Chronic Non-specific Back Pain Research Articles

The Impact of Baseline Pain Intensity on the Effectiveness of Whole-Body Electromyostimulation (WB-EMS) for Nonspecific Chronic Back Pain.

Recent clinical studies confirmedthat whole-body electromyostimulation (WB-EMS) training is a safe and time-efficient therapeutic method for patients with nonspecific chronic back pain (NSCBP). However, significant variations in initial pain intensity among subjects in these studies have been observed. This study aims to determine if patients with differing initial pain intensities experience varying degrees of benefit from WB-EMS and to assess the overall correlation between initial pain levels and pain reduction. Pain intensity datasets from two studies were combined. The pooled data included 121 NSCBP patients (38 males and 83 females) with an average age of 55.1 years (±11.8 years). Data was categorized by baseline pain intensity on the numeric rating scale (NRS) into seven groups: 0 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6, >6 to 7, and >7. Both absolute and relative changes were analyzed. Additionally, a Spearman rho correlation test was performed on the entire dataset to evaluate the relationship between initial pain level and pain reduction. Significant improvements were noted across all NRS11 categories, with strong effect sizes (p) in all classes above 2, ranging from 0.56 to 0.90. The >7 category exhibited the highest rate of clinically significant changes (80%) and an average improvement of 3.72 points. The overall group from >1 to 10 showed an average improvement of 1.33 points, with 37% of the participants experiencing clinically significant improvements. The Spearman rho correlation test revealed a moderate positive relationship between initial pain level and pain reduction (r_s = 0.531, p < 0.001), indicating that, generally, higher initial pain levels are associated with greater pain reduction. The findings support the hypothesis that NSCBP patients with higher baseline NRS values benefit more substantially from WB-EMS. Those with NRS values above 7 show the greatest improvement and highest rate of clinical significance. The overall positive correlation between initial pain intensity and pain reduction further underscores the efficacy of WB-EMS in managing NSCBP across different pain intensities.

Alflutop Russian longitudinal multicenter observational study: use in patients with chronic back pain (message 3)

The use of slow-acting disease-modifying symptomatic drugs, such as bioactive concentrate from small marine fish (BCSMF, Alflutop), is considered a potential element of complex therapy for chronic non-specific back pain (CNBP).Objective: to evaluate the efficacy of the BCSMF in patients with CNBP in real-life clinical practice.Material and methods. An open observational study included 10,047 patients with CNBP (age – 58.3±14.9 years, 58.4% women) with moderate or severe pain – 60 [50; 70] mm on the visual analogue scale (VAS). All patients received a course of BCSMF medication: 1 ml intramuscular (IM) daily No. 20 or 2 ml IM every other day No. 10. 68.8 % of patients also took non-steroidal anti-inflammatory drugs. Treatment outcomes were assessed 10 days after completion of BCSMF therapy (30 days after initiation of treatment).Results and discussion. As a treatment result, the pain intensity according to the VAS decreased from 60 [50; 70] to 20 [10; 30] mm (p&lt;0.0001), the patients’ overall health assessment according to the VAS increased from 50 [30; 60] to 80 [60; 90] mm (p&gt;&lt;0.0001) and the quality of life assessment (EQ-5D) – from 0.52 [0.06; 0.66] to 0.8 [0.71; 1] points (p&gt;&lt; 0.0001). A good response to treatment (pain reduction &gt;50%) was observed in 73% of patients. On average, an improvement was observed on the 8th [5; 10] day of BCSMF therapy. There were no serious adverse effects associated with the use of the drug. Older age, overweight, initially more severe pain, and the presence of comorbid conditions were slightly more frequently associated with a less pronounced response to therapy.Conclusion. The use of BCSMF rapidly and effectively reduces the severity of pain and other symptoms associated with CNBP.

