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PubMedDate not supplied

A cost-benefit analysis of a California county's back injury prevention program.

Back-related injuries have become a major health problem in the workplace, affecting as many as 35 percent of the work force and accounting for about 25 percent of all compensation claims. This study evaluates a back injury prevention program among employees in a northern California county in 1989-90. Six divisions of the county government were selected for the study because they had the highest prevalence of back pain experienced and the most back-related injuries in recent years. Four of the six divisions were randomly selected as the intervention group and the remaining two, the control group. Overall, 77 percent or 205 of the targeted employees in the intervention group participated in the study. The intervention group was given an identical health risk assessment (HRA) before and after the 1-year back injury prevention program that offered employees a combination of education, training, physical fitness activities, and ergonomic improvement. The control group was neither given the HRA nor offered the program. The back injury and cost data of both the control and intervention groups were collected before and after the 1-year intervention. The results showed a modest overall decline in back pain prevalence rates, but significant improvement in satisfaction and reduction in risky behaviors. Cost-benefit analysis showed the net benefit of introducing back injury prevention program was $161,108, and the return on investment is 179 percent. Therefore, the study offers suggestive evidence for the initial benefits of a back injury prevention program and lends support to the widely held belief that health promotion in the workplace can reduce employee health risks, increase healthful behaviors and attitudes, and improve attitudes toward the employer organization.Whether such intervention will continue to reap benefits in future years depends, to a large extent,on a favorable work environment and the maintenance and continuation of positive behavioral changes.

Adult↗
PubMed2004

Spinal manipulative therapy for low back pain.

BACKGROUND: Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain. OBJECTIVES: To resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL were electronically searched from their respective beginning to January 2000, using the Back Group search strategy; references from previous systematic reviews were also screened. SELECTION CRITERIA: Randomized, controlled trials (RCT) that evaluated spinal manipulative therapy for patients with low-back pain, with at least one day of follow-up, and at least one clinically-relevant outcome measure. DATA COLLECTION AND ANALYSIS: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). MAIN RESULTS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. REVIEWER'S CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.

Humans↗
PubMed2002

Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain.

BACKGROUND: Chronic low back pain is, in many countries, the main cause of long term disability in middle age. Patients with chronic low back pain are often referred for multidisciplinary treatment. Previous published systematic reviews on this topic included no randomised controlled trials and pooled together controlled and non-controlled studies. OBJECTIVES: To assess the effect of multidisciplinary bio-psycho-social rehabilitation on pain, function, employment, quality of life and global assessment outcomes in subjects with chronic disabling low back pain. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PsychLIT, CINAHL, Health STAR, and The Cochrane Library from the beginning of the database to June 1998 using the comprehensive search strategy recommended by the Back Review Group of the Cochrane Collaboration. INTERVENTION specific key words for this review were: patient care team, patient care management, multidisciplinary, interdisciplinary, multiprofessional, multimodal, pain clinic and functional restoration. We also reviewed reference lists and consulted the editors of the Back Review Group of the Cochrane Collaboration. SELECTION CRITERIA DESIGN: randomised controlled trials comparing multidisciplinary bio-psycho-social rehabilitation with a non-multidisciplinary control intervention. POPULATION: Adults with disabling low back pain of more than three months in duration. INTERVENTION: Patients had to be assessed and treated by qualified professionals according to a plan that addresses physical and at least one of psychological, or social/occupational dimensions. OUTCOMES: Only trials which reported treatment effect in at least one of pain, function, employment status, quality of life or global improvement. Exclusion: Pure educational interventions (back schools) and pure physical interventions were excluded. DATA COLLECTION AND ANALYSIS: Selection, data extraction and quality grading of studies was done by two independent reviewers using pre-tested data forms. Study quality was assessed according to the scheme recommended by the Back Review Group of the Cochrane Collaboration. Trials with internal validity scores of five or more in a ten point scale were considered high quality. Discrepancies between reviewers were resolved by consensus or by a third reviewer. Given the marked heterogeneity in study settings, interventions and control groups we decided not to pool trial results in a meta-analysis. Instead, we summarized findings by strength of evidence and nature of intervention and control treatments. The evidence was judged to be strong when multiple high quality trials produced generally consistent findings. It was judged to be moderate when multiple low quality or one high quality and one or more low quality trials produced generally consistent findings. Evidence was considered to be limited when only one randomised trial existed or if findings of existing trials were inconsistent. MAIN RESULTS: Ten trials (12 randomised comparisons) were included. They randomised a total of 1964 patients with chronic low back pain. There was strong evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improved function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improved pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary bio-psycho-social intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psycho-physical treatments did not improve pain, function or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments. REVIEWER'S CONCLUSIONS: The reviewed trials provide evidence that intensive multidisciplinary bio-psycho-social rehabilitation with a functional restoration approach improves pain and function. Less intensive interventions did not show improvements in clinically relevant outcomes.

