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At least 559 records · Page 31Linked to original sources
PubMed1998

Lumbar olisthesis and lower back symptoms in elderly white women. The Study of Osteoporotic Fractures.

STUDY DESIGN: A Cross-sectional study. OBJECTIVES: To determine the prevalence of lumbar olisthesis among white women aged 65 years and older and its relation to low back pain and back function. BACKGROUND: Degenerative changes in the lumbar spine of elderly individuals may affect spinal stability, causing olisthesis (subluxation) of the lumbar spine. Neither the prevalence of this condition in the United States nor its relation to back symptoms has been studied previously. METHODS: Lateral radiographs of the lumbar spine for 788 women aged 65 years and older who were enrolled in the Study of Osteoporotic Fractures were digitized. Olisthesis (antero- and retro-) was assessed at L3-L4, L4-L5, and L5-S1. Back pain and function also were assessed. RESULTS: When olisthesis was defined as subluxation of 3 mm or more at any of the three levels studied, the overall prevalence of anterolisthesis was 29% and that of retrolisthesis was 14%. In 90% of women with anterolisthesis and 88% of women with retrolisthesis, subluxation occurred at a single vertebral level. The prevalence of anterolisthesis and retrolisthesis did not vary by smoking status, presence of diabetes, or history of oophorectomy. Anterolisthesis was not associated with the presence of back symptoms. Only retrolisthesis at L3-L4 was associated with a statistically significantly increased likelihood of lower back pain, greater severity of back pain, and impairment of back function. CONCLUSIONS: Anterolisthesis of 3 mm or more in the lower lumbar spine is relatively common among elderly women but is not correlated with back problems. Retrolisthesis at L3-L4 is associated with increased back pain and impaired back function.

Aged↗
PubMed1999

The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up.

STUDY DESIGN: A prospective, randomized, controlled trial with a stratification block design in which a Mensendieck exercise program was compared with the experience of a control group. OBJECTIVE: To evaluate the effect of a Mensendieck program on the incidence of recurrent episodes of low back pain in patients with a history of the condition who currently are working. SUMMARY OF BACKGROUND DATA: One episode of low back pain increases the risk of further episodes of the condition. The Mensendieck approach combines education and exercise. This approach has been used for many years in Scandinavia and the Netherlands. However, the effects on low back pain have not been evaluated previously in a randomized, controlled trial. METHODS: A total of 77 men and women, mean age 39.6 years (range, 21.2-49.8 years), who had finished treatment for a low back pain episode, were stratified according to incidence of low back pain episodes and symptoms of sciatica over the preceding 3 years. The patients were assigned at random to either the Mensendieck program or a control group. The Mensendieck group received 20 group sessions of exercises and ergonomic education in 13 weeks. At 5- and 12-month follow-up examinations, the patients were assessed for recurrence of low back pain, days of sick leave, low back pain, and functional scores. RESULTS: After 12 months, there was a significant reduction in recurrent low back pain episodes in the Mensendieck group compared with the control group (P < 0.05). There was a trend toward fewer days of sick leave because of low back pain in the Mensendieck group, but no significant differences between the groups. There was reduction in pain and improvement in function in both groups, with no significant differences between the groups. CONCLUSIONS: A secondary prophylaxis Mensendieck exercise program of 20 group sessions significantly reduced the incidence of low back pain recurrences in a population with history of the condition. However, there were no differences between the groups with regard to days of sick leave, low back pain, and function.

Activities of Daily Living↗
PubMed1999

Association of atherosclerosis with low back pain and the degree of disc degeneration.

