Experience Of Low Back Pain Research Articles

Evaluation of three machine learning models for self-referral decision support on low back pain in primary care

BackgroundMost people experience low back pain (LBP) at least once in their life and for some patients this evolves into a chronic condition. One way to prevent acute LBP from transiting into chronic LBP, is to ensure that patients receive the right interventions at the right moment. We started research in the design of a clinical decision support system (CDSS) to support patients with LBP in their self-referral to primary care. For this, we explored the possibilities of using supervised machine learning. We compared the performances of the three classification models − i.e. 1. decision tree, 2. random forest, and 3. boosted tree − to get insight in which model performs best and whether it is already acceptable to use this model in real practice. MethodsThe three models were generated by means of supervised machine learning with 70% of a training dataset (1288 cases with 65% GP, 33% physio, 2% self-care cases). The cases in the training dataset were fictive cases on low back pain collected during a vignette study with primary healthcare professionals. We also wanted to know the performance of the models on real-life low back pain cases that were not used to train the models. Therefore we also collected real-life cases on low back pain as test dataset. These cases were collected with the help of patients and healthcare professionals in primary care. For each model, the performance was measured during model validation − with 30% of the training dataset −as well as during model testing − with the test dataset containing real-life cases. The total observed accuracy as well as the kappa, and the sensitivity, specificity, and precision were used as performance measures to compare the models. ResultsFor the training dataset, the total observed accuracies of the decision tree, the random forest and boosted tree model were 70%, 69%, and 72% respectively. For the test dataset, the total observed accuracies were 71%, 53%, and 71% respectively. The boosted tree appeared to be the best for predicting a referral advice with a fair accuracy (Kappa between 0.2 and 0.4). Next to this, the measured evaluation measures show that all models provided a referral advice better than just a random guess. This means that all models learned some implicit knowledge of the provided referral advices in the training dataset. ConclusionsThe study showed promising results on the possibility of using machine learning in the design of our CDSS. The boosted tree model performed best on the classification of low back pain cases, but still has to be improved. Therefore, new cases have to be collected, especially cases that are classified as self-care cases. This to be sure that also the self-care advice can be predicted well by the model.

Individuals\u2019 explanations for their persistent or recurrent low back pain: a cross-sectional survey

BackgroundMost people experience low back pain (LBP), and it is often ongoing or recurrent. Contemporary research knowledge indicates individual’s pain beliefs have a strong effect on their pain experience and management. This study’s primary aim was to determine the discourses (patterns of thinking) underlying people’s beliefs about what causes their LBP to persist. The secondary aim was to investigate what they believed was the source of this thinking.MethodsWe used a primarily qualitative survey design: 130 participants answered questions about what caused their LBP to persist, and where they learned about these causes. We analysed responses about what caused their LBP using discourse analysis (primary aim), and mixed methods involving content analysis and descriptive statistics to analyse responses indicating where participants learnt these beliefs (secondary aim).ResultsWe found that individuals discussed persistent LBP as 1) due to the body being like a ‘broken machine’, 2) permanent/immutable, 3) complex, and 4) very negative. Most participants indicated that they learnt these beliefs from health professionals (116, 89%).ConclusionsWe concluded that despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. Relatedly, they often see their condition as very negative. Contrary to current “best practice” guidelines for LBP management, a potential consequence of such beliefs is an avoidance of physical activities, which is likely to result in increased morbidity. That health professionals may be the most pervasive source of this thinking is a cause for concern. A small number of people attributed non-physical, unknown or complex causes to their persistent LBP – indicating that other options are possible.

Biopsychosocial risk factors associated with chronic low back pain after lower limb amputation

Low back pain is a common secondary health condition after lower limb amputation with important implications related to functional capabilities and overall quality of life. Despite the high prevalence of low back pain after lower limb amputation, the underlying etiologies of the disorder remain unknown. This hypothesis-driven communication provides evidence in support of using the multifactorial, biopsychosocial model of low back pain experience in the general population for identification of potential risk factors and rehabilitation targets for low back pain after lower limb amputation. Key findings that link biological, psychological, and social factors and the experience of low back pain in the general patient population with LBP are discussed while highlighting gaps in our current state of knowledge related to the association of these factor and presence of low back pain after lower limb amputation. Importantly, the aim of this communication was not to propose a new model, but rather to organize data originating from prior work into a coherent hypothesis-driven conceptual framework to better understand the need for multifaceted and multidisciplinary intervention approaches for effective treatment of low back pain after lower limb amputation.

