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At least 19 recordsLinked to original sources

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↗

PubMed2004

Nigerian back school model: development and effect on industrial workers' knowledge of back pain and back care.

Back schools are health education programmes on back pain. Many back schools have been developed for different populations since 1969 when the first one was developed in Sweden, but none for the Nigerian setting. The need to develop a back school that would be appropriate for the Nigerian environment was therefore identified. As a step towards its development, this preliminary study was carried out to determine the effect of a back school model (BSM) on some Nigerian industrial workers' knowledge of low back pain and back care. The subjects were 110 workers of a soap industry in Lagos, Nigeria. Apre-test, post-test quasi-experimental design was used. The BSM consisted of two 45 minute teaching sessions on structure and functions of the back, epidemiology and causes of back pain, correct postures and demonstration of exercises that may prevent/alleviate back pain. Data on demographic information, low back pain (LBP) experience, knowledge of back structure and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8-weeks after BSM administration. The results showed that the subjects' mean knowledge score increased significantly from an initial value of 16.1 + 5.3 to 24.0 + 5.6 (p < 0.05) immediately after and 23.1 + 3.9 (p < 0.05) 8 weeks after BSM administration. Educational attainment had no influence on subjects' knowledge scores before or 8 weeks after BSM administration. Reported experience of LBP and duration on the job had no significant influence on subjects' knowledge scores before, immediately or 8-weeks following BSM administration. It was concluded that the BSM was effective in improving the workers' knowledge of LBP and back care. We believe that this findingjustifies the effort to develop the Nigerian model of back school.

Adult↗

PubMed1999

The influence of previous low back trouble, general health, and working conditions on future sick-listing because of low back trouble. A 15-year follow-up study of risk indicators for self-reported sick-listing caused by low back trouble.

STUDY DESIGN: A 15-year follow-up study. OBJECTIVE: To find risk indicators for self-reported sick-listing because of low back trouble and to evaluate which variables were the most important indicators of work incapacity resulting from low back trouble during the follow-up period of 15 years. SUMMARY OF BACKGROUND DATA: The initial data were obtained from a health survey conducted in a general population from the Municipality of Glostrup, Denmark. The follow-up data included information from the Central Person Register, the Early Retirement Pension Register, and a postal questionnaire regarding self-reported sick-listing because of low back trouble. METHODS: An epidemiologic study, in which logistic regression analyses were used for evaluation of the data. The model used consisted of the variable in question, age, gender, and previous experience of low back trouble, along with interactions. RESULTS: It was found that 22 of 37 variables were risk indicators for later self-reported sick-listing because of low back trouble during the preceding year or the 7 years before the date of follow-up evaluation. In analyzing the most significant variables simultaneously, it was found that information from the initial investigation about sick-listing in general during the previous 10 years, sciatic pain, use of analgesics for low back trouble, previous sick-listing because of low back trouble, and occupation were the most important risk indicators for self-reported work incapacity resulting from low back trouble during the follow-up period of 15 years. CONCLUSION: Findings showed that the strongest prognostic indicators of later sick-listing because of low back trouble involve information from the person about previous sick-listing behavior in general and previous experience of low back trouble episodes, especially if these had been accompanied by sciatic pain, use of analgesics, or previous low back trouble sick-listing.

Adult↗

PubMed2005

Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effectiveness of back schools for patients with nonspecific low back pain (LBP). SUMMARY OF BACKGROUND DATA: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with LBP. However, the content of back schools has changed and appears to vary widely today. METHODS: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to November 2004 for relevant trials reported in English, Dutch, French, or German. We also screened references from relevant reviews and included trials. Randomized controlled trials that reported on any type of back school for nonspecific LBP were included. Four reviewers, blinded to authors, institution, and journal, independently extracted the data and assessed the quality of the trials. We set the high-quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. Because data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited, or no evidence), taking into account the methodologic quality of the studies. We also evaluated the clinical relevance of the studies. RESULTS: Nineteen randomized controlled trials (3,584 patients) were included in this updated review. Overall, the methodologic quality was low, with only six trials considered to be high-quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short- and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting are more effective than other treatments and placebo or waiting list controls on pain, functional status, and return to work during short- and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. CONCLUSION: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain and improve function and return-to-work status, in the short- and intermediate-term, compared with exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodologic quality and clinical relevance and evaluate the cost-effectiveness of back schools.

Humans↗

PubMed2005

Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study.

