This study evaluated the effects of passive back-support exoskeletons (BSEs) on biomechanical load and postural stability during simulated manual timber felling at three cutting heights. Twenty healthy adult male participants performed timber felling tasks under four BSE conditions (two rigid, one soft, and no BSE). During the tasks, electromyographic (EMG) activity, trunk angle, postural sway, and perceived exertion were measured. Results showed that rigid BSEs reduced trunk flexion and low back EMG activity at the middle cutting height, where trunk flexion was greatest. No significant changes were observed at low or high cutting heights, likely due to insufficient exoskeleton engagement. BSE use shifted postural control strategies rather than providing a uniform stabilizing effect. Additionally, BSEs lowered perceived exertion for the whole body and low back. These findings suggest that BSEs may help reduce low back loading at the middle cutting height during manual timber felling, but further field testing is warranted.

Objective gait analysis using wearable sensors is critical for managing neurological and orthopedic conditions. However, optimizing sensor placement for specific clinical tasks and mitigating the impact of hidden dataset biases on artificial intelligence (AI) models remain significant challenges. A multi-stream, attention-based deep learning model was applied to the Voisard et al. (2025) multi-cohort gait dataset, which includes data from 260 participants. The model was trained and evaluated on four distinct binary classification tasks: Parkinson’s Disease (PD) screening, Osteoarthritis (OA) screening, post-stroke asymmetry detection, and a differential diagnosis between PD and Cerebrovascular Accident (CVA). The model’s outputs included both classification performance and a quantitative map of learned sensor importance weights for four body locations: Head, Lower Back, Left Foot, and Right Foot. The model achieved robust performance in Asymmetry Detection (AUC 0.96) and PD Screening (AUC 0.83). Crucially, for OA Screening, rigorous normalization corrected an artifactually high performance (AUC 1.00 → 0.76), exposing a dataset confounder. This framework provides a data-driven method for optimizing sensor protocols and functions as an automated data auditor. We emphasize that the proposed minimal sensor sets are hypotheses requiring prospective external validation.

BackgroundMobility impairments during straight-line walking show utility in detecting dementia-related cognitive impairment (e.g., Alzheimer's disease). Wearable technologies can now derive mobility outcomes related to turning, considered a more cognitively complex movement. However, it is unclear which turning variables would best detect cognitive impairment.ObjectiveThis study aimed to develop a data-driven model of turning performance relevant to cognitive impairment and compare selected turning variables between people with cognitive impairment and cognitively-intact older adults.Methods77 people with cognitive impairment (31 mild cognitive impairment, 46 dementia) and 28 cognitively-intact older adults. performed six intermittent walking trials with a 180° turn while wearing an inertial measurement unit (APDM Opal) attached to their lower back. 102 spatiotemporal and signal-based turning variables were captured. Following data reduction, 15 variables underwent exploratory factor analysis. One-way ANCOVA, adjusting for age, sex and height, explored between-group differences (Bonferroni correction applied).ResultsThree factors emerged: turn initiation, magnitude and smoothness, accounting for 67% of the total variance in turning performance. The cognitively impaired group demonstrated significant differences in turn initiation (start-phase root mean square (RMS) in vertical direction, start-phase jerk RMS in vertical/mediolateral/anterior-posterior directions) and magnitude (mid-phase RMS in mediolateral direction, mean RMS in vertical direction) domains (p < 0.003) with moderate-large effect sizes (Partial η2 = 0.09-0.17). Turn initiation and magnitude factor scores were associated with cognitive performance.ConclusionsKey findings suggest that people with cognitive impairment exhibit smaller and slower turning movements specifically during turn initiation and demonstrate lower signal magnitude (RMS) across the turn. Further work should consider use of these variables in predicting incidence of cognitive impairment in at-risk populations.

