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PubMedDate not supplied

A one-year prospective study on back pain among novice golfers.

We conducted a 1-year follow-up study on back pain among 196 men taking up golf. A questionnaire on individual characteristics, occupation, sports, and back pain was distributed at the start of the study and was followed by another questionnaire after 12 months. Eleven percent of the original subjects (25 of 211) were lost to followup, but withdrawal from the survey was not associated with health status. In the baseline survey (N = 221), the self-reported lifetime cumulative incidence of back pain was 63%; 28% reported back pain during the month before answering the questionnaire, and 13% reported current back pain. Athletes had an increased odds ratio of 2.1 (95% confidence interval, 1.1 to 4.0) for previous back pain. During the 12 months between the surveys, the incidence of first-time back pain was 8% and the incidence of recurrent back pain was about 45%. Men involved in golf and another sport demonstrated a risk of 1.4 for recurrence of back pain, compared with men playing golf only. Six subjects attributed the recurrent back pain to playing golf. Given the high proportion of athletes in this study (68%), the risk factor of playing golf failed to demonstrate an additional significant effect on the general relationship between sport and back pain.

Adult↗
PubMed1999

[Subjective pain and tenderness in low back among care workers in relation to work load and daily life].

Five hundred and fifty-two care-workers aged 20 to 60 years, who worked at six custodial-care homes, were examined to clarify the relationship between subjective pain and tenderness in the low back, together with the factors affecting occupational low back pain. Subjects who were diagnosed as having tenderness in the low back by one medical practitioner at the time of health examinations, and those who reported the presence of low back pain in self-rating questionnaires were defined as those with "objective" and "subjective" low back pain, respectively. Complaints concerning workloads and daily life, as well as musculoskeletal and systemic symptoms, were inquired of in the self-rating questionnaires; the former complaints were compiled into four factors representing "environmental load at work," "physical load at work," "mental load at work," and "daily life" by the factor analysis. The corresponding rates in subjective and objective low back pains were 67.0% in 188 male care workers and 70.9% in 364 female care workers. In males and females, "physical load at work" was positively related to subjective low back pain (P < 0.05) with the use of the multiple logistic regression analysis including all the causal and confounding factors. Musculoskeletal symptoms in females were also positively related to subjective and objective low back pain (P < 0.05). These data suggest that subjective low back pain clearly reflects the problem of occupational low back pain as a whole, and that low back pain is mainly related to the physical load at work in care workers.

Adult↗
PubMed2004

Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems.

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest rate of back pain, with an annual prevalence of 40-50% and a lifetime prevalence of 35-80%. The American Nursing Association believes that manual patient handling is unsafe and is directly responsible for musculoskeletal disorders encountered in nurses. It has been well documented that patient handling can be done safely with the use of assistive equipment and devices that eliminate these hazards to nurses that invite serious back injuries. The benefit of assistive patient handling equipment is characterized by the simultaneous reduction of the risk of musculoskeletal injury to the nursing staff and improvement in the quality of care for patient populations. To understand the cause of disabling injuries in health care workers, several factors must be considered, including the following: (1) anatomy/physiology of the back, (2) risk factors, (3) medical legal implications, and (4) prevention. Among nurses, back, neck, and shoulder injuries are commonly noted as the most prevalent and debilitating. While mostly associated with dependant patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Workers compensation guidelines for occupational back injury differ in public and private health care sectors from state to state. Nursing personnel should be reminded that the development of back pain following occupational activities in the hospital should be reported immediately to the Occupational Health Department. A nurse's failure to report OBPN immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

Back Injuries↗
PubMed1997

Oral contraceptive use among female elite athletes and age-matched controls and its relation to low back pain.

BACKGROUND: Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain. OBJECTIVE: To evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non-users and if it differs between women taking part in different sports. METHODS: A questionnaire was sent to female elite athletes in volleyball (n = 205), basketball (n = 150), and soccer (n = 361) as well as to age-matched controls (n = 113). The questionnaire comprised questions about age, constitution, occupation, parity and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems. RESULTS: The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups with an average of 30%, whereas only 18% of the controls suffered from low back pain (p < 0.01). The prevalence of low back pain within each group, athletes as well as controls, was similar in women who used, and did not use oral contraceptives. CONCLUSIONS: This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity is probably more important.

