A lombalgia, comum em muitas atividades profissionais acomete principalmente indivíduos que trabalham na condução de veículos motorizados. O objetivo deste estudo foi investigar a prevalência da lombalgia em motoristas de caminhão, bem como os fatores de risco relacionados à sua ocorrência. Para isso foi elaborado um questionário que abordou fatores como: idade, prática de atividade física e esportiva, hábitos gerais de saúde e questões relativas ao exercício profissional. Calculou-se também o índice de massa corpórea através da relação entre o peso corporal e o quadrado da estatura. Foram avaliados 489 caminhoneiros do sexo masculino e selecionados 410 para o estudo. Os resultados obtidos foram: a prevalência da lombalgia em 59% dos caminhoneiros; e dentre as variáveis estudadas apenas o número de horas de trabalho mostrou-se estatisticamente significante, sendo que o risco do caminhoneiro ter dor lombar aumenta 7% para cada hora de trabalho. / Low back pain is common in several kinds of professional activities mainly in people who drive a lot in their job. The aim of this study was to evaluate the prevalence of low back pain in truckers and the risk factors related to the occurrence of lumbar pain. For this, a questionnaire was elaborated including such as: age, physical and sports activities, general health habits and aspects related to the job. Besides, the index of corporal mass has been calculated, based on the relation between the truckers weight and his square height. 489 male truckers were evaluated and 410 have been selected for the study. The results showed that 59% of the truckers have suffered from low back pain, and among the different aspects which have been analysed, only the number of working hours has been more significant: for each working hour, the risk of truck driver in having lumbar pain increases 7%.

M. Tech. / This randomised, comparative study was undertaken in order to evaluate whether a menthol-containing gel (Deep Heat® Rub) combined with Chiropractic adjustments on mechanical low back pain, over a three-week period, is more effective than Chiropractic adjustments and aqueous cream only.Thirty participants who conformed to the specified inclusion and exclusion criteria, were accepted to form part of the study. The thirty participants were placed randomly into two groups of fifteen participants each. The Experimental Group received lumbar spine and/or Sacroiliac adjustment(s) over the restricted joint(s) together with the application of Deep Heat® Gel, and the Control Group received lumbar spine and/or Sacroiliac adjustment(s) over the restricted joint(s) together with the application of non-medicated aqueous cream. All participants received a total of six treatments over a three-week period, i.e. two treatments per week. Each participant was requested to come in for a follow-up consultation one day after the last treatment session used for data capturing only. The subjective data was collected by means of the Revised Oswestry Low Back Pain Disability Questionnaire, taken prior to the first, fourth and at the seventh consultations. The objective data, in the form of lumbar range of motion, was obtained by means of a Digital Inclinometer, taken prior to every consultation. Data was statistically analysed by means of the Friedman and Wilcoxon Signed Rank tests for intra-group comparisons and the Mann-Whitney test for inter-group comparisons.The results indicated that the treatment protocols used in the Control and the Experimental Group were equally effective in reducing low back pain and disability as well as increasing the lumbar range of motion. The Control Group did, however, demonstrate statistically significant differences in three out of six ranges of motion, compared to two out of six for the Experimental Group, although no statistically significant differences were found.The results of this study suggest that Chiropractic adjustive therapy (with non-medicated aqueous cream) alone or when administered with Deep Heat® Rub are equally effective in terms of subjective pain perception and objective clinical findings in the treatment of mechanical low back pain. No statistically significant difference could be seen when participants received diversified spinal adjustive therapy and application of aqueous cream, compared to receiving diversified spinal adjustive therapy and application of Deep Heat® Rub.

There is a high prevalence of musculoskeletal symptoms (MSS) among manual material handling (MMH) workers. However, limited investigations have been undertaken among one large group of workers using a particular MMH method called traditional posterior load carriage (PLC). Such load carriage is typically done without the use of an assistive device (e.g., backpack) in developing countries, and involves exposure to known risk factors for MSS such as heavy loads, non-neutral postures, and high levels of repetition. The current work was completed to investigate the characteristics of the PLC task and physical effects on workers, and to evaluate a practical intervention that may help improve the task. The first study investigated, through structured interviews with 108 workers, the types, prevalence, and impacts of MSS. PLC workers incur a relatively high MSS burden, primarily in the lower back, but also in the feet, knees, shoulders, and neck. These MSS were reported to interfere with daily activity, but only few workers sought medical treatment. Workers suggested several task improvements including the use of a belt, hook, or backpack/frame, and changes in the carriage method. The second and third study investigated, in a laboratory setting involving nine healthy males, the effects of load mass and size, and the use of a simple intervention, respectively, on factors related to low back pain risks during PLC. Increasing load mass caused increased torso flexion, lumbosacral flexion moment, abdominal muscle activity, and torso movement stability in the frontal plane. Increasing load size also caused higher torso flexion, peak torso angular velocity and acceleration, and abdominal muscle activity. Complex interactive effects of load mass and size were found on paraspinal muscle activity and slip risk. The intervention, involving a simple frame to support a load, and use with a higher load placement was found to be potentially beneficial as indicated by reduced lumbosacral moment and ratings of perceived discomfort in several anatomical regions compared to the traditional PLC. Outcomes of this research can facilitate future ergonomic guidelines and interventions to improve working conditions and occupational health and safety for PLC workers. / Ph. D.

