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PubMed1993

The impact of physician attitudes on patient satisfaction with care for low back pain.

We wished to determine whether patient satisfaction was related to physicians' confidence in their abilities to effectively manage low back pain, and to examine their attitudes about patients with back pain. The confidence and attitudes of primary care providers were determined using self-administered questionnaires. Patient satisfaction with care was assessed during telephone interviews conducted 3 weeks after a clinic visit for low back pain. The study was conducted in a primary care clinic of a large health maintenance organization. Completed surveys were obtained from 21 primary care providers (18 physicians and three physician assistants) and 270 of their patients with low back pain. Three satisfaction scales specific to low back pain were used to measure patient satisfaction with regard to information received from provider, caring, and effectiveness of treatment. The results showed that the providers' attitudes about patients with low back pain were not associated with any of the patient satisfaction measures. However, patients of more confident providers were significantly more satisfied with the information they received than were patients of less confident providers. These differences could not be explained by years in practice, length of visit, patient demographics, or the severity and duration of low back pain. These findings suggest that providers who have more confidence in their abilities to effectively manage low back pain may in fact be more effective patient educators.

Adolescent↗
PubMed2003

Systematic review of antidepressants in the treatment of chronic low back pain.

BACKGROUND: Three previous reviews have reached conflicting conclusions regarding the efficacy of antidepressants for patients with back pain. OBJECTIVES: To systematically review the efficacy of antidepressants for the treatment of patients with back pain and to determine whether there is evidence that outcomes vary between classes of antidepressants. MATERIALS AND METHODS: Best evidence synthesis of randomized, placebo-controlled trials of oral antidepressive agents in patients with back pain. Studies were identified by searching MEDLINE, PsycINFO, and the Cochrane Controlled Trials Registry. Two independent reviewers performed data extraction and assessed included studies with a 22-point methodologic quality assessment scale. Effect sizes were calculated if sufficient data were available. RESULTS: Twenty-two trials of antidepressants for the treatment of back pain were identified, of which seven studies of chronic low back pain met inclusion criteria. Among studies using antidepressants that inhibit norepinephrine reuptake (tricyclic or tetracyclic antidepressants), four of five found significant improvement in at least one relevant outcome measure. Assessment of these agents' impact on functional measures produced mixed results. No benefit in pain relief or functional status was found in three studies of antidepressants that do not inhibit norepinephrine reuptake. CONCLUSIONS: Based on a small number of studies, tricyclic and tetracyclic antidepressants appear to produce moderate symptom reductions for patients with chronic low back pain. This benefit appears to be independent of depression status. SSRIs do not appear to be beneficial for patients with chronic low back pain. There is conflicting evidence whether antidepressants improve functional status of patients with chronic low back pain.

Antidepressive Agents↗
PubMed2006

[Surgical treatment for lumbar discogenic low back pain].

OBJECTIVE: To explore the curative effect of surgical treatment for lumbar discogenic low back pain. METHODS: Forty-two patients with lumbar discogenic low back pain were treated with disc excision and lumbar interbody fusion: 12 of them were treated with posterior lumbar interbody fusion (PLIF), 30 with afront lumbar interbody fusion (ALIF). The clinical results were evaluated by pre- and post-operative visual analogue scale (VAS), and the fusion rates of the lumbosacral spine were evaluated by X-ray. RESULTS: The average follow-up period was 18 months, ranging from 6 to 36 months. Low back pain basically disappeared in 11 patients treated with PLIF, with mild back pain in one patient; VAS after the operation decreased significantly in comparison with that preoperatively (P<0.01). Low back pain basically disappeared in 28 patients treated with ALIF; VAS after the operation decreased significantly in comparison with that preoperatively (P<0.01). The fusion rate was 90% in patients treated with PLIF, and 93% in patients with ALIF. CONCLUSION: Disc excision and interbody fusion is effective in the treatment of lumbar discogenic low back pain, but the operation indications should be paid attention to.

Adolescent↗
PubMed2002

Low back pain in individuals with chronic airflow limitation and their partners--a preliminary prevalence study.

