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PubMed2003

To seek or not to seek? Care-seeking behaviour among people with low-back pain.

AIM: The present study sought to identify potential differences between subjects who seek care for their low-back pain problems and those who do not with respect to pain intensity, grade of disability, physical or psychosocial working conditions, individual physical and physiological factors, and lifestyle factors. MATERIAL AND METHODS: The study population was obtained from a population-based, case-referent study, the MUSIC-Norrtälje study. All persons with low-back pain among cases as well as "referents" were compared according to care-seeking behaviour. In all 727 cases with low-back pain who had sought care by any of 75 caregivers in the region, including all physicians and physiotherapists as well as chiropractors, osteopaths, and homeopaths, 721 referents with low-back pain who did not seek care participated. All participants underwent a clinical examination, and filled in a questionnaire about personal and occupational data, pain and disability, pain history, psychosomatic complaints, and present psychosocial situation. RESULTS: High disability and high pain intensity were strongly related to care seeking among men and women with low-back pain. The odds ratios for high disability were 7.4 (CI 5.0 - 11.0) for women and 4.9 (CI 3.3 - 7.1) for men respectively. The odds ratios for high pain intensity were 3.7 (CI 2.2 - 6.0) for women and 1.7 (CI 1.1 - 2.8) for men. A more strained economic situation and use of passive coping strategies significantly increased the probability of women not seeking care. Neither previous pain history, high physical workload, nor jobstrain, poor job satisfaction, or life style factors (high body weight, smoking, and exercise) or psychosomatic complaints affected care-seeking behaviour. CONCLUSIONS: The most decisive factors for seeking care were disability and pain. However, numerous individuals with low disability and low pain intensity also seek care for their pain problems. Better information and advice on the common course of low-back pain may make those individuals less frightened of their pain and, as a result, reduce the consumption of care and social costs for society. The majority of people seek care for pain without wanting a medical prescription. The fact that economic factors seemed to be of importance indicates that costs for healthcare must be kept low if the goal is to give healthcare on equal terms for all.

Adult↗
PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 6. Sickness absence due to back and neck disorders.

The scientific evidence on the causes for sick leave attributed to back and neck disorders was reviewed. Categories were established for acute, recurring, and chronic problems based on the duration of the sick leave period. Forty-eight articles were found to be relevant, whereof two were of high quality and 26 were of medium or low quality. Quality was assessed exclusively in relation to the aim of this systematic review. The results reveal limited published research on causes for sick leave from back and neck disorders. The generalisability of the findings is also limited since most of the subjects were men and employees in manufacturing industries. Women, white-collar workers, employees in the public sector (care, social services, schools, etc) were underrepresented in the studies. Hence, these groups and areas should be studied further to verify conclusions and enhance knowledge about the causes for sick leave from back and neck disorders. The following factors were found to have consistent, but limited, support as regards their influence on the risk for sick leave due to back and neck disorders: (a) heavy physical workload, bent or twisted working position, and low work satisfaction increases the risk for short-term and long-term sick leave; (b) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave; (c) female gender, smoking, exposure to vibration, and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave; (d) self-reported pain and functional impairments were associated with a high risk for long-term sick leave; (e) longer employment periods reduced the risk for short-term sick leave; (f) perceived demands at work did not influence short-term sick leave; (g) female gender and higher age increases the risk for disability pension.

Absenteeism↗
PubMed2007

Risk factors for low back injury among farmers in Iowa: A case-control study nested in the agricultural health study.

The aim of this study was to assess risk factors for low back injury requiring medical advice or treatment among Iowa farmers. Although farmers are at risk for low back injury, few studies have addressed risk factors for farm work-related low back injury. We screened 6999 participants in the Iowa portion of the Agricultural Health Study to identify 49 male farmers who reported farm work-related low back injury requiring medical advice or treatment in the previous year. We compared them with 465 uninjured male farmer controls. Multivariable modeling identified four risk factors significantly associated with low back injury: age less than 45 years (OR = 3.32; 95% CI 1.75-6.20), doctor-diagnosed asthma (OR = 4.26; 95% CI 1.49-12.10), education beyond high school (OR = 2.12; 95% CI 1.13-3.90), and difficulty hearing normal conversation (even with a hearing aid, in the case of those using one) (OR = 1.98; 95% CI 1.02-3.80). Although hearing difficulty may be a general risk factor for occupational injury, asthma may be a more specific risk factor for low back injury. Future research to assess the risk factors, asthma and difficulty hearing, may be particularly important, since farmers are at increased risk for hearing loss, and farmers come into contact with many inhaled agents that can cause asthma.