Virtual reality training and pain neuroscience plus motor control on pain, disability, health, and quality of life of women with non-specific chronic back pain

Background: Non-specific chronic low back pain is defined as a complex disorder involving structural, biomechanical, cognitive, psychological, social, and lifestyle factors. This randomized clinical trial study compared the effects of 8-week Virtual Reality Training (VRT) and pain neuroscience plus motor control training (PNE/MCT) on pain, disability, health, and quality of life of women with non-specific chronic back pain. Methodology: This research is a single-center parallel RCT. Thirty-six participants participated in this study. They were divided into two groups: VRT (G1) and PNE/MCT (G2), both with 18 women. The training was performed for eight weeks for 45 minutes – 60 minutes. The VRT was applied by Oculus Quest 2. Visual Analogue Scale (VAS), disability (Oswestry Disability Index), general health (GHQ-28), and quality of life (QOL- WHO) were assessed before and after eight training weeks using a within-between group analysis (ANOVA 2×2). Results: Before training, no difference was observed between the groups (p &gt; 0.05). After the intervention, both groups improved VAS, disability, GHQ, and QOL (all p &lt; 0.001). In the comparison between the groups, the G1 had a better performance according to the p-value and effect size in anxiety (p = 0.001, ES= 0.71), depression symptoms (p = 0.03, ES: 0.25), physical health (p = 0.03, ES: -0.24), mental health (p = 0.001, ES: 0.66), and total QOL (p = 0.048, ES: 0.21) than G2. Conclusion: Despite the effectiveness of both interventions, VRT improved the general health and quality of life in women with NSCLBP more than PNE/MCT.

The Effect of Cognitive Functional Therapy on Psychological Variables in Women With Non-specific Chronic Back Pain: A Randomized Control Trial

Purpose: Chronic non-specific low back pain (CNSLBP) is a common health issue caused by a mix of biological, psychological, and social factors. Cognitive functional therapy (CFT) is a comprehensive way to treat CNSLBP that focuses on changing negative thoughts and unhelpful habits through relaxation techniques. Since the evidence on the efficacy of CFT is still limited, it is essential to conduct clinical trials aimed at the effectiveness of CFT in the treatment of CNSLBP. This study aims to examine the effect of cognitive functional therapy on psychological variables in women with CNSLBP. Methods: Thirty women with CNSLBP were recruited for the clinical trial. They were randomly divided into two experimental and control groups (15 patients in each group). Our experimental group will have 18 individualized CFT sessions, each lasting an hour, over two months. The control group received no intervention. Pain intensity, disability, and kinesiophobia were assessed via the visual analog scale, Oswestry, and Tampa scale, respectively. Two-way repeated measures analysis of variance (ANOVA) was used to compare results between groups. Results: Two-way repeated measures ANOVA results showed that the experimental group compared to the control group in reducing pain (P=0.000, ηp2=0.787), disability (P=0.005, ηp2=0.457) and Kinesiophobia (P=0.000, ηp2=0.561) had a significant difference. Conclusion: CFT reduced pain, disability, and kinesiophobia in patients with CNSLBP. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among patients with CNSLBP is recommended.

Gabapentinoids: a therapeutic review.

The Australian Therapeutic Goods Administration's approved indications for prescription of gabapentinoids are refractory focal epilepsy and neuropathic pain. Use of gabapentinoids outside of the approved indications is common, but evidence for this is limited, especially for chronic nonspecific back pain and nonradicular leg pain. Some effects of gabapentinoids encourage their nonmedical use (e.g. euphoria, sedation, disinhibition). Widespread nonmedical use has increased the incidence of accidental and deliberate poisonings. Dependence may develop with chronic use of gabapentinoids and abrupt cessation may induce withdrawal symptoms. If the indication for continued use is unclear, gradual dose tapering as a means of deprescribing is recommended. Clinicians should consider the indication, patient characteristics and harm-benefit profile when prescribing gabapentinoids. Some people, such as those with kidney disease, have an increased risk of harm when using these drugs.

Hydrocortisone Differentially Affects Reinstatement of Pain-related Responses in Patients With Chronic Back Pain and Healthy Volunteers