Back Pain↗
PubMed2006

Low back pain and musculoskeletal symptoms among Kansas farmers.

BACKGROUND: Farming continues to rank as one of the most dangerous occupations in the United States. The purpose of this study was to determine the prevalence of low back pain and other musculoskeletal disorders (MSDs) among the farmers and to examine the factors associated with occupational back pain. Farmers in a predominately corn and soybean growing region of Kansas served as the study sample. METHODS: Questionnaires were mailed out to 499 active farmers of a Farmers' Cooperative in Southeast Kansas. The self-administered questionnaire was used to determine the prevalence of self-reported symptoms of back pain and other MSDs and to determine the strength of associations between back pain and work factors. RESULTS: The participation rate was 57.2%. The low back was the anatomical area with the highest prevalence of self-reported work-related pain (37.5%), followed by the shoulders (25.9%), knees (23.6%), and neck (22.4%). Close to 60% of the farmers reported that they experienced farm work-related MSD symptoms in at least one of the nine body areas in the previous year. Nearly one quarter of the farmers reported seeing a physician for their low back symptoms, and one in five farmers had to modify their work habits due to low back symptoms during the previous year. CONCLUSIONS: Low back pain and other musculoskeletal conditions are a significant problem for Kansas farmers. This group of Kansas farmers experienced low back pain at a much higher rate than the general working population and higher than other groups of farmers previously studied.

Aged↗
PubMed1994

Physician variation in diagnostic testing for low back pain. Who you see is what you get.

OBJECTIVE: This study examined patterns of diagnostic test use for patients with low back pain. Three specific questions were addressed: 1) What tests do physicians recommend for patients with 3 common types of low back pain? 2) Do physicians in various specialties differ in the tests they would order? and 3) How appropriate are physicians' choices of tests, based on current medical knowledge and expert recommendations? METHODS: A stratified national random sample of 2,604 physicians in 8 specialties was mailed questionnaires asking about the tests they would order for hypothetical patients with acute back pain, sciatica, or chronic low back pain. Physicians were also asked which procedures they generally used to evaluate suspected lumbar nerve root compression. These responses were compared with guidelines that have been suggested by the Quebec Task Force on Spinal Disorders, based on comprehensive evaluation of the scientific literature. RESULTS: Approximately 1,100 physicians responded to the survey (43% response rate). Magnetic resonance imaging was the most frequently used procedure for evaluating suspected lumbar nerve root compression, although a majority of neurosurgeons would still use myelography. Neurosurgeons and neurologists were twice as likely as other specialists to order an imaging study for patients with acute nonradiating pain or chronic back pain. Physiatrists and neurologists were more than 3 times as likely as other specialists to order electromyograms for acute back pain with sciatica or chronic back pain. Rheumatologists were almost twice as likely as other specialists to order laboratory tests for both acute and chronic back pain. The reported use of imaging and electrodiagnostic tests was generally premature and more extensive than that recommended by the Quebec Task Force. CONCLUSION: There is little consensus, either within or among specialties, on the use of diagnostic tests for patients with back pain. Thus, the diagnostic evaluation depends heavily on the individual physician and his or her specialty, and not just the patient's symptoms and findings. Furthermore, many physicians may be ordering imaging studies too early and for patients who do not have the appropriate clinical indications. These results suggest a need for additional clinical guidelines as well as better adherence to existing guidelines.