Adult↗
PubMed2001

The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial.

OBJECTIVES: To test the hypotheses that: (1) Lumbar spine radiography in primary care patients with low back pain is not associated with improved patient outcomes, including pain, disability, health status, sickness absence, reassurance, and patient satisfaction or belief in the value of radiography. (2) Lumbar spine radiography in primary care patients with low back pain is not associated with changes in patient management, including medication use, and the use of primary and secondary care services, physical therapies and complementary therapies. (3) Participants choosing their treatment group (i.e. radiography or no radiography) do not have better outcomes than those randomised to a treatment group. (4) Lumbar spine radiography is not cost-effective compared with usual care without lumbar spine radiography. DESIGN: A randomised unblinded controlled trial. SETTING: Seventy-three general practices in Nottingham, North Nottinghamshire, Southern Derbyshire, North Lincolnshire and North Leicestershire. Fifty-two practices recruited participants to the trial. SUBJECTS: Randomised arm: 421 participants with low back pain, with median duration of 10 weeks. Patient preference arm: 55 participants with low back pain, with median duration of 11 weeks. INTERVENTION: Lumbar spine radiography and usual care versus usual care without radiography. MAIN OUTCOME MEASURES: Roland adaptation of the Sickness Impact Profile, visual analogue pain scale, health status scale, EuroQol, use of primary and secondary care services, and physical and complementary therapies, sickness absence, medication use, patient satisfaction, reassurance and belief in value of radiography at 3 and 9 months post-randomisation. RESULTS: Participants randomised to receive an X-ray were more likely to report low back pain at 3 months (odds ratio (OR) = 1.56; 95% confidence interval (CI), 1.02 to 2.40) and had a lower overall health status score (p = 0.02). There were no differences in health or functional status at 9 months. A higher proportion of participants consulted the general practitioner (GP) in the 3 months following an X-ray (OR = 2.72; 95% CI, 1.80 to 4.10). There were no differences in use of any other services, medication use or sickness absence at 3 or 9 months. No serious spinal pathology was identified in either group. The commonest X-ray reports were of discovertebral degeneration and normal findings. Many patients did not perceive their information needs were met within the consultation. Satisfaction with care was greater in the group receiving radiography at 9 months. Participants randomised to receive an X-ray were not less worried, or more reassured about serious disease causing their low back pain. Satisfaction was associated with meeting participants' information needs and reduced belief in the necessity for investigations for low back pain, including X-rays and blood tests. In both groups, at 3 and 9 months 80% of participants would choose to have an X-ray if the choice was available. Participants in the patient preference group achieved marginally better outcomes than those randomised to a treatment group, but the clinical significance of these differences is unclear. Lumbar spine radiography was associated with a net economic loss at 3 and 9 months. CONCLUSIONS: Lumbar spine radiography in primary care patients with low back pain of at least 6 weeks duration is not associated with improved functioning, severity of pain or overall health status, and is associated with an increase in GP workload. Participants receiving X-rays are more satisfied with their care, but are not less worried or more reassured about serious disease causing their low back pain. CONCLUSIONS - RECOMMENDATIONS FOR FURTHER RESEARCH: Further work is required to develop and test an educational package that educates patients and GPs about the utility of radiography and provides strategies for identifying and meeting the information needs of patients, and the needs of patients and GPs to be reassured about missing serious disease. Guidelines on the management of low back pain in primary care should be consistent about not recommending lumbar spine radiography in patients with low back pain in the absence of red flags for serious spinal pathology, even if the pain has persisted for at least 6 weeks.

Adult↗
PubMed1998

Occupational factors affecting sick leave attributed to low-back pain.