STUDY DESIGN: This was a cross-sectional observational study in which the abdominal aorta was evaluated for atheromatous lesions visible in computed tomographic scans in patients with and without low back pain. OBJECTIVES: To evaluate whether patients with low back pain have more atherosclerosis in the abdominal aorta than patients without low back pain and whether the severity of atherosclerosis in the abdominal aorta correlates with the grade of disc damage. SUMMARY OF BACKGROUND DATA: There are studies in which results indicate that insufficient blood supply may be a significant causative factor in disc degeneration. There are also studies in which smoking, one of the risk factors for arterial disease, has been correlated with low back pain. Calf pain has also been shown to correlate with low back pain. Results in a long-term follow-up study have further indicated an association between disc diseases and fatal ischemic heart disease. However, there seems to be only one postmortem study in which results show an association between atherosclerosis in the arteries of the lumbar area and disc diseases. METHODS: Computed tomographic images of 29 patients with low back pain, who had been evaluated with computed tomographic discography for diagnostic purposes, were evaluated for the quantity of atherosclerotic calcifications visible on computed tomographic scans of the abdominal aorta. A similar evaluation was performed in an age- and sex-matched control group of 52 patients without low back pain selected from among the patients referred for abdominal computed tomography. RESULTS: Sixteen (55%) of the 29 patients with low back pain had atherosclerotic calcifications visible on computed tomographic scans, whereas 11 (21%) of the 52 age-matched patients without low back pain were found to have aortic calcifications. Eleven (48%) patients with low back pain who were 50 years of age or less (n = 23) had aortic calcifications, whereas only 3 (8%) of the 36 control patients aged less than 50 years had aortic calcifications. There was no correlation between the amount of calcifications and the degree of disc degeneration assessed by computed tomographic discography. CONCLUSIONS: A significant association is indicated between atheromatous lesions in the abdominal aorta and low back pain.

Adult↗
PubMed1999

The quantification of low back disorder using motion measures. Methodology and validation.

STUDY DESIGN: Trunk angular motion features were used as a means to quantify the extent of a low back disorder in healthy people and patients with chronic low back disorders. OBJECTIVE: To refine and validate a previously reported means of quantifying the extent of a low back disorder. SUMMARY AND BACKGROUND: Many assessment tools of low back disorder are subjective. A quantitative assessment tool would facilitate the tracking of the recovery and help document the appropriateness of treatments. METHODS: The trunk motion characteristics of 374 healthy people and 335 patients with chronic low back disorders of varying severity were documented as they flexed and extended their trunks in five different planes of motion. The trunk motion features were normalized as a function of age and gender. Four classification techniques were used to assess the ability of the quantitative motion measure to identify those with and without low back disorders. In addition, 31 patients were observed longitudinally to determine whether the motion measures agreed with observed changes in back pain symptoms. RESULTS: The quantitative trunk motion measure distinguished between people with low back disorders and healthy people between 88% and 94% of the time, depending on which classification system was used. Sensitivity and specificity varied between 83% and 97%. The quantitative measure also showed promise as a means to distinguish between muscle-based and structure-based low back disorders. Prospective findings indicated that the quantification system agreed well with clinical observations of progress. CONCLUSIONS: The quantification of trunk motion can serve as a measure of the extent of a low back disorder. When considered along with other clinical information, the ability to assess and treat low back disorders is enhanced.

Adult↗
PubMed2000

Can discography cause long-term back symptoms in previously asymptomatic subjects?

STUDY DESIGN: A prospective controlled study of patients without low back pain observed after experimental lumbar discography. OBJECTIVES: To determine whether discography may cause long-term low back symptoms in selected patients. BACKGROUND: Lumbar discography is generally considered safe, although controversial, with few complications. There is little information on long-term follow-up of asymptomatic patients after experimental discography. METHODS: Twenty-six patients without pre-existing low back pain were observed for 1 year after lumbar discography to determine the effects of lumbar discography in three experimental groups: 10 patients who had remote cervical spine surgery with excellent results (pain-free group); 10 patients who had the same surgery with poor results (chronic pain group); and 6 patients who had primary somatization disorders. Two control groups were also observed: a group of patients with somatization disorder who were similarly evaluated but without discography, a group of patients with low back pain observed for 1 year after discography without surgery. RESULTS: In the three experimental groups (no back pain before discography) no subject with normal psychometric testing had persistent pain after discography (0/11), whereas 6 (40%) of 15 with abnormal psychometric test results reported significant new low back pain. None of the pain-free group (0/10), 20% of the chronic neck pain group (2/10), and 66% of the somatization group (4/6) continued to have significant back pain 1 year after injection. Psychological testing and occupational disability strongly predicted continued pain after discography. The control groups had no significant change in low back symptomatology during the year of observation. CONCLUSION: Discography in a subject group without low back pain but with significant emotional and chronic pain problems may result in reports of significant back pain for at least 1 year after injection. Subjects with normal psychometric test results had no reports of significant long-term back pain after discography.

Adult↗
PubMed2000

Do functional tests predict low back pain?

