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PubMed1999

Are risk factors for atherothrombotic disease associated with back pain sickness absence? The Whitehall II Study.

STUDY OBJECTIVE: To explore the previously stated hypothesis that risk factors for atherothrombotic disease are associated with back pain. DESIGN: Prospective (mean of four years of follow up) and retrospective analyses using two main outcome measures: (a) short (< or = 7 days) and long (> 7 days) spells of sickness absence because of back pain reported separately in men and women; (b) consistency of effect across the resulting four duration of spell and sex cells. SETTING: 14 civil service departments in London. PARTICIPANTS: 3506 male and 1380 female white office-based civil servants, aged 35-55 years at baseline. MAIN RESULTS: In age adjusted models, low apo AI was associated with back pain across all four duration-sex cells and smoking was associated across three cells. Six factors were associated with back pain in two cells: low exercise and high BMI, waist-hip ratio, triglycerides, insulin and Lp(a). On full adjustment (for age, BMI, employment grade and back pain at baseline), each of these factors retained a statistically significant effect in at least one duration-sex cell. Triglycerides were associated with short and long spells of sickness absence because of back pain in men in fully adjusted models with rate ratios (95% confidence intervals) of 1.53 (1.1, 2.1) and 1.75 (1.0, 3.2) respectively. There was little or no evidence of association in age adjusted models with: fibrinogen, glucose tolerance, total cholesterol, apoB, hypertension, factor VII, von Willebrand factor, electrocardiographic evidence of coronary heart disease and reported angina. CONCLUSIONS: In this population of office workers, only modest support was found for an atherothrombotic component to back pain sickness absence. However, the young age of participants at baseline and the lack of distinction between different types of back pain are likely to bias the findings toward null. Further research is required to ascertain whether a population sub-group of atherothrombotic back pain can be identified.

Absenteeism↗
PubMed2006

Physical capacity in relation to low back, neck, or shoulder pain in a working population.

AIMS: To investigate the longitudinal relation between physical capacity (isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine) and low back, neck, and shoulder pain. METHODS: In this prospective cohort study, 1789 Dutch workers participated. At baseline, isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine were measured in the pain free workers, as well as potential confounders, including physical workload. Low back, neck, and shoulder pain were self-reported annually at baseline and three times during follow up. RESULTS: After adjustment for confounders, Poisson generalised estimation equations showed an increased risk of low back pain among workers in the lowest sex specific tertile of performance in the static back endurance tests compared to workers in the reference category (RR = 1.42; 95% CI 1.19 to 1.71), but this was not found for isokinetic trunk lifting strength or mobility of the spine. An increased risk of neck pain was shown for workers with low performance in tests of isokinetic neck/shoulder lifting strength (RR = 1.31; 95% CI 1.03 to 1.67) and static neck endurance (RR = 1.22; 95% CI 1.00 to 1.49). Among workers in the lowest tertiles of isokinetic neck/shoulder lifting strength or endurance of the shoulder muscles, no increased risk of shoulder pain was found. CONCLUSIONS: The findings of this study suggest that low back or neck endurance were independent predictors of low back or neck pain, respectively, and that low lifting neck/shoulder strength was an independent predictor of neck pain. No association was found between lifting trunk strength, or mobility of the spine and the risk of low back pain, nor between lifting neck/shoulder strength or endurance of the shoulder muscles and the risk of shoulder 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↗
PubMed2002

Working hours spent on repeated activities and prevalence of back pain.

BACKGROUND AND AIMS: Back pain is the most common reason for filing workers' compensation claims in the United States and affects large numbers of workers in many other countries. To evaluate the associations between working hours spent on repeated activities and back pain, data gathered through the 1988 National Health Interview Survey were analysed. The data were also used to identify high risk occupations. METHODS: A total of 30 074 workers participated in the survey. They were asked to provide information on their job, including the time spent on repeated strenuous physical activities (RSPA) and the time spent on repeated bending, twisting, or reaching (RBTR) on a typical job. A case of back pain was defined as a worker who had back pain every day for a week or more during the past 12 months. Each case was asked to report the cause of back pain. Those who attributed their back pain to repeated activities (RA) or a single accident or injury (AI) were asked to recall whether they performed RA or had the AI at work. RESULTS: Whereas the prevalence of back pain increased as the number of working hours spent on RSPA or RBTR increased, the dose-response relations were not linear for either factor, suggesting the involvement of other unmeasured factors. The estimated overall prevalence of RA back pain was 8.9% among male workers and 5.9% among female workers. "Carpenters" had the highest prevalence (19.2%) and most cases (338 000) among the major occupations of men, and "nursing aides, orderlies, and attendants" had the highest prevalence (15.2%) and most cases (217 000) among the major occupations of women. CONCLUSIONS: The number of hours spent on repeated activities at work was associated with the prevalence of back pain. This study identified high risk occupations for future research and intervention.

