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PubMed2005

Back pain reporting in young girls appears to be puberty-related.

BACKGROUND: There is a large increase in back pain reporting in the early teens. In no previous study has the prevalence of low back pain been investigated in relation to the onset of puberty. The objective of this study was to establish whether the onset of puberty is associated with back pain reporting in young girls. METHODS: A subsample of 254 girls aged 8-10 years and 165 girls aged 14-16 years from a cross-sectional survey of 481 children aged 8-10 years and 325 adolescents aged 14-16 years of both sexes. Main outcome measures were back pain defined as low back pain, mid back pain, and/or neck pain in the past month. Other variables of interest were Puberty (five different stages), age, body mass index, and smoking. Independent information on onset of puberty was obtained through a physical examination and on back pain through an individual structured interview. The association was studied between onset of puberty and the outcome variable (the one month period prevalence of back pain), controlling for overweight, and smoking. Odds ratios with 95% confidence intervals were used to describe bivariate associations, logistic regression with robust standard errors was used for multivariate analyses. RESULTS: There is a highly significant trend for increased back pain reporting with increasing level of puberty until maturity is reached. The biggest leap appears between the second level (beginning of puberty) and the third level (mid puberty) and the findings remain after controlling for the covariates. These results emanate from the low back, whereas pain in the mid back and neck do not seem to be linked with pubertal stage. CONCLUSION: In girls, the reporting of low back pain increases in frequency during puberty until maturity, regardless of age. Why some girls are susceptible to back pain in the early stage of puberty is unknown.

Adolescent↗
PubMed2003

Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria.

BACKGROUND: Low back pain is the most common musculo-skeletal problem in the workplace. Data from low-income countries are scant. OBJECTIVES: To determine the prevalence and risk factors for low back pain among office workers in Ibadan, Nigeria. METHODS: A cross-sectional study design was utilized. Questionnaires were distributed among office workers in the civil service in Ibadan, Nigeria. RESULTS: Eight hundred and forty questionnaires were analysed, with a response rate of 66%. The 12 month prevalence of low back pain was 38% and the point prevalence was 20%. Low back pain was significantly associated with senior staff grade and smoking. Severity of low back pain was associated with sitting for >3 h. Only 16 respondents (5%) reported sickness absence due to back pain in the previous year. A total of 75 days were lost, a mean of 4.7 days per year. CONCLUSIONS: The occurrence of low back pain in this study is comparable with that reported in studies from more industrialized countries, but does not constitute a major cause of sickness absence in this group of workers.

Adult↗
PubMed2006

Low back pain investigations and prognosis: a review.

Low back pain is reviewed in terms of when investigations are useful and its clinical course. Despite the extensive evaluation of the accuracy of investigations such as radiography, magnetic resonance imaging, and myelography, there is a surprising dearth of research to inform their use in primary care. There is no clear evidence on which to base judgments for selection of appropriate tests to confirm or exclude low back pain pathology. It appears that investigations are rarely necessary for low back pain. Specific investigations should be ordered to identify a particular pathology but should not be ordered routinely for general screening. In the absence of pathology, low back pain and its associated disability improve rapidly in the first weeks after onset, but, in contradiction to all guidelines, both commonly persist and the best evidence suggests that recurrences are common.

Humans↗
PubMed2005

Differences among outcome measures in occupational low back pain.

The rate of recurrence in low back pain patients has been reported as high as 70%; therefore, it is believed that researchers have a poor understanding of low back pain recovery. To enhance our understanding of recovery, a large cross-sectional study was conducted to compare outcome measures of return to work, impairment of activities of daily living, pain symptoms, and functional performance probability. A total of 208 workers were examined. The percentage of workers recovered based on return to work criteria was 99% compared to 25% for impairment of activities of daily living, 17% for symptoms, and 12.5% for functional performance probability. Single functional performance measures of range of motion, velocity, and acceleration had recovery rates of 59, 13, and 10%, respectively. It appears that all these criteria are measuring very different parameters of low back pain recovery. The residual loss in functional performance may indicate a decreased tolerance to physical demand providing potential insight for why recurrent low back pain rates are high.