A Patient-Centered Approach to Developing Entrustable Professional Activities.

The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA. The authors chose "management of acute low back pain (LBP)" as a common, important clinical task on which to base the patient-centered EPA. In 2015, 14 patients who presented to a teaching hospital with acute LBP participated in semistructured interviews exploring their illness experience and expectations of doctors. Clinicians representing multiple disciplines participated in a focus group. The authors used the Framework Method to analyze data, identifying and developing themes, similarities, and differences between patient and clinician input. They used the findings to develop the EPA. Through an iterative procedure of data review and tracking data sources, they determined how patient and clinician input informed each EPA descriptor. Drawing from their firsthand experience of LBP, patients described unique expectations of trainees which directly informed EPA descriptors. For example, the authors primarily used patients' detailed descriptions of desirable and observable trainee behaviors to inform the required attitudes descriptor. Patients can provide unique contributions, complementary to those of clinicians, to EPAs. Consultations with patients led to the development of a patient-centered EPA, which aligned best clinical practice with patient expectations. Educators seeking to apply patient-centered care to EPA development could adopt a similar approach.

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial.

BackgroundLow back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.DesignA cluster-randomized controlled trial.MethodsPublically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP—the ‘functional-disturbance’-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.ResultsThere was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08–3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.ConclusionReassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.

Perceived discrimination and low back pain among 28,532 workers in South Korea: Effect modification by labor union status

ObjectivesThis study investigated the association between workplace discrimination and low back pain among Korean workers and explored the role of labor union in the association. MethodsWe analyzed a cross-sectional survey of 28,532 workers from the 3rd Korean Working Conditions Survey (2011), a nationally representative dataset in South Korea. Experience of workplace discrimination for five different reasons was assessed using the questions: “Over the past 12 months, have you ever experienced workplace discrimination based on your: (a) age, (b) education, (c) birth region, (d) sex, and (e) employment status?” Experience of low back pain within a 12 month period was measured using a yes/no question. Labor union membership was coded into three categories: (1) workers at workplaces without a labor union; (2) workers without union membership at workplaces with a labor union; (3) workers with union membership. ResultsIn workplaces without a labor union, low back pain was statistically significantly associated with workplace discrimination based on age (OR: 2.02, 95% CI: 1.73, 2.35), education (OR: 1.45, 95% CI: 1.23, 1.71), birth region (OR: 1.42, 95% CI: 1.10, 1.84), sex (OR: 2.22, 95% CI: 1.81, 2.73), and employment status (OR: 2.33, 95% CI: 1.99, 2.72) after adjusting for covariates including physical work factors. However, no significant association was observed among workers at workplaces with a labor union regardless of workers’ union membership. ConclusionsWorkplace discrimination was associated with low back pain only in workplaces without a labor union. Presence of labor union at workplaces may have a protective effect on workers’ low back pain against workplace discrimination.

Gender differences in asymmetrical limb support patterns between subjects with and without recurrent low back pain

New insight regarding limb-dominance effects on temporal-spatial gait parameters is needed to further investigate subjects with recurrent low back pain (LBP). Although an asymmetrical gait pattern was found to reflect natural functional differences, there is a lack of information regarding gender differences on dominant limb support patterns in subjects with LBP. The purpose of this study was to investigate temporal-spatial gait parameters based on limb dominance and gender between subjects with and without LBP. One hundred and ten right limb dominant older adults (51 subjects with LBP and 59 control subjects) participated in the study. A three-dimensional motion capture system was utilized to measure temporal-spatial gait parameters, including initial double, single, and terminal double limb support times and walking speed. The gender differences between subjects with and without LBP were analyzed based on dominance for those parameters. Overall, limb dominance demonstrated significant differences on single and terminal double limb support times as well as walking speed. Limb dominance also demonstrated interactions on group x gender for single limb support time and walking speed. The male subjects with LBP demonstrated significantly increased single limb support times on the non-dominant limb. The significant gender and group interactions based on limb dominance account for a possible pain avoidance, asymmetrical limb support pattern. The causal pathway in dominance dependency gait by unweighted ambulation might be considered as an intervention for correcting these gait deviations in subjects with LBP. The specific modification recovery profiles of the subjects with LBP could shed light on variability of current LBP experiences of the subjects and reasons for gait deviations. Clinicians need to consider the mechanism of dominant limb dependency, which requires postural control strategies in male subjects with recurrent LBP.