OBJECTIVES: The purpose of this study was to determine the occupational factors that cause workers to take sick leave attributed to low-back pain. METHODS: Twice, with a 24-month interval, 117 white- and 189 blue-collar employees from 2 metal industry companies completed a questionnaire on recurrent low-back pain and exposure to potential risk factors (biomechanical loads, physical environment, psychosocial factors) at work. Sick leave was monitored for the period between the questionnaires. RESULTS: Low-back pain was predicted by exposure to harmful biomechanical loads among both white- and blue-collar workers [odds ratio (OR) 4.1 and 4.7, respectively), stress among white-collar workers (OR 2.4), and draft among blue-collar workers (OR 2.3). The take-up of sick leave was predicted by exposure to harmful biomechanical loads [rate ratio (RR) 1.7]; for sick leaves attributed to low-back pain the rate ratio was 3.1. Lack of recognition and respect at work predicted sick leave attributed to low-back pain (RR 2.0), but not sick leave attributed to other disorders. CONCLUSIONS: Recurrent low-back pain is preceded by reports of harmful biomechanical loads at work among white- and blue-collar workers, by stress among white-collar workers and by draft among blue-collar workers. The environmental and psychosocial factors under study did not modify the relation between biomechanical loads and recurrent low-back pain. Sick leave attributed to back disorders is preceded by exposure to biomechanical loads at work and by a lack of recognition and respect at work among blue-collar workers. Biomechanical loading seems to be the most important occupational factor predicting both recurrent low-back pain and sick leave attributed to back disorders. Lack of recognition and respect at work appear to affect sick leave attributed to back disorders.

Adolescent↗
PubMed2004

Prognostic factors related to recurrent low-back pain and sickness absence.

OBJECTIVES: This study aimed at determining the prognostic factors related to the recurrence of low-back pain and future sickness absence due to low-back pain. METHODS: Data were used from a prospective cohort study in a working population with a 3-year follow-up period. They were collected with annual questionnaires. A generalized estimating equation model was used to study the relation between pain characteristics, individual characteristics, and work-related factors and the recurrence of low-back pain or sickness absence due to low-back pain in the following year. Adjustments were made for potential confounders. RESULTS: All the pain characteristics [odds ratios (OR) varying from 1.4 to 2.4], flexion and rotation of the upper part of the body [OR 1.6, 95% confidence interval (95% CI) 1.1-2.5], low decision authority (OR 1.6, 95% CI 1.0-2.6), and low job satisfaction (OR 1.5, 95% CI 1.0-2.3), increased the risk of recurrent low-back pain. High disability due to low-back pain (OR 2.6, 95% CI 1.2-5.7), low co-worker support (OR 4.1, 95% CI 1.6-10.5), and low job satisfaction (OR 2.4, 95% CI 1.3-4.5) were predictors of sickness absence due to low-back pain. Lifting weights did not influence the risk of recurrences or sick leave. CONCLUSIONS: According to this study, high disability due to low-back pain is a prognostic factor for recurrent low-back pain and future sickness absence due to low-back pain. In addition, the following work-related factors predict a poor prognosis of low-back pain: flexion or rotation of the trunk, low job satisfaction, low decision authority, and low social support.

Adult↗
PubMed2005

Meta-analysis: exercise therapy for nonspecific low back pain.

BACKGROUND: Exercise therapy is widely used as an intervention in low back pain. OBJECTIVE: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. DATA SOURCES: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. STUDY SELECTION: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. DATA EXTRACTION: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. DATA SYNTHESIS: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). LIMITATIONS: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias. CONCLUSIONS: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.

Absenteeism↗
PubMedDate not supplied

Epidemiology of low-back pain in industry.

Low-back pain and back injuries are of such a complex nature that any one criterion cannot be applied by itself to give a valid assessment of the risk associated with manual materials-handling jobs. There is no question that low-back pain is an extremely significant cause of disability and has a major socioeconomic impact, but many different personal and job factors are associated with the incidence and prevalence of these complaints. There is a need for ongoing systematic investigations of the multiple risk factors that may be causally related to low-back pain and may possibly be amendable to preventive interventions. Knowledge of workplace and individual risk factors is far from complete. Prospective studies are needed so that factors contributing to the development of low-back pain can be separated from factors resulting from low-back pain. It is difficult to relate low-back pain to the workplace because it occurs quite often in workers employed in sedentary occupations. However, incidence, severity, and disability are all related to the physical demands of the job. In this regard, jobs involving lifting, lowering, pushing, pulling, carrying, and holding; body movements such as frequent bending, twisting, and sudden movements; and working in bent-over postures appear to have a significant potential for producing low-back pain. A combination of lifting, bending, and twisting appears to be most hazardous. It is concluded that lifting heavy loads contributes to increased frequency and severity rates for low-back pain. This is true regardless of whether the lifting is performed over a short period or throughout the day and whether it is performed a few times per day of repetitively. If, however, such lifting is performed repetitively, the medical hazard extends beyond low-back problems to other musculoskeletal strain and sprain injuries and to fatigue-related injuries, particularly for weaker workers. In this latter regard, gender, age, anthropometry, and previous history of back pain are known to modify these risks for populations of workers. The inherent variability between workers and within any worker over time precludes the use of such factors to assign risk to any particular individual.

