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PubMed2003

Distance-dependent modifiable threshold for action potential back-propagation in hippocampal dendrites.

In hippocampal CA1 pyramidal neurons, action potentials generated in the axon back-propagate in a decremental fashion into the dendritic tree where they affect synaptic integration and synaptic plasticity. The amplitude of back-propagating action potentials (b-APs) is controlled by various biological factors, including membrane potential (Vm). We report that, at any dendritic location (x), the transition from weak (small-amplitude b-APs) to strong (large-amplitude b-APs) back-propagation occurs when Vm crosses a threshold potential, x. When Vm > x, back-propagation is strong (mostly active). Conversely, when Vm < x, back-propagation is weak (mostly passive). x varies linearly with the distance (x) from the soma. Close to the soma, x << resting membrane potential (RMP) and a strong hyperpolarization of the membrane is necessary to switch back-propagation from strong to weak. In the distal dendrites, x >> RMP and a strong depolarization is necessary to switch back-propagation from weak to strong. At approximately 260 micrometer from the soma, 260 approximately RMP, suggesting that in this dendritic region back-propagation starts to switch from strong to weak. x depends on the availability or state of Na+ and K+ channels. Partial blockade or phosphorylation of K+ channels decreases x and thereby increases the portion of the dendritic tree experiencing strong back-propagation. Partial blockade or inactivation of Na+ channels has the opposite effect. We conclude that x is a parameter that captures the onset of the transition from weak to strong back-propagation. Its modification may alter dendritic function under physiological and pathological conditions by changing how far large action potentials back-propagate in the dendritic tree.

Action Potentials↗
PubMed2000

Epidemiology of low back pain.

Low back pain is a symptom that cannot be validated by an external standard. It is a disorder with many possible etiologies, occurring in many groups of the population, and with many definitions. Low back pain is a common problem, with a prevalence in the United States ranging from 8% to 56%. It is estimated that 28% experience disabling low back pain sometime during their lives, 14% experience episodes lasting at least 2 weeks, 8% of the entire working population will be disabled in any given year, and the lifetime prevalence of low back pain is 65% to 80%. It is believed that most episodes of low back pain will be short-lived and that 80% to 90% of attacks of low back pain resolve in about 6 weeks, irrespective of the administration or type of treatment. However, multiple studies in the late 90s showed recurrent or chronic low back pain, evaluated at 3 months, 6 months, or 12 months, ranging from 35% to 79%. Risk factors of low back pain are multifactorial, with many possible etiologies. Multiple risk factors of low back pain and lower-extremity pain include physical factors, social demographic characteristics, habits, and psychosocial factors. This review will discuss the epidemiology of low back pain, with emphasis on frequency, causes, and consequences of low back pain; the influence of age, gender, morphologic characteristics, and genetics; and the influence of occupational, mechanical, social, habitual, and psychological factors.

Journal Article↗
PubMed2006

Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria.

OBJECTIVE: Back pain associated with ankylosing spondylitis (AS) is referred to as inflammatory back pain (IBP). The value of the clinical history in differentiating IBP from mechanical low back pain (MLBP) has been investigated in only a few studies. In this exploratory study, we sought to evaluate the individual features of IBP and to compose and compare various combinations of features for use as classification and diagnostic criteria. METHODS: We assessed the clinical history of 213 patients (101 with AS and 112 with MLBP) younger than 50 years who had chronic back pain. Single clinical parameters and combinations of parameters were compared between the AS and MLBP patient groups. RESULTS: Morning stiffness of >30 minutes' duration, age at onset of back pain, no improvement in back pain with rest, awakening because of back pain during the second half of the night only, alternating buttock pain, and time period of the onset of back pain were identified as independent contributors to IBP. Importantly, none of the single parameters sufficiently differentiated AS from MLBP. In contrast, several sets of combined parameters proved to be well balanced between sensitivity and specificity. Among these, a new candidate set of criteria for IBP, which consisted of morning stiffness of >30 minutes' duration, improvement in back pain with exercise but not with rest, awakening because of back pain during the second half of the night only, and alternating buttock pain, yielded a sensitivity of 70.3% and a specificity of 81.2% if at least 2 of these 4 parameters were fulfilled (positive likelihood ratio 3.7). If at least 3 of the 4 parameters were fulfilled, the positive likelihood ratio increased to 12.4. CONCLUSION: A new set of criteria for IBP performed better than previous criteria in AS patients with established disease. A prospective study is needed to validate the diagnostic properties of the new candidate criteria set in patients with early disease.

