Characteristics Of Low Back Pain Research Articles

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain.

BackgroundPsychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness.ObjectivesTo evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP.MethodsThe relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r 2) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure.ResultsFear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r2 = 0.33, P = 0.03), but not backward perturbation (r2 = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01).ConclusionsFear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation.

Association Between Beliefs and Care-Seeking Behavior for Low Back Pain

Cross sectional population-based survey. To investigate the relationship between low back pain (LBP) beliefs and care seeking in LBP. Not all people experiencing LBP seek care for their problem. Consistent predictors of care-seeking behavior seem to be female sex and high perceived disability; the role of beliefs about LBP has not been investigated sufficiently. A questionnaire booklet was mailed to a random sample of 2860 individuals otherwise participating in an epidemiological study of musculoskeletal health. It contained the Back Beliefs Questionnaire (BBQ), the Fear-Avoidance Beliefs Questionnaire (FABQ; physical activity and work scales), and questions about sociodemographics, LBP characteristics, and LBP-related care seeking in the last month ("yes" = visit to specialist, general practitioner, physiotherapist, or other health care practitioner; "no" = none of these). Logistic regression was used to identify whether beliefs made a significant contribution to care-seeking behavior, beyond known predictors conceptualized in the behavioral model of health services use. A total of 2507 of 2860 (88%) individuals completed the questionnaire; 1071 (43%) reported current LBP, 301 (28%) of which had sought care. In univariate analyses the following were all significantly related to care seeking (all P < 0.01): female sex; increasing age; not working full time; lower income; greater LBP frequency, LBP intensity, and limitations in activities of daily living; worse general health; higher FABQ-Physical Activity, FABQ-Work, and Back Beliefs Questionnaire scores. In multiple regression, female sex (odds ratio [OR], 1.731; 95% confidence interval [CI], 1.174-2.551; P = 0.006), LBP frequency (OR, 1.492; 95% CI, 1.249-1.783; P < 0.0001), limitations in activities of daily living (OR, 1.010; 95% CI, 1.001-1.020; P = 0.037), and high FABQ-Work Scores (OR, 1.025; 95% CI, 1.005-1.044, P = 0.012) contributed significantly to the final model. That the odds of seeking care are higher in fear-avoidant individuals, even when controlling for other established predictors, emphasizes the importance of addressing such beliefs during the consultation; public health education programs may serve to underpin the delivery of positive messages, ultimately reducing health care demands.

Percutaneous therapy versus surgery in chronic back pain: how important is imaging in decision-making?

This article addresses whether or not imaging (including both noninvasive and invasive techniques) is important in decision-making for the treatment of patients with chronic low back pain. It begins by studying the characteristics of low back pain. A brief summary of all diagnostic techniques is given, including radiography and axial imaging with CT and MRI, as well as invasive techniques (i.e., discography, myelography and infiltrations). A close and critical inspection is then made upon the value and limitations inherent in these different techniques. In conclusion, future improved imaging that will contribute to more proper patient selection is described.

Preliminary evidence for the features of non-reducible discogenic low back pain: survey of an international physiotherapy expert panel with the Delphi technique

ObjectivesThe lumbar intervertebral disc is a known source of low back pain (LBP). Various clinical features of discogenic pain have been proposed, but none have been validated. Several subgroups of discogenic pain have been hypothesised, with non-reducible discogenic pain (NRDP) proposed as a relevant clinical subgroup. The objectives of this study were to obtain consensus from an expert panel on the features of discogenic low back pain, the existence of subgroups of discogenic LBP, particularly NRDP, and the associated features of NRDP. DesignThree-round Delphi survey. ParticipantsTwenty-one international physiotherapists with expertise in LBP. MethodsPanellists listed and ranked features that they believed to be indicative of discogenic pain and NRDP. On completion of Round 3, features with ≥50% agreement between panellists were deemed to have reached consensus. ResultsAfter three rounds, 10 features of discogenic LBP were identified. Nineteen of the panellists believed that NRDP was a subgroup of discogenic LBP, and nine features of NRDP were identified. ConclusionThis study provides preliminary validation for the features associated with discogenic LBP. It also provides evidence supporting the existence and features of NRDP as a separate clinical subgroup of discogenic LBP.

Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients

AimTo determine the prevalence of low back pain (LBP), investigate the sociodemographic characteristics of patients with LBP, and examine its association with psychological distress such as anxiety, depression, and somatization.Subjects and methodsOf the 2742 patients approached, 2180 agreed to participate in this cross-sectional study (79.5% response rate). The survey was conducted among primary health care visitors from March to October 2012 and collected sociodemographic details and LBP characteristics. General Health Questionnaire-12 was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder-7, depression was assessed with Patient Health Questionnaire-9, and somatization was measured with Patient Health Questionnaire-15.ResultsThe study sample consisted of 52.9% males and 47.1% females. The prevalence of LBP was 59.2%, comprising 46.1% men and 53.9% women. LBP was significantly higher in Qataris (57.9%), women (53.9%), housewives (40.1%), and individuals with higher monthly income (53.9%). Somatization (14.9%) was observed more in LBP patients, followed by depression (13.7%) and anxiety disorders (9.5%). The most frequently reported symptoms were “headaches” (41.1%) and “pain in your arms, legs, or joints” (38.5%) in LBP patients with somatization. The most frequent symptoms among depressed LBP patients were “thinking of suicide or wanting to hurt yourself” (51.4%) and “feeling down, depressed, or hopeless” (49.2%). “Not being able to stop or control worrying” (40.2%), “worrying too much about different things” (40.2%), and “feeling afraid as if something awful might happen” (40.2%) were the most common anxiety symptoms in LBP patients. Psychological distress such as anxiety (9.5% versus 6.2%), depression (13.7% versus 8.5%), and somatization (14.9% versus 8.3%) were significantly higher in LBP patients.ConclusionThe prevalence of LBP in this study sample was comparable with other studies. Furthermore, psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP.

Low Back Pain in Time: Risk Factors Associated with Persistence, Recurrence, and Time Till Patients Seek Help in Primary Care

Introduction Time characteristics of early episodes of low back pain (LBP) like duration and recurrence may relate to current risk factors and lack of resources that increase the risk of persistent LBP. In addition, when suffering from a first episode of LBP and individuals decide to seek medical care, time till individuals do should be not too long. Again, delay of presentation may relate to risk factors and lack of resources. Aim of our study was to estimate the relationship between time-related LBP characteristics and prognostic factors for acute/subacute LBP in primary care. Materials and Methods Prospective inception cohort study of 315 consecutive patients attending a health practitioner for their first episode of acute/subacute LBP or recurrent LBP. One-tailed correlations conducted between patient characteristics and the three time-related characteristics “subacute LBP”, “recurrent LBP,” and “delayed presentation”. Results The pattern of correlation between risk factors and resources against persistent LBP differed between three time-related variables. “Subacute LBP” and “delayed presentation” were positively associated with psychological factors (pain catastrophizing, magnification, and helplessness). Both indicators were negatively correlated with resources (job satisfaction and time control) against development of persistent LBP. Moreover, “delayed presentation” was related positively with occupational stressors (“resigned attitude towards the job”, “uncertainty”, “problem with organization of work tasks”, “work interruptions”). In contrast, “recurrent LBP” was only related to more impaired health-related factors (functional limitation, sensory, and affective pain). Conclusion Patients with current LBP waiting longer till seeking help in primary care have a more disadvantageous profile of occupational and psychological risk factors and lower resource levels. A similar but less pronounced pattern occurred in those with subacute LBP compared to those with acute LBP. Implications for clinical practice are twofold; (1) LBP-patients with prolonged symptoms or delayed care-seeking behavior, who are at risk of developing persistent LBP, should be screened for psychological factors such as magnification and helplessness, (2) In these patients, occupational resources like job satisfactionand time control should be addressed and strengthened in primary and secondary prevention, where feasible. Future research should examine time-related variables that influence prognostic factors for LBP in different clinical settings such as predominantly retired or unemployed populations. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared

Is It Time to Rethink the Typical Course of Low Back Pain?