Female↗
PubMed2005

Relationship of health related quality of life to prevalent and new or worsening back pain in postmenopausal women with osteoporosis.

OBJECTIVE: To examine the association between back pain and health related quality of life (HRQOL) in postmenopausal women with osteoporosis. METHODS: The Fracture Prevention Trial was a prospective double blinded, placebo controlled study designed to compare the proportion of women receiving teriparatide who experienced a new fracture to the proportion of women receiving placebo who experienced a new fracture. Subjects were ambulatory postmenopausal women with osteoporosis and prior vertebral fracture. As part of this trial, English-speaking women from Canada, New Zealand, Australia, and the United States participated in a HRQOL substudy using the Osteoporosis Assessment Questionnaire (OPAQ). OPAQ was administered at baseline, 12 months, and at study termination (median treatment duration 19 mo). Back pain data were collected as part of the adverse event monitoring during the trial. Subjects considered to have experienced back pain reported this event spontaneously and were not queried specifically. We examined the influence of prevalent back pain on HRQOL after controlling for spine deformity index score, and the influence of new or worsening back pain on HRQOL after controlling for incident vertebral fracture. RESULTS: Of 471 women who completed OPAQ at baseline, 172 reported back pain that was associated with a mean decrease in all OPAQ dimension scores (p < 0.05). Of 429 women who completed OPAQ at all timepoints, 88 experienced new or worsening back pain that was associated with a mean decrease in physical function, emotional status, and symptoms scores (p < 0.01 for each). In a subset of 65 women who experienced moderate to severe back pain, all OPAQ dimensions were significantly reduced (p < 0.05). CONCLUSION: Both prevalent back pain and new or worsening back pain affected HRQOL negatively. Osteoporosis therapies that prevent the development of back pain in postmenopausal women may also prevent decreases in HRQOL.

Affect↗
PubMed2005

Prevalence of low back pain among peasant farmers in a rural community in South West Nigeria.

This study is a survey conducted in Iju-Odo rural community of Ondo State in South West Nigeria to determine the prevalence and risk factors for low back pain amongst peasant farmers. Five hundred peasant farmers were selected using a multi-stage sampling technique. A questionnaire was administered which sought information on demographic characteristics, presence of low back pain in the last 12 months prior to the time of the study and the duration, severity of low back pain and its effect on farming activity. The five hundred peasant farmers that participated in this study were 276 men (55.2%) and 224 women (44.8%). Three hundred and sixty two peasant farmers (72.4% of the population) had low back pain in the last 12 months prior to the time of this study, of which two hundred and three (73.5%) were males and one hundred and fifty nine (71.0%) were females peasant farmers having low back pain. The nature of onset of low back pain was that of gradual onset in 57.5%. One hundred and eighty-eight (51.9%) respondents indicated that low back pain reduced their farming workload, while one hundred and twenty four (34.3%) respondents were prevented from going to farm because they could not walk, resulting in 675 work days being lost by one hundred and twenty one (24.2%) peasant farmers in the last one-year with a mean of 5.6 days lost. This study concluded that low back pain prevalence is high among peasant farmers, with higher prevalence in males compared with females (P<0.05). The prevalence also increased with age (P<0.05). Years of farming was found to have a significant influence on the prevalence of low back pain (P<0.05) with prevalence of low back pain increasing as years of farming increases. Low back pain was found to be a cause of work absenteeism in this working population.

Adult↗
PubMed1988

Back pain.