Activities of Daily Living↗
PubMed2003

Surface electromyography assessment of back muscle intrinsic properties.

The purpose of this study was to assess (1) the reliability and (2) the sensitivity to low back pain status and gender of different EMG indices developed for the assessment of back muscle weakness, muscle fiber composition and fatigability. Healthy subjects (men and women) and chronic low back pain patients (men only) performed, in a static dynamometer, maximal and submaximal static trunk extension tasks (short and long duration) to assess weakness, fiber composition and fatigue. Surface EMG signals were recorded from four (bilateral) pairs of back muscles and three pairs of abdominal muscles. To assess reliability of the different EMG parameters, 40 male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three occasions. Reliable EMG indices were achieved for both healthy and chronic low back pain subjects when specific measurement strategies were applied. The EMG parameters used to quantify weakness and fiber composition were insensitive to low back status and gender. The EMG fatigue parameters did not detect differences between genders but unexpectedly, healthy men showed higher fatigability than back pain patients. This result was attributed to the smaller absolute load that was attributed to the patients, a load that was defined relative to their maximal strength, a problematic measure with this population. An attempt was made to predict maximal back strength from anthropometric measurements but this prediction was prone to errors. The main difficulties and some potential solutions related to the assessment of back muscle intrinsic properties were discussed.

Abdominal Wall↗
PubMed1997

Back pain in relation to pregnancy: a 6-year follow-up.

STUDY DESIGN: A prospective randomized controlled 6-year follow-up study of women with back pain during pregnancy. OBJECTIVES: To describe the long-term development of back pain in relation to pregnancy and to identify the effects of a physiotherapy and patient education program attended during pregnancy. SUMMARY OF BACKGROUND DATA: Pain incidence and intensity during pregnancy can be reduced by physiotherapy. No study has described the development of pain experienced for a period of years after delivery or the long-term effect of physiotherapy. METHODS: Pregnant women, registered consecutively, were randomly assigned to one control group and to two intervention groups and were observed throughout pregnancy, with follow-up after 3 months and 6 years. RESULTS: The first phase of the study was completed by 362 women. After 3 months, 351 and after 6 years, 303 women had been observed. Back pain among 18% of all women before pregnancy and among 71% during pregnancy declined to 16% after 6 years. Pain intensity was highest in Week 36 (visual analog score, 5.4) and declined markedly 6 years later (visual analog score, 2.5). Slow regression of pain after partus correlated with having a back pain history before pregnancy, (r = 0.30; P < 0.05), with high pain intensity during pregnancy (r = 0.45; P < 0.01), and with much residual pain 3 months after pregnancy (r = 0.41; P < 0.01). These correlations were not found in the intervention groups. Furthermore, frequency of back pain attacks at 6 years correlated with frequency of attacks during pregnancy (r = 0.41; P < 0.01) and with a vocational factor (r = -0.25; P < 0.01). Physiotherapy and patient education had no effects on back pain development among women without pain during pregnancy. CONCLUSIONS: Back pain during pregnancy regressed spontaneously soon after delivery and improved in few women later than 6 months post partum. Expected correlations between back pain in relation to pregnancy and back pain 6 years later were not present in the intervention groups who had attended a physiotherapy and education program during pregnancy. The program had no prophylactic effects on women without back or pelvic pain during pregnancy.

Back Pain↗
PubMed1998

Relation between functional characteristics of the trunk and the occurrence of low back pain. Associated risk factors.

