Specific Low Back Research Articles

Osteopathic intervention in chronic non-specific low back pain: a systematic review

BackgroundChronic Non Specific Low Back Pain (CNSLBP) is a common, complex and disabling condition that has been present for longer than three months and is not caused by a serious pathology. Osteopaths are health practitioners who commonly diagnose and treat CNSLBP patients using a complex set of interventions that includes manual therapy. The study aimed to complete a Systematic Review of clinical research into osteopathic intervention in CNSLBP using a rigorous assessment of study quality.MethodsThe literature was searched to August 2011 using the following databases: AMED, CINAHL Plus, Cochrane Central Register of Clinical Trials, MEDLINE Plus, EMBASE, MANTIS, OSTMED, PEDro, ScienceDirect. Multiple search terms were used in various combinations: osteopathy/osteopathic, osteopathic manipulative technique, OMT, Spinal Manipulative Therapy, SMT, clinical trial, back pain, chronic back pain. The inclusion criteria were papers that: reported clinical trials; had adult participants; tested the effectiveness and/or efficacy of osteopathic manual therapy intervention applied by osteopaths, and had a study condition of CNSLBP. The quality of the papers was assessed using the Cochrane Back Review Risk of Bias criteria. A meta-analysis would proceed if the studies had adequate clinical and methodological homogeneity.ResultsInitial searches revealed 809 papers, 772 of which were excluded on the basis of abstract alone. The remaining 37 trial papers were subjected to a more detailed analysis of the full text, which resulted in 35 being excluded. The two remaining trials had a lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different comparators with regards to the primary outcomes, the number of treatments, the duration of treatment and the duration of follow-up.ConclusionThere are only two studies assessing the effect of the manual therapy intervention applied by osteopathic clinicians in adults with CNSLBP. One trial concluded that the osteopathic intervention was similar in effect to a sham intervention, and the other suggests similarity of effect between osteopathic intervention, exercise and physiotherapy. Further clinical trials into this subject are required that have consistent and rigorous methods. These trials need to include an appropriate control and utilise an intervention that reflects actual practice.

Development of APLAR-COPCORD Core Qestionnaire for Identification of Risk Factors for Non Specific low Back Pain

Background: Non specific low back pain (NSLBP) has been identified as one of the commonest rheumatic disorders in prevalence surveys in Asia-Pacific. Objective: Development of a core questionnaire for identification of risk factors of NSLBP at community level. Methods: Following steps were followed: 1) item generation from literature survey, existing Nordic questionnaires and patient focus group discussions, 2) development of a preliminary APLARCOPCORD English questionnaire, 3) translation into target language, back translation and development of a synthetic target language version, 4) adaptation of the synthetic target language version through tests of comprehensibility, content validity test-retest reliability, and 5) finalization of the English questionnaire. Results: 45 items were generated. A preliminary English questionnaire was developed. Conclusion: The developed English questionnaire will serve as an efficient tool for identification of risk factors of NSLBP in Asia-Pacific communities.DOI: http://dx.doi.org/10.3329/kyamcj.v2i2.13263KYAMC Journal Vol.2(2) January 2012, 187-192

A Review of Relationship between Fear Avoidance Beliefs and Postural Stability in Non Specific Chronic Low Back Pain

Introduction: Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, affecting 70% to 80% of adults at some time during their lives. Recent evidence suggests that psychosocial factors especially fear-avoidance beliefs (FAB) are important in predicting patients who will progress from an acute to a chronic stage as well as failure of interventions. The aim of this study is to review the Relationship between Fear Avoidance Beliefs and Postural stability in non specific Chronic Low Back Pain (CLBP). Methods: In this narrative article we have searched PubMed, CINHAL, APTA and MEDLINE data bases. The key words included: chronic low back pain, fear avoidance beliefs, posture, stability, balance, motor control, center of pressure and force plate. The inclusion criteria were being related to FAB and postural stability and adults with non specific CLBP, in English language, up to 2013, regardless of their study design. Results: The results showed that psychological factors such as FAB influence the chronicity of LBP, a group of studies indicated that FAB is related to pain and disability. Another group of studies indicated that postural stability is related to pain and disability. The only study on the relationship between postural stability and FAB did not found any significant relationship. Conclusion: FAB is related to pain and disability. Postural stability is related to pain and disability. More studies with stronger methodology such as larger population with control group are needed for evaluating the relationship of FAB and postural control.

**Poster 383 Study of the Efficacy of Paraspinous Blocks Combined With Analgesics and Exercises in the Treatment of Chronic Non Specific Low Back Pain

**Poster 383 Study of the Efficacy of Paraspinous Blocks Combined With Analgesics and Exercises in the Treatment of Chronic Non Specific Low Back Pain

Low Back Pain and Comorbidity Clusters at 17 Years of Age: A Cross-sectional Examination of Health-Related Quality of Life and Specific Low Back Pain Impacts

