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PubMed1994

The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part IV: Surgical correction and back pain.

OBJECTIVES: This study determined whether the prevalence, nature, and consequences of back pain in adulthood among persons who underwent Harrington rod instrumentation was related to the number of vertebrae fused, distal level of hook insertion, and degree of correction. STUDY DESIGN: This study was designed as a comparative retrospective cohort study. Subjects referred for AIS between 1960 and 1979 to a large pediatric hospital in Montreal, Quebec, were entered into the cohort. A population based control group was selected from the general population of Quebec using a telephone survey. METHODS: Back pain was assessed by postal questionnaire administered in 1990. Data was analyzed using two multivariate regression models: relative risk regression for dichotomous outcomes and ordinal regression for outcomes measured on an ordinal scale. RESULTS: Among the 723 AIS subjects who had surgery at Ste. Justine's Hospital, 555 completed the questionnaire on back pain. Overall, 73% of patients treated surgically reported back pain in the past year. Proportions varied little by presurgery characteristics or by degree of surgical correction. The distal level of fusion did not influence, in any consistent way, the occurrence of back pain in later life nor the degree of disability associated with back pain. This study does not provide any evidence that extending the level of fusion down even as far as L4 will increase the prevalence of back pain in adulthood.

Adolescent↗
PubMed1997

Interexaminer reliability in physical examination of patients with low back pain.

STUDY DESIGN: Seventy-one patients with low back pain were examined by two physiotherapists (50 patients) and two physicians (21 patients). The two physiotherapists had worked together for many years, but the two physicians had not. The interexaminer reliability of the clinical tests included in the physical examination was evaluated. OBJECTIVES: To evaluate the interexaminer reliability of clinical tests used in the physical examination of patients with low back pain under ideal circumstances, which was the case for the physiotherapists. SUMMARY OF BACKGROUND DATA: Numerous clinical tests are used in the evaluation of patients with low back pain. To reach the correct diagnosis, only tests with an acceptable validity and reliability should be used. Previous studies have mainly shown low reliability. It is important that clinical tests not be rejected because of low reliability caused by differences between examiners in performance of the examination and in their definition of normal results. METHODS: Two examiners, either two physiotherapists or two physicians, independently examined patients with low back pain. RESULTS: In approximately half of the clinical tests studied, an acceptable reliability was demonstrated. CONCLUSION: On the basis of the physiotherapists series, the reliability was acceptable for a number of clinical tests that are used in the evaluation of patients with low back pain. The results suggest that clinical tests should be standardized to a much higher degree than they are today.

Adolescent↗
PubMed2006

Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany.

BACKGROUND: Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown. AIMS: The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure. METHODS: The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18-79. RESULTS: One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease. CONCLUSIONS: The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

Adolescent↗
PubMed1996

An interactive videodisc program for low back pain patients.

Decisions about back pain treatment are often made in the presence of both physician and patient uncertainty. Therefore, we developed a computerized, interactive video program to help patients make informed decisions about undergoing low back surgery. Program development was guided by the shared decision-making model, a comprehensive literature synthesis, information from administrative databases, and focus groups of patients and physicians. Core segments are tailored to each patient's age and diagnosis; and include a narrative, excerpts from patient interviews, animated graphics illustrating spinal anatomy, and tabular summaries of the benefits and risks of both surgical and non-surgical treatment. As part of a multifocal information dissemination effort, interactive videodiscs were placed in five medical facilities in two Washington State counties. Patients (N = 239) who viewed the video program completed short evaluation forms. The majority rated the video's understandability (84%) and interest (64%) as very good or excellent. Most patients felt the amount of information provided was appropriate (75%) and over half (56%) believed the discussion of surgical versus non-surgical treatment was completely balanced. Fewer patients (17%) remained undecided about therapy after watching the program than before (29%). We conclude that interactive videodisc technology offers substantial promise as a means of involving patients in their own medical decision making.

Adolescent↗
PubMed1995

Does 48 hours' bed rest influence the outcome of acute low back pain?

