Self-reported Back Pain Research Articles

Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients.

BackgroundCatastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF).MethodsNinety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0–10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records.ResultsNo difference between the groups’ self-reported back pain (p = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention.ConclusionParticipation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention.Trial registrationThe study was approved by the Danish Protection Agency (2011-41-5899) and the Ethics Committee of the Central Denmark Region (M-20110047). The trial was registered in Current Controlled Trials (ISRCTN42281022).

Work-related back discomfort and associated factors among automotive maintenance mechanics in Eastern Nigeria: A cross sectional study.

Back pain has been identified as a common cause of disability in the working population. Automotive mechanics habitually use awkward back posture in their course of manual activity and hence may be at risk of work-related back pain. To investigate the prevalence, pattern and severity of back pain among automotive maintenance mechanics, as well as the personal and job variables associated with or predicting occurrence of back pain. Using a cross-sectional design, information about self-reported back pain and the associated variables were collected among 684 randomly recruited automotive mechanics. Prevalence of back pain was 76.02%; with the majority experiencing low back pain. 63.3% of the workers reported they limited their activity due to the back pain. Older workers (>50 years), daily work lasting ≥5 hours duration, no more than primary education, being normal weight, frequent use of kneeling and sustained postures, and lack of knowledge of ergonomic postures were associated with increased prevalence of back pain. Lack of job autonomy, inadequate task clarity, heavy physical work load, manual material handling, strenuous posture, noisy environment, vibrations, work schedule and inadequate auxiliary support were also associated with increased prevalence of back pain among the mechanics. Work-related back pain is prevalent among automotive maintenance mechanics. Work-related back pain is high among automotive maintenance mechanics. Workstation policy and legislation on reduction of risks with combined health literacy and ergonomic education programs in this occupational group are imperative.

Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain

Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received. Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. clinicaltrials.gov Identifier: NCT01467843.

Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study.

BackgroundIn the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP.MethodsFive-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003–2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain ≥3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs).ResultsThe frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree.ConclusionThe proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0960-8) contains supplementary material, which is available to authorized users.

“Little Nudge”: an evaluation of the feasibility of using activity-reminder computer software in office workers to increase movement at work

Event Abstract Back to Event “Little Nudge”: an evaluation of the feasibility of using activity-reminder computer software in office workers to increase movement at work Emily Tims1* 1 Little Nudge, United Kingdom BACKGROUND The amount of time people spend sedentary is linked to health risks, including mortality. This link remains even in people who exercise (Van der Ploegg et al., 2012). There are unique physiological effects that occur due to being sedentary, which are separate from the physiological responses caused by structured exercise (Hamilton et al., 2007). Breaking up periods of sitting is linked with beneficial physiological responses, including reducing post-prandial glucose and insulin responses (Peddie et al., 2013). Novel solutions for facilitating interruptions to periods of sitting in the workplace are needed. DESCRIPTION Aim: To investigate the feasibility and effectiveness of using online exercise-reminder software for increasing frequency of movement in office workers. Design: A follow-up investigation of the impact of “Little Nudge” computer software. Participants were 118 office workers. Intervention: This consisted of computer software which reminded users to ‘stand up and move’, as well as other healthy activities. Newsletters and posters were also used to promote engagement with the software. Outcomes: These were measured via an online questionnaire at baseline and after using the software for three months or more. The primary outcome was self-reported frequency of movement. Secondary outcomes included self-reported frequency of eye-resting, mind-resting, self-reported back pain, neck pain and headaches. Qualitative feedback was collected about users’ experiences of using the software. Results: The following outcomes measured at baseline and three months from 118 participants’ (87 female, 30 male, 1 unknown) were analysed using marginal homogeneity tests. Primary outcome: Self-reported frequency of movement increased significantly (p = 0.000). Secondary outcomes: Self-reported eye-resting increased (p = 0.000), self-reported mind-resting increased but not significantly (p = 0.107). Self-reported back pain (p=0.013) and headaches reduced significantly (p =0.000). Self-reported neck pain (p = 0.218) reduced but not significantly. CONCLUSION This is an acceptable intervention, which increased self-reported frequency of movement and reduced self-reported painful symptoms. There is no control comparison or objective measures of movement, so future research is recommended to assess the effects on different samples using objective measures of movement. References Hamilton, M. T., Hamilton, D. G., & Zderic, T. W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56(11), 2655-2667. doi:10.2337/db07-0882 Peddie, M. C., Bone, J. L., Rehrer, N. J., Skeaff, C. M., Gray, A. R., & Perry, T. L. (2013). Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr, 98(2), 358-366. doi:10.3945/ajcn.112.051763 van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E., & Bauman, A. (2012). Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med, 172(6), 494-500. doi:10.1001/archinternmed.2011.2174 Keywords: break-reminder, exercise-reminder, Sedentary behaviour, office-workers, computer users Conference: 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016. Presentation Type: Poster presentation Topic: Practitioner Citation: Tims E (2016). “Little Nudge”: an evaluation of the feasibility of using activity-reminder computer software in office workers to increase movement at work. Front. Public Health. Conference Abstract: 2nd Behaviour Change Conference: Digital Health and Wellbeing. doi: 10.3389/conf.FPUBH.2016.01.00033 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Dec 2015; Published Online: 09 Jan 2016. * Correspondence: Miss. Emily Tims, Little Nudge, London, United Kingdom, emily@littlenudge.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Emily Tims Google Emily Tims Google Scholar Emily Tims PubMed Emily Tims Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures.

Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures.

Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE).

BackgroundBack pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs.MethodsStandardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability.ResultsPrevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p<0.01). About 8% of respondents reported that they experienced intense back pain in the previous month.ConclusionsEvidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

Self-reported back and/or leg pain in young and middle-aged Greek adults. Does pain location and intensity affect life-functioning factors?

Self-reported back and/or leg pain in young and middle-aged Greek adults. Does pain location and intensity affect life-functioning factors?

Prevalence and pattern of radiographic intervertebral disc degeneration in Vietnamese: a population-based study.

Intervertebral disc degeneration (IDD) is one of the most common skeletal disorders, yet few data are available in Asian populations. We sought to assess the prevalence and pattern of radiographic IDD in a Vietnamese population. This population-based cross-sectional investigation involved 170 men and 488 women aged ≥40 years, who were randomly sampled from the Ho Chi Minh City (Vietnam). Anthropometric data, clinical history and self-reported back and neck pain were ascertained by a questionnaire. Plain radiographs (from the cervical spine, thoracic spine to the lumbar spine) were examined for the presence of disc space narrowing and/or osteophytosis using the Kellgren-Lawrence (KL) grading system. The presence of radiographic IDD was defined if the KL grade was 2 or greater in at least one disc. The prevalence of radiographic IDD was 62.4% (n = 106) in men and 54.7% (n = 267) in women. The most frequently affected site was the lumbar spine with prevalence being 50.6 and 43.2% in men and women, respectively. The prevalence of IDD increased with advancing age: 18.8% among those aged 40-49 years, and increased to 83.4% in those aged ≥60 years. Self-reported neck pain and lower back pain were found in 30 and 44% of individuals, respectively. There was no statistically significant association between self-reported neck pain and cervical spine OA. These data suggest that radiographic IDD is highly prevalent in the Vietnamese population, and that self-reported back pain is not a sensitive indicator of IDD.

The association between obesity and back pain in nine countries: a cross-sectional study.

BackgroundThe association between obesity and back pain has mainly been studied in high-income settings with inconclusive results, and data from older populations and developing countries are scarce. The aim of this study was to assess this association in nine countries in Asia, Africa, Europe, and Latin America among older adults using nationally-representative data.MethodsData on 42116 individuals ≥50 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) study conducted in Finland, Poland, and Spain in 2011–2012, and the World Health Organization’s Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa in 2007–2010 were analysed. Information on measured height and weight available in the two datasets was used to calculate Body Mass Index (BMI). Self-reported back pain occurring in the past 30 days was the outcome. Multivariable logistic regression analysis was used to assess the association between BMI and back pain.ResultsThe prevalence of back pain ranged from 21.5% (China) to 57.5% (Poland). In the multivariable analysis, compared to BMI 18.5-24.9 kg/m2, significantly higher odds for back pain were observed for BMI ≥35 kg/m2 in Finland (OR 3.33), Russia (OR 2.20), Poland (OR 2.03), Spain (OR 1.56), and South Africa (OR 1.48); BMI 30.0-34.0 kg/m2 in Russia (OR 2.76), South Africa (OR 1.51), and Poland (OR 1.47); and BMI 25.0-29.9 kg/m2 in Russia (OR 1.51) and Poland (OR 1.40). No significant associations were found in the other countries.ConclusionsThe strength of the association between obesity and back pain may vary by country. Future studies are needed to determine the factors contributing to differences in the associations observed.

