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PubMed1990

Effects of a 1-minute back rub on mixed venous oxygen saturation and heart rate in critically ill patients.

In this study we evaluated mixed venous oxygen saturation (SvO2) and heart rate responses after a 1-minute back rub in 173 critically ill patients. The back rub was the third and last intervention in a study conducted in intensive care units at four hospitals. For this multiple-intervention study all patients were placed in a supine position to obtain baseline SvO2 and heart rate, then underwent suctioning via endotracheal tube, and were turned to a lateral position. After 15 minutes in a side-lying position, the subjects received a 1-minute back rub. Data were collected immediately after the back rub and at 1-minute intervals for 4 minutes. After the back rub, SvO2 decreased immediately from the mean baseline of 67% to 63% and gradually increased, returning to baseline by minute 4. The mean baseline heart rate of 99 beats/min increased to 103 beats/min immediately after the back rub and gradually decreased after massage, but remained higher than baseline by minute 4. Although the findings were statistically significant (p = 0.0001), these minimal physiologic changes do not represent clinical significance. Based on the findings, the back rub, a traditional nursing measure that can provide comforting touch, represented a minor stimulus affecting heart rate and oxygen demands in most critically ill patients. However, because of the variability found in heart rate and SvO2, individual responses need to be assessed.

Adult↗
PubMed1986

Low back pain: a radiographic enigma.

Ninety-nine anteroposterior and lateral lumbar radiographs taken of males ages 18-55 were independently analyzed by three chiropractors who assessed 56 variables, including determinations of disc space height, vertebral malalignments and subluxations, spondylosis, postural disturbances, relationships between pelvis and spine, and other congenital or acquired abnormalities. The distribution of low back complaints in this study included 31% with no low back pain, 44% with previous or present mild low back pain and 24% with previous or current severe, and often disabling, low back pain. Determinations were made of interobserver reliability between the three chiropractors and a medical radiologist. Of the 56 radiographic variables assessed by the chiropractors, six demonstrated a high interobserver reliability. In general, the best reliability was for variables that were actual measurements, rather than subjective observations. Sixteen additional variables demonstrated a fair interobserver reliability. Comparison of the observations between a radiologist and the chiropractors showed correlations in their assessments of disc space height at L3-4 and L4-5; otherwise, there was poor interobserver reliability. Few of the radiographic variables were found to be reliable predictors of present or prior history of low back and leg complaints. A few variables (most notably disc space narrowing) were statistically associated with back or leg complaints (P = 0.025). We conclude that spinal radiographs, whether analyzed by measurements, by a radiologist or by chiropractors, have minimal value in predicting the presence or absence of low back complaints and, in particular, have no value in epidemiological studies.

Adolescent↗
PubMed1987

Acute care to prevent back disability. Ten years of progress.

Efforts to curb back problems through preemployment screening, safety measures, and educational programs have had little effect on this most expensive musculoskeletal malady. Present knowledge raises doubts about the possibility of preventing back pain. However, recent scientific investigations indicate that chronic back pain disability, which accounts for 80% of the costs for back problems, can be prevented. In Gothenburg, Sweden, the collective use of proven treatment methods during the acute stage of back symptoms markedly reduced the period of time patients were disabled from back problems. Effective early intervention centers around: teaching patients about back care, including how to control symptoms through improved body mechanics; applying these educational principles, specifically to the patient's livelihood; avoiding the debilitation that results from overusing bed rest and medication; recommendations to increase cardiovascular fitness; and the judicious use of orthopedic surgery. This approach targets the few patients who tend to be disabled the longest, suffer the most, and become the most costly to society.

Back Pain↗
PubMed1987

Exercise and smoking habits in patients with and without low back and leg pain.

The exercise and smoking habits of low back or leg pain sufferers vs. persons not having low back or leg pain are compared. The type, frequency and length of exercise is determined from a study of 576 low back or leg pain sufferers compared to 50 persons who state they are symptomatic. The same was done for smoking habits. Thirty-three percent of low back or leg pain sufferers smoked as compared to 14% of those without pain. Forty-seven percent of low back or leg pain sufferers as compared to 86% of non-sufferers exercised regularly. The level of physical activity and general exercise have been found to improve strength, mobility and endurance; this might prevent future back injury. Our study is to determine differences in the exercise habits of persons with low back and/or leg pain vs. those who do not have pain, with the intention being to see if pain sufferers exercise less.

Back Pain↗
PubMed1988

Managing low back pain--a comparison of the beliefs and behaviors of family physicians and chiropractors.

Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain--such as drug therapy versus spinal manipulation--but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.