To determine the frequency and the characteristics of low back pain (LBP) recurrences. The research questions were as follows: (1) Are LBP recurrences common? (2) Do episodes worsen with multiple recurrences? (3) Does pain change location in any recognizable pattern during an episode? Single-page self-administered questionnaire. Thirty clinical practices (primary care, physical therapy, chiropractic, and surgical spine) in North America and Europe. A convenience sample of 589 respondents with LBP. There were no exclusions based on type of LBP, history of onset, or comorbidities. The survey was distributed during patients' assessment or initial treatment at their respective clinics. The survey queried the following: (1) the severity of original versus most recent episodes based on the following: pain intensity, interference with leisure and work activities, duration of episodes, and most distal extent of pain; and (2) changes in pain location within episodes. In response to research question 1, a previous episode was reported by 73%; of those, 66.1% reported their first episode lasted ≤3 months, 54% reported ≥10 episodes, and 19.4% reported >50 episodes. In response to research question 2, of those with recurrences, 61.1% reported that at least one of the survey domains was worse in recent episodes (P < .01) and only 36.9% reported that they were better; 20.5% were worse in all domains, whereas 8.6% were better or the same. In response to research question 3, the pain location changed during the episode in 75.6%; of these, 63.2% reported that their pain first spread distally before retreating proximally during recovery; there was a strong trend toward those reporting worsening episodes also reporting proximal-to-distal-to-proximal changes in pain location during their episodes (r = 0.132, P < .06). Recurrent LBP episodes were common and numerous. Recurrences often worsened over time. It seems inappropriate to characterize the typical course of LBP as benign and favorable.

Key Characteristics of Low Back Pain and Disability in College-Aged Adults: A Pilot Study

Handrakis JP, Friel K, Hoeffner F, Akinkunle O, Genova V, Isakov E, Mathew J, Vitulli F. Key characteristics of low back pain and disability in college-aged adults: a pilot study. ObjectiveTo identify which factors commonly associated with low back pain (LBP) and disability differ between college-aged persons with LBP and with no or minimal LBP. DesignClinical measurement, observational study. Subjects were assessed for LBP with the visual analog scale (VAS) and for disability from LBP using the Oswestry Disability Index (ODI). Subjects were measured for variables commonly associated with LBP and were grouped by both VAS (minimum [min]/no pain, pain) and ODI (no disability, disability) scores. SettingCollege campus at a university. ParticipantsA convenience sample (N=84) of English-speaking students (34 men, 50 women) between 18 and 30 years of age. InterventionsNot applicable. Main Outcome MeasuresSports activity (sports activity score of the Baecke Physical Activity Questionnaire), depression, hamstring and hip flexor range of motion, low back extensor endurance, abdominal strength and endurance. ResultsA significant main effect of group was found for both pain (P=.019) and disability groups (P=.006). The min/no pain and pain groups differed in back endurance (114.2±38.8s vs 94.5±44.5s, respectively; P=.04). The no disability and disability groups differed in back endurance (116.3±35.9s vs 97.1±45.7s, respectively; P=.03) and the sports activity score of the Baecke Physical Activity Questionnaire (2.98±.95 vs 2.48±.85, respectively; P=.01). Subjects with hyperkyphotic postures compared with the normative thoracic group had higher depression scores (49 vs 38.5, respectively; P=.03) and less hamstring flexibility (30.5 vs 49.9, respectively; P<.001). ConclusionsBack extensor endurance was consistently different between both the pain and disability groups. Addressing limited low back extensor endurance and low levels of physical activity in young adults may have clinical relevance for the prevention and treatment of LBP and disability.

Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia

Osteoarthritis (OA), low back pain (LBP), and fibromyalgia (FM) are common chronic pain disorders that occur frequently in the general population. They are a significant cause of dysfunction and disability. Why some of these chronic pain disorders remain localized to few body areas (OA and LBP), whereas others become widespread (FM) is unclear at this time. Genetic, environmental, and psychosocial factors likely play an important role. Although patients with OA, LBP, and FM frequently demonstrate abnormalities of muscles, ligaments, or joints, the severity of such changes is only poorly correlated with clinical pain. Importantly, many patients with these chronic pain disorders show signs of central sensitization and abnormal endogenous pain modulation. Nociceptive signaling is actively regulated by the central nervous system to allow adaptive responses after tissue injuries. Thus, abnormal processing of tonic peripheral tissue impulse input likely plays an important role in the pathogenesis of OA, LBP, or FM. Tonic and/or intense afferent nociceptive barrage can result in central sensitization that depends on facilitatory input from brainstem centers via descending pain pathways to the spinal cord. Abnormal endogenous control of these descending pathways can lead to excessive excitability of dorsal horn neurons of the spinal cord and pain. Ineffective endogenous pain control and central sensitization are important features of OA, LBP, and FM patients.

