Activity-limiting Low Back Pain Research Articles

Stressful life events and low back pain in older men: A cross-sectional and prospective analysis using data from the MrOS study.

Stressful life events, such as loss of a partner, loss of a pet or financial problems, are more common with increasing age and may impact the experience of pain. The aim of the current study is to determine the cross-sectional and prospective association between stressful life events and low back pain reporting in the Osteoporotic Fracture in Men Study, a cohort of older men aged ≥65 years. At a study visit (March 2005-May 2006), 5149 men reported whether they had experienced a stressful life event or low back pain in the prior 12 months. Following that visit, data on low back pain patients were gathered through triannual questionnaires every 4 months for 1 year. Multivariable logistic regression analyses estimated the association of stressful life events with recent past low back pain or future low back pain. N = 2930, (57%) men reported at least one stressful life event. The presence of a stressful life event was associated with greater odds of any low back pain (OR = 1.42 [1.26-1.59]) and activity-limiting low back pain (OR = 1.74 [1.50-2.01]) in the same period and of any low back pain (OR = 1.56 [1.39-1.74]) and frequent low back pain (OR = 1.80 [1.55-2.08]) in the following year. In this cohort of men, the presence of stressful life events increased the likelihood of reporting past and future low back pain. Stressful life events such as accident or illness to a partner are common in later life and may impact the experience of pain. We present cross-sectional and prospective data highlighting a consistent association between stressful life events and low back pain in older men. Further, there is evidence to suggest that this relationship is upregulated by an individual's living situation. This information may be used to strengthen a biopsychosocial perspective of an individual's pain experience.

Effectiveness and cost-effectiveness of a progressive, individualised walking and education program for prevention of low back pain recurrence in adults: statistical analysis plan for the WalkBack randomised controlled trial

BackgroundExercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack trial.MethodsWalkBack is a prospectively registered, pragmatic, randomised controlled trial. The aim is to investigate the effectiveness and cost-effectiveness of a 6-month progressive and individualised walking and education program (intervention) for the prevention of low back pain recurrences, compared to a no-treatment control group. The primary outcome is days to the first recurrence of an episode of activity-limiting low back pain. Key secondary outcomes include days to any recurrence of low back pain, days to a care-seeking recurrence of low back pain, disability level, health-related quality of life, costs associated with low back pain and adverse events. All participants will be followed for a minimum of 12 months. Analysis will follow the intention-to-treat principle. Cox regression is planned to assess the effects for the outcomes of time to activity-limiting, minimal and care-seeking recurrence. Hazard ratios and median survival times with 95% confidence intervals will be calculated. The effect of the intervention on continuous outcomes will be estimated with repeated-measure linear mixed models. An economic evaluation will be performed from the societal perspective for recurrence prevented (yes/no) and quality-adjusted life years. The proportion of adverse events between groups will be compared using Fisher’s exact test.DiscussionThe WalkBack trial will provide evidence on the effectiveness and cost-effectiveness of a walking intervention to prevent low back pain recurrences. This statistical analysis plan provides transparency on the analysis of the trial.Trial registrationWalkBack - Effectiveness and cost-effectiveness of a progressive individualised walking and education program for the prevention of a recurrence of low back pain. ACTRN12619001134112. Date Registered: 14/08/2019.

Recurrence of low back pain: A difficult outcome to predict. Development and validation of a multivariable prediction model for recurrence in patients recently recovered from an episode of non-specific low back pain

BackgroundRecurrence of low back pain (LBP) is common. If clinicians could identify an individual's risk of recurrence, this would enhance clinical decision-making and tailored patient care. Objective/designTo develop and validate a simple tool to predict the probability of a recurrence of LBP by 3- or 12-months following recovery. MethodsData utilised for the prediction model development came from a prospective inception cohort study of participants (n = 250) recently recovered from LBP, who had sought care from chiropractic or physiotherapy services. The outcome measure was a recurrence of activity-limiting LBP. Candidate predictor variables (e.g., basic demographics, LBP history, levels of physical activity, etc) collected at baseline were considered for inclusion in a multivariable Cox model. The model's performance was tested in a separate validation dataset of participants (n = 261) involved in a randomised controlled trial investigating exercise for the prevention of LBP recurrences. ResultsThe final model included the number of previous episodes, total sitting time, and level of education. In the development sample, discrimination was acceptable (Harrell's C-statistic = 0.61, 95% CI, 0.59–0.62), but in the validation sample, discrimination was poor (0.56, 95% CI, 0.54–0.58). Calibration of the model in the validation dataset was acceptable at 3 months but was less precise at 12 months. ConclusionThe developed prediction model, which included number of previous episodes, total sitting time, and level of education, did not perform adequately in the validation sample to recommend its use in clinical practice. Predicting recurrence of LBP in clinical practice remains challenging.