BACKGROUND: Bed rest is a traditional treatment for back pain, yet only in recent years has the therapeutic benefit of this been questioned. AIM: The aim of this pilot study was to ascertain whether or not 48 hours' bed rest had an effect on the outcome of acute low back pain. METHOD: The study was conducted as a randomized controlled trial to compare a prescription of 48 hours' strict bed rest with controls; the control subjects were encouraged to remain mobile and to have no daytime rest. Nine general practitioners from practices in the West Midlands recruited patients in the age range 16-60 years who presented with low back pain of less than seven days' duration, with or without pain radiation. The outcome measures assessed were: change in straight leg raise and lumbar flexion after seven days, Oswestry and Roland-Morris disability scores after seven days and 28 days, and time taken from work. RESULTS: Forty two patients were recruited: 20 were allocated to bed rest and 22 as controls. Compared with the bed rest group the control group had statistically better Roland-Morris scores at day seven (P < 0.05) but not at day 28. At day seven, there were no statistically significant differences between groups in straight leg raise or lumbar flexion measurements although the control group had a better mean lumbar flexion than the bed rest group. The improvement in disability scores at day seven compared with day one was similar for the two groups but more of the control group had fully recovered (defined as scores of one or zero on the Roland-Morris disability scale and five or less on the Oswestry disability scale) by day seven. Remaining mobile did not appear to cause any adverse effects. The number of days lost from work in both groups was equal. A large number of self-remedies and physical therapies were recorded by subjects from both groups. CONCLUSION: The results of this pilot study did not indicate whether bed rest or remaining mobile was superior for the treatment of acute low back pain; however, the study sample was small. Subjects in the control group possibly fared better as they appeared to have better lumbar flexion at day seven. It appears that 48 hours' bed rest cannot be recommended for the treatment of acute low back pain on the basis of this small study. Large-scale definitive trials are required to detect clinically significant differences.

Acute Disease↗
PubMed1997

The prevalence of low back pain and associations with body fatness, fat distribution and height.

OBJECTIVES: To examine the associations of low back pain symptoms with waist circumference, height, waist to hip ratio and body mass index, and to test the interactions between (1) waist circumference and height, and (2) waist to hip ratio and body mass index. SETTING: Cross-sectional study set in The Netherlands of a random sample of 5887 men and 7018 women aged 20-60 y. RESULTS: The prevalences of low back pain in men and women in the past 12 months were 46% and 52%, of whom 17% and 21% had low back pain for a total of 12 or more weeks, and 13% and 18% had symptoms suggestive of intervertebral disc herniation. After adjustments for age, smoking and education, more women in the highest tertile of waist circumference reported low back pain in the past 12 months (odds ratio = 1.2, 95% confidence interval: 1.1-1.4), low back pain for a total of 12 or more weeks (odds ratio = 1.5, 95% confidence interval: 1.3-1.8), and intervertebral disc herniation symptoms (odds ratio = 1.3, 95% confidence interval: 1.1-1.6) than women in the lowest waist tertile. Corresponding values of low back pain symptoms for women with high body mass index or high waist to hip ratio were similar to those with high waist. There were no significant differences between men in different tertiles of waist, waist to hip ratio or body mass index reporting low back pain symptoms. Tallest subjects did not report low back pain symptoms more often than shortest subjects. There was no significant interactions between waist and height or between waist to hip ratio and body mass index on low back pain symptoms. CONCLUSIONS: Women who are overweight or with a large waist have a significantly increased likelihood of low back pain. There are no significant interactions between waist and height, or waist to hip ratio and body mass index on low back pain symptoms.

Adipose Tissue↗
PubMed1998

Back pain in Australian military helicopter pilots: a preliminary study.

BACKGROUND: Several studies have highlighted the problem of back pain among helicopter pilots, but few have controlled for potential confounding factors in their analyses, or sought to examine the effects of back pain on operational readiness and flying performance. There have been no previous studies of the prevalence of back pain among Australian military pilots. METHODS: The prevalence, risk factors, and consequences of low back pain were assessed in a cross-sectional survey of 200 Australian military helicopter pilots by self-completion questionnaire. RESULTS: Responses were received from 131 (66%) of available pilots. The overall prevalence of reported back pain was 64% (95% CI 56%-72%), with a further 28% of pilots describing back discomfort while flying. More than half the pilots (55%) indicated that back pain had interfered with their concentration while flying, with 16% reporting that they had hurried flying missions because of pain. A minority of pilots (7%) had refused to fly because of back problems. After adjusting for age, education, BMI, posture and numbers of hours flown, multiple logistic regression modelling indicated that a prior history of back injury was the most significant predictor of back pain among rotary wing pilots (OR 2.63, 95% CI 1.11-6.23). CONCLUSIONS: We conclude that the prevalence of back pain in Australian military helicopter pilots is unacceptably high and may be limiting operational readiness, pilot performance, flying safety, and pilot health. Urgent attention needs to be given to improved ergonomic design in aircraft, and both back pain prevention and back injury rehabilitation programs.

Adult↗
PubMed2005

Back pain and decline in lower extremity physical function among community-dwelling older persons.

