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PubMed1994

[Chemonucleolysis of disk herniation with low back pain as the single symptom: 20 cases].

Disk herniation can manifest as isolated low back pain, which is usually intermittent and accompanied with stiffness of the lumbar spine. There is almost general agreement that neither neurosurgical treatment nor chemonucleolysis is appropriate in patients with this clinical pattern. We used chemonucleolysis in 19 patients with recurrent episodes of isolated low back pain and one patient with severe permanent isolated low back pain dating back to a conservatively-treated episode of sciatica. All 20 patients had disk herniation documented by imaging studies. A very good or satisfactory outcome was recorded in ten patients after three months, 11 after six months and 12 in March 1993 after a mean follow-up of 72 months. The treatment was well tolerated, even in those patients who were not improved; a single patient developed an episode of acute low back pain that required surgical treatment. In patients with low back pain and disk herniation, there is currently no means of determining whether a causal relationship links these two abnormalities. Nevertheless, we believe that chemonucleolysis can be proposed in severe forms, provided the patients are apprised of current success rates.

Adult↗
PubMed1994

Relationship of performance on the ERGOS work simulator to illness behavior in a workers' compensation population with low back versus limb injury.

A prospective blinded cohort study was performed to test for a difference in the pattern of physical activity factors measured with the ERGOS work simulator in subjects with low back injuries versus those with limb injuries. Also tested was the relationship between physical activity factors measured with the ERGOS and several psychological tests and measures of nonorganic pain behavior in subjects with low back pain. Subjects were 70 men, 22 to 64 years old, who attended a 2-week physical capacity assessment after undergoing rehabilitation for a work-related injury. In subjects with a complaint of low back pain, nonorganic pain behavior was measured with the Waddell score. In addition, two brief psychological tests, the Coopersmith Self-Esteem Inventory and analog self-rating of wellness, were administered. It was found that subjects with low back complaints underperformed globally in comparison with subjects with limb complaints. This underperformance was statistically significant (P < .05) for 7 of 13 strength variables and 2 of 7 dexterity variables. In the subjects with low back complaints, those who exhibited excessive illness behavior (Waddell score, 3 to 5) performed significantly worse on all 13 strength variables and on 3 of 7 dexterity variables. In the subjects with low back complaints, those with low self-assessment ratings were found to have a high Waddell score (P < .01) and to perform significantly worse (P < .05) on 12 of 13 strength variables and 6 of 7 dexterity variables. There were no significant relationships (P > .05) between Coopersmith Self-Esteem score and Waddell score or performance on ERGOS testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Backfire: AHCPR practice guideline for acute low back pain.

The AHCPR "Guideline for Acute Low Back Problems in Adults" is a must-read for every South Carolina physician treating low back pain. The 25-page pamphlet excels as a practical guide for swiftly triaging acute low back problems into the 90 percent majority who recover within a month, from the few "red flag" and "red herring" serious back problems requiring urgent attention. But the Guideline panel overstepped its policymaking mandate by venturing into the quicksand of treatment by committee edict, rather than by on-the-spot caretakers. The rumbling backfire is that U. S. Government document, intended as practice guideline for routine acute back care, will come to haunt us as a practice standard for all back care. One-size-fits-all proposals for the majority short-change the few with more demanding healthcare resource requirements. Be sure to read the pamphlet; your patients, insurers, providers, administrators, journalists and attorneys will!

Humans↗
PubMed1996

Back injury prevention interventions in the workplace: an integrative review.

The purpose of this integrative review is to describe the state of knowledge about the effect of worksite back injury prevention programs on selected study outcomes. Fifteen experimental and quasi-experimental studies published between 1987 and 1994 were identified through a comprehensive literature search. The research studies were reviewed and analyzed using a data collection abstracting tool. Four types of back injury prevention intervention programs were identified: back belts, back schools, exercise/flexibility training, and educational classes. Positive program outcomes were reported for all four program types; however, the back school and the exercise/flexibility training programs were studied more frequently and demonstrated a greater proportion of positive results than the other two program types. Conclusions should be viewed cautiously due to the small number of studies reviewed and their methodological limitations. Implications for occupational health nursing practice and future research related to worksite back injury prevention are offered.