Embedding Psychosocial Perspectives Within Clinical Management of Low Back Pain: Integration of Psychosocially Informed Management Principles Into Physical Therapist Practice—Challenges and Opportunities

As the biopsychosocial model of health has become increasingly understood, it has become clear that there are complex, interdependent relationships between the physical and biomedical features of low back pain and the psychological and social factors that present concomitantly. Epidemiological studies have not only highlighted that psychological and social factors are associated with back pain and disability but also have shed light on the way in which these factors serve as prognostic indicators, or obstacles to recovery, predicting which patients will have a poor prognosis. Integrating the assessment of these obstacles to recovery into physical therapist practice and using this information to guide clinical decision making have the potential to improve the quality of care offered by physical therapists by improving the targeting of treatments to individuals and enhancing the therapist-patient relationship and adherence to management advice and treatment programs. In turn, such approaches may improve both patients' clinical outcomes and the efficiency and effectiveness of service provision, helping direct interventions to those who need them. This article summarizes the key challenges to embedding psychosocial perspectives within physical therapist practice for patients with low back pain and the opportunities that could be realized by doing so, and it highlights new developments in research, clinical practice, and education that are shaping future directions in this field.

Investigation of low back pain in a non-hospital population of the coastline of the State of São Paulo

BACKGROUND AND OBJECTIVES: Low back pain is a prevalent complaint of multifactorial origins. To date, there have been no studies on the prevalence and characteristics of low back pain in the city of Santos, in the coastal region of the State of São Paulo, Brazil. The objective of the present study was to assess the profile of middle-aged individuals with low back pain from the general population aged 40-59 years, regarding gender, body mass index, regular physical activity and load handling. METHOD: The study design was prospective, exploratory and transversal, comprising 200 adults aged between 40 and 59 years, randomly selected as the study population. These individuals were sequentially approached by the researchers and asked whether they would agree to answer a medical questionnaire. No indication of the intention of researching low back pain was given before the individuals had agreed to participate. RESULTS: Out of 200 individuals (78 males and 122 females), 159 of them (60 males and 99 females) answered that they had experienced at least one significant and limiting episode of low back pain in their lives. A subgroup of 109 individuals (37 males and 72 females) had sought medical care for this painful episode. There were no statistically significant differences regarding gender, body mass index or number of hours sitting down at work and the presence of low back pain. There was a small positive correlation between low back pain and load handling at work, as well as a slight negative correlation between low back pain and regular physical activity. CONCLUSION: Low back pain was a highly prevalent condition in otherwise healthy individuals in our region.

Increased prevalence of low back pain among physiotherapy students compared to medical students

Some studies have demonstrated that physiotherapists have a high prevalence of low back pain (LBP). The association between physiotherapy students, who are potentially exposed to the same LBP occupational risks as graduates, and LBP has never been demonstrated. The objective of the study is to evaluate the association between undergraduate physiotherapy study and LBP. The study design includes a cross-sectional study. A questionnaire-based study was carried out with physiotherapy and medical students. LBP was measured as lifetime, 1-year and point prevalence. Bivariate and multivariate analyses were performed to find the factors associated with LBP. Bivariate analyses were also performed to assess differences between LBP characteristics in the two courses. 77.9% of the students had LBP at some point in their lives, 66.8% in the last year and 14.4% of them reported they were suffering from LBP at the moment of answering the questionnaire. Physiotherapy students reported a higher prevalence of LBP when compared with the medical students in all measures. In the logistic regression model, physiotherapy students (A-OR 2.51; 95% CI 1.35-4.67; p = 0.003), and being exposed to the undergraduate study for more than four semesters (A-OR 2.55; 95% CI 1.43-4.55; p = 0.001) were independently associated with LBP. There were no differences between the courses concerning pain intensity and disability. As it was a cross-sectional study, we were not able to observe accurately if there is an increasing incidence of LBP during the course. Also, we did not intend to identify which activities in the course were associated with the development of LBP. This study clearly demonstrated an association between undergraduate physiotherapy study and LBP. The length of course exposure is also associated with LBP.

Low Back Pain Prevalence and Characteristics in Caregivers of Stroke Patients: A Pilot Study

Purpose: The aim of this study was to determine the frequency and features of low back pain (LBP) among stroke caregivers. Method: Participants included 64 caregivers of stroke survivors in our inpatient clinic. Age, gender, body weight, FIM™, and Brunnstrom Scale of patients and low back pain history, Short Form-36 (SF-36), Beck Depression Measure (BDM), and Oswestry Disability Scale (ODS) of caregivers were reported. Descriptive statistics, Spearman correlation, and Mann-Whitney U test were used. Results: Fifty-three (82.8 %) of caregivers had LBP. Stroke survivors of caregivers with LBP (group 1) had significantly lower FIM™ scores when compared with stroke survivors of caregivers without LBP (group 2) (P < .05). All SF-36 subscores and total score of group 1 except mental health were significantly lower than SF-36 scores of group 2. Discussion: The lifetime, 12-month period, and point prevalence of LBP were 44.1%, 34.0%, and 19.7%, respectively, in our country. Caregivers had a higher frequency of LBP in this study. However it was a study with a small number of participants. There are many studies about stroke caregivers’ depression and life quality. LBP should also be investigated.