An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial.

What is the effect of a McKenzie-based self-management exercise and education program on the risk of recurrence of low back pain (LBP) and on the impact of LBP? Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. 262 adults recently recovered from an episode of LBP. The experimental group received a McKenzie-based self-management exercise and education program delivered over two individual sessions of 30 to 45 minutes with a physiotherapist, approximately 2 weeks apart. The control group received a single advice session over the phone. The primary outcome was time to first recurrence of an episode of activity-limiting LBP. Secondary outcomes included time to recurrence of any LBP, time to a recurrence causing care seeking and a composite measure of pain and function ('impact of LBP'). Participants were followed-up monthly for ≥ 12 months. The estimated effect of the experimental intervention on the risk of recurrence of an episode of: activity-limiting LBP was HR 1.11 (95% CI 0.80 to 1.54), any LBP was HR 0.95 (95% CI 0.72 to 1.26), and LBP for which care was sought was HR 0.69 (95% CI 0.46 to 1.04). The quarterly estimates of the experimental intervention's effect on impact of LBP and their 95% CIs were all within 4 points above or below 0 (no effect) on this scale from 8 to50. This study's best estimate is that a McKenzie-based self-management exercise and education program does not produce a worthwhile reduction in the risk of an activity-limiting episode of LBP; however, modestly reduced or moderately increased risk cannot be ruled out. It may markedly reduce the risk of an episode of LBP resulting in care seeking, but does not have any worthwhile effect on the impact of LBP over 12 months. ACTRN12616000926437.

Family History Influences the Effectiveness of Home Exercise in Older People With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

ObjectiveTo investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP. DesignSecondary analysis of a randomized controlled trial. SettingLocal community. ParticipantsPeople older than 55 years with chronic LBP (N=60). InterventionsParticipants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors. Main Outcomes MeasuresParticipants indicated whether any of their immediate family members had a history of “any” LBP or “activity-limiting” LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise. ResultsParticipants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (β=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (β=−0.17; 95% CI, −2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects. ConclusionsA family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.

Recurrence of low back pain is common: a prospective inception cohort study.

How commonly and how quickly does low back pain reoccur in a cohort of people who have recently recovered from an episode of low back pain? What are the prognostic factors for a recurrence of low back pain? Prospective inception cohort study with monthly follow-up for 12 months. A total of 250 patients who had recovered from an episode of low back pain within the last month. The primary outcome was days to recurrence of an episode of low back pain. Secondary outcomes were: days to recurrence of low back pain severe enough to limit activity moderately, and days to recurrence of low back pain for which healthcare was sought. Within 12 months after recovery, 69% (95% CI 62 to 74) of participants had a recurrence of an episode of low back pain, 40% (95% CI 33 to 46) had a recurrence of activity-limiting low back pain, and 41% (95% CI 34 to 46) had a recurrence of low back pain for which healthcare was sought. The median time to recurrence of an episode of low back pain was 139 days (95% CI 105 to 173). Frequent exposure to awkward postures, longer time sitting (> 5 hours per day), and more than two previous episodes were predictive of recurrence of an episode of low back pain within 12 months (p < 0.01). Recurrence of low back pain is very common, with more than two-thirds of individuals having a recurrence within 12 months after recovery. Prognostic factors for a recurrence include exposure to awkward posture, longer time sitting, and more than two previous episodes.

Use of The Global Alliance for Musculoskeletal Health survey module for estimating the population prevalence of musculoskeletal pain: findings from the Solomon Islands

BackgroundMusculoskeletal (MSK) conditions are common and the biggest global cause of physical disability. The objective of the current study was to estimate the population prevalence of MSK-related pain using a standardized global MSK survey module for the first time.MethodsA MSK survey module was constructed by the Global Alliance for Musculoskeletal Health Surveillance Taskforce and the Global Burden of Disease MSK Expert Group. The MSK module was included in the 2015 Solomon Islands Demographic and Health Survey. The sampling design was a two-stage stratified, nationally representative sample of households.ResultsA total of 9214 participants aged 15–49 years were included in the analysis. The age-standardized four-week prevalence of activity-limiting low back pain, neck pain, and hip and/or knee pain was 16.8, 8.9, and 10.8%, respectively. Prevalence tended to increase with age, and be higher in those with lower levels of education.ConclusionsPrevalence of activity-limited pain was high in all measured MSK sites. This indicates an important public health issue for the Solomon Islands that needs to be addressed. Efforts should be underpinned by integration with strategies for other non-communicable diseases, aging, disability, and rehabilitation, and with other sectors such as social services, education, industry, and agriculture. Primary prevention strategies and strategies aimed at self-management are likely to have the greatest and most cost-effective impact.