OBJECTIVES: We sought to estimate the effects of recreational physical activity and back exercises on low back pain, related disability, and psychological distress among patients randomized to chiropractic or medical care in a managed care setting. METHODS: Low back pain patients (n=681) were randomized and followed for 18 months. Participation in recreational physical activities, use of back exercises, and low back pain, related disability, and psychological distress were measured at baseline, at 6 weeks, and at 6, 12, and 18 months. Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain, disability, and psychological distress. RESULTS: Participation in recreational physical activities was inversely associated--both cross-sectionally and longitudinally--with low back pain, related disability, and psychological distress. By contrast, back exercise was positively associated--both cross-sectionally and longitudinally--with low back pain and related disability. CONCLUSIONS: These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health.

Adult↗

PubMed2005

Back and neck extensor loading and back pain provocation in urban bus drivers with and without low back pain.

This study assessed low back and trapezius muscle activity in bus drivers, with or without recurrent low back pain (LBP), during the long term driving. In addition, low back and neck-shoulder pain intensities and fatigue were measured and the effect of low back support was observed. Also the possible source of LBP was attempted to assess by vibration pain provocation test and lumbar MRI. Forty bus drivers (recurrent LBP n = 25) participated in this study. Low back and neck-shoulder pain and subjective fatigue intensity was assessed by visual analogue scales (VAS) before and after driving. Lumbar paraspinal and trapezius muscle activation during driving was measured by surface EMG. Vibration pain provocation test was applied for all subjects. Average paraspinal myoelectric activity during driving was approximately 1% of MVC in both groups. Average trapezius myoelectric activity during driving was from 2 to 4% of MVC. Trapezius muscle activity was higher in back healthy drivers than in those with LBP. The low back support had no effect either on paraspinal or trapezius EMG activity. Low back and neck-shoulder fatigue increased during driving in both groups especially in those subjects with positive vibration pain provocation. The neck-shoulder pain and fatigue were more severe in drivers suffering from LBP. Low back support had no effect on low back and neck-shoulder subjective fatigue and neck-shoulder pain but tended to limit the LBP increase during driving. Paraspinal muscle loading in urban bus drivers was very limited and either LBP or ergonomic low back support had no effect on it. Trapezius muscle seemed to be less active in drivers suffering from recurrent LBP. Internal disc disruptions may expose to pain and fatigability during driving.

Journal Article↗

PubMed2004

Effects of seat-back angle and accelerometer height at the seat-back on seat-back x axis r.m.s. acceleration in filed experiments according to the ISO2631-1 standard.

The effects of seat-back angle and accelerometer height at the seat-back on seat-back x-axis frequency-weighted root-mean-square (r.m.s.) acceleration have been investigated in field experiments. Experiment 1 investigated the range and variability, of frequency-weighted r.m.s. acceleration at the same measurement position, where the seat-back angle was 24 degrees from vertical on the floor and the accelerometer height was 38 cm up from the seat cushion surface. Experiment 2 investigated ranges of frequency-weighted r.m.s. acceleration between the reference position, which was the position used in experiment 1, and test positions at different seat-back angles, 4 degrees ahead of and 4 degrees behind the reference position. Experiment 3 investigated the range of frequency-weighted r.m.s. acceleration between the reference position which was the same as in experiments 1 and experiment 2, and test positions at different accelerometer heights at the seat-back from a seat cushion surface, 2.5 cm higher, 2.5 cm lower and 5 cm lower than the reference position. This investigation clarifies that different seat-back angles and accelerometer heights at the seat-back affect the frequency-weighted r.m.s. acceleration at these measurement positions, which is beyond the exposure values at which people are able to distinguish different vibration acceleration magnitudes.

Acceleration↗

PubMedDate not supplied

Back supports and back injuries: a second visit with the Home Depot cohort study data on low-back injuries.

The back support has been controversial as a means of reducing injuries to the lower back. Diverse issues bear on the interpretation of data obtained in a major epidemiologic investigation of the utility of back supports in the retail-trade home improvement industry. These concerns are focused on alternate explanations for the changes in injury rates observed over the six-year study period, on individual and group factors other than the use of the back support that might have contributed to reducing the risk of injury, and on related methodologic issues. Each issue is addressed with specific reference to how it might affect the analyses and the conclusion that the supports showed a protective effect.

Adult↗

PubMed2005

Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion.