STUDY DESIGN: A 2-year prospective study relating a set of subject characteristics (professional and extraprofessional constraints, personal and anthropometric characteristics, and static and dynamic performance of the trunk) and incidence of low back pain in a population of male Belgian steel workers. OBJECTIVES: To investigate the relation between occurrence of new cases of low back pain and prior personal, anthropometric, or functional characteristics. SUMMARY OF BACKGROUND DATA: Some functional characteristics--in particular, dynamic parameters of the trunk such as the velocity--have been shown to be significantly reduced for low back pain in workers in cross-sectional studies. The question remained as to whether modifications of these parameters preceded the development of low back pain. METHODS: The protocol included a questionnaire, a clinical examination, anthropometric measurements, and a set of functional tests on an isoinertial dynamometer. It was carried out twice, after a 1-year interval, on a sample of 215 workers without any history of low back pain. The reports of low back pain were again investigated 1 year later. RESULTS: The development of low back pain is related to frontal plane imbalance of the trunk, lower body weight, and perception of heavy lifting efforts at the workplace. Individuals performing dynamic tests at higher velocities appear also to be at a greater risk of low back pain. CONCLUSIONS: Although workers with a history of low back pain performed dynamic tests at significantly lower velocities, the probability for development of low back pain in the following year is greater for workers performing such tests at greater velocities.

Adult↗
PubMed2006

Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.

STUDY DESIGN: Review and analysis of data from two U.S. national surveys in 2002. OBJECTIVES: To examine the prevalence of back pain and physician visits for back pain in the United States. SUMMARY OF BACKGROUND DATA: National data on the prevalence of back pain become available only intermittently. METHODS: We summarized published data from the 2002 National Health Interview Survey (NHIS) on the prevalence of back pain and compared it with earlier surveys. We also analyzed the 2002 National Ambulatory Medical Care Survey (NAMCS) to determine physician visit rates for back pain. RESULTS: In the 2002 NHIS, there were 31,044 adult respondents. Low back pain lasting at least a whole day in the past 3 months was reported by 26.4% of respondents, and neck pain was reported by 13.8%. Among racial groups, American Indians and Alaska Natives had the highest prevalence of low back pain, and Asian Americans had the lowest. Prevalence generally declined with greater levels of education and increasing income. Prevalence estimates were consistent with those from previous surveys, although methodologic differences limited comparisons. NAMCS data suggested that the proportion of all physician visits attributable to low back pain (2.3% in 2002) has changed little since the early 1990s. CONCLUSIONS: About one fourth of U.S. adults report low back pain in the past 3 months; the proportion of physician visits attributed to back pain has changed little in the past decade.

Adult↗
PubMed2006

Effect of local analgesia on movement of the equine back.

REASONS FOR PERFORMING STUDY: Diagnostic infiltration of local anaesthetic solution is commonly used in cases of equine back pain. Evaluation is subjective and it is not known how local analgesia of the back affects horses without clinical signs of back pain. OBJECTIVES: To evaluate the effect of infiltration of local anaesthetics on the movement of the back in horses without clinical signs of back pain, and to evaluate the usefulness of kinematic studies as an objective and quantitative tool in evaluating local analgesia in clinical practice. METHODS: The kinematics of the back in 10 clinically sound horses were measured on 2 occasions at walk and trot before and after injections with mepivacaine and sodium chloride around the interspinous spaces between T16 and L2. The kinematics were compared between the 2 occasions before injections and before and after each injection. RESULTS: The range of motion (ROM) for dorsoventral flexion-extension (FE) of the back was increased significantly in all measured segments other than T10 at walk, as was lateral bending (LB) at T10, L3 and L5 after injection of mepivacaine. For lateral excursion (LE), total movement increased at all measured segments. At trot the only affected segment was L3, where the injection with mepivacaine decreased the ROM for FE. After injection of sodium chloride the ROM for FE increased at T13 and T17 at walk. Lateral bending and LE were not affected at walk. At trot, LB increased at L3 and L5. CONCLUSIONS AND POTENTIAL RELEVANCE: Diagnostic infiltration of local anaesthetic solution affects the function of the back in clinically sound horses, which must be considered when interpreting the use of this clinical aid in assessing clinical cases of back dysfunction. Kinematics can qualitatively and quantitatively evaluate the effect of local analgesia of the back.

