child, and weight of his or her backpack were recorded. Results of scoliosis screening were evaluated with regard to the above information. Data were analyzed using the chi test and univariate or multivariate logistic regression analysis as appropriate. RESULTS: Overall, 37% of the children reported back pain. Backpacks were used by 97% of children, hence there were too few students not using backpacks to treat backpack use as an independent variable. Multivariate analysis found back pain associated with use of a heavier backpack (P=0.001), younger age (P<0.001), female sex (P<0.001), and a positive screening examination for scoliosis (P=0.009). Children with lockers available reported less back pain (P=0.016). The use of 1 or 2 straps to carry the backpack did not have a significant association with back pain (P=0.588). Of the children who reported back pain, 34% limited their activity due to the pain, 14% use medication for pain relief, and 82% believed their backpack either caused or worsened their pain. CONCLUSIONS: The incidence of back pain in early adolescence approaches that seen in adults. Recommendations for an "acceptable" weight of backpacks cannot be made from this study, as the weights of students' backpacks seem directly proportional to the likelihood of back pain. This study identifies 2 factors associated with self-reported back pain in early adolescents that are amenable to change: availability of school lockers and lighter backpacks. These findings may be useful in advising families and influencing school policies.

Adolescent↗