Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials

Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials

Effect of education on non-specific neck and low back pain: a systematic review of randomized controlled trials

The objective of this thesis was to develop a health literacy questionnaire for predicting non-specific neck pain in office workers. This thesis was divided into four stages: 1) systematic review of randomized control trials to gain insights into the effectiveness of education on the prevention and cure of non-specific neck and low back pain and to identify effective educational content to prevent and treat non-specific neck and low back pain; 2) the development of neck pain-specific health literacy questionnaire; 3) evaluation of the predictive validity of the neck pain-specific health literacy questionnaire; and 4) evaluation of the ability of neck pain-specific health literacy questionnaire to predict duration of recovery from non-specific neck pain in office workers. The results showed that the education programs were not effective in preventing and treating neck pain as well as treating low back pain. Three education topics that may be effective in the prevention and treatment of neck and low back pain were identified, namely, function of the spine, information on activities, and information on coping with the problems. The neck pain-specific health literacy questionnaire comprised six questions, with total score ranging from 0 to 24. The questionnaire had acceptable psychometric properties and can differentiate between office workers with and without non-specific neck pain. The questionnaire had acceptable ability to predict incident non-specific neck pain, but was unable to predict duration of recovery from non-specific neck pain in office workers.

The objective of this thesis was to develop a device for postural change while sitting for the prevention of neck or low back pain in office workers. This thesis was divided into four stages: 1) to evaluate the effects of postural shifting frequency on perceived musculoskeletal discomfort during 1 hour of sitting in healthy office workers; 2) to evaluate the effects of the postural shift intervention on the 12-month incidence of the onset of neck and low back pain in high-risk office workers; 3) to investigate the efficacy of postural shift interventions on recovery duration and recurrence of neck and low back pain among high-risk office workers, and 4) to identify variables that moderate the effects of postural shifts interventions on the development of neck and low back pain in office workers. The finding of the first study showed that a postural shift frequency of 20-30 times/h significantly led to lower perceived discomfort in the neck, shoulder, upper back, and low back compared to a postural shift frequency of 10 times/h during 1 hour of sitting. These findings were used to develop a custom-designed device for postural change while sitting by the author and engineering team. The device consisted of three components: a seat pad, processor, and smartphone application. The device collected sitting behavior data and provided recommended postural shifting by gradually pumping air into various parts of the seat pad. The device had good to excellent validity and consistency. The results of the study two and three revealed that office workers who received the postural shift intervention significantly reduced the 12-month incidence rate, shortened recovery time, and reduced recurrence of neck and low back pain. Finally, the finding of the fourth study showed that workers who worked more hours/day and who endorsed higher levels of psychological work demand gained more benefits from the postural shift intervention regarding the prevention of neck pain development than those in the control group. In addition, the workers who had no lumbar support gained more benefits from the postural shift intervention regarding the prevention of low back pain development than those in the control group.

Low back pain

Low back pain is the most common complaint experienced by the majority of people at some point in their lifetime. Physical therapy has been in favor of effective treatment and prevention of low back pain. However, there is a lack of agreement on the best exercise treatment and abundant studies are in progress. Categorical studies are lacking particularly in this part of the world. This study was designed to compare the effectiveness and efficiency of two specific exercises, core stability exercises with Williams’ flexion exercises, in patients with non-specific low back pain. Objective:The objective of this study was to find out the most effective treatment for patients with non-specific low back pain Methods: This study is a single-blinded randomized clinical trial that was conducted in the physiotherapy outdoor patient department of the public hospital, Jinnah Hospital Lahore (JHL). 20 patients with non-specific low back pain were randomly allocated in two treatment groups, 10 in A (core stability exercises) and 10 in B (Williams’ flexion exercises), after giving informed consent. The conventional treatment of low back pain. e.g. Hot or cold pack, electrotherapeutic modalities was given to the patients of both groups along with their specialized group treatment. The visual analog scale (VAS) and Modified Oswestry Low Back Pain Disability Questionnaire were used before treatment and after the third treatment session during the period of one to two weeks to measure outcomes. The independent samples T-test was used for data analysis. A P-value <0.05 was considered statistically significant Results: The results of this study illustrated that there is a significant difference between the two groups in clinical and therapeutic effect in the reduction of pain as the P-value is <0.05. While the results in the reduction of pain-related disability, measured by the Modified Oswestry Low Back Pain Disability Questionnaire, were not significant as P-value >0.05(P= 0.184). Conclusions: The study indicates that core stability exercises are more effective than Williams’ flexion exercises for the reduction of non-specific low back pain except for a reduction in pain-related disability.

