Recurrent Non-specific Low Back Pain Research Articles

Risk factors Associated with Pain Severity in Syrian patients with non-specific low back Pain

BackgroundLow back pain (LBP) majorly contributes to activity limitations and work absences worldwide. Therefore, a comprehensive knowledge of the risk factors linked to non-specific low back pain (NSLBP) can enable early and timely interventions to achieve long-term improvements. Current study aimed to assess the risk factors associated with the severity of NSLBP patients in Syria.MethodsThis study used a cross-sectional design and a self-assessment questionnaire to collect data on NSLBP, as well as personal and physical factors, across four provinces in Syria (Damascus, Aleppo, Homs, and Latakia) from November 2021 to September 2022. The assessments incorporated the Short Form 36-Item Health Survey (SF-36), the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Then we examined the relationship between the severity of NSLBP and these potential risk factors. Descriptive statistics were employed to summarize the demographic characteristics of the participants. Additionally, multiple logistic regression analysis was performed to evaluate the risk factors for non-specific low back pain.ResultsThe study included a total of 875 patients with NSLBP. The results indicated that patients with primary school education, a high body mass index (BMI), prolonged driving and sitting durations, smoking habits, and recurrent low back pain had higher VAS and ODI scores, as well as lower SF-36 scores (p < 0.01). Additionally, workers and drivers had higher VAS and ODI scores and lower SF-36 scores compared to waiters and patients who lifted objects heavier than 10 kg for more than a quarter of their work time for over 10 years (p < 0.01). The multiple logistic regression analysis revealed that lower education levels, low back pain lasting 1–7 days, chronic low back pain in the past year, smoking, driving for prolonged time, and higher BMI were associated with more severe VAS scores.ConclusionThe severity of NSLBP is related to lower education levels, poor living conditions, strenuous physical labor, inactive lifestyle, and driving for a long time. Additionally, patients with recurrent NSLBP experience more intense pain. To manage these issues, potential interventions could include reducing obesity rates, limiting the duration of hard physical work, limiting driving duration and reducing sedentary behaviors and smoking. These measures may help alleviate the overall burden of NSLBP.

Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain

BackgroundExercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.MethodsSome 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.ResultsA low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times.ConclusionHealthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.

The prognostic merit of self-reported triggers of recurrent low back pain: study protocol

BackgroundMost cases of low back pain (LBP) are regarded as non-specific and current studies indicate that for many this is a chronic recurrent condition, in which people experience episodes of pain with symptom-free periods in between. It is likely that acute exposure to some factors triggers the reappearance of new episodes in recurrent LBP regardless of the causality of the underlying condition (i.e. risk factors). Additionally, it has been shown that LBP patients present with different trajectories and different trajectories possibly have different triggers. Hence, dividing patients into some clinically meaningful subgroups may offer new insights into triggers, effective preventive strategies and, therefore, prognosis. This study aims to identify self-reported triggers and trajectories of episodes of recurrent LBP and to examine the prognostic association between different triggers and LBP trajectories.MethodsThis is a longitudinal, multicentre, Australia-wide observational study of patients with recurrent non-specific LBP. Two hundred adults with at least a one-year history of LBP will be recruited from primary care clinics or private practices and followed for a year. Each will receive an SMS every fortnight (26 time-points in total) enquiring the occurrence of a new episode of pain in the past 2 weeks and its intensity. Upon report of a new episode, a telephone interview will be performed to appraise exposure to self-nominated triggers in a period of 24 h preceding the pain. Trajectories will be identified by latent class analysis at the end of the follow-up based on the pain intensity, frequency, and length of episodes. Triggers will be categorised into physical and psychosocial groups. Generalised linear mixed models with logit links will be used to explore pain triggers associated with pain trajectories.DiscussionThe completion of this study will provide insight into the patients’ self-reported triggers of LBP and also their possible prognostic association with different trajectories. Some newly-identified and pre-identified triggers are likely to be found and reported.

Differences in brain processing of proprioception related to postural control in patients with recurrent non-specific low back pain and healthy controls.

