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At least 163 records · Page 9Linked to original sources
PubMed2000

Between-days reliability of subjective and objective assessments of back extensor muscle fatigue in subjects without lower-back pain.

BACKGROUND: It is important to evaluate the reliability of common used methods of examining muscle fatigue from the lower back since the methods are used in patient evaluation. METHODS: To establish between-days reliability, ten subjects without lower-back pain performed a Sorensen test, a prone test for back extensor muscles against gravity, on three separate days. EMG was recorded from the L1 and L5 of the back extensor muscles. Fatigue was subjectively rated using a Borg CR-10 scale. Intraclass correlation coefficient, standard error of measurement and coefficient of variation were calculated from a one-way ANOVA. Percent agreement was also calculated. RESULTS: The study revealed good reliability for the slope for the total time (ICC 0.65-0.90), the initial and end median frequency (ICC 0.75-0.89), median frequencies at Borg ratings of three (ICC 0.63-0.88), five (ICC 0.62-0.84) and seven (ICC 0.67-0. 87), endurance time (ICC 0.89). The Borg ratings of the first minute agreed better than those of the second and the third. The Borg ratings at the second and the third test agreed to 40-80%, indicating a need for a practice session. CONCLUSION: The protocol used for assessing fatigue in the back extensor muscles proved to be reliable and is recommended for further use.

Adult↗
PubMed2001

Short-term outcomes of a back school program for chronic low back pain.

OBJECTIVE: To assess the short-term outcome of a back school program for patients suffering from chronic, nonspecific low back pain (LBP). DESIGN: Quasi-experimental cohort study with a waiting list control group. SETTING: Dutch rehabilitation department. PARTICIPANTS: Experimental group (n = 14) participating in the back school program and a waiting list control group (n = 10). INTERVENTION: A back school program aimed to achieve optimal functional capacity and functional health status by teaching participants to react appropriately to overload signals. MAIN OUTCOME MEASURES: Functional capacity assessed by the RAND-36 instrument; functional health status assessed by the Roland-Morris Disability Questionnaire; and static and dynamic lifting capacity, endurance, and range of motion assessed by objective measures. RESULTS: The experimental group significantly improved in functional capacity and functional health status, with a large power, likely attributable to adequate reactions to signals of overload. Significant differences existed between the 2 groups, with large powers for the main outcomes. CONCLUSION: The back school program improved the functional capacity and functional health status of patients with chronic, nonspecific LBP.

Activities of Daily Living↗
PubMed1995

The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project.

BACKGROUND: Patients with back pain receive quite different care from different types of health care practitioners. We performed a prospective observational study to determine whether the outcomes of and charges for care differ among primary care practitioners, chiropractors, and orthopedic surgeons. METHODS: Two hundred eight practitioners in North Carolina were randomly selected from six strata: urban primary care physicians (n = 39), rural primary care physicians (n = 48), urban chiropractors (n = 32), rural chiropractors (n = 32), orthopedic surgeons (n = 29), and primary care providers at a group-model health maintenance organization (HMO) (n = 28). The practitioners enrolled consecutive patients with acute low back pain. The patients were contacted by telephone periodically for up to 24 weeks to assess functional status, work status, use of health care services, and satisfaction with the care received. RESULTS: The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors. CONCLUSIONS: Among patients with acute low back pain, the outcomes are similar whether they receive care from primary care practitioners, chiropractors, or orthopedic surgeons. Primary care practitioners provide the least expensive care for acute low back pain.

Acute Disease↗
PubMed2005

Myths and perceptions of back pain in the Norwegian population, before and after the introduction of guidelines for acute back pain.

AIM: Deyo's seven "myths" about back pain are based on common misconceptions of causality and therapy of back pain. These myths were alive in the Norwegian population in 2001; this report investigates whether this is true two years later. METHODS: A representative sample of the Norwegian population in 2003 (n = 1,014) were asked to rate their agreement with the seven myths. RESULTS: There is significantly less acceptance of all myths except "Most back pain is caused by injuries or heavy lifting" in 2003. Myths concerning the use and importance of X-ray were still common: 43% agreed that "X-ray and newer imaging tests can always identify the cause of pain" and 50% that "Everyone with back pain should have a spine X-ray". Low level of education is still associated with high acceptance of the myths, but the changes from 2001 are most pronounced for these groups. CONCLUSION: Perceptions in the general population in Norway are slowly changing to be more in accordance with existing knowledge on accurate behaviour and treatment of back pain. This may be related to introduction of new evidence-based guidelines. The difference between educational groups is reduced, but is still a challenge to health professionals and health authorities.

Acute Disease↗
PubMed2006

What is "the good back-consultation"? A combined qualitative and quantitative study of chronic low back pain patients' interaction with and perceptions of consultations with specialists.

OBJECTIVE: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ("The Good Back-Consultation"). DESIGN: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded. SUBJECTS: Thirty-five patients with chronic low back pain referred to a specialist. METHODS: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method. RESULTS: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of "The Good Back-Consultation" was that the specialist took the patient seriously. CONCLUSION: The findings may represent an important potential for enhancing clinical communication with patients.