The purpose of this study was to assess if chronic low back pain patients have impaired paraspinal muscle O2 turnover and endurance capacity as compared to healthy control subjects during dynamic exercise. Middle-aged healthy male subjects (n = 12, control) and male patients with chronic low back pain (n = 17, CLBP) participated in the study. L4–L5 level paraspinal muscle fatigue was objectively assessed during earlier validated 90 s dynamic back endurance test (spectral EMG, MPFslope). Also EMG amplitude (EMGamplitude) and initial MPF (MPFinitial) were assessed from the initial 5 s of the endurance contraction. Simultaneously near infrared spectroscopy (NIRS) was used for quantitative measurement of local L4–L5 paraspinal muscle O2 consumption. Subcutaneous tissue thickness (ATT) was measured from the EMG and NIRS recording sites. The results indicated that control and CLBP groups were compatible as regarding anthropometric variables, paraspinal muscle activation levels (EMGamplitude), initial MPF (MPFinitial) and ATT. When the ATT was used as a covariate in the ANOVA analysis, CLBP group did not show significantly greater paraspinal muscle fatigability (right MPFslope – 12.2 ± 10.7%/min, left right MPFslope – 12.6 ± 13.3%/min) or O2 consumption (right NIRSslope – 52.8 ± 79.6 μM/l/s) as compared to healthy controls (right MPFslope – 11.9 ± 7.6%/min, left MPFslope – 12.7 ± 8.6%/min, right NIRSslope – 53.7 ± 95.2 μM/l/s). As a conclusion, these CLBP male patients did not show any impaired rate of paraspinal muscle oxygen consumption or excessive paraspinal muscle fatigability during dynamic exercise as compared with healthy controls. Subcutaneous tissue thickness has a strong influence on the NIRS and EMG amplitude measurements and, if unchecked, it could result in the false interpretation of the results.

Journal Article↗

PubMed1995

Outcome of treatment of chronic low back pain in inpatients. Effect of individual physiotherapy including intensive dynamic training in inpatients with chronic low back trouble, evaluated by means of low back pain rating scale.

UNLABELLED: The purpose of the present study is to evaluate the efficacy of the treatment regime for chronic low back pain patients of the impatient clinic of Ringe Rehabilitation Hospital, Denmark, by means of a modified version of Claus Manniche's Low Back Pain Rating Scale. Ninety-three patients were included, of whom 63 (67%) participated in the one year follow-up interview. RESULTS: improvements in subjective as well as objective measures when discharge scores are compared to admission scores. The one year follow-up scores are on the same level as the admission scores. More patients are at work, but still more patients receive pension for health reasons at the one year follow-up. CONCLUSION: The improvements achieved during admission do not last. We suggest that the patients should be more carefully selected for intensive treatment during admission, and that the treatment perhaps should continue beyond the inpatient period. Perhaps the regime should include psychological treatment and vocational rehabilitation, all to be offered at the same institution.

Adult↗

PubMed1996

Low back pain and its relationship to back strength and physical activity in children.

OBJECTIVE: The objective of the study was to determine the occurrence of low back pain and its relationship to back strength and physical activity in children. METHODS AND MATERIALS: The study included 53 boys and 43 girls aged 10 to 19 years from a group of 116 children who had undergone isometric strength testing 4 years previously. No intervention was performed. Each child was asked five questions concerning low back pain. A questionnaire to quantify participation in athletic activities and manual labor was used as the basis for calculation of each child's activity level. Isometric back flexor and extensor strength were measured with the same method used 4 years previously. Statistical analyses were performed with appropriate correction for confounding factors. RESULTS: The frequency of low back pain and the relationship between low back pain and age, between low back pain and back strength, and between low back pain and physical activity were determined. There was a history of low back pain in 51%, and the frequency of low back pain in the past year was 35%. Eight percent of the children had been limited by low back pain, and 7% had seen a doctor for the pain. The first incident of low back pain occurred at a mean age of 12.3 years. The frequencies of a history of low back pain and of low back pain in the past year increased significantly with age (p = 0.02 and 0.01 respectively). Increased physical activity was significantly associated with a history of low back pain (p = 0.03), and increased back flexor strength was significantly associated with a history of low back pain and of low back pain in the past year (p = 0.03 and 0.008, respectively). The rate of low back flexor or strength over 4 years had a significantly positive association with the occurrence of low back pain in the past year (p = 0.008). CONCLUSIONS AND RELEVANCE: Low back pain is common in children, and, in contrast to adults, low back pain in these children was more common with increased physical activity and stronger back flexors. We believe the main causes of low back pain in children are musculotendinous strains and ligamentous sprains.

Adolescent↗

PubMed2000

A prospective study of back belts for prevention of back pain and injury.