Bharatanatyam, a venerable and highly structured classical dance form from India, requires significant physical strength, postural control, and precise movements. Dancers often begin to training during adolescence, a crucial period of musculoskeletal development. A key posture in Bharatanatyam, the Araimandi (half-sitting position), involves sustained hip and knee flexion with external rotation, which imposes considerable stress on the lumbopelvic complex. Repeatedly practicing this position may lead to compensatory changes, such as increased lumbar lordosis and anterior pelvic tilt, which potentially predispose the dancers to low back pain (LBP). This study aims to examine the relationship between sitting posture and the severity of low back pain in female Bharatanatyam dancers. A total of 100 female Bharatanatyam dancers aged 16-35years were selected through convenience sampling to evaluate their sitting posture using GaitON Software. Low back pain intensity and functional disability were measured using the Visual Analog Scale and the Roland-Morris Disability Questionnaire. Statistical analysis was conducted using R-Studio. Age and BMI showed a moderate positive correlation (r=0.53). Hip-knee alignment was negatively correlated with trunk-thigh angle (r=-0.66) and knee angle (r=-0.59). A weak positive correlation was found between knee angle and trunk-thigh angle (r=0.38). The Roland-Morris Disability Score showed no significant relationship with biomechanical or demographic characteristics. The results indicated no significant correlation between low back pain and sitting postural parameters. Despite the physical demands and sustained postures involved in Bharatanatyam practice, this study found no significant link between sitting postural parameters and low back pain. This suggests that discomfort in dancers may be more influenced by dynamic performance factors, repetitive loading, and training intensity than by static sitting posture alone. The results highlight the intricate characteristics of low back pain in dancers and the necessity of focusing on movement patterns and muscular endurance in effective rehabilitation approaches.

Rigid and soft back-support exoskeletons affect biomechanical and perceptual demands, but in different ways, during simulated shingle installation.

Low back pain (LBP) is a leading cause of disability, significantly affecting quality of life and imposing a substantial economic burden in India. Despite its high prevalence, utilisation of rehabilitation services remains low. In a country characterised by socio-cultural diversity, it's important to understand how individuals perceive chronic low back pain (CLBP) and the role of physiotherapy interventions. This study aims to explore in-depth the perceptions of CLBP and physiotherapy among individuals with CLBP in India. A qualitative approach was used, involving semi-structured interviews with 20 participants who had CLBP. Interpretative Phenomenological Analysis was employed to explore the lived experiences and perceptions of physiotherapy among people with CLBP. Participants with CLBP based their management decisions on cultural, social, and personal influences. The major theme, physiotherapy is not a priority for the management of CLBP in India, was driven by four interconnected sub-themes: passive acceptance of pain, the influence of recommendations, perceived limitations of physiotherapy, and a focus on treatment for short-term management of flare-ups but not for long-term management or prevention. These themes illustrate how patients rationalise their pain and navigate available treatments. Perceptions of physiotherapy among participants with CLBP in India were shaped by ingrained beliefs, social influences, and a preference for quick symptom relief over long-term management. These perceptions may contribute to the delayed or limited use of physiotherapy for CLBP management among Indians.

What Is Low Back Pain?

Reassurance is recommended in the management of chronic low back pain (CLBP). Reassuring messages include that serious pathology has been excluded and movement is safe. The impact of patient awareness of reassuring messages on patient outcomes has not been investigated. We aimed to describe the characteristics of people reporting awareness of reassuring messages after a 3 month education and exercise program for CLBP and to determine if awareness of reassuring messages at 3 months influences patient outcomes at 6 months. We performed a secondary analysis of 3850 adults who received a structured group-based education and exercise program for CLBP. Expert knowledge was used to construct directed acyclic graphs to identify relevant confounders. We used linear mixed models, adjusted for the identified confounders, to determine associations between self-reported awareness of reassuring messages at 3 months and patient outcomes at 6 months (pain, disability, fear-avoidance and self-efficacy), and to determine associations between baseline patient characteristics and awareness of reassuring messages at 3 months. More awareness of reassuring messages at 3 months positively influenced pain intensity (regression coefficients; 95% confidence interval: -0.27; -0.39, -0.14), disability (-1.01; -1.58, -0.44), and fear-avoidance (-0.85; -1.13, -0.57) at 6 months. Less threatening illness perceptions and higher levels of self-efficacy at baseline were associated with more awareness of reassuring messages at 3 months; whereas being older, male, having more leg pain, and higher fear-avoidance were associated with less awareness of reassuring messages at 3 months. While effects were small, awareness of reassuring messages positively influenced patient outcomes at 6 months. Our study is the first to examine whether patient awareness of reassuring messages influences patient outcomes in chronic low back pain. We found that more awareness of reassuring messages after a group education and exercise intervention reduced pain intensity, disability and fear-avoidance. While effects were small, awareness of reassuring messages positively influenced patient outcomes. Clinicians should consider the benefits of delivering key reassuring messages as part of multi-modal low back pain management.