If Depression may be Associated with Future Care Seeking of Activity-limiting Low Back Pain, We Must Properly Address the Depression as Well.

If Depression may be Associated with Future Care Seeking of Activity-limiting Low Back Pain, We Must Properly Address the Depression as Well.

Symptoms of Depression and Risk of Low Back Pain: A Prospective Co-Twin Study.

To investigate whether symptoms of depression increase the risk of low back pain (LBP), after adjusting for genetic and environmental influences. Baseline data of 1607 twins from the Murcia Twin Registry (Spain) were collected in 2009 to 2011 and follow-up data in 2013. Twins answered questions on depression-related symptomatology and LBP. Only participants not reporting chronic LBP (pain >6 mo) at baseline were included. The association between symptoms of depression and LBP was investigated using logistic regression analysis including the complete sample. Subsequent matched within-pair case-control analyses were performed with all complete dizygotic twin pairs discordant for LBP, followed by monozygotic twins. In the total sample analysis, symptoms of depression did not significantly increase the risk of chronic LBP (odds ratio [OR]=1.40; 95% confidence interval [CI], 0.96-2.03), LBP care seeking (OR=1.21; 95% CI, 0.81-1.81), or activity-limiting LBP (OR=1.09; 95% CI, 0.69-1.72). State depression (participants' symptoms at the moment of the interview) was significantly associated with future care seeking (OR=1.06; 95% CI, 1.01-1.12) and activity-limiting LBP (OR=1.07; 95% CI, 1.01-1.14). A significant association was found between trait depression and activity-limiting LBP (OR=1.05; 95% CI, 1.01-1.10), but not for the other LBP outcomes. No significant association was observed in any of the subsequent case-control analyses. The magnitude of the association between depression and LBP seems to be small and may be confounded by genetic and early shared environment influences, although firm conclusions could not be made due to small sample size in the case-control analysis. In addition, the observed association is dependent on the method of assessment used for both conditions.

Effectiveness of McKenzie Method-Based Self-Management Approach for the Secondary Prevention of a Recurrence of Low Back Pain (SAFE Trial): Protocol for a Pragmatic Randomized Controlled Trial.

Although many people recover quickly from an episode of low back pain (LBP), recurrence is very common. There is limited evidence on effective prevention strategies for recurrences of LBP. The purpose of this study was to determine the effectiveness of a McKenzie method-based self-management approach in the secondary prevention of LBP. This will be a pragmatic randomized controlled trial. Participants will be recruited from the community and primary care, with the intervention delivered in a number of physical therapist practices in Sydney, Australia. The study will have 396 participants, all of whom are at least 18 years old. Participants will be randomly assigned to either the McKenzie method-based self-management approach group or a minimal intervention control group. The primary outcome will be days to first self-reported recurrence of an episode of activity-limiting LBP. The secondary outcomes will include: days to first self-reported recurrence of an episode of LBP, days to first self-reported recurrence of an episode of LBP leading to care seeking, and the impact of LBP over a 12-month period. All participants will be followed up monthly for a minimum of 12 months or until they have a recurrence of activity-limiting LBP. All participants will also be followed-up at 3, 6, 9, and 12 months to assess the impact of back pain, physical activity levels, study program adherence, credibility, and adverse events. Participants and therapists will not be masked to the interventions. To our knowledge, this will be the first large, high-quality randomized controlled trial investigating the effectiveness of a McKenzie method-based self-management approach for preventing recurrences of LBP. If this approach is found to be effective, it will offer a low-cost, simple method for reducing the personal and societal burdens of LBP.

