Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population. Methods: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods >= 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. Results: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. Conclusions: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.

Background: The use of meta-analysis to combine the results of observational studies is controversial. Despite its common use, methodological work in this area is lacking. Because of the diversity of study designs, exposure and outcome measures, and differential adjustment for confounding variables, the identification of sources of heterogeneity among study effect estimates is particularly important when combining data from observational studies. This thesis presents the results of a study that examines the relative ability of individual participant data (IPD) meta-analysis (which was considered a “gold standard”) and traditional aggregate data (AD) meta-analysis to identify sources of heterogeneity among studies examining mechanical exposure and low back pain (LBP) in workers. Materials and Methods: A systematic literature search was conducted to identify relevant articles. The corresponding author of each article was contacted to request their individual-level data. Because the outcome definitions and exposure measures were not uniform across studies, two sub-studies were conducted 1) to identify sets of outcome definitions that could be combined in a meta-analysis and 2) to develop methods to translate mechanical exposure onto a common metric. IPD analyses were conducted using generalized estimating equation (GEE) regression to identify variables that acted as strong confounders and effect modifiers. Traditional AD meta-analysis was also conducted and potential sources of heterogeneity were tested using meta-regression. Key Findings: (1) Overall, we found an association between both forces and postures on LBP, although the magnitude varied depending on the exposure-outcome combination. Among the outcomes, the ORs tended to be highest for sick leave due to LBP. (2) There was very little evidence of strong confounders in the relationship between mechanical exposure and LBP; thus differential adjustment for confounders in studies would not likely be an important source of heterogeneity in an AD meta-analysis. (3) AD meta-analysis was able to identify the same study-level effect modifiers as IPD meta-analysis, but did not consistently identify individual-level effect modifiers. Both individual-level characteristics (older age and being male), and study-level characteristics (population-based studies and self-reported mechanical exposure), were associated with an increased OR for many of the LBP outcome and mechanical exposure combinations. Conclusion: AD meta-analysis is likely sufficient to detect heterogeneity for study-level factors but is not sufficient to identify individual-level effect modifiers. When the primary source of evidence in a research area is observational studies and when there is controversy despite several systematic reviews, IPD meta-analysis can be used to better understand sources of heterogeneity and provide context

Background: The use of meta-analysis to combine the results of observational studies is controversial. Despite its common use, methodological work in this area is lacking. Because of the diversity of study designs, exposure and outcome measures, and differential adjustment for confounding variables, the identification of sources of heterogeneity among study effect estimates is particularly important when combining data from observational studies. This thesis presents the results of a study that examines the relative ability of individual participant data (IPD) meta-analysis (which was considered a “gold standard”) and traditional aggregate data (AD) meta-analysis to identify sources of heterogeneity among studies examining mechanical exposure and low back pain (LBP) in workers. Materials and Methods: A systematic literature search was conducted to identify relevant articles. The corresponding author of each article was contacted to request their individual-level data. Because the outcome definitions and exposure measures were not uniform across studies, two sub-studies were conducted 1) to identify sets of outcome definitions that could be combined in a meta-analysis and 2) to develop methods to translate mechanical exposure onto a common metric. IPD analyses were conducted using generalized estimating equation (GEE) regression to identify variables that acted as strong confounders and effect modifiers. Traditional AD meta-analysis was also conducted and potential sources of heterogeneity were tested using meta-regression. Key Findings: (1) Overall, we found an association between both forces and postures on LBP, although the magnitude varied depending on the exposure-outcome combination. Among the outcomes, the ORs tended to be highest for sick leave due to LBP. (2) There was very little evidence of strong confounders in the relationship between mechanical exposure and LBP; thus differential adjustment for confounders in studies would not likely be an important source of heterogeneity in an AD meta-analysis. (3) AD meta-analysis was able to identify the same study-level effect modifiers as IPD meta-analysis, but did not consistently identify individual-level effect modifiers. Both individual-level characteristics (older age and being male), and study-level characteristics (population-based studies and self-reported mechanical exposure), were associated with an increased OR for many of the LBP outcome and mechanical exposure combinations. Conclusion: AD meta-analysis is likely sufficient to detect heterogeneity for study-level factors but is not sufficient to identify individual-level effect modifiers. When the primary source of evidence in a research area is observational studies and when there is controversy despite several systematic reviews, IPD meta-analysis can be used to better understand sources of heterogeneity and provide context