Adult↗
PubMed1995

Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population.

Two studies using retrospective questionnaires were conducted to obtain epidemiological information from nursing personnel (n = 1134) and among an age- and gender-matched cross-section of the general population (n = 315). The point and annual prevalence of back pain did not differ between the two sample groups. Nurses demonstrated a greater annual incidence of back pain (14.7%, compared to 11.5% in non-nurses). The point prevalence of back pain increased with age in both sample groups. Nurses considered patient-handling tasks instrumental in the onset of back pain symptoms. Comparison of results with those obtained from a similar study published in 1983 indicated an increase of almost 40% in the prevalence of back pain symptoms in nurses, although the linearity of the rise was not ascertained. The implementation of guidelines on the manual handling of loads has led to revised training procedures and these may have influenced the epidemiological findings.

Adolescent↗
PubMed2002

The back home trial: general practitioner-supported leaflets may change back pain behavior.

STUDY DESIGN: A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain. OBJECTIVE: To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function. SUMMARY OF BACKGROUND DATA: Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals. METHODS: For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discretely recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behavior, and function. RESULTS: In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P = 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P = 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested. CONCLUSIONS: This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.

Acute Disease↗
PubMed2004

Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain.

OBJECTIVE: To obtain data on patient demographics, clinical practices, and long-term outcomes for patients with chronic low back pain treated with implantable drug-delivery systems. DESIGN: The National Outcomes Registry for Low Back Pain collected data at baseline, trialing, implant (or decision not to implant), and at 6- and 12-month follow-ups. Data were collected at all time points, regardless of implant status. OUTCOME MEASURES: Numeric pain ratings and Oswestry Low Back Pain Disability scores from implanted patients were compared among baseline and 6- and 12-month follow-ups. Patients were also asked to rate their quality of life and satisfaction with the therapy. RESULTS: Thirty-six physicians enrolled 166 patients to be trialed for drug-delivery systems. The trialing success rate was 93% (154 patients). In all, 136 patients (82%) were implanted. In the implant group, numeric pain ratings dropped by more than 47% for back pain and more than 31% for leg pain at the 12-month follow-up. More than 65% of implanted patients reduced their Oswestry scores by at least one level at their 12-month follow-ups compared with baseline. At 12-month follow-ups, 80% of implanted patients were satisfied with their therapy and 87% said they would undergo the procedure again. CONCLUSIONS: Current clinical practices related to trialing of drug-delivery systems resulted in the majority of patients successfully trialed. At 12-month follow-ups, implanted patients experienced reductions in numeric back and leg pain ratings, improved Oswestry scores, and high satisfaction with the therapy.

Adult↗
PubMed2004

Back muscle fatigue during intermittent prone back extension exercise.

UNLABELLED: The purpose of this study was to estimate the level of muscular activation and muscle fatigue of the low back muscles during the performance of an intermittent prone back extension (PBE) exercise. Forty-one healthy students (24 males and 17 females) lying prone on a bench with the legs fixed performed two maximal voluntary contractions (MVC) in extension, a maximum of 100 repetitions of an intermittent PBE exercise immediately followed by a final MVC in extension. In addition, 12 subjects (11 males and one female) repeated the PBE exercise but with the addition of a 45-N weight on the back. The PBE exercise consisted of a task broken into four 1-s segments, while lying prone on a bench (10 degrees below horizontal): (1) raising the trunk to a horizontal position; (2) holding the trunk in the static phase (10 degrees above horizontal); (3) returning to the original position; and (4) resting on the bench. Electromyography (EMG) was used to measure the level of muscle activity (erector spinae (ES), gluteus maximus (GM), hamstrings (HA)) relative to the maximum voluntary EMG (MVE). RESULTS: Most of the subjects (34 out of 41) completed the 100 repetitions without excessive muscle fatigue according to the post-exercise MVC values. The intermittent PBE increased fatigue in the lumbar and hip extensor muscles in terms of: (1) a decrease in the MVC; (2) an increase in the level of muscle activation; and (3) a decline of the median frequency (MF). There was no gender difference in all EMG measurements. The level of muscle activation in the hip extensors (GM and HA) was associated with task failure (number of repetitions <100) for some subjects and the addition of a weight of 45 N had more impact on HA than ES. In conclusion, the PBE exercise as performed in the present study (including rest intervals), although not very strenuous for our healthy subjects, seems an adequate exercise to measure and train the aerobic capacity of the back muscles. However, to train specifically the back muscles, the exercise must be adjusted to avoid task failure due to possible hip extensor fatigue.

Adult↗
PubMed2000

Individual and occupational determinants of low back pain according to various definitions of low back pain.

OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.

Adult↗
PubMed1997

Reanalysis of the occurrence of back pain among construction workers: modelling for the interdependent effects of heavy physical work, earlier back accidents, and aging.

