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PubMed1987

Psychological factors in low back pain.

Even though low back pain is one of the commonest diseases, little is known about its aetiology, its natural history and its treatment. This may explain why the myth exists that low back pain is often psychogenic in origin or that psychological factors are often at least involved in low back pain. The aim of the early studies on low back pain and psychological factors was to try to divide these pains into functional (psychogenic) and organic, according to the aetiology. The aim of the studies was to predict the quality and success of the treatment. According to the current view, it is not meaningful to try to dichotomize low back pain in this way. According to the earlier literature, both conversion hysteria and psychoses were the main cause of psychogenic low back pain. More recent studies do not, however, support this view. It seems that the most common psychiatric disturbances associated with low back pain are neuroses and neurotic traits. There is controversy as to how often psychological factors are involved in low back pain. Population studies have shown that this association may be weaker than was thought earlier. It seems that individuals who suffer from low back pain, more often than others, have aggression problems and weaknesses in their ego function and more frequently have problems in interpersonal relations and sexual problems. There is no clear picture of what kind of psychotherapy is best suited to low back pain patients who have mental problems. The results attained by learning therapy and also with multidisciplinary ward programs seem quite promising.

Back Pain↗
PubMed1994

The effectiveness of four interventions for the prevention of low back pain.

OBJECTIVE: Low back pain affects 60% to 80% of US adults at some time during their lives. This review evaluates the effectiveness of four strategies to prevent low back pain for asymptomatic individuals: back and aerobic exercises, education, mechanical supports (corsets), and risk factor modification. DATA SOURCES: The MEDLINE database was searched for all relevant articles published in English between 1966 and 1993. Bibliographies of identified articles were searched to ensure that all pertinent articles had been gathered and back pain specialists reviewed our final bibliography for completeness. STUDY SELECTION AND DATA EXTRACTION: A total of 190 articles were identified, and the 64 that contained original data about preventing low back pain were reviewed. Studies were graded according to strength of study design. DATA SYNTHESIS: There is limited evidence based on randomized trials and epidemiological studies that exercises to strengthen back or abdominal muscles and to improve overall fitness can decrease the incidence and duration of low back pain episodes. There is minimal evidence to support the use of educational strategies to prevent low back pain and insufficient evidence to recommend about the use of mechanical supports. Although there is no evidence supporting risk factor modification for preventing low back pain (smoking cessation and weight loss), there are other reasons to recommend the interventions. CONCLUSION: There is limited evidence to recommend exercise to prevent low back pain in asymptomatic individuals, but there is insufficient evidence to recommend other prevention strategies. These conclusions should be viewed cautiously since they are primarily based on studies conducted in the workplace rather than in clinical settings.

Behavior Therapy↗
PubMed1994

Back pain distribution patterns: relationship to subjective measures of pain severity and disability.

OBJECTIVE: To investigate the relationship between subjective pain measures and clinical subgroupings as determined by pain distribution patterns in back pain patients. DESIGN: A prospective study using a computer-interview system. SETTING: The Anglo-European College of Chiropractic outpatient clinic. PATIENTS: Two hundred fourteen new patients with low back pain completed the computer back pain interview on their first or second visit to the clinic. No other inclusion criteria were applied. MAIN OUTCOME MEASURES: Computer versions of the VAS, Oswestry and St. Thomas' disability questionnaires and the pain drawing. RESULTS: Back pain patients with pain radiating below the knee (Group 3 patients) reported significantly higher levels of disability than patients with back pain alone (Group 1 patients) (p < .001) and back pain with pain referred to the buttock/thigh region (Group 2 patients) (p < .01). Similarly, Group 3 patients reported significantly higher levels of pain severity than both Group 1 (p < .01) and Group 2 (p < .05) patients. The increased level of disability reported by Group 3 patients almost exactly matched the increase in self-assessed pain severity. No differences were observed in the report of either pain severity or disability between Group 1 and Group 2 patients. CONCLUSION: Subjective pain measure scores were shown to be related to recognizable clinical subgroupings of back pain based on the distribution, but not the extent, of the patient's pain. Back pain patients with radicular pain below the knee were found to be a high disability/pain severity group compared with other groups of back pain patients. More work is needed to investigate the potential of subjective pain measures in the differential diagnosis of back pain syndromes.