CONTEXT: Despite scientific uncertainties about effectiveness, wearing back belts in the hopes of preventing costly and disabling low back injury in employees is becoming common in the workplace. OBJECTIVE: To evaluate the effectiveness of using back belts in reducing back injury claims and low back pain. DESIGN AND SETTING: Prospective cohort study. From April 1996 through April 1998, we identified material-handling employees in 160 new retail merchandise stores (89 required back belt use; 71 had voluntary back belt use) in 30 states (from New Hampshire to Michigan in the north and from Florida to Texas in the south); data collection ended December 1998, median follow-up was 6(1/2) months. PARTICIPANTS: A referred sample of 13,873 material handling employees provided 9377 baseline interviews and 6311 (67%) follow-up interviews; 206 (1.4%) refused baseline interview. MAIN OUTCOME MEASURES: Incidence rate of material-handling back injury workers' compensation claims and 6-month incidence rate of self-reported low back pain. RESULTS: Neither frequent back belt use nor a belt-requirement store policy was significantly associated with back injury claim rates or self-reported back pain. Rate ratios comparing back injury claims of those who reported wearing back belts usually every day and once or twice a week vs those who reported wearing belts never or once or twice a month were 1.22 (95% confidence interval [CI], 0.87-1.70) and 0.95 (95% CI, 0.56-1.59), respectively. The respective odds ratios for low back pain incidence were 0.97 (95% CI, 0.83-1.13) and 0.92 (95% CI, 0.73-1.16). CONCLUSIONS: In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain. JAMA. 2000;284:2727-2732.

Adult↗

PubMed1997

Risk indicators of low back pain among workers in Japan. Association of familial and physical factors with low back pain.

STUDY DESIGN: A questionnaire was given to 3,042 Japanese workers at a factory in 1992. It surveyed age, gender, weight, height, job classification, and work environment, as well as the perceived causes, onset age, and characteristics of low back pain. Family history of low back pain among first-degree relatives and perception of physical condition also were assessed. OBJECTIVES: To investigate the risk indicators of low back pain in Japanese workers with various kinds of job classifications in a manufacturing company. SUMMARY OF BACKGROUND DATA: Risk indicators of low back pain in Japanese patients have not been fully investigated in previous studies. METHODS: Prevalence rates and characteristics of low back pain were examined among 3,042 factory workers (2,517 men and 525 woman) with jobs with varying physical demands. In the analysis of risk indicators of low back pain, the odds ratios and 95% confidence intervals were computed. In addition, a multiple logistic analysis was performed to evaluate risk indicators of low back pain. RESULTS: Point and lifetime prevalence of low back pain were correlated with the physical demands of the job. The perceived cause found to be most associated with low back pain were lifting in workers with jobs requiring moderate to heavy work and sports activity in sedentary workers. Family history of low back pain in parents, siblings, and children was a risk indicator of low back pain. The average age of the first attack of low back pain in workers with a family history of it in their parents was significantly younger than that in workers with no family history in a multiple logistic analysis in male workers, the physical work demands, age, and family history of low back pain in their parents were risk indicators; however, obesity was not a risk indicator. Physical and mental conditions of workers also were associated with low back pain. CONCLUSIONS: The physical job demands show a clear association with the point and lifetime prevalence of low back pain, and improvements in work conditions may decrease low back symptoms among workers. It is likely that a family history of low back pain and physical and mental conditions of workers also should be considered in the management of low back pain.

Adult↗

PubMed2006

Back education in elementary schoolchildren: the effects of adding a physical activity promotion program to a back care program.

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.

Back Pain↗

PubMed1999

[Back problems during military service--significance for later back problems. A 12-year follow-up study].

One thousand and fifty-eight conscripts participating in an investigation of back problems among conscripts in 1979-80 were re-examined 12 years later with an identical questionnaire concerning back problems. The questionnaire was answered by seven hundred and eighty-four persons (74%). The lifetime prevalence for low-back trouble was 73%, the one-year prevalence 53% and the point prevalence 26%. At the time of follow-up the incidence of low-back trouble depended on ever having had back pains and on having an X-ray made because of back problems. The probability for sick leave from work caused by lowback trouble was increased when back troubles had been reported at the time of the initial investigation. A significant amount of the conscripts that had been rejected due to back problems (60%) had been unfit for work because of low-back trouble in the follow-up period, and 95% of them had had low-back trouble in the year before follow-up, compared to 51% of the other conscripts. Previous back trouble increases the risk of getting back trouble once again. The risk of sick leave from work caused by low-back trouble increases with the incidence of back trouble up to the investigation in 1979-80. Rejection from service due to back problems increases the risk of later low-back trouble and sick leave from work caused by low-back troubles.

Adult↗

PubMed2000

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults.