BACKGROUND AND PURPOSE: The prevalence of low back pain in individuals with chronic airflow limitation, and their partners, is unknown. Individuals with chronic airflow limitation, and their respective partners, are likely to have several risk factors that may increase the predisposition for low back pain. The aim of the present study was to provide preliminary data on the prevalence of low back pain in individuals with chronic airflow limitation, and their partners. METHOD: A cross-sectional observational study design was used. Individuals with chronic airflow limitation, and their partners, were approached at South Australian metropolitan Lung Support Group meetings and invited to participate in the study. Three commonly used questionnaires: the Medical Outcomes Survey Short-Form 36 (MOS SF-36); the St George's Respiratory Questionnaire (SGRQ); and the Nordic Low Back Pain Questionnaire (NLBPQ) were used to collect data on general health, respiratory health and low back pain prevalence, respectively. Odds ratios and independent Student's t-tests were used to analyse data by use of Epi Info Version 6.0 software. RESULTS: Sixty subjects participated in the study: 41 individuals with chronic airflow limitation and 19 partners of individuals with chronic airflow limitation. The lifetime, 12-month and seven-day prevalence of low back pain in individuals with chronic airflow limitation was 69%, 58% and 31%, respectively. The prevalence of low back pain in the partners of individuals with chronic airflow limitation was found to be higher, at 74%, 68% and 58%, respectively. Four significant relationships between general and respiratory health, and low back pain were demonstrated for individuals with chronic airflow limitation. CONCLUSIONS: The prevalence of low back pain in individuals with chronic airflow limitation was comparable to the lifetime prevalence for the general and older population, and greater than the 12-month prevalence reported for the older population. The prevalence of low back pain for the partners of individuals with chronic airflow limitation was consistently higher than the lifetime and 12-month prevalence reported for individuals with chronic airflow limitation, the older population and family care workers. These findings suggest a larger prevalence study of low back pain in individuals with chronic airflow limitation, and their partners, is warranted.

Activities of Daily Living↗
PubMed1997

Low back pain: risk factors for chronicity.

The burden of low back pain disability has increased steadily over the last few decades in western countries. The high social and economic cost of low back pain is related to the minority of individuals who lose more than six months from work. Although the risk factors for low back pain have been well delineated, methodologic obstacles have hindered the collection of information on factors associated with a chronic course. The most reliable data are those generated by prospective studies involving multivariate analyses. Advanced age is associated with an increased risk of chronic pain, as is male gender (except in some recent studies). Weight and height are not related to chronicity. Disease-related factors predictive of chronic pain include presence of multiple functional symptoms, evidence of nonorganic disease, pain in the legs, significant disability at onset, a protracted initial episode, multiple recurrences and a history of low back pain or inhospital treatment. Occupational factors have a very substantial impact: workers in blue-collar jobs, those involved in heavy labor or in jobs that require efforts beyond their physical capabilities and those who have a low level of job satisfaction or poor working conditions, who are new at their job, or who are not well rated by their superiors are more likely to develop chronic pain. A history of compensation for a spinal condition, receipt of work-related sickness payments, or litigation about compensation are also associated with an increased risk of chronic pain. Social and economic factors predictive of a chronic course are a low level of schooling, language problems, a low income and an unfavorable family status. The impact of psychological factors is controversial. Depression, a number of specific coping strategies and a sensation of being "sick all the time" may be associated with an increase in the risk of chronicity. Overall, progression to a chronic pattern of pain is more closely dependent on demographic, psychosocial and occupational factors than on the medical characteristics of the spinal condition itself. Simple questionnaires can be used to identify patients at a high risk for chronicity. Treatment should be prompt and comprehensive in these patients since the likelihood of a return to work decreases rapidly as sick leave duration increases.

Age Factors↗
PubMed2000

The Cochrane review of bed rest for acute low back pain and sciatica.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to rest in bed for patients with acute low back pain (LBP) or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, and reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Nine trials with a total of 1435 patients were included. Four trials compared bed rest with advice to stay active, and the overall results were heterogeneous. Overall, results from two high-quality studies indicate no difference in pain intensity at the 3-week follow-up (standardized mean difference 0.0; 95% confidence interval [CI] -0.3, 0.2]), and a small difference in functional status in favor of staying active (weighted mean difference 3.2 [on a 0-100 scale] 95% CI 0.6, 5.8). In two high-quality trials no differences were reported in pain intensity between 2-3 days of bed rest and 7 days of bed rest. In another two high-quality trials, no differences were found between bed rest and exercises in pain intensity or functional status. CONCLUSION: Bed rest compared with advice to stay active at best has no effect, and at worst may have slightly harmful effects on LBP. There is not an important difference in the effects of bed rest compared with exercises in the treatment of acute low back pain, or 7 days compared with 2-3 days of bed rest in patients with low back pain of different durations with and without radiating pain.