Adolescent↗
PubMed1998

Low back pain in mineral sand mine workers. Incidence and management.

OBJECTIVES: To establish the prevalence of low back pain suffered by workers in three mineral sand mining companies operating in the south west of Western Australia; to determine what use was made of health care providers by those experiencing low back pain; to derive the perceptions of the value of the treatment for low back pain by health care providers. METHOD: A total of 350 questionnaires were distributed to sand mine workers who were asked to complete the questionnaires which were collected 1 week later. RESULTS: completed questionnaires were returned by 204 workers giving a 58% response rate. Seventy-seven percent of male workers and 60% of female workers could remember suffering low back pain sometime in their lives. Low back pain was experienced by 61% of male sufferers and 57% of female sufferers at least two to three times a month. A total of 16% of men and 12% of women experienced low back pain on a daily basis while 30% of men and 22% of women reported that the type of work they were doing increased their low back pain. Only 19% of all male workers and 6% of all female workers had ever taken time off work due to low back pain with the average time taken off work for an acute episode, being 14 days. Overall, 47% of respondents indicated that the treatment received from general practitioners was ineffective, and only 16% of respondents assessed GPs as being better than average. Chiropractors were rated higher than physiotherapists or general practitioners in providing the most effective treatment for low back pain. Mobilising exercises were considered to be better treatment than analgesics or anti-inflammatory medication. CONCLUSION: Low back pain is a common problem among mineral sand mine workers who preferred the services of the chiropractor or the physiotherapist to the general practitioner. Physical treatment modalities with stretching and mobilising exercises were preferred to pharmacological treatment.

Adult↗
PubMed2003

Back injuries and pain in adolescents attending a ski high school.

This study compared overuse injuries, small abnormalities, and pain alone in different types of skiing and activity levels. Subjects were 45 ski high school athletes aged 15-19 years. We found the back and knees significantly more prone to activity-related injuries and pain than other body regions. Thirty subjects (67%) had low back pain on the first examination, and 17 had pain caused by overuse of the back. This was more frequent among active, young competitive boys in the cross-country skiing group, with mature height less than 99%, than among noncompetitive boys in the same group or among the alpine skiers. Neck pain was reported only by girls. Eight subjects had low back pain related to small abnormalities. The subjects were given counseling about training and physiotherapy. The 1-year follow-up found a significant reduction in back pain due to overuse injuries (from 17 to 3 subjects) and indistinct neck pain (from 10 to 2) but no reduction in pain in those with small abnormalities in the low back. Low back pain was common in young athletes, particularly in cross-country skiers. Excessively rapid progression of training and faulty technique increased back pain complaints from 36% when entering the school to 67% at the first examination. A proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced the low back pain problems to 29% of subjects 1 year later in spite of a maintained high activity level. A minimum entrance requirement to conditioning seems mandatory for students attending a ski high school.

Adolescent↗
PubMed2000

The effect of lumbar back support tension on trunk muscle activity.