Adult↗
PubMedDate not supplied

Lumbar mobility and low back pain during adolescence. A longitudinal three-year follow-up study in athletes and controls.

In this 3-year longitudinal study, we studied lumbar mobility and the occurrence of low back pain among 98 adolescents who were free of previous severe low back pain: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (ice hockey and soccer players) and 31 girl athletes (figure skaters and gymnasts). During the followup, low back pain lasting longer than 1 week was reported by 29 athletes (15 boys and 14 girls) and by 6 nonathletes (3 boys and 3 girls). In multivariate analyses, participation in sports and low maximal lumbar flexion at the baseline predicted low back pain during the followup among boys; however, these factors accounted for only 16% of the variability between the groups with and without low back pain. Among girls, decreased range of motion in the lower lumbar segments, low maximal lumbar extension, and high body weight at the baseline were predictive of low back pain during the followup, accounting for 31% of the variability between the groups. The girls in the lowest tertile of maximal lumbar extension at baseline had a relative risk of 3.4 to have future low back pain compared with those in the highest tertile. We conclude that the low individual physiologic maximum of lower segment lumbar extension mobility may cause overloading of the low back among athletes involved in sports with frequent maximal lumbar extension and that it predicts future low back pain.

Adolescent↗
PubMed2004

Rationale and design of a multicenter randomized controlled trial on a 'minimal intervention' in Dutch army personnel with nonspecific low back pain [ISRCTN19334317].

BACKGROUND: Researchers from the Royal Netherlands Army are studying the potential of isolated lumbar extensor training in low back pain in their working population. Currently, a randomized controlled trial is carried out in five military health centers in The Netherlands and Germany, in which a 10-week program of not more than 2 training sessions (10-15 minutes) per week is studied in soldiers with nonspecific low back pain for more than 4 weeks. The purpose of the study is to investigate the efficacy of this 'minimal intervention program', compared to usual care. Moreover, attempts are made to identify subgroups of different responders to the intervention. METHODS: Besides a baseline measurement, follow-up data are gathered at two short-term intervals (5 and 10 weeks after randomization) and two long-term intervals (6 months and one year after the end of the intervention), respectively. At every test moment, participants fill out a compound questionnaire on a stand-alone PC, and they undergo an isometric back strength measurement on a lower back machine. Primary outcome measures in this study are: self-assessed degree of complaints and degree of handicap in daily activities due to back pain. In addition, our secondary measurements focus on: fear of movement/(re-) injury, mental and social health perception, individual back extension strength, and satisfaction of the patient with the treatment perceived. Finally, we assess a number of potential prognostic factors: demographic and job characteristics, overall health, the degree of physical activity, and the attitudes and beliefs of the physiotherapist towards chronic low back pain. DISCUSSION: Although a substantial number of trials have been conducted that included lumbar extension training in low back pain patients, hardly any study has emphasized a minimal intervention approach comparable to ours. For reasons of time efficiency and patient preferences, this minimal sports medicine approach of low back pain management is interesting for the population under study, and possibly for comparable working populations with physical demanding job activities.

Exercise Therapy↗
PubMed2006

Prognosis of acute low back pain: design of a prospective inception cohort study.

BACKGROUND: Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. METHODS/DESIGN: The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. DISCUSSION: This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

Acute Disease↗
PubMed2006

Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population.

BACKGROUND: Neck and low back pain are common musculoskeletal complaints generating large societal costs in Western populations. In this study we evaluate the magnitude of long-term health outcomes for neck and low back pain, taking possible confounders into account. METHOD: A cohort of 2,351 Swedish male farmers and rural non-farmers (40-60 years old) was established in 1989. In the first survey, conducted in 1990-91, 1,782 men participated. A 12-year follow-up survey was made in 2002-03 and 1,405 men participated at both times. After exclusion of 58 individuals reporting a specific back diagnosis in 1990-91, the study cohort encompassed 1,347 men. The health outcomes primary care consultation, hospital admission, sick leave and disability pension were assessed in structured interviews in 2002-03 (survey 2). Symptoms and potential confounders were assessed at survey 1, with the exception of rating of depression and anxiety, which was assessed at survey 2. Multiple logistic regression generating odds ratios (OR) with 95% confidence intervals (95% CI) was performed to adjust the associations between reported symptoms and health outcomes for potential confounders (age, farming, workload, education, demand and control at work, body mass index, smoking, snuff use, alcohol consumption, psychiatric symptoms and specific back diagnoses during follow up). RESULTS: Of the 836 men reporting current neck and/or low back pain at survey 1, 21% had had at least one primary care consultation for neck or low back problems, 7% had been on sick leave and 4% had disability pension owing to the condition during the 12 year follow up. Current neck and/or low back pain at survey 1 predicted primary care consultations (OR = 4.10, 95% CI 2.24-7.49) and sick leave (OR = 3.22, 95% CI 1.13-9.22) after potential confounders were considered. Lower education and more psychiatric symptoms were independently related to sick leave. Lower education and snuff use independently predicted disability pension. CONCLUSION: Few individuals with neck or low back pain were on sick leave or were granted a disability pension owing to neck or low back problems during 12 years of follow up. Symptoms at baseline independently predicted health outcomes. Educational level and symptoms of depression/anxiety were important modifiers.