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

An Exploration of Maitland's Concept of Pain Irritability in Patients with Low Back Pain

Maitland's construct of musculoskeletal pain irritability is widely used by physical therapists for making decisions about the vigor of examination and treatment, but this construct has not been defined to the extent that its measurement properties can be tested. The purposes of this study were to 1) determine if physical therapists utilize low back pain (LBP) irritability judgments to make treatment decisions, 2) identify LBP characteristics appropriate for an LBP irritability construct, and 3) develop a measurement construct of LBP irritability. Physical therapists evaluated and treated 183 subjects with LBP. The therapists judged the subjects' LBP as irritable or non-irritable, and recorded treatments provided at the initial visit. A principal-components analysis (PCA) was performed on 14 patient-reported LBP characteristics to identify potential components of a measurement construct of LBP irritability. The therapists' irritability judgments were found to be associated with the types of treatments prescribed. Five dimensions of LBP irritability were identified by the PCA from the 14 LBP characteristics considered. Four of these dimensions were associated with the therapists' LBP irritability judgments. The Roland-Morris Disability Questionnaire, presence of distal symptoms, and forward bending tolerance were found to have a stronger association with the irritability judgments than the dimensions of irritability identified in this study. Validated measures of LBP characteristics in current clinical use may adequately capture Maitland's concept of irritability.

Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors

Background Low back pain (LBP) is a common and costly problem in pregnancy. It is one of the main reasons for disability, absence from work, and responsible for huge direct and indirect economical impact. Purpose The purpose of this study was to determine the prevalence and risk factors of LBP during pregnancy. Study design A cross-sectional study was carried out on Iranian pregnant women. Patient sample Eleven hundred randomly selected pregnant women. Outcome measures A structured questionnaire including demographic, lifestyle, as well as prevalence and characteristics of LBP was used. Visual Analog Scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively. Methods After ethical approval from Medical Ethics Board at the Mazandaran University of Medical Sciences and Health Services, a cross-sectional study was conducted on 1,100 pregnant women from 18 health centers in Sari district, at northern Iran. Results Point, last-month, last 6-month, last-year, and lifetime prevalence of LBP were 40.2%, 55.9%, 59.4%, 76.2%, and 84.1%, respectively. Prolonged standing and rest were found to be the most significant aggravating and relieving factors (76.3% and 87.7%, respectively). LBP was significantly correlated with history of previous LBP and LBP in previous pregnancy (p=.000 in both cases). Conclusion The prevalence of LBP in pregnant women appears to be high and future research should focus on different preventive strategies during pregnancy.

Spinal Mechanical Load as a Risk Factor for Low Back Pain

Systematic review. To review and critically evaluate the past literature for spinal mechanical load as risk factor for low back pain (LBP). LBP is a costly health problem worldwide, and treatments are often unsuccessful. Therefore, prevention might be more beneficial in the management of LBP. With respect to prevention, the knowledge of risk factors is essential. From the literature, exposures involving spinal mechanical load is frequently discussed as a potential risk factor for LBP. For a better understanding of this risk factor, we performed a systematic review of the literature. Additionally, we evaluated exposures of spinal mechanical load for possible dose-response relations with LBP. We systematically searched Medline, Embase, PsycINFO, and CINAHL databases (without language restriction) for full-report publications of prospective cohort studies, evaluating spinal mechanical load during work and/or leisure time activities as risk factors for nonspecific LBP in patients (>18 years of age) free of LBP at baseline. We assessed the methodology of each article and extracted information on population, response rates, characteristics of LBP, exposures, and estimated association(s), using standardized forms. We performed a best evidence synthesis of the obtained information. In total, 18 studies were eligible (all rated as high methodologic quality) reporting on 24,315 subjects. We found strong evidence that leisure time sport or exercises, sitting, and prolonged standing/walking are not associated with LBP. Evidence for associations in leisure time activities (e.g., do-it-yourself home repair, gardening), whole-body vibration, nursing tasks, heavy physical work, and working with ones trunk in a bent and/or twisted position and LBP was conflicting. We found no studies, thus no evidence, for an association between sleeping or sporting on a professional level and LBP.