Patients with non-specific low back pain (NSLBP) show an impaired postural control during standing and a slower performance of sit-to-stand-to-sit (STSTS) movements. Research suggests that these impairments could be due to an altered use of ankle compared to back proprioception. However, the neural correlates of these postural control impairments in NSLBP remain unclear. Therefore, we investigated brain activity during ankle and back proprioceptive processing by applying local muscle vibration during functional magnetic resonance imaging in 20 patients with NSLBP and 20 controls. Correlations between brain activity during proprioceptive processing and (Airaksinen et al., 2006) proprioceptive use during postural control, evaluated by using muscle vibration tasks during standing, and (Altmann et al., 2007) STSTS performance were examined across and between groups. Moreover, fear of movement was assessed. Results revealed that the NSLBP group performed worse on the STSTS task, and reported more fear compared to healthy controls. Unexpectedly, no group differences in proprioceptive use during postural control were found. However, the relationship between brain activity during proprioceptive processing and behavioral indices of proprioceptive use differed significantly between NSLBP and healthy control groups. Activity in the right amygdala during ankle proprioceptive processing correlated with an impaired proprioceptive use in the patients with NSLBP, but not in healthy controls. Moreover, while activity in the left superior parietal lobule, a sensory processing region, during back proprioceptive processing correlated with a better use of proprioception in the NSLBP group, it was associated with a less optimal use of proprioception in the control group. These findings suggest that functional brain changes during proprioceptive processing in patients with NSLBP may contribute to their postural control impairments.

Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial

BackgroundRegistered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment.MethodsWe randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY.ResultsWe conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined- (p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0–12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062–€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29–4.17, p = 0.025). None of the intervention-arms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained.ConclusionsExercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain, but was not cost-effective.Trial registrationClinicalTrials.gov, NCT01465698 November 7, 2011 (prospective).

Risk Factors Associated with Pain Severity in Patients with Non-specific Low Back Pain in Southern China.

Study DesignA prospective cross-sectional study.PurposeTo evaluate the risk factors associated with the severity of pain intensity in patients with non-specific low back pain (NSLBP) in Southern China.Overview of LiteratureLow back pain (LBP) is the leading cause of activity limitation and work absence throughout the world, so a firm understanding of the risk factor associated with NSLBP can provide early and prompt interventions that are aimed at attaining long-term results.MethodsParticipants were recruited from January 2014 to January 2016 and were surveyed using a self-designed questionnaire. Anonymous assessments included Short Form 36-Item Health Survey (SF-36) and Visual Analogue Scale (VAS). The association between the severity of NSLBP and these potential risk factors were evaluated.Results A total of 1,046 NSLBP patients were enrolled. The patients with primary school education, high body mass index (BMI), those exposed to sustained durations of driving and sitting, smoking, recurrent LBP had increased VAS and Oswestry Disability Index (ODI) scores with lower SF-36 scores (p <0.01). Workers and drivers compared with waiters and patients who lifted >10 kg objects in a quarter of their work time for >10 years had higher VAS and ODI scores with lower SF-36 scores (p <0.01). Multiple logistic regression showed lower levels of education, LBP for 1–7 days, long-lasting LBP in last year, smoking, long duration driving, and higher BMI were associated with more severe VAS score.Conclusions The severity of NSLBP is associated with lower levels of education, poor standards of living, heavy physical labor, long duration driving, and sedentary lifestyle. Patients with recurrent NSLBP have more severe pain. Reducing rates of obesity, the duration of heavy physical work, driving or riding, and attenuating the prevalence of sedentary lifestyles and smoking may reduce the prevalence of NSLBP.

Individual preferences for physical exercise as secondary prevention for non-specific low back pain: A discrete choice experiment.

