京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22890号 / 人健博第82号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 林 悠, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Title: Effect of mobility exercises in offline and online environment on subjective perception of back pain Objectives: The main goal of this work was to determine whether the onset of daily mobility contributes to the reduction of individual's back pain perception. Within the work the results between the offline and online group was compared. Methods: The diploma thesis has the character of qualitative research, where case study of 20 probands was applied. Online input and output questionnaires were compiled to obtain data, which respondents filled in at the beginning and end of the intervention. Results: The research included 11 women and 9 men aged 21 - 44 years. Individuals have mostly sedentary jobs and some of them play recreational sports in their free time. At the end of the intervention, all individuals showed an improvement on the scale of the pain intensity, when the perceived back pain was alleviated or disappeared. The offline group performed better than the online group. Conclusion: The study confirmed that the inclusion of daily mobility contributes to the reduction of subjectively perceived back pain. It confirmed that exercising in offline lessons is more effective than in an online environment. Keywords: mobility, back pain, diaphragmatic breathing, torso stabilization, DNS

Bakgrund.Ländryggssmärta förekommer hos piloter och kan eventuellt vara en anledning till framtida långtidssjukskrivningar. Möjliga påverkande faktorer är antal yrkesverksamma år och träningsvanor. Det finns få antal studier gjorda på kommersiellt flygande piloter.  Syfte.Att kartlägga förekomsten av ländryggssmärta hos piloter inom kommersiell luftfart samt undersöka risken för långtidssjukskrivning. Vidare kartlägga skillnader i förekomst av ländryggssmärta hos piloter som arbetat <10 respektive >10 år samt att undersöka sambandet mellan ländryggssmärta och självskattad träningsvana. Metod.En tvärsnittsstudie genomfördes med webbenkät. Enkäten bestod av ett antal inledande egendesignade frågor och därefter följde Örebroformuläret kortversion av Steven Linton. Resultat.Antalet deltagare i studien var 73 respondenter vilket motsvarar en svarsfrekvens på 30 %. Totalt 57.5 % av de 73 respondenterna angav sig ha ländryggssmärta, av dessa hade majoriteten besvärats av smärtan i över ett år. Resultaten visade på att de piloter som hade ländryggssmärta inte hade en ökad risk för långtidssjukskrivning men att det fanns en skillnad i förekomst av ländryggssmärta hos de som arbetat över respektive under tio år (p=0.017). Korrelationen mellan träningsvanor och förekomst av ländryggssmärta var inte statistiskt signifikanta (r=0.03), (p=0.80). Konklusion.Prevalensen av ospecifik ländryggssmärta hos kommersiellt flygande piloter var hög och föreföll att öka med antalet yrkesverksamma år. Ytterligare forskning behöver undersöka vilka faktorer som bidrar till den höga förekomsten av ospecifik ländryggssmärta. / Background.Low back pain is common among commercial flying pilots and may possibly be a reason for future long- term sick leave. Possible influencing factors are the number of working years and exercise habits. There are few studies researching commercial flying pilots. Purpose.To describe the prevalence of low back pain among commercial flying pilots and to investigate the risk of long- term sick leave. Furthermore, identify differences in the incidence of low back pain among pilots who has worked <10 compared to >10 years, as well as to investigate the correlation between low back pain and self-assessed exercise habits. Method.A cross-sectional study was conducted with a web survey. The survey initially consisted of self-designed questions followed by “Örebroformuläret kortversion” by Steven Linton. Results.The study contained 73 respondents, which corresponded to a response rate of 30%. A total of 57.5% of the 73 respondents indicated that they had low back pain, of which the majority had been suffering for over a year.  The results showed that the pilots who had low back pain had no risk of long-term sick leave. There was a difference in the incidence of low back pain in those who worked over compared to under ten years (p=0.017). The correlation between exercise habits and the incidence of low back pain was not statistically significant (r=0.03), (p=0.08). Conclusion.The prevalence of nonspecific low back pain in commercial flying pilots was high and seemed to increase with the number of working years. Further research needs to investigate which factors contribute to the high incidence of nonspecific low back pain.