The RESOLVE Trial for people with chronic low back pain: protocol for a randomised clinical trial

Low back pain is the leading worldwide cause of disability, and results in significant personal hardship. Most available treatments, when tested in high-quality randomised, controlled trials, achieve only modest improvements in pain, at best. Recently, treatments that target central nervous system function have been developed and tested in small studies. Combining treatments that target central nervous system function with traditional treatments directed towards functioning of the back is a promising approach that has yet to be tested in adequately powered, prospectively registered, clinical trials. The RESOLVE trial will be the first high-quality assessment of two treatment programs that combine central nervous system-directed and traditional interventions in order to improve chronic low back pain. To compare the effectiveness of two treatment programs that combine central nervous system-directed and traditional interventions at reducing pain intensity at 18 weeks post randomisation in a randomised clinical trial of people with chronic low back pain. Two-group, randomised, clinical trial with blinding of participants and assessors. Two hundred and seventy-five participants with chronic low back pain that has persisted longer than 3 months and no specific spinal pathology will be recruited from the community and primary care in Sydney, Australia. Both of the interventions contain treatments that target central nervous system function combined with treatments directed towards functioning of the back. Adherence to the intervention will be monitored using an individual treatment diary and adverse events recorded through passive capture. Participants are informed prior to providing informed consent that some of the treatments are not active. Blinding is maintained by not disclosing any further information. Complete disclosure of the contents of the intervention has been made with the UNSW HREC (HC15357) and an embargoed project registration has been made on the Open Science Framework to meet the Declaration of Helsinki requirement for transparent reporting of trial methods a priori. Participants randomised to Intervention A will receive a 12-session treatment program delivered as 60-minute sessions, scheduled approximately weekly, over a period of 12 to 18 weeks. All treatment sessions are one-on-one. The program includes a home treatment component of 30minutes, five times per week. The intervention comprises discussion of the participant's low back pain experience, graded sensory training, graded motor imagery training and graded, precision-focused and feedback-enriched, functional movement training. Treatment progression is determined by participant proficiency, with mandatory advancement at set time points with respect to a standard protocol. Participants randomised to Intervention B will receive a 12-session treatment program of the same duration and structure as Intervention A. The intervention comprises discussion of the participant's low back pain experience, transcranial direct current stimulation to the motor and pre-frontal cortices, cranial electrical stimulation, and low-intensity laser therapy and pulsed electromagnetic energy to the area of greatest pain. Treatment is delivered according to published recommendations and progressed with respect to a standard protocol. The primary outcome is pain intensity at 18 weeks post randomisation. Secondary outcomes will include disability, depression, pain catastrophising, kinesiophobia, beliefs about back pain, pain self-efficacy, quality of life, healthcare resource use, and treatment credibility. Assessment will occur at baseline and at 18, 26 and 52 weeks after randomisation. Treatment credibility will be assessed at baseline and 2 weeks after randomisation only. A statistician blinded to group status will analyse the data by intention-to-treat using linear mixed models with random intercepts. Linear contrasts will be constructed to compare the adjusted mean change (continuous variables) in outcome from baseline to each time point between intervention A and intervention B. This will provide effect estimates and 95% confidence intervals for any difference between the interventions. Preliminary data suggest that combining treatments that target central nervous system function with traditional interventions is a promising approach to chronic low back pain treatment. In the context of modest effects on pain intensity from most available treatments, this approach may lead to improved clinical outcomes for people with chronic low back pain. The trial will determine which, if either, of two treatment programs that combine central nervous system-directed and traditional interventions is more effective at reducing pain intensity in a chronic low back pain cohort. Central nervous system-directed interventions constitute a completely new treatment paradigm for chronic low back pain management. The results have the potential to be far reaching and change current physiotherapy management of chronic low back pain in Australia and internationally.

Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain.

BackgroundIndividuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions. Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP.ObjectivesThe present study applied an integrative model (IM) of behavioral prediction for improvement of AT training.MethodsThis was a quasi-experimental study of female teachers with nonspecific LBP in southern Tehran in 2014. Group A contained 42 subjects and group B had 35 subjects. In group A, AT lessons were designed based on IM constructs, while in group B, AT lessons only were taught. The validity and reliability of the AT questionnaire were confirmed using content validity (CVR 0.91, CVI 0.96) and Cronbach’s α (0.80). The IM constructs of both groups were measured after the completion of training. Statistical analysis used independent and paired samples t-tests and the univariate generalized linear model (GLM).ResultsSignificant differences were recorded before and after intervention (P < 0.001) for the model constructs of intention, perceived risk, direct attitude, behavioral beliefs, and knowledge in both groups. Direct attitude and behavioral beliefs in group A were higher than in group B after the intervention (P < 0.03).ConclusionsThe educational framework provided by IM for AT training improved attitude and behavioral beliefs that can facilitate the adoption of AT behavior and decreased CLBP.

Socio-Cultural Factors and Experience of Chronic Low Back Pain: a Spanish and Brazilian Patients' Perspective. A Qualitative Study.

BackgroundLow back pain (LBP) could be influenced by socio-cultural factors. Pain narratives are important to understand the influence of environment on patients with chronic LBP. There are few studies that have explored the experience of patients with chronic LBP in different socio-cultural environments. The aim of this study was to describe the experience of patients with chronic LBP in Spain and Brazil.MethodsA qualitative phenomenology approach was implemented. Chronic LBP patients from the University Hospital of Salamanca (Spain), and/or Federal University of São Carlos (Brazil) were included, using purposeful sampling. Data were collected from 22 Spanish and 26 Brazilian patients during in-depth interviews and using researchers’ field notes and patients' personal diaries and letters. A thematic analysis was performed and the guidelines for reporting qualitative research were applied.ResultsForty-eight patients with a mean age of 50.7 years (SD: ± 13.1 years) were included in the study. The themes identified included: a) ways of perceiving and expressing pain—the participants focused constantly on their pain and anything outside it was considered secondary; b) the socio-familial environment as a modulator of pain—most participants stated that no one was able to understand the pain they were experiencing; c) religion as a modulator of pain—all Brazilian patients stated that religious belief affected the experience of pain; and d) socio-economic and educational status as a modulator of pain—the study reported that economic factors influenced the experience of pain.ConclusionsThe influences of LBP can be determined based on the how a patient defines pain. Religion can be considered as a possible mechanism for patients to manage pain and as a form of solace.

Capturing the experience of chronic low back pain through personal visualisations of significant walks an art and health project