BackgroundExercise is effective in improving non-specific low back pain (LBP). Certain components of physical exercise, such as the type, intensity and frequency of exercise, are likely to influence participation among working adults with non-specific LBP, but the value and relative importance of these components remain unknown. The study’s aim was to examine such specific components and their influence on individual preferences for exercise for secondary prevention of non-specific LBP among working adults.MethodsIn a discrete choice experiment, working individuals with non-specific LBP answered a web-based questionnaire. Each respondent was given ten pairs of hypothetical exercise programs and asked to choose one option from each pair. The choices comprised six attributes of exercise (i.e., type of training, design, intensity, frequency, proximity and incentives), each with either three or four levels. A conditional logit regression that reflected the random utility model was used to analyze the responses.ResultsThe final study population consisted of 112 participants. The participants’ preferred exercise option was aerobic (i.e., cardiovascular) rather than strength training, group exercise with trainer supervision, rather than individual or unsupervised exercise. They also preferred high intensity exercise performed at least once or twice per week. The most popular types of incentive were exercise during working hours and a wellness allowance rather than coupons for sports goods. The results show that the relative value of some attribute levels differed between young adults (age ≤ 44 years) and older adults (age ≥ 45 years) in terms of the level of trainer supervision required, exercise intensity, travel time to exercise location and financial incentives. For active study participants, exercise frequency (i.e., twice per week, 1.15; CI: 0.25; 2.06) influenced choice of exercise. For individuals with more than one child, travel time (i.e., 20 minutes, -0.55; CI: 0.65; 3.26) was also an influential attribute for choice of exercise, showing that people with children at home preferred to exercise close to home.ConclusionsThis study adds to our knowledge about what types of exercise working adults with back pain are most likely to participate in. The exercise should be a cardiovascular type of training carried out in a group with trainer supervision. It should also be of high intensity and preferably performed twice per week during working hours. Coupons for sports goods do not appear to motivate physical activity among workers with LBP. The findings of the study could have a substantial impact on the planning and development of exercise provision and promotion strategies to improve non-specific LBP. Providers and employers may be able to improve participation in exercise programs for adults with non-specific LBP by focusing on the exercise components which are the most attractive. This in turn would improve satisfaction and adherence to exercise interventions aimed at preventing recurrent non-specific LBP.

Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents

BackgroundIn Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition.MethodsThe study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study.ResultsTwenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89).ConclusionExcellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.

Neuromuscular control strategies of the trunk antagonist muscles during the Biering-Sorensen test in individuals with recurrent low back pain and healthy subjects

OBJECTIVES To compare the activation pattern of the trunk antagonistic muscles and also the myoelectric manifestations of muscle fatigue between subjects with and without recurrent non-specific low back pain, during the fatigue provocation of the erector spinae. METHODS The study involved 19 subjects with recurrent low back pain with a non-specific cause (seven men, 12 women, 38.53 ± 8.12 years, 68.35 ± 18.12 kg, 1.66 ± 0.09 m), and 19 healthy subjects (seven men, 12 women, 40.42 ± 8.63 years, 69.57 ± 12.76 kg, 1.64 ± 0.07 m). The electromyographic signal of the internal oblique, lumbar multifidus, rectus abdominis and lumbar iliocostalis muscles, bilateral, were collected during Biering-Sorensen test execution. RESULTS The group with low back pain showed a lower co-contraction rate of the internal oblique/lumbar multifidus (p = 0.006) and lower activation amplitude of the internal oblique (p = 0.019), both on the right side when compared to the group without low back pain. No differences were observed between the groups for muscle fatigue indicators (p > 0.05). CONCLUSION When the erector spine muscle fatigue occurs - even when the groups were similar as to the ability of extensors muscles to resist fatigue - differences were found between subjects with and without low back pain regarding the recruitment pattern of the task antagonist muscle, because subjects with low back pain showed lesser activation and co-contraction in relation to the healthy group.

Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial

Background: Non-specific chronic low back pain (NSCLBP) is a major health problem. Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group. We developed a multimodal treatment (MMT) for patients with moderate to severe disability and medium risk of poor outcome. MMT includes a) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP, b) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk, and c) motor training to regain definite movement control of the trunk. A pilot study was conducted to investigate the feasibility of MMT, prior to a larger RCT, with focus on patients’ adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy. Method: We conducted a randomised controlled trial (RCT) in a primary care physiotherapy centre in Switzerland. Outcome assessment was 12 weeks after baseline. Patients with NSCLBP, considerable disability (five or more points on the Roland and Morris Disability Questionnaire (RMDQ) and medium or high risk of poor outcome on the Keele Start Back Tool (KSBT) were randomly allocated to either MMT or usual physiotherapy treatment (UPT) by an independent research assistant. Treatment included up to 16 sessions over 8 to 12 weeks. Both groups were given additional home training of 10 to 30 minutes to be performed five times per week. Adherence to treatment was evaluated in order to assess the feasibility of the treatment. Assessments were conducted by an independent blinded person. The primary outcome was pain (NRS 0-10) and the secondary outcome was disability (RMDQ). Between-group effects with Student’s t-test or the Mann-Whitney U test and the standardized mean difference of the primary outcome were calculated. (Continued on next page)