OBJECTIVE: Assess the effect of different controlled lumbar back support tightness levels on trunk muscle activity. DESIGN: Two-way repeated measure design assessing lumbar back support tension and submaximal trunk extension moments on trunk muscle electromyographic activity. BACKGROUND: Biomechanical studies on lumbar back supports often use electromyography (EMG) to assess the affect on trunk muscle activity. However, the lumbar back support may alter the electromyographic signal by changing the electrode-muscle distance. METHODS: Subjects performed trunk extensions at three static submaximal extension moment levels (25%, 50% and 75% MVC) while stabilized at the hips and shoulders, with the back support tensioned to three different tightness levels (44.5, 66.7 and 89.0 N) as well as a no-back support condition. RESULTS: Statistical analysis failed to find a significant effect (P</=0.05) of lumbar back support tension on the average normalized EMG across the 10 trunk muscles sampled. CONCLUSIONS: For static experimental tasks, as long as electrodes are protected from direct contact with the back support, studies assessing the effect of lumbar back supports on the trunk muscles via EMG during static tasks are not subject to confounding due to differences in tensions across subjects. RelevanceThe results of this study suggest that variable tensions from previous studies for static exertions with lumbar back supports do not significantly alter the pick-up volume of protected electrodes.

Adult↗
PubMed2000

Public perceptions about low back pain and its management: a gap between expectations and reality?

OBJECTIVE: To compare public perceptions and patient perceptions about back pain and its management with current clinical guidelines. DESIGN: A survey using a quota sampling technique. SETTING: On-the-street in South Derbyshire in the UK. SUBJECTS: 507 members of the general population aged between 20 and 60 years, including a representative subsample of 40% who had experienced back pain in the previous year. SURVEY: To test knowledge and perceptions of back pain and its best management using statements based on The Back Book which was produced in conjunction with the Royal College of General Practitioners and based on best available evidence. In addition expectations of back pain management and outcome were investigated. RESULTS: Forty percent of this sample had experienced back pain during the previous year, more than half of whom had consulted their GP. More than half believed the spine is one of the strongest part of the body, but nearly two thirds incorrectly believed that back pain is often due to a slipped disc or trapped nerve. Two thirds expected a GP to be able to tell them exactly what was wrong with their back, although slightly fewer among those who had consulted. Most expected to have an X-ray, especially if they had consulted. Most recognised that the most important thing a GP can do is offer reassurance and advice. The responses were not related to age, gender or social class. Those who had consulted appeared to have slightly more misconceptions: this could be partly due to people with more severe problems or more misconceptions being more likely to consult, but also suggests either that GPs are still giving inaccurate information or at least failing to correct these misconceptions. CONCLUSIONS: The problem of managing back pain might be reduced by closing the gap between the public's expectations and what is recommended in the guidelines through the promotion of appropriate health education messages. Further professional education of GPs also appears to be needed to update them in the most effective approach to managing back pain.

Journal Article↗
PubMed1993

A prospective, randomized trial of gonadotropin-releasing hormone agonist plus estrogen-progestin or progestin "add-back" regimens for women with leiomyomata uteri.

Treatment of women with myomas with GnRH agonists (GnRH-a) for 3-6 months will result in profound hypoestrogenism, a significant but temporary reduction in uterine volume, and menstrual suppression. Long-term (i.e. > 6 months) treatment with a GnRH-a is not recommended because of accelerated bone resorption and the presence of hypoestrogenic symptoms. In this 2-yr study, women with myomas were treated with GnRH-a plus one of two steroid "add-back" regimens to minimize adverse sequelae of chronic hypoestrogenism. Fifty-one premenopausal women with large, symptomatic uterine myomas all received the GnRH-a, leuprolide acetate depot (LAD), every 4 weeks for 12 weeks at which time the women were randomized to receive LAD plus either an estrogen-progestin or progestin-only add-back regimen for an additional 92 weeks. Efficacy parameters assessed included serial uterine volumes, hemoglobin concentrations, and hematocrits; safety parameters evaluated included serial bone mineral density measurements, lipid profiles, and medication-related symptoms. This report analyzes the first 52 weeks of study data. Mean uterine volume decreased to 64% of pretreatment size at 12 weeks of LAD treatment in both groups. The estrogen-progestin add-back group had no significant regrowth of uterine volume, which was 75% of pretreatment size at treatment week 52; in contrast, the progestin add-back group had a mean uterine volume of 92% of pretreatment size by treatment week 52. Both groups demonstrated significant improvements in mean hemoglobin concentrations and hematocrits. The progestin add-back group had a significant decline in mean high density lipoprotein-cholesterol concentration, which was not seen in the estrogen-progestin add-back group. Finally, after a significant 3% bone loss during the first 12 weeks of treatment, bone mineral density stabilized in both add-back regimen groups. GnRH-a/steroid add-back regimens provide a useful long-term treatment strategy in women with large, symptomatic uterine myomas and may obviate the need for surgical intervention in selected cases. The estrogen-progestin add-back regimen was superior or equal to the progestin add-back regimen in all efficacy and safety parameters assessed.