Adult↗
PubMed1995

Back pain during 6 degrees head-down tilt approximates that during actual microgravity.

Astronauts often experience back pain during spaceflight. Retrospectively, Wing et al. (14) found that during spaceflight, 14 of 19 Shuttle crewmembers experienced back pain, which they described as dull (62%), localized to the lower back (50%), and with an intensity of 2 on a 5-point scale. Further, the spine lengthens 4-7 cm in microgravity. Our objective was to compare back pain and spinal lengthening (body height increase) during simulated microgravity (6 degrees head-down tilt, HDT) with the same parameters during actual microgravity. Eight male subjects completed a modified McGill pain questionnaire with intensity graded from zero (no pain) to five (intense and incapacitating pain) each day at 7:00 pm during 2 d pre-HDT control, 16 d HDT, and 1 d post-HDT recovery periods. Also, the subjects' heights were measured each day while supine (control and recovery) and during HDT. Back pain increased from zero (pre-tilt control period) to 2.3 +/- 0.4 at days 1 to 3 of HDT, and was categorized as dull and/or burning pain in subjects' lower backs. Only 2 subjects reported any pain after day 9 of HDT and during recovery. Heights increased 2.1 +/- 0.5 cm by day 3 of HDT and remained at that level until the end of the HDT period. Although spinal lengthening in space is greater than that during HDT, the HDT model approximates the level, type, distribution, and time course of back pain associated with actual microgravity. In the HDT model, pain subsides in intensity when spinal lengthening stops.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A lumbar body support (KBS 2000) alters lumbar muscle recruitment patterns in patients with acute-upon-chronic lower back pain.

OBJECTIVE: To determine the effects of a locally designed lumbar body support (LBS) on integrated electromyographic (IEMG) activity of the lumbar erector spinae muscles, on heart rate and on ratings of discomfort in patients with low back pain. DESIGN: Non-randomised controlled trial. SETTING: Patients referred from general practitioners and back pain rehabilitation programmes in Cape Town. PATIENTS AND OTHER PARTICIPANTS: Ten patients with low back pain of diverse causes. Values were compared with those in 10 control subjects without low back pain. INTERVENTION: Patients and controls lay supine on (in random order) either a flat conventional mattress or a LBS placed on top of the flat mattress, for a 30-minute period (acute exposure), and every night for 2 weeks (chronic exposure). MAIN OUTCOME MEASURES: IEMG activity of the lumbar erector spinae muscles, heart rate, and perception of comfort. RESULTS: IEMG activity of the lumbar erector spinae muscles did not differ between controls and patients when lying on the LBS on top of the CM after either acute or chronic exposure. However, it was significantly greater (P < 0.05) in patients than in controls when lying on the flat mattress. Subjective ratings of discomfort and heart rates mirrored these changes and were higher in patients only when lying on the flat mattress (P < 0.05). Patients with low back pain also reported that sleeping overnight on the LBS on top of their own mattress significantly reduced discomfort ratings. CONCLUSIONS: When lying on a mattress with a flat surface, patients with chronic low back pain have higher IEMG activity of the erector spinae muscles, higher heart rates and higher subjective ratings of discomfort than do control subjects. These differences disappear when both groups use a specially designed lumbar body support placed on top of the flat surface. These preliminary studies suggest that a lumbar body support should be evaluated in the chronic management of low back pain.

Adult↗
PubMed1995

Occupational low back disability: effective strategies for reducing lost work time.

1. The important variables related to lost work time in this study are: back diagnosis (lumbar disc displacement), history of back surgery, job satisfaction, and employee reluctance to report low back pain to supervisor. 2. The findings support the complexity of low back disability. Lost work time related to low back pain must be managed using a "holistic" approach by addressing all dimensions of a person (physical, emotional, and environmental). 3. To minimize low back disability, occupational health providers should be part of a community task force with representatives from other disciplines who can plan and develop low back disability guidelines and standards of care.

Absenteeism↗
PubMedDate not supplied

Mechanical low back pain: etiology and conservative management.

OBJECTIVE: To review literature pertaining to low back pain (including lumbar disk herniation) and its treatment by manipulative therapy and rehabilitative exercises. DATA SOURCES: A Medline literature search was performed. English and foreign language materials were reviewed. Key words included the following: manipulation, manipulative therapy, lumbar intervertebral disk herniation, lower back pain. STUDY SELECTION: The studies detailed the neurologic and biomechanical aspects of manipulative therapy, as well as the efficacy of manipulative and rehabilitative management of mechanical low back pain. Also included were studies detailing the etiology of mechanical low back pain. DATA SYNTHESIS: Recent studies have indicated there are certain activities that commonly precipitate lower back injuries. Several methods of treatment for these injuries are discussed. The review indicated the most effective form of treatment is manipulative therapy. The neurologic and biomechanical aspects of manipulation are discussed. CONCLUSION: Low back pain is a common cause of physical, emotional and financial distress. This paper concluded that manipulative therapy is an efficacious as well as cost-effective method of treatment in cases of mechanical low back pain.