Repeat surveys were sent to general and subspecialty surgeons in the evening of their operating room (OR) days in one month. Age, sex, BMI, weekly exercise, NASA Task Load Index (NASA-TLX: a composite measure of workload), and pain scores were collected. Operating room case length and approach were collected from a registry. All variables were analyzed for their independent association with mean pain score changes in 12 body regions (with 95% CI). There were 29 surgeons who performed a total of 537 operative cases on 228 OR days. Increases in NASA-TLX by 100 were associated with increased pain in neck +0.23 (0.10-0.35), hands/fingers +0.22 (0.11-0.33), upper back +0.22 (0.10-0.34), lower back +0.31 (0.18-0.44), buttocks +0.07 (0.02-0.13), hips +0.10 (0.03-0.18), legs +0.14 (0.06-0.21), and feet +0.15 (0.05-0.24). Longer total case length increased pain in neck and upper back (+0.15 and +0.13 for every increase in 4 hours, respectively). An OR day with higher proportion of robotic time was associated with increased pain in wrists +0.32 (0.10-0.54) and lower back +0.36 (0.02-0.70). Higher proportion of lap/endo time was associated with increased pain in upper back +0.33 (0.08-0.58). Workload was the strongest contributor to musculoskeletal pain during operating days, with associations seen across most body regions. Case length and approach contributed to pain in a smaller number of regions. Targeted ergonomic strategies may reduce the burden of MSK pain among surgeons.

Low back pain (LBP) is a leading cause of disability worldwide, and treatment often necessitates invasive interventions that carry significant risks and economic burdens. While prior studies demonstrated durable benefit following percutaneous 60-day peripheral nerve stimulation (PNS), real-world data are needed to characterize long-term outcomes across routine clinical practice. This survey evaluated the durability of patient-reported improvements among a real-world cohort of patients with LBP who responded to 60-day PNS. A cross-sectional follow-up survey was administered to patients who previously responded to 60-day PNS targeting the lumbar medial branch nerves. Outcomes assessed included patient-reported percent pain relief and impression of change in quality of life (QoL), physical function, mood, and sleep. Participants also reported use or avoidance of other LBP treatments or interventions since completing 60-day PNS. The survey was completed by 602 participants, with follow-up durations ranging from 6 to 68months. Overall, 79% (475/602) of participants required no radiofrequency ablation (RFA), permanent implant, or surgery following 60-day PNS. Among participants who avoided subsequent interventions, 79% (376/475) reported durable improvements in at least one domain (≥ 50% pain relief and/or clinically meaningful improvement of QoL, physical function, mood, and/or sleep) at follow-up. Among participants without a prior permanent neurostimulator implant, 92% (309/336) of those who sought to avoid permanent implantation succeeded. Among those without prior low back surgery who wanted to avoid it, 95% (353/370) avoided surgery through follow‑up. These findings suggest that patients with LBP who respond to percutaneous 60-day PNS may experience durable relief, with benefits sustained by some for 5+ years. Participants reported reductions in pain leading to improvements in other health domains, and avoidance of subsequent interventions, including surgery, permanent implants, and/or RFA, through long-term follow-up, highlighting the potential use of percutaneous 60-day PNS as a minimally invasive, short-term treatment capable of producing long-lasting benefits in patients with LBP.

