Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Back”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed2006

A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study.

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To compare the long-term effectiveness of medical and chiropractic care for low back pain in managed care and to assess the effectiveness of physical therapy and modalities among patients receiving medical or chiropractic care. SUMMARY OF BACKGROUND DATA: Evidence comparing the long-term relative effectiveness of common treatment strategies offered to low back pain patients in managed care is lacking. METHODS: A total of 681 low back pain patients presenting to a managed-care facility were randomized to chiropractic with or without physical modalities, or medical care with or without physical therapy, and followed for 18 months. The primary outcome variables are low back pain intensity, disability, and complete remission. The secondary outcome is participants' perception of improvement in low back symptoms. RESULTS: Of the 681 patients, 610 (89.6%) were followed through 18 months. Among participants not assigned to receive physical therapy or modalities, the estimated improvements in pain and disability and 18-month risk of complete remission were a little greater in the chiropractic group than in the medical group (adjusted RR of remission = 1.29; 95% CI = 0.80-2.07). Among participants assigned to medical care, mean changes in pain and disability and risk of remission were larger in patients assigned to receive physical therapy (adjusted RR = 1.69; 95% CI = 1.08-2.66). Among those assigned to chiropractic care, however, assignment to methods was not associated with improvement or remission (adjusted RR = 0.98; 95% CI = 0.62-1.55). Compared with medical care only patients, chiropractic and physical therapy patients were much more likely to perceive improvement in their low back symptoms. However, less than 20% of all patients were pain-free at 18 months. CONCLUSIONS: Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care.

Academic Medical Centers↗
PubMed1987

[Labor of freight-container tractor drivers and low-back pain. Characteristics of the low-back pain through clinical findings].

In order to clarify the characteristics of the low-back pain which is prevalent among freight-container tractor drivers, a medical examination, composed of orthopedic tests and questions about health conditions, was carried out on 231 tractor drivers. Prevailing complaints were: dullness or stiffness of the shoulder (71%); dullness of the neck (69%); dullness of the low back (62%); low-back pain (42%); dullness of the lower limbs (39%) and dullness of the back (36%). The rates of complaints of dullness or pain of the neck, shoulder, upper limbs, back or lower limbs, and disturbance of daily activity were associated with the grade of low-back pain evaluated from the subjective symptoms. Orthopedic examination revealed fatigue signs of muscles i.e. tenderness of the body trunk and limbs, tenderness or percussion pain on the spinous processes, and poor results in some tests on muscle strength. These findings were seen more frequently in the group with subjective symptoms, but even among the group without symptoms, they were evident to some degree. These findings were considered to originate from the fact that the freight-container tractors had many ergonomic problems and the daily driving hours of many drivers were estimated to exceed the allowable vibration exposure time of the ISO.

Activities of Daily Living↗
PubMed1996

Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina Back Pain Project.

BACKGROUND: Low back pain is a common reason for visiting a physician. Authors of guidelines and insurance payers are currently scrutinizing use of radiography and computed tomography (CT) or magnetic resonance imaging (MRI). OBJECTIVE: To study the determinants of the use of lumbar spine radiography and either CT or MRI in patients with acute low back pain. DESIGN: Prospective cohort study. SETTING: Community-based practices in North Carolina in six strata: urban primary care physicians, rural primary care physicians, urban chiropractors, rural chiropractors, orthopedic surgeons, and practitioners at a group-model health maintenance organization. PATIENTS: 1580 patients with acute low back pain. MEASUREMENTS: Telephone interviews done after the index office visit and at 2, 4, 8, 12, and 24 weeks or until complete recovery; survey of practitioners; and chart abstraction. RESULTS: During the acute back pain episode, 46% of patients had radiography and 9% had CT or MRI. Patient variables related to use of radiography included pain that began more than 2 weeks before the index visit and no previous episodes of low back pain. Practitioner variables associated with use of radiography were being a chiropractor or orthopedic surgeon and having a solo practice. Use of CT or MRI was associated with white race, neurologic deficit at baseline, sciatica, poor functional status at baseline, and small group-practice size. Practitioners' responses to clinical vignettes were associated with aggregate practitioner behavior: In the vignettes and in real life, practitioners were more likely to order CT for patients with sciatica. However, a practitioner's response to a vignette did not predict that practitioner's use of CT or MRI for similar patients in his or her own practice. CONCLUSION: Radiography is commonly used as a diagnostic test for patients with acute back pain. Clinical factors and provider specialty are major correlates of the use of imaging studies.

Acute Disease↗
PubMed1989

The Swedish back school in chronic low back pain. Part I. Benefits.