Background: This study was developed from a collaboration between a musculoskeletal therapist and researcher, a fine artist, a media specialist and an engineer. All the team had an interest in Chronic Low Back Pain from a range of perspectives and shared a range of skills and knowledge which had never before been combined and utilised in this area of study. In context, Chronic Low Back Pain is an invisible problem that affects 80% of the UK population at some time in their lives. It is however a largely misunderstood which is an issue that individuals who experience it sometimes have difficulty communicating. Purpose: The purpose of the study was to capture participants' meaningful experiences of Chronic Low back pain in everyday life focusing on a personal significant walk. The aim of the project was to produce a series of visualisations with each of the participants which would enhance health professionals and members of the Publics understanding of the difficulties faced by individuals with chronic Low back pain. Methods: Twelve participants with Chronic Low Back Pain chose a walk of personal significance to them, either Positive or negative. Demographic data were collected at the start of the process as well as details regarding the extent and position of their pain.Prior to their walk Inertial sensors were attached to their Lumbar spine (L1-S1)and a head mounted video camera was fitted to their forehead to capture a video of their walk. Pain levels were monitored every 2 minutes during their 20 minute walk and qualitative data were collected prior to, during and after their walk using a range of approaches. Results: Using the data gathered, visual representationsof each of the significant walks have been co-produced by the researchers and the participants. Key elements of the video footage and data have been selectedand combined in a seriesof audio visual exhibitions. Each participant used their own movement data to manipulate special effects applied to the original video footage and data was synchronised to create hybrid footage that the participant felt represented their personal experience. Conclusion: Low Back Pain is a complex issue that creates significant personal challenges for those affected. This combined arts science and health approach to this work has demonstrated a range of outcomes that may be helpful in building a range of visualisations of a range of Musculoskeletal conditions. Implications: These very personal and valid expressions of Chronic Low Back Pain syndromes are now available for exhibition purposes. More public knowledge of the impact of Chronic Low Back Pain on individuals who experience the problem could create a greater understanding of the challenges faced by these people. The outcomes of the project will also be useful for teaching purposes in relation to health professional students. The more understanding members of the public and health professionals have of the personal impact of chronic low back pain the more likely it is that individuals with back pain will meet with more positive understanding from their family their friends and their colleagues. Funding acknowledgements: This Project was funded by The Welcome Trust in the UK Ethics approval: The research project was approved by the Un iversity of Brighton,Faculty of Health's Ethic and Governance committee Disclosure of interest: None Declared Keywords: Art and Health, Chronic low back pain, Patient experiences

The pain of being misunderstood: Invalidation of pain complaints in chronic low back pain patients.

A particular form of social pain is invalidation. Therefore, this study (a) investigates whether patients with chronic low back pain experience invalidation, (b) if it has an influence on their pain, and (c) explores whether various social sources (e.g. partner and work) influence physical pain differentially. A total of 92 patients completed questionnaires, and for analysis, Pearson's correlation coefficients and hierarchical linear regression analyses were conducted. They indicated a significant association between discounting and disability due to pain (respective β = .29, p > .05). Especially, discounting by partner was linked to higher disability ( β = .28, p > .05).

The Occurrence of LBP and the Level of Exposure to Possible LBP Contributors Among Teenagers

This study determined the occurrence of low back pain (LBP) among 158 teen students of the University of Northern Philippines and correlated this on their exposure level to the possible LBP contributors. Through a descriptive design, a questionnaire was used, and the data was treated with frequency count, mean and multiple regression. Statistics presented that most of the respondents are 16 y.o., males, are normally postured, and yet experienced LBP once in a while, upon getting up from bed, upon standing after long hours of sitting, while carrying heavy backpacks and after strenuous sports. They are moderately exposed to metabolic contributors of LBP and have a very low disability with LBP experience in the activities of daily living (ADL’s). Meanwhile, watching tv, fishing, exposure to lipids and carbohydrates, mother’s and father’s occupation on ADL’s were also positively correlated. This study concludes that most of the teens already experienced LBP but with a slight disability on the ADL’s and this correlates on their increased exposure to aforementioned contributors. Educators, health workers, and parents must be informed of this to help prevent LBP continue into adult life. .

Women's experience of low back and/or pelvic pain (LBPP) during pregnancy

Objectiveto explore the experiences of women suffering low back and/or pelvic pain during pregnancy. Designa qualitative design using focus groups. Each group was recorded with a digital audio recorder and analysed using the Newell and Burnard framework for thematic analysis. Settingan urban maternity hospital. Participantsa self-selecting sample of 14 women who had taken part in a pilot randomised controlled trial investigating reflexology for pregnancyrelated low back and / or pelvic pain. Measurements and Findingsthe group discussions were guided by a pre-determined schedule of questions designed to investigate women's experiences of pregnancyrelated low back and / or pelvic pain. Three main themes emerged:(1)The physical and emotional impact that pregnancy-related low back and / or pelvic pain had on women's lives(2)Women's attitudes towards, and knowledge about pregnancy-related low back and/or pelvic pain(3)Women's use of treatments to manage their symptoms and levels of dissatisfaction with standard advice and treatment. Key conclusionslow back and/ or pelvic pain affected women physically and emotionally during pregnancy. Their attitudes towards, and knowledge about the conditions differed. Women used a range of self-help strategies for their symptoms and there was a general sense of dissatisfaction with routine advice and treatment, a finding supported by a growing body of research. Implications for practicegiven that pregnancy-related low back and/ pelvic pain occur across the world, and affects the majority of pregnant women, heath care providers need to ensure that standard care provided is meeting women's needs.Health care professionals may require specific training in order to effectively provide individualised and evidence-based advice and support to pregnant women experiencing this pain.