STUDY DESIGN: A cohort of 307 nonsymptomatic workers and another cohort of 123 workers with previous episodes of low back pain were followed up for 2 years. The outcomes were measured by symptoms, medical consultations, and sick leaves due to low back disorders. OBJECTIVES: To study the predictive value of a set of tests measuring the physical performance of the back in a working population. The hypothesis was that subjects with poor functional capacity are liable to back disorders. SUMMARY OF BACKGROUND DATA: Reduced functional performance has been associated with back pain. There are few data to show whether reduced functional capacity is a cause or a consequence of pain. METHODS: Mobility of the trunk in forward and side bending, maximal isokinetic trunk extension, flexion and lifting strength, and static endurance of back extension were measured. Standing balance and foot reaction time were recorded with a force plate. Clinical tests for the provocation of back or leg pain were performed. Gender, workload, age, and anthropometrics were managed as potential confounders in the analysis. RESULTS: Marked overlapping was seen in the measures of the subjects with different outcomes. Among the nonsymptomatic subjects, low performance in tests of mobility and standing balance was associated with future back disorders. Among workers with previous episodes of back pain, low isokinetic extension strength, poor standing balance, and positive clinical signs predicted future pain. CONCLUSIONS: Some associations were found between the functional tests and future low back pain. The wide variation in the results questions the value of the tests in health examinations (e.g., in screening or surveillance of low back disorders).

Adult↗
PubMed2002

Fatigue-related changes in torque output and electromyographic parameters of trunk muscles during isometric axial rotation exertion: an investigation in patients with back pain and in healthy subjects.

STUDY DESIGN: A cross-sectional case-control study. OBJECTIVES: To examine the effect of fatigue on torque output as well as electromyographic frequency and amplitude values of trunk muscles during isometric axial rotation exertion in back pain patients and to compare the results with a matched control group. SUMMARY OF BACKGROUND DATA: Back pain patients exhibited different activation strategies in trunk muscles during the axial rotation exertions. Fatigue changes of abdominal and back muscles during axial rotation exertion have not been examined in patients with back pain. METHODS: Twelve back pain patients and 12 matched controls performed isometric fatiguing axial rotation to both sides at 80% maximum voluntary contraction in a standing position. During the fatiguing exertion, electromyographic changes of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum, and multifidus were recorded bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were also measured. RESULTS: No difference in the endurance capacity was found between back pain and control groups. At the initial period of the exertion, back pain patients demonstrated a statistical trend (P = 0.058) of greater sagittal coupling torque as well as lower activity of rectus abdominis and multifidus and higher activity in external oblique. During the fatigue process similar changes of coupling torque were demonstrated in both sagittal and coronal planes, but a smaller fatigue rate for right external oblique, increase in median frequency for latissimus dorsi, and lesser increase in activity for back muscles were found in the back pain group compared with the control group. CONCLUSIONS: Alterations in electromyographic activation and fatigue rates of abdominal and back muscles demonstrated during the fatigue process provide insights into the muscle dysfunctions in back pain and may help clinicians to devise more rational treatment strategies.

Abdomen↗
PubMed2003

Patterns and perceptions of care for treatment of back and neck pain: results of a national survey.

STUDY DESIGN: We conducted a nationally representative random household telephone survey to assess therapies used to treat back or neck pain. OBJECTIVES: The main outcome was complementary therapies used in the last year to treat back or neck pain. SUMMARY OF BACKGROUND DATA: Back pain and neck pain are common medical conditions that cause substantial morbidity. Despite the presumed importance of complementary therapies for these conditions, studies of care for back and neck pain have not gathered information about the use of complementary therapies. METHODS: Our nationally representative survey sampled 2055 adults. The survey gathered detailed information about medical conditions, conventional and complementary therapies used to treat those conditions, and the perceived helpfulness of those therapies. RESULTS: We found that of those reporting back or neck pain in the last 12 months, 37% had seen a conventional provider and 54% had used complementary therapies to treat their condition. Chiropractic, massage, and relaxation techniques were the most commonly used complementary treatments for back or neck pain (20%, 14%, and 12%, respectively, of those with back or neck pain). Chiropractic, massage, and relaxation techniques were rated as "very helpful" for back or neck pain among users (61%, 65%, and 43%, respectively), whereas conventional providers were rated as "very helpful" by 27% of users. We estimate that nearly one-third of all complementary provider visits in 1997 (203 million of 629 million) were made specifically for the treatment of back or neck pain. CONCLUSIONS: Chiropractic, massage, relaxation techniques, and other complementary methods all play an important role in the care of patients with back or neck pain. Treatment for back and neck pain was responsible for a large proportion of all complementary provider visits made in 1997. The frequent use and perceived helpfulness of commonly used complementary methods for these conditions warrant further investigation.