Adult↗
PubMed1999

Estriol add-back therapy in the long-acting gonadotropin-releasing hormone agonist treatment of uterine leiomyomata.

The hypoestrogenic state induced by gonadotropin-releasing hormone agonists (GnRHa) has been shown to be effective in the treatment of uterine leiomyomas but to induce bone loss. Estriol has been described to be a weak and short-acting estrogen without an increased risk of endometrial proliferation and hyperplasia. The purpose of this study was to evaluate whether treatment of uterine leiomyomata with GnRHa plus oral estriol add-back therapy could prevent bone loss, without deteriorating the therapeutic effect of GnRHa. Twelve premenopausal women with symptomatic uterine leiomyomas were randomized to receive either leuprolide acetate depot alone at a dose of 3.75 mg s.c. every month for 6 months (non add-back group; n = 6), or GnRHa for 6 months plus oral estriol 4 mg/day for 4 months commencing with the third GnRHa injection (add-back group; n = 6). In the add-back group, leiomyoma volume, as measured by transvaginal ultrasound, decreased to 59.1% of baseline at 2 months of GnRHa therapy with no significant change in size during the remaining treatment period. In contrast, it decreased to 31.3% of pretreatment size at the end of treatment in the non add-back group. The levels of bone metabolic markers such as CrossLaps, deoxypyridinoline, osteocalcin and bone-specific alkaline phosphatase, increased significantly throughout the treatment in the non add-back group, whereas they were suppressed by the add-back therapy. The bone mineral density of lumbar spine (L2-L4) as measured by dual-energy X-ray absorptiometry decreased significantly by 7.5% at the end of treatment in the non add-back group, but did not change significantly in the add-back group. In conclusion, GnRHa plus estriol add-back therapy might be considered for long-term treatment of uterine leiomyomata.

Absorptiometry, Photon↗
PubMed2004

Epidemiology and natural history of low back pain.

Low back pain is a common problem affecting most adults at some point during their lifetime. At any one time, around 1 in 5 adults will report symptoms of low back pain, rising to 40% when asked if they have experienced symptoms during the previous month. The majority of people who experience an episode of low back pain will improve over time. However a sizeable proportion experience repeated episodes or recurrences, and some report continuous symptoms for many years. A wide range of factors are linked to both the onset and persistence of low back pain. Some studies have related age and gender to low back pain, but the link overall is equivocal. Work-related factors such as heavy lifting, and socio-demographic factors such as smoking and obesity have been linked with the onset of low back pain. High levels of functional impairment and the presence of pain radiating to the leg have been cited as factors associated with a poor prognosis among primary care consulters with low back pain. Other characteristics associated with both the development and the persistence of low back pain include psychological factors such as depression and anxiety and workplace factors such as job satisfaction. Low back pain places large demands on health, social and welfare systems. Further research is needed to identify practical interventions to reduce this burden from low back pain.

Journal Article↗
PubMed1996

Should add-back therapy for endometriosis be deferred for optimal results?