Obesity does not increase the risk of chronic low back pain when genetics are considered. A prospective study of Spanish adult twins

Background ContextObesity is commonly investigated as a potential risk factor for low back pain (LBP); however, current evidence remains unclear. Limitations in previous studies may explain the inconsistent results in the field, such as the use of a cross sectional design, limitations in the measures used to assess obesity (eg, body mass index—BMI), and poor adjustment for confounders (eg, genetics and physical activity). Purpose and DesignTo better understand the effects of obesity on LBP, our aim was to investigate in a prospective cohort whether obesity-related measures increase the risk of chronic LBP outcomes using a longitudinal design. We assessed obesity through measures that consider the magnitude as well as the distribution of body fat mass. A within-pair twin case-control analysis was used to control for the possible effects of genetic and early shared environmental factors on the obesity-LBP relationship. Patient Sample and Outcome MeasuresData were obtained from the Murcia Twin Registry in Spain. Participants were 1,098 twins, aged 43 to 71 years, who did not report chronic LBP at baseline. Follow-up data on chronic LBP (>6 months), activity-limiting LBP, and care-seeking for LBP were collected after 2 to 4 years. Risk FactorsThe risk factors were BMI, percentage of fat mass, waist circumference, and waist-to-hip ratio. MethodsSequential analyses were performed using logistic regression controlling for familial confounding: (1) total sample analysis (twins analyzed as independent individuals); (2) within-pair twin case-control analyses (all complete twin pairs discordant for LBP at follow-up); and within-pair twin case-control analyses separated for (3) dizygotic and (4) monozygotic twins. ResultsNo increase in the risk of chronic LBP was found for any of the obesity-related measures: BMI (men/women, odds ratio [OR]: 0.99; 95 % confidence interval [CI]: 0.86–1.14), % fat mass (women, OR: 0.87; 95% CI: 0.66–1.14), waist circumference (women, OR: 0.98; 95% CI: 0.74–1.30), and waist-to-hip ratio (women, OR: 1.05; 95% CI: 0.81–1.36). Similar results were found for activity-limiting LBP and care-seeking due to LBP. After the adjustment for genetics and early environmental factors shared by twins, the non-significant results remained unchanged. ConclusionsAfter 2 to 4 years, obesity-related measures did not increase the risk of developing chronic LBP or care-seeking for LBP with or without adjustment for familial factors such as genetics in Spanish adults.

The Epidemiology of low back pain

Low back pain is an extremely common problem that most people experience at some point in their life. While substantial heterogeneity exists among low back pain epidemiological studies limiting the ability to compare and pool data, estimates of the 1 year incidence of a first-ever episode of low back pain range between 6.3% and 15.4%, while estimates of the 1 year incidence of any episode of low back pain range between 1.5% and 36%. In health facility- or clinic-based studies, episode remission at 1 year ranges from 54% to 90%; however, most studies do not indicate whether the episode was continuous between the baseline and follow-up time point(s). Most people who experience activity-limiting low back pain go on to have recurrent episodes. Estimates of recurrence at 1 year range from 24% to 80%. Given the variation in definitions of remission and recurrence, further population-based research is needed to assess the daily patterns of low back pain episodes over 1 year and longer. There is substantial information on low back pain prevalence and estimates of the point prevalence range from 1.0% to 58.1% (mean: 18.1%; median: 15.0%), and 1 year prevalence from 0.8% to 82.5% (mean: 38.1%; median: 37.4%). Due to the heterogeneity of the data, mean estimates need to be interpreted with caution. Many environmental and personal factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Other commonly reported risk factors include low educational status, stress, anxiety, depression, job dissatisfaction, low levels of social support in the workplace and whole-body vibration. Low back pain has an enormous impact on individuals, families, communities, governments and businesses throughout the world. The Global Burden of Disease 2005 Study (GBD 2005) is currently making estimates of the global burden of low back pain in relation to impairment and activity limitation. Results will be available in 2011. Further research is needed to help us understand more about the broader outcomes and impacts from low back pain.

The Change in the Diffusion of Water in Normal and Degenerative Lumbar Intervertebral Discs Following Joint Mobilization Compared to Prone Lying