Bakgrund:Ländryggssmärta är en vanlig orsak till nedsatt funktionsförmåga och 60–80% av alla vuxna har upplevt smärta i ländryggen någon gång i livet. Fysisk aktivitet (FA) har god evidens att förhindra att ländryggssmärtan utvecklas till kronisk samt för att minska smärta och öka/bibehålla funktion. Fysioterapeutstudenter inhämtar under utbildningen kunskap om betydelsen av FA i både prevention och behandling, men lever vi som vi lär? Syfte:Att undersöka förekomst av ländryggssmärta, genomsnittlig mängd FA samt skillnader gällande mängd och intensitet av FA hos fysioterapeutstudenter i Sverige med respektive utan ländryggssmärta. Studien har även undersökt könsskillnader avseende prevalens av ländryggssmärta.  Metod:En tvärsnittsstudie av kvantitativ, komperativ och icke-experimentell design. En webbenkät skickades till samtliga fysioterapeutprogram i Sverige. Totalt deltog 252 personer av uppskattningsvis 1700 studerande. De svarande fick fylla i bakgrundsdata samt för de senaste sju dagarna skatta sin upplevda ländryggssmärta enligt 1–10 på Numeric Rating Scale (NRS) och sin mängd FA på olika intensiteter enligt International Physical Activity Questionnaire Short Form (IPAQ-SF). Resultat: Prevalensen av ländryggssmärta var 60% och förekomsten var lika mellan könen (män: 58%, kvinnor: 60%). Majoriteten av deltagarnas aktivitetsmängd klassificeras som hög. Resultaten påvisade ingen skillnad i FA mellan grupperna gällande total, mycket ansträngande samt måttligt ansträngande FA.  Konklusion:Inga statistiska skillnader gällande prevalens av ländryggssmärta kunde ses mellan könen. Studien påvisade ingen signifikant skillnad mellan grupperna med respektive utan ländryggsmärta gällande mängd eller intensitet av FA. Vidare forskning behövs på ämnet. / Background:Low back pain (LBP) is a common cause of disability and 60-80% of adults have experienced LBP at some point in their lives. Physical activity (PA) has good evidence to prevent LBP from becoming chronic, reduce pain and increase function. Physical therapy students learn of the importance of PA in both prevention and treatment. But do we live as we learn? Objective:To investigate the prevalence of LBP, average amount of PA and differences regarding the amount and intensity of PA amongst physical therapy students with and without LBP in Sweden. The study has also examined gender differences in the prevalence of LBP. Method:A cross-sectional study with quantitative, comparative and non-experimental design. A web survey was distributed to all physiotherapy programs in Sweden. Out of an estimated 1,700 students, 252 responded. Respondents submitted background information and estimated for the last seven days their LBP from 1-10 according to Numeric Rating Scale (NRS) and their amount of PA at different intensities according to International Physical Activity Questionnaire Short Form (IPAQ-SF). Results:The prevalence of LBP was 60%. 58% of men and 60% of women estimated LBP in the last seven days. The majority of the participants’ PA was classified as high. The results showed no significant difference in PA between the groups. Conclusion:No statistic differences regarding prevalence of LBP could be seen between the sexes. No significant difference regarding amount or intensity of PA was found between the groups with and without LBP. Further research is needed.