Adult↗
PubMed2004

Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

BACKGROUND: Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. METHODS: We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months) of 70% of the patients with such diagnoses and all eligible respondents were interviewed. RESULTS: Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively), mostly for back pain (45% and 24%, respectively). Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23%) than users of other therapies (5-16%). Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale) and meditation least helpful (median of 3) in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. CONCLUSIONS: Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional studies evaluating their effectiveness and suggests that researchers conducting clinical trials of these therapies may not have difficulties recruiting patients.

Acupuncture↗
PubMed2002

Systematic review of conservative interventions for subacute low back pain.

OBJECTIVE: To evaluate the effect of conservative interventions on clinically relevant outcome measures for patients with subacute low back pain. This is particularly important because effective treatment for subacute low back pain will prevent the transition to chronic low back pain, a condition that is largely responsible for the high health care costs of low back pain. DESIGN: Systematic review of randomized controlled trials. MAIN OUTCOME MEASURES: Methodological quality of each trial was assessed. Effect sizes and 95% confidence intervals were calculated for pain and disability and risk ratios for return to work. RESULTS: Thirteen trials were located, evaluating the following interventions: manipulation, back school, exercise, advice, transcutaneous electrical nerve stimulation (TENS), hydrotherapy, massage, corset, cognitive behavioural treatment and co-ordination of primary health care. Most studies were of low quality and did not show a statistically significant effect of intervention. For the strict duration of low back pain (six weeks to three months), no evidence of high internal validity was found but when other methodological criteria were considered, evidence was found for the efficacy of advice. Furthermore, there is evidence that when a broader view is taken of the duration of subacute low back pain (seven days to six months), other treatments (e.g. manipulation, exercise, TENS) may be effective. CONCLUSIONS: Our review identified a major gap in the evidence for interventions that are currently recommended in clinical practice guidelines for the treatment of subacute low back pain. Lack of a uniform definition of subacute low back pain further limited current evidence.

Cognitive Behavioral Therapy↗
PubMed2006

Back pain in whitewater rafting guides.

OBJECTIVE: The purpose of this study was to quantify rates of back pain among whitewater rafting guides and to look for correlations between the presence of back pain and specific activities associated with guiding. The secondary objective was to provide suggestions for outfitters according to the results of this study, which may be of assistance to their guide staff. METHODS: A mail-out-mail-back survey was sent to 2510 rafting guides working in Washington, Oregon, Idaho, Utah, Colorado, and the Grand Canyon during the summer of 2004 to quantify whitewater raft guiding characteristics and incidence of back pain. RESULTS: Of the 390 surveys returned, 77.4% of guides reported back pain while guiding and 20.8% had back pain lasting longer than 1 week at the time of the survey. Stacking 5 or more inflated boats for transport was correlated with the presence of pain (chi(2) = 8.4, v = 1, P < .01), and loading and unloading rafts while guests are waiting was correlated with back pain lasting longer than 1 week (chi(2) = 8.1, v = 1, P < .01). CONCLUSIONS: The rates of back pain among, and activities of, whitewater rafting guides were reported. Rates of back pain among whitewater rafting guides who returned our survey appear similar to the general population. Although determining a particular cause of pain is difficult, the typical injury seems to be relatively minor in scope.

Adolescent↗
PubMed1997

The prevalence of back pain in children who have idiopathic scoliosis.