Add-back hormone replacement therapy has been shown to alleviate some of the hypo-oestrogenic side effects associated with gonadotrophin-releasing hormone agonists, including demineralisation of bone. Studies on patients with uterine fibroids have shown that concomitant add-back therapy reduced the efficacy of these agents, but that deferred administration was less detrimental. This trial set out to investigate if deferred add-back therapy could offer any advantages to patients with endometriosis compared with immediate therapy. Zoladex [goserelin acetate (3.6 mg every 4 weeks)] was given for 24 weeks either with placebo, with medrogestone (10 mg/day) for 24 weeks (immediate add-back therapy), or with placebo for 12 weeks followed by medrogestone (10 mg/day) for 12 weeks (deferred add-back therapy) to 123 patients. The number of responders measured using the Revised American Fertility Society score (decrease in this score of > or = 50%) was greatest in the immediate add-back therapy group, although there were no significant differences between groups. All three treatment groups showed significant decreases in bone mineral density compared with baseline but smaller losses were generally observed in the add-back groups. A significantly smaller number of patients in the immediate add-back group reported hot flushes during the first 12 weeks of treatment compared with the deferred add-back group. In conclusion, it appears that there is no extra advantage to patients with endometriosis being treated with goserelin in delaying the start of add-back therapy.

Bone Density↗
PubMed1996

Study provides new evidence of back belts' effectiveness.

A major new study conducted by the UCLA School of Public Health has bolstered the claim that back support devices reduce low-back injuries. The study involved nearly 36,000 employees at Home Depot stores in California who logged 101 million work hours from 1989 through 1994. The company implemented mandatory wearing of belts in early 1990, and the study's authors reported that the workers' rate of acute low back injuries fell from 30.6 per million hours before implementation to 20.2 per million hours. UCLA Professor of Epidemiology Jess F. Kraus, the study's lead author, told The Wall Street Journal. "The study found a pretty big effect with a simple countermeasure. It is pretty hard to argue that it is a chance phenomenon." Kraus, who is the director of UCLA's Southern California injury Prevention Research Center, began his research by visiting 30 Home Depot stores to see whether employees were wearing the belts consistently. Compliance with the mandatory policy was quite high overall-above 98 percent, as calculated during an unannounced walk-through of all 77 stores in late 1993 and early 1994, according to the study. Back support manufactures hailed the Home Depot study as the largest long-term epidemiological study yet undertaken of the supports. It is proof, they said, that back supports are effective personal protective equipment-a contention at odds with the position of NIOSH the National institute for Occupational Safety and Health. In 1994, NIOSH reviewed the scientific literature and concluded there was not enough evidence to recommend that the supports be worn by uninjured workers. Sales plunged after NIOSH released its findings, according to the manufactures. The UCLA researchers found that low-back injuries declined in workers of both sexes, in younger workers as well as those older than 55, and among those with low levels of lifting as well as those with higher levels. The researchers concluded that mandatory use of back supports significantly reduces acute low-back work injuries. Low-back injuries account for one-fourth of all workers' compensation claims paid by U.S. employers-$11 billion in 1990 alone. NIOSH's ergonomic coordinator, Lawrence Fine, told The Journal, "for many companies this is the largest health and safety issue they are wrestling with." NIOSH has embarked on its own, smaller study of back supports' effectiveness among Wal-Mart workers.

Adult↗
PubMed1997

Why don't more Israelis wear seat belts in the back seat?--a possible explanation.