Objetivo: Describir principales motivos de consulta de pacientes atendidos en el servicio de terapia física en el Centro Universitario de Salud de UPC. Materiales y métodos: Estudio descriptivo de corte transversal analítico. Se evaluó motivo de consulta y cumplimiento de atenciones. Las variables categóricas (sexo, ocupación, actividad física, motivo de consulta, área corporal, tipo de atención recibida y cumplimiento de atenciones) fueron presentadas mediante frecuencia absoluta (n) y porcentaje (%). La única variable cuantitativa (edad), se presentó mediante mediana y rango intercuartílico, ya que, no presentó distribución normal. Análisis bivariado fue dicotomizado (< 6 sesiones y ≥ 6 sesiones), factor categórico utilizó prueba de Chi2 o prueba exacta de Fisher; factor edad, prueba de K medianas para establecer diferencias entre ambos grupos. Ánálisis multivariado, para cálculo de razón de prevalencia (RP), calculando RP cruda y RP ajustada a otras variables, mediante intervalo de confianza (95%). Se determinó p valor < o igual a 0,05. Resultados: Se incluyeron 171 historias clínicas de pacientes atendidos en servicio de terapia física con predominio masculino (54.4%). Prevalencia de motivo de consulta fue dolor en columna lumbar (12.3%) y columna cervical (11.7%). En ocupación, (50.3%) trabajaban y (32.7 %) fueron estudiantes; (42.1%) practicaban al menos un deporte. Tipo de atención recibida (71.9%) fue dada por estudiantes internos. Conclusiones: El principal motivo de consulta es dolor músculoesquelético (78.4%). El cumplimiento de atenciones es (59.1%). El género masculino es el más predominante, (30.4%) eran profesionales. El área corporal más consultado fue columna lumbar (12.3%). No se encontraron factores asociados al cumplimiento de atenciones. / Objective: Describe main reasons for consulting patients treated in physical therapy service at the University Health Center in UPC. Methods: Descriptive study of analytical cross section. The reason for consultation and compliance with attentions were evaluated. The categorical variables (sex, occupation, physical activity, reason for consultation, body area, type of care received and compliance with care) were performed using absolute frequency (n) and percentage (%). The only quantitative variable (age) was presented using the median and interquartile range, since there was no normal distribution. Bivariate analysis was dichotomized (<6 sessions and ≥ 6 sessions), a categorical factor determined by Chi2 test or Fisher's exact test; age factor, median K test to establish differences between both groups. Multivariate analysis, calculation of prevalence ratio (RP), calculation of crude RP and RP adjusted to other variables, using a confidence interval (95%). P value <or equal to 0.05 was determined. Results: This study included 171 medical records of patients attended in physical therapy service with male predominance (54.4%) were included. Prevalence of reason for consultation was pain in the lumbar spine (12.3%) and cervical spine (11.7%). In occupation, (50.3%) worked and (32.7%) were students; (42.1%) practiced at least one sport. Type of care received (71.9%) was given by internal students. / Tesis

Nursing staff members (registered nurses, licensed practical nurses, and nursing aides) have one of the highest incidence rates of work-related musculoskeletal disorders (WMSDs) of all occupations. Ergonomic research has identified patient handling and movement tasks that put the caregiver at high risk for a WMSD each time they are performed. The purpose of this study was to determine whether the frequency of performing the highest risk tasks, as well as certain other risk factors affecting physical workload, were related to the frequency of musculoskeletal discomfort. Also investigated was whether the manual handling workload varied by job category. The cross-sectional study was conducted at a Veterans' Administration hospital in Tampa, Florida in August 2001 on 11 in-patient units with 113 participants, who completed musculoskeletal discomfort and demographic surveys at the end of a week of observation of their workloads. Multiple regression analysis indicated that the number of high risk patient handling and movement tasks performed per hour, the number of patients cared for who weighed 212 pounds or more, and the interaction of the two were associated with the frequency of knee and wrist pain, but not with low back pain. The following variables were not associated with the frequency of musculoskeletal discomfort in any body part: patient census/able bodied staff ratio, patient classification rating, or number or use of patient handling and movement equipment. Manual handling workload did differ significantly among job categories, with registered nurses performing the fewest at- risk patient handling tasks and nursing aides the most. The seven-day prevalence rate of at least moderate discomfort in at least one body part was 62%. Recommendations include instituting recorded patient assessments to standardize the type of equipment and the number of staff members needed for specific handling and movement activities, as well as improved staff training. Further research is needed on the following: biomechanical forces on the wrist and knee during patient handling and movement tasks; the effect of patient weight on the risk of patient handling and movement tasks; and psychosocial stressors in addition to the physical workload of nursing staff.