Exercise Therapy↗
PubMed1996

Chronic back disability: USAF officers at separation and exposure to +Gz.

This is the second of two studies done to determine whether moderate Gz exposure facilitates back disability. Cumulative trauma (repeated moderate to high G) exposures could be a precipitant of back pain in the military population. There is at present no reliable method of predicting who will suffer from back pain. We looked at officer back disability rates at separation from the Air Force (1972-1993). We compared non-rated Air Force officers to pilots and navigators exposed to low G and moderate to high G. We found no significant differences between aircrew and non-aircrew individuals until 1985, when the rates for aircrew fell below those of non-rated officers. Moderate G exposure does not seem to be a predictor of subsequent back disability. We recommend a larger prospective study of all rated and non-rated officers. We recommend that each separating officer undergo a detailed physical examination and answer a detailed back questionnaire.

Aerospace Medicine↗
PubMed1997

[Current approach to low back pain].

Despite advances in medical knowledge and available methods of treating spinal problems, the costs these problems generate are growing in a constant and exponential manner in western countries. Back pain is not different, commoner or more severe than in the past. This raises the question whether present-day management, which often runs counter to current scientific evidence, is appropriate. Practically speaking, so-called specific back pain is to be distinguished from nonspecific or common back pain. The former arises from a precise lesion (infectious, tumoral, inflammatory or traumatic), while the latter has no obvious underlying cause. Fortunately this preliminary differentiation is usually possible on the basis of the history and clinical workup alone. In this paper we deal solely with common back pain, as being by far the most frequent in everyday practice. Once a specific origin has been ruled out, the chief aim should be earliest possible resumption of the patient's normal activities. Various methods, embracing drug treatment, physiotherapy, and in appropriate cases ergotherapy, are available for this purpose. If this fails, the physician must react as rapidly as possible to prevent the condition becoming chronic. Regard should be had for the various psychosocial factors which interfere with the healing process, and a method should be adopted which is no longer based on the classic biomedical model but on a bio-psycho-social approach as proposed by Waddell. If necessary the patient should be referred to a specialist (rheumatologist, rehabilitation, orthopedist etc). Back pain is extremely widespread in the population at large and is a frequent reason why people consult a physician. On these grounds the primary care physician has a key role to play in the initial workup and also in the acute, subacute or chronic stage of the evolution. This review of the principles which should guide the practical approach to the back-pain patient is intended to aid the practitioner in his tasks of diagnosis and therapy.

Combined Modality Therapy↗
PubMed1998

Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside.

Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly offer appropriately modified duties can reduce time lost per episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches to back pain in the workplace suggest that a combination of all these approaches, in a coordinated workplace-linked care system, can achieve a reduction of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings.

Absenteeism↗
PubMedDate not supplied

Dependent HIV incidences in back-projection of AIDS incidence data.

Techniques for reconstructing plausible HIV incidence curves from AIDS incidence data are called methods of back-projection, or back-calculation. Approaches to back-projection tend to make the simplifying assumption that the quarterly HIV incidences are independent, which is not even approximately true. Here we investigate whether smoothed non-parametric back-projection based on this simplifying assumption gives sensible back-projections and appropriate measures of precision for these reconstructed HIV incidence curves. Simple models for HIV transmission are shown to have much greater variation than the corresponding non-homogeneous Poisson process arising from the independence assumption. Nevertheless, bearing in mind that the objective is to reconstruct the HIV epidemic curve for the current epidemic, it is argued that such back-projection does give sensible HIV curves. This conclusion is supported by a simulation study, which also finds that confidence intervals for the HIV incidences are wider for transmission data than those determined from independent Poisson data.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Reticulospinal and reticuloreticular pathways for activating the lumbar back muscles in the rat.