A retrospective study of 2442 patients who had idiopathic scoliosis was performed to determine the prevalence of back pain and its association with an underlying pathological condition. Five hundred and sixty (23 per cent) of the 2442 patients had back pain at the time of presentation, and an additional 210 (9 per cent) had back pain during the period of observation. There was a significant association between back pain and an age of more than fifteen years, skeletal maturity (a Risser sign of 2 or more), postmenarchal status, and a history of injury. There was no association with gender, family history of scoliosis, limb-length discrepancy, magnitude or type of curve, or spinal alignment. At the latest follow-up evaluation, 324 (58 per cent) of the 560 patients who had had back pain at presentation had no additional symptoms. Forty-eight (9 per cent) of the 560 patients who had back pain had an underlying pathological condition: twenty-nine patients had spondylolysis or spondylolisthesis, nine had Scheurmann kyphosis, five had a syrinx, two had a herniated disc, one had hydromyelia, one had a tethered cord, and one had an intraspinal tumor. A painful left thoracic curve or an abnormal neurological finding was most predictive of an underlying pathological condition, although only eight of the thirty-three patients who had such findings were found to have such a condition. When a patient with scoliosis has back pain, a careful history should be recorded, a thorough physical examination should be performed, and good-quality plain radiographs should be made. If this initial evaluation reveals normal findings, a diagnosis of idiopathic scoliosis can be made, the scoliosis can be treated appropriately, and non-operative treatment can be initiated for the back pain. It is not necessary to perform extensive diagnostic studies to evaluate every patient who has scoliosis and back pain.

Adolescent↗
PubMed2005

Influence of back support conditions on the apparent mass of seated occupants under horizontal vibration.

The response characteristics of seated human subjects exposed to fore-aft (x-axis) and lateral (y-axis) vibration are investigated through measurements of dynamic interactions between the seated body and the seat pan, and the upper body and the seat backrest. The experiments involved: (i) three different back support conditions (no back support, and upper body supported against a vertical and an inclined backrest); (ii) three different seat pan heights (425, 390 and 350 mm); and three different magnitudes (0.25, 0.5 and 1.0 m/s2 rms acceleration) of band limited random excitations in the 0.5-10 Hz frequency range, applied independently along the fore-aft and lateral directions in an uncoupled manner. The body force responses, measured at the seat pan and the backrest along the direction of motion, are applied to characterize the total body apparent mass (APMS) reflected on the seat pan, and those of the upper body reflected on the backrest. Unlike the widely reported responses of seated occupants under vertical vibration, the responses to horizontal vibration show strong effect of excitation magnitude. The large displacements at lower frequencies cause considerable rotations of the upper body, and the knees and ankles, particularly when seated without a back support, which encouraged the occupants to continually shift larger portion of the body weight towards their feet. This together with the strong dependence on the excitation magnitude resulted in considerable inter-subject variability of the data. The addition of a back support causes stiffening of the body to limit the low frequency rocking motion of the upper body under x-axis motion, while considerable dynamic interactions with the backrest occur. The mean apparent mass (APMS) responses measured at the seat pan and the backrest suggest strong contributions due to the back support condition, and the direction and magnitude of horizontal vibration, while the role of seat height is important only in the vicinity of the resonant frequencies. In the absence of a back support, the seat pan responses predominate at a lower frequency (near 0.7 Hz) under both directions of motion, while two secondary peaks in the magnitude also occur at relatively higher frequencies. The addition of back support causes the seat pan response to converge mostly to a single primary peak, resulting in a single-degree-of-freedom like behavior, with peak occurring in the 2.7-5.4 Hz range under x-axis, and 0.9-2.1 Hz range under y-axis motions, depending upon the excitation magnitude and the back support condition. This can be attributed to the stiffening of the body in the presence of the constraints imposed by the backrest. A relaxed posture with an inclined backrest, however, causes a softening effect, when compared to an erect posture with a vertical backrest. The backrest, however, serves as another source of vibration to the seated occupant, which tends to cause considerably higher magnitude responses. The considerable magnitudes of the apparent mass response measured at the seat back under fore-aft motions suggest strong interactions with the backrest. Such interactions along the side-to-side motions, however, are relatively small. The results suggest that the biodynamic characterization of seated occupants exposed to horizontal vibration requires appropriate considerations of the interactions with the backrest.

Adult↗
PubMed1995

The use of patient symptoms to screen for serious back problems.

Even when a patient is referred by a physician, the physical therapist must remain alert to the possibility that the patient may require medical care outside the realm of physical therapy. Physical therapists must be able to screen low back pain patients to identify those who have serious low back problems which require additional diagnostic evaluation and treatment by a physician. It is important for physical therapists to know which symptoms and signs or combination of symptoms and signs best indicate the likelihood of a serious problem. The purpose of this study was to test the sensitivity and specificity of low back pain symptoms in distinguishing individuals with a benign low back problem from those requiring surgical or medical intervention. Demographic and clinical data were collected retrospectively from a standardized low back pain questionnaire located in the medical records of 174 low back pain patients. Patients were classified as having a benign low back problem (N = 41) or a serious low back problem (N = 133) based on surgical findings or long term follow-up. Some individual symptoms had high specificity, but none had high sensitivity. To improve sensitivity while attempting to maintain moderate specificity, a number of symptoms were considered in parallel. The highest combination of sensitivity (.87) and specificity (.50) was obtained by combining in parallel the symptoms of unable to sleep, awakened and unable to fall back to sleep, medication required to sleep, and pain worsened by walking.