BACKGROUND: Most Israelis wear seat belts in the front seat of automobiles; most do not wear them in the back. A possible explanation is considered, that Israelis believe seat belts to be less necessary in the back, and that this is related to the relative discrepancy in seat belt use. METHOD: A telephone survey of 1148 Israeli adults was conducted in September 1996, using random-digit dialing. RESULTS: On a six-point scale of perceived risk, respondents rated seat belts as more necessary for passengers in the front than in the back seat [D = 0.6, SD = 1.0, t (873) = 18.3; p < .001]. Moreover, respondents' self-reported use of seat belts in the back seat (35% overall) was significantly higher among respondents who believed seat belts in the back to be necessary [46%; chi 2 (N = 882, df = 2) = 20.6; p < .001)], yet was not significantly higher among respondents who believed wearing seat belts in the front to be necessary [38%; chi 2 (N = 903, df = 2) = 3.8; p > .05)]. Respondents' reports of buckling their children in the back seat (55% overall) were significantly higher among respondents who believed seat belts in the back to be necessary [62%; chi 2 (N = 309, df = 2) = 7.0; p < .05)], yet were not significantly higher among respondents who believed wearing seat belts in the front to be necessary [57%; chi 2 (N = 313, df = 2) = 0.9; p > .05)]. CONCLUSIONS: The results suggest that a potentially effective strategy in Israel for promoting the use of seat belts in the back seat of automobiles should include convincing the public of the necessity of wearing seat belts in the back, by increasing the perceived risk of injury to back seat passengers.

Accidents, Traffic↗
PubMed2000

Interventions for preventing and treating backache in pregnancy.

BACKGROUND: More than a third of women experience back pain during pregnancy. OBJECTIVES: The objective of the review was to assess the effects of preventive interventions and treatments for backache in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of any treatment to reduce the incidence or severity of back pain in pregnancy, or to prevent back pain arising in pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: One trial of 109 women was included. This cross-over trial compared the use of a special shaped pillow to fit under the woman's abdomen (Ozzlo pillow) with a standard pillow. Women experienced less pain in the week when they used the Ozzlo pillow than in the week with the standard pillow (odds ratio 0.32, 95% confidence interval 0.18 to 0.58). REVIEWER'S CONCLUSIONS: Specially shaped pillows appear to help reduce back pain in late pregnancy and improve sleep.

Back Pain↗
PubMed1995

The perceived relationship between back symptoms and preceding injury.

A questionnaire was used to gather information regarding the prevalence of minor back symptoms related to performing everyday tasks, including sitting, lifting, etc. in a population of hospital employees. We studied 175 subjects, of whom 111 had not suffered a back injury. Of this group, 68 (61.3 per cent) had suffered back discomfort during or after performing everyday tasks. Sixty-four reported a previous injury to their back, and of these 55 (85.9 per cent) described back discomfort during or after performing everyday tasks. Of the symptomatic cases, 46 (83.3 per cent) maintained that they had no back symptoms prior to their injury, and attributed all of their back symptoms to the injury. The chi 2 test was used to test the null hypothesis that the group attributing their symptoms to injury was derived from the same population as the group who had not suffered any definite injury, and yet had back symptoms. This hypothesis was rejected (P < 0.001), indicating that there was a significant difference between these two groups. We conclude that individuals who sustain a back injury sometimes do not recall that they suffered symptoms prior to their injury. This may be of medico-legal importance in cases where compensation is being sought.

Activities of Daily Living↗
PubMed2000

Coordination of primary health care for back pain. A randomized controlled trial.

STUDY DESIGN: A randomized controlled trial comparing usual care with a program for the coordination of primary health care (CORE) for the treatment of subacute low-back pain patients. OBJECTIVES: To measure the effectiveness of the CORE program as a mean for implementing clinical practice guidelines for low-back pain in an urban community. SUMMARY OF BACKGROUND DATA: Clinical practice guidelines have been developed for primary care physicians and patients on the clinical management of low-back pain. The implementation of the guidelines in a large community is difficult with the multiplicity of medical and nonmedical back care providers and products. The CORE program was designed to make the guidelines fit in this complex environment. METHODS: One hundred ten workers compensated for low-back pain for 4 to 8 weeks in metropolitan Montreal were randomized in two groups: usual care (N = 56) and the CORE program (N = 54). Coordination of primary health care was performed by two primary care physicians and a nurse in liaison with the treating physicians, and included a complete examination, recommendations for the clinical management, and support to carry out the recommendations. All workers were followed for 6 months. Back pain and functional status were assessed at baseline, 3 months, and 6 months. RESULTS: In the 6-month follow-up, the CORE group returned to work 6.6 days (standard error = 8.9) quicker than the control group, a difference that was not statistically significant. However, the CORE group showed a sustained improvement in pain and functional status with two-fold differences at the end of the 6 months of follow-up. This represented nine points on the Oswestry scale (P = 0.02) and 12 points on the Quebec Back Pain Disability Scale (P = 0.01). The CORE group also used three times less specialized imaging tests of the spine at 3 months (P < 0.01) and exercised twice as much at 6 months (P < 0.05) than the controls. CONCLUSIONS: The therapeutic results for workers with low-back pain could be improved by implementing the clinical practice guidelines with primary care physicians in a large community, without delaying the return to work. The CORE intervention for back pain patients is highly relevant to primary care practice. It is simple in its application, flexible to accommodate physicians' and- patients' preferences in health care, and it is effective on patients' clinical outcome.