Despite the crucial role of effective and sustained extinction of conditioned pain-related fear in cognitive-behavioral treatment approaches for chronic pain, experimental research on extinction memory retrieval in chronic pain remains scarce. In healthy populations, extinction efficacy of fear memory is affected by stress. Therefore, we investigated the effects of oral hydrocortisone administration on the reinstatement of pain-related associations in 57 patients with non-specific chronic back pain (CBP) and 59 healthy control (HC) participants in a differential pain-related conditioning paradigm within a placebo-controlled, randomized, and double-blind design. Participants’ skin conductance responses indicate hydrocortisone-induced reinstatement effects in HCs but no observable reinstatement in HCs receiving placebo treatment. Interestingly, these effects were reversed in patients with CBP, that is, reinstatement responses were only observed in the placebo and not in the hydrocortisone group. Our findings corroborate previous evidence of stress-induced effects on extinction efficacy and reinstatement of fear memory in HCs, extending them into the pain context, and call for more research to clarify the role of stress in fear extinction and return of fear phenomena possibly contributing to treatment failure in chronic pain treatment. PerspectiveOpposing effects in HCs and patients with non-specific CBP may be associated with changes in the patients’ stress systems. These findings could be of relevance to optimizing psychological, extinction-based treatment approaches.

Does an alternative breast support garment provide symptomatic relief for larger breasted women with chronic non-specific back pain?

Nonsurgical guidelines recommend implementing a correctly fitted bra when managing back pain among larger breasted women. Achieving this is challenging with current bra solutions, sizing principles, and fitting approaches. Persistent wearing of an ill-fitting bra can cause negative health implications, including non-specific back pain. This study investigated immediate and short-term biomechanical and pain responses to changing breast support garment among larger breasted women with non-specific back pain. Participants (n = 24) performed a standing task, drop jumps, and seated typing tasks while bra and spinal kinematic data were recorded. Five breast support conditions were assessed: participants' usual bra (control), a professionally fitted bra in the immediate term (standard) and after 4 weeks wear (standard28), and a bra with an alternative design, measurement, and fitting approach in both the immediate term (alternative) and after 4 weeks wear (alternative28). A bra fit assessment and clinical pain/disability questionnaires were included. All participants failed the bra fit assessment in the control bra, compared with 87.5% (n = 21) in the standard and 4.2% (n = 1) in the alternative bras. The standard28 and alternative28 bras provided symptomatic relief, with the alternative28 bra improving a greater number of outcome measures. Reduced nipple-sternal-notch distance was observed only in the alternative28 bra condition. Symptomatic relief may be associated with the resting position of the breast tissue on the anterior chest wall. The alternative bra may provide potential clinical benefit if implemented as part of a nonsurgical or conservative pain management strategy. Alternative breast support garments should be considered to provide solutions to the problems associated with traditional bras.

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study.

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting. A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large. A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.

Is There a Relationship between Psychological Status and Posture in Chronic Low Back Pain?

Context: Chronic non-specific low back pain (CNLBP) is a major public health. Numerous studies have evaluated the contribution of post urology in the assessment and the rehabilitation of this pathology. Nevertheless, the relationship between post urology and muscle assessment is still a subject of controversy and no clear cause and effect relationship between the two could be established. Aim: The aim of our work was to investigate the relationship between post urological and muscular assessments in patients with CNLBP. Methods: It’s about an observational, descriptive, and cross-sectional study. The muscle assessment included Quadriceps Femoris flexibility using the heel-to-buttock distance and Hamstrings flexibility using the popliteal angle. Isometric muscle strength of the extensor and flexor muscles of the trunk was assessed by the Biering-Sorensen test and the Shirado test, respectively. The evaluation of static postural control was performed by the SATEL® force platform in two conditions (opened eyes/closed mouth) and (closed eyes/closed mouth). The selected parameters were S (mm2), XY (mm), X (mm), Y (mm), support (%), and Romberg Quotient (RQ). The chi-square test or Fisher's exact test was used to assess differences between categorical variables, and means were compared using Pearson's or Spearman's correlation tests depending on the distribution of the variables. Comparison between qualitative and quantitative variables was done by ANOVA test for normally distributed variables and Mann-Whitney or Kruskall-Wallis tests for non-normally distributed data. Results: Forty patients were included. The study of muscle flexibility according to force platform parameters showed that left Hamstring stiffness was significantly correlated with XY (p=.037) and with instability in the sagittal plane (p=.036). On the other hand, the stiffness of the anterior rectus muscles (right and/or left) was significantly correlated with XY (p=0.019 for the right muscle and 0.011 for the left muscle) and with postural instability in the frontal plane (p=.015 for the right muscle and .026 for the left muscle). We also founded a significant association between the increase in Romberg quotient and right Hamstring stiffness (p=.003). Conclusions: Our study as well as literature findings suggest that the Quadriceps Femoris and the Hamstrings play have a significant role in core stability of patients with chronic non-specific back pain. However, the origin of the population is also an important factor in the postural evaluation. A larger number of patients and a control group would have made it possible to establish a cause- effect relationship between Quadriceps Femoris, Hamstrings and static postural control abnormalities.