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation programs are widely applied for chronic low back pain patients. The biopsychosocial approach for low back pain could also be considered to prevent chronicity by carrying out the rehabilitation if the acute pain is prolonged. Nevertheless multidisciplinary treatment programmes are often laborious and long processes and require good collaboration between the patient, the rehabilitation team and the work place. By workplace visits and close relationship with occupational health care one might expect results in terms of patients working ability. OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for subacute low back pain among working age adults. SEARCH STRATEGY: The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on subacute low back pain were separated afterwards. SELECTION CRITERIA: From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for working age patients suffering from subacute low back pain (more than 4 weeks but less than 3 months). The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these. DATA COLLECTION AND ANALYSIS: Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation. MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria on subacute low back pain. They were both considered to be methodologically low quality randomized controlled trials. The clinical relevance of included studies was sufficient. The level of scientific evidence for the effectiveness of multidisciplinary rehabilitation was moderate on subacute low back pain showing that multidisciplinary rehabilitation which includes workplace visit or more comprehensive occupational health care intervention helps patients to return to work faster, makes sick leaves less and alleviates subjective disability. REVIEWER'S CONCLUSIONS: We conclude that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for subacute low back pain and workplace visit increases the effectiveness. But because this evidence is based on the trials that had some methodological shortcomings and several expensive multidisciplinary rehabilitation programmes are commonly used for common subacute low back problems, there is an obvious need for high quality trials in this field.

Acute Disease↗

PubMed2003

Back strength cannot be predicted accurately from anthropometric measures in subjects with and without chronic low back pain.

OBJECTIVES: (1) To develop a multiple regression equation using anthropometric measurements to predict back strength and (2) to estimate the effect of practice on the back strength results and back strength predictions. DESIGN: Comparative study with repeated measures performed on three days. BACKGROUND: The assessment of back muscle relative endurance (% maximal strength) requires the measurement of maximal back strength which is problematic with low back pain patients. METHODS: The back strength (L5/S1 static extension moment), age and 26 anthropometric parameters were obtained from 83 male volunteers [42 healthy subjects and 41 chronic low back pain patients] aged between 20 and 60 years. A subsample of 20 healthy subjects and 20 patients were assessed through three days of testing to evaluate the variations of back strength with practice. RESULTS: The final regression model (n=42 healthy subjects) explained 39% of the variance in back strength. Back strength increased with practice (Day1<Day2 & 3) for both healthy and patients groups. However, the error of prediction of back strength derived from the regression model showed a significant improvement with practice for the patients only. CONCLUSIONS: Back strength cannot be predicted from simple anthropometric measures without important errors. The decrease of the error of prediction obtained for the patient group is indicative of a decreasing influence of psychological factors that are independent of motor learning because the effect of motor learning would have occurred on both groups if present. RELEVANCE: The prediction of back strength would be useful to determine (1) the relative force level of a given exercise or (2) the preinjury back strength. Unfortunately, anthropometric measurements are not enough good predictors of back strength.

Adult↗

PubMed2001

Back muscle fatigability is associated with knee extensor inhibition in subjects with low back pain.

STUDY DESIGN: Cross-sectional study of 25 male golfers with chronic low back pain and 16 healthy controls of similar age. OBJECTIVES: To assess the association between functional capacity of the back extensors and the quadriceps muscles. SUMMARY OF BACKGROUND DATA: Chronic low back pain has been shown to lead to changes in muscle activation patterns of the abdominals and the gluteus maximus. The effect of chronic low back pain on lower limb function has not been investigated. METHODS: Back extensor endurance was assessed by a Biering-Sørensen test; surface EMG was measured bilaterally on the erector spinae at T12 and L4--L5. Muscle inhibition in the quadriceps was assessed by applying an electrical twitch to the maximally contracted muscle. The associations between holding time, decrease in EMG median frequency (i.e., the slope of the regression line on median frequency vs. time), and muscle inhibition were compared for study participants with chronic low back pain and controls. RESULTS: Mean back extensor holding times were 88 +/- 30 seconds for study participants with chronic low back pain and 92 +/- 17 seconds for controls. Both groups showed bilaterally similar decreases in EMG median frequency at L4--L5 and T12; however, the slopes were significantly steeper at L4--L5 than T12. Study participants with chronic low back pain with poor back endurance had significantly higher muscle inhibition compared with study participants with chronic low back pain with good back endurance, whereas such an association was not evident in healthy controls. CONCLUSIONS: In golfers with chronic low back pain reduced back endurance was associated with significant inhibition of the knee extensors, indicating that this muscle group cannot be activated to a full extent. These findings suggest a possible association between back extensor fatigability and knee extensor dysfunction in male golfers with chronic low back pain.

Adult↗