Adult↗
PubMed2000

Prognosis for people with back pain under a No-fault 24-hour-cover compensation scheme.

STUDY DESIGN: A retrospective descriptive casenote review of consecutive back pain claimants assessing claim outcome at 12 months from onset. OBJECTIVE: To assess prognosis for back pain claimants in a no-fault 24-hour-cover accident compensation system. BACKGROUND: New Zealand has a unique accident compensation system that may provide incentives for health professionals to classify people with backache as having a back injury and incentives for back pain claimants to continue claims longer than would be the case in other compensation systems. METHODS: One hundred consecutive back pain claimants were identified from a single office of New Zealand's sole accident compensation insurer (Accident Rehabilitation and Compensation Insurance Corporation; ACC), who were still receiving compensation payments 4 weeks after the initial date of the claim. The study end point was case closure in the subsequent 12 months. Case closure rate was analyzed in relation to several potential prognostic variables. RESULTS: Of the 100 cases identified in which the claimant was receiving compensation 4 weeks from the initial date of the claim, 43 cases were not closed by 6 months, and 30 cases were not closed at 12 months. The variable most strongly associated with case nonclosure was whether the claimant was receiving earnings-related compensation (equal to 80% of previous income), with 41% of this group still receiving compensation at 12 months versus 16% of the group not receiving earnings-related compensation (chi2 = 8.55, P = 0.003). These results compare unfavorably with those from previous published studies from The Netherlands and Jersey in the United Kingdom. CONCLUSION: New Zealand's unique accident compensation environment may discourage return to work for people with back pain. New Zealand legislators should assess the impact of the ACC scheme on people with back pain, particularly in light of the recent recommendations of the International Association for the Study of Pain Task Force on Back Pain in the Workplace, that compensation cover for workers with back pain be limited to 6 weeks.

Adolescent↗
PubMed2004

The frequency and associated factors of low back pain among a younger population in Turkey.

STUDY DESIGN: Open design cross-sectional questionnaire. OBJECTIVES: The aims of this study are to determine the frequency of low back pains in the younger population and the factors that have an influence on this frequency. SUMMARY OF BACKGROUND DATA: Low back pain is one of the most important social problems that causes injuries in the younger population. Low back pain frequency is around 30% among adolescents, and 88% of those with low back pain experiences in adolescence have low back pain in later years. Therefore, identifying and, if possible, preventing the associated factors in adolescence and young adulthood is essential for the solution of this social problem. METHODS: A total of 1,552 students from a total of 8,000 who had come from all parts of Turkey for university registration accepted to participate in the study and were given a questionnaire about low back pain experiences, disability, and possible associated factors. RESULTS: Low back pain frequency was found to be 40.9%. This rate increases with age. Abandonment of moderate level physical activity and traumas such as slipping on ice and falling down the stairs were identified as associated factors. CONCLUSIONS: Regular physical activity and the prevention of falls might be ways for decreasing the frequency of low back pain experiences among the youth and significantly influencing the frequency of low back pain in adult population.

Accidental Falls↗