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...

Balance recovery reactions in individuals with recurrent nonspecific low back pain: Effect of attention

People who suffer from Low Back Pain (LBP) demonstrate impaired postural control. Deficits in sensory-motor systems have been proposed to be related to these changes. Considering higher cognitive process contribution to postural control, the aim of this study was to investigate the effects of cognitive load on balance control of patients with LBP. Twenty subjects with recurrent non-specific LBP and 20 healthy controls participated. They stood on a moveable platform with each foot placed on a separate force plate. They were asked to maintain their balance (a) while expecting translations of the support surface at two sizes of perturbation (b) with and without performing a cognitive (auditory Stroop) task. The outcomes included reaction time (RT), latency, initial velocity and amplitude of center of pressure response for balance, and RT for cognitive performance. Compared to the healthy group, LBP group demonstrated delayed RT and latency, and reduced initial velocity (P<0.05). Moreover, they had slower Stroop RT (F=70.88, P<0.001). Concurrent performance of tasks resulted in increased Stroop RT (F=3.42, P=0.03) and adaptation in initial velocity (F=6.70, P=0.01). At the smaller size of perturbation, cognitive load increased velocity in LBP group but decreased this variable in the healthy group. When the cognitive load was added at the larger size of perturbation, velocity of response decreased in LBP group (P<0.05). These findings imply altered cognitive regulation of dynamic balance in patients with LBP and suggest that the adopted strategy might alter depending upon the characteristics of the postural challenge.

Differences in personal and lifestyle characteristics among Zimbabwean high school adolescents with and without recurrent non-specific low back pain: a two part cross-sectional study.

BackgroundRecurrent non-specific low back pain (NSLBP) is increasingly becoming common among adolescents worldwide. A recent study in Zimbabwe showed a relatively high prevalence (28.8 %) among high school students. Influential associated factors, however, remain unclear. This is a significant shortcoming. The aim was to determine personal or lifestyle-related factors associated with recurrent NSLBP among high school adolescents in Harare, Zimbabwe.MethodsThis study was part of a large epidemiological study conducted in two continuous parts. Part one sought to determine self-reported associated factors among 532 participants (mean age =16 ± 1.72 years) drawn randomly from selected government schools using a reliable and content-validated questionnaire (Kappa coefficient, k = 0.32–1). Part two purposively identified adolescents (N = 64, median age =17 years, interquartile range, IQR = 15–18 years) with a history of ‘severe’ recurrent NSLBP from part one based on a specific eligibility criteria and compared body mass index, relative school bag weight and hamstring flexibility with matched adolescents without NSLBP. Data was analysed using Statistica version 11. Independent t-tests or χ2 tests of association were used for continuous and categorical data, respectively. The statistical significance was set at p < .05.ResultsRecurrent NSLBP was associated with self-reported factors such as perceptions of a heavy school bag [χ2 (1) = 85.9, p < 0.001]. A significant proportion of adolescents with recurrent NSLBP spent over 30 min carrying the school bag to and from school [χ2 (1) =32.2, p < 0.001]. It was also associated with prolonged sitting (p < 0.001), not playing sports [χ2 (1) =5.85, p = 0.02] and tight hamstrings [χ2 (1) =7.6, p = 0.006].ConclusionsAlthough conclusions from this study are hesitant because of the cross-sectional nature of the study and the relatively small sample size in follow-up study, recurrent NSLBP is associated with perceptions of a heavy school bag, duration of school bag carriage, no sports participation, prolonged sitting on entertainment activities, and tight hamstrings. These findings add to the importance of promoting physical activity at school or home especially aimed at improving muscle flexibility.