Self-reported back pain among nurses in a tertiary hospital in Singapore

Background: Back pain among nurses is a well-known occupational health problem. Given a paucity of local studies, there is a need to identity the magnitude and risk factors of back pain among nurses in Singapore. Objective: To explore the prevalence and intensity of self-reported back pain among nurses in a tertiary hospital in Singapore, and factors which influence the intensity of back pain. Methods: A cross-sectional survey design was used. Registered nurses working in 2 medical, 2 surgical and 1 rehabilitation (rehab) wards in a tertiary hospital were approached. Data was collected via a self-administered questionnaire. The questionnaire was divided into 3 section; (1) Demographic data; (2) Practice of Safe transferring techniques; and (3) Aberdeen Back Pain Scale. Results: 292 nurses participated. The majority were female (88%), staff nurses (53%), between 20–30 years of age (64%) with less than 5 years’ experience in their current ward (80%). The most frequently practiced safe transferring technique was on “ensuring that brakes are locked” (mean = 3.8), while the least frequent was ”stabilise lower back” (mean = 2.8) (score 0 = very seldom or never; score 5 = very often or always). The mean back pain score (based on the Aberdeen Back Pain Scale) was 17.2 (SD 11) (min = 0, max = 100). Back pain score was not associated with gender, age, nor years of experience in current ward. There was a statistically significance difference in the back pain score for the 5 different wards F(4, 287) = 4.6, p-0.0. Post-hoc comparison indicated that the mean score for nurses working in the general medical ward (m = 19, SD = 9) and neurology ward (m = 19.5, SD = 11.6) was significantly different from nurses in the rehab ward (m = 11.7, SD = 9.5). Conclusion: Although nurses in this study seemed to experience a low level of back pain; more need to be done to facilitate the manual handling component of nursing in the general medical and neurology ward.

Neutral Spine Control Exercises in Rehabilitation After Lumbar Spine Fusion

Lumbar spine fusion (LSF) has been reported to change the biomechanics of the spine and therefore the rehabilitation after LSF is important. In this study, the effect of selected neutral spine control exercises on activation of trunk muscles after LSF was evaluated. Muscle activity was measured by surface electromyography of the rectus abdominis, external oblique, longissimus, and multifidus muscles during 6 exercises in 22 LSF patients (mean age = 59 years; age range = 25-84 years; 50% women). Muscle activity concurrent with trunk flexion and extension during maximal voluntary isometric contraction (MVIC) was used as a reference value. Pain during the effort was assessed with a visual analog scale (VAS). The highest activity in the rectus abdominis muscles was measured during bilateral shoulder extension (51% of MVIC), and in the external oblique, it occurred during unilateral shoulder horizontal adduction (48% of MVIC) and unilateral hip extension (46% of MVIC) exercises. The highest activation of the multifidus and longissimus muscles (60-104%) was measured during bilateral shoulder flexion and modified Roman chair exercises. The mean (SD) self-reported back pain VAS scores during exercises varied from 3 (7) to 16 (26). Neutral spine control exercises activate trunk muscles and cause minimal pain and are therefore feasible exercises for home-based training to improve muscle endurance and postural control after LSF. In addition, the level of muscle activity during bilateral shoulder flexion and modified Roman chair exercises was over 60% of MVIC, justifying their use in training for strength of the trunk extensor muscles.

Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial.

BackgroundLow back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.Methods/designThis study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.DiscussionThis is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.Trial registration(ClinicalTrials.gov NCT01096628).

Impact of biogas digesters on wood utilisation and self-reported back pain for women living on rural Kenyan smallholder dairy farms

Women living on rural Kenyan dairy farms spend significant amounts of time collecting wood for cooking. Biogas digesters, which generate biogas for cooking from the anaerobic decomposition of livestock manure, are an alternative fuel source. The objective of this study was to quantify the quality of life and health benefits of installing biogas digesters on rural Kenyan dairy farms with respect to wood utilisation. Women from 62 farms (31 biogas farms and 31 referent farms) participated in interviews to determine reliance on wood and the impact of biogas digesters on this reliance. Self-reported back pain, time spent collecting wood and money spent on wood were significantly lower (p<0.01) for the biogas group, compared to referent farms. Multivariable linear regression showed that wood consumption increased by 2 lbs/day for each additional family member living on a farm. For an average family of three people, the addition of one cow was associated with increased wood consumption by 1.0 lb/day on biogas farms but by 4.4 lbs/day on referent farms (significant interaction variable – likely due to additional hot water for cleaning milk collection equipment). Biogas digesters represent a potentially important technology that can reduce reliance on wood fuel and improve health for Kenyan dairy farmers.