Neuromuscular exercise and back counselling for female nursing personnel with recurrent non-specific low back pain: study protocol of a randomised controlled trial (NURSE-RCT)

IntroductionNursing personnel have high risk for incidence of low back pain (LBP) followed by development of chronic pain and disability. Multiple risk factors such as patient handling, night shift work...

Clinical features of patients with pars defects identified in adulthood.

Lumbar spondylolysis is considered a stress fracture of the pars interarticularis that occurs during growth. However, it is sometimes insidious and identified in adults as pseudoarthrosis, the terminal-stage of spondylolysis. The purpose of this study was to identify the clinical features of patients with terminal-stage spondylolysis that first manifested during adulthood. Thirty-six patients (21 men, 15 women; mean age 55.8years; age range 25-77years) with low back pain (LBP) were studied. In all patients, lumbar spondylolysis had not been diagnosed until the first visit to our hospital. Patient data collected were history of athletic activity and LBP during their growth period and radiological findings, such as spinal level, displacement, and spina bifida occulta (SBO). Among the 36 patients, including a patient with multi-level spondylolysis (L4 and L5), a total of 37 vertebrae with terminal-stage spondylolysis were identified. Twenty-three (89.2%) of the 37 vertebrae had L5 spondylolysis. Sixteen patients (44.4%) had no history of athletic activity, 26 (72.2%) had no experience of LBP during their growth period, and 14 (38.9%) had neither. Twenty of the 37 vertebrae (70.4%) involved displacement (grade 1=14; grade 2=6). In nine patients (25.0%; eight men, one woman), SBO of the sacrum was accompanied by L5 spondylolysis. Approximately 90% of patients with terminal-stage spondylolysis that was first diagnosed in adulthood involved the L5. Also, about 40% had no history of athletic activity or experience of LBP during their growth period. In addition, only some patients with L5 spondylolysis had SBO, and all but one of these patients was male. This suggests that male patients with L5 spondylolysis may have some congenital predisposition.

Volition and low back pain: When patients talk

ObjectiveOur objective was to explore, describe and understand volition of chronic low back pain (LBP) patients, highlighting barriers and facilitators to practicing regular physical activity in order to develop a questionnaire assessing those volitional competencies. MethodsA content analysis of semi-structured interviews with 30 chronic LBP patients was performed. Participants were asked about their pain, motivation, physical abilities, barriers and facilitators to regular exercises and finally strategies implemented to achieve the exercise program. ResultsPatients often reported that they were motivated and that exercises had no negative effects on LBP. Many patients recognized having difficulties performing all their exercises regularly. The main barriers were: lack of time, fatigue, lack of visible results, pain and other daily priorities. The main facilitators were: group exercise, help from the therapist, strategic planning, favorable environment, pleasure associated with exercises, fear of pain recurrence and pain itself. ConclusionContent analysis showed that sharing stories allowed patients to express their experience of LBP in their own words. It provides a solid ground to develop a questionnaire assessing volitional competencies in chronic LBP patients in order to identify patients who will not realize their exercises and help them be (more) active and avoid chronicity.