Prospective, repeated measures obtained under treatment and control conditions. The purposes of this study were to provide preliminary evidence regarding the immediate change in the diffusion of water in the nuclear region of normal and degenerative lumbar intervertebral discs (IVDs) following a single session of lumbar joint mobilization, and to compare these findings to the immediate change in the diffusion of water following a 10-minute session of prone lying. There is conflicting evidence regarding the effectiveness and efficacy of lumbar joint mobilization. Increased knowledge of the physiologic effects of lumbar joint mobilization can lead to refinement of its clinical application. A total of 24 people (15 males and 9 females), ranging in age from 22 to 58 years, participated in this study. All subjects had a history of activity-limiting low back pain. Diffusion-weighted magnetic resonance images (DW-MRIs) were obtained immediately before and after a 10-minute session of lumbar joint mobilization. At least 1 month later, a second session was performed in which DW-MRIs were obtained immediately before and after a 10-minute session of prone lying. Following lumbar joint mobilization, a significant increase (P = .002) in the mean values for diffusion of water was observed within degenerative IVDs at L5-S1 (22.2% increase; effect size, 0.97). Degenerative IVDs at L1-2 to L4-5 and normal IVDs at L1-2 to L5-S1 did not demonstrate a change in diffusion following joint mobilization. Prone lying was not associated with a change in diffusion for normal or degenerative IVDs. The stimulus provided by lumbar joint mobilization may influence the diffusion of water in degenerative IVDs at L5-S1; however, these are preliminary findings and the relationship of these findings to pain and function needs further investigation.

Outcomes After a Prone Lumbar Traction Protocol for Patients With Activity-Limiting Low Back Pain: A Prospective Case Series Study

Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective, case series study. Objective To determine outcomes after administration of a prone lumbar traction protocol. Design Prospective, longitudinal, case series. Setting Suburban, chiropractic practice. Participants A total of 296 subjects with low back pain (LBP) and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels of the lumbar spine. We excluded patients involved in litigation and those receiving workers’ compensation. Intervention An 8-week course of prone lumbar traction, using the vertebral axial decompression (VAX-D) system, consisting of five 30-minute sessions a week for 4 weeks, followed by one 30-minute session a week for 4 additional weeks. Main Outcome Measures The numeric pain rating scale and the Roland-Morris Disability Questionnaire (RMDQ) were completed at preintervention, discharge (within 2 weeks of the last visit), and at 30 days and 180 days after discharge. Intention-to-treat strategies were used to account for those subjects lost to follow-up. Results A total of 250 (84.4%) subjects completed the treatment protocol. On the 30-day follow-up, 247 (83.4%) subjects were available; on the 180-day follow-up, data were available for 241 (81.4%) subjects. We noted significant improvements for all postintervention outcome scores when compared with preintervention scores ( P<.01). Conclusions Traction applied in the prone position using the VAX-D for 8 weeks was associated with improvements in pain intensity and RMDQ scores at discharge, and at 30 and 180 days after discharge in a sample of patients with activity-limiting LBP. Causal relationships between these outcomes and the intervention should not be made until further study is performed using randomized comparison groups.

Physical Therapist Management of a Patient With Acute Low Back Pain and Elevated Fear-Avoidance Beliefs

Elevated fear-avoidance beliefs are believed to be a precursor of chronic disability, yet effective intervention options have not been described in the literature. The purpose of this case report is to describe physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. The patient was a 42-year-old sales manager with acute low back pain. The patient had no previous history of activity-limiting low back pain and initially had limitations in straight leg raising, limitations in lumbar movement, and elevated fear-avoidance beliefs. Treatment-based classification and graded exercise were used. Disability, fear-avoidance beliefs, and pain decreased 4 weeks after starting physical therapy. Six months later, disability and fear-avoidance beliefs had increased, but were still improved when compared with the initial measurements. Disability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.

Investigation of the Flexible Ruler as a Noninvasive Measure of Lumbar Lordosis in Black and White Adult Female Sample Populations

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Army, the Department of Defense, or the U.S. Government. The purpose of this study was to investigate the validity of the flexible ruler as a noninvasive measure of lumbar lordosis in black and white adult females. The bony landmarks of the second lumbar vertebra (L2) and the intersection of the posterior superior iliac spines (PSIS) were palpated and marked on 45 adult females (21 blacks, 24 whites). Potential subjects with a previous history of activity-limiting low-back pain, spinal surgery, or spinal anomaly were excluded from the study. A lateral lumbosacral roentgenograph was taken of each subject, and an actual (skeletal) lumbosacral lordosis angle (ALS) was calculated from the roentgenograph. A flexible ruler was then molded to the contour of the subject's lumbosacral spine, and the previously marked L2 and PSIS intersection bony landmarks were located on the flexible ruler. The flexible ruler lordosis angle (FRA) was then calculated and correlated to the subject's ALS. The criterion validity of the flexible ruler as a measure of actual lumbosacral lordosis was poor (Pearsons' Correlation Coefficient = 0.30, N = 45). Because of the poor criterion validity of the flexible ruler compared to roentgenographically confirmed lumbar lordosis, the flexible ruler has questionable clinical value in the assessment of lumbar lordosis. J Orthop Sports Phys Ther 1989;11(1):3-7.