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PubMed2005

Low back pain, work absenteeism, chronic back disorders, and clinical findings in the low back as predictors of hospitalization due to low back disorders: a 28-year follow-up of industrial employees.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study symptoms, chronic disorders, and clinical findings in the low back, and work absenteeism, as predictors of hospitalization. SUMMARY OF BACKGROUND DATA: Socioeconomic and lifestyle factors are associated with back-related hospitalization, but the significance in the working normal population of low back symptoms and clinical findings are not known. METHODS: The cohort (n = 902) was drawn in 1973 from among employees in the metal industry (n = 2,653). The data were collected by questionnaire and a structured clinical assessment by a physiotherapist. Weight was measured. A sum score of local and radiating low back symptoms (frequency during the past year on a 4-point Likert scale) was categorized as no/yes and no/infrequent/frequent. Local and radiating symptoms were considered also separately. The data were linked with those from the Finnish Hospital Discharge Register during 1973 to 2000. Logistic regression and the Cox proportional hazard models were used. RESULTS: As compared with persons without low back pain, those with frequent or radiating low back pain had an increased risk of hospitalization due to low back disorders (hazard rate ratio (HRR), 3.0; 95% confidence interval (CI), 1.4-6.5, and 3.7; 1.8-7.7, respectively) after adjustment for age, gender, and occupational class. Similarly, clinical findings (HRR, 2.4; 95% CI, 1.3-4.7), back-related absenteeism (HRR, 3.3; 95% CI, 1.6-6.7), and chronic low back disorders (HRR, 2.8; 95% CI, 1.5-5.4) predicted hospitalization. The associations persisted when further adjusted for smoking, body mass index, and distress symptoms at baseline. CONCLUSION: Frequent or radiating low back symptoms, chronic low back disorders, back-related work absenteeism, and having clinical findings in the low back predicted inpatient hospital care for low back disorders.

Absenteeism↗
PubMed2006

Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II.

STUDY DESIGN: Prospective inception cohort study. OBJECTIVES: To compare the clinical course of fear-avoidance beliefs in acute and chronic low back pain (LBP) and investigate the contribution of fear-avoidance beliefs to predict pain and disability after 1 year. SUMMARY OF BACKGROUND DATA: Fear-avoidance beliefs are involved in disability development. There is little knowledge on the development of fear-avoidance beliefs among different LBP subgroups. METHODS: Patients with acute (n = 123) and chronic (n = 50) LBP completed a comprehensive assessment, including the Fear-Avoidance Beliefs Questionnaire (FABQ), and were followed at 3, 6, 9, and 12 months. RESULTS: At baseline, patients with chronic LBP had significantly higher FABQ-scores for work (FABQ-Work) than patients with acute LBP (P < 0.001), and this difference remained unchanged over 1 year (P > 0.21). At baseline, there was no statistical significant difference in FABQ-scores for physical activity (FABQ-PA) between the two groups (P = 0.57). FABQ-PA scores decreased significantly over the first 4 weeks among patients with acute LBP during follow-up and remained unchanged thereafter, whereas in the chronic sample the FABQ-PA scores were unchanged throughout the first year (time effect, P < 0.001; and interaction effect, P < 0.001). In the acute sample, FABQ-Work predicted pain (P < 0.05) and disability at 12 months (P = 0.01). In the chronic sample, FABQ-PA predicted disability at 12 months (P = 0.03). The associations between the FABQ and pain/disability disappeared with distress included in the models. CONCLUSION: Patients with chronic LBP had more fear-avoidance beliefs for work than patients with acute LBP. There were small changes in fear-avoidance beliefs during the year of follow-up, except for a rapid decrease during the first month in the FABQ-PA in the acute sample. Fear-avoidance beliefs predicted pain and disability at 12 months after adjusting for socio-demographic and pain variables. Distress was a stronger predictor than fear-avoidance beliefs.

Acute Disease↗
PubMed1983

Low back pain.

Low back pain probably always will be a problem because of the anatomic arrangement of the lower spine and posture in standing and walking. However, during recent years, new attempts at diagnosis and treatment of this difficult problem have occurred, and it is now possible, in most cases, with a good history, physical examination, and diagnostic work-up to determine the cause of the problem. The injuries are still difficult to treat in many cases, but often with a thorough explanation to the patient about the underlying problem and mechanism of pain, and with use of the "back school" and conservative measures, most of the patients can continue on with daily activities. Formal surgery is playing less of a role in the treatment of back problems, with the development of various injections and percutaneous techniques. Still to be addressed, and where considerable effort and energy should be spent, is in the prevention of back problems with changes in daily habits and in increased awareness of ways to avoid back injuries.