Adult↗
PubMed2002

Does good trunk extensor performance protect against back-related work disability?

In this cohort study, dynamic trunk extensor performance was studied as a predictor of permanent work disability due to back disorders. As part of the comprehensive Mini-Finland Health Survey in 1978-80, the back muscle performance of 535 persons (267 men, 268 women) was measured using standardized repetitive arch-up and sit-up tests. At baseline, the participants were between 30 and 64 years of age. Retirements were followed for 12 years on average. During the follow-up, 56 subjects developed permanent work disability; 15 of these cases were back-related. Good dynamic trunk extensor performance was predictive of a decreased incidence of work disability due to chronic back disorders but not work disability due to other diseases. The risk of back-related work disability in the three highest quartiles in relation to the lowest quartile of dynamic trunk extension capacity was 0.28 (95% confidence interval, 0.09-0.94). Our study suggests that good dynamic trunk extension performance may protect against back-related permanent work disability.

Adult↗
PubMed2003

Course of back pain in primary care: a prospective study of physical measures.

OBJECTIVE: To describe physical measures used in patients with back pain when no specific treatment is given, to examine associations between change over time in these measures and changes in pain and back-related disability, and to study the value of physical measures at baseline and at a 4-week follow-up to predict outcome at 12 months. DESIGN: A prospective consecutive study. SUBJECTS: Forty-four patients presenting with low back pain in primary care. METHODS: The patients underwent a physical examination at baseline and at 4 weeks. Follow-up was carried out using questionnaires until 12 months. Linear regression was used to identify predictors. RESULTS: Most measures had improved significantly at the 4-week follow-up. Thoracolumbar rotation, isometric endurance back extensors, and fingertip-to-floor distance at 4 weeks were significant predictors for pain intensity and back-related disability at the 12-month follow-up. Eighteen out of 44 patients reported an increase in pain after the assessment of the physical measures at baseline. This group of patients improved more in physical measures between baseline and the 4-week follow-up. CONCLUSION: Physical measures assessed at the 4-week follow-up, but not at baseline, could provide important additional information for identifying those patients at risk for worse outcome in pain or back-related disability at 12 months.

Adolescent↗
PubMed1998

Trends of back pain in eastern Finland, 1972-1992, in relation to socioeconomic status and behavioral risk factors.

The aim of this study was to compare the trends in the prevalence of back pain between several population subgroups and to assess the stability of the associations between back pain and its potential risk factors. Five cross-sectional surveys with independent random samples were conducted in two provinces in eastern Finland every fifth year from 1972 to 1992. There were 29,043 respondents aged 30-59 years. The respondents completed a questionnaire that asked about the occurrence of back pain during the preceding month. The prevalence of back pain varied between 46 and 50 percent among men and between 46 and 51 percent among women. In general, the trend for the entire sample was fairly stable, but the prevalence rates seemed to differ considerably between subgroups of the population. Back pain was more prevalent among those with lower education and income, those with blue-collar occupations, and those doing heavy work. The trends were significantly inconsistent (p < 0.05), for example, between the categories according to household income and, among men, between the categories according to body mass index, a suspected risk factor for back pain.

Adult↗
PubMed2006

Is the occurrence of back pain in Germany decreasing? Two regional postal surveys a decade apart.

BACKGROUND: Back pain is often perceived as an epidemic disorder with an ever-increasing prevalence. The objective of this paper is to estimate and compare point and period prevalence rates of back pain from two highly comparable postal surveys, a decade apart within a single regional population in the north of Germany. METHODS: In 1991/1992 and 2003 two systematic random samples of German residents of Lübeck aged 25-74 years were independently drawn from the municipal population registry. They received a short postal questionnaire with maximally two reminders. All data were directly standardised on the age, sex, and educational distribution of the merged samples. A sharp decrease in response rates from 81% in the early 1990s to 60% in 2003 required complex considerations of non-response bias. RESULTS: Both the overall and gender-specific point and 1 year prevalence rates of back pain remained fairly stable as well as the rate of severe disabling back pain. The overall prevalence (adjusted for age, sex, and education) of 'back pain today' was 39.2% (1991/92) and 38.2% (2003), the 1 year prevalence was 75.3% (1991/92) and 73.8% (2003), and the prevalence of severe pain was 9.9% (1991/92) and 10.2% (2003). CONCLUSIONS: The data do not support the widespread public notion of a growing epidemic of back pain in Germany.