Prevalence of Low Back Pain and Its Effect on Health-Related Quality of Life in Adolescents

To assess the prevalence of low back pain (LBP) in adolescents and the clinical features of LBP in 2 European countries and to evaluate the effect of LBP on health-related quality of life (HRQOL) using standardized validated generic and disease-specific instruments. Cross-sectional study. Secondary schools of Barcelona, Spain, and Fribourg, Switzerland. Representative sample of adolescents from the 2 cities. Intervention Selected adolescents completed a questionnaire including a generic HRQOL (KIDSCREEN-52) and 2 LBP-specific instruments. Results of KIDSCREEN-52, the Roland-Morris Disability Questionnaire, and the Hanover Functional Ability Questionnaire. A total of 1470 adolescents (52.6% male) with a mean (SD) age of 15.05 (1.17) years completed the questionnaires (response rate, 85.1%). Low back pain was reported by 587 adolescents (39.8%): isolated LBP in 250 (42.6%), LBP plus other pain in 271(46.2%), LBP plus whole-body pain in 50 (8.5%, and unclassifiable LBP in 16 (2.7%). Five hundred adolescents (34.7%) reported no pain, and 369 (25.6%) reported other pain without LBP. In those with isolated LBP, the percentage of adolescent boys was higher (54.6%; P < .001) and the LBP was mildest. In those with LBP plus whole-body pain, the percentage of adolescent girls was higher (62%; P < .001) and LBP was most severe. All KIDSCREEN scores in the group with LBP plus whole-body pain were significantly lower than in the other groups (effect size, 0.52-1.24). No differences were found between the groups who reported isolated pain, no pain, or other pain with no LBP. On the LBP-specific instruments, adolescents who reported LBP plus other pain had significantly poorer scores (P < .001) compared with those with isolated LBP but better scores (P < .001) than those with LBP plus whole-body pain. Low back pain in adolescents is a prevalent symptom with overall low associated disability and little effect on health-related quality of life. A subset of adolescents in whom LBP is associated with whole-body pain report significant impairment and deserve more attention.

Low Back Pain During Labor and Related Factors

A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p < .01) and had greater body weight when hospitalized (OR = 1.13; p = .02) were most likely to be in the low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.

Low back pain characteristics from undergraduate student to working nurse in Australia: A cross-sectional survey

Background Nurses are known to be a high risk group for occupational low back pain (LBP). The periods of greatest risk for developing low back pain in this population are not well defined. Recent literature suggests current preventative strategies are not consistently effective in improving low back injury statistics among health care populations. Objectives To identify the relative contributions of age and occupational exposure on the prevalence, duration and severity of low back pain episodes among undergraduate nursing students and recently graduated nurses. Design Cross-sectional survey. Settings Two university undergraduate nursing schools and one public teaching hospital graduate nurse training program in Western Australia. Participants 897 undergraduate nursing students (years 1, 2 and 3) and 111 graduate nurses recruited by personal invitation during lectures. Methods Using a modified version of the Nordic Low Back Questionnaire, information regarding low back pain episode prevalence, impact, duration, frequency and causes was obtained. Results Mean age was consistent across all groups (26.7 ± 9.0 years) and had no significant effect on lifetime low back pain prevalence ( p = 0.30). Very high lifetime (79%), 12 month (71%) and 7 day (31%) low back pain prevalence rates were consistent across all 3 year groups of undergraduate nursing students, but were significantly higher after 12 months of full-time employment [lifetime (95.5%), 12 month (90%) and 7 day (39%)]. Around 60% of all respondents with low back pain utilised at least one of (a) treatment, (b) medication, or (c) a reduction in activity. Nursing students and graduate nurses attributed the majority of their low back pain to bending or lifting despite recent efforts to reduce manual workplace demands (lifting) on nurses. Strategies for managing low back pain differed between nursing students and graduate nurses. Conclusions These results may suggest a rise in occupational exposure from student to working nurse is the primary cause of the increase in low back pain. Increased exposure may be to physical as well as psychological stressors. Given that prevalence rates are very high prior to commencing work, nursing student populations should be a target group for low back pain preventative strategies.