Adult↗
PubMed1998

An analysis of posture and back pain in the first and third trimesters of pregnancy.

While the incidence of back pain during pregnancy has been shown to be high, few studies have investigated postural changes that occur during pregnancy and their relationship to back pain. The purpose of this study was to determine if posture and back pain changed from the first to the third trimester of pregnancy and whether there was a relationship between the two. Twelve healthy women who were having uncomplicated pregnancies participated in the study. During the first and third trimesters, each subject had their standing posture and back pain assessed by a Metrecom Skeletal Analysis System and a 0- to 10-cm line pain scale, respectively. Repeated measures analysis of variance and Pearson correlation coefficients were calculated on or between back pain and nine posture variables and revealed significant increases in third trimester back pain and postures compared with first trimester back pain (p < .05) and postures for lumbar angle (p < .01), posterior head position (p < .01), right pelvic sagittal tilt (p < .01), and left pelvic sagittal tilt (p < .01). No significant relationships were found between magnitude of or change in posture and back pain. These results suggest that in the standing position the lumbar lordosis and sagittal pelvic tilt increased and head position become more posterior as women progressed from the first trimester to the last trimester of pregnancy. These postural changes, however, were not related to back pain. This suggests that many of the posture-correcting clinical exercise regimens given to pregnant women need to be investigated.

Adult↗
PubMed2006

Relationship between impaired functional stability and back pain in children: an exploratory cross-sectional study.

QUESTIONS UNDER STUDY: On surveys, about every fifth child in the school age reports back pain. There is a dearth of literature on the association between functional stability and back pain in children. OBJECTIVE: To examine the association between functional stability, measured with the Matthiasstest, and "back pain during the last week". METHODS: We used data from a cross-sectional survey on third, fourth and fifth grade school-years (128 children aged between 8 and 12 years) in seven different classes in two different rural regions of Switzerland, to evaluate in an explorative manner the association between the score of the Matthiass-test and low back pain and upper back pain in the last week with two multivariable logistic regressions. RESULTS: The Matthiass-test score, controlled for age, sex and language region of the school, was significantly associated with low back pain in the last week (adjusted odds ratio 1.77 with an 95% confidence interval from 1.08 to 2.91) and non significantly with the upper back pain in the last week (adjusted odds ratio 1.67 with an 95% confidence interval from 0.98 to 2.81). CONCLUSION: The Matthiass-test score is associated with low back pain. Because of the exploratory character of this study, these results should be regarded with caution. Whether a high score on the Matthiass-test could be a risk factor for back pain should be evaluated in prospective studies.

Back Pain↗
PubMed2003

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.

BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.

Acupuncture Therapy↗
PubMed1999

Prevalence and consequences of low back problems in The Netherlands, working vs non-working population, the MORGEN-Study. Monitoring Project on Risk Factors for Chronic Disease.

OBJECTIVE: To study the burden of illness of low back problems--prevalence and consequences--in the working and the non-working population. METHODS: Data from the Monitoring Project on Risk factors for Chronic Diseases, the MORGEN-study, were used. This project provided data on a probability sample of the general population aged 20-59 y in the Netherlands. Cross-sectional questionnaire data on 6317 men (24% non-working) and 7505 women (47% non-working) gathered over the period 1993-1995 were analysed. RESULTS: The 12 month period prevalence of low back problems for the working and non-working population was 44.4% and 45.8% for men, and 48.2% and 55.0% for women. Larger differences were found for chronic low back problems, and activity limitation and use of health services due to low back problems. More than one-third of those who were disabled were so because of low back problems. When those unable to work because of disability (work disabled) were excluded, the prevalence and consequences of low back pain were still higher in the non-working group in comparison with the working population. Most of the non-working women were housewives and this group was both large in size and had a high prevalence of low back problems. CONCLUSIONS: Among the men studied, more than a quarter of the total burden of low back problems in those aged 20-59 y were found in the non-working population, among women this was 50%. Both research on causes and determinants of low back pain and the development of preventive actions--now being extensively focused on the working population--should also be translated to the non-working population.

Adult↗