Are parents and adolescents in agreement on reporting of recurrent non-specific low back pain in adolescents? A cross-sectional descriptive study.

BackgroundNon-specific low back pain is a prevalent symptom in adolescents and is recurrent in some instances. Recent studies have highlighted the marked impact the condition has on daily life of adolescents. However, it is unclear if parents of adolescents reporting recurrent non-specific low back pain know about their child’s status. The purpose of the study was to determine the level of agreement between adolescents and their parents in reporting recurrent non-specific low back pain in Harare, Zimbabwe.MethodsThis cross-sectional study formed part of a large study carried out to ascertain the prevalence of non-specific low back pain in Zimbabwean adolescents. Six hundred and twenty (n = 620) Medical Health Questionnaires were sent to parents. School-children with returned questionnaires and informed consents signed were subsequently eligible to participate. A reliable and validated low back pain study questionnaire was administered to 544 adolescents between the ages of 13 and 19 years randomly selected from government-administered schools. The questionnaire sought to determine adolescents with recurrent NSLBP. The Kappa statistic (k) was used to analyse agreement between adolescents and parental reports on recurrent NSLBP status.ResultsParental and school-children response rates were acceptable (90.3 and 97.8 %, respectively). The prevalence of recurrent NSLBP was 28.8 % [95 % Confidence Interval, CI = 26.0–31.6]. Both sexes were equally affected [χ2(1) =0.19, p = 0.67]. The prevalence increased with age in both sexes [χ2trend =90.9, p < 0.001]. Parental reports agreed in 16.3 and 98.7 % for the adolescents with and without recurrent NSLBP respectively. The value of kappa (k) was 0.20 [SE = 0.04; 95 % CI, 0.13–0.27] with a prevalence index and bias index of −0.65 and 0.23, respectively. These results suggest poor strength of the agreement.ConclusionsRecurrent non-specific low back pain is relatively common among Zimbabwean adolescents. Most of the parents of school-children with recurrent non-specific low back pain are unaware of the low back pain status of their children. Although this does not dismiss the relevance of non-specific low back pain reported during adolescence, these findings create a need to involve parents in awareness or preventive initiatives against low back pain in schools.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0518-1) contains supplementary material, which is available to authorized users.

Classification of patients with incident non-specific low back pain: implications for research

Background ContextComparing research studies of low back pain is difficult because of heterogeneity. There is no consensus among researchers on inclusion criteria or the definition of an episode. PurposeThis study aimed to determine pattern(s) of recurrent non-specific low back pain from data collected over 27 months. Study Design/SettingThis study used retrospective cohort study using administrative claims from multiple payers. Although claims are designed for capturing costs, not clinical complexity, they are valid for describing utilization patterns, which are not affected by potential “upcoding.” Patient SampleThe patient sample consisted of population-based, nationally generalizable sample of 65,790 adults with continuous medical and pharmaceutical commercial health insurance who received health care for incident, non-specific low back pain. Potential subjects were excluded for plausible cause of the pain, severe mental illness, or cognitive impairment. Outcome MeasuresDiagnostic and therapeutic health-care services, including medical, surgical, pharmaceutical, and complementary, received in inpatient, outpatient, and emergency settings were the outcome measures for this study. MethodsThe methods used for this study were latent class analysis of health-care utilization over 27 months (9 quarters) following index diagnosis of non-specific low back pain occurring in January–March 2009 and an analysis sample with 60% of subjects (n=39,597) and validation sample of 40% (n=26,193). ResultsFour distinct groups of patients were identified and validated. One group (53.4%) of patients recovered immediately. One third of patients (31.7%) may appear to recover over 6 months, but maintain a 37–48% likelihood of receiving care for low back pain in every subsequent quarter, implying frequent relapse. Two remaining groups of patients each maintain very high probabilities of receiving care in every quarter (65–78% and 84–90%), predominantly utilizing therapeutic services and pain medication, respectively. Probabilistic grouping relative to alternatives was very high (89.6–99.3%). Grouping was not related to demographic or clinical characteristics. ConclusionsThe four distinct sets of patient experiences have clear implications for research. Inclusion criteria should specify incident or recurrent cases. A 6-month clean period may not be sufficiently long to assess incidence. Reporting should specify the proportion recovering immediately to prevent mean recovery rates from masking between-group differences. Continuous measurement of pain or disability may be more reliable than measuring outcomes at distinct endpoints.