Adolescent↗
PubMed2003

Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial was conducted. OBJECTIVE: To determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear. METHODS: This trial was conducted in a university-based clinic from 2000 through 2001. Of the 199 subjects who responded to recruitment procedures, 91 met the eligibility criteria. They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation. The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain. The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care. RESULTS: As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months. The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects. There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation. CONCLUSIONS: Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects.

Chronic Disease↗
PubMed2004

Back and neck pain exhibit many common features in old age: a population-based study of 4,486 Danish twins 70-102 years of age.

STUDY DESIGN: Cross-sectional and longitudinal analysis of data comprising 4486 Danish twins 70-102 years of age. OBJECTIVES: To describe the 1-month prevalence of back pain, neck pain, and concurrent back and neck pain and the development of these over time, associations with other health problems, education, smoking, and physical, and mental functioning. SUMMARY OF BACKGROUND DATA: Back pain and neck pain are prevalent symptoms in the population; however, there is little research addressing these conditions in older age groups. METHODS: Extensive interview data on health, lifestyle, social, and educational factors were collected in a nationwide cohort-sequential study of 70+-year-old Danish twins. Data for back pain, neck pain, lifetime prevalence of a comprehensive list of diseases, education, and self-rated health were based on self-report. Physical and mental functioning were measured using validated performance tests. Data including associated factors were analyzed in a cross-sectional analysis for answers given at entry into the study, and longitudinal analysis was performed for participants in all four surveys. RESULTS: The overall 1-month prevalence for back pain only was 15%, for neck pain only 11%, and for concurrent back and neck pain 11%. The prevalence varied negligibly over time and between the age groups, and 63% of participants in all surveys had no episodes or only one episode of back or neck pain. Back pain and neck pain were associated with a number of other diseases and with poorer self-rated health. Back and neck pain sufferers had significantly lower scores on physical but not cognitive functioning. CONCLUSIONS: Back pain and neck pain are common, intermittent symptoms in old age. Back pain and neck pain are associated with general poor physical health in old age.

Aged↗
PubMed2004

Force production parameters in patients with low back pain and healthy control study participants.

STUDY DESIGN: A control group study with repeated measures. OBJECTIVE: To compare isometric force production parameters in low back pain and healthy study participants. SUMMARY AND BACKGROUND DATA: Recent evidence suggests that chronic patients with low back pain exhibit deficits in trunk proprioception and motor control. The control of force and its between-trial variability are often taken as critical determinants of performance. We compared various force time characteristics in patients with low back pain and healthy study participants. METHODS: Fifteen control study participants and 16 patients with low back pain participated in this study. Study participants were required to exert 50% and 75% of the maximal trunk flexion and extension. In a learning phase, visual and verbal feedback was provided. Following these learning trials, study participants were asked to perform 10 trials without any feedback. Time to peak force, time to peak force variability, peak force variability, and absolute error in peak force were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak force achieved. RESULTS: Two subgroups of patients with low back pain were identified. Controls and patients with low back pain with more pain showed faster time to peak force than patients with low back pain with less pain (331 ms and 341 ms vs. 574 ms, respectively). Linear regressions showed that, for control study participants and low back pain study participants with more pain, peak dF/dt explained 94.0% and 97.0% of the variance observed in peak force while 84.4% was explained for low back pain study participants with less pain. Peak force variability and absolute error in peak force were similar for all groups. CONCLUSIONS: Patients with low back pain were able to produce isometric forces with an accuracy similar to control study participants. The longer time to peak force and the smaller percentage of variance observed for the linear regressions suggest that some patients with low back pain adopted a control mode that was less "open-loop." It is possible that this mode of producing forces results from an adaptation to chronic pain or tissue degeneration.

Adult↗
PubMed2004

Low back pain in a representative sample of Greek population: analysis according to personal and socioeconomic characteristics.