The aim of this 12-month follow-up study was to evaluate the effect of the Swedish-type back school in chronic low back pain. 188 subjects completed the study (95 in the treatment group and 93 in the control group). The following were assessed: 1) subjective scores of pain and disability; 2) clinical measurement and evaluation including spinal mobility and strength measurement; 3) number and length of sick-leaves. At 12 months, subjective scores of pain and disability, and mobility of the lumbosacral section of the spine showed differences in the favour of the treatment group. There was no difference, however, in the number or the length of sick-leaves after the back school. It was concluded that patients with chronic or recurrent low back pain may get relief of subjective symptoms of low back pain from the back school. In addition to chronicity, there may be other factors affecting the outcome of treatment.

Back Pain↗
PubMed1997

Isokinetic and psychophysical lifting strength, static back muscle endurance, and magnetic resonance imaging of the paraspinal muscles as predictors of low back pain in men.

Magnetic resonance imaging was used to determine the cross-sectional areas and the T2-weighted and proton density-weighted signal intensities of the paraspinal muscles in a group of 128 men, aged 35-63, who had varied histories of occupational and leisure-time physical activities. These measures, and the isokinetic lifting, psychophysical lifting, and static back muscle endurance tests were examined as predictors of low back pain over 12 months of follow-up, in the 43 men who reported no low back pain in the year preceding testing. None of the imaging measures or the muscle function tests was useful as a predictor of future low back pain. Associations with the frequency of low back pain before testing were investigated in the larger group. Smaller total cross-sectional area of the paraspinal muscles and greater signal intensities had weak but significant correlations with more frequent low back pain in the previous year, possibly due to muscle atrophy.

Humans↗
PubMed2005

Extended flip-back schemes for sensitivity enhancement in multidimensional HSQC-type out-and-back experiments.

In many NMR experiments, only polarisation of a limited sub-set of all protons is converted into observable coherence. As recently shown by the "longitudinal" TROSY implementation (Pervushin et al. (2002) J. Am. Chem. Soc., 124, 12898-12902) and SOFAST-HMQC (Schanda and Brutscher (2005) J. Am. Chem. Soc., 127, 8014-8015), recovery of unused polarisation can be used indirectly and unspecifically to cool the proton lattice and, thus, accelerate re-equilibration for the selected proton subset. Here we illustrate transfer of this principle to HSQC-based multi-dimensional out-and-back experiments that exploit only polarisation of 15N-bound protons. The presented modifications to the pulse sequences can be implemented broadly and easily, extending standard flip-back of water polarisation to a much larger pool of protons that may comprise all non-15N-bound protons. The underlying orthogonal separation of H(N) polarisation (selected by the main transfer path) from unused H(u) polarisation (flipped-back on the recovery path) is thereby achieved through positive or negative selection by J-coupling, or using band-selective pulses. In practice, H(u) polarisation recovery degrades mostly through cumulative pulse imperfections and transverse relaxation; we present, however, strategies to substantially minimise such losses particularly during interim proton decoupling. Depending on the protein's relaxation properties and the extended flip-back scheme employed, we recovered up to 60% H(u) equilibrium polarisation. The concomitant cooling of the proton lattice afforded substantial gains of more than 40%, relative to the water-only flip-back version, in the fast pulsing regime with re-equilibration delays tau much shorter than optimal (tau(opt) = 1.25 x T1(H(N))). These would be typically employed if resolution requirements dominate the total measurement time. Contrarily, if sensitivity is limiting and optimal interscan delays tau(opt) can be set (optimal pulsing regime), the best of the presented flip-back schemes may still afford up to ca. 10% absolute sensitivity enhancement.

Magnetic Resonance Spectroscopy↗
PubMed1995

Correlations of isokinetic and psychophysical back lift and static back extensor endurance tests in men.

Isokinetic lift, psychophysical lift, and static back endurance tests are among the most widely used measurements of muscle function for determining risk for, and recovery from, back problems. After determining test repeatability we examined the degree of association between these test measures in 100 men selected to represent a variety of occupations and lifestyles. Isokinetic lifting had low correlations with test results for psychophysical lifting (r = 0.28) and static back endurance (r = 0.24). Static back endurance and psychophysical lift test results were not at all correlated (r = 0.03). RELEVANCE--:Muscle function measurements for back problems are sometimes arbitrarily selected due to health practioners' beliefs and preferences or practical reasons such as the availability of equipment. Yet little is known about the associations of these tests with one another or with anthropometric factors. The data presented in this study document that isokinetic lift, psychophysical lift, and static back endurance tests appear to measure very different aspects of muscle function, and comparing studies using these different test methods should be approached with these low inter-test correlations in mind.

