PubMed · 14892092
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J C IVINS. 1951-12-05. Backache.. https://pubmed.ncbi.nlm.nih.gov/14892092/
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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.
STUDY DESIGN: A 5-year follow-up of a randomized, controlled trial. OBJECTIVE: To evaluate the long-term health and economic consequences of a cognitive behavioral intervention. SUMMARY OF BACKGROUND DATA: Linton and Andersson (Spine 2000;25:2825-31) provide 1 of only a few studies on the preventive effects of a cognitive behavioral intervention. The present study is a 5-year follow-up. METHODS: In the original study, 213 participants were randomized to the cognitive-behavioral group intervention or to usual care plus information on self-care (information comparison group). Of participants, 97% completed a follow-up questionnaire 5 years after the intervention, and supplemental records were obtained from the National Insurance Authority. RESULTS: The cognitive behavioral group had significantly less pain, was more active, enjoyed better quality of life, and had better general health relative to the information comparison group. There was no difference on health care use. The risk of long-term sick leave was 3 times higher in the information comparison group. The cognitive behavioral group had significantly less lost productivity costs and a lower total cost/y/person (16,514 Swedish kronor) compared to the information comparison group (45,990 Swedish kronor). CONCLUSIONS: A cognitive-behavioral group intervention produces long-term health and economic benefits. Usual medical care might be improved considerably by implementing these psychologic methods.
OBJECTIVE: To describe how patients with back pain are usually handled at a health centre. DESIGN: Retrospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: All patients seen for back pain in the centre's general medical consultations during 2003. MAIN MEASUREMENTS: Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. RESULTS: Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). CONCLUSIONS: Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy.