Related Low Back Pain Research Articles

A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery.

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.

Classification of pregnancy related non-specific low back pain and pelvic girdle pain: a systematic review

Background: Pregnancy related non-specific low back pain (PNSLBP) and pelvic girdle pain (PGP) affect almost half of pregnant women, causing substantial disability for some. These diagnoses, which may represent several possible individual or co-occurring conditions, lack the specificity required to guide personalized treatment decisions. A reliable and valid classification is needed to direct effectiveness research and inform treatment strategies.Objectives: To describe the psychometric properties of pathoanatomic classifications of PNSLBP and PGP as well as to assess the risk of bias of supporting evidence.Methods: Two independent reviewers systematically searched PubMed, Embase, Cochrane and PEDro databases and conducted a manual search of reference list of eligible articles reporting office-based examination for classifying PNSLBP/PGP. QUADAS-2 tool was used to assess the risk of bias and applicability of reviewed studies.Results: Ten studies were eligible. Inter-rater reliability was 87% for PNSLBP and 84.6% for PGP. Major sources of potential bias included the lack of reference standard diagnostic tests, insufficient blinding, non-systematic order of index test application, and unclear participant selection procedures. Patient flow throughout studies and the interval between testing (flow and timing) showed the lowest risk of bias. The applicability of the reference standard had the highest concern, while participant selection and index test had the lowest.Conclusion: Although acceptable inter-rater reliability has been demonstrated, there is no current evidence to support the validity of PNSLBP and PGP classification systems. Future studies should consider including reference standard diagnostic tests, random order sequencing of index tests, rigorous selection criteria, and blinded assessors.

Observational study to correlate BMI with low back pain in young adults

Introduction: Low back pain is a common condition comprising a major health problem worldwide& will eventually affect almost everyone in life, men and women equally. In the present generation Overweight and obesity a major health hazard and predisposing to major non communicable disease. Young adults between 20-30yrs presenting with low back ache were taken and measured BMI with standard method. Results:In our the study correlation of low back pain in relation to the duration and BMI was analyzed, in which we observed as the BMI increases the duration of LBA also increases. Conclusion: our study the strong association of body mass index in relationship with development of low back ache in young adults of both genders is greatly implicated.

Prevalence of Work Related Low Back Pain among Physical Therapists with Different Foot Postures at Fayoum, Egypt: A Survey Study

AbstractBackground: Low Back Pain (LBP) is the commonest form of musculoskeletal disorder among physical therapists. Repetitive tasks, high force manual techniques bending/twisting postures, patient transfer assisting with mat activities, lifting heavy equipment, prolonged constrained posture and foot abnormalties identified as risk factors of low back pain which is common in the field of physical therapy.Aim of the Study: The purpose of this study was to identify prevalence of work related LBP among physical therapists with different foot postures working in governmental hospitals in fayoum-Egypt.Subjects and Methods: 147 physical therapists who are working in the governmental hospitals in Fayoum-Egypt, the LBP will be measured by Nordic Questionnaires (NQ) and foot postures measured by Foot Posture Index (FPI).Results: 112 of the 147P. Ts (76.19%) have completed the questionnaire. WRLBP (n=68), non WRLBP (n=25), no LBP (n=19). The lifetime prevalence of WRLBP was 60.71%, the twelve-month prevalence of WRLBP was 52.67%, the point prevalence of WRLBP was 47.32%, concerning BMI and WRLBP 74.28% of subjects with BMI of 20-24.9kg/m2 and 54.54% of subjects with BMI of 25-29.9kg/m2, the WRLBP was present in 54.83% of female subjects and in 68% of male subjects, the WRLBP was present in 56% of subjects with normal foot posture, 55% of subjects with pronated foot posture, 91% of subjects with highly pronated foot posture, 100% of subjects with supinated foot posture and 67% of subjects with highly supinated foot posture.Conclusion: There was no statistically significant associ-ation between LBP and foot postures, however there was a statistically significant association between WRLBP and BMI. There was a high prevalence of WRLBP among physical therapists who working in governmental hospitals in Fayoum-Egypt.