OBJECTIVES: To re-examine the relation between heavy physical work and the occurrence of sciatic pain among construction workers reported previously to be absent in an epidemiological study. METHODS-Poisson log linear regression was used to model for the frequency of sciatic pain among concrete reinforcement workers and maintenance house painters with adjustment for the interactive effects of earlier back accidents and aging that modified the relation. RESULTS: Concrete reinforcement work not only had a direct effect on the frequency of sciatic pain, but it also contributed significantly to the risk indirectly through earlier back accidents. The risk of sciatic pain increased from age 25 to 54 in a different manner for a worker depending on his occupational group and record of back accidents. CONCLUSIONS: Epidemiological studies on low back pain need to be analysed with sound methodology. This is important in view of future meta-analyses that will be performed for the purpose of providing guidelines on the prevention of back disorders in heavy physical work.

Accidents, Occupational↗
PubMed1999

Back care instructions in physical therapy: a trend analysis of individualized back care programs.

BACKGROUND AND PURPOSE: The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. SUBJECTS: Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. METHODS: Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. RESULTS: Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. CONCLUSION AND DISCUSSION: The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.

Activities of Daily Living↗
PubMed2000

Fibro-fatty nodules and low back pain. The back mouse masquerade.

BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. METHODS: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs.

Bursitis↗
PubMed2000

[Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective; traction not effective; results of systematic reviews].

OBJECTIVE: To inventory the current state of the art regarding the effectiveness of conservative treatment of chronic low back pain. DESIGN: Systematic reviews. METHOD: The relevant literature from the period January 1966-September 1999 was retrieved via Medline, Embase, PsychLit and the Cochrane Library and via reference lists in the articles found. The methodological quality of the studies was assessed using criteria for internal validity. On the basis of the number of examinations, their quality and the consistency of the findings, conclusions were subdivided into four levels of strength of scientific evidence. RESULTS: There was strong evidence that exercise therapy and multidisciplinary treatment programmes were effective in chronic low back pain, and moderate evidence that non-steroidal anti-inflammatory drugs (NSAIDs), back schools and behavioural therapy were effective in chronic low back pain. There was also strong evidence that traction was not effective in chronic low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?

BACKGROUND: Spinal signs found in association with atypical chest and abdominal pain may suggest the pain is referred from the thoracic spine. However, the prevalence of such signs in these conditions has rarely been compared with that in those without pain. In this study, the prevalence of spinal signs and dysfunction in patients with back, chest and abdominal pain is compared with that in pain free controls. The aim of the study is to determine the significance of spinal findings in patients with such pain. METHODS: A general practitioner blinded to the patients' histories performed a cervical and thoracic spinal examination on general practice patients with back, chest and/or abdominal pain and on controls without pain. Thoracic intervertebral dysfunction was diagnosed on the basis of movement and palpation findings. RESULTS: Seventy-three study patients plus 24 controls, were examined. For cervical spinal signs, pain in the back, chest and/or abdomen was associated with pain with active movements and overpressure at end range and with loss of movement range. For thoracic spinal signs, this association held for pain with active movements and overpressure, but not with loss of movement range. The prevalence of thoracic intervertebral dysfunction was 25.0% in controls, 65.5% with chest/abdominal pain, 72.0% with back pain and 79.0% with back pain with chest/abdominal pain. This prevalence was higher with chest pain than with abdominal pain. CONCLUSIONS: The results show an association, but not a causal link between thoracic intervertebral dysfunction and atypical chest/abdominal pain. A spinal examination should be performed routinely assessing these conditions. The minimum examination for the detection of intervertebral dysfunction is testing for pain with spinal movements and palpation for tenderness. The interpretation of positive signs requires knowledge of their prevalence in pain free controls and in patients with visceral disease.

Abdominal Pain↗
PubMed2002

Back Performance Scale for the assessment of mobility-related activities in people with back pain.

BACKGROUND AND PURPOSE: Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. SUBJECTS: The participants were 288 patients with long-lasting musculoskeletal pain. METHODS: The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. RESULTS: Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. DISCUSSION AND CONCLUSION: The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.

Adult↗
PubMed1991

Low back pain--back care through proper lifting technique.

The study was designed to evaluate the level of knowledge of the subjects about back care and proper lifting techniques. Two groups of subjects were taught correct lifting method and back care through practical demonstrations and illustrated diagrams. The subjects' knowledge was measured pre- and post-test, using written and practical tests. Subjects with low back pain and those without back pain both benefited from the training. The need for physiotherapists to teach back injury prevention to the general populace was highlighted.

Adolescent↗
PubMed1993

[Low back pain and back exercise].

In the last decennium, information regarding the efficacy of back exercises in the treatment of back pain has increased. It has been shown that exercise programs in acute back pain prevents chronicity, and that back exercises in chronic patients decreases back pain and disability. It is primarily the high intensity and duration of the exercise program which is the most important for a successful result rather than the design of the exercises.

Exercise↗