Activities of Daily Living↗
PubMed2000

Exercise therapy for low back pain.

BACKGROUND: Exercise therapy is a widely used treatment for low back pain. OBJECTIVES: The objective of this review was to assess the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement and return to work. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (1999, issue 1), MEDLINE (1966 - April 1999), EMBASE (1988 - September 1998), PsycLIT (from 1984 to April 1999) and reference lists of articles. SELECTION CRITERIA: Randomised trials of all types of exercise therapy for subjects with non-specific low back pain with or without radiation into the legs. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions and outcomes, we decided not to perform a meta-analysis but to summarise the results using a rating system of four levels of evidence (strong, moderate, limited or no evidence). MAIN RESULTS: 39 RCTs were identified. There is strong evidence that exercise therapy is not more effective than inactive or other active treatments it has been compared with for acute low back pain. There is conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments for chronic low back pain. Exercise therapy was more effective than usual care by the general practitioner and equally effective as conventional physiotherapy for chronic low back pain. REVIEWER'S CONCLUSIONS: The evidence summarised in this systematic review does not indicate that specific exercises are effective for the treatment of acute low back pain. Exercises may be helpful for chronic low back pain patients to increase return to normal daily activities and work.

Exercise Therapy↗
PubMed2001

The assessment of radiating low back pain by thermal sensory testing.

Low back pain radiating into the legs is a common pain syndrome. However, neurological examination, imaging and electromyographic studies are of limited value for prognosis or therapy. The origin of the pain remains unknown. The aim was to evaluate the potential of thermal sensory testing to serve as a diagnostic tool in 24 patients who had low back pain radiating down the S1 dermatome, compared with 26 pain-free controls. The method of limits was used to detect the thresholds of warm sensation, cold sensation, warm pain and cold pain at the L4, L5 and S1 dermatomes of the symptomatic and the non-symptomatic legs. Thresholds on the asymptomatic leg were similar to values obtained in controls. We found a significantly higher threshold for cold sensation in the S1 dermatome of the symptomatic leg of the patients compared with the controls (p< 0.005). In addition, patients who had abnormal neurological examination (50%) had higher thresholds for cold sensation or cold pain in the three dermatomes tested at the symptomatic leg compared with the non-symptomatic leg. No differences in the thresholds of warm sensation or warm pain were detected. We propose that these findings indicate selective damage to the Adelta fibres which are involved in transmission of cold sensation and pain, presumably by root compression. We found no evidence of involvement of C fibres, which transmit warm sensation and pain. Thermal testing should be considered among the testing modalities that are capable of demonstrating objective findings in patients with radiating low back pain.

Adult↗
PubMed2004

Correlation between pain, disability, and quality of life in patients with common low back pain.

STUDY DESIGN: Correlation among previously validated questionnaires. OBJECTIVES: To determine the correlation between pain, disability, and quality of life in patients with low back pain. SUMMARY OF BACKGROUND DATA: The Visual Analogue Scale (VAS), and the Roland-Morris (RMQ), Oswestry (OQ), and EuroQol (EQ) Questionnaires are validated instruments to assess pain, low back pain-related disability, and quality of life. METHODS: The study was done in the primary care setting, in Mallorca, with 195 patients who visited their physician for LBP. Individuals were given the VAS, RMQ, OQ, and EQ on their first visit and 14 days later. RESULTS: Median duration of pain when entering the study was 10 days (P25,P75: 3, 40). On day 1, simple correlation was r = 0.347 between VAS and RMQ, r = -0.422 between VAS and EQ, and r = -0.442 between RMQ and EQ. On day 15, simple correlation was r = 0.570 between VAS and RMQ, r = -0.672 between VAS and EQ, and r = -0.637 between RMQ and EQ. Multiple linear regression models showed that, on day 1, the VAS score explains 12% of the RMQ score and the VAS and RMQ scores explain 27% of the EQ score. On day 15, the VAS score explains 33% of the RMQ score, and the VAS and RMQ scores explain 58% of the EQ score. On day 1, a 10% increase in VAS worsens disability by 3.3% and quality of life by 2.65%. On day 15, a 10% increase in VAS worsens disability by 4.99% and quality of life by 3.80%. Prestudy duration of pain had no influence on any model. All these correlation coefficients and models are significant at the P < 0.001 level. The OQ had lower correlation values with the other three scales, and only two of them were significant. CONCLUSION: Clinically relevant improvements in pain may lead to almost unnoticeable changes in disability and quality of life. Therefore, these variables should be assessed separately when evaluating the effect of any form of treatment for low back pain. The influence of pain and disability on quality of life progresses while they last, and doubles in 14 days. In acute and subacute patients, this increase is not dependent on the previous duration of pain.