These experiments tested hypotheses about the logic of reticulospinal and reticuloreticular controls over deep back muscles by examining descending efferent and contralateral projections of the sites within the medullary reticular formation (MRF) that evoke EMG responses in lumbar axial muscles upon electrical stimulation. In the first series of experiments, retrograde tracers were deposited at gigantocellular reticular nucleus (Gi) sites that excited the back muscles and in the contralateral lumbar spinal cord. The medullary reticular formation contralateral to the Gi stimulation/deposition site was examined for the presence of single- and double-labeled cells from these injections. Tracer depositions into Gi produced labeled cells in the contralateral Gi and Parvocellular reticular nucleus (PCRt) whereas the lumbar injections retrogradely labeled cells only in the ventral MRF, indicating that separate populations of medullary reticular cells project to the opposite MRF and the lumbar cord. In the second series of experiments the precise relationships between the location of neurons retrogradely labeled from lumbar spinal cord depositions of the retrograde trace, Fluoro-Gold (FG) and effective stimulation tracks through the MRF were examined. The results indicate that the Gi sites that are most effective for activation of the back muscles are dorsal to the location of retrogradely labeled lumbar reticulospinal cells. To verify that cell bodies and not fibers of passage were stimulated, crystals of the excitatory amino acid agonist, N-methyl-D-aspartate (NMDA) were deposited at effective stimulation sites in the Gi. NMDA decreased the ability of electrical stimulation to activate back muscles at 5 min postdeposition, indicating a local interaction of NMDA with cell bodies at the stimulation site. In the third series of experiments, electrical thresholds for EMG activation along a track through the MRF were compared to cells retrogradely labeled from FG deposited into the cervical spinal cord. In some experiments, Fast Blue was also deposited into the contralateral lumbar cord. Neurons at low threshold points on the electrode track were labeled following cervical depositions, indicating a direct projection to the cervical spinal cord. The lumbar depositions, again, labeled cells in MRF areas that were ventral to the locations of effective stimulation sites, primarily on the opposite side of the medulla. In addition, the lumbar depositions back-filled cells in the same cervical segments to which the Gi neurons project. These results suggest that one efferent projection from effective stimulation sites for back muscle activation is onto propriospinal neurons in the cervical cord, which in turn project to lumbar cord levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2000

[Measuring disability of patients with low-back pain--validation of a German version of the Roland & Morris disability questionnaire].

INTRODUCTION: In this study three instruments measuring disability of patients with low-back pain are presented and evaluated: (1) the Behinderungsfragebogen (RM) - a German version of the Roland & Morris disability questionnaire (RDQ) (2) a numerical rating scale measuring disability in general and (2) eight numerical rating scales measuring specific dimensions of disability (standing, sitting, walking, driving a car, carrying light loads, carrying heavy loads, sleeping, and sexual intercourse). METHODS: The psychometric evaluation, including the item analysis, test reliability, test validity, and responsiveness of the instruments, is based on two samples. Sample A comprises 345 patients with low-back pain: 282 of these patients took part in the Swiss multicentre intervention study testing the effectiveness of in-patient rehabilitation of sub-chronic and chronic low-back pain under an integrative group treatment program. The instruments were administered at different times in the therapeutic process (t1: at hospital admission; t4: follow-up after one year). 63 patients were hospitalized (orthopedic or rheumatological units) for medical examinations (myelography or infiltration of facets) or rehabilitation of low-back pain. The instruments were administered twice within 24 h to measure test-retest correlation. In order to determine the psychometric parameters as accurately as possible, the two samples were examined jointly. Sample B is composed of 41 patients with low-back pain participating in the study "Prädiktoren des Erfolgs bei stabilisierenden Wirbelsäuleneingriffen" (Success predictors of effectiveness of surgical interventions for spinal stabilization). RESULTS: All instruments proved to be generally reliable and valid (high or medium correlations with each other and with a German version of the Oswestry Disability Questionnaire) as well as responsive tools for measuring the momentary disability of patients with back pain. The psychometric examination of the test validity showed that patients' perceptions of their disability were influenced by their psychological well-being. The correlation between the 3 instruments and physical tests was low. The RM is not a homogeneous instrument. Factor analysis (principal component analysis, rotation Varimax) indicated 6 factors. Because of the small number of items for each factor it is not appropriate to treat RM in terms of dimensions of disability. CONCLUSIONS: The RM is an instrument measuring patients' perception of their disability that offers simple, fast practicability for patients and tester. The 2 rating scales: The 8 numerical rating scales measuring specific dimensions of disability (QL3) offer all the advantages of the numerical rating scale measuring disability in general (QL1) (simple instruction, high plausibility for the patients, and simple, fast practicability), but they provide more information about the patient's disability, which allows comparisons of disability at different times in the therapeutic process. Numerical rating scales are not suitable for patients with poor ability to abstract. For these patients it is necessary to use a questionnaire which asks concretely about what the patient can or cannot do (e. g. RM). Because of its better psychometric properties, the QL3 should be favored over the RM.