Diagnostic Tests, Routine↗
PubMed1990

Self-reported back pain in tractor drivers exposed to whole-body vibration.

A postal questionnaire on symptoms of ill health and exposure to whole-body vibration was completed by 577 workers (response rate 79%) who were employed in certain functions by two companies 11 years before. The relation between the occupational history of driving vibrating vehicles (mainly agricultural tractors) and back pain has been analyzed. The prevalence of reported back pain is approximately 10% higher in the tractor drivers than in workers not exposed to vibration. The increase is mainly due to more pain in the lower back and more pain lasting at least several days. A vibration dose was calculated by assigning each vehicle driven a vibration magnitude, estimated on the base of vibration measurements. The prevalence of back pain increases with the vibration dose. The highest prevalence odds ratios are found for the more severe types of back pain. These prevalence odds ratios do not increase with the vibration dose. This might be due to health-related selection which is more pronounced for severe back pain than for back pain in general. The two components of the vibration dose, duration of exposure and estimated mean vibration magnitude, have also been considered separately. Back pain increases with duration of exposure but it does not increase with the estimated mean magnitude of vibration. This is probably due to the inaccuracy of this estimate. The higher prevalence of back pain in tractor drivers might be (partly) caused by whole-body vibration, but prolonged sitting and posture might also be of influence.

Adult↗
PubMed1999

[Effectiveness of the back school. A review of the results of evidence-based evaluation].

Back schools are high frequency-low cost interventions. Their effectiveness has lately been regarded with skepticism. The variety of back school programs makes an over-all evaluation difficult. The number of evaluative publications has increased dramatically during the last 10 years, including 18 randomized controlled trials. Results of these studies have been contradictory. The results of two lately published randomized controlled trials, of 18 randomized controlled trials, of five systematic reviews, two publications conducting metaanalyses, and five task forces presenting guidelines for clinical practice are reported. According to the conclusions of the reviews there is limited to strong evidence for the effectiveness of back schools for chronic back pain. The metaanalyses show clear effects for knowledge and behavior change up to 6 months. Three of five task forces recommend back schools for acute pain respectively at worksite. Summarizing the results of the given evidence based recommendations it is concluded that back schools at work sites and back schools with intensive training is effective. There is still need to prove the effectiveness of single elements of the back school programs, of strategies to increase long term effects, the effectiveness for subtypes of patients and the effectiveness of back schools as part of a comprehensive orthopedic pain therapy.

Chronic Disease↗
PubMed2004

Back pain, disability, and radiographic vertebral fracture in European women: a prospective study.

Vertebral fractures are associated with back pain and disability. There are, however, few prospective data looking at back pain and disability following identification of radiographic vertebral fracture. The aim of this analysis was to determine the impact of radiographically identified vertebral fracture on the subsequent occurrence of back pain and disability. Women aged 50 years and over were recruited from population registers in 18 European centers for participation in the European Prospective Osteoporosis Study. Participants completed an interviewer-administered questionnaire which included questions about back pain in the past year and various activities of daily living, and they had lateral spine radiographs performed. Participants in these centers were followed prospectively and had repeat spine radiographs performed a mean of 3.7 years later. In addition they completed a questionnaire with the same baseline questions concerning back pain and activities of daily living. The presence of prevalent and incident vertebral fracture was defined using established morphometric criteria. The data were analyzed using logistic regression with back pain or disability (present or absent) at follow-up as the outcome variable with adjustment made for the baseline value of the variable. The study included 2,260 women, mean age 62.2 years. The mean time between baseline and follow-up survey was 5.0 years. Two hundred and forty participants had prevalent fractures at the baseline survey, and 85 developed incident fractures during follow-up. After adjustment for age, center, and the baseline level of disability, compared with those without baseline prevalent fracture, those with a prevalent fracture (odds ratio [OR] = 1.4; 95% confidence interval [CI] 1.0 to 2.0) or an incident fracture (OR = 1.7; 95% CI, 0.9 to 3.2) were more likely to report disability at follow-up, though the confidence intervals embraced unity. Those with both a prevalent and incident fracture, however, were significantly more likely to report disability at follow-up (OR = 3.1; 95% CI, 1.4 to 7.0). After adjustment for age, center, and frequency of back pain at baseline, compared with those without baseline vertebral fracture, those with a prevalent fracture were no more likely to report back pain at follow-up (OR = 1.2; 95% CI, 0.8 to 1.7). There was a small increased risk among those with a preexisting fracture who had sustained an incident fracture during follow-up (OR = 1.6; 95% CI, 0.6 to 4.1) though the confidence intervals embraced unity. In conclusion, although there was no significant increase in the level of back pain an average of 5 years following identification of radiographic vertebral fracture, women who suffered a further fracture during follow-up experienced substantial levels of disability with impairment in key physical functions of independent living.