Biomechanical Phenomena↗
PubMed1993

Occupational risk factors for low back pain among sedentary workers.

In a cross-sectional study, the relationship of low back pain and sedentary work was examined among crane operators (n = 94), straddle-carrier drivers (n = 95), and a reference group of office workers (n = 86), aged 25 to 60 years. Information about history of low back pain, individual characteristics, and working conditions in past and present was obtained by a standardized interview. Assessment of postural load on the back was performed by observation of non-neutral postures of the trunk during normal work activities. Measurements of exposure to whole-body vibration in cranes and straddle-carriers were conducted. The 12-month prevalence of low back pain among crane operators was 50%; among straddle-carrier drivers, 44%; and among office workers, 34%. After adjustment for age and confounders, the odds ratio for newly developed cases of low back pain in the current job among crane operators was 3.29 (95% confidence interval, 1.52 to 7.12), and among straddle-carrier drivers 2.51 (95% confidence interval, 1.17 to 5.38). In both occupations the daily exposure to whole-body vibration was low, and therefore not considered an important risk factor for low back pain in this study. The observations showed that non-neutral postures of the trunk were frequently adopted among all workers. The results of this study suggest that sustained sedentary work in a forced non-neutral trunk posture is a risk factor for low back pain.

Adult↗
PubMed1994

Patient benefits of attending a chiropractic low back wellness clinic.

OBJECTIVE: To demonstrate low back and/or leg pain patient reaction to attendance at a low back wellness school conducted to teach them how to control their back pain in daily living so as to reduce the incidence and severity of their problem. DESIGN: Sixty-one patients attending the clinic filled out a seven-question form that ranked their opinions of the class based on their feelings and reactions about it. SETTING: The private clinic of the author where a three-part back pain prevention clinic utilizing a slide lecture and patient participation was presented. PATIENTS: All suffered from low back and/or leg pain and were invited to attend at the time of their initial examination and report of findings. INTERVENTION: None. This is a patient questionnaire only. MAIN OUTCOME MEASURES: Immediately following the class, the patients were presented with a seven-question form to answer. RESULT: A very positive acceptance of low-back wellness training is evidenced by 95% of the patients feeling it was worth their time to attend and feeling they learned something to prevent reinjury in daily living; 100% felt it worth the doctor's time to present the class. CONCLUSION: Low back wellness school is a positive program from the patients' and doctor's viewpoints.

Adolescent↗
PubMed1994

The relative impact of chiropractic vs. medical management of low back pain on health status in a multispecialty group practice.

PURPOSE: The objective of the study was to compare chiropractic management and medical management of low back pain of musculoskeletal etiology in a multispecialty group practice. STUDY DESIGN: The design was a retrospective cohort study in which the subcohorts were defined by source of low back pain care and identified before follow-up was complete. Data collection occurred at the end of the third month following their initial visits. One hundred and three chiropractic patients and 187 medical patients aged 16 or greater who had not been treated within the preceding month of their initial visit participated. MAIN FINDINGS: A greater proportion of chiropractic than medical patients perceived their treatment to be successful (RR = 1.91, 95% CI = 1.29, 2.82), had 0 days with low back pain during the week preceding the evaluation (RR = 1.60, 95% CI = 1.00, 2.59), and had no functional impairment due to low back pain after 3 months following their initial visit according to the Roland-Morris Disability Questionnaire (RR = 1.42, 95% CI = 0.81, 2.50). General health status was similar for both chiropractic and medical patients. CONCLUSIONS: Chiropractic care was at least as effective as medical care in reducing low back pain and functional disability due to low back pain. Chiropractic patients were more likely to perceive their treatment to be successful in reducing low back pain compared to medical patients.

Adult↗
PubMed1997

Aircraft type and diagnosed back disorders in U.S. Navy pilots and aircrew.