Low back pain

Aims: The aim of this study was to assess the perspectives of the female nurses regarding the prevention and treatment of low back pain (LBP). Materials and Methods: This cross-sectional study was conducted on 222 female nurses working in Borujen Hospital (situated in Chaharmahal and Bakhtiari Province of Iran) in 2015 selected using simple random sampling. The data were collected using a self-designed questionnaire consisting of 29 items designed in terms of personal information, self-care, awareness, and prevention of LBP. The validity and reliability of this questionnaire was confirmed. Results: About 93.7% of the participants of this study suffered from LBP with a majority of them (21.6%) reporting the monthly episodes of LBP. In terms of actions taken by the nurses when experiencing LBP, it was found that 58.1% of them used to rest during the LBP episodes while 36.5% of them preferred to seek care from a physician, especially a general practitioner. In general, the best-reported ways to ease the LBP were as follows: resting (80.2%), going to doctor (32.4%), and physical exercises (32%), especially practice of back-strengthening exercises. Nearly 53.2% of the nurses proposed that when experiencing LBP, the analgesics should be taken while 44.6% and 1.4% of them believed the nonsteroidal anti-inflammatory drugs and muscle relaxants or drugs can be helpful, respectively. Conclusion: It is very important for the nursing personnel to equip themselves with some information regarding how to manage LBP properly as well as its respective preventive measures so that they can create a healthy work environment for themselves.

Low back pain

Lumbar supports are used in the treatment of low back pain patients to make the impairment and disability vanish or decrease. Lumbar supports are also used to prevent the onset of low back pain (primary prevention) or to prevent recurrences of a low back pain episode (secondary prevention). The objective of this systematic review was to assess the effects of lumbar supports for prevention and treatment of non-specific low back pain. We searched the Medline, Cinahl and Current Contents databases and the Cochrane Controlled Trials Register up to September 1999, and the Embase database up to September 1998. We also screened references given in relevant reviews and identified controlled trials, and used Science Citation Index to identify additional controlled trials. Controlled clinical trials that reported on any type of lumbar supports as preventive or therapeutic intervention for non-specific low back pain were included. One author extracted data from the trials considering characteristics of the study population, characteristics of the interventions and the final results for each outcome measure. The author compared these findings to data regarding the same characteristics of the same studies published already in other reviews. The methodological quality was independently assessed by two authors. Because it was not possible to perform a quantitative analysis, a qualitative meta-analysis was performed in which the strength of evidence on the effectiveness of lumbar supports was classified as being strong, moderate, limited or conflicting, and no evidence. Five randomized and two nonrandomized controlled preventive trials and six randomized therapeutic trials were included in our review. Overall the methodological quality of the studies included in our review was rather low. Only four of the thirteen studies scored positive on 50% or more of the the internal validity items. There was moderate evidence that for primary prevention lumbar supports are not more effective than other types of treatment or no intervention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, while it is still unclear if lumbar supports are more effective than other interventions for treatment of low back pain. There is still a need for high quality randomised trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realisation of an adequate compliance.

The aim of this study was to determine the effect of health education on prevention of low back pain for health caregivers and cleaning workers. Low back pain is a common health problem in the workplace. Health education is important in the prevention and recurrence of low back pain. A quasi-experimental design with a pre-test and post-test control group was used. The population of the study consisted of health caregivers and cleaning workers working in a university hospital in Turkey. A total of 120 participants, 60 in the intervention group and 60 in the control group, were included in the study. Data were collected between October 2016 and April 2017. A questionnaire, the Oswestry Low Back Pain Scale and the Knowledge Evaluation Form were used to collect data. Health education was given to the intervention group. Following the health education, the mean scores of the Oswestry Low Back Pain Scale in the intervention group were significantly lower than the control group and had a larger effect size. This study provides evidence for the effectiveness of health education in the prevention of low back pain in health caregivers and cleaning workers.