BACKGROUND: Little is known regarding the longitudinal effects of back pain on physical function among older persons. We sought to determine whether back pain leading to activity restriction (i.e., restricting back pain) is associated with decline in lower extremity physical function among community-dwelling older persons. METHODS: In this prospective study with an 18-month follow-up period, participants (N = 659) were aged 70 years or older and independent in bathing, dressing, transferring, and walking at baseline. Restricting back pain, defined as staying in bed for at least one-half day or cutting down on one's usual activities due to back pain, was ascertained during monthly telephone interviews. Lower extremity physical function was assessed using three timed, performance-based tests (rapid gait, chair stands, and foot taps) at baseline and 18 months. Decline in lower extremity physical function was defined as an increase in timed scores on these tests between the baseline and 18-month assessments. RESULTS: The mean (standard deviation) number of months with restricting back pain was 1.3 (2.3); 364 (55%) participants reported 0 months, 209 (32%) reported 1-3 months, and 86 (13%) reported 4 or more months. After adjustment for baseline performance score and other covariates, the number of months with restricting back pain was independently associated with worsening rapid gait (p <.001), chair stand (p =.030), and foot tap (p <.001) performance. The deleterious effects of the "exposure" were limited to participants with 4 months of restricting back pain. CONCLUSIONS: Restricting back pain is independently associated with decline in lower extremity physical function among community-dwelling older persons. Treatment of restricting back pain may help to decrease functional decline in this population.

Aged↗
PubMed2002

The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey.

OBJECTIVE: To determine the prevalence of low back pain during pregnancy (LBPP) in an Australian population. DESIGN: A representative population-based survey of women aged 15 years and older. SETTING AND SAMPLE: Four thousand four hundred randomly selected South Australian households were visited by trained surveyors who interviewed 1531 women (69.7% response rate) using pre-tested questions. METHODS: The South Australian Health Omnibus survey was utilised. MAIN OUTCOME MEASURES: Demographic data were collected along with details of previous pregnancies, and degree of back pain during pregnancy treatment regimens, and persistence of back pain. RESULTS: Thirty-five and a half per cent of women recall having at least moderately severe back pain during pregnancy. Women who reported such back pain were younger, were more likely to report ill health and be unemployed. Increasing parity was not associated with current back pain. The most commonly used treatments were bed rest, pain killing medication, physiotherapy, and chiropractic treatment. Half of those with symptoms were untreated. Sixty-eight per cent of women who experienced moderate or worse low back pain during pregnancy continued to experience recurring low back pain with a self reported reduction in their health. CONCLUSIONS: Chronic low back pain is commonly associated with an onset in pregnancy subjectively contributing to long-term morbidity The high prevalence may be an underestimate in view of the potential for recall bias in older women.

Adolescent↗
PubMed1997

Back pain in children and adolescents: a retrospective review of 648 patients.

Back pain in children has long been considered a serious condition with an organic cause. The staff of the Shriner's Hospital had been informally noting that diagnoses among children with back pain had been changing. We conducted a retrospective study of 648 patients with spinal disorders treated at the Shriner's Hospital for Crippled Children, Spokane Unit, between January 1991 and June 1993. The patients were divided into two groups: those with pain and those without pain. It was found that back pain with no organic cause was the primary diagnosis in 57% of the group having pain. Only one child had a diagnosis of malignancy, and there were no cases of active infection. In the group with pain, three interesting associations were found concerning psychosocial problems, disability, and litigation. It was found that the diagnoses in children with back pain treated at this referral center during the study period parallel those in the adult population with back pain.

Adolescent↗
PubMed2001

Long-term assessment of a sanitary education and lumbar rehabilitation program for health care workers with chronic low back pain at the University Hospital of Lille.

A back school was established in 1992 at the University Hospital of Lille (France) for employees with low back pain. We report its medical and socioeconomic benefits with a mean time to follow-up of 4 years. Our retrospective study included 108 health care workers and provides objective data (absenteeism, use of health care) and subjective information (progression of pain and disorder, social and professional impact) before training and a mean of 4 years after training. We found that 92% of the participants were satisfied with the training and that back pain had regressed or resolved for 55% of them. Both the frequency and duration of pain had decreased significantly. Seventy percent continue to apply the advice they received in their everyday life. Dealing with the problems specific to professional activities contributed to reduce the strain experienced on the job by the health care workers and improved their satisfaction at work. Global absenteeism was reduced by 57.8%, whereas it was reduced by 33% for back pain alone 4 years after implementing this program. Our study provides evidence of the positive impact of this type of training on the way back pain is perceived and on everyday life. The assessment of the cost/efficiency ratio completes the list of durable benefits reported here.

Adult↗
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↗
PubMed1994

Low back pain and urinary incontinence. A hypothetical relationship.