Enhancing Functional Ability in Chronic Nonspecific Lower Back Pain: The Impact of EMG-Guided Trunk Stabilization Exercises.

Nonspecific lower back pain (NSLBP) is described as pain that is not caused by an identifiable, well-known disease, such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory condition, radicular syndrome, or cauda equina syndrome. The aim of this study was to determine the effect of EMG-guided trunk stabilization exercises on functional disability associated with LBP. A single-blinded pre- and post-test experimental comparative design was used for this study. Fifty individuals with chronic NSLBP were screened for inclusion criteria. Of these, forty were randomly grouped into the EMG group receiving trunk-stability exercises with electromyography biofeedback and non-EMG group receiving trunk-stabilization exercises without EMG biofeedback. Participants performed five trunk-stability exercises 3 days a week for 4 weeks. The intensity of pain, range of motion, functional disability, and balance were measured at baseline and after 4 weeks. Both techniques indicated a significant effect on chronic NSLBP; however, trunk-stability exercises combined with EMG biofeedback produced better results in alleviating the intensity of pain, increasing the range of motion, and improving functional disabilities and static balance. The present study confirms that trunk-stability exercises with EMG biofeedback can be practiced safely, contributes to a greater boost in neuromuscular efficiency in the lumbar flexors and extensors, and is effective in modifying functional disability for patients with NSLBP.

Kinesiotherapy in chronic back pain and combined tension type headache

Kinesiotherapy is eff ective in the treatment of chronic nonspecific back pain (CNBP), but its eff ectiveness in tensiontype headache (TTH) is unclear. The effectiveness of kinesiotherapy in patients with CNBP and comorbid TTH has been little studied.The aim of the study was to evaluate the effectiveness of kinesiotherapy in patients with CNBS and comorbid TTH. Patients and methods. 52 patients (22 men and 30 women, mean age 32.4 ± 7.5 years) with CNBP and combined TTH were included in the study. All patients received standard treatment, of which 28 patients received kinesiotherapy (Group 1) and 24 patients were included in the comparison group (Group 2). All patients used pain diaries. All patients were tested by using the Beck Anxiety Inventory, the Beck’s Depression Inventory, the Pain Catastrophization Scale, the Kinesiophobia Scale, the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, the Headache Impact Test 6, numerical pain rating scale before treatment and 3, 6 months after treatment. Clinical effcacy was assessed by reducing the frequency and intensity of headache (by ≥ 50%), back pain (by ≥ 30%), and by increasing functional activity during the day (by ≥ 30%).Results. At 6 months follow-up signifiantly more patients in group 1 than in group 2 achieved a clinical effect on TTH and CNBP: 78.5% (n = 22) compared to 41.7% (n = 10); OR (95% CI) = 1.99. In 9 patients (32%) of group 1, a complete remission of TTH and CNBP was noted, in group 2 there were no such patients. At 6 months follow-up group 1 showed a significant improvement (p &lt; 0.05) in comparison with group 2 in terms of functional activity and emotional state.Conclusion. Kinesiotherapy for CNBP and combined TTH is effective both for back pain and headache. It increases functional activity and improves the emotional state of patients.

Effect of Nordic Walking Training on Physical Fitness and Self-Assessment of Health of People with Chronic Non-Specific Lower Back Pain