English Abstract↗
PubMed1996

[Multidisciplinary treatment program on chronic low back pain, part 3. Psychosocial aspects].

PROBLEM: The majority of authors agree today that psychosocial factors have more influence on a successful treatment of chronic back pain than other variables, in particular medical findings. Therefore treatments aim to integrate psychotherapeutic intervention in order to lessen emotional impairment, to change behavioral patterns (which advocate rest and the avoidance of physical activity), and to change cognitive attitudes and fears concerning exercise and work ability. Nevertheless, the interplay of cognitive measures and disability in treatment programs still remains an unclear issue. METHODS: Ninety disabled patients with chronic low back pain were admitted to an 8-week outpatient program of functional restoration and behavioral support. The program consisted of a pre-program (education, stretching and calisthenic exercises) and an intensive treatment period (physical exercises, back school education, cognitive behavioral group therapy, relaxation training, occupational therapy, vocational counseling), which took place for 5 weeks, 7 h a day, as an outpatient program. The targets of the psychological interventions were (a) to change maladaptive behavior (inactivity, social withdrawal) and increase the patient's activity level at home, (b) to alter maladaptive cognitions (somatization, catastrophizing, passive expectations concerning treatment) and to improve their own positive coping skills, (c) to identify and stop operant conditioned behavior, and (d) to prevent depressive symptoms and strengthen the level of emotional control. The program's philosophy encouraged the patients' active efforts to improve their functional status within a therapeutic environment that reinforced positive behavior traits conductive to getting well. The main therapeutic target was to facilitate a return to work. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This included variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and following 6- and 12-month intervals. RESULTS: In comparison with the initial values, a statistically significant improvement became evident in reducing pain, disability, depression, and psychovegetative signs (P < 0.001). Nearly all results remained stable at the 6- and 12-months examinations. Apart from these results, coping measurements demonstrated little improvement in the three factorial coping dimensions. By use of regression analyses, a differentiated description of psychosocial connections became apparent in three different ways of coping (catastrophizing, searching for information, cognitive control) and parameters of disability. Disability levels corresponded poorly with pain descriptions, physical impairment and coping dimensions. This result indicates that disability should be viewed as a separate component in assessing the patients' description of low back pain. CONCLUSION: An analysis of coping dimensions demonstrated that current cognitive measures might be too general to explain low back disability adequately. In addition, the results indicate that the use of the 'catastrophizing' factor as a separate variable is questionable, since it may simply be a symptom of depression. The relevance of coping as a sensitive parameter for change is also addressed. It is suggested that an alteration in coping strategies may be an important treatment effect, but is subject to individual prerequisites to maximize treatment response. Thus, future research must focus on the complex interactions between personality variables, environmental factors, and the coping demands posed by the specific nature of pain problems. A more lengthy evaluation of so-called 'fear-avoidance beliefs' in combination with 'disability' and coping dimensions could possibly lead to further treatment on the development of chronicity in chronic low back pain patients.