Analgesia↗
PubMed2001

Risk factors for back pain among male farmers: analysis of Iowa Farm Family Health and Hazard Surveillance Study.

BACKGROUND: Back pain causes considerable morbidity, disability, and economic loss among workers. Farmers handle heavy objects, often in awkward postures. However, the prevalence of back pain among farmers and the risk factors associated with back pain are not well known. METHODS: In this study, we assess the frequency of risk factors for back pain among 287 Iowa male farmers. From 1992 to 1994, using a mail questionnaire, we collected data on potential risk factors for back pain. Eighteen months later, we surveyed occurrence of back pain as the outcome measure. RESULTS: Thirty-one percent of farmers reported having daily back pain for a week or more during the past 12 months compared to 18.5% in the general working population. Using a multiple logistic regression model, we found two factors associated with back pain: 45-59 years of age (OR = 2.13, 95% CI 1.02-4.43) and having a non-agricultural job as the major occupation (OR = 2.02, 95% CI 0.98-4.17, P = 0.055). CONCLUSIONS: Farmers had a significantly higher prevalence of back pain than the general working population. Middle-aged farmers and those with additional non-agricultural jobs had the highest risk for back pain.

Adult↗
PubMed1984

Personal characteristics and back injury among hospital nursing personnel.

Since back injury is the largest workman's compensation claim in most industries, the relationship between selected personal characteristics and back injury in hospital nursing personnel were studied. The sample included 64 female nursing personnel, half back injured and half not. Demographic: Workers were more likely to be back injured if they were older, worked longer on nursing units requiring frequent lifting, had family members with back problems, and had family members whose back problems began at an early age. Physical: The back injured had less muscle flexibility, less keen proprioception, and greater unequal leg length. Life style: Back injured were more vulnerable to frustration and stress overload (overstimulation), smoked more cigarettes, spent fewer hours exercising, and rated their physical condition lower. The variables with the greatest discriminatory power to predict back injury were a sense of overload, muscle flexibility, proprioception, family history of back problems, difference in leg length, years of risk in nursing practice, and smoking.

Adult↗
PubMed2005

Cross-sectional view of factors associated with back pain.

OBJECTIVE: To examine the factors associated with back pain within a working population. METHODS: A cross-sectional survey of employees using a self-administered questionnaire and physical fitness tests. This study assessed 10,321 participants (6,251 male and 4,070 female) of two nationwide companies throughout Switzerland between 1996 and 1998. The participation rate was 41%. RESULTS: Of the participants, 4,945 (48%) suffered mild back pain and 696 (7%) suffered severe back pain. Reported "stress" was associated with back pain of any intensity. Abdominal muscle strength was inversely associated with severe back pain, while physical activity was non-linearly associated with severe back pain. Smoking was directly associated with any intensity of back pain. The variables gender, obesity, strength of the abdominal musculature and frequency of physical activity were insignificant for back pain of any intensity in multivariate analyses. CONCLUSION: Our results confirm the association of back pain with physical and behavioural factors. The non-linear relationship between physical activity and back pain may need further examination. Performing any kind of sport three to four times a week appears optimal.

Abdominal Muscles↗
PubMed2001

[Treatment of low back pain--significance, principles and danger].