Introduction: Physical inactivity, related lifestyle diseases and back pain are severe problems in today’s society. One way to increase physical activity level is through Motivational Interviewing (MI).   Purpose: Comparing participants who were in need of MI for physical activity due to risk of heart- and coronary disease with participants not in need of MI, and to describe whether MI for physical activity and other factors can predict change of physical activity level.   Method: A cohort was followed during two years and measured on lifestyle factors, socioeconomic and psychological factors, general health, motivation to change lifestyle and back pain by questionnaires. Based on risk of heart and coronary disease, participants underwent an MI-session for increased physical activity (n=393) or no MI-session (n=380) at baseline.   Results: Besides having a deteriorated lifestyle, the majority of participants who received MI were females, had lower self-estimated economy, had lower health-related quality of life, scored lower on psychological factors and had comorbidity and back pain to a larger extent. Factors related to increase of physical activity level included being physically inactive at baseline, being a female, not having MI and not having disability due to back pain.   Conclusion: Participants in the MI-group had poorer health and more back pain. Having MI did not predict an increase of physical activity, but a low level of physical activity in the past and being a female did play a part in the prediction. More research is needed on MI for increase of physical activity level for an individual with risk of heart- and coronary disease and/or with back pain. / Introduktion: Fysisk inaktivitet, livsstilssjukdomar, och ryggsmärta är stora problem i dagens samhälle. Ett sätt att öka fysisk aktivitet är motiverande samtal (MI).   Syfte: Att jämföra deltagare som på grund av ökad risk för hjärt-/kärlsjukdom har behov för MI för ökad fysisk aktivitet med de som inte har behov, samt att beskriva om MI för ökad fysisk aktivitet och andra faktorer kan predicera en ökning i fysisk aktivitetsnivå efter två år.   Metod: En cohort följdes genom två år och mättes med enkäter beträffande livsstils-, socioekonomiska och psykologiska faktorer, hälsa, motivation till ändrad livsstilsbeteende samt ryggsmärta. Baserad på sin risk för hjärt-/kärlsjukdom fick deltagare ett MI-samtal syftat till att öka sin fysiska aktivitetsnivå (n=393) eller inget MI-samtal (n=380) vid baslinjen.   Resultat: Deltagare som fick MI för ökad fysisk aktivitet var oftare kvinnor, hade lägre själv-estimerad ekonomi, sämre hälsorelaterad livskvalitet, sämre psykologisk hälsa, mera komorbiditet och mera ryggsmärta. Faktorer relaterade till ökning av fysisk aktivitetsnivå var att vara inaktiv vid baslinjemätningen, att vara kvinna, att inte ha haft MI och att inte ha funktionsnedsättning på grund av ryggsmärta.   Konklusion: Deltagare i MI-gruppen hade sämre hälsa och mera ryggsmärta. MI predicerade inte en ökning av fysisk aktivitetsnivå. Däremot predicerade tidigare låg aktivitetsnivå och att vara kvinna en ökning. Mer forskning behövs avseende effekt av MI för ökning av fysisk aktivitetsnivå för individer med risk för hjärt-/kärlsjukdom och/eller ryggsmärta.

<p>Back pain has been reported to be the most common type of discomfort in all occupational groups. Studies have shown that dentists experience more neck, shoulder and back pain than practitioners in other occupational groups. This has caused an increase of social and economic costs of healthcare and increased frequency of sickness absenteeism in Western countries. About 72% of dentists experience back pain according to studies done in Western countries thus showing a very high prevalence among dentist. This study aimed to investigate the prevalence of back pain among dentistry undergraduate students. As there have been reports of high prevalence of back pain among dentistry students in<br /> Western countries.</p>