Disability Evaluation↗
PubMed2001

Factors associated with medical care-seeking due to low-back pain in scaffolders.

BACKGROUND: Few studies have demonstrated the consequences of having back pain and the mechanisms underlying decisions to seek medical care. This study aimed to assess the prevalence of back pain and other musculoskeletal complaints and to identify factors that determine specific type of care-seeking due to back pain among scaffolders. METHODS: A cross-sectional study was conducted among 323 scaffolders. A questionnaire was used to collect data on musculoskeletal complaints and type of medical care sought. Logistic regression analysis was performed to study the risk factors for care-seeking for LBP, estimating Prevalence Ratios (PR) as a measure of association. RESULTS: The prevalence of musculoskeletal complaints was high. Severe back pain was reported by 28% of the scaffolders, LBP with sciatic pain by 23%, with sickness absence by 21%, with disability by 21%, and chronic back pain by 14%. Back pain was often accompanied by complaints of neck, shoulder, or knee. A general practitioner was sought by 44% of the workers with LBP, a physiotherapist by 22%, an occupational physician by 20%, and a specialist by 11%. The nature and severity of back pain seemed to determine the decision to visit the GP. Irradiating pain and sickness absence were the strongest predictors for seeking medical care and being referred to a specialist or physiotherapist. CONCLUSION: The particular definition of back pain and the selection process of workers with LBP may partly determine the findings on work-related risk factors and health care utilization.

Adult↗
PubMed1996

Can a pharmacological pain analysis in patients with chronic low back pain predict the outcome of lumbar fusion? Preliminary report.

Chronic low back pain patients chosen for lumbar fusion surgery were entered into a prospective study with the aim of evaluating whether pre-operative pharmacological pain classification correlated with the outcome of surgical treatment. Twenty consecutive patients (mean age 39 years, range 29-50 years) with a mean pain duration of 4.6 years (range 1-8 years) participated. The patients' pain, disability and work situation were evaluated pre- and post-operatively. According to the results of pharmacological pain testing the patients were classified into five pain groups: (1) those with nociceptive pain, (2) those with neuropathic pain, (3) placebo responders, (4) non-responders and (5) unclassified. This classification was based on the following approaches: intravenous morphine, intravenous lidocaine, epidurally administered fentanyl and a local anaesthetic. Surgical treatment consisted of posterolateral fusion of the lower two functional lumbosacral spinal units combined, if necessary with appropriate decompression. The results of the pharmacological pain assessment were not disclosed until the end of the follow-up period and outcome was evaluated by an unbiased observer. The distribution of patients between pain groups was as follows; nine had nociceptive pain, two suffered neuropathic pain, there were no placebo responders and seven were non-responders. Two patients could not be classified into any of these groups. Outcome was rated at 6, 12 and 24 months as excellent/good in eight out of nine patients with nociceptive pain. In the group with non-responding pain surgical outcome was significantly poorer (P < 0.01), and was ranked as excellent/good in only one out of seven patients. There was a significant improvement (P < 0.05) concerning both pain and disability in the nociceptive group, but not in the non-responding group. Pre-operative pharmacological pain testing may be useful as a predictor of surgical outcome and we suggest that it can be employed as a means to identify patients with non-responding pain and poor surgical prognosis.