Association of chronic degenerative arthritis related chronic low back pain with altered lumbar facet joint orientation

ObjectiveTo examine the relationship between changes in lumbar spine facet joint (FJ) orientation and chronic low back pain (CLBP). MethodsWe retrospectively analyzed lumbar spine CT and MRI images of 98 patients referred for localized paraspinal CLBP and 98 age-and sex-matched asymptomatic individuals as controls. They were divided into four age groups (A, <40; B, 41–50; C, 51–60; D, 61–70; and E, 71–80 years old, respectively). FJ orientations were evaluated at the L3-4, L4-5, and L5-S1 lumbar levels. ResultsFJ angle showed a statistically significant more sagittal orientation in CLBP patients than in control groups in lower lumbar spine segments. The overall mean FJ angles in CLBP groups including all age groups combined at L3-4, L4-5, and L5-S1 levels were 32.33 ± 4.5, 36.11 ± 2.9, and 37.4 ± 6.1, degrees, respectively. The FJ angles in control group for all ages were 32.21 ± 3.7, 38.01 ± 4.6, and 40.18 ± 6.8°, respectively. The differences in FJ angle were statistically significant at both L4-5 and L5-S1 levels between the control and the CLBP groups (p < 0.01). The FJ orientation from upper lumbar spine to lumbar sacral junction demonstrated a gradual more coronal orientation transition in all subjects but this trend was significantly less in CLBP patients. The mean FJ angles for the control group at age groups A, B, C, D, and E were 33.52 ± 3.8, 35.7 ± 4.5, 38.25 ± 2.4, 35.49 ± 4.1, and 38.13 ± 5.8, respectively, while those in the CLBP groups were 35.63 ± 2.4, 35.26 ± 3.6, 35.99 ± 5.1, 35.3 ± 4.3, and 35.17 ± 6.7, respectively. ConclusionThere is a significant association between a more sagittal FJ orientation and facetogenic CLBP in lower lumbar vertebral levels. There is also age-dependent decrease in FJ orientation in sagittal plane at lower lumbar spinal levels in control as well as CLBP groups, however, this decrease in the CLBP groups was significantly more pronounced. Whether this change was an adaptive remodeling or alterations associated with chronic FJ osteoarthropathy should warrant further longitudinal studies.

Ossification of the mamillo-accessory ligament: a review of the literature and clinical considerations.

Ossification of the mamillo-accessory ligament (MAL) is a misunderstood phenomenon; however, many have posited that it can result in nerve entrapment of the medial branch of the dorsal ramus causing zygapophyseal joint related low back pain. The MAL has been studied anatomically by few, yet the data indicate possible associations between ossification of this ligament and spondylosis. It has been proposed that mechanical stress upon the lumbar spine may also lead to progressive ossification of the MAL into a bony foramen.

Accurate diagnosis of low back pain in adult elite athletes.

Background : There is few reports evaluated accurately the pain generator of low back pain in elite athletes. The purpose of this report was to show case series and to investigate the cause of unidentified low back pain of elite athletes. Methods : Twenty-three adult elite athletes consulted our sports spine clinic to seek a second opinion for low back pain between April 2013 and March 2016. Their cause of low back pain had not been identified by nearby doctor. Spine surgeons had diagnosed using diagnostic injection and STIR-MRI and the final diagnosis made by the spine surgeon were collected. Results : The mean age of 23 patients (16 male, 7 female) was 30.4 years. The most common sport played was baseball. The final diagnosis made by a spine surgeon was as follows : disc related low back pain (n = 12), facet joint arthritis (n = 5), vertebral endplate injury (n = 4), early-stage lumbar spondylolysis (n = 1), supraspinous ligament injury (n = 1). Conclusions : A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and injection block examination can effectively identify the cause of low back pain. J. Med. Invest. 66 : 252-257, August, 2019.

Neck pain and low back pain in relation to functional disability in different sport activities.

This population-based, cross-sectional study aimed to determine the frequency of neck pain, low back pain (LBP) and also the LBP related functional disability in five sport categories including football, volleyball, basketball, wrestling, and other sports in one of the Iranian sport Olympiads. The prevalence of neck pain and LBP in different time points was evaluated with the use of an interview questionnaire. A visual analogue scale was used to evaluate the athlete’s current pain. Furthermore, the functional disability related to LBP was assessed by the Athletes Disability Index Questionnaire (ADI). A total of 452 male athletes aging between 12 and 20 were screened. Three hundred seventy-seven participants responded to the questionnaires in which their mean age (standard deviation) was 15.95 (1.25). Collectively, the life-time prevalence of neck pain and LBP in all the athletes was 38.8% and 42.0%, respectively. The highest risk of neck pain at all-time points was observed among basketball players compared to other sport groups (P<0.05). The risk of LBP in most time points was the least among wrestlers (P<0.05). The ADI score was significantly higher among basketball players (13.89%) compared to volleyball players and wrestlers (P<0.05). Our study revealed a high prevalence of neck pain and LBP among Iranian young male athletes. A higher risk of neck pain and LBP among basketball players predisposes this sport at high risk of developing spine injuries which needs further consideration.

Effects of Exercises On Pregnancy Related Low Back Pain: A Quasi Experimental Study

Objective: To evaluate the effect of therapeutic exercises on pregnancy related low back pain in a tertiary care hospital of Karachi. Material &amp; Methods: This was a quasi-experimental study with non-probability convenience sampling technique. Study was carried out at Liaquat National Hospital Karachi. Patients were divided into two groups (Experimental and Control). Inclusion criteria were age &lt;30 years, 2nd and 3rd trimester, stable medical status and those who gave the informed consent. Exclusion were pregnancy induced hypertension (&gt;140/90mmHg), Cardiac disease, diabetes mellitus, persistent vaginal bleeding, history of miscarriages, decreased foetal movement. Data was collected through assessment Modified Oswestry Low back pain disability questionnaire. SPSS version 23.0 was used to analyze the data. Results: A total of 30 samples were selected for the study. There were 15 respondents in experimental while 15 in control group. Disability levels were found to be significantly decreased after post treatment in experimental group with P-value= 0.002. It was seen that number of patients was increased from 1(6.7%) to 6(40%) in minimal disability group whereas crippled back pain group in pre-treatment group was totally shifted towards minimal or moderate pain 3(20.0%) and no case was seen in post-treatment. Conclusion: Low back pain in pregnancy can disturb daily life routine but exercise therapy and proper counselling will lead stress free life to female in gestation. After post treatment in experimental group showed decrease in pain as compare to control group who were not provided any exercise therapy. Working women in experimental group also showed decrease by crippled back pain to moderate pain after exercise. So in the end researcher suggest that physiotherapy exercises play a vital role in reducing Low Back Pelvic Pain (LBPP) during pregnancy.