CAUDAL EPIDURAL STEROIDS

Introduction: About 85% of the population experience low back pain duringadulthood and annual incidence is 5 to 15% with no gender discrimination. Design: Quasiintervention experimental study. Setting: DHQ teaching Hospital &amp; at Fazil Memorial HospitalGujranwala. Period: November 2010 to November 2012 (two years). Material &amp; Methods:Hundred patient fulfilling the inclusion criteria with SYMPTOMATIC LUMBER DISC herniationwere selected. Efficacy was determined by improvement in Denis Pain scale and Mcnab’sfunctional criteria. Safety was determined by absence / rareness of complications i.e spinalanesthesia, transient hypotension, and paresthesia, difficulty in voiding, infection andmeningitis. Follow up was weekly for 6 weeks Results: Out of hundred cases 53 were gentsand 47 were ladies. Mean age was 37.56 (22-50 yrs). Maximum cases 72% were in third decadeof life. Maximum pain relief was noted after three weeks of first injection, 72% of the cases wereeither having no or mild pain. Functional recovery was excellent in 44% and good in 40% of thepatients. Complications were fewer and mild, Spinal anesthesia in 2%, transient hypotensionin 3%. Paresthesia in 8% and 10% of the patient developed supra pubic fullness but only oneneeded catheterization. Infection and meningitis was not observed in any case. Conclusions:Caudal epidural steroids injection is safe &amp; effective mode of treating lumbar disc herniation.

Application of Computer-aided Ergonomic Simulation in Designing Supine Computer Workstation

Seated posture has been considered as potentially one of the major contributing factors for several musculoskeletal disorders such as lower back pain, neck and shoulder disorders. Especially, people with low back pain experience great discomfort related to computer operations in sitting position. When changing posture to lying down, not only can release psychological stress, but also alleviate musculoskeletal burdens. Therefore, the main purpose of this study is to design a new supine computer workstation, allowing people to lie in the bed and operate a computer. This paper presents how to apply computer-aided ergonomic simulation in designing a new supine computer workstation. At first, Taiwanese anthropometric data were referred to build a 3D model of a supine computer workstation. And then, JACK software was used to simulate human-workstation interaction in order to find the problems of the original design. Finally, a physical prototype of the revised supine computer workstation was made for realistic test. The developed supine computer workstation was confirmed to be used successfully for operating computer in lying position. More field studies are required to test if supine computer workstation outpaces the sitting position workstation for musculoskeletal strains, subjective comfort, and operation performance.

“Significant walks”: personal visualisations of the chronic low back pain experience—an arts, health and science project

Background: More than a third of the adult UK population are affected by low back pain, approximately 17 million people. The socio-economic cost is huge; the cost of healthcare alone is estimated to be £1.5 billion per year. However the personal cost is immeasurable. Back pain remains a hidden and misunderstood problem, with many sufferers finding it difficult to effectively communicate the pain and its devastating impact on their daily lives. Significant Walks was a collaborative project involving experts in the visual arts, health and science. The project explored the reality of walking for individuals with chronic low back pain and their personal visualisation of this experience. The aim was to deepen public and professional perceptions of the meaning for low back pain for those living with the condition. Purpose: The purpose of this project was to enable participants to express the nature of their experience of chronic low back pain by documenting a walk that is significant to them. Methods: Twelve participants suffering from chronic low back pain were invited to choose a personal walk of particular significance to them. The significance could be negative or it could be positive. Video recordings were collected during the walk using a head-mounted camera, giving point of view footage. Movement and acceleration data were simultaneously collected using external inertial sensors attached to the lumbar spine at L1 and S1 vertebrae. The inertial sensors captured the movement pattern, for example the rhythm of the walk, as well as the acceleration which occurred during the walking process. Pain levels were also monitored throughout the walk and qualitative data from each participant was gathered using a questionnaire format. The participants then used their own movement data to manipulate special effects applied to the original video and synchronised data creating hybrid footage that they felt represented their personal experience. Results: A visual representation of 12 significant walks has been co-produced by the researchers together with the participants. Key elements have been selected and combined in an immersive audio-visual exhibit. The exhibit demonstrates the interaction of the visual walk with spinal range of motion and acceleration data, pain levels and qualitative statements which express the individual's experience during their significant walk. Conclusion(s): The data has been consolidated into personal and valid expressions of the chronic low back pain experience. Implications: Implications are that collaborative working across Art, Health and Science disciplines and the use of visual arts and science can lead to powerful and significant visualisation of health experiences which has implications for the expression of a range of health topic areas which are usually invisible to the general public. Keywords: Art; Health; Chronic low back pain Funding acknowledgements: The project was funded by the Wellcome Trust, the University of Brighton and the University of Chichester. Ethics approval: Approved by University of Chichester Ethics Committee and FREG Committee, Faculty of Health and Social Science, University of Brighton.