Adult↗
PubMed2005

The value of computed tomography in the diagnosis of low back pain. A review of 2,012 cases.

AIM: The aim of this study was to establish the effective role of CT in the diagnosis of low back pain, and whether CT features correlate with clinical signs and symptoms. METHODS: Two thousand and twelve consecutive patients, of which 866 males and 1,146 females, aged 22 to 91 years, affected by generic painful back, have been studied in the period between January 2000 and October 2002. Volumetric CT of the lumbo-sacral column was performed on all the patients, employing a Philips Tomoscan SR 7000 (Eindhoven, The Netherlands). Sections of 3 mm in thickness were obtained, employing window and level of window both for bone and soft tissues. Contrast medium was not injected. RESULTS: Regarding the distribution of lesions, 172 males were affected by one, 586 from 2 to 4, 102 more than 4 lesions; 6 subjects were without. On the contrary, 196 females had a single lesion, 611 from 2 to 4, 331 more than 4 and 8 did not have any one. In females, the age group most involved is encompassed between 51 and 80 years; the more frequent alterations, in decreasing order, were: bulging disc, synovial facet syndrome, disc herniation and vacuum phenomenon. In males incidence age related and frequency of various pathologies were overlapped to that observed in females; however the incidence of disc herniation in males is greatest between 41 to 50 years. CONCLUSIONS: Low back pain, with or without radiation to the sciatic and femoral nerves, is one of the most common diseases, involving approximately 2/3 of the adult population sooner or later in life. Anatomically the center of pain is the lumbar column (from L3 to L5), the lumbo-sacral junction, the sacrum, the sacro-iliac joints, and the sacral-coccygeal region. Generally, it is a benign syndrome; however, since a pathologic condition is recognized in 15% of cases, then this condition must always be diagnosed. The list of events producing lumbar pain seems to be endless: therefore differential diagnosis must be based on appropriate anatomic and etiologic factors, also considering that pathogenesis (due to mechanical, compression, inflammatory, and neuropathic factors) is directly influenced by social and psychologic factors. Initially a conventional X-ray was used for the diagnosis of images, subsequently, arthrography and myelography were used; today CT is useful in the detection of bone and soft tissue structures, especially using multiplanar reformatted images. It is a noninvasive procedure that usually reveals the cause of radicular compression and demonstrates lateral and intraforaminal pathologic condition well. MRI represents the last technical development. The characteristics of all these techniques are such as to achieve a full diagnosis. Their reconciled use is in relation to the current clinical question, and it also depends on various considerations, not only technical matters, but availability of equipment and costs too, even if conventional radiography must always precede every other survey.

Adult↗
PubMed2000

A prospective follow-up study of low back pain in the community.

STUDY DESIGN: Opportunistic prospective follow-up study. OBJECTIVE: To describe the natural history of low back pain in the community and to model the factors predictive of recovered versus persistent low back pain. SUMMARY OF BACKGROUND DATA: A two-phase questionnaire was mailed to adults in the Bradford Metropolitan Health District in 1994. Valid respondents were surveyed again in 1997. Analysis is based on the combined results of these two surveys. METHODS: Unifactorial and multifactorial statistics were analyzed based on 1455 adults, with and without low back pain. RESULTS: One third of respondents reported no lifetime low back pain. Average lifetime prevalence was 59% and average annual prevalence 41%. Of those who reported lifetime low back pain, 42% reported persistent annual low back pain, 18% reported a first episode in 1997, resulting in a 4% population incidence rate, and 40% reported intermittent low back pain. The likelihood of having had low back pain increased significantly with age. Those who reported a new case of low back pain in 1997 were significantly more likely to be 25-34 years of age, and these persons were most likely to report acute low back pain with very little disability. Those with persistent low back pain were significantly more likely to report chronic low back pain with some disability. Logistic regression modeling was unable to predict recovered versus persistent low back pain, given the person, pain, and treatment factors available. CONCLUSIONS: Results showed that low back pain is a mutable problem with acute episodes blending into longer periods resulting in more disability as time progresses. A wide range of demographic, pain, consultation, and treatment factors were not predictive of low back pain recovery.