Epidemiology and Risk Factors of Work-Related Low Back Pain

Objects and methods of research. Of the 580 employees of a petrochemical plant, 507 people went through survey for low back pain using the Nordic questionnaire. In the prospective part of the study, 188 workers without any back problems during 12 months before the study were followed up for 6 and 12 months using the same questionnaire. Physical load at work place, age, gender, body mass index (BMI), smoking, and gene PARK2 polymorphism were regarded as potential risk factors. 177 workers provided buccal epithelium for investigation of rs926849 polymorphism A/G in the gene PARK2 by real-time PCR.The results of the study and their discussion. One-year prevalence of low back pain was 38.7% (95% CI 33.6–42.3%), and the incidence of new cases was 20.7% (95% CI 15.3–27.4%).In the presence of the genotype AA the probability of developing the low back pain in the group of up to 30 years were as high as in the group of 30 years and older: OR 0,99 (95% CI 0.29–4.52). For the low back pain with reduction of physical activity or disability, in the presence of AA genotype risk of such pain in workers aged 30 years and older was significantly higher than in the younger group: OR 1.86 (95% CI 1.03–3.57). The probability of low back pain was highest in the simultaneous presence of risk factors such as AA genotype and body mass index 25 kg/m² and more: OR 3,83 (95% CI 2.34–4.88) for all cases of low back pain, OR 10.0 (95% CI 5.04–19.85) for low back pain with reduction of physical activity or disability.Occupational risk factors of high significance (after controlling for non-occupational risk factors and their interactions) were revealed: fixed working posture of more than 25% of the work shift: OR 4.8 (95% CI 1.57–14.69), high dynamic physical load: OR 1.48 (95% CI 0.67– 3.26), as well as high physical load in general: OR 2.96 (95% CI 0.72–12.18). For the low back pain with reduction of physical activity or disability the structure of the risk factors was the same, while the odds ratios were higher and confidence intervals did not include 1.0.Conclusion.The following risk factors of work-related low back pain have been revealed: the age (30 years and older), overweight, genetic predisposition, namely the polymorphism of the PARK2 gene, high physical load, predominantly a fixed working posture of more than 25% of the work shift, and dynamic physical load. It has been shown that interactions of the factors «age» and «genotype», as well as «BMI» and «genotype» should be considered for better understanding of the structure of risk factors of work related low back pain.

Long-term effects of exercise programs among helicopter pilots with flying related LBP.

BACKGROUND: Flying related transient Low Back Pain (LBP) among helicopter pilots is considered an occupational distress.OBJECTIVE: To examine if exercise programs can alleviate transient LBP.METHODS: Sixty-five helicopter pilots (92% males), all reporting flying related LBP, responded to an epidemiological survey and a long-term follow-up, 44.8 months later, comprising questions regarding transient LBP and number of sick leaves. Data from 37 pilots participating in two exercise programs, A; general for LBP, B; focused for lumbar trunk (LT), included information from clinical examinations and muscular endurance tests of the LT before and after intervention. Twenty-eight pilots did not participate in any intervention.RESULTS: At long-term follow-up 42% of the pilots still reported flying related transient LBP. Among participants in program B 26% had persistent pain, 70% in program A and 46% among pilots without intervention. Sick-leave reduction was only observed among participants in program B (30% to 4%). Upon re-occurrence of LBP symptoms, half of the pilots in program B again performed exercises to improve their pain.CONCLUSION: This study indicates that exercise programs focused towards lumbar trunk muscular endurance reduces flying related transient LBP and sick-leave among helicopter pilots. These findings may have implications for the pilots’ working conditions.

Impact of exercise programs among helicopter pilots with transient LBP

BackgroundFlight related low back pain (LBP) among helicopter pilots is frequent and may influence flight performance. Prolonged confined sitting during flights seems to weaken lumbar trunk (LT) muscles with associated secondary transient pain. Aim of the study was to investigate if structured training could improve muscular function and thus improve LBP related to flying.Methods39 helicopter pilots (35 men and 4 women), who reported flying related LBP on at least 1 of 3 missions last month, were allocated to two training programs over a 3-month period. Program A consisted of 10 exercises recommended for general LBP. Program B consisted of 4 exercises designed specifically to improve LT muscular endurance. The pilots were examined before and after the training using questionnaires for pain, function, quality of health and tests of LT muscular endurance as well as ultrasound measurements of the contractility of the lumbar multifidus muscle (LMM).ResultsApproximately half of the participants performed the training per-protocol. Participants in this subset group had comparable baseline characteristics as the total study sample. Pre and post analysis of all pilots included, showed participants had marked improvement in endurance and contractility of the LMM following training. Similarly, participants had improvement in function and quality of health. Participants in program B had significant improvement in pain, function and quality of health.ConclusionsThis study indicates that participants who performed a three months exercise program had improved muscle endurance at the end of the program. The helicopter pilots also experienced improved function and quality of health.Trial registrationIdentifier: NCT01788111 Registration date; February 5th, 2013, verified April 2016.