Today, a wide range of efficient analgesic and non-analgesic drugs for the treatment of back pain are available. However, drugs should never be the only mainstay of a back pain treatment program. Non-steroidal antiinflammatory drugs (NSAID) are widely used in acute back pain. NSAIDs prescribed at regular intervals are effective to reduce simple back pain. The different NSAIDs are effective for the reduction of this pain. They have serious adverse effects, particularly at high doses, in the elderly, and on long-term administration. The new cyclooxygenase II-inhibitors have less gastrointestinal complications. But the long-term experiences are limited up to now. Considerable controversy exists about the use of opioid analgesics in chronic noncancer pain. Many physicians are concerned about the effectiveness and adverse effects of opioids. Other clinicians argue that there is a role for opioid therapy in chronic noncancer pain, e. g. especially in chronic low back pain. There is a low incidence of organ toxicity in patients who respond to opioids. The incidence of abuse and addiction is likewise relatively low. The potential for increased function and improved quality of life seems to outweigh the risks. However, there is a lack of randomised controlled trials (RCT) on opioid therapy in a multimodal pain treatment approach. Clinical experience and some studies suggest administration of sustained release opioids because of better comfort for the patient and less risks for addiction. The opioids should be selected due to the specific side effects of the different drugs. For patients with pre-existing constipation transdermal fentanyl should be preferred. Antidepressant medications have been used for the treatment of chronic back pain, though there is only little scientific evidence for their effectiveness. There is no evidence for the use of antidepressants in acute low back pain. Trials of muscle relaxants for patients with acute back pain have used a wide range of agents, e. g. benzodiazepines. They mostly reduce acute back pain, but they have significant adverse effects including drowsiness and psychological and physical dependence even after relatively short treatment. Benzodiazepines are not indicated in the treatment of chronic back pain. Drugs are sometimes necessary for the patients to begin and persevere a multimodal treatment program. Drug therapy should be terminated as soon as other treatment strategies succeed. Unfortunately, no studies exist evaluating the place of analgesics within a multimodal treatment program.

Analgesics, Opioid↗
PubMed2001

[Physiotherapy in low back pain--indications and limits].

These times of changing paradigms raise the question of the indications for and limits of physical therapy in back pain management. At present, several national and international guidelines for the care of chronic back pain are available. Unfortunately, the guidelines are often inconsistent concerning physiotherapy. An encompassing framework for an effective, efficient, and appropriate physiotherapy treatment needs to be developed. Within the German national health system, the "Arzneimittelkommission" [2] issued guidelines for low back pain. These guidelines endeavour to distinguish between disease related specific back pain and non specific back pain of a more functional or mechanical origin. Furthermore, the "Bundesausschuss der Arzte und Krankenkassen" in Germany dispatched guidelines (Heilmittelrichtlinien) for the prescription of "Heilmittel" (remedies other than drugs) on October 16th, 2000. These guidelines seek to appropriately refer, assign and limit the physiotherapy treatment of back pain according to a set indications catalogue. On an international basis, the World Health Organisation (WHO) [21] offers well established guidelines for the "International Classification of Functioning and Disability", 2nd version (ICIDH-2). These guidelines describe the progressive health dysfunction over three major levels: 1) body functions and structures, 2) activities of an individual, and 3) participation of an individual in social and other essential aspects of life. National and international scientific studies support the use of ICIDH-2-categories and suggest that different back pain management is required at different levels of dysfunction. For example, there is a trend to prescribe increasingly active types of treatment instead of passive ones for increasing levels of dysfunction [54]. Multimodal treatment programs [17, 29], which include physical activity, training and psychological programs as well as training of activities of daily living (ADL) ("workhardening program") demonstrate particular benefit in the treatment of chronic low back pain at the disability and handicap level. Current physical therapy on back pain management operates at all three categories of ICIDH-2. Therapists aim to treat local spinal symptoms and their secondary functional changes, reorganise altered physiological patterns and improve the psycho-social state of the patient. This level overlaps with the fields of occupational therapy (training of work related tasks), psychosocial therapy (training of social competence etc.) and physical training (improvement of physical performance). Physical training as a means of physical therapy, combined with certain aspects of occupational therapy, offers an important possibility of transfer into workday life. Borders between neighbouring fields are not sharp. Physical therapy is contraindicated only in rare cases (e.g. clear indications for surgery; predominant psychological disorder). Unfortunately, the national German guidelines for physical therapy (Heilmittelrichtlinien) which have been put in effect by July 1st, 2001 appear to direct the prescription of physical therapy primarily to treating structural and functional dysfunction. At an activity level, occupational therapy is recommended only for the treatment of specific diseases. Moreover, recommendations for physical therapy for patients with an acute impairment and those with a chronic handicap are almost identical. This is not in accordance with the scientific evidence for effective treatment. So far there are no studies investigating the various implications of ICIDH-2-guidelines for physical therapy management of back pain. Considering the ICIDH-2 directives it is not helpful to judge efficacy solely by somatic parameters such as mobility and muscle force. A patient without good mobility could still return to work. A subjective feeling of well being or low disability on the side of the patient is an equally important parameter of successful treatment as the good physical capacity for daily life.