Functional consequences and health-care seeking behaviour for recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study.

The purpose of the study was to investigate the consequences of recurrent non-specific low back pain in Zimbabwean adolescents. Recurrent non-specific low back pain is a common cause of adult disability in low-income countries. However, its impact in adolescents has been a matter of debate in the literature. A survey was conducted using a cluster sample of 544 school children between the ages of 13 and 19 years. The school children were randomly selected from government-administered secondary schools in Harare, Zimbabwe. Parental and students' response rate were 90.3 and 97.8 %, respectively. Almost a third (28.8 %) of school children reported recurrent symptoms (CI 27.8-31.6). However, the majority (84 %) of these cases were unknown to parents. Twenty-seven percent reported having sought medical treatment. On the nine-item Hanover Low Back Pain Disability Questionnaire, 71.2 % of school children had at least one activity of daily living compromised by recurrent NSLBP, especially sports participation. However, severe disability was reported in 28 % of the adolescents. Health-care seeking behaviour was not associated with the level of disability [χ (2)(1) = 0.36, p = 0.55]. Although most parents are unaware, recurrent NSLBP is common in Zimbabwean school children. However, treatment is rarely sought for the symptoms. A preponderance of adolescents with recurrent NSLBP experiences some degree of functional consequences, although severe disability is rare. There is need to raise awareness of the condition in schools and to parents. Spinal health educational programmes may need to be implemented to avert the functional consequences. Further studies are needed in the future to investigate the coping strategies for pain in adolescents.

Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial.

BackgroundNon-specific chronic low back pain (NSCLBP) is a major health problem. Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group. We developed a multimodal treatment (MMT) for patients with moderate to severe disability and medium risk of poor outcome. MMT includes a) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP, b) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk, and c) motor training to regain definite movement control of the trunk.A pilot study was conducted to investigate the feasibility of MMT, prior to a larger RCT, with focus on patients’ adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy.MethodWe conducted a randomised controlled trial (RCT) in a primary care physiotherapy centre in Switzerland. Outcome assessment was 12 weeks after baseline. Patients with NSCLBP, considerable disability (five or more points on the Roland and Morris Disability Questionnaire (RMDQ) and medium or high risk of poor outcome on the Keele Start Back Tool (KSBT) were randomly allocated to either MMT or usual physiotherapy treatment (UPT) by an independent research assistant. Treatment included up to 16 sessions over 8 to 12 weeks. Both groups were given additional home training of 10 to 30 minutes to be performed five times per week. Adherence to treatment was evaluated in order to assess the feasibility of the treatment. Assessments were conducted by an independent blinded person. The primary outcome was pain (NRS 0-10) and the secondary outcome was disability (RMDQ). Between-group effects with Student’s t-test or the Mann-Whitney U test and the standardized mean difference of the primary outcome were calculated.ResultsTwenty-eight patients (46% male, mean age 41.5 years (SD 10.6)) were randomized to MMT (n = 14) or UPT (n = 14). Patients’ adherence to treatment was >80% in both groups. Pain reduction (NRS; [95% CI]) was 2.14 [1.0 to 3.5] in the MMT and 0.69 [-2.0 to 2.5.] in the UPT. The between-group difference was 1.45 [0.0 to 4.0] (p = 0.03), representing a moderate effect size of 0.66 [-0.1 to 1.5]. Reduction in disability on the RMDQ was 6.71 [4.2 to 9.3] in MMT and 4.69 [1.9 to 7.4] in UPT, with a non-significant between-group difference of 2.02 [-1.5 to 5.6] (p = 0.25). The required sample size for a RCT with six months follow-up was estimated at 170 patients.ConclusionsMMT was found to be feasible and to significantly reduce pain in the short term when compared with UPT. A future RCT with a six-month follow-up would require approximately 170 patients.Trial registrationCurrent Controlled Trials ISRCTN66262199. Registered 8 January 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0533-2) contains supplementary material, which is available to authorized users.