Among the multitude of potential etiologies for low back pain in the elderly, cauda equina syndrome is the only genuine surgical emergency. The consequence of delayed recognition, referral, and decompression may be permanent neurologic deficit. Fortunately, this event is rare. Certain other warning signs and symptoms (as outlined in Fig. 1) should alert the clinician to possible systemic disease and warrant earlier, more aggressive evaluation. Careful history-taking and focused physical examination remain the cornerstones of clinical decision making in managing the geriatric patient with back pain. Laboratory and/or radiologic studies are indicated in carefully defined circumstances. Advanced age, independent of other risk factors, is probably not an indication for obtaining roentgenograms and laboratory studies as part of the initial screening of patients with back complaints. Available epidemiologic studies suggest that the predicament as well as the illness of back pain is common in the elderly, and that most people who suffer from back pain in old age had back complaints before the age of 65. Furthermore, although back complaints are among the most commonly mentioned symptoms by elderly patients to their physicians, they are less often the chief or presenting complaint. Studies that examine the reasons for health-care-seeking behavior in older patients with back pain, or that compare older and younger patients in this regard, are lacking. Several factors potentially contribute to age-related differences in patient behavior related to back pain. The removal of employment compensation issues in the postretirement population may alter the relative frequency of physician visits. A higher incidence of serious chronic and/or life-threatening disease in the elderly, as well as perceived threats to independent function, may heighten anxiety about back pain. Conversely, because of the greater prevalence of musculoskeletal and other activity-limiting conditions in the elderly, older patients may believe that back pain is just another burden of aging. These questions await further research.

Aged↗
PubMedDate not supplied

Does obesity cause low back pain?

OBJECTIVES: The purpose of this study is to review the recent literature on the association between obesity and low back pain, in an effort to determine whether weight control can be considered an appropriate treatment for low back pain, and whether obesity can be considered a primary etiology of low back pain. DATA SOURCES: We reviewed articles in English from 1970 to present on MEDLINE that listed both obesity and low back pain as key words. Because of the paucity of articles retrieved this way, we also reviewed the bibliographies of each article to draw more studies into our review. Our search generated only seven studies. A standard textbook of obesity was also utilized as a source of basic science of obesity. CONCLUSION: Our review of these articles revealed a possible association between obesity and low back pain only in the upper quintile of obesity, and no evidence of a temporal relationship between weight change and low back pain change. The studies reviewed failed to differentiate low back pain patients by diagnosis and failed to quantify the possible presence of emotional factors in obese low back pain patients. As an incidental finding, one study documented a significant correlation between smoking history and low back pain. We concluded that there is no evidence in the current literature to support obesity that is not in the highest quintile as a cause of low back pain. We recommended that a longitudinal study be done that subclassified obese low back pain patients by mechanical and psychological diagnosis.

Body Mass Index↗
PubMed1996

The role of congruence between patient and therapist in chronic low back pain patients.

OBJECTIVE: To determine the role of congruence in the perception of the evolution of back pain during treatment and in the expectations about the future of back pain problems. Congruence was defined as the agreement between patient and therapist on various aspects of back pain problems and of treatment. DESIGN: Semistructured interviews at the beginning and the end of treatment. SUBJECTS: Seventy-one back pain patients and their therapists (6 chiropractors and 6 rheumatologists). MAIN OUTCOME MEASURES: Synthesized index of congruence based on 24 questions asked of both the patient and his/her therapist. RESULTS: The distribution of the congruence scores indicated a high level of congruence in 39.4% of the cases, an average level in 35.2% and a low level in 25.4%. The results demonstrated that congruence was significantly associated with the perception of an improvement in back pain. This positive perception was nevertheless associated with the expectation of persistence or recurrence of the back pain problem in the future. Noncongruence was correlated with the patient's estimation of a less favorable evolution of the back pain problem during the treatment and with a major difficulty for both the therapist and the patient to express clear expectations about the future of the patient's back pain problem. CONCLUSIONS: Congruence mainly reflects an agreement that the treatment is aimed at the management of a long-term condition rather than at the resolution of the back pain problem. Congruent patients seem to accept living with their back problems, a position shared by their therapists, whereas noncongruent patients do not seem to share this conception of back pain.

Adult↗
PubMed1997

Prevalence of subtypes of low back pain in a defined population.

BACKGROUND: For two generations, some back care specialists have emphasized that clinical low back pain is composed of a number of specific syndromes, such as sacroiliitis or trigger points, but the prevalence of these syndromes outside of specialized clinics remains unknown. The purpose of this study was to describe the prevalence of subtypes of low back pain in a defined population. METHODS: The setting was a group model HMO with a population of 54,000. We used a formal group process involving clinicians from many disciplines, long interviews, critical appraisal of the literature, case discussions, and clinical audits to define a set of subtypes of low back pain. Trained physical therapists assessed subtypes in all patients referred for low back pain over a 9-month period, from July 1992 to April 1993. RESULTS: Of the 213 patients evaluated for low back pain, 72% had acute pain (< 3 months) and only 15% had work-related injury. After classification into subtypes, 32% had acute low back strain, 28% had radicular syndromes, 14% had chronic back strain, 10% had sacroiliac syndromes, 6% had posterior facet syndrome, and the remaining 10% included 12 different syndromes. Only about 10% had more than one clinical syndrome. CONCLUSIONS: A limited number of subtypes of low back pain make up the vast majority of low back pain seen in the population at large. Attention to subtypes may provide a way to improve primary care management of low back pain.