Adult↗
PubMed2006

Fear-avoidance beliefs and temporal summation of evoked thermal pain influence self-report of disability in patients with chronic low back pain.

INTRODUCTION: Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work. METHOD: Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability. RESULTS: None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work. CONCLUSION: Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain. SIGNIFICANCE: This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.

Avoidance Learning↗
PubMed2005

Back belt use for prevention of occupational low back pain: a systematic review.

BACKGROUND: Back pain continues to be the leading overall cause of morbidity and lost productivity in the workplace. Recently, there has been a renewed interest in the use of back belts by industry to reduce occupational low back pain (LBP). OBJECTIVES: To examine the literature and evaluate the effectiveness of back belt use for the primary prevention of occupational LBP. METHODS: MEDLINE, CINAHL, EMBASE, and HEALTHSTAR were searched for relevant articles published up to July 2003. Studies were included if participants were material handlers, and outcomes included the incidence and/or duration of lost time of reported LBP among workers who wore back belts compared with those who did not. The quality of the evidence was scored independently by 2 reviewers using a double rating method, first according to research design followed by an internal validity rating. Final synthesis of the evidence was performed in which the evidence was classified as good, fair, conflicting, or insufficient. RESULTS: Ten epidemiologic studies meeting inclusion criteria were identified. Of 5 randomized controlled trials, 3 showed no positive results with back belt use; 2 cohort studies had conflicting results; and 2 nonrandomized controlled studies and 1 survey showed positive results. CONCLUSIONS: Currently, because of conflicting evidence and the absence of high-quality trials, there is no conclusive evidence to support back belt use to prevent or reduce lost time from occupational LBP.

Humans↗
PubMed1991

The sports medicine approach to occupational low back pain.

Absenteeism caused by low back pain costs industry millions of dollars per year. Innovative approaches for the prevention and treatment of low back pain in workers are mandatory. The sports medicine approach for aggressive rehabilitation offers a possible solution.

Back Pain↗
PubMed1987

Prevalence of back pain in chiropractors.

An epidemiological survey was made of the prevalence of back pain in a sample of 320 Canadian chiropractors. In addition, demographic, postural and other variables were studied to determine their effect on back pain. The overall prevalence of back pain was 87%. Low back pain was claimed by 74% of responding chiropractors. It was found that male chiropractors complained most frequently of lumbar pain, while among female respondents thoracic pain was most common. No apparent correlation was found between back pain and operating postures or table heights. Yet, 82% of the chiropractors that believed their back pain was aggravated by practice made these kinds of changes to avoid pain.

Adult↗
PubMed1995

Manual handling activities and risk of low back pain in nurses.

OBJECTIVE: To investigate the risk factors for low back pain in hospital nurses, with particular emphasis on the role of specific nursing activities. METHODS: A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. RESULTS: The overall response rate was 69%. Among 1616 women, the lifetime prevalence of back pain was 60% and the one year period prevalence 45%. 10% had been absent from work because of back pain for a cumulative period exceeding four weeks. Rates in men were generally similar to those in women. In women back pain during the previous 12 months was weakly associated with height, and was significantly more common in those who reported frequent non-musculoskeletal symptoms such as headache and low mood. After adjustment for height and non-musculoskeletal symptoms, significant associations were found with frequency of manually moving patients around on the bed, manually transferring patients between bed and chair, and manually lifting patients from the floor. In contrast, no clear increase in risk was found in relation to transfer of patients with canvas and poles, manually lifting patients in and out of the bath, or lifting patients with mechanical aids. Confirmation of these findings is now being sought in a prospective study of the same population. CONCLUSIONS: This study confirms that low back pain is highly prevalent among nurses and is associated with a high level of sickness absence. People who often report non-musculoskeletal symptoms were significantly more likely to report low back pain. Specific manual handling tasks were associated with an increased risk of back pain; however, no such association was found with mechanised patient transfers.