Objective : Low back pain (LBP), and in particular sacroiliac joint syndrome, is a significant health concern for both patient and their chiropractor with regards to quality of life and work related musculoskeletal disorders. Therefore, chiropractors often utilise mechanical aids to reduce the impact on the chiropractor’s health. It is, however, important to establish whether these mechanical aids are indeed clinically effective, therefore, this study evaluated the Activator Adjusting Instrument (AAI) against an AAI placebo to determine whether this adjusting instrument is an effective aid for both the chiropractor and the patient. Method : This randomised, placebo controlled clinical trial consisted of 40 patients (20 per group), screened by stringent inclusion criteria assessed through a telephonic and clinical assessment screen. Post receipt of informed consent from the patients, measurements (NRS, Revised Oswestry Disability Questionnaire, algometer) were taken at baseline, prior to consultation three and at the follow consultation. This procedure occurred with four interventions over a two week period. Results: The AAI group showed clinical significance for all clinical measures as compared to the AAI placebo group which attained clinical significance only for the Revised Oswestry Disability Questionnaire. By comparison there was only a statistically significant difference between the groups in terms of the algometer readings (p= 0.037). Conclusion : Therefore, it is evident that the AAI seems to have clinical benefit beyond a placebo. However this is not reflected in the statistical analysis. It is, therefore, suggested that this study be repeated with a larger sample size in order to verify the effect on the statistical analysis outcomes.

Darbo tikslas: Įvertinti specializuotos treniruočių programos poveikį darbingo amžiaus žmonių, jautusių NAD skausmą, taisyklingo judesio atlikimo rodiklių pokyčiams.Uždaviniai: 1. Įvertinti specializuotų ir bendrojo lavinimo treniruočių ciklų poveikį juosmens – dubens srities stabilumui ir judesių valdymui bei liemens raumenų ištvermei. 2. Palyginti specializuotos ir bendro lavinimo treniruočių programų poveikio rezultatus juosmens – dubens srities stabilumui ir judesių valdymui bei liemens raumenų ištvermei. Tyrimui buvo pakviesta 60 asmenų jautusių NAD skausmą. Visiems buvo pateiktas NAD skausmo trukmės ir fizinio aktyvumo vertinimo klausimynai, atliktas pirminis diagnostinis testavimas. Juosmens – dubens stabilumas vertintas statinės atlikties testais, naudojant slėgio matavimo prietaisą su grįžtamuoju ryšiu ,,Stabilizer‘‘. Juosmens – dubens srities judesių valdymas vertintas 6 judesių valdymo testais (,,Movement control tests’’). Liemens raumenų jėgos ištvermė vertinta statinės atlikties testais. Duomenų vertinimui buvo naudojama video kameros medžiagos ekspertinė analizė. Pagal atsakymus į klausimynus ir atlikus pirminį tyrimą, atrinkta 30 asmenų, kurių juosmens - dubens srities judesių valdymas įvertintas kaip nepakankamas. Tiriamųjų amžiaus vidurkis – 21,37 ± 0,2 metai (±SEM, standartinė vidurkio įverčio paklaida). Kūno masės indeksas – 21,7 ± 0,5 kg/m². Atsitiktine tvarka tiriamieji suskirstyti į tiriamąją (n=15) ir kontrolinę (n=15) grupes. Taikytos... [toliau žr. visą tekstą] / The aim of the study: To evaluate the effect of a specialized training program to the changes in indicators of the lumbarpelvic region motion performance of the employble age persons with low back pain. Tasks: 1. Evaluate the effect of the specialized training program cycle and general training program cycle for the lumbar-pelvic region stability, motions control and trunk muscle strength endurance.2. Compare the results between a specialized training program and the results of the general training program to the the lumbar-pelvic stability, motions control and trunk muscle strength endurance. The study involved 60 subjects with low back pain. All were submitted to the low back pain duration and physical activity assessment questionnaires, performed the primary diagnostic testing. Lumbar - pelvic stability was evaluated with static tests carried out by using a pressure measuring device with feedback,'' Stabilizer”. Lumbar - pelvic motion control was evaluated by 6 motion control tests ("Movement control tests'') by Hannu Luomajoki. Back and abdominal muscle endurance rated static tests carried out. For evaluation of the study data was used video materials expert analysis. According to the answers to the questionnaires and the primary investigation, 30 people with inadequate lumbar - pelvic motion control were selected for further research. Average age - 21.37 ± 0.2 years (± SEM, standard error of the mean estimate. Body mass index - 21. 7 ± 0.5 kg / m². Patients were... [to full text]