Germany↗
PubMed2002

[Interventions for improvement of primary care in patients with low back pain: how effective are advice to primary care physicians on therapies and a multimodal therapy program arising out of cooperation of outpatient health care structures?].

BACKGROUND: Treatment for chronic low back pain in primary care has a poor-quality outcome. There is evidence that multimodal therapy is the most successful approach to its management. We tried to evaluate whether giving primary care physicians evidence-based recommendations on therapy of chronic back pain or directly implementing a multimodal program would improve the outcome of patients with low back pain treated in primary care. METHODS: In the first phase, physicians were asked to document the course of patients suffering from low back pain of at least 4 weeks' duration with no decrease in intensity, noting pain intensity before and after 6 months of conventional, nonsurgical treatments. In the present, second, phase of the study, recommendations issued by the Medicines Committee of the German Medical Profession and the U.S. Agency for Health Care Policy and Research for the management of back pain were presented to doctors in printed form and at conferences. In parallel with this, a multimodal program for the treatment of chronic low back pain (4 h/day for 20 days: medical training therapy, cognitive-behavioral therapy, physiotherapy, and patient education) was organized in a private health-oriented sports center in cooperation with three private physiotherapy practices, and a psychologist and a pain specialist from the outpatient pain clinic at the University Hospital in Erlangen. We examined how physicians changed the therapy and how effective it was, the latter as reflected in the mean sum value of the percent pre- to posttreatment changes in pain intensity, how much pain interfered with daily living, depressivity, and quality of life. Data after interventions were compared with baseline data from the first phase. RESULTS: Data relating to 36 patients following treatment by 14 primary care physicians who had been given information about therapy recommendations and to 51 patients who had participated in the multimodal therapy program were compared with baseline data recorded in 157 patients. Recommendations changed neither the therapy preferred by primary care physicians nor the quality of outcome of conventional treatment. In contrast, the multimodal program of therapy for chronic low back pain improved the outcome significantly more than conventional therapy (mean improvement in general outcome score 22 vs. 7%, respectively, compared with baseline data; P<0.001). CONCLUSIONS: Giving primary care physicians information on the therapy recommended for treatment of low back pain does not lead to any change in physicians' preferred therapy. Multimodal programs for treatment of chronic low back pain should be organized locally, with existing health care providers joining forces to improve the quality of outcome in chronic low back pain managed in primary care.

Adult↗
PubMed2005

Relationship between low-back pain, muscle spasm and pressure pain thresholds in patients with lumbar disc herniation.

It is not known whether or not muscle spasm of the back muscles presented in patients with sciatic scoliosis caused by lumbar disc herniation produces muscle pain and/or tenderness. Pressure pain thresholds (PPTs) of the lower back and low-back pain were examined in 52 patients (13 of 52 presenting sciatic scoliosis) with lumbar disc herniation who complained of radicular pain and in 15 normal subjects. PPTs were measured at five points bilaterally using an electronic pressure algometer. Low-back pain was evaluated using visual analogue scale (VAS) ratings. All patients complained of radicular leg pain and were divided into the following three groups according to the presence of and the region of low-back pain: no low-back pain group, low-back pain with no laterality group, and low-back pain dominantly on the herniation side group; the VAS rating on the side ipsilateral to the herniation side was higher than that on the contralateral side. In the normal subjects, there were no statistically significant differences between sides in mean PPTs at all sites examined. PPTs were not lower in the spasmodic side (concave side) than the convex side in patients with sciatic scoliosis. PPTs on the herniation side were significantly lower than those on the contralateral side in patients with low-back pain dominantly on the herniation side. Furthermore, the areas of low PPTs were beyond the innervation area of dorsal ramus of L5 and S1 nerve root. It was considered that not only the peripheral mechanisms but also the hyper excitability of the central nervous system might contribute in lowering PPTs of the lower back on the herniation side.