Adult↗
PubMed1999

The early stages of low back pain: a pilot study of patient diaries as a source of data.

BACKGROUND: Low back pain accounts for a significant proportion of a GP's workload, but care of the condition is widely regarded as unsatisfactory. Recent recommendations to improve primary care management include more appropriate explanatory models and early access to physical therapy. OBJECTIVES: This study explored the feasibility and utility of patient diaries as a source of qualitative data on patients' experience of low back pain presenting in primary care. METHOD: Within a larger study of physiotherapist-led management of low back pain presenting in general practice, a random sample of patients was invited to keep a record of their illness experience over 7 days using a diary. Patients' written accounts were then subject to qualitative thematic analysis. RESULTS: Diary respondents did not differ from the wider group of patients presenting with back pain. Patients recounted diverse experience of disability, pain and emotional reactions. The specific themes which emerged from our analysis support the relevance to patients of a biopsychosocial paradigm in the management of low back pain. CONCLUSIONS: Diaries are a feasible and valid source of qualitative data in patients with new episodes of low back pain. In addition, they may provide the clinician with useful information and their completion may offer direct benefits to patients.

Activities of Daily Living↗
PubMed2005

Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain.

BACKGROUND: Cross-sectionally, lower trunk muscle attenuation (higher fat infiltration) has been associated with poorer physical function in older adults. We hypothesize that lower trunk muscle attenuation will be associated with lower functional capacity 3 years later and that back pain status will moderate this relationship. METHODS: The study sample consisted of a biracial cohort of well functioning men (739) and women (788) aged 70-79 years from the Pittsburgh site of the Health, Aging and Body Composition (Health ABC) study. Computed tomography was used to measure trunk muscle area and attenuation of the lumbar paraspinal, lateral abdominal, and rectus abdominus muscles at baseline. The Health ABC Physical Performance Battery (usual and narrow walk, chair stands, and standing balance) was used to measure functional capacity at the first and fourth annual clinic visits. RESULTS: Regardless of back pain status, average trunk muscle attenuation (but not muscle area) was positively associated with overall physical performance, particularly balance (p <.01), in a fully adjusted model. The association between trunk attenuation and functional capacity was significantly stronger in participants with at least moderate back pain in the year prior to baseline (p <.05 for interaction; attenuation x back pain). Participants with moderate to extreme back pain had a greater decline in function over time (p <.05). CONCLUSIONS: Older adults with poorer trunk muscle composition (higher fat infiltration) exhibit reduced functional capacity, especially balance, 3 years later. Improving trunk muscle composition may be an important yet overlooked approach to maintain function and potentially reduce balance impairments, particularly in persons with a history of back pain.

Aged↗
PubMed1997

Transitions in chronic low back pain in Japanese older adults: a sociomedical perspective.

This study examines the patterns and determinants of chronic low back pain over a three-year period among older adults in Japan. We tested our model based on a sociomedical perspective, using a two-wave national probability sample survey of persons aged 60 and older (N = 2,200) conducted in 1987 and 1990 in Japan. At baseline, the prevalence of chronic low back pain was 18 percent. Among those who were free of back pain at baseline, the probabilities of onset, death, and nonresponse were 13 percent, 7 percent, and 10 percent. Among those who had back pain at baseline, the probabilities of recovery, death, and nonresponse were 43 percent, 8 percent, and 9 percent, respectively. Our multinomial logistic regression analysis supports our thesis that societal factors (age, gender, education, and social relationships) affect transitions in chronic back pain not only directly, but also indirectly through mediating health and health behavior factors. The results suggest that social relationships have both favorable and unfavorable effects on chronic low back pain.

Aged↗
PubMed1993

Back pain and its correlates among workers in family care.