Background: Healthcare workers commonly develop musculoskeletal disorders due to prolonged standing, repetitive movements, patient handling, and poor posture. In Pakistan, this burden is worsened by limited ergonomic awareness and inadequate workplace safety measures, increasing occupational health risks among healthcare professionals. Objective: To assess the prevalence of musculoskeletal disorders among healthcare professionals in Pakistan and examine their association with ergonomic knowledge, daily practices, and factors contributing to poor ergonomic understanding, and evaluate its effects on knowledge and practice. Methodology: A quasi-experimental study was conducted on 150 healthcare professionals (doctors, nurses, and physiotherapists) from tertiary care hospitals in Lahore and Karachi. Participants were divided into intervention and control groups. Baseline musculoskeletal disorders were assessed using the Nordic Musculoskeletal Questionnaire, while ergonomic knowledge and practices were measured with a structured tool. The intervention group received ergonomic training, whereas the control group continued routine practices. Post-intervention assessment was done after 8–12 weeks. Data were analyzed using SPSS version 25. Paired and independent t-tests, chi-square test, and multivariable regression were applied, with p&lt;0.05 considered statistically significant. Results: The 12-month prevalence of musculoskeletal disorders was 74.7%. The lower back was the most affected region (48%), followed by the upper back (36%), neck (34%), shoulders (32%), and elbows (18%). Around 59% of participants demonstrated low ergonomic knowledge, and 34% reported poor practices. A significant association was found between musculoskeletal disorders and low knowledge (p = 0.002) as well as poor practices (p=0.041). Factors associated with poor knowledge included longer work experience (OR=1.8; 95% CI: 1.01–3.2), lack of formal ergonomics training (OR=3.2; 95% CI: 1.7–6.1), and poor practices (OR=1.7; 95% CI: 1.1–2.8). Conclusion: Musculoskeletal disorders are highly prevalent among healthcare professionals in Pakistan, particularly affecting the lower back. Poor ergonomic knowledge is associated with inadequate training, work exposure, and unsafe practices, highlighting the need for improved ergonomic education and workplace interventions in healthcare settings.

Background: Low back pain is a prevalent musculoskeletal condition associated with substantial functional limitations and disability across populations. Physiotherapy interventions such as general stretching, Muscle energy technique, and conventional therapeutic approaches are commonly applied to reduce symptoms and improve patient function. Objective: To evaluate and compare the effectiveness of general stretching exercises and muscle energy technique, combined with conventional physiotherapy, on pain intensity and functional disability in individuals with non-specific low back pain. Methodology: This randomized controlled trial included 60 individuals diagnosed with sub-acute non-specific low back pain, all presenting with pain scores above 3 cm on the Visual Analog Scale. Participants were randomly assigned to two equal groups. The experimental group received the muscle energy technique alongside conventional physiotherapy, whereas the control group performed general stretching exercises in combination with conventional care. Each group received nine therapy sessions distributed across three weeks, with treatments administered three times weekly. Pain severity and level of functional limitation were measured before and after the intervention using the Visual Analog Scale and the Roland-Morris Disability Questionnaire. Changes within each group were evaluated using the Wilcoxon signed-rank test, whereas differences between groups were assessed through the Mann–Whitney U test. Statistical significance was determined at a threshold of p&lt;0.05. Results: Significant improvements in both pain and disability were observed in each group following treatment. However, the group receiving the muscle energy technique demonstrated greater reductions in Visual Analog Scale and the Roland-Morris Disability Questionnaire scores, with statistically significant differences compared to the stretching group. Conclusion: Although both interventions were effective, the muscle energy technique combined with conventional physiotherapy yielded superior improvements in pain reduction and functional outcomes compared to general stretching.

While low back pain is a common complaint in physiatry clinics, atypical presentations require astute clinical reasoning to prevent delayed diagnoses of severe spinal pathologies. We present a 43-year-old female with a two-month history of insidious right low back and gluteal pain, accompanied by new-onset bilateral lower limb pitting edema. The initial symptom distribution closely resembled lumbosacral discodural pain; however, the presence of multiple red flags-including constant pain and pain in a supine position-suggested a non-mechanical etiology. Physical examination yielded positive provocation signs suggesting simultaneous lumbar, sacroiliac, and hip joint involvement, without true radicular symptoms. Provocative maneuvers, including anterior distraction and FABER tests, elicited positive responses only during breath-holding. This "Valsalva effect" suggested an intrathecal lesion. Magnetic resonance imaging confirmed a 24×13×12mm intradural extramedullary schwannoma at the L1-L2 level compressing the conus medullaris. Surgical resection led to complete resolution of both the musculoskeletal symptoms and the lower limb edema. This concurrent resolution implies that the edema was neurogenic in origin, resolving once sympathetic vasomotor control was restored. This case underscores the added diagnostic utility of Valsalva-augmented physical examinations and highlights neurogenic dependent edema as an underrecognized autonomic manifestation of spinal tumors.