Low back pain (LBP) is the most prevalent work-related musculoskeletal disorder. Occupational risk factors have been studied for current ergonomic prevention strategies; however, other underlying mechanisms may exist since not all workers performing the same task develop the same severity. Previous research has identified personal and psychosocial risk factors that also contribute to LBP. Research quantifying the interactive effects of the various personal, psychosocial and occupational factors is limited, along with research on the effect of risk factor combinations on LBP severity. The objectives of this study were to: 1) study the various factors that are known to be involved in low back pain and analyze interactions, and 2) develop a model to predict low back pain and validate it. In order to address these objectives, 2 studies were conducted. The first study investigated the effects of various personal, genetic, occupational and psychosocial factors on two subjective LBP severity ratings: Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS), and three physician-based ratings: MRI severity, canal stenosis and nerve impingement. Personal and psychosocial factors, in addition to occupational factors, were found to significantly affect the severity ratings. The second study involved building predictive models of LBP severity for each risk factor category as well as a combined risk factor model. Results showed that the combined risk factor models considering interaction effects both within and across risk factor categories were significantly better in predicting severity ratings than the individual models. However, validation conducted using 5 random samples showed inconsistent accuracies. Results obtained may help to develop a more reliable way to predict and, hence, prevent chronic LBP.

Physical function has been identified as a core outcome to be assessed in low back pain (LBP). However, all recommended physical function measures are Patient-Reported Outcome Measures (PROMs). Performance-Based Measures (PBMs) are important measures that are practical and are prone to fewer biases. Two systematic reviews provided evidence on the psychometric properties of PBMs but were not comprehensive. Therefore, the purpose of this study was to identify PBMs developed for or used to assess physical function in LBP and to review studies evaluating the psychometric properties of these PBMs systematically. The first manuscript of the thesis was the systematic review protocol developed using the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) manual 2018. The protocol was also registered on PROSPERO (CRD42020147968). The protocol also outlined the use of the COMINS Risk of Bias (COSMIN-ROB) checklist 2018; standard priory hypotheses and criterions developed to evaluate the results of each psychometric property; as well as a GRADE criterion (Grading of Recommendations, Assessment, Development and Evaluations) to assess the level of evidence. Two reviewers independently screened, evaluated, and extracted data. The second manuscript was the systematic review written in the format of a journal for future submission. Our database search identified 47 studies assessing 115 PBMs. In general, findings included five different LBP diagnoses (e.g., non-specific LBP) and different LBP durations (e.g., acute, chronic). The level of evidence of each PBM or psychometric property mainly were generated from single studies. A high risk of bias assessed by the COSMIN-ROB checklist was found for most of the included studies. Overall, the included studies' results often did not meet our priory hypotheses for good psychometric properties. Hence, most PBMs' psychometric properties were found to have a low level of evidence. There was not a single PBM that demonstrated a good level of evidence for all properties. In conclusion, significant heterogeneity was found between studies leading to a limited level of evidence. PBMs need to be used with great caution. High-quality studies that investigate PBMs' psychometric properties are needed. / Thesis / Master of Science Rehabilitation Science (MSc) / Low Back Pain (LBP) care costs the Canadian health care system millions of dollars every year. Most clinicians and researchers use self-report questionnaires filled out by their patients to assess physical function. However, performance measures where patients perform tasks while being observed are also recommended to assess physical function. Performance-based measures can be used alone or in combination with self-report measures. To select the most appropriate performance measures, we need to know how good and trustworthy these measures are. Therefore, the purpose of this study was to collect all possible performance measures that were developed or used to assess physical function in LBP patients; then summarized the available evidence on their psychometric properties (reliability, validity and responsiveness). We searched five scientific databases and found 47 studies that evaluated 115 performance measures. Most included studies were of low quality and evaluated different tests or test properties. We found that most measures were not reliable, accurate or were sensitive to change. Therefore, clinicians and researchers need caution when selecting and interpreting results of these performance measures when evaluating physical function in LBP.

Background: Low back pain is very common and has a tremendous economic impact. With the prevalence and incidence of low back pain on the rise, individuals are turning to alternative treatments. Yoga is the most widely used complementary and alternative medicine treatment for low back pain and it is not fully certain how effective this method is for resolving the symptoms. Objectives: The purpose of this manuscript is to systematically review the current literature for randomized controlled trials that assess the outcomes of yoga intervention in individuals with low back pain. Methods: An electronic database search was performed to analyze studies. To be included in the review, the studies were required to be a randomized controlled trial, published in English, present in a peer reviewed journal, identify yoga as the primary treatment focus for low back pain in at least one group, and included participants with at least a 12 week history of low back pain. Results: A search of the databases revealed 177 articles, of which, 8 met the inclusion criteria. Conclusions: Yoga intervention appears to be effective in alleviating symptoms brought on by low back pain. Yoga was either demonstrated to significantly improve quality of life and reduce disability, stress, depression, and medication usage associated with low back pain in 6 of the 8 analyzed trials. More research is necessary to account for the lack of between-group differences in two trials.