Comorbidities in adults negatively affect the course of low back pain (LBP). Little is known of the presence and/or impact of LBP comorbidities in adolescents. Subjects from the Raine Study cohort at age 17 years (n = 1,391) provided self-report of diagnosed medical conditions/health complaints, health-related quality of life (36-Item Short Form Health Survey [SF-36]), lifetime experience of LBP, and specific LBP impacts (taking medication, missing school/work, interference with normal/physical activities). Latent class analysis was used to estimate clusters of comorbidities based on diagnosed disorders. Profiles of SF-36 and impact were examined between clusters. Four distinct comorbidity clusters were identified: cluster 1: Low probability of diagnosed LBP or any other medical condition (79.7%); cluster 2: High probability of diagnosed LBP and neck/shoulder pain, but a low probability of other diagnosed health conditions (9.6%); cluster 3: Moderate probability of diagnosed LBP and high probability of diagnosed anxiety and depression (6.9%); cluster 4: Moderate probability of diagnosed LBP and high probability of diagnosed behavioral and attention disorders (3.8%). The clusters had different SF-36 and LBP impact profiles, with clusters 3 and 4 having poorer SF-36 scores, and clusters 2 to 4 having greater risk for specific LBP impacts, than cluster 1. Identified comorbidity clusters support adolescent and adult studies reporting associations between LBP, other pain areas, psychological disorders, and disability. Tracking these clusters into adulthood may provide insight into health care utilization in later life, whereas identification of these individuals early in the life span may help optimize intervention opportunities.

The Impact of Fear-Avoidance Model Variables on Disability in Patients With Specific or Nonspecific Chronic Low Back Pain

A prospective cross-sectional design. The objectives were to describe the occurrence and to investigate the association of the fear-avoidance model variables (pain intensity, kinesiophobia, depression, and disability) in patients with specific or nonspecific chronic low back pain (CLBP). Affective factors, particularly fear, have proven to be central in the explanation and understanding of chronic pain. The fear-avoidance model has shown that fearful patients with CLBP are at risk of becoming trapped in a vicious cycle of pain, fear, disability, and depressive symptoms. Little is known about the relationship between these factors in patients subgrouped as specific or nonspecific CLBP. All 147 patients (81 women and 66 men) were examined by an orthopedic surgeon and diagnosed as either specific or nonspecific CLBP on the basis of that examination. Hierarchical multiple regression analysis was used to assess the ability of three independent variables (back pain intensity, VAS; kinesiophobia, TSK; depressed mood, Zung) to predict levels of disability after controlling for the influence of age and sex. RESULTS.: Both groups (specific and nonspecific CLBP) presented elevated values on the fear-avoidance model variables. All the independent fear-avoidance variables contributed in a statistically significant manner to predict disability in patients with specific CLBP, 67.0%, F (5, 59) = 24.46, P < 0.000. In patients with nonspecific CLBP, all variables except kinesiophobia predicted disability in a statistically significant manner, 63.0%, F (5, 59) = 22.64, P < 0.000. We conclude that persistent musculoskeletal pain affects the individual in a similar manner, regardless of the cause of the pain. In clinical terms, this means that pain must be analyzed and treated as a parallel process to searching for the cause of the pain.

Study of Alleviating and Exacerbating Movement in Nurses with non Specific Chronic Low Back Pain: The Sahrmann’s Approach

Study of Alleviating and Exacerbating Movement in Nurses with non Specific Chronic Low Back Pain: The Sahrmann’s Approach

Translation and standardisation into Greek of the standardised general Nordic questionnaire for the musculoskeletal symptoms

Musculoskeletal disorders represent a common reason for the general population to seek care from the health services.1,2 Standardised questionnaires are among the widely accepted methods for collection and analysis of relevant data. The standardised questionnaires for the analysis of musculoskeletal symptoms (Nordic Musculoskeletal Questionnaires, NMQs),3 the general form and the specific low back and neck/shoulder questionnaires, have been extensively used as a screening instrument in epidemiological studies across Europe and all over the world.4,5 The lack of specific questionnaires that are validated in the Greek language was the main reason for this study of translation and validation of the general NMQ into Greek.

Chiropractic technique procedures for specific low back conditions: Characterizing the literature

Background: Many original clinical trials and several review papers have come to the conclusion that manipulation is safe and effective for the treatment of low back pain. However, it is necessary to determine which specific types of manipulation and nonmanipulative types of chiropractic adjustive care are most effective for particular types of low back pain across both tissue-specific and functional classifications. Objective: To characterize the quantity and quality of literature gathered for an Expert Panel that was convened to rate various specific chiropractic adjustive procedures for the treatment of common types of low back pain, drawing on the clinical expertise of the panel members and the relevant literature. Study Design: Systematic review of treatment-specific, condition-specific trials, studies, and case reports of chiropractic care for low back pain. Methods: Computerized searching and hand searching were used to identify references in the medical and chiropractic literature pertaining to the chiropractic treatment of low back pain in which both the condition and specific treatment procedures were adequately described. This literature was then categorized according to a variety of characteristics and used by a panel to evaluate the specific procedures. Results: The 3 most studied adjustive procedures are side-posture high-velocity, low-amplitude; distraction (mostly flexion distraction); and mobilization, respectively. The clinical condition most commonly addressed by the included studies is low back pain. The procedure with the widest base of evidence support is side posture manipulation for low back pain. (J Manipulative Physiol Ther 2001;24:407-24)