BACKGROUND: Back disorders have long been recognized as a serious problem within the military aviation community and a possible threat to mission accomplishment. The purpose of the present study was to determine the extent to which the type of aircraft flown is associated with diagnosed back problems, and to examine differences in the prevalence of back disorders between pilots and aircrew. METHODS: A case-control study was conducted in which U.S. Navy pilots and aircrew members with a diagnosed back disorder on their most recent physical exam between 1991 and 1993 were compared with pilots and aircrew without such diagnoses. Data were obtained from the automated physical examination records maintained by the Naval Operational Medicine Institute for all Naval aviation personnel. RESULTS: Results showed that aircrew members have a higher risk of diagnosed back problems than pilots for both helicopters and fixed-wing aircraft. The study revealed that flight engineers have a higher risk of diagnosed back problems than other aircrew members. Among pilots, no association was found between type of aircraft and diagnosed back problems.

Adult↗
PubMed1996

Concordance between ANSI occupational back injury codes and claim form diagnoses and a lower bound estimate of the fraction associated with disc displacement/herniation.

The current BLS Annual Survey of Occupational Illnesses and Injuries and several recent analyses of factors affecting missed worktime in occupational back injuries rely on ANSI-based injury codes derived from injury narratives to classify occupational injuries and estimate incidence and outcome. No population-based studies of the concordance between back injury codes and clinical diagnoses have been reported. Back injury cases were identified in two large work-injured populations totaling almost 80,000 cases in the states of Michigan and Minnesota. In both populations, cases had been coded by the single nature-of-injury and part-of-body-injured codes assigned by an ANSI-based injury-coding system and by as many as four (Michigan) or three (Minnesota) clinical diagnoses according to the International Classification of Diseases-Clinical Modification, 9th Revision. Concordance was measured by the sensitivity and predictive value positive (PVP, aka PV+ or PPA) of the injury coding scheme for related diagnostic groups. We also used an algorithm based on the limited clinical information available to corroborate the diagnosis of displaced/herniated disc for cases that underwent spinal surgery. Cases identified by the algorithm were then used to obtain a lower bound estimate of the fraction with disc injury. The injury coding scheme had PVPs of 82.9-90.1% and overall sensitivities of 69.7-75.9%. Sensitivities for individual diagnostic groups show that their distribution in ANSI-coded injury groups is skewed slightly toward cases with sprain and disc displacement/herniation, but these shifts are modest. The lower bound estimate of the fraction of cases with disc displacement/herniation in a population of cases with back injuries producing at least 1 day of missed worktime is 5.8%. The demographic comparisons indicate that, as the time between injury and cohort ascertainment increases during the first 8 days of missed worktime following injury, the proportion of younger workers in an injury cohort decreases. The relationship between increasing age and increasing missed worktime disability, reported in various outcome studies, is also present during the first few days following injury. The use of ANSI injury codes underestimates the contribution of back injuries to missed worktime because 24-30% of cases are missed by the ANSI coding system. However, the distribution of diagnostic groups in the injury-coded groups approximates that observed with all diagnosed cases and supports the use of such data to study outcome. Our estimate, and one from Quebec, suggest that disc displacement/herniation occurs more frequently in the subset of occupational back injuries compared to the set of back injuries from all sources.

Adolescent↗
PubMed1991

Risk and severity of non-back occupational injuries after lumbar laminectomy for degenerative disc disease.

An increased risk, after lumbar laminectomy, for lost work time occupational back injury (odds ratio, 5.9; 95% confidence interval, 1.9-18.8) and disability (mean 292.8 days vs. 24.8 for controls) was previously demonstrated. Such differences could be due to physical sequelae of back surgery or to psychosocial factors. Extensive literature addresses the impact of psychosocial factors on the incidence of occupational injury and severity of disability. This study assumes that psychosocial factors would affect both back and non-back injuries, while surgery-related physical factors would not. The odds ratio for non-back lost work time injury for subjects in the same cohort studied previously was 1.5 (0.5-4.5), with no significant increase in duration of disability (mean 27.0 days vs. 24.8 for controls). The increased risk for back injury in the absence of an increased risk for other injuries suggests that physiologic rather than psychosocial factors provide the more likely explanation for the differences in back injuries.

Adult↗
PubMed2004

Tumor prevalence and biomarkers of exposure in brown bullhead (Ameiurus nebulosus) from Back River, Furnace Creek, and Tuckahoe River, Maryland.