Journal Article↗
PubMed2004

Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.

OBJECTIVES/HYPOTHESIS: The ideal material for reconstructing the nasal septum in the deficient nose has not been found. Since 1986, the authors have used autogenous cartilage from the cavum conchae to successfully correct the anterior septum and the associated cartilaginous saddle. The long-term results in 26 patients with a destroyed septum and a saddle nose are reported. STUDY DESIGN: Retrospective study. METHODS: The mean age of the patients at surgery was 40.2 years, and the mean number of previous nasal procedures was 1.6. Because 11 patients had septal perforations and insufficient septal cartilage or bone, ear cartilage grafts from the cavum conchae were harvested through an anterolateral approach. A special incision was used to divide the concave ear cartilage while preserving the posterior perichondrium. This produced a stable, balanced back-to-back graft. The graft was 2.5 to 3 cm long, long enough to allow reconstruction of the anterior septum and to correct part of the saddle nose deformity. The rest of the conchal cartilage was used to fill the remaining cartilaginous saddle. Follow-up investigations included photographs and visual analogue scales of the patients' symptoms and satisfaction. RESULTS: After a mean interval of 36.7 +/- 22.3 months, the back-to-back grafts showed no macroscopic signs of resorption. Graft position and shape remained intact after transplantation. All noses were adequately projected and mobile. All patients but one were satisfied with the functional and esthetic result. With a score of 4 representing the level of satisfaction as "very good," the mean score of the patients was 3.2 +/- 0.79. The saddle of the nose completely disappeared in 65.4% of patients, was minimally visible in 23.1%, and was slightly present in 11.5%. Nasal breathing improved considerably in 21 patients, remained the same in 4 patients, and worsened in 1 patient. The mean score of all patients for nasal breathing was 7.3 +/- 1.87 on a visual analogue scale of 0 to 10, with 10 representing satisfaction as "very good". CONCLUSION: The back-to-back autogenous ear cartilage graft is a viable, stable, and balanced graft for functional and aesthetic reconstruction of the anterior nasal septum and cartilaginous saddle deformity in patients with a severely traumatized and deficient septum.

Adolescent↗
PubMed1995

The Use of Back Belts to Increase Intraabdominal Pressure as a Means of Preventing Low Back Injuries: A Survey of the Literature.

Published reports of relevant empirical research do not suggest a consistent relationship between intraabdominal pressure and the activity of the erector spinae muscles or the magnitude of the intradiscal pressure during lifting. Intraabdominal pressure varies in response to load magnitude and lift method, but there is no pattern of activity that would suggest that an increase in intraabdominal pressure decreases intradiscal pressure. Early models of back biomechanics predicted that the increase in intraabdominal pressure relieved the compressive forces on the low back by providing an extensor moment. In the newer models, intraabdominal pressure functions to stabilize the loaded spine. Studies of human subjects fail to consistently show any clear biomechanical advantage from using a back belt. Some studies suggest a slight decrease in back injury incidence when using a back belt; however, there are conflicting results regarding the severity of the injuries involved and the cost-effectiveness of back belts.

Journal Article↗
PubMed1997

Back Pain among U.S. Workers: Comparison of Worker Attributes According to Self-reported Causes of Back Pain.

Back pain is a significant health problem, especially in industry. To gain a better understanding of back pain in light of its diverse causality, data for 29,322 working adults interviewed in the Occupational Health Supplement to the 1988 National Health Interview Survey were analyzed by self-reported cause of back pain. The 12-month prevalences of back pain for "injury or repeated activities at work," "injury or repeated activities not at work," and "other reasons," were 9.1%, 4.4%, and 4.0%, respectively. The worker attributes and work impacts associated with these self-reported causes were compared for this nationally representative sample. Results from multivariate logistic regressions indicated different profiles of worker attributes among the three cause-specific subgroups of back-pain sufferers. Work impact was substantial in all cases, but was highest for workers with work-related back pain.

Journal Article↗
PubMed1998

A submaximal back extension endurance test utilising subjective perception of low back fatigue.

The present study was designed to evaluate the diagnostic value of a new submaximal back extension endurance test in the classification between patients with non-specific chronic/recurrent low back trouble (LBT) and controls. The back pain questionnaires included pain duration, intensity, regularity and the Pain & Disability Index. The subjects performed dynamic back extensions on a specially designed measurement and training unit at a fixed repetition rate with a load that was based on the subject's estimated upper body mass. The degree of perceived fatigue (unmodified Borg scale, 6-20) was inquired in 15 second intervals throughout the protocol and the slope (change/minute) was calculated. The Borg scale slope increased faster and the score at the end of the test was higher in the LBT group than in the control group during the test. Receiver operating characteristics analysis revealed significant diagnostic value for the Borg scale slope (0.74) and for the Borg scale at the end of the test (0.70). We conclude that LBT patients experience fatigue faster than controls during a repetitive submaximal back extension task. The test may offer a low-risk, low-cost evaluation method for assessing the severity of LBT when combined with other relevant clinical data.