In order to determine the impact of a four-week cycle of Nordic Walking (NW) training on the physical fitness of people with chronic non-specific lower back pain and the impact of this form of activity on their self-assessment of health quality, the study included 80 men and women aged 29 to 63 years. The subjects were divided into two equal (40-person) groups: experimental and control. In both study groups the degree of disability in daily activities caused by back pain was assessed with the FFb-H-R questionnaire, the physical fitness was evaluated with the modified Fullerton test and the sense of health quality was assessed with the SF-36 questionnaire. The same tests were repeated after four weeks. In the experimental group NW training was applied between the two studies. During four weeks, 10 training units were carried out, and each training session lasted 60 min with a two-day break between each training. The four-week NW training resulted in a statistically significant sense of disability due to back pain (p < 0.001), significant improvement of physical fitness expressed by improvement in upper (p < 0.001) and lower (p < 0.01) body strength, upper and lower body flexibility (p < 0.001) and ability to walk a longer distance in a 6-min walk test (p < 0.001). The training participants also showed significant improvements in health quality in both physical (p < 0.001) and mental (p < 0.001) components. The four-week NW training has a positive impact on the physical fitness of men and women with chronic lower back pain. Participation in NW training also contributes to a significant reduction in the sense of disability caused by back pain and improvement in the self-assessment of health quality.

Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a “Frozen Back”?

The thoracolumbar fascia (TLF) plays an important role in lower back pain (LBP). Recent studies have revealed an association between increases in TLF thickness and reduced TLF gliding in patients with LBP. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the TLF at the bilateral L3 level of the lumbar spine in the longitudinal and transverse axes in chronic non-specific LBP and in healthy subjects. A cross-sectional study was performed using US imaging to measure the longitudinal and transverse axes with a new protocol in a sample of 92 subjects: 46 chronic non-specific LBP patients and 46 healthy participants. The findings for TLF thickness revealed statistically significant differences (p &lt; 0.05) in the longitudinal and transverse axes between the two groups. Moreover, in the healthy group, a statistically significant difference was found between the longitudinal and transverse axes (p = 0.001 for left and p = 0.02 for right), which was not evident in the LBP patients. These findings suggest that the LBP patients lost anisotropy of the TLF, with it becoming homogeneously thicker and losing adaptability in the transversal direction. The US imaging evaluation suggests that TLF thickness behavior points out altered fascial remodelling compared to healthy subjects, a sort of “frozen back”.

Chronic musculoskeletal pain: pathogenesis, clinical features, therapy possibilities

The control of musculoskeletal pain (MSP) is an important part of the complex treatment of rheumatic diseases (RD). Analgesic therapy still plays the leading role in osteoarthritis (OA) and chronic nonspecific back pain (most cases of this syndrome are associated with spinal OA) treatment. Despite the use of modern basic anti-inflammatory drugs (including biological and JAK inhibitors), the problem of MSP control remains relevant in immuno-inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis. The pathogenesis of MSP is complex and closely related to the processes of damage, inflammation and degeneration. A fundamental role here belongs to local and systemic inflammatory response occurrence, which largely determines such elements of the pathogenesis of chronic MSP as peripheral and central sensitization. Depending on the prevailing pathogenesis mechanisms, MSP can manifest itself in several phenotypes: «inflammatory», «mechanical», «enthesopathic», associated with central sensitization. A combination with such symptoms as stiffness, fatigue, muscle tension, sleep disturbance, depression and anxiety is characteristic for MSP. The control should be comprehensive and must include the use of both drug and drug-free preparations. Nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressants and anticonvulsants, local injection therapy (glucocorticoids, hyaluronic acid, platelet-rich plasma), as well as methods of physiotherapy and rehabilitation are used in pain treatment.

The Effect of Eight Weeks of Exercises Based on Prayer Movements on Pain and Endurance of Trunk Flexor and Extensor Muscles in Patients with Non-Specific Chronic Back Pain

The Effect of Eight Weeks of Exercises Based on Prayer Movements on Pain and Endurance of Trunk Flexor and Extensor Muscles in Patients with Non-Specific Chronic Back Pain

Anatomical study and clinical significance of the posterior ramus of the spinal nerve of the lumbar spine.