Activities of Daily Living↗
PubMed2005

[Preaching to the converted: deficits and surpluses in preventative pain therapy in German back care programs].

BACKGROUND: In response to the growing incidence of back pain, increasing emphasis is being placed on individualized preventive measures. The purpose of the present study was to investigate representative data for back pain, participation rates of back care programs, and their correlates in the German general population. METHODS: The first National Health Survey was carried out in the Federal Republic of Germany in the period from October 1997 to March 1999. It comprised a representative, cross-sectional study of the population with a total sample of 6235 participants between the ages of 18 and 79. RESULTS: The 7-day prevalence for back pain in Germany was found to be 36%, and 7% of all Germans had participated in a back care program within the past year. The 1-year participation rate was significantly lower in persons with higher risk for back pain (men, full-time workers, unmarried people, and those with an unhealthy lifestyle). CONCLUSIONS: The user profile for back care programs indicates that genuine needs are not being met and the target group is not being reached. A "preaching to the converted" phenomenon is evident, as indicated by the fact that the user group is made up of individuals who already have a healthy lifestyle and few risks while the population group most likely to develop back pain is significantly less likely to participate in preventive back care programs.

Adult↗
PubMed2001

Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up.

This study is a prospective, consecutive, 3-year cohort study of women with back pain in an index pregnancy. The aim was to describe the physical status and disability among women with back pain 3 years after delivery. Pain was identified as lumbar back pain, posterior pelvic pain or combined lumbar as well as posterior pelvic pain. Previous studies have established that all three types of pain can be reduced by structured physiotherapy during pregnancy, and the beneficial effect may last for several years. Though it is known that some women have residual pain for a long time, the relative incidence of the three pain types and their degree of disability associated with each have never been reported. Neither has any study presented findings of a physical examination of women 3 years post partum with a focus on the type of pain. All women who were registered as having experienced back pain during an index pregnancy were interviewed by mail 3 years post partum. Women who had residual back pain filled in an additional questionnaire and were physically examined. Out of 799 pregnant women, 231 had some type of back pain during the index pregnancy, and 41 women had pain 3 years later. Women with combined lumbar and posterior pelvic pain were significantly more disabled ( P<0.05) and had significantly lower endurance in the lumbar back and hip abduction muscles ( P<0.01). Some 5% of all pregnant women, or 20% of all women with back pain during pregnancy, had pain 3 years later. The key problem may be poor muscle function in the back and pelvis.

Cohort Studies↗
PubMed2002

Patient-oriented assessment of back pain in pregnancy.

Back pain is a common symptom in women during the last period of pregnancy. Only a few studies using validated patient-oriented tools have been undertaken on this topic. We report on a multicenter study on back pain in women during the last period of pregnancy, which involved seven Italian institutions. Seventy-six women in their 8th and 9th months were studied using the Italian validated version of the Roland questionnaire -- a disease-specific patient-oriented tool for low back pain. Sixty-two percent of the women had gone through at least one previous pregnancy, and clinical data concerning both the period before all pregnancies and the period before the current pregnancy were acquired. The study found that 31% of the women had no back pain symptoms (Roland score 0), 40% scored from 1 to 4, 21% scored from 5 to 10, and 8% scored more than 10. With regard to the predictive factor, history of back pain and sciatica before the pregnancy were found to be associated with occurrence of back pain symptoms during pregnancy. Unexpectedly, our results showed that male sex of the fetus seems to be related to occurrence of back pain symptoms during pregnancy. However, back pain was not associated with having gone through previous pregnancies, nor was the Roland score related to the weight before pregnancy or to increment of weight during pregnancy. Evaluation of the patient's perspective made it possible to identify predictive factors for occurrence of back pain, thereby furnishing important information for the clinical approach to pregnancy.