STUDY DESIGN: A cross-sectional study of low back pain and its related aspects in a representative sample of Greek population. OBJECTIVES: To estimate the prevalence of low back pain in the Greek population and to study the association of low back pain frequency and severity with socioeconomic and demographic characteristics. SUMMARY OF BACKGROUND DATA: Several prevalence studies carried out in different populations suggest a high frequency of this condition in the general population. Socioeconomic and demographic factors are likely to influence frequency and severity of low back pain. In Greece, there have been no previous studies investigating low back pain frequency and severity and its related aspects in the general population. Studies carried out in selected Greek populations suggest a 3-month prevalence of about 50%. METHODS: A 2000-person sample of the Greek population older than 15 years was selected by multiple-stage sampling, with definition of sample quotas based on demographic characteristics. Information about low back pain and its related aspects, as well as about socioeconomic and demographic characteristics, was collected by personal interviews. The study was carried out between March 10 and April 12, 2000. RESULTS: A total of 635 persons (31.7%) reported low back pain the last month. Among them 126 (19.9%) stayed in bed for some time, with a mean duration of staying in bed of 5.5 days. Work absenteeism represented a 19.1% of people younger than 65 years (54 persons) with a mean duration of 4.52 days. Low back pain frequency and severity were related to several socio-demographic factors at a statistically significant level. Sex, age, and kind of job presented a significant association with risk of low back pain independently from other socioeconomic factors. CONCLUSIONS: According to the results of the study, low back pain is a frequent symptom in the general Greek population. Low back pain frequency and severity are associated with several socio-demographic factors, especially with age, sex, and kind of job.

Absenteeism↗
PubMed2004

Comorbidity with low back pain: a cross-sectional population-based survey of 12- to 22-year-olds.

STUDY DESIGN: Cross-sectional, population-based survey. OBJECTIVES: To investigate the pattern of comorbidity with low back pain in adolescents. SUMMARY OF BACKGROUND DATA: Low back pain is usually dealt with as a specific and independent entity. However, the existing literature shows comorbidity to be common with low back pain, suggesting that low back pain may be part of a broader pattern of general health. The present knowledge is based on studies of adult populations; therefore, associations could be explained by work and lifestyle factors. Information in this area is lacking regarding subjects still unaffected by such factors. METHODS: A questionnaire-survey about general health, including low back pain, was carried out among twins registered in the population-based Danish Twin Registry. Associations between disorders were calculated and patterns of comorbidity investigated, by means of logistic regression and a finite mixture model. Finally a twin-control study was conducted. RESULTS: A total of 9,567 individuals, 12 to 22 years of age, responded to the questionnaire. Positive associations between low back pain and asthma and headache/migraine were demonstrated, mainly because of study participants with several disorders. No association between low back pain and atopic dermatitis/hay fever was found. The presence of two other disorders increased the probability of low back pain considerably more than the presence of only one other disorder. The finite mixture model indicated that the probability of belonging to a frail subgroup decreased from 60% at age 13 to 25% at age 21, and in the frail subgroups nearly all report low back pain and headache in the older ages. Furthermore, increasing duration of low back pain increased the likelihood of having other disorders. Results from the twin-control study were similar. CONCLUSION: Young people are more likely to suffer from asthma and headache, but not from atopic dermatitis/hay fever, if they have low back pain. All of the investigated disorders cluster in some individuals. A model of common origin for these seemingly independent disorders should be considered.

Adolescent↗
PubMed2005

Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration.

OBJECTIVES: To assess the effects of acupuncture and dry-needling for the treatment of nonspecific low back pain. BACKGROUND: Low back pain is usually a self-limiting condition that tends to improve spontaneously over time. However, for many people, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed. SEARCH STRATEGY: We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003. SELECTION CRITERIA: Randomized controlled trials of acupuncture (that involved needling) or dry-needling for adults with nonspecific acute/subacute or chronic low back pain. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodologic quality (using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analysis methods or levels of evidence when the data reported did not allow statistical pooling. RESULTS: Thirty-five randomized clinical trials were included: 20 were published in English, 7 in Japanese, 5 in Chinese, and 1 each in Norwegian, Polish, and German. There were only 3 trials of acupuncture for acute low back pain. These studies did not justify firm conclusions because of their small sample sizes and low methodologic quality. For chronic low back pain, there is evidence of pain relief and functional improvement for acupuncture compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and in short-term follow-up. There is also evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, the effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low back pain. No clear recommendations could be made about the most effective acupuncture technique. CONCLUSIONS: The data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain. For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low back pain. Because most of the studies were of lower methodologic quality, there is a clear need for higher quality trials in this area.

Acupuncture Therapy↗
PubMed1995

Epidural anaesthesia and low back pain after delivery: a prospective cohort study.

OBJECTIVE: To determine whether epidural anaesthesia during labour and delivery is a risk factor for postpartum back pain. DESIGN: Prospective cohort study with follow up at one day, seven days, and six weeks after delivery. SETTING: Teaching hospital in Montreal. SUBJECTS: 329 women who delivered a live infant(s) during the study period. Exclusion criteria were back pain before pregnancy and delivery by elective caesarean section. INTERVENTION: Epidural anaesthesia during labour and delivery. MAIN OUTCOME MEASURES AND RESULTS: The primary outcome variable was development of postpartum low back pain. Back pain was quantified with self reports (yes/no), a pain score (numeric rating scale), and degree of interference with daily activities. Of the 329 women, 164 received epidural anaesthesia during labour and 165 did not. The incidence of low back pain in epidural v non-epidural group was 53% v 43% on day one; 21% on day seven; and 14% v 7% at six weeks. The relative risk for low back pain (epidural v non-epidural) adjusted for parity, delivery, ethnicity, and weight was 1.76 (95% confidence interval 1.06 to 2.92) on day one; 1.00 (0.54 to 1.86) on day seven; and 2.22 (0.89 to 5.53) at six weeks. There were no differences between the two groups in pain scores or the frequency of interference with daily activities. Similar results were obtained in the subgroup of women with low back pain of new onset--that is, those women with no back pain during their pregnancy. CONCLUSIONS: Postpartum low back pain was common but decreased considerably over the short term. The association between epidural anaesthesia and postpartum low back pain was inconsistent over time with a significantly increased risk of low back pain (epidural v non-epidural) noted only on the first day after delivery.

Anesthesia, Epidural↗
PubMed1997

Back pain among echocardiographers.

OBJECTIVE: By having to adopt unnatural postures, echocardiographers place themselves at risk of back injury. The present study sought to document the incidence and severity of back pain among echocardiographers, and to identify personal, lifestyle and occupational characteristics that may predict risk of back pain. DESIGN: A questionnaire concerning occupational, personal, and lifestyle characteristics, as well as the extent and severity of back pain was completed and returned by 183 echocardiographers. RESULTS: The standard echocardiography examination position of "machine on the left, patient on the right, and transducer held in the right hand" (used by 66% of respondents) greatly increased the risk of back pain (odds ratio (OR) = 4.9; 95% confidence interval (95% CI) = 1.49-16.4). Echocardiographers with more than 11 years experience in the field were also at risk of back pain (OR) = 3.4; 95% CI = 0.97-11.6). The intensity of back pain was strongly associated with the amount of time spent on echocardiography examinations (P = 0.035), limitation of lifestyle (P < or = 0.001), and interference with work (P < or = 0.001). There was a significantly higher relative risk of back pain for the respondents whose job involved frequent or occasional lifting compared with nonlifters (P = 0.01; OR = 4.8, 95% CI = 1.25-18.7). At least some limitation of lifestyle from back pain was reported by 56% of the respondents. CONCLUSIONS: There is a high incidence of back pain among echocardiographers, and specific tasks and activities increase the risk of back pain. Further research should focus on preventative measures and optimum work station designs that may serve as a guide to echocardiography departments.

Back Pain↗
PubMed2006

Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability.

BACKGROUND: Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods. METHODS: A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health. RESULTS: The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load. CONCLUSION: The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.

Adult↗
PubMed2001

Interrelations of risk factors and low back pain in scaffolders.

OBJECTIVES: To assess with a cross sectional study the interrelations between physical, psychosocial, and individual risk factors and different end points of low back pain. METHODS: In total, 229 scaffolders and 59 supervisors completed a questionnaire about manual handling of materials, awkward back posture, strenuous arm position, perceived exertion, psychosocial load, need for recovery, and general health. Physical load at the worksite was also measured with many frequent observations. Interrelations between risk factors and their relation with four end points of low back pain were investigated. RESULTS: Interrelations were strong among self reported determinants of physical load but showed an inverted trend for both age and total working experience, which could indicate the presence of a healthy worker effect. Weak relations existed between variables of psychosocial and physical load. The multivariate analyses showed a significant relation between high manual handling of materials, moderate perceived general health, high job demands, and low back pain in the past 12 months. Chronic low back pain was significantly correlated with high perceived exertion and moderate perceived general health. Severe low back pain was significantly correlated with awkward back postures, high need for recovery, and high job demands. Finally, low back pain with perceived disability was significantly related to strenuous shoulder positions and moderate perceived general health. All end points of low back pain were consistently associated with physical load whereas psychosocial aspects showed a more diverse pattern. CONCLUSIONS: The findings of this study suggest that work related risk factors may vary according to different definitions of low back pain. Distinct patterns of risk factors might enhance different expressions of it. Scaffolders are a group at high risk of developing persistent forms of low back pain.

Adult↗