Background and objectives: Chronic nonspecific back pain is a common clinical disease typically treated by ultrasound-guided spinal injection. This minimally invasive treatment targets the posterior ramus of the spinal nerve (PRSN). The target of the medial branch is clear, but there is unclear target for the intermediate and lateral branches. This study attempted to observe the distribution of PRSN in the dorsal region of transverse process to provide a more detailed anatomical basis for treating spinal pain. Methods: The present study was conducted on 16 transverse processes of six adult male embalmed corpses. The dorsal area of the transverse process was divided into three equal zones, which are zone I, zone II and zone III from inside to outside. The origin, distribution, quantity, transverse diameter, and relationship with the bone structure of the PRSN on the transverse process were observed. Results: Sixty PRSNs were found in the lumbar of six cadavers, of which 48 were divided into three branches, and 12 PRSNs were divided into two branches. The intermediate branch is mainly distributed in zone I, and the lateral branch is mainly distributed in zone II. Twenty-nine communicating branches were found in 48 adjacent segments of six specimens, all of which originated from the intermediate branch of the previous segment and connected with the lateral branch of the next segment. Conclusion: This anatomical study describing the PRSN may have important clinical significance for spinal surgeons. Understanding the bony localization targets of the PRSN and the links between the PRSNs may benefit patients with low back pain who receive spinal injections.

Chronic back pain as a spinal osteoarthritis manifestation: rationale and practice of symptomatic slow acting drugs for osteoarthritis use

Chronic non-specific back pain (CNBP) is the most common pathology of the musculoskeletal system, affecting from 10 to 60% of the adult population in the world, causing severe suffering, disability and a significant deterioration in the quality of life. Osteoarthritis (OA) should be considered as one of the main reasons of the development of CNBP – inflammatory and degenerative changes in the facet and sacroiliac joints, as well as the spinal column itself (in particular, osteitis of the Modic 1 type). Spinal OA is accompanied by biomechanical disturbances, nociplastic (peripheral and central sensitization) and psycho-emotional changes that form a complete picture and various CNBP phenotypes.Recognizing the leading role of OA as the cause of CNBP, it is advisable to use the same therapeutic approaches in this syndrome as in OA of peripheral joints. In particular, it is necessary to consider the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) in CNBP as the main pathogenetic therapy.Alflutop is one of the most popular parenteral SYSADOA widely used in Russian practice. This drug has a good evidence base: this review presents data from 12 clinical trials of Alflutop in CNBP (n=1479), which confirmed its efficacy and safety.

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

BackgroundThere is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria’s fragmented social health insurance system.MethodsUsing a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsThe findings from the 25 expert interviews were organised within Levesque’s conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients’ ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient’s socio-economic status, health literacy and ability to pay.ConclusionsWhile studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential ‘invisible’ barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients’ specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.

The Effect of Water Walking on Pain Intensity and Motor Function in Men with Non-Specific Chronic Back Pain

The Effect of Water Walking on Pain Intensity and Motor Function in Men with Non-Specific Chronic Back Pain

Comparison Of The Effectiveness Of Back School Exercises And Mckenzie Exercises In The Treatment Of Chronic Low Back Pain; A Randomized Controlled Trial”RCT

Low back pain has become the most common critical health problem and it is well known for causing a personal, and community financial burden globally. Low back pain is demarcated as non-specific, non-radiating pain with no accompanying neurological signs and symptoms. Objective: The purpose of this study was to compare the effectiveness between Mckenzie exercises and back school exercises in the treatment of low back pain. Methods: This research included 36 patients who met the eligibility criteria. Prior to undertaking any examinations or receiving treatments, each participant in this study gave their ethical approval via filling out informed consent. Patients with nonspecific chronic back pain were divided randomly into 3 groups. In ‘group A’ only the conventional treatment was provided and in group 2 patients performed back school exercises. Similarly, in group 3 patients performed Mckenzie exercises. The lottery method was used to assign patients to these three randomized groups. All of these aforementioned groups received conventional therapy, which remained identical throughout the study. The conventional treatment included a hot pack for 10 minutes and back isometrics. Additionally, group A received conventional therapy, group B received conventional therapy along with back school exercises, and group 3 received Mckenzie exercises and conventional therapy. Each patient received treatment three times a week for of total 4 weeks. Roland Morris’s disability questionnaire was used to measure self-reported physical impairment due to low back pain. Moreover, a numeric pain rating scale was used to measure pain severity. Results: This study showed that patients receiving back school and Makenzie exercises showed marked improvement in pain and disability scores. Conclusion: This study concluded that Mckenzie exercises are more effective than back school exercises for the management of chronic nonspecific low back pain. That is because Mckenzie’s exercises not only decrease pain but equally improve, the flexibility and posture of the spine