Recurrent Non-Specific Low Back Pain: A Cross-Sectional Survey on Prevalence, Nature of Recurrent Episodes and The Role of Physical Activity and Psychological Status in High School Adolescents in Harare, Zimbabw

Abstract Objective: Recurrent non-specific low back pain (NSLBP) is a common occurrence in adolescents. There is limited data on the factors associated with the condition in Zimbabwe. The study sought to determine the association between physical activity and psychological status with recurrent non-specific low back pain among high school adolescents. Methods: An analytical cross sectional study was conducted among 199 randomly selected adolescents between the ages of 12-19 years from government schools in Harare. Recurrent non-specific low back pain data was collected using a reliable and validated questionnaire. Level of physical activity and psychological status were evaluated using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Mental Health Inventory-5 (MHI-5), respectively. Results: The students’ response rate was 98.5%. The 12-month prevalence of recurrent NSLBP was 30.7 % [95% CI = 24.3%-37.1%]. Girls were significantly affected than boys [X2(1) =4.73, p= 0.03]. The majority with recurrent NSLBP (68.9%) reported between 2-7 episodes, with an average duration per episode of less than thirty minutes in 62% of cases. There was no association between level of physical activity and recurrent NSLBP [X2 (1) =0.86, p= 0.35]. However, the majority (n=42) of those who reported recurrent NSLBP reported a low level of physical activity. Psychological status was not found to be associated with recurrent NSLBP [X2 (1) =0.76, P= 0.38]. Conclusion: Recurrent non-specific low back pain is a common condition among Zimbabwean adolescents affecting mainly girls. However, the episodes are of a short duration and are not significantly associated with the level of physical activity and psychological status

Inspiratory muscle training affects proprioceptive use and low back pain.

We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle-back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Prevalence and associated characteristics of recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study.

BackgroundUntil recently, non-specific low back pain (NSLBP) in adolescents was considered a rare phenomenon unlike in adults. The last two decades has shown an increasing amount of research highlighting the prevalence in this age group. Recent studies estimate lifetime prevalence at 7%-80%, point prevalence at 10%-15%, and prevalence of recurrent NSLBP at 13%-36%. In Zimbabwe, there is dearth of literature on the magnitude of the problem in adolescents. Therefore, the aims of the study were to determine the prevalence (lifetime, point, recurrent) and the nature of recurrent NSLBP reported by adolescents in secondary schools.MethodsA cross-sectional study was conducted using a questionnaire. A cluster sample of 544 adolescents (age 13–19 years) randomly derived from government schools participated in the study. Lifetime prevalence, point prevalence and prevalence of recurrent NSLBP were presented as percentages of the total population. Exact 95% confidence intervals were given. Chi-square test was used to evaluate the effect of gender and age on prevalence.ResultsThe students’ response rate was 97.8%. The lifetime prevalence was 42.9% [95% confidence interval = 40.8-44.6] with no significant difference between sexes [χ2 (1) =0.006, p = 0.94]. However, NSLBP peaked earlier in female students (13.9 years) than in male students (15 years) [t (226) = 4.21, p < 0.001]. About 10% of the adolescents reported having an episode of NSLBP on the day of the survey. However, female students (14.2%) were more affected on the day [χ2 (1) = 11.2, p < 0.001]. Twenty-nine percent of the adolescents experienced recurrent NSLBP with 78% experiencing at least three episodes in the last 12 months. On average, recurrent NSLBP reported was mild in intensity (4.8 ± 1.9) on the visual analogue scale (VAS) and short in duration. Recurrent NSLBP was associated with sciatica in 20.9% of adolescents.ConclusionsNSLBP is a common occurrence among Zimbabwean adolescents in secondary schools. It increases with chronological age and is recurrent in the minority of adolescents. Although much of the symptomatology may be considered benign, the existence of recurrent NSLBP in adolescents before their work-life begins should be a concern to health professionals, teachers and parents.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-381) contains supplementary material, which is available to authorized users.