Acute Disease↗
PubMed1998

Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.

OBJECTIVES: Because musculoskeletal pain is the second most frequent reason for seeking health care, the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis. STUDY DESIGN: A prospective study was conducted on consecutive patients with acute or subacute back pain, in which patients completed a screening questionnaire and were then followed up for 6 months to determine outcome. The primary outcome variable was accumulated sick leave. METHODS: One hundred forty-two consecutive patients were asked to complete a questionnaire designed for this study. This questionnaire contained 24 items concerning psychosocial aspects of the problem. Six months later, patients were contacted to complete outcome questions about accumulated sick leave. RESULTS: A total of 97% of the patients completed both questionnaires. Although patients, on average, improved greatly, 18% had 1-30 days and 20% had fewer than 30 days of sick leave during the follow-up period. Five variables were found to be the strongest predictors of sick leave outcome (fear-avoidance work beliefs, perceived improvement, problems with work function, stress, and previous sick leave), correctly classifying 73% of the patients as opposed to a chance rate of 33%. A total score was evaluated as a means of judging risk and found to be strongly related to outcome. CONCLUSION: Potent psychosocial risk factors associated with future sick absenteeism were identified. Because the total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations.

Acute Disease↗
PubMed1994

Back pain, sciatica and disability following first-time conventional haemilaminectomy for lumbar disc herniation. Use of "Low Back Pain Rating Scale" as a postal questionnaire.

To determine the value of "Low Back Pain Rating Scale" as a postal questionnaire, a retrospective study was undertaken of patients who had undergone first-time lumbar disc surgery 14-72 months previously. Rate of response was 86% (261/304). From the results, it was concluded that 87% of the patients felt that a satisfactory surgical outcome was obtained; 67% had minor or major functional restrictions of their daily activities; 65% experienced significant low-back symptoms in the period prior to follow-up examination; and 57% experienced sciatica. Thirty-seven patients were receiving pensions in the postoperative period due to continued back pain. "Low Back Pain Rating Scale" used as a postal questionnaire was found to be useful in determining general overall assessment status in patients who had undergone lumbar surgery. This evaluation method could be used as a quality control in future studies regarding this patient group.

Adult↗
PubMed2005

Discogenic pain in acute nonspecific low-back pain.

Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral disc sites with an obvious enhanced region in the posterior annulus of the disc on enhanced T1-weighted MR images was selected for intradiscal injection. When no enhanced region was detected, the most severely degenerated disc on T2-weighted MR images was selected. Acute nonspecific low-back pain with an improvement rate of 70% or higher 5 min after injection was judged to be discogenic. The clinical characteristics and pathogenesis of discogenic acute nonspecific low-back pain were investigated. Forty of the 55 patients (73%) had discogenic acute nonspecific low-back pain. As for the characteristics of patients, the mean age was 37 years, and onset occurred upon casual daily movements in 18 patients (45%). Nineteen patients (48%) had bilateral low-back pain, and 29 patients (73%) had no tenderness in the paravertebral muscles. On plain X-ray radiograms, degeneration of the disc was normal or mild in 36 patients(91%). On the discograms, a radial tear extending to the posterior annulus was noted in all patients, but epidural leakage was seen only in six patients (15%). The degree of disc degeneration on T2-weighted MR images (Gibson's classification) was grade 3 in 30 patients (75%). Gadolinium-DTPA enhanced T1-weighted MR images showed an obvious enhanced region in the posterior annulus of the intervertebral disc in 19 patients (48%). As for the clinical characteristics of discogenic acute nonspecific low-back pain, the relatively young adult patients had no tenderness in the paravertebral muscles, and showed moderately degenerated intervertebral discs. The pathogenesis of discogenic acute nonspecific low-back pain is mostly considered to be a re-rupture in an asymptomatic ruptured region in the posterior annulus, repaired by granulation tissue, in a moderately degenerated intervertebral disc with a radial tear.

Acute Disease↗
PubMed2006

Decreased limits of stability in response to postural perturbations in subjects with low back pain.