Adult↗
PubMed1983

Assessment of abdominal and back extensor function. A quantitative approach and results for chronic low-back patients.

A method was developed to obtain static and dynamic measures of trunk flexor and extensor strength and endurance. The method was evaluated using 32 normal subjects. Variables of trunk strength and endurance were used to compare 24 normals (12 men and 12 women) and 24 patients (16 men and eight women) with chronic low-back dysfunction. The Iowa Trunk Dynamometer is acceptably reliable and provides for assessment of isolated function of the abdominal and back muscles. For peak abdominal and back extensor strength, the range of superiority of men over women was 39-57%, and the range of superiority of normals over patients with chronic low-back dysfunction was 48-82%. Using time to percent decrement of peak strength as a criterion, the abdominals were more susceptible to fatigue than the back extensors, women demonstrated more endurance than men, and the endurance for normals was less than those patients who were able to perform dynamic reciprocal trunk movements.

Abdominal Muscles↗
PubMed1997

The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a 3-year follow-up period.

STUDY DESIGN: A prospective, randomized investigation. OBJECTIVES: To compare the effect of dynamic strength back muscle training with that of a home training program and to evaluate the long-term effect of the home training program in patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: In a health survey of 57-year-old women, those with chronic low back pain were selected using the Nordic Questionnaire. Of 172 women with low back pain, 74 participated in the study. METHODS: The participants were randomly assigned to either dynamic strength back exercises at a fitness center and a home training program or to the home training program for the first 3 months, after which both groups continued to pursue the home training program. Follow-up observation was by examination at 3 and 12 months and by mailed questionnaire after 3 years. The primary effect variables were disability, sick-leave, and use of health care services. RESULTS: Both training groups manifested significant improvement at the 3- and 12-month follow-up examinations, yet the adherence rate was much better in the group assigned to the fitness center. Those who adhered to the training program for the first year manifested significant improvement according to the 3-year follow-up questionnaire. There was a significant reduction in the number of women on sick-leave and in use of health care services after 1 year, but not after 3 years. CONCLUSIONS: The home training program was as effective as the supervised dynamic strength muscle training program and yielded lasting improvement after at least 1 year of adherence. The adherence rate was much better, however, when the training was supervised at the start.

Back↗
PubMed1991

Effects of back school education and exercise in back injured municipal workers.

Low back injury is the leading cause of compensable injury. A National Health Objective for the year 2000 is to increase to at least 50% the number of worksites offering back injury protection programs. The 6 week Back School intervention included exercise and education. A portion of the sample of 74 back injured municipal employees also was assigned randomly to a counseling intervention. Pre-intervention and post-intervention testing revealed significant posttest increases in back strength and flexibility. Significant improvements also were noted in psychological well being, depression, anxiety, and perceptions of pain. No significant differences were found, on any of the measures, between employees who did and who did not receive the counseling intervention. Methodological concerns relate to the possibility of sampling bias and instrumentation. Future research with control groups is needed, as well as the testing of interventions that may be both effective and require less work release time.

Accidents, Occupational↗
PubMed2006

Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany.

Given the increasing medical and economic implications of back pain, occupation-specific prevalence data may provide important pointers for preventive programmes targeted at promoting preventive behaviour and improving conditions. The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence by occupational category. The net sample comprises a total of 3,488 earners aged 18-69. One in three earners in the Federal Republic of Germany (34%) experienced back pain during the 7 days prior to being interviewed. The 1-year prevalence rate is 60%. Occupational categories associated with a lower-than-average back pain prevalence are highly qualified professionals, senior management, and production occupations associated with a comparatively low degree of manual labour. In contrast, an above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather. Our data demonstrates significant inter-occupational differences in terms of self-reported back pain. The results underline the importance of measures to promote preventive behaviour and improve the working conditions of those in low-skill manual labour occupations.

Adolescent↗
PubMed1991

Intensive dynamic back exercises for chronic low back pain: a clinical trial.

The effect of intensive dynamic back extensor exercises for patients with chronic low back pain was investigated in a controlled clinical trial in which chronic low back pain patients underwent a 3-month intensive training program with a total of 30 sessions. The 105 patients were divided into 3 groups: a treatment group, an alternative group which underwent 1/5 of the treatment group's exercise program per session, and an alternative group in which treatment consisted of thermotherapy, massage and mild exercise. Regardless of whether the treatment outcome is assessed qualitatively or quantitatively, a statistically significant, favorable difference was found between the results for the treatment group and for the alternative groups at conclusion and at the 3-month follow-up. It appeared from the quantitative assessment that patients in the treatment group who completed the training program at least once a week for the entire 1-year follow-up period were the only patients with a significantly better back status after 1 year compared to the time of inclusion. Irrespective of sex, age, duration and degree of severity of back trouble, or of pre-existing sciatica or pathological findings upon X-ray of the spine, patients obtained a favorable result from the training program. The therapy was found to be without risk, but patients with clinical signs of current lumbar nerve root compression or radiological signs of spondylolysis or halisteresis of the spine were excluded from the study.

Adult↗
PubMedDate not supplied

Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain.

BACKGROUND CONTEXT: A range of morphologic and psychosocial variables has been suggested as risk factors for serious low back pain (LBP) illness. Although the relative contributions of structural and psychosocial variables are intensely debated, the validity of differing hypotheses has proven difficult to test because the incidence of serious disabling LBP illness is low in healthy subjects. These factors dictate the requirement for large sample sizes, extensive structural imaging and extended longitudinal study. Previous studies included either small cohorts with intensive imaging testing or large population studies that do not establish a detailed morphologic baseline. PURPOSE: To establish, using a strict patient sample design, the relative contribution of structural and psychosocial determinants of serious LBP illness among subjects with no previous LBP disability or clinical LBP illness. STUDY DESIGN/SETTING: A prospective, longitudinal study of subjects with high risk factors for serious LBP as determined by structural and psychosocial characteristics. PATIENT SAMPLE: One hundred subjects with known mild persistent low back pain and a 2:1 ratio of chronic (non-lumbar) pain syndrome were recruited from a study population with a predisposition to disc degenerative disease, to undergo baseline examination, testing and 5-year follow-up. OUTCOME MEASURES: Observations were made at 6-month intervals over 4 to 6 years (mean, 5.3) for the after primary outcomes measures: episodes of serious back pain (visual analogue scale [VAS] > or =6), episodes of occupational disability less than 1 week, episodes of occupational disability for 1 week, remission episodes of all back pain symptoms at least 6 months and medical visits primarily for LBP evaluation and treatment. METHODS: Lumbar magnetic resonance imaging (MRI), lumbar provocative discography (in psychometrically normal subjects), physical examinations, medical and work histories and psychometric testing were performed at baseline. Imaging and psychometric testing were graded by blinded examiners. A scripted interview was conducted every 6 months during follow-up by independent research assistants who also were blinded to patient baseline data. The interview covered interval medical, occupational and accident or injury histories. RESULTS: Psychosocial variables strongly predicted both long- and short-term disability events, duration and health-care visits for LBP problems (p<0.0001-0.004). The likelihood of a sustained remission from the baseline persistent (subclinical) LBP appeared to be linked to occupation factors (leaving a heavy labor occupation; p=0.0001), neurophysiologic variables (chronic nonlumbar pain; p=0.0002) and psychometric profiles at baseline (DRAM and FABQ-PA; p=0.003-0.002). Of the structural findings measured only moderate or severe Modic changes of the vertebral end plate were weakly associated with an adverse outcome. A positive provocative discogram at baseline did not predict any future adverse event. CONCLUSION: The development of serious LBP disability in a cohort of subjects with both structural and psychosocial risk factors was strongly predicted by baseline psychosocial variables. Structural variables on both MRI and discography testing at baseline had only weak association with back pain episodes and no association with disability or future medical care.

Adult↗
PubMedDate not supplied

Perception of difficulties for the back related to assembly work: general findings and impact of back health.

The study objective was to describe the perceptions of airplane assemblers on job demand for the back and how back pain modulated these perceptions. One hundred and seventy-six workers answered two questionnaires concerning back pain and the perception of work related difficulties (work activities, work contexts, tools, work positions, efforts). Results show that positions and work contexts are perceived as greater sources of difficulty than efforts or dynamic activities. The duration of a given position is more important than its frequency. Back pain has a significant but complex impact on the perception of difficulty. Assemblers appear to integrate several factors when evaluating their difficulties as opposed to individual aspects, as it is often measured in ergonomic studies. The results have important implications for the measurement of ergonomic factors in the genesis of back pain and illustrates the potential for misclassification and biases in current epidemiologic studies.

Adult↗