In order to assess the prevalence of back pain problems among family care workers, and the association of back pain with selected variables, a cross-sectional survey among the 4723 employees of the largest Flemish organization for family care was conducted. A self-administered questionnaire comparable to the standardized Nordic questionnaire on musculoskeletal symptoms was distributed to all employees of the organization. The response rate was 90 per cent (n = 4256) and the study population was almost uniformly composed of females (99.8 per cent). The period prevalence (12 months) amounted to 63 per cent (95 per cent CI: 61.7-64.6) and the point prevalence to 18 per cent (95 per cent CI: 16.5-18.8). Among the respondents suffering from back pain during the past year, 72 per cent suffered from repeated episodes of pain. In 82 per cent low back pain was involved. Twenty-nine per cent of the complaints interrupted their work during the past year, yielding a total number of 23,396 days of sick leave. The mean sick leave for back pain was 36 days and the median 15 days. The frequency of back pain was found to vary according to the regional departments to which the employees belonged, some sections experiencing up to 36 per cent higher period prevalences than the units with the lowest figures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The epidemiology of back injuries in nurses at a large Canadian tertiary care hospital: implications for prevention.

Two years of prospective data on 416 back injuries were gathered at a 1100-bed acute and tertiary care hospital to assist target prevention efforts. The rate of injury among 1645 nurses was found to be highest for those working on orthopaedic, medicine, neurology, spinal and surgery wards, indicating priorities for prevention. In fact, 51% of the orthopaedic nurses sustained at least one back injury during the two-year period. Gender did not significantly affect the risk of back injury; however, injuries were slightly more common in nurses with less seniority and younger nurses were found to be at significantly increased risk of back injury. Almost 63% of the back injuries which occurred in nurses working 8 h shifts on the high-risk wards occurred during the first two hours of the shift. Lifting and transferring patients with assistance were the two most common mechanisms for back injury (22.6% and 23.3%, respectively). In total, injured nurses attributed 52.3% of their injuries to inadequate training; inadequate staffing was given as the primary reason for 13.8% of the injuries. The results suggest that training in the indications for and use of mechanical devices for lifting/transferring patients requires intensification, and a 'warm-up' period should also be considered in the face of injuries occurring early in the shift if work activities cannot be evenly planned.

Adult↗
PubMed1996

Do attitudes and beliefs influence work loss due to low back trouble?

Recent evidence indicates that the influence of psychosocial factors on low back disability is as great as, if not greater than, ergonomic aspects; negative attitudes and beliefs are likely to be related to absenteeism. To measure workers attitudes and beliefs about low-back trouble, pain, work and activity five questionnaires were used. Two new instruments (Back Beliefs Questionnaire and Psychosocial Aspects of Work questionnaire) were developed and tested. The attitudes and beliefs were measured among workers in a biscuit manufacturing factory, and the responses related to absenteeism. Workers who had taken in excess of one week's absence due to low-back trouble had significantly more negative attitudes and beliefs when compared with workers who had taken shorter absence (or indeed those reporting no history of back trouble). A subset of the psychosocial parameters accounted for 32% of the variance in absence. Interventions designed to reduce negative attitudes and promote positive beliefs may help to reduce detrimental, inappropriate longer-term absenteeism due to low-back trouble.

Absenteeism↗
PubMed1994

Physical therapy episodes of care for patients with low back pain.

BACKGROUND AND PURPOSE: Although individuals with low back pain frequently receive treatment from a physical therapist, few published studies exist that describe who sees a physical therapist for their low back pain nor is much known about physical therapy episodes of care for this condition. Secondary analysis of data from the American Physical Therapy Association's Survey of Physical Therapy Outpatient Practice provides new descriptive data on services provided to a national, representative sample of patients discharged from hospital-based and private outpatient practices. In addition, specific hypotheses were tested on clinical and background factors believed to influence low back pain episodes of care. SUBJECTS: Patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices. METHODS: A mail survey was conducted with representatives of a national probability sample of facilities that provided outpatient physical therapy services. Data were provided on each facility and on a discharge sample of patients treated at each facility. RESULTS: On average, episodes of care extended over 5 weeks and consisted of 11 therapy visits, for an average charge of $766.70. Duration and charge for low back episodes of care did not differ, on average, in private versus hospital-based practices. Certain aspects of care, however, did vary across regions of the country. Episodes of care charged to workers' compensation were costlier than those charged to other insurance carriers, and whites were charged less, on average, than nonwhites. Duration of back symptoms was related to intensity, duration, and charges incurred for the episode of care. CONCLUSION AND DISCUSSION: Further research is needed to understand the reasons for the relationships observed in this study, as well as studies that relate care provided by physical therapists to specific patient outcomes. Further research is also needed to compare outcomes achieved across different health professions.