Exposing the skin to low (non-burning) doses of ultraviolet radiation (UVR) can avoid vitamin D deficiency, but whether delivering these doses at naturally occurring UVR indices causes DNA damage in humans is unknown. Participants (Fitzpatrick skin type I-III; N = 58) received solar-simulated UVR (0.7 and 1.6 standard erythemal doses, SED) on the lower back on four consecutive days. Doses were delivered at either UVI 2.8 or UVI 8.0. Skin biopsies were collected at baseline, and from exposed sites at 15 min, 24, and 72 h. Immunofluorescent staining assessed the induction of cyclobutane pyrimidine dimers (CPD), P53 expression, and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) damage in epidermal cells. Exposure to 1.6 SED caused a significantly greater increase in the percentage of CPD-positive cells compared with 0.7 SED (e.g., UVI 8: 15 min 3.67% vs. 0.89%, p < 0.0001). Similarly, exposure to the 1.6 SED dose caused greater P53 expression than the 0.7 SED dose; at 72 h there was a 2.5- to 3-fold higher P53 expression in the samples exposed to 1.6 SED. UVR irradiance did not affect CPD or P53 responses. 8-oxodG showed minimal, nonsignificant changes over time. UVR delivered at doses that can maintain adequate vitamin D status, and at naturally occurring irradiance, leads to measurable DNA damage.

Back pain is among the most common, disabling, and costly conditions managed in primary care in the US, but current treatment options often do not provide adequate relief. Mindfulness-based interventions have demonstrated effectiveness in individuals with chronic low back pain (CLBP); however, mindfulness remains underused in part because it is not integrated into most outpatient care models. To assess whether persons with CLBP participating in a mindfulness group medical visit intervention experience significantly improved pain intensity and interference compared with those receiving usual care. This randomized clinical trial, Optimizing Pain Treatment in Medical Settings Using Mindfulness (OPTIMUM), using a pragmatic approach (designed to evaluate interventions under typical conditions of care) was conducted from May 7, 2021, to November 6, 2024. Adults with CLBP attending primary care clinics in Massachusetts, Pennsylvania, and North Carolina were included. Participants were randomized 1:1 to the OPTIMUM intervention, an 8-week telehealth-delivered mindfulness group medical visit program delivered as part of primary care (intervention), or usual care (controls). The primary analysis assessed the between-group difference in the primary outcome of change from baseline to month 6 in the Pain, Enjoyment of Life and General Activity (PEG) scale score. A mean minimal clinically important difference (MCID) in PEG score of at least 1 was considered. Secondary analyses evaluated the between-group differences in change from baseline to week 8 and month 12 in PEG score. Of 451 participants (mean [SD], 52.1 [14.7] years; 318 [70.5%] female), 224 were randomized to the intervention group and 227 to the control group. All reported moderate pain interference at baseline. In intention-to-treat analyses, the intervention participants had a statistically significant improvement in PEG score from baseline compared with controls at the 6-month primary time point (mean change, -1.21 [95% CI, -1.50 to -0.92] vs -0.59 [95% CI, -0.86 to -0.31]; between-group difference, -0.62 [95% CI, -1.02 to -0.23]; P = .002) and at 8 weeks (mean change, -1.16 [95% CI, -1.44 to -0.88] vs -0.27 [95% CI, -0.53 to -0.003]; between-group difference, -0.89 [95% CI, -1.27 to -0.51]; P < .001) and 12 months (mean change, -1.52 [95% CI, -1.81 to -1.23] vs -0.78 [95% CI, -1.05 to -0.50]; between-group difference, -0.74 [95% CI, -1.14 to -0.34]; P < .001). The MCID was not met at any time point. In this randomized clinical trial, a telehealth-delivered mindfulness group medical visit program for persons with CLBP resulted in significant improvements in pain intensity and interference compared with usual care; however, these changes did not meet the prespecified mean 1-point MCID between groups. The program incorporated primary care clinicians, was accessible, and is potentially scalable as a nonpharmacologic treatment for CLBP. ClinicalTrials.gov Identifier: NCT04129450.