Effect of movement control and stabilization exercises in people with extension related non -specific low back pain- a pilot study

BackgroundExercise is considered an effective treatment strategy for non-specific chronic low back pain (NSCLBP).backgroundIn spite of the wide use of exercise protocols, it is not clear what type of exercise is more effective in decreasing pain, disability and normalizing muscle activation patterns in people with chronic low back pain. ObjectivesTo assess the effects of two exercise protocols (stabilization vs movement control) on pain and disability scores and the flexion relaxation ratio (FRR) of lumbar multifidus (LM) and iliocostalis lumbarum pars thoracic (ICLT) in people with extension related non-specific chronic low back pain. Study designPilot randomized control trial. Methods32 subjects with active extension pattern chronic low back pain (stabilization group = 16, movement control group = 16) participated in this study. Treatment groups received 4 weeks of exercise therapy. Outcomes were based on pain score (Numeric rating Scale-NRS), disability (Oswestry Disability Index- ODI) and FRR of the LM and ICLT. ResultsFour people dropped out of the study in each group for reasons unrelated to the protocols of the study. Pain and disability reduced in both groups, with no significant difference between the groups. The FRR of LM did not change in either treatment group after treatment. However, the FRR of ICLT was significantly increased after treatment in the movement control group. ConclusionBoth movement control and stabilization exercises reduced pain and disability in the short-term among people with extension pattern NSCLBP, with no difference in effectiveness between the groups. However, movement control exercises were more effective in normalizing back muscle activation patterns than stabilization exercises.

Exploring musculoskeletal injuries in the podiatry profession: an international cross sectional study

BackgroundWorkplace injury is an international costly burden. Health care workers are an essential component to managing musculoskeletal disorders, however in doing this, they may increase their own susceptibility. While there is substantial evidence about work-related musculoskeletal disorders across the health workforce, understanding risk factors in specific occupational groups, such as podiatry, is limited.The primary aim of this study was to determine the prevalence and intensity of work related low back pain in podiatrists.MethodsThis was an international cross-sectional survey targeting podiatrists in Australia, New Zealand and the United Kingdom. The survey had two components; general demographic variables and variables relating to general musculoskeletal pain in general or podiatry work-related musculoskeletal pain. Multivariable regression analyses were used to identify factors associated with musculoskeletal stiffness and pain and low back pain intensity. Thematic analysis was used to group comments podiatrists made about their musculoskeletal health.ResultsThere were 948 survey responses (5% of Australian, New Zealand and United Kingdom registered podiatrists). There were 719 (76%) podiatrists reporting musculoskeletal pain as a result of their work practices throughout their career. The majority of injuries reported were in the first five years of practice (n = 320, 45%). The body area reported as being the location of the most significant injury was the low back (203 of 705 responses, 29%). Being female (p < 0.001) and working in private practice (p = 0.003) was associated with musculoskeletal pain or stiffness in the past 12 months. There were no variables associated with pain or stiffness in the past four weeks. Being female was the only variable associated with higher pain (p = 0.018). There were four main themes to workplace musculoskeletal pain: 1. Organisational and procedural responses to injury, 2. Giving up work, taking time off, reducing hours, 3. Maintaining good musculoskeletal health and 4. Environmental change.ConclusionsThe postures that podiatrists hold while treating patients appear to impact on musculoskeletal pain and stiffness. Recently graduated and female podiatrists are at higher risk of injury. There is a need for the profession to consider how they move and take care of their own musculoskeletal health.

Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis?

BackgroundThe condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS.MethodsTwo sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS.ResultsIndividuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS.ConclusionsOur results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.