BACKGROUND: Low back pain is associated with abnormal movement strategies due to changes in neuromuscular control. A plausible contributing factor to low back pain is poor control of trunk muscles, thus understanding motor control alterations in this population can guide rehabilitation. Quantification of postural responses following support surface translations is one way to examine motor control impairments in people with low back pain. METHODS: Twenty-four healthy subjects [mean 33 (SD 11) years] who had no low back pain and 26 subjects [mean 39 (SD 13) years] with chronic, recurrent low back pain were instructed to stand with feet placed on separate force plates, which were mounted on a moveable platform. The platform was translated unexpectedly in one of 12 directions for a total of 72 trials. For both the sagittal and frontal planes, the net center of pressure displacement was derived and the total body center of mass was calculated by combining kinematic and anthropometric data. FINDINGS: For sagittal plane responses, subjects with low back pain had reduced and delayed sagittal plane center of pressure responses (P<0.01) compared to the subjects without low back pain. In contrast, the sagittal plane center of mass responses were larger in magnitude (P=0.03) yet similarly delayed in onset (P=0.04) for the low back pain group. Frontal plane responses did not differ between groups. INTERPRETATION: Subjects with low back pain have altered automatic postural coordination, both in terms of magnitude and timing of responses, indicating alterations in neuromuscular control.

Adult↗
PubMed1958

LOW BACK pain.

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Back Pain↗
PubMedDate not supplied

LOW BACK pain.

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Back Pain↗
PubMed2002

Patient-oriented assessment of back pain in pregnancy.

Back pain is a common symptom in women during the last period of pregnancy. Only a few studies using validated patient-oriented tools have been undertaken on this topic. We report on a multicenter study on back pain in women during the last period of pregnancy, which involved seven Italian institutions. Seventy-six women in their 8th and 9th months were studied using the Italian validated version of the Roland questionnaire -- a disease-specific patient-oriented tool for low back pain. Sixty-two percent of the women had gone through at least one previous pregnancy, and clinical data concerning both the period before all pregnancies and the period before the current pregnancy were acquired. The study found that 31% of the women had no back pain symptoms (Roland score 0), 40% scored from 1 to 4, 21% scored from 5 to 10, and 8% scored more than 10. With regard to the predictive factor, history of back pain and sciatica before the pregnancy were found to be associated with occurrence of back pain symptoms during pregnancy. Unexpectedly, our results showed that male sex of the fetus seems to be related to occurrence of back pain symptoms during pregnancy. However, back pain was not associated with having gone through previous pregnancies, nor was the Roland score related to the weight before pregnancy or to increment of weight during pregnancy. Evaluation of the patient's perspective made it possible to identify predictive factors for occurrence of back pain, thereby furnishing important information for the clinical approach to pregnancy.

Adult↗
PubMed2006

Preventing chronic back pain: evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain.

OBJECTIVE: For long-term treatment effects, patients with subacute back pain need to adhere to treatment recommendations beyond the prescribed exercise treatment. Adherence rates are as low as 30%, so we developed a cognitive-behavioural training programme to enhance patients' self-efficacy, maximise severity perceptions and reduce barrier perceptions. METHOD: A 2 x 4 (group x time) repeated measurement design was applied. Forty-seven patients with non-specific, subacute back pain were randomly assigned to a training group (exercise treatment plus cognitive-behavioural training programme) or a control group (exercise treatment only). RESULTS: Repeated measures ANOVA revealed significant main and interaction effects; the training group reported enhanced self-efficacy and severity perceptions, reduced barrier perceptions, and self-reported that they exercised more often than the control group over time. However, no group differences regarding pain intensity emerged. CONCLUSION: Our findings demonstrate that a short and inexpensive cognitive-behavioural training programme is an effective tool to enable back pain patients to follow treatment recommendations on a regular basis. PRACTICE IMPLICATIONS: The short and simple intervention can easily be conducted by personnel, other than psychologists, i.e., physiotherapists.

Adult↗
PubMed2006

Screening for yellow flags in first-time acute low back pain: reliability and validity of a Norwegian version of the Acute Low Back Pain Screening Questionnaire.