An ergonomics training program for student notebook computer users: Preliminary outcomes of a six-year cohort study

The Maine Learning Technology Initiative (MLTI) is a program established in the state of Maine in the United States of America, where all students in 7th and 8th grades are provided with a notebook computer to use at school and at home during the academic year. This study aimed to describe the anthropometric measurements and typing proficiency of a cohort of students in the MLTI. It also investigated the impact of participatory ergonomics education and use of peripheral notebook accessories on their reported musculoskeletal and visual discomfort over the first three years of a six year study. This longitudinal study commenced in 2009 with 34 students in 7th grade consenting to participate for six years through the 12th grade. Students received ergonomics education about healthy notebook use, reinforced with web-based resources; and were provided with peripheral notebook accessories including a notebook riser, and external keyboard (split or non-split) and mouse. The use of an external keyboard resulted in a reduction in neck and shoulder pain. Participants self-reported fewer headaches when using an external mouse. Using no external accessories was associated with self-reported back pain. Although other musculoskeletal discomforts decreased over time, the changes were not statistically significant. There was a trend for the reduction of visual symptoms including dry/watery eyes and sore, tired eyes during the study. Participatory ergonomics training and use of external devices may have significant health benefits for children involved in notebook programs who have daily exposure to this technology for school and leisure purposes. Internal and external validity of the results were limited by small sample size.

Dose response and structural injury in the disability of spinal injury

In traumatic injury there is a clear relationship between the dose of energy involved, structural tissue damage and resultant disability after recovery. This relationship is often absent in cases of non-specific chronic low back pain that is perceived by patients as attributed to a workplace injury. There are many studies assessing risk factors for non-specific low back pain. However, studies addressing causality of back pain are deficient. To establish whether there exists a causal relationship between structural injury, low back pain and spinal disability. Retrospective analysis of prospectively gathered validated spinal outcome measures [Oswestry disability index (ODI), low back outcome score (LBO), modified somatic perception (MSP), modified Zung depression index (MZD)] between patients with healed high energy thoracolumbar spinal fractures and patients with self-perceived work-related low back pain. Causality was established according to two of Bradford Hill's criteria of medical causality, temporal and dose-response relationships. Twenty-three patients with spinal fractures (group 1) of average age 44 years were compared to 19 patients with self-reported back pain in the workplace pursuing claims for compensation (group 2) of average age 48 years. Both groups were comparable in terms of age and sex. The average ODI in group 1 was 28 % (SD 19) compared to 42 % (SD 19) in group 2 (P < 0.05). Similarly, LBOS was 39.7 versus 24.3 (P < 0.05), MSP 4.3 versus 9.3 (P < 0.05) and MZD 20.2 versus 34.8 (P < 0.05) in groups 1 and 2, respectively. Despite high-energy trauma and significant structural damage to the spine, patients with the high energy injuries had better spinal outcome scores in all measures. There is no 'dose-response' relationship between structural injury, low back pain and spinal disability. This is the reverse of what would be anticipated if structural injury was the cause of disability in workplace reported onset of low back pain.

Does back and neck pain become more common as you get older? A systematic literature review.

BackgroundIt is generally believed that the prevalence of back pain increases with age and as the proportion of elderly will keep rising we may be facing serious public health concerns in the future.AimThe aim of this systematic literature review is to establish whether back pain (i.e. neck, mid-back and/or low back pain) becomes increasingly common in the older population, specifically to study 1) whether there is a significant increase in the prevalence of back pain after middle age, and 2) whether there is a significant gradually increasing prevalence of back pain with continued old age.MethodsA systematic literature search was conducted in Pubmed on articles in English, published between January 2000 and July 2011. Non-clinical studies from the developed countries with prevalence estimates on elderly people (60+) on any type of self-reported back pain and on different age groups with adequate sample sizes were included in the review. The included articles were extracted for information by two independent reviewers.ResultsA total of 12 articles were included covering the entire spine. Neck pain was studied nine times, low back pain eight times, back pain three times, upper back two times and neck/shoulders once. All studies showed no significant increase of back pain with age, neither when passing from middle age (i.e. 45+ years of age) into the sixties, nor later in life. In contrast, most studies reported a decline for the oldest group.ConclusionsBack pain is no more common in the elderly population (>60 years) when compared to the middle age population. Back pain does not increase with increasing age, but seems to decline in the oldest people.