Activities of Daily Living↗
PubMed1999

The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients.

OBJECTIVE: Develop and test a short-form comprehensive outcome measure for back pain. DESIGN: Prospective longitudinal study of 3 consecutive cohorts of back pain patients. SETTING: Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practices. METHOD: Domains judged important in the back pain model and responsive to clinical change were identified from the literature. Items were scored on an 11-point numerical rating scale. The instrument was psychometrically tested by use of those tests relevant to an evaluative measure. RESULTS: Seven dimensions of the back pain model were included in the questionnaire. Having established face validity, the instrument was shown to demonstrate high internal consistency (Cronbach's alpha = 0.9) and good test-retest reliability (ICC = 0.95). All items were retained on the basis that they contributed to the overall score (item-corrected total score correlations) and to the instrument's responsiveness to clinical change (item change-corrected total change score correlations). The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures. The effect size of the instrument was high (1.29) and comparable with established measures. CONCLUSION: A reliable, valid, and responsive instrument has been developed for use in back pain patients. It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments.

Activities of Daily Living↗
PubMedDate not supplied

Prevalence of low-back pain in Lesotho mothers.

OBJECTIVES: To identify factors that strongly affect the presence of severe low-back pain in mothers living in the Maseru District of Lesotho, to find out whether there is any truth to the widespread belief that rural mothers are more vulnerable to severe low-back pain than their urban counteTparts, and to identify influential factors that are strongly associated with each other. METHODS: A random sample of 4001 mothers was collected from the Maseru District of Lesotho in September 1994 by using sampling techniques of stratification and proportional allocation with respect to size. The following 10 explanatory variables of study were used: intensive farm work, gravidity (number of births plus abortions), residential area, heavy weight lifting, the literacy status of the mother, strenuous manual labor, the availability of basic health services, the income status of the mother, cooking method at home, and breast-feeding. The dependent variable of study was the presence or absence of severe low-back pain. Discriminant and log-linear analyses were done to analyze the data collected. Discriminant analysis was done by using the presence or absence of severe low-back pain as a classifying variable and the 10 explanatory variables that affect the classifying variable. Log-linear analysis was also done by using the same data with 9 of the 11 variables of study. RESULTS: A total of 405 (10.12%) of the 4001 mothers in the study had severe low-back pain at the time of data collection, 513 (12.82%) had moderate low-back pain, and 1422 (35.54%) had mild low-back pain. A total of 319 (78.77%) of the 405 mothers with severe low-back pain were poor, illiterate, and from rural communities. Results from discriminant analysis revealed that the presence of severe low-back pain was strongly affected by intensive farm work, the residential area of the mother, and gravidity of the mother in a decreasing order of strength and led to results similar to those obtained from discriminant analysis. The study also showed that rural mothers and their children were more disadvantaged than their urban counterparts with regard to basic health services. CONCLUSION: Recommendations were made to the Ministry of Health and Social Welfare of Lesotho to improve the provision of basic health services, including health education on the importance of chiropractors to the community.

Discriminant Analysis↗
PubMed2003

How common is back pain in Al-Qaseem region.