OBJECTIVES: The purpose of this study was to evaluate the reliability and construct and predictive validity of the Norwegian version of the Acute Low Back Pain Screening Questionnnaire (ALBPSQ). METHODS: A prospective study with a 12-month follow-up was conducted on 123 patients with acute low back pain (LBP) seeking help in primary health care for the first time and 50 patients with chronic LBP for more than 3 months. RESULTS: Test-retest reliability was high with intraclass correlation coefficients of 0.90, minimal detectable change of 12 points (of a total score of 210), and coefficient of variation of 4%. Internal consistency was 0.95. Principal-components analysis revealed 3 factors explaining 49% of the variance. The ALBPSQ score correlated highly (r> or =0.60) with disability variables, moderately (0.30<r<0.60) with age, pain intensity, and psychologic, questionnaires, and weakly (r< or =0.30) with most sociodemographic and clinical variables. The ALBPSQ were significantly lower in acute compared with chronic LBP at all follow-up visits (P<0.001). Significant associations were found between high-risk and low-risk subgroups on the ALBPSQ and pain and disability variables during follow-up. Different cut-off points on the accuracy of predicting outcomes at 6 and 12 months' follow-up showed high specificity and low sensitivity with a best cut-off of 90 points. DISCUSSION: The findings of this study provide further evidence of the utility of the ALBPSQ in clinical studies and in primary care settings (general practitioners, chiropractors, and physiotherapists) to help identify patients at risk of developing chronic LBP and disability.

Adolescent↗
PubMed2006

[Back pain].

Low back pain created a dramatic increase in sick leave from 1970-95 despite of no pain-relevant biological changes of the back. An update of several disc-related pathologies is presented. Especially discovering the significance of Modic changes and a new muscle-function understanding contribute to a modernized view on pain mechanisms. Generally, traditional treatment modalities have an effect wise sparse influence on natural history over time. Subgroup identification is a central issue in modern research, because the effect of treatment can be very different across such groups.

Humans↗
PubMed2003

Straightforward consultation or complicated condition? General practitioners' perceptions of low back pain.

BACKGROUND: Low back pain is a common condition in general practice and represents a significant part of a general practitioner's workload. However, despite guidelines, back pain still presents considerable challenges to clinicians. OBJECTIVE: To explore the perceptions and declared behaviour of UK general practitioners in relation to patients with low back pain. METHOD: A qualitative design was used, involving semi-structured interviews with 17 GPs in the North of England. Interviews were transcribed verbatim and analysed using qualitative thematic analysis. RESULTS: Two major themes emerged from the data relating to approaches to and perceptions of low back pain. A dichotomy emerged, where GPs describe their approach to what they know to be a straightforward consultation where most patients recover, and the frustration they experience when patients do not. Although GPs are using a simple bio-mechanistic approach to low back pain, they also operate a method of categorising patients, which involves identifying real and pseudo patients. When confronted with 'challenging' cases, that is those who do not recover, most GPs feel isolated and poorly prepared. CONCLUSION: GPs adopt a bio-mechanistic approach to LBP which appears to work well for the majority of patients, as the natural history of low back pain dictates that most patients will recover. However, this approach to low back pain fails at the margins and this is evident by the significant minority of persistent sufferers and the GP's reaction to them. Expanding patient-centredness to explore psychological and social dimensions in relation to low back pain presents an ongoing challenge in general practice.

Adult↗
PubMed1996

Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain.

The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized controlled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with "return to work" (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles were initially reviewed; 35 studies met our selection criteria. Twenty-two studies were discussed in Part 1 (Acute Interventions) or will be discussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The treatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality of methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative care, epidural steroids, traction, and other approaches to determine their individual effects for RTW after discogenic disease.

Adrenal Cortex Hormones↗
PubMed1993

Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients.

OBJECTIVE: To determine the intercorrelation between subjective disability, as assessed with the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with visual analogue scale (VAS) pain intensity ratings. DESIGN AND SUBJECTS: Questionnaires were administered to 94 patients with chronic low back pain with or without radiation into the legs of at least 3 months' duration. SETTING: Tertiary care center. RESULTS: High correlations were noted between the ODQ and PDI (r = 0.83) and PDI factor 1 (r = 0.84), a subscale of the PDI. Lower correlations were noted between pain intensity (VAS) scores and the ODQ (r = 0.62) and the PDI (r = 0.69). A weaker correlation (r = 0.41) was noted between the ODQ and PDI factor 2. Intraclass correlation coefficients (ICC) for test-retest reliability in 20 patients (time interval 1 week) were for the ODQ ICC = 0.83, PDI ICC = 0.91, PDI percentage score ICC = 0.91, PDI factor 1 ICC = 0.87, and PDI factor 2 ICC = 0.73, respectively. CONCLUSIONS: The present results suggest that either the PDI or the percentage score PDI and also the even shorter-to-administer PDI factor 1 may be useful and reliable tests for the assessment of subjective disability in low back pain patients. As noted by the moderate intercorrelations with pain intensity scores, both the PDI and the ODQ address a broader concept of disability than that directly related to pain intensity.

Adolescent↗