Adolescent↗
PubMed1994

Evaluation of a sitting aid: the back-up.

The effects of a portable back support, the Back-Up, were tested in 28 variables. Both subjective and objective physical load measures were recorded during sitting with and without Back-Up, most of them during VDU work. The main result was that the posture of the upper back and neck/head was improved by the Back-Up. However, the knee straps induced unacceptable high pressure and increased significantly the discomfort in the legs. Based on these results the Back-Up was modified: the contact area between the strap and the knee was enlarged. This modified Back-Up was tested again for 13 variables with 10 new subjects. The knee pressure turned out to be acceptable and the discomfort was equal to sitting without the Back-Up. Based on this research the Back-Up is considered as a possible addition to more fundamental ergonomic improvements such as adjustable furniture and variation between sitting, standing and walking tasks, especially for improvement of the neck load. However, the Back-Up should not replace proper ergonomic workstation and work organization design or a backrest on the chair. Furthermore, the Back-Up should not be made obligatory, and it should be worn only for a part of the day, because it limits variation in postures.

Journal Article↗
PubMed1999

The effect of comorbidity on care seeking for back problems in the United States.

PURPOSE: We assess the effect of comorbidity on self-reported use of health care for back problems in the United States. METHODS: Data from the 1989 National Health Interview Survey (NHIS) were used to perform cross-sectional analyses of adults who reported a back-related condition. The presence of one or more nonback-related conditions (and associated disability and health care) were the primary predictor variables. Weighted logistic regression modeling was performed to estimate odds ratios (ORs) adjusted for the effects of covariates. RESULTS: The 1989 NHIS included 84,572 adults, of which 4790 (5.7%) reported at least one back-related condition. Of these, 931 (19.6%) sought health care for their back condition during the 2-week reference period. Among all adults with reported back problems, those with disabling comorbidities and those who sought care for their comorbidities during the reference period were less likely to have sought back care than were those with no comorbidities. Subjects with back-related disabilities who reported nondisabling comorbidities without associated health care were much more likely to have sought back care than were similar subjects without any comorbidities. CONCLUSIONS: The decision to seek care for a back problem is a complex process that depends upon the presence and impact of other conditions and the use of care for these conditions. Comorbid back problem sufferers may not seek back care when afflicted with other disabling conditions or conditions that may be perceived to be more amenable to care.

Adult↗
PubMed2001

National supply-chain survey of drug manufacturer back orders.

The impact of manufacturer back orders on the supply chain for pharmaceuticals in the institutional setting was studied. A questionnaire was distributed during May and June 2000 to 600 institutional pharmacies affiliated with a major national drug and supply group purchasing organization. The instrument included questions on basic institutional demographics, perceptions about the frequency of manufacturer back orders for pharmaceuticals, the quality of communication with manufacturers and wholesalers about back orders, the two most significant back orders that had occurred in the 12 months preceding the survey, and the reasons for and impact of back orders. A total of 170 usable surveys were returned (net response rate, 28.3%). Reported manufacturer back orders included an array of drug classes, including blood products, antimicrobials, antiarrhythmics, benzodiazepine antagonists, thrombolytics, corticosteroids, and antihypertensives. Respondents perceived significant back orders as increasing in frequency. Communication by manufacturers and wholesalers about back orders was reported to be relatively poor. A raw-material shortage was the most common reason given by manufacturers for back orders (36.5%), followed by a regulatory issue (23.2%). In most cases (92%), medical staff members had to be contacted, indicating an interruption in the normal drug distribution process. In over a third of instances, respondents stated that the back order resulted in less optimal therapy. A survey found that manufacturer back orders for pharmaceuticals were increasing in frequency and that information flow within the supply chain was insufficient to meet the needs of end users.

Commerce↗