STUDY DESIGN: An apparent association of low back pain with urinary incontinence was observed. Sixteen patients were investigated for organic neurologic and genito-urinary disease or deficit, which could provide a conventional explanation for the incontinence. OBJECTIVES: The unusual association of low back pain alone, with urinary incontinence, should be brought to the attention of clinicians, in the search for neurologic mechanisms to explain the phenomenon. SUMMARY OF BACKGROUND DATA: Over 5 years, a spinal practice reviewed 5000 new patients, most presenting with low back pain. Sixteen low back pain patients had urgency incontinence of urine, of varying severity but sufficient in all cases to cause daily distress and disruption of routine. Twelve of the sixteen patients had surgery (spinal fusion in 11 and total hip replacement in one), and four are awaiting surgery. Follow-up ranged from 1 to 4 years. METHODS: Plain radiography, detailed neurologic examination, myelography, or computed tomography scanning of lumbar spine, urine culture, and urodynamic studies were the investigations used, with a few exceptions relating to those patients whose urinary symptoms were revealed retrospectively. RESULTS: When surgery reduced low back pain successfully (11 of 12 patients), the urgency incontinence was cured or improved. In one patient, the low back pain continued, associated with a pseudarthrosis in the fusion mass, and the urinary symptoms were unchanged. In the four patients awaiting surgery, the urinary symptoms are unchanged. The investigations did not reveal any neurologic or genito-urinary pathology in any patient. CONCLUSION: A rare association between severe low back pain and urgency incontinence of urine, not explained on the basis of any conventional neurologic or genito-urinary pathology, should be recognized.

Female↗
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↗
PubMed1994

A ten-year prospective study of vertebral canal size as a predictor of back pain.

This prospective study compared ultrasound measurement of the lumbar vertebral canal with subsequent back pain; 669 mining and nursing recruits had been measured before 1980, and 450 replied to a postal questionnaire in 1990. There was no significant difference in the prevalence of back pain or the need to be off work with back pain, in those whose canals were above and below the mean. However, going to bed with back pain was more frequent in those with small canals and approached significance (P = 0.068). Those with small canals were more likely to visit doctors and have treatment for back pain. Canal measurement is not a predictor for back pain, but as a risk factor for severe back pain in early working life, it approaches significance.

Adult↗
PubMed2005

The economic cost of low back pain in Sweden in 2001.

BACKGROUND: Low back pain (LBP) is a common cause of lost work days and disability. In 2001, expenditure for back pain represented 11% of the total costs for short-term sick leave in Sweden, and about 13% of all early retirement pensions were granted for back problems, of which LBP is the most important symptom. The magnitude of LBP as a health problem justifies a closer look at its burden of illness to society. MATERIALS AND METHODS: We assessed the costs of LBP to society in Sweden in 2001. The study was conducted in a cost-of-illness framework, measuring both the direct costs of providing health care to LBP patients, and the indirect costs as the value of the production that is lost because people are too ill to work. The costs were estimated by a prevalence and top-down approach. RESULTS: The total cost of LBP was 1860 million EUR in Sweden in 2001. The indirect costs due to lost productivity accounted for 84% of the total cost. INTERPRETATION: The cost of illness due to low back pain was substantial, but does not appear to have risen during the last 10-15 years.

Adolescent↗
PubMed1982

Liquid crystal thermography. A new tool for evaluating low back pain.

Liquid crystal thermography was used to determine low back skin temperature patterns in 62 patients hospitalized for low back pain and 22 college volunteers with no previous history of back pain. The patients were separated into four groups according to their diagnoses at discharge: patients with 1) degenerative discogenic lesions, 2) acquired lesions, 3) congenital and developmental lesions, 4) back pain resulting from unknown causes. No significant differences were found between the average equilibrated thermogram temperatures of the control subjects (32.4 +/- 0.5 degrees C) and patient groups. However, the temperature gradients found on the thermograms of patients with discogenic lesions (3.1 +/- 0.6 degrees C) and acquired lesions (3.1 +/- 1.0 degrees C) were significantly greater (p less than .05) than those of the pain-free subjects (2.5 +/- 0.5 degrees C). Tenderness to palpation was associated with elevated skin temperatures in 80 percent of the patients studied. This study suggests that liquid crystal thermography may be a potentially useful tool for localizing soft tissue trauma in patients with low back pain.

Adult↗
PubMed2003

The association of backpack use and back pain in adolescents.

STUDY DESIGN: A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted. OBJECTIVE: To investigate the relation between backpack use and back pain in adolescents. SUMMARY OF BACKGROUND DATA: The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain. METHODS: A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain. RESULTS: Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights. CONCLUSION: The use of backpacks during the school day and backpack weights are independently associated with back pain.

Adolescent↗