OBJECTIVE: The aim of this study was to estimate the prevalence of back pain in the adult population of Al-Qaseem Central Province, Kingdom of Saudi Arabia and to find associated features and factors. METHODS: A house-to-house survey covering 1,000 household in the towns and villages of Al-Qaseem province was carried out over a period of 18 months extending from September 1993 until the end of February 1995. A total of 5,894 adults, aged 16 years and above, were questioned by trained staff regarding back pain, and the demographic data in addition to general, medical and social history. RESULTS: A response was obtained in 5,743 (97.4%). Their mean age was 34.14 15.16 (range 16-99). Back pain was reported by 1,081 (18.8%), wherein 499 (8.8%) were men, and 574 (10%) were women. Back pain was more prevalent in married (23.3%) individuals than unmarried (6.4%). Adjusted odds ratio (OR) for back pain in married individuals was 1.88 (95% confidence intervals [CI] 1.49-2.37). Back pain was strongly correlated with age (correlation coefficient = 0.378 P < 0.01). It also showed significant correlation with weight and height, depression, family history of back pain, change in work ability, frequency of attendance at local doctor, use of medication and lower education level. The association with body mass index became evident only after comparing the heaviest 20th percentile to the lightest (OR 1.335 [95% CI, 1.279-1.402]). Certain occupational status (unemployed, farmers, professional workers and housewives) were associated with back pain. CONCLUSION: Back pain was relatively common in this largely unindustrialized community although its prevalence is lower than reported from some western countries.

Adolescent↗
PubMed2002

Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain.

STUDY DESIGN: Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants. OBJECTIVES: To gain insight into the consequences of low back pain for gait and to identify clinically useful measures for characterizing the quality of walking in patients with low back pain. SUMMARY OF BACKGROUND DATA: Gait studies in patients with low back pain have reported a decrease in walking velocity. In normal gait, in-phase pelvis-thorax coordination (synchronicity) evolves toward antiphase coordination (counterrotation) as walking velocity increases. This study examined the effect of walking velocity on pelvis and thorax rotations in patients with low back pain. METHODS: Amplitudes of pelvis and thorax rotations were calculated, and spectral analyses were performed. Pelvis-thorax coordination was characterized in terms of relative Fourier phase, and coupling strength was assessed by means of cross-spectral analysis. RESULTS: In comparison with healthy participants, relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher, whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h. No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations. CONCLUSION: In comparison with healthy participants, the gait of patients with low back pain was characterized by a more rigid, less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations. This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations, and that conservative therapy should use methods aimed at improving intersegmental coordination.

Adult↗
PubMed2000

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues.

OBJECTIVE: To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain. BACKGROUND: Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results. METHODS: This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes. RESULTS: The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain. CONCLUSION: Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers). RELEVANCE: This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

Humans↗
PubMed1993

Lumbar muscle usage in chronic low back pain. Magnetic resonance image evaluation.

Methods for detecting recruitment patterns of the lumbar muscles during exercise in patients with chronic low back pain are limited. This article discusses the use of magnetic resonance imaging with Roman chair extension exercise to examine lumbar muscle usage in five normal volunteers, five chronic low back pain patients without surgery, and five chronic low back pain patients with surgery. Changes in signal intensities of psoas, multifidus, and longissimus/iliocostalis with graded exercise were measured at three lumbar disc levels. At rest, there was a difference between multifidus and longissimus/iliocostalis signal intensity in chronic low back pain subjects without surgery (P = 0.0162) and in chronic low back pain subjects with surgery (P = 0.0036), but not in normal subjects. At peak exercise, there was a difference in signal intensities between multifidus and longissimus/iliocostalis in all groups (normal volunteers, P = 0.0069; chronic low back pain patients without surgery, P = 0.0125; chronic low back pain patients with surgery, P = 0.0060). The exercise response was attenuated in chronic low back pain patients with surgery. Thus, MRI demonstrates static and dynamic differences in lumbar paraspinal musculature in chronic low back pain subjects compared to normal subjects.

Exercise↗
PubMed2006

A Cochrane review of superficial heat or cold for low back pain.

STUDY DESIGN: Cochrane systematic review. OBJECTIVE: To assess the effects of superficial heat and cold therapy for low back pain in adults. SUMMARY OF BACKGROUND DATA: Heat and cold are commonly used in the treatment of low back pain. METHODS: We searched electronic databases from inception to October 2005. Two authors independently assessed inclusion, methodologic quality, and extracted data, using the criteria recommended by the Cochrane Back Review Group. RESULTS: Nine trials involving 1,117 participants were included. In two trials of 258 participants with a mix of acute and subacute low back pain, heat wrap therapy significantly reduced pain after 5 days (weighted mean difference [WMD], 1.06; 95% confidence interval [CI], 0.68-1.45, scale range, 0-5) compared with oral placebo. One trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (WMD, -32.20; 95% CI, -38.69 to -25.71; scale range, 0-100). One trial of 100 participants with a mix of acute and subacute low back pain examined the additional effects of adding exercise to heat wrap and found that it reduced pain after 7 days. CONCLUSIONS: The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.