Bakgrund: Under graviditeten genomgår kvinnans kropp stora fysiologiska förändringar och ryggsmärta är ett vanligt förekommande besvär för  gravida kvinnor.  Ryggsmärta kan leda till stor påverkan på kvinnans liv genom exempelvis sömnbesvär, nedsatt funktionalitet och sjukskrivning från arbetet. Det är i dagsläget oklart om och vilken typ av träning som eventuellt kan verka lindrande eller förebyggande vid graviditetsrelaterad ryggsmärta. Det är därför av intresse att undersöka huruvida träning kan fungera som en lindrande metod vid ryggsmärta under graviditeten. Syfte: Syftet med studien var att undersöka om träning under graviditeten kan verka som en preventiv eller lindrande metod mot graviditetsrelaterad ryggsmärta. Metod: En systematisk litteratursökning genomfördes i databaserna Pubmed och CINAHL avseende relevanta artiklar publicerade från 2005 och framåt. Resultat: Åtta studier ingick i litteraturstudien och sex av de granskade artiklarna visade att någon form av träning under graviditeten kan verka lindrande gällande smärtintensiteten. Det sågs ingen påverkan gällande förekomst av ryggsmärta. Slutsats: Muskelstärkande övningar i kombination med stretchövningar verkar ha en lindrande effekt avseende smärtintensiteten vid graviditetsrelaterad ryggsmärta. Konditionsträning verkar inte ha samma gynnsamma effekt. / Background: During pregnancy women’s bodies undergoes major physiological changes, and back pain is a common problem for many pregnant women. Back pain can have a major impact on women’s life and can lead to sleeping problems, reduced functionality       and sick leave from work. At present it is unclear if and what type of exercise that could possibly alleviate or prevent pregnancy-related back pain. It is therefore of interest to investigate exercise as a method for alleviating back pain during pregnancy. Objective: The aim of this study was to investigate whether exercise during pregnancy can serve as a method for alleviating pregnancy-related back pain. Method: A systematic literature search was conducted, using the databases Pubmed and CINAHL, regarding articles published from 2005 and until today. Results: Eight studies were included in this review and six of the studies showed that some form of exercise during pregnancy may appear to alleviate pain intensity. There was no effect regarding the occurrence of back pain. Conclusion: Muscle strengthening exercise in combination with stretching appear to have an alleviating effect on the intensity of pregnancy-related back pain. Cardio training does not seem to have the same beneficial effect.

Bakgrund: Ländryggssmärta är en av de vanligaste typerna av muskuloskeletal smärta och den ledande formen av nedsatt funktion världen över. Styrketräning (ST) är en av de vanligaste formerna av konservativ behandling vid kronisk ospecifik ländryggssmärta (CNSLBP). Det saknas rekommendationer för dosering av ST och effekten av olika doseringar är oklar. Syfte: Syftet med denna systematiska litteraturstudie var att kartlägga rapporterade träningsdoseringar vid CNSLBP samt att jämföra effekten av olika doseringar. Metod: En systematisk granskning av randomiserade kontrollerade studier publicerade de fem senaste åren genomfördes efter sökningar i databaserna MEDLINE, CINAHL och PEDro. En kvalitetsbedömning av studierna genomfördes och träningsdosering av styrketräning som behandling vid CNSLBP kartlades och kategoriserades. I inkluderade studier där liknande träningsupplägg med olika dosering jämförts, utvärderades doseringarnas effekt avseende smärtintensitet och funktion. Resultat: Totalt inkluderades sex artiklar. Risken för systematiska fel bedömdes som genomgående låg till medelhög. Träningsdoseringarna kategoriserades som moderata till medelhöga. Enbart en av de sex inkluderade studierna jämförde olika träningsdosering där komponenten intensitet varierats i två grupper. Högintensiv styrketräning uppvisade signifikanta förbättringar avseende funktion och små ickesignifikanta förbättringar avseende smärtintensitet jämfört med den medelintensiva träningsgruppen. Slutsats: Den här litteraturstudien visade att få studier anger träningsdosering av styrketräning som behandling för patienter med CNSLBP. De kartlagda träningsdoseringarna var moderata till medelhöga och liknar doseringarna som rekommenderas för motionärer. Inga slutsatser kunde dras avseende doseringarnas effekt. Framtida kliniska studier med träning som intervention bör definiera styrketräningsdosering vilket anses relevant för såväl forskare som fysioterapeuter i praktiken. / Background: Low back pain is one of the most common musculoskeletal disorders and the leading cause of disability worldwide. Resistance training (RT) is an effective therapeutic modality for the treatment of patients with chronic non-specific low back pain (CNSLBP). However, recommendations of RT dosages is lacking and the effects of different dosages remains unclear. Objective: The objective of this review was to map and evaluate the effectiveness of reported RT dosages for the treatment of CNSLBP. Method: A systematic search for literature was conducted in the databases MEDLINE, CINAHL and PEDro. Dosages were mapped and categorized. Effect sizes of pain intensity and disability were extracted from articles with comparisons between dosages. The risk of bias was judged for the articles, respectively. Results: A total of six articles were included. The dosages were categorized as moderate to medium high. Comparison between dosages was made in one of the included articles. Significant improvements in pain intensity and non-significant improvements in disability in favour of a high intensity group compared to a low intensity training group was found. The risk of bias was consistently judged as low or moderate. Conclusion: This study showed a lack of correctly reported RT dosages. The mapped dosages where corresponding to the recommendations for a healthy population. No conclusions could be drawn upon the effect of different dosages. A clear definition of the RT dosage in future trials is of importance to further investigate the effect of RT as an intervention for the treatment of CNSLBP.