English Abstract↗
PubMed1971

Back muscle strength, lifting, and stooped working postures.

When lifting loads and working in a forward stooped position, the muscles of the back rather than the ligaments and bony structures of the spine should overcome the gravitational forces. Formulae, based on measurements of back muscle strength, for prediction of maximal loads to be lifted, and for the ability to sustain work in a stooped position, have been worked out and tested in practical situations. From tests with 50 male and female subjects the simplest prediction formulae for maximum loads were: max. load = 1.10 x isometric back muscle strength for men; and max. load = 0.95 x isometric back muscle strength - 8 kg for women. Some standard values for maximum lifts and permissible single and repeated lifts have been calculated for men and women separately and are given in Table 1. From tests with 65 rehabilitees it was found that the maximum isometric strength of the back muscles measured at shoulder height should exceed 2/3 of the body weight, if fatigue and/or pain in the back muscles is to be avoided during work in a standing stooped position.

Journal Article↗
PubMed1988

Esophageal intelligibility training: back consonants and clusters.

Seven esophageal speakers recorded multiple choice intelligibility lists loaded with words beginning with +BACK consonants and clusters. (A third of the items began with -BACK consonants and clusters). After recording several lists, they played them back and scored them, noting their errors for independent practice. After eight sessions (four weeks) of practice, prepractice and postpractice recordings were randomized and presented to a group of naive listeners. The group scores for the +BACK words improved significantly from prepractice to postpractice (84.1% to 90.6%). The average gain per session for +BACK practice was 0.81%, a result that was in close agreement with prior research. The average gain for the less-practiced -BACK items was 0.46%.

Adult↗
PubMed1995

In vitro changes in back vertex distance of chick and pigeon lenses: species differences and the effects of aging.

We have used a scanning laser technique to measure in vitro changes in back vertex distance of chick and pigeon lenses. Enucleated eyes were dissected, leaving the lens naturally suspended by the ciliary body and intraocular muscles. Ray tracing techniques were used to measure the resting back vertex distance of the lenses by passing a laser beam through the lens and scanning it across the pupillary aperture. The pupil diameter was measured videographically. The measurements were repeated while the intraocular muscles were pharmacologically stimulated with increasing concentrations of either nicotine or carbachol. Drug stimulation caused changes in pupil diameter and changes in the back vertex distance of the lenses. These experiments were conducted on the eyes of young chicks, young pigeons, and on the eyes of three pigeons older than 10 yr. The lenses from the eyes of the old pigeons had the greatest resting back vertex distance, followed by those of the young pigeons and finally those of the young chicks. Lenses from the eyes of young chicks and young pigeons underwent similar drug-induced changes in back vertex distance, but the lenses from old pigeon eyes showed an almost complete absence of such changes. Further, we demonstrated that, just as in the chick eye, lenticular changes in pigeon eyes are due to a contraction of the iris muscle. This is evident because after the iris has been removed the lens undergoes no change in back vertex distance during stimulation. We conclude with a discussion of the lenticular accommodative ability of the pigeon eye with reference to the recently reported accommodative mechanism of the chick eye and a comparison of chick and pigeon iris morphology.

Accommodation, Ocular↗
PubMed1995

Exercise, posture, and back pain during pregnancy.

In this article the effect of exercise on pregnancy-related back pain is reported. Sixty five pregnant volunteers were included in the study, of whom 27 were enrolled in exercise classes designed according to Canadian guidelines, and 38 acted as sedentary controls. Back pain and functional limitations were assessed every 4 weeks during pregnancy and 4 months postpartum by questionnaires. No significant differences in back pain or functional limitations reported by the two groups were found. The biomechanical factors measured in this study, weight, back posture, and laxity, were unable to explain most of the variation in pain reported. RELEVANCE: This study showed that fitness classes for pregnant women designed according to Canadian guidelines had no detectable effect on back pain during pregnancy. If prevention of pregnancy-related back pain is sought through exercise, design of fitness programmes for pregnant women should be reconsidered.