Acute Disease↗
PubMed1991

Prevalence of HLA-B27 in patients with back pain attending a pain clinic.

101 patients presenting to a pain clinic with low back pain were tested for HLA-B27 status. Eight (7.9%) of the patients were positive for HLA-B27. This prevalence is similar to that recorded in the general population and suggests that few patients referred to our clinic with back pain have undiagnosed spondyloarthropathies.

Adult↗
PubMed1999

Use of a subjective health measure on Chinese low back pain patients in Hong Kong.

STUDY DESIGN: A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale. OBJECTIVE: To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain. SUMMARY OF BACKGROUND DATA: Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing. METHODS: Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment. RESULTS: The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patient's perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version). CONCLUSIONS: The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.

Adolescent↗
PubMed1977

[The treatment of chronic low back pain with psychotropic drugs (author's transl)].

The results are reported of many years' experience in the treatment of severe chronic painful conditions, including low back pain, with psychotropic drugs. Out of 103 inpatients with severe chronic painful states, 82 showed considerable improvement after treatment with a combination of antidepressants and neuroleptics. There were also 9 patients with chronic back pains, 8 of whom recorded a good effect. The treatment of chronic painful conditions with psychotropics, especially with a combination of antidepressants and neuroleptics, offers, among other things, the advantages of analgesic potentiation, analgesic saving and the avoidance of misuse or dependence on analgesics. A concrete plan of treatment with chlorimipramine and haloperidol for outpatients and inpatients in presented.

Antidepressive Agents↗
PubMed2004

Low back pain in competitive rhythmic gymnasts.

AIM: It has been reported that rhythmic gymnasts are at risk of suffering from low back injuries, because of repetitive lumbar hyperextensions. On the other hand, this sport requires features of leanness, muscular strength and flexibility that should represent protective factors for back pain. METHODS: This cross-sectional study aimed to assess the prevalence of low back pain in 67 club-level competitive rhythmic gymnasts aged 13-19 years. A standardized questionnaire was used to evaluate back-pain symptoms. Anthropometric measurements, time spent in physical activity, psychological testing results, smoking habits and age of menarche were recorded. One hundred and four age-matched general females served as control group. RESULTS: Low back pain complaints were reported by 7 rhythmic gymnasts and by 27 controls (10.4% vs 26.0%, p<0.05); the prevalent location of back pain was bilateral in gymnasts and central in controls. Gymnasts had lower body weight, body mass index, fat body mass and delayed menarche. The females with low-back pain displayed higher body weight, body mass index, fat body mass, age, a greater smoking habit and more anxious/depressive behaviour, both in the gymnast and in the control group. CONCLUSION: Competitive, club-level rhythmic gymnasts show a reduced prevalence of low back-pain. Being younger in age, having greater leanness, not smoking, displaying less anxious/depressive behaviour, and developing increased muscle strength and flexibility, all can represent preventive factors for low back pain. This study suggests that rhythmic gymnastics is not a discipline at increased risk of low back pain.

Adolescent↗
PubMed1995

Postural aberrations in low back pain.

The purpose of this study was to measure and describe postural aberrations in chronic and acute low back pain in search of predictors of low back pain. The sample included 59 subjects recruited to the following three groups: chronic, acute, or no low back pain. Diagnoses included disc disease, mechanical back pain, and osteoarthritis. Lumbar lordosis, thoracic kyphosis, head position, shoulder position, shoulder height, pelvic tilt, and leg length were measured using a photographic technique. In standing, chronic pain patients exhibited an increased lumbar lordosis compared with controls (p < .05). Acute patients had an increased thoracic kyphosis and a forward head position compared with controls (p < .05). In sitting, acute patients had an increased thoracic kyphosis compared with controls (p < .05). These postural parameters identified discrete postural profiles but had moderate value as predictors of low back pain. Therefore other unidentified factors are also important in the prediction of low back pain.

Acute Disease↗