PubMed · 13978418
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P SOUPLET, J BOULET-GERCOURT. 1962-09-25. [Organic backache functional backache].. https://pubmed.ncbi.nlm.nih.gov/13978418/
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The diagnosis of juvenile spondyloarthritis (JSA) is rarely entertained in young children who present with back and leg pain. We present a case of a 6-year-old male who presented with a 3-year history of severe back and leg pain and a positive Gower's sign, and was given a presumed diagnosis of muscular dystrophy. Presenting serologic evaluation included a mildly elevated sedimentation rate and C-reactive protein (CRP). Computed tomography of the pelvis demonstrated large erosions affecting both sacro-iliac joints. Despite the unusually young age of this patient, ankylosing spondylitis seemed the most plausible diagnosis. Following rheumatological evaluation and treatment for JSA, he showed significant clinical improvement. His disease, however, has not entirely remitted with signs of enthesitis at the Achilles tendon and knees. We present this case to illustrate that JSA could account for symptoms at an early age and not considering it could lead to multiple medical visits and diagnoses. To our knowledge, based on a search of the World literature, this would appear to be the youngest case of JSA reported with demonstrable severe sacroiliitis.
A technique-training approach has traditionally been used to address the problem of back pain associated with patient handling. This project aimed to investigate whether different levels of safety culture, based on competency-based training, resulted in different behaviour (physical and cognitive) for patient handling tasks. Sixteen healthcare organisations in the UK participated from the acute and primary healthcare sectors. Archival data for each organisation were benchmarked against the Royal College of Nursing competencies for manual handling. Behavioural data were collected on two patient handling tasks: (1) sitting-to-standing and (2) repositioning-in-sitting using observations (postural analysis) and interviews (verbal protocol analysis). The data were analysed for each organisation and then grouped by task and method into larger data sets. These data sets were triangulated using the key decision-making points (from the interview data) as the framework. The results showed that in organisations with a more positive safety culture the nursing staff demonstrated more complex decision-making about the patient handling tasks and had lower levels of associated postural risk.
Promoting a physically active lifestyle whilst optimizing the spinal load at a young age seems to be advocated within the scope of early back pain prevention efforts. The present study aimed at evaluating the effects of combining a back care program with a physical activity promotion program in elementary schoolchildren. In a pre-post design over two school years, back care knowledge, back care behavior, fear avoidance beliefs and back pain reports were evaluated in children classified into three categories--those who received a back care and a physical activity promotion program (n=190), those who received only a back care program (n=193) and those in a control group (n=172) (mean age at baseline: 9.7 years+/-0.7). Physical activity levels were evaluated in a sub-sample of 26 pupils in each group. The back care program and the physical activity promotion program were both comprehensive ones. In both intervention groups, the scores for back care related knowledge and back care behavior were significantly higher than the control group. The increase in the sum score for back care behavior was significantly higher in the back care group than in the back care plus physical activity promotion group. Significant interaction effects showed an increase in fear-avoidance beliefs between pre- and post-tests in the control group, significantly different from the better scores in both intervention groups. Interaction effects were not significant for pain reports. In the back care plus physical activity promotion group, the daily moderate to vigorous physical activity levels decreased by 8 min per day while a decrease by 31 min per day was found in the back care group and a decrease by 36 min per day in the control group. However, group differences were not significant. The present study findings favor the addition of a physical activity promotion program to a back care program in elementary schools within the scope of early back pain prevention efforts. However, the findings also emphasize the disadvantages of implementing both programs simultaneously in a school curriculum that is already full.