Brown bullheads (Ameiurus nebulosus) were collected from 2 locations near Baltimore, Maryland, Back River and Furnace Creek, and 1 (reference) location, Tuckahoe River, to compare the prevalence of tumors (liver and skin) and visible skin lesions (fin erosion and abnormal barbels). Cytochrome P450 activity measured as ethoxyresorufin-O-deethylase, biliary PAH-like fluorescent metabolites, and fillet contaminant concentrations were determined as indicators of exposure in a randomly selected subset of the fish. There were no significant differences in liver tumor prevalence: Back River = 8% (4/50), Furnace Creek = 0% (0/50), and Tuckahoe River = 2.6% (1/39; p = 0.20, extension of Fisher's exact test). Skin tumor prevalence was as follows: Furnace Creek = 12% (6/50), Back River = 8% (4/50), and Tuckahoe River = 0% (0/39; p = 0.063). In the Back River fish, there was a 40% (20/50) prevalence of fin erosion and a 28% (14/50) prevalence of abnormal (shortened, clubbed, or missing) barbels. Fin erosion was not observed in the other collections, and only 10% (5/50) of the Furnace Creek fish had abnormal barbels (p < 0.001 for both lesions). There were statistically significant differences in mean EROD activity, with levels in Furnace Creek and Back River fish approximately twice that found in Tuckahoe River fish. There were also significant differences in mean benzo(a)pyrene-like bile metabolite concentrations: the lowest mean was in the Tuckahoe River fish, 8 times higher in Furnace Creek fish, and 13 times higher in Back River fish. Of the 3 groups, the Back River bullheads appear to be most adversely affected by contaminant exposure because they had the highest prevalence of liver tumors, fin erosion, and abnormal barbels.

Animals↗
PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 2. Somatic aspects].

PROBLEM: There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons. METHODS: Our study group consisted of 90 disabled CLBP patients (44 female, 46 male; average age 42 years) who underwent a multidisciplinary 8-week daily treatment program of functional restoration with behavioral support (instruction, endurance training, strength exercises, behavioral and treatment to facilitate return to work therapy). Initially these patients where compared with 107 asymptomatic persons (44 female, 63 male, average age 41 years). The patients were investigated before and after treatment, and at intervals of 6 and 12 months. The reliability of the functional measurements was evaluated by interrater comparison. Physical assessment included a medical examination (mainly diagnosis of radicular or nonradicular pain), changes in the lumbar spine revealed by X-ray studies according to Herron and Turner, rating of physical impairment according to Waddell, flexibility, length of hamstrings muscles (SLR), test of power and endurance of trunk movement by standardized exercises according to the Swiss group of Spring and isokinetic measurements (LIDO Back), tests of lifting capacity (LIDO Lift), and (in part) of general endurance on a cycle ergometer (CASE 15 Marquette). RESULTS: Physical findings showed that mobility was reduced substantially in patients suffering from back pain due to reduced SLR (shortened hamstrings) and decreased spinal mobility. Patients also demonstrated significant reductions in their ability to perform lifting tasks in comparison to healthy individuals. The results of trunk flexion showed no significant differences between patients and the control group, whereas the ability to perform trunk extension was much better in the control group. In principle we found the same results with isokinetic measurements as in the exercises without machines. Cardiovascular endurance was also much better in the control group than it was in the back pain patients. At the end of the treatment program all physical deficits were improved significantly. In many cases performance was comparable with that of the control group. With time, however, training effects gradually decreased. The success of treatment (return to work, absence from work, pain reduction, use of medical care) was independent of the functional status of the patients before and after treatment. CONCLUSION: Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and severe physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of patients and their home training programs is necessary. Overall, treatment of CLBP has to include physical training and psychosocial treatment to achieve satisfactory results.

English Abstract↗
PubMed2005

Muscarinic and nicotinic receptor modulation of object and spatial n-back working memory in humans.

Working memory impairments in the n-back task in schizophrenia have been linked to sustained deficiency in mesocortical dopamine function. More recently, abnormalities in the cholinergic system have also been documented in schizophrenia, with cortical reductions in both nicotinic and muscarinic receptors. While the cholinergic hypothesis of memory is well established, the role of cholinergic receptors in modulating n-back working memory is not known. We investigated the effects of selective and simultaneous muscarinic and nicotinic antagonism on spatial and object n-back working memory performance. The study was a double-blind, placebo-controlled repeated-measures design in which 12 healthy subjects were tested under four acute treatment conditions; placebo (P), mecamylamine (M), scopolamine (S) and mecamylamine+scopolamine (MS). Muscarinic antagonism with scopolamine significantly impaired both object and spatial n-back working memory, whereas nicotinic antagonism with mecamylamine had little effect. Simultaneous antagonism of both muscarinic and nicotinic receptors produced greater impairments in both object and spatial n-back working memory performance than muscarinic or nicotinic antagonism alone. These results suggest that: (1) both muscarinic and nicotinic receptors may functionally interact to synergistically modulate n-back working memory, and (2) that n-back working memory impairments in schizophrenia may in part be due to reductions in both muscarinic and nicotinic receptors.

Adult↗