Adult↗
PubMed1993

A clinical and radiological study of back pain in rheumatoid arthritis.

Five hundred and three patients with RA were questioned about the symptom of back pain. Chronic back pain, lasting more than 3 months, occurred in 33 per cent of the group. A group of 100 back pain patients were studied in more detail using a structured questionnaire, clinical examination and radiology. Ninety-four of these patients had low back pain. Particular clinical patterns (such as that of the facet syndrome) were sought but no clear characteristics were found. Fifty-two lumbar spine X-rays were available from the RA population and these were compared to 52 age and sex matched X-rays from outpatients with chronic mechanical low back pain. Significant differences between these groups radiologically were a higher frequency of osteoporosis and a higher frequency of disc narrowing without associated osteophytes in the RA population. This study differs from previous reports which found other characteristic radiological features of RA of the lumbar spine (spondylolisthesis, facet erosions, and vertebral fracture), a discrepancy possibly resulting from the use of a control group having low back pain.

Adult↗
PubMed1999

Prediction of maximal back muscle strength from indices of body mass and fat-free body mass.

OBJECTIVES: The purpose of this study was to examine, in healthy volunteers, the relationship between back extensor muscle strength and body size. METHODS: The maximal voluntary isometric back extensor strength of 456 volunteers, aged 18-42 yr and with no history of low back pain, was measured in a standing, slightly flexed forward posture. This was then correlated with two indices of body size: body mass and fat-free body mass. RESULTS: Significant linear relationships were observed between back muscle strength and each of the two indices of body size. There was a gender difference in both the slope and the intercept of the regression equations describing the relationships. There was no independent influence of age within the range studied. CONCLUSION: It was possible to establish predictive equations for back extensor strength based on body size which could be used to quantify strength 'deficits', for instance in patients with low back pain, and to prescribe submaximal target forces for use in endurance training and testing.

Adult↗
PubMed1990

American and Japanese chronic low back pain patients: cross-cultural similarities and differences.

The study compared and contrasted medical, psychological, social and general behavioral functioning of American and Japanese low back pain patients and normal controls. The Sickness Impact Profile and a standardized Medical Examination Protocol for Pain instrument were used to assess all subjects. Findings showed that the American and Japanese low back pain patients had similar and significantly higher medical-physical findings than their respective controls. Likewise, the American and Japanese low back pain patients showed significantly greater psychological, social, and general behavioral dysfunction compared to control subjects. Finally, despite similar medical and physical findings, the Japanese low back pain patients were significantly less impaired in psychological, social, vocational, and avocational functioning than the American low back pain patients. It was concluded that there were significant cross-cultural differences between the American and Japanese low back pain patients, primarily in the psychosocial and behavioral areas. However, given the small sample size, any conclusion should be considered with caution; replication is needed before more definite conclusions are possible.

Adult↗
PubMed1993

Childhood psychological trauma and chronic refractory low-back pain.

OBJECTIVE: To examine the correlation between childhood psychological trauma(s) and refractory back pain in patients with and patients without prior spine surgery. DESIGN: Retrospective chart review survey of 101 consecutive patients who had undergone multidisciplinary evaluation for refractory back pain. SETTING: Private practice, tertiary care spine center. MAIN OUTCOME MEASURES: Each psychological risk factor (physical abuse, sexual abuse, emotional neglect or abuse, abandonment, and chemically dependent caregiver) was rated as present or absent. Spinal pathology was graded as significant or not significant. RESULTS: There were 56 patients with failed back surgery syndrome, 28 men and 28 women, with a mean age of 43 and mean pain duration of 45 months. There were 45 patients with no prior surgery, 26 men and 19 women, with a mean age of 43 and mean pain duration of 33 months. In the failed back surgery syndrome group, 27 (48%) had three or more risks and 39 (70%) had two or more. When the 12 patients with significant pathology are not considered, 24 of the remaining 44 (55%) patients had three or more risks. In the group with no prior surgery, 26 (58%) had three or more risks and 38 (84%) had two or more. When the five patients with significant pathology are not considered, 24 (60%) had three or more risks. CONCLUSIONS: Multiple childhood psychological traumas may predispose a person to chronic low back pain. In patients in this setting with refractory low back pain with or without prior lumbar spine surgery, three or more childhood psychological risk factors are prevalent, especially in patients with minimal structural pathology.

Adult↗