Adult↗
PubMed2005

Discogenic pain in acute nonspecific low-back pain.

Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral disc sites with an obvious enhanced region in the posterior annulus of the disc on enhanced T1-weighted MR images was selected for intradiscal injection. When no enhanced region was detected, the most severely degenerated disc on T2-weighted MR images was selected. Acute nonspecific low-back pain with an improvement rate of 70% or higher 5 min after injection was judged to be discogenic. The clinical characteristics and pathogenesis of discogenic acute nonspecific low-back pain were investigated. Forty of the 55 patients (73%) had discogenic acute nonspecific low-back pain. As for the characteristics of patients, the mean age was 37 years, and onset occurred upon casual daily movements in 18 patients (45%). Nineteen patients (48%) had bilateral low-back pain, and 29 patients (73%) had no tenderness in the paravertebral muscles. On plain X-ray radiograms, degeneration of the disc was normal or mild in 36 patients(91%). On the discograms, a radial tear extending to the posterior annulus was noted in all patients, but epidural leakage was seen only in six patients (15%). The degree of disc degeneration on T2-weighted MR images (Gibson's classification) was grade 3 in 30 patients (75%). Gadolinium-DTPA enhanced T1-weighted MR images showed an obvious enhanced region in the posterior annulus of the intervertebral disc in 19 patients (48%). As for the clinical characteristics of discogenic acute nonspecific low-back pain, the relatively young adult patients had no tenderness in the paravertebral muscles, and showed moderately degenerated intervertebral discs. The pathogenesis of discogenic acute nonspecific low-back pain is mostly considered to be a re-rupture in an asymptomatic ruptured region in the posterior annulus, repaired by granulation tissue, in a moderately degenerated intervertebral disc with a radial tear.

Acute Disease↗
PubMed2006

Rasterstereographic analysis of axial back surface rotation in standing versus forward bending posture in idiopathic scoliosis.

The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20 degrees and 82 degrees were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1 degrees in standing to 26.3 degrees in forward bending posture. The standard deviation of this difference was high (6.1 degrees ). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor (R (2)=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation (R (2)=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity (R (2)=0.07), likewise no correlation with the height of the apex of the scoliosis (R (2)=0.005) and the age of the patient (R (2)=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture.

Back↗
PubMed1995

A cost-of-illness study of back pain in The Netherlands.

In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One-third of the hospital care costs and one-half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. The total direct medical costs of back pain were estimated at US$367.6 million. The total costs of hospital care due to back pain constituted the largest part of the direct medical costs and were estimated at US$200 million. The mean costs of hospital care for back pain per case were US$3856 for an inpatient and US$199 for an outpatient. The total indirect costs of back pain for the entire labour force in The Netherlands in 1991 were estimated at US$4.6 billion; US$3.1 billion was due to absenteeism and US$1.5 billion to disablement. The mean costs per case of absenteeism and disablement due to back pain were US$4622 and US$9493, respectively. The indirect costs constituted 93% of the total costs of back pain, the direct medical costs contributed only 7%. It is therefore concluded that back pain is not only a major medical problem but also a major economical problem.

Absenteeism↗
PubMed2005

[Low back pain disability assessment tools].

OBJECTIVES: To identify and compare low back pain functional assessment tools and to determine their characteristics and the selection criteria for their use. MATERIALS AND METHOD: We systematically searched Medline with the key words: low back pain, scale validity, questionnaire, assessment, outcome, and functional evaluation and with some data from the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation", which allowed us to complete the search on specific tools including the Roland Disability Questionnaire, Dallas Pain Questionnaire, Quebec Back Pain Questionnaire, and Oswestry Back Pain Questionnaire. We restricted our analysis to studies about the psychometric properties of functional tools. RESULTS: We identified 19 scales or questionnaires, 9 specifically for low back pain and with a concept of functional incapacity. Four tools are recognised as having good psychometric properties and are widely used with linguistic adaptations in different countries. We also identified 10 generic tools proposed to assess outcome in low back pain, which are more conceptually linked to perceived health status, quality of life, and pain assessment. CONCLUSION: A "gold standard" to evaluate disability in low back pain does not exist, but only 4 tools (the Dallas Pain Questionnaire, Roland Disability Questionnaire, Quebec Back Pain Disability Scale and Oswestry Low Back Pain Disability Questionnaire) demonstrated strong qualities (content and construct validity, feasibility, linguistic adaptation and international use).