Adult↗
PubMed1998

Spontaneous onset of back pain.

OBJECTIVES: To assess the frequency with which patients attribute low back pain to spontaneous onset. DESIGN: A consecutive sample of two distinct groups of patients seeking treatment for back pain: those without need to identify cause (study group, n = 4,689) and those required to report a specific event to qualify for benefits paid for by a third party (compensated group, n = 6,687). SETTING: Active exercise-based back pain rehabilitation clinics. SUMMARY OF BACKGROUND DATA: Research on the natural history of back pain has revealed frequent reports of spontaneous recovery, usually within 8-12 weeks after onset. There is little comparable literature pertaining to the report of spontaneous onset. METHODS: Data were collected for two groups of consecutive patients who attended for initial assessments of their back pain at 16 Canadian Back Institute locations, between May 1, 1994 and February 28, 1995. Patient responses were collected using a standardized, professionally administered questionnaire. RESULTS: In the group without need to identify cause, 66.7% of patients could not identify an event producing their symptoms. For those required to report a specific event, only 9.8% of patients failed to attribute cause. Multivariate logistic regression revealed that the required-to-report group was approximately 15 times more likely to report an event (odds ratio = 14.95; 95% confidence interval = 13.44, 16.65) than the study group; those pursuing litigation were more than 2.5 times more likely to report a causative event (odds ratio = 2.68; 95% confidence interval = 2.09, 3.49). CONCLUSIONS: Back pain occurred spontaneously in approximately 67% of patients seeking treatment in the study group. The authors consider spontaneous onset to be part of the natural history of back pain for this group.

Adult↗
PubMedDate not supplied

Randomized, controlled trial of breath therapy for patients with chronic low-back pain.

CONTEXT: Patients suffering from chronic low back pain (cLBP) are often unsatisfied with conventional medical care and seek alternative therapies. Many mind-body techniques are said to help patients with low back pain by enhancing body awareness, which includes proprioception deficit in cLBP, but have not been rigorously studied in cLBP. Breath therapy is a western mind-body therapy integrating body awareness, breathing, meditation, and movement. Preliminary data suggest benefits from breath therapy for proprioception and low back pain. OBJECTIVE: To assess the effect of breath therapy on cLBP. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Thirty-six patients with cLBP. INTERVENTIONS: Six to eight weeks (12 sessions) of breath therapy versus physical therapy. MAIN OUTCOME MEASURES: Pain by visual analog scale (VAS), function by Roland Scale, overall health by Short Form 36 (SF-36) at baseline, six to eight weeks, and six months. Balance as a potential surrogate for proprioception and body-awareness measured at the beginning and end of treatment. RESULTS: Pre- to post-intervention, patients in both groups improved in pain (VAS: -2.7 with breath therapy, -2.4 with physical therapy; SF-36: +14.9 with breath therapy and +21.0 with physical therapy). Breath therapy recipients improved in function (Roland: -4.8) and in the physical and emotional role (SF-36: +15.5 and 14.3). Physical therapy recipients improved in vitality (SF-36: +15.0). Average improvements were not different between groups. At six to eight weeks, results showed a trend favoring breath therapy; at six-months, a trend favoring physical therapy. Balance measures showed no improvements and no correlations with other outcomes. CONCLUSIONS: Patients suffering from cLBP improved significantly with breath therapy. Changes in standard low back pain measures of pain and disability were comparable to those resulting from high-quality, extended physical therapy. Breath therapy was safe. Qualitative data suggested improved coping skills and new insight into the effect of stress on the body as a result of breath therapy. Balance measures did not seem to be valid measures of clinical change in patients' cLBP.

Adaptation, Psychological↗