Interest in identifying biomarkers that reflect spine condition and support therapy monitoring has grown. Since low-grade inflammation and comorbidities can complicate treatment, they should be considered in research. Vaspin (SERPINA12) has been linked to low back pain (LBP) severity and disability, highlighting its potential as a biomarker connecting LBP and adipose tissue inflammation. The study aimed to assess the effect of traction therapy on serum vaspin levels and compare responses between women with obesity and normal BMI. A secondary aim was to explore associations between vaspin, LBP severity, disability scores, and selected inflammatory markers. It is a prospective clinical trial. Women aged 34-50 years with chronic LBP were divided into two groups: those with normal BMI and those with obesity. Both groups underwent 20 30-min sessions of lumbar traction therapy. At baseline and after therapy, LBP intensity, the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RMDQ) were assessed, and blood samples were collected for analysis of vaspin, RANTES, interleukin (IL)-2, IL-17A, IL-4, and IL-10. After completing the traction therapy, there was a significant decrease in LBP, ODI, and RMDQ and an increase in the circulating levels of IL-10, regardless of BMI. However, vaspin concentration increased significantly only in women with normal BMI. Post-therapy, vaspin negatively correlated with ODI. IL-4 and IL-17A levels also correlated with vaspin, positively in women with normal BMI and negatively in those with obesity. Obesity-related inflammation may alter the biochemical response to traction therapy. Increases in vaspin concentration were found exclusively in women with normal BMI, indicating a possible BMI-dependent association between circulating vaspin concentrations and response to therapy.Registration: The study was registered at ClinicalTrials.gov with the ID number NCT04507074.

Introduction: Dentistry is considered a highly stressful profession due to its nature, placing dentists at an increased risk of occupational burnout and musculoskeletal disorders. This study aimed to investigate stress, occupational burnout, and musculoskeletal discomfort among dentists, as well as the role of ergonomics in reducing these problems. Material and Methods: This study is a systematic review of articles published from 2000 to March 2025 in three databases: Scopus, Web of Science, and PubMed. The inclusion criteria required original research in English—experimental, observational, or conference-based—addressing both the prevalence of occupational stress, burnout, and/or WMSD in dentists and the impact of ergonomic interventions. Unrelated articles, review papers, books, letters to the editor, and book chapters were excluded. Results: Out of 366 identified articles, 28 met the inclusion criteria. The most frequently reported discomforts were in the neck, lower back, shoulders, wrists, upper back, forearms, and arms, respectively. Dentists with a higher risk of occupational burnout reported more health complaints, and patient care was identified as the main source of stress. Moreover, the use of ergonomic aids—such as dental magnification loupes, optimized hand tool designs, and prismatic glasses—played a significant role in reducing musculoskeletal discomfort among dentists. Conclusion: Stress, burnout, and musculoskeletal disorders are common challenges in the dental profession. Strong evidence supports the effectiveness of ergonomic interventions in reducing the physical burden of these problems; however, implementation faces barriers such as high costs and insufficient training. Therefore, it is recommended that ergonomic principles and the use of assistive tools be integrated as essential components of dental education curricula and ongoing professional development programs.