Back Pain Among Farmers in a Northern Area of China

This was a population-based survey conducted in 2008 in a northern area of China. To investigate back pain prevalence and to examine the associations between potential risk factors and back pain among Chinese farmers. Few studies have investigated back pain and its associated risk factors among farmers in low-income and developing nations. Farmers ages 15 years and older were chosen from 800 families in Heilongjiang province of the People's Republic of China using cluster sampling methods. Complete survey data were obtained from 2045 farmers. The prevalence of self-reported back pain during the previous 3 months was reported. Associations between back pain and potential risk factors, which included age, gender, education levels, perceived stress, main farm activities, smoking, and drinking status, were examined in logistic regression models. A total of 786 (38.4%) farmers reported back pain. Two-thirds of those with back pain (66.0%) reported that back pain affected work quantity and quality. The adjusted odds ratios of reporting back pain increased with advancing age. Females and farmers who experienced stress regularly were also more likely to report back pain. Back pain is a common problem among Chinese farmers and is reported more frequently by females. Significant positive associations of gender, age, and perceived stress with back pain warrant additional study.

Diffuse Idiopathic Skeletal Hyperostosis and Its Relation to Back Pain Among Older Men: The MrOS Study

To estimate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a cross-sectional study of elderly men age 65 to 100 years and to examine back and neck pain as possible correlates of DISH. DISH was defined using Resnick's criteria and scored according to Mata on lateral spine radiographs of 298 randomly selected participants from the MrOS Study. Standardized self-reported questionnaires were used to assess the frequency and severity of back and neck pain, and the relation of these to DISH status was estimated with χ(2) tests, as well as prevalence ratios and 95% confidence intervals using log-binomial regression models. DISH was observed in 126 older men (42%), increased with age (30%, 39%, 48%, and 56% for ages 65-69, 70-74, 75-79, and ≥80 respectively), and was positively associated with body mass index (BMI) (P = 0.04) and blood pressure (P = 0.02). Significantly less back pain in the past 12 months was reported among men with DISH as compared to men without (59% vs 71%, P = 0.03), which remained after adjustment for age, BMI, and blood pressure (prevalence ratios = 0.73, 95% confidence interval = 0.57-0.95). Back pain severity (P = 0.07) and frequency (P = 0.06) were also less frequent among men with DISH compared to men without, whereas reported neck pain was similar between groups (P = 0.39). Among community-dwelling elderly men, DISH prevalence is high, increases with age, and is positively associated with BMI and blood pressure. Frequency of self-reported back pain over the past 12 months was lower in older men with DISH as compared to those without DISH.

Differences in Comorbidities on Low Back Pain and Low Back Related Leg Pain

Investigate the influence of external factors such as depression and BMI among subjects with primary severe low back pain (LBP) and low back related leg pain (LBLP). The report of disability in patients with LBP may be significantly influenced by confounding and moderating variables. No similar studies have examined the influence of these factors on LBLP. This study included 1,448 consecutive subjects referred to a tertiary spine clinic. Unconditional binary logistic regression was used to determine the influence of comorbidities on the relationship between self-reported back and leg pain. A change in estimate formula was used to quantify this relationship. Among those subjects with primary LBP the unadjusted odds ratio was 8.58 (95% CI 4.87, 15.10) and when adjusting for BMI, depression and smoking was 5.94 (95% CI 3.04, 11.60) resulting in a 36.7% change due to confounding by these comorbidities. Among those with primary LBLP, the unadjusted odds ratio was 4.49 (95% CI 2.78, 7.27) and when adjusting for BMI and depression was 4.60 (95% CI 2.58, 8.19) resulting in a 1.7% change due to confounding by these comorbidities. The disability statuses of the patients with primary LBP in this study were more significantly affected by comorbidities of BMI, depression and smoking than patients with report of LBLP. However, these comorbidities contribute little to the relationship of primary low back related leg pain and Oswestry scores ≥ 40.