Low back pain

A systematic review of randomized and nonrandomized controlled trials. Lumbar supports are used in the treatment of low back pain, but also to prevent the onset (primary prevention) or recurrences of a low back pain episode (secondary prevention). To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain. The Medline, Cinahl, and Current Contents databases; the Cochrane Controlled Trials Register up to September 1999; and the Embase database up to September 1998 were all searched. References of identified trials and systematic reviews were reviewed and the Science Citation Index used to identify additional trials. Methodologic quality assessment and data extraction were performed by two reviewers independently. A quantitative analysis was performed in which the strength of evidence was classified as strong, moderate, limited or conflicting, and no evidence. Five randomized and two nonrandomized preventive trials and six randomized therapeutic trials were included in the review. Only 4 of the 13 studies were of high quality. There was moderate evidence that lumbar supports are not effective for primary prevention. No evidence was found on the effectiveness of lumbar supports for secondary prevention. The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment, whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain. There continues to be a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance.

BackgroundLow back pain (LBP) is a significant public health problem in Western industrialised countries and has been reported to affect up to 80% of adults at some stage in their lives. It is associated with high health care utilisation costs, disability, work loss and restriction of social activities. An intervention of foot orthoses or insoles has been suggested to reduce the risk of developing LBP and be an effective treatment strategy for people suffering from LBP. However, despite the common usage of orthoses and insoles, there is a lack of clear guidelines for their use in relation to LBP. The aim of this review is to investigate the effectiveness of foot orthoses and insoles in the prevention and treatment of non specific LBP.MethodsA systematic search of MEDLINE, CINAHL, EMBASE and The Cochrane Library was conducted in May 2013. Two authors independently reviewed and selected relevant randomised controlled trials. Quality was evaluated using the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist. Meta-analysis of study data were conducted where possible.ResultsEleven trials were included: five trials investigated the treatment of LBP (n = 293) and six trials examined the prevention of LBP (n = 2379) through the use of foot orthoses or insoles. Meta-analysis showed no significant effect in favour of the foot orthoses or insoles for either the treatment trials (standardised mean difference (SMD) -0.74, CI 95%: -1.5 to 0.03) or the prevention trials (relative risk (RR) 0.78, CI 95%: 0.50 to 1.23).ConclusionsThere is insufficient evidence to support the use of insoles or foot orthoses as either a treatment for LBP or in the prevention of LBP. The small number, moderate methodological quality and the high heterogeneity of the available trials reduce the strength of current findings. Future research should concentrate on identification of LBP patients most suited to foot orthoses or insole treatment, as there is some evidence that trials structured along these lines have a greater effect on reducing LBP.

BackgroundA high prevalence of low back pain has persisted over the years despite extensive primary prevention initiatives among nurses’ aides. Many single-faceted interventions addressing just one aspect of low back pain have been carried out at workplaces, but with low success rate. This may be due to the multi-factorial origin of low back pain. Participatory ergonomics, cognitive behavioral training and physical training have previously shown promising effects on prevention and rehabilitation of low back pain. Therefore, the main aim of this study is to examine whether a multi-faceted workplace intervention consisting of participatory ergonomics, physical training and cognitive behavioral training can prevent low back pain and its consequences among nurses’ aides. External resources for the participating workplace and a strong commitment from the management and the organization support the intervention.Methods/designTo overcome implementation barriers within usual randomized controlled trial designed workplace interventions, this study uses a stepped-wedge cluster-randomized controlled trial design with 4 groups. The intervention is delivered to the groups at random along four successive time periods three months apart. The intervention lasts three months and integrates participatory ergonomics, physical training and cognitive behavioral training tailored to the target group. Local physiotherapists and occupational therapists conduct the intervention after having received standardized training. Primary outcomes are low back pain and its consequences measured monthly by text messages up to three months after initiation of the intervention.DiscussionIntervention effectiveness trials for preventing low back pain and its consequences in workplaces with physically demanding work are few, primarily single-faceted, with strict adherence to a traditional randomized controlled trial design that may hamper implementation and compliance, and have mostly been unsuccessful. By using a stepped wedge design, and obtain high management commitment and support we intend to improve implementation and aim to establish the effectiveness of a multi-faceted intervention to prevent low back pain. This study will potentially provide knowledge of prevention of low back pain and its consequences among nurses’ aides. Results are expected to be published in 2015–2016.Trial registrationThe study is registered asISRCTN78113519.