Darbo tikslas – ištirti slaugytojų darbo aplinką ir su darbu susijusį nugaros skausmą. Darbo uždaviniai. 1. Ištirti slaugytojų darbo aplinką, susijusią su nugaros skausmo rizika; 2. Įvertinti slaugytojų patiriamą, su darbu susijusį, nugaros skausmą; 3. Nustatyti sąsajas tarp slaugytojų darbo aplinkos ir patiriamo nugaros skausmo; Tyrimo metodika. 2013m. rugsėjo – lapkričio mėn. Lietuvos sveikatos mokslų universiteto Kauno klinikose, apklausta 384 slaugytojos, dirbančios 13 konservatyvios medicinos (KMP) ir 16 operacinės medicinos (OMP) profilio skyriuose. Į anketos klausimus atsakė 320 slaugytojų, atsako dažnis – 83,3 proc. / Aim of the research – to assess working environment and work-related back pain in nursing personnel Goals of the research. 1. To assess work environment of nurses associated with the risk of back pain; 2. To evaluate work-related back pain; 3. To identify relationship between working environment and experienced back pain in nursing personnel; Methodology. Research was performed in 13 conservative (CMP) and 16 surgery (SMP) medicine departments of Lithuanian University of Health Sciences Hospital Kauno klinikos in September – November 2014. 384 nurses were involved in the research, 320 of them answered the questionnaire (response rate - 83,3%).

Background: In the clinical examination of patients with low back pain (LBP), musculoskeletal physiotherapists routinely assess lumbar spinal segmental motion by performing physical examination procedures such as observation of active range of motion and palpation of intervertebral motion. The validity of manual assessment of segmental motion, however, has not been adequately investigated. Methods: In this pragmatic, multi-centre, criterion-related validity study, 138 consecutive patients with LBP were recruited and examined by physiotherapists with postgraduate training in musculoskeletal manual therapy. Clinicians examined each patient�s spine for the presence of segmental motion abnormalities, described as lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI), then referred the patients for flexion-extension (FE) radiographs. The physical examination procedures of interest were: 1) assessment of forward-bending (FB) active range of motion (AROM); 2) FB and backward-bending (BB) passive physiological intervertebral motion testing (PPIVMs) in the sagittal plane; and 3) central postero-anterior passive accessory intervertebral motion testing (PAIVMs). Sagittal displacement kinematics of the lumbar spinal segments were measured from the FE radiographs, and served as the criterion standard against which the clinical assessment results were compared. The kinematic parameters measured were sagittal rotation, sagittal translation, ratio of translation per degree of rotation (TRR), instantaneous axis of rotation (IAR), and centre of reaction (CR). Reference ranges for normal motion were calculated from the analysis of FE radiographs of 30 asymptomatic volunteers. The accuracy and validity of the clinical examination procedures were then calculated, and reported as sensitivity, specificity, and likelihood ratios for a positive test (LR+) and a negative test (LR-). Results: In patients with LBP, sagittal rotation LSR and sagittal translation LSR had a prevalence of approximately 5.7% (p <0.0005) in this cohort. Sagittal rotation LSI was not found in statistically significant numbers. Sagittal translation LSI was found at a prevalence of 3.6% (p <0.05). Abnormal TRR (23.3%), IAR (17.7%), and CR (16.5%) were more prevalent findings (all p <0.0005). Observation of the quantity of AROM, during FB, is not valid for the assessment of either total lumbar segmental sagittal rotation, or detection of individual segments with abnormal segmental motion. PPIVMs and PAIVMs are specific, but not sensitive, for the detection of rotation LSI and translation LSI. A positive test (grade 4 on a scale from 0 to 4) with BB PPIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 8.4 and 7.1 respectively (and 95% CIs from around 1.7 to 38). Likelihood ratio statistics for FB PPIVMs were not statistically significant. A positive test (grade 2 on a scale from 0 to 2) with PAIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 2.7 and 2.5 respectively (and 95% CIs from around 1.01 to 7.5). Neither PPIVMs nor PAIVMs were useful for the detection of LSR, or abnormal quality of motion as measured by TRR, CR, and IAR. Conclusions: Abnormal spinal segmental motion is associated with the symptom of LBP, in patients presenting to physiotherapists with a new episode of recurrent or chronic LBP, however prevalence is low due to highly variable lumbar segmental motion among asymptomatic individuals. Manual physical examination has moderate validity, but limited utility on its own, for the detection of translation LSI. Further research should investigate the utility of other clinical examination findings for the detection of lumbar segmental mobility disorders.

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.