BackgroundThe COVID-19 pandemic has affected the physical and mental health of Brazilian workers, especially those who have started working in home offices. Changes in the workplace, increased physical inactivity, and fear of contracting the disease, known as coronaphobia, may be related to increased musculoskeletal pain (MSP).ObjectiveTo analyze the prevalence of MSP and coronaphobia in home-office workers during the COVID-19 pandemic and to evaluate the relationships between these variables.MethodsA cross-sectional, observational, and descriptive study with 736 participants was conducted through an online questionnaire. Data on sociodemographic characteristics, working conditions, and pain were collected, along with the evaluation of coronaphobia using the COVID-19 Phobia Scale (C19P-S) and MSP using the Nordic Questionnaire of Osteomuscular Symptoms (NMQ).ResultsMost participants were female (78%), with an average age of 32.8 (SD = 10.7 years). During the pandemic, 71% reported some osteomuscular symptoms, and of these, 64% developed new symptoms of pain during the pandemic, with a higher incidence in the lower back and neck. Participants who began home-office work presented a higher incidence of pain, and among them, 53% reported that their furniture was not suitable for working at home. Most had little fear of COVID-19, but moderate levels of coronaphobia increased the likelihood of MSP (PR = 1.74; 95% CI). Coronaphobia and MSP were significantly associated.ConclusionsThe prevalence of MSP increased after the pandemic, especially among those who worked from home, primarily affecting the lumbar and cervical regions. Coronaphobia was also associated, with a higher probability of pain in individuals with moderate or high fear.

Percutaneous endoscopic lumbar discectomy (PELD) is a preferred minimally invasive surgery for lumbar disc herniation (LDH); however, postoperative recurrence, nerve root damage, and hyperesthesia continue to present key clinical challenges. Chitosan represents a novel preventive approach against postoperative complications. This study aimed to assess the clinical efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID) plus medical chitosan in treating lumbar 4-5 disc herniation (L4-5 LDH). Totally, 200 L4-5 LDH patients were prospectively recruited and randomly divided into the control group (ultrasound-guided PEID) and observation group (ultrasound-guided PEID plus medical chitosan). Low back and leg pain and lumbar dysfunction were assessed preoperatively and postoperatively using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA). Efficacy and postoperative complications were evaluated according to the modified MacNab criteria. Logistic regression analyses identified the risk factors. Mann-Whitney U test was used for inter-group comparisons, and the Kruskal-Wallis test for timepoint comparisons. The two groups showed significant differences in pre-treatment Pfirrmann classification and operation time. As time progressed, patients exhibited reduced VAS and ODI scores and increased JOA scores postoperatively. Significant differences were observed in VAS, JOA, and ODI scores in the observation group at 2 weeks postoperatively. The observation group demonstrated superior treatment efficacy and a lower complication incidence than the control group. Age, disease course, and postoperative bleeding were independent risk factors affecting clinical efficacy of ultrasound-guided PEID plus chitosan. Ultrasound-guided PEID plus medical chitosan reduces postoperative pain and perioperative complications, demonstrating superior clinical efficacy.

BackgroundBathing residents is among the most physically demanding tasks in long-term care facilities, involving frequent lifting, turning, washing, and dressing. In Taiwan, chronic staff shortages force caregivers to work under time pressure and adopt awkward, non-ergonomic postures, substantially increasing the risk of cumulative musculoskeletal disorders (MSDs).ObjectiveThis study examined the association between postural risk and MSDs among caregivers performing bathing tasks in long-term care facilities.MethodsFifteen caregivers from long-term care institutions in Yunlin and Chiayi, Taiwan, participated. The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess musculoskeletal discomfort, and the Rapid Entire Body Assessment (REBA) method was applied to evaluate postural risks.ResultsThe mean REBA score was 11.67 (SD = 0.94), indicating a very high-risk task requiring immediate intervention. The trunk and upper arms showed greater risk than the lower arms and legs. The mean MSD score was 1.87 (SD = 1.97), with a prevalence of 84.4%. Symptoms were most severe in the lower back, followed by the upper limbs. Pain locations corresponded with high-risk postures, suggesting an association between posture and discomfort. Risk levels were unrelated to age or work tenure but were linked to task exposure and environmental constraints.ConclusionsBathing assistance poses a risk for long-term care workers. Facilities should prioritize height-adjustable electric shower beds and armrest-supported chairs to reduce trunk flexion. Although body mechanics training and job rotation may help, they cannot fully address staffing shortages or workspace "constraints." Long-term adoption of automated bathing systems is needed to reduce hazardous exposure and improve safety.