Disability Evaluation↗
PubMed2005

Effects of reducing resistance, repetitions, and frequency of back-strengthening exercise in healthy young women: a pilot study.

OBJECTIVE: To determine the effects of reducing intensity or frequency of back-strengthening exercise on back extensor strength. DESIGN: Randomized controlled trial. SETTING: Exercises were performed in participants' homes. Instruction and measurements were performed at the rehabilitation center in the hospital. PARTICIPANTS: Fifty-eight healthy female volunteers (mean age, 20 y). INTERVENTIONS: Participants were assigned to 1 of 5 exercise intervention groups: control; standard protocol (STD) that has been shown to increase back extensor strength; weight reduction (WRD); repetition reduction (RRD); and frequency reduction (FRD). Back exercises involved lifting a weighted backpack while in a prone position. The study period was 12 weeks. MAIN OUTCOME MEASURE: Isometric back extensor strength. RESULTS: Back extensor strength increased significantly in all groups except the control group. The maximum increase was achieved by the STD group (39%), followed by the FRD (25%), WRD (22%), RRD (20%), and control (5%) groups. Percentage change in back extensor strength was significantly greater in the STD group than in all other groups except the FRD group. CONCLUSIONS: Back extensor strength in the WRD, RRD, and FRD groups was significantly higher at 12 weeks compared with baseline. Reductions in intensity and frequency resulted in similar effects on increases in back extensor strength.

Adolescent↗
PubMed2006

Decreased limits of stability in response to postural perturbations in subjects with low back pain.

BACKGROUND: Low back pain is associated with abnormal movement strategies due to changes in neuromuscular control. A plausible contributing factor to low back pain is poor control of trunk muscles, thus understanding motor control alterations in this population can guide rehabilitation. Quantification of postural responses following support surface translations is one way to examine motor control impairments in people with low back pain. METHODS: Twenty-four healthy subjects [mean 33 (SD 11) years] who had no low back pain and 26 subjects [mean 39 (SD 13) years] with chronic, recurrent low back pain were instructed to stand with feet placed on separate force plates, which were mounted on a moveable platform. The platform was translated unexpectedly in one of 12 directions for a total of 72 trials. For both the sagittal and frontal planes, the net center of pressure displacement was derived and the total body center of mass was calculated by combining kinematic and anthropometric data. FINDINGS: For sagittal plane responses, subjects with low back pain had reduced and delayed sagittal plane center of pressure responses (P<0.01) compared to the subjects without low back pain. In contrast, the sagittal plane center of mass responses were larger in magnitude (P=0.03) yet similarly delayed in onset (P=0.04) for the low back pain group. Frontal plane responses did not differ between groups. INTERPRETATION: Subjects with low back pain have altered automatic postural coordination, both in terms of magnitude and timing of responses, indicating alterations in neuromuscular control.

Adult↗
PubMed2004

Work-related low back pain: secondary intervention.

A review of the literature indicates that non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics and personal behavior. The cause of low back pain is unknown in most cases, and most of the treatments in routine use are ineffective. There is no evidence that low back pain has decreased in recent years. Consequently, there are a growing number of investigators who believe that efforts at preventing low back pain are futile; that low back pain is an unavoidable consequence of life that will afflict two thirds of the adult population at some point in their lives. These investigators believe that programs aimed at reducing low back disability are likely to be more effective and less costly. Only a small percentage of people with low back pain become disabled, but this small percentage consumes most of the cost. The literature pertaining to the reduction of low back disability is reviewed and discussed. It is concluded that low back disability can be reduced, and that management (not the health care provider) has the primary responsibility for reducing disability.

Adult↗