Journal Article↗
PubMed1982

Reduction of disruptively loud voice volume using a "tok-back" device.

This study addressed the disruptively loud voice volume of three adult mentally retarded subjects. A reduction in voice volume was affected through the use of the "tok-back" device, a crescent-shaped device made of lightweight plastic, which when fitted over the face covers the mouth and ears and provides feedback on sounds emitted. In Experiment 1, the tok-back was used with two subjects as an aversive consequence to disruptive screaming. The tok-back was placed over the face after each scream and remained in place until the end of a specified period of quiet. Using a multiple baseline across settings design with each subject, results showed a substantial reduction in screaming following the implementation of the tok-back condition. A multi-element design was used in Experiment 2 to compare the effects of baseline, cueing and tok-back conditions on percent of correct responses, responses given in a soft volume, to simple conversational questions with the third subject. Results showed the tok-back condition to result in a higher percent of correct responding then did either the baseline or cueing conditions.

Adolescent↗
PubMed2005

Effectiveness of the stent pull-back technique for nonaorto ostial coronary narrowings.

Coronary stenting of nonaorto ostial coronary lesions is challenging because of plaque shift into the main vessel, triggering the use of additional stents. Furthermore, inappropriate coverage of the ostium of the side branch increases the risk of restenosis and target vessel revascularization (TVR). To improve the treatment of nonaorto ostial coronary lesions with a novel interventional technique, we tested the hypothesis that inflating a balloon in the main vessel before stenting the side branch (stent pull-back technique) will limit plaque shifting and reduce the use of additional stents. In addition, proper coverage of the side branch ostium may also reduce 8-month TVR. A case-control design with 100 consecutive patients who underwent drug-eluting stent placement was performed; 55 patients were treated with the stent pull-back technique and 45 patients with a conventional stent technique. Procedural success was 100% for the 2 techniques. The use of additional stents was reduced in the stent pull-back group compared with the conventional stent group (2% vs 18%, p = 0.007). A tendency toward lower ostial miss was also observed in the stent pull-back group (4% vs 13%, p = 0.11). The incidence of in-hospital and 30-day cardiac events was similar between the 2 groups. TVR was lower in the stent pull-back group compared with the conventional group (5% vs 20%; p = 0.03). In conclusion, the stent pull-back technique improves the percutaneous treatment of nonaorto ostial coronary lesions. The technique is associated with a lower use of additional stents and improved clinical outcome, reducing TVR at 8 months of follow-up.

Case-Control Studies↗
PubMed2004

Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury.

OBJECTIVE: To evaluate the functional outcomes for people with a recent spinal cord injury (SCI) when using 3 different back-support options. DESIGN: Repeated-measures within-subject comparison. SETTING: Rehabilitation center. PARTICIPANTS: Twenty-seven manual wheelchair users with recent SCI. INTERVENTIONS: Three types of wheelchair back supports--a standard sling upholstery, a Jay J2 back, and a Pindot PaxBac--were used by each participant to evaluate performance of 4 functional tasks. MAIN OUTCOME MEASURES: Functional tasks included timed forward wheeling, ramp ascent, distance for forward vertical reach, and 1-stroke push. Product satisfaction was also rated. RESULTS: For most participants, best performance for each task varied with back support used. Significant differences in functional performance were found for the reaching activity (P=.01), with greater reach when the J2 was used. Satisfaction ratings also differed significantly (P=.017), with participants indicating greater satisfaction with the J2. Participants' choice of back support varied and did not consistently correspond with best performance. CONCLUSIONS: Except for reaching, performance of functional activities did not differ depending on back support used. Objective evaluation of reaching ability may assist in product decision making. Inclusion of a consistent battery of functional tasks could provide a standardized reference point for clients' subjective evaluations.

Adolescent↗