The effectiveness of laser therapy on the management of chronic low back pain

Background/Aims: Chronic low back pain is a global musculoskeletal challenge, resulting in pain and disability on individuals. Laser therapy can be used to treat chronic low back pain. This review evaluates the effectiveness of laser therapy including high level laser therapy (HLLT) and low level laser therapy (LLLT) on chronic low back pain in relation to pain or functional disability. Methods: The authors conducted a systematic review of randomised controlled trials (RCTs) and searched the Cochrane Library, MEDLINE, CINAHL, AMED and PEDro from their start to June 2015. All studies that met predetermined inclusion and exclusion criteria were appraised with The Cochrane Collaboration's tool for assessing risk of bias and Critical Appraisal Skills Programme tools in June 2015. Results: Six RCTs met the inclusion criteria: two RCTs reported significant improvement in pain and functional disability with the use of HLLT but with a small sample size (n=103); one RCT (n=61) reported significant improvement and three RCTs (n=215) reported insignificant improvement in pain and functional disability with the use of LLLT. Conclusions: On the strength of the evidence available, HLLT and LLLT are not currently recommended to be replaced or be offered in addition to conventional treatment. Further rigorous research is required to confirm the potential use of laser therapy on individuals presenting with chronic low back pain.

Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study.

To clarify the significance of Modic changes, bony endplate lesions, and disc degeneration as predictors of chronic low back pain (LBP) during 1-year follow-up. 49 patients with severe, non-specific, chronic LBP, and Modic 1 lesion (M1) were prospectively studied with MRI and questionnaire. Changes in grade of disc degeneration, severity of Modic changes, Schmorl lesions, and bony endplate irregularities were evaluated and changes assessed in LBP intensity on numeric rating scale 0-10 and severity with Oswestry disability index 0-100 (ODI). Association between change in MRI findings and symptoms was computed using generalized estimating equations analysis. Although pain decreased in most patients during 1-year follow-up, it increased or persisted in 36%. Change in M1, M2, bony endplate lesions, and signal intensity (SI) and height of the disc associated with change of pain intensity, while change in M1, bony endplate lesions, and disc height associated with change of ODI. Not only persistent M1s, increasing bony endplate lesions, decreasing disc height, and M2s, but also new M2s predicted persistence of pain, while decrease of M1s and SI of the disc and increase of size of M2s predicted decrease of pain. Changes in disc bulges did not associate with pain. In patients with chronic non-specific LBP, persisting M1, decreasing disc height, and increasing bony endplate lesions associated with persisting pain while decrease of SI of the disc with decrease of pain. Such changing MRI findings in the same disc space have earlier been shown to progress abnormally fast. They may be signs or biomarkers of a prolonged pain causing, deforming degenerative process, and should lead to considering early intervention or specific treatments to affect that process.

“Are We hurting ourselves?” What is the prevalence of back pain in anesthesia providers?

Study objectiveBack injuries are a highly reported category of occupational injury in the health care setting. The daily clinical activities of an anesthesia provider, including lifting, pushing stretchers, transferring patients, and bending for procedures, are risk factors for developing low back pain. The purpose of this study is to investigate the prevalence of work related low back pain in anesthesia providers. Design/settingWe conducted a cross-sectional survey study of anesthesia providers at an academic institution. PatientsThe target population included all 141 clinical anesthesia providers employed by the Penn State Milton S. Hershey Medical Center Department of Anesthesia. InterventionsA survey study was conducted using the Oswestry Disability Index (ODI), a validated scoring system for low back pain. Additional questions related to the daily activities of clinical anesthesia practice were also asked. The survey instrument underwent pretesting and clinical sensibility testing to ensure validity and consistent interpretation. MeasurementsThe primary self-reported measures were the prevalence of low back pain in anesthesia providers and an assessment of disability based on the ODI. Secondary functional measures included the impact of low back pain on work flow. Main resultsNearly half (46.6%) of respondents suffer from low back pain attributed to clinical practice. In this subset of respondents, 70.1% reported not having back pain prior to their anesthesia training. Of those with low back pain, 44% alter their work flow, and 9.8% reported missing at least one day of work. Six providers (5.3%) required surgical intervention. Using the ODI score interpretation guidelines, 46% of respondents had a “mild disability” and 2% had a “moderate disability.” Respondents reporting feeling “burned out” from their job had a significantly higher average ODI score compared to those who did not (6.8 vs 3.3, respectively; P=.01). ConclusionsNearly half of all anesthesia providers sampled suffer from low back pain subjectively attributed to their clinical practice. This leads to changes in work flow and missed days of work. The results of this study suggest a deficiency in the effectiveness of anesthesia training programs in teaching proper techniques to prevent musculoskeletal injuries.

Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14months postpartum.

BackgroundPregnancy related low back pain (PLBP) and pelvic girdle pain (PGP) are considered common complications of pregnancy. The long-term consequences for women with persistent PLBP/PGP postpartum are under-investigated. The main objective was to investigate the prevalence, pattern and degree of sick leave as well as healthcare utilisation and its perceived effect in women with persistent PLBP/PGP at 12 months postpartum.MethodThis is a follow-up study of a cohort involving of a sample of women, who delivered from January 1st 2002 to April 30th in 2002 at Umeå University Hospital and Sunderby Hospital, and who reported PLBP/PGP during pregnancy. A total of 639 women were followed-up by a second questionnaire (Q2) at approximately 6 months postpartum. Women with persistent PLBP/PGP at the second questionnaire (N = 200) were sent a third questionnaire (Q3) at approximately 12 months postpartum.ResultsThe final study sample consisted of 176 women reporting PLBP/PGP postpartum where N = 34 (19.3 %) reported ‘no’ pain, N = 115 (65.3 %) ‘recurrent’ pain, and N = 27 (15.3 %) ‘continuous’ pain. The vast majority (92.4 %) of women reported that they had neither been on sick leave nor sought any healthcare services (64.1 %) during the past 6 months at Q3. Women with ‘continuous’ pain at Q3 reported a higher extent of sick leave and healthcare seeking behaviour compared to women with ‘recurrent’ pain at Q3. Most women with persistent PLBP/PGP had been on sick leave on a full-time basis. The most commonly sought healthcare was physiotherapy, followed by consultation with a medical doctor, acupuncture and chiropractic.ConclusionMost women did not report any sick leave or sought any healthcare due to PLBP/PGP the past 6 months at Q3. However, women with ‘continuous’ PLBP/PGP 14 months postpartum did report a higher prevalence and degree of sick leave and sought healthcare to a higher extent compared to women with ‘recurrent’ PLBP/PGP at Q3. Women with more pronounced symptoms might constitute a specific subgroup of patients with a less favourable long-term outcome, thus PLBP/PGP needs to be addressed early in pregnancy to reduce both individual suffering and the risk of transition into chronicity.

Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India

Background: The level of quality of life (QOL) and disability among women with low back pain is an important health issue at global level. Objective: To find out the prevalence of low back pain and to assess the relationship of low back pain with disability and QOL among women. Materials and Methods: A community-based cross-sectional study was conducted among 250 women in age group of 30-65 years residing in field practice area of a Tertiary Care Medical Institution, Puducherry. Severity of the pain was assessed using Numerical Pain Scale. Modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF scale to assess the QOL among women with low back pain. Results: Overall, the prevalence of low back pain was found to be 42%. The majority of women (60.9%) with low back pain experienced moderate disability. Almost 72% of women with low back pain perceived their QOL as good and overall mean QOL score was 88.41 (standard deviation = 12.9). The low back pain was influenced by the demographic variables that include age, marital status, illiteracy, total family income, type of delivery, number of children and household chores, menopausal status, and chronic illness (P < 0.05). Disability was influenced by age, education, and occupation, whereas QOL was influenced by education of the women with low back pain (P < 0.05). Conclusions: Prevalence of low back pain among women was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good.