Adult↗
PubMed2001

Absence of back disorders in adults and work-related predictive factors in a 5-year perspective.

Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86; 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0; 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.

Adult↗
PubMed2005

Self-report measure of low back-related biomechanical exposures: clinical validation.

Low back pain and symptoms are major contributors to ambulatory visits, economic burden, and reduced readiness among military personnel and employers in the civilian workplace as well. While a link between low back pain and biomechanical exposures has been established, efficient surveillance methods of such exposures are still needed. Furthermore, the utility of self-report measures for biomechanical exposures has not been examined extensively. The present cross-sectional study analyzed questionnaire data from US Army soldiers (n = 279) working in previously identified occupational specialties that were associated with high risk for low back pain and/or low back pain disability. Demographic characteristics, physical workload, health behaviors, and psychosocial factors were assessed in addition to self-reported workplace biomechanical exposures using the Job Related Physical Demands (JRPDs). Outcomes included self-reported low back pain severity, low back symptoms, functional limitations, and general physical health. The results indicated that the self-report measure of biomechanical exposure had a high degree of internal consistency (Cronbach alpha, 0.95). The JRPD index correlated with low back symptoms, pain intensity, function, and perceived work load using the Borg scale. Regression analyses indicated statistically significant associations between the JRPD and back pain specific pain severity and physical function, but not for general physical health (SF-12) after controlling for age, gender, educational level, job type, and reported exercise and work stress. Specifically, higher JRPD scores (representing greater biomechanical exposure) were associated with higher levels of pain intensity and functional limitations. Higher JRPD scores were found to place an individual at a greater likelihood for being a case with low back pain within the past 12 months (OR = 1.01 per point increase in scale-95%; range 38-152; CI = 1.00-1.02, p < or = 0.05). While future longitudinal studies of the JRPD determining the predictive validity of the measure are needed, the present study provides evidence of the utility of the JRPD for assessing biomechanical exposures associated with low back pain within high-risk jobs. The findings suggest that the JRPD may assist with surveillance efforts and be useful as a process and/or outcome measure in research related to occupational rehabilitation.

Adolescent↗
PubMed1994

The efficacy of back schools: a review of randomized clinical trials.

The purpose of this study was to assess the efficacy of back school programmes for low-back pain. Data sources comprised computer-aided search of published randomized clinical trials and assessment of the methods of the studies. 21 papers reporting on 16 randomized clinical trials evaluating a back school programme were selected for the study. Data extraction included a score for quality of the methods, based on four categories: study population, interventions, effect measurement and data presentation and analysis; and the conclusion of the author(s) with regard to the efficacy of the back school programme. Only two studies scored more than 50 points (maximum = 100 points) indicating the overall poor quality of the methods. Seven studies indicated that the back school programme was more effective than the reference treatment and seven reported it to be no better or worse than the reference treatment. In two studies the authors refrained from drawing a conclusion. The studies reporting positive results showed higher methods scores (4/7 positive vs 0/7 negative scored > or = 45 points). Reported benefits of back schools were usually of short duration only. There are major flaws in the design of most studies. The best studies indicated that back schools may be effective in occupational settings in acute, recurrent or chronic conditions. The most promising type of interventions were (modifications of) the "Swedish back school" and were quite intensive (a 3 to 5-week stay in a specialized centre). Future research efforts should focus on the identification of patients who would benefit most from back schools. In addition, more attention should be paid to the cost-effectiveness of back schools.

Humans↗