This study examined the effects of self-monitoring behavior and health locus of control on improvement in a work hardening program. The subjects included 22 male and 18 female outpatients in a hospital-based rehabilitation program. Subjects were classified as having an internal or external health locus of control, and were randomly assigned to either a self-monitoring or a non-self-monitoring group. Improvement was assessed via objective performance data and self-ratings of perceived improvement. The results indicated that individuals identified as having an internal health locus of control did not show greater gains in physical functioning or perceived improvement relative to externally oriented individuals. Additionally, those subjects participating in self-monitoring activities were no different from non-self-monitoring subjects in terms of improvement in exercise activities or perceived improvement. The results also indicated no interaction between health locus of control and the presence or absence of self-monitoring. It was suggested that other factors such as workman's compensation, pain patient characteristics, low self-concept, and severe stress may have proved more powerful influences on patient improvement than internal health locus of control or self-monitoring. It was also suggested that rehabilitation programs might benefit from creating structured environments in which patients receive frequent staff feedback and reinforcement for improvement. Monitoring small, discrete, easily attainable goals might prove more effective than monitoring mood, pain, etc. In addition, teaching specific internal health locus of control behaviors to patients may help them improve their self-concepts and progress. Further research is needed to explore the roles that pain patient personality characteristics, self-concept, and stress play in the progress of patients in a work hardening program.

Chronic low back pain (CLBP) is defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, that lasts for at least twelve weeks.1 It is the leading cause of disability and loss of productivity in the United States.2 There is conflicting evidence on what is the most effective nonpharmacological treatment for CLBP. Many studies have shown that any general exercise routine is effective for improving symptoms, but the literature provides conflicting evidence about what specific type of exercise is best.3 A few studies have demonstrated decreased pain and disability with supervised directional preference exercise routines compared to non-directional preference routines. The objective of this study was to determine the effectiveness of a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients in a residency clinic and to expand on the limited evidence of directional preference exercise effectiveness. Unlike other directional preference interventional studies, this program’s simplicity and convenience of performing at home potentially could increase patient compliance and therefore effectiveness. Patients were screened at a routine clinic visit and considered eligible if they had a known diagnosis of CLBP. They were excluded if they were in an acute exacerbation. Participating patients were categorized on directional range of motion preference based on their physical exam, either flexion or extension, whichever improved their pain. They were given a simple routine with instructions and pictures consisting of three exercises and stretches that emphasized their specific directional preference. Subjects performed three sets of each routine two to three days per week. Degree of disability score was measured at initial visit by completing the gold standard disability index questionnaire, the Oswestry Disability Index (ODI). Degree of disability was reassessed with ODI at a follow-up assessment four to eight weeks later with five follow-up questions regarding compliance and acute exacerbation. Patients were excluded if they were in an acute exacerbation. Pre-interventional disability scores were then compared to post-interventional disability scores. Twelve total patients enrolled in the program. Seven were lost to follow up. Five completed the study at the proper follow up interval; however, one was in an acute exacerbation so was excluded. Of the four patients included, two had extension and two had flexion preference. Three out of four patients had decreased disability scores at follow up. Total post-intervention score on ODI improved by an average of 10 points compared to pre-intervention score for the patients who improved. The most improved post-interventional ODI score category was walking and changing degree of pain. Seventy-five percent of the patients who completed the study had an improvement in their CLBP disability score. However, due to a small sample size and study power, the results are not statistically significant. Therefore, a conclusion cannot be appropriately drawn about the effectiveness of performing a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients at a residency clinic. Nevertheless, the results are promising and deserve further investigation with a larger sample size.