Background: Low back pain is a common muskuloskeletal issue. Kinesiophobia constitutes as excessive fear of movement and has been associated with greater levels of pain. Nocebic terms has been found to influence kinesiophobia. Purpose: The purpose of this study was to investigate the participants’ experiences with low back pain and nocebic terms, and if the language use of the healthcare professionals correlated with negative beliefs. Method: A digital survey was sent out to individuals with low back pain who had visited a healthcare professional. The survey included questions from Tampa Scale of Kinesiophobia, and questions about nocebic terms and the understanding of them. Participants were recruited via Luleå University of Technology and Facebook. Results: The study included a total of 51 participants. In the kinesiophobic group, there was 13 participants, and the most occurring terms were injury, disc herniation, and wear and tear. In the non-kinesiophobic group, there was 38 participants, and the most occurring terms were weakness, pinched nerve and bad posture. Conclusion: No strong correlation was found between language use and kinesiophobia, thus challenging the hypothesis that language use has an influence on patients’ beliefs. The most occurring nocebic terms differed between the kinesiophobic group and non-kinesiophobic group.

Background: Low back pain (LBP) is considered the leading cause of inactivity and lost employment time. It can be extremely difficult to treat as most conventional therapies have poor success rates. People with LBP need to be made more aware of the diverse and economical treatments available in order to save on expenses and diminish stress. Patients and healthcare professionals have many choices when deciding on the best plan of care; however, it is often difficult to determine which option is best. Objectives: The purpose of this systematic review was to determine if aerobic exercises play a role in reducing pain in the low back. Methods: A computerized electronic search was performed using CINAHL, Medline, and Cochrane Central Register of Controlled Trials with key words including low back pain or lumbar pain combined with aerobic and exercise. Inclusion criteria consisted of studies that were randomized controlled trials or controlled clinical trials, peer reviewed, published in the English language, identified low back pain as the primary concern, and identified aerobic exercises as one of the treatment options. Results: The initial search of the database revealed a total of 40 studies. Hand searching of the references had also revealed an additional 7. Of those 47 studies, 13 were selected as potentially meeting the inclusion criteria. Ultimately, 10 studies were retained for the final results of the systematic review. Conclusion: The evaluations provided evidence to suggest that aerobic exercise has positive effects on subjects with LBP. Aerobic exercise encourages strength, flexibility, and muscular endurance. This outcome has also shown to promote levels of activity, leaving the subject feeling better both physically and mentally.

Introduction: Low back pain (LBP) is a common, globally occurring, and difficult to treat health issue. In Swedish primary health care, there is an issue with health care providers not using up-to-date practice when dealing with LBP. BetterBack😊 is an evidence-based model of care (MOC) providing guidelines for assessment and treatment of LBP to facilitate working with LBP for caregivers. Purpose: To investigate if patients treated by clinicians educated in the BetterBack😊 MOC in primary care leads to (a) patients having greater improvements in functional impairments and activity limitations according to physiotherapist assessment and (b) are receiving different treatment, compared to controls, compared to usual care. Method: Prospective cluster randomised trial with linear mixed model analysis was used to compare functional impairment and activity limitations based on the Clinical Reasoning and Process Evaluation tool. Chi2-test was used to analyse differences in choice of treatment between groups. Result: Analysis showed statistically significantly greater reduction in level of exercise tolerance and movement related functional impairments (0.25, 95%CI=0.04-0.46, p=0.02) and limitations of dynamic activities of daily living (0.35, 95%CI=0.17-0.69, p=0.04) in the intervention compared to control group. The intervention group was more frequently treated with behavioural medicine interventions and less with manual therapy interventions (18.4% vs. 30.1%, p<0.05) and physical modalities (4.9% vs 10.8%, p<0.05) compared to the control group. Conclusion: The use of the BetterBack😊 MOC can lead to better treatment outcomes, more use of behavioural medicine interventions and less use of manual therapy and physical modalities. / Introduktion: Ländryggssmärta (LBP) är ett vanligt förekommande globalt och svårbehandlat hälsoproblem. I svensk primärvård finns ett problem att vårdgivare inte följer senaste evidens vid hantering av LBP. BättreRygg😊 är ett evidensbaserat vårdprogram med riktlinjer för undersökning och behandling för att underlätta för vårdgivare att möta patienter med LBP. Syfte: Undersöka om patienter som behandlats av kliniker utbildade i BättreRygg😊 i primärvården leder till att (a) patienter, enligt utvärdering av fysioterapeut, har förbättrats mer gällande funktionsnedsättningar och aktivitetsbegränsningar samt (b) behandlas med andra interventioner, jämfört med ordinarie behandling vid tre månaders uppföljning. Metod: Prospektiv klusterrandomiserad studie med mixed model-analysjämförde funktionell och aktivitetsbaserad status genom Clinical Reasoning and Process Evaluation-verktyget. Chi2-test genomfördes för att analyseraskillnader av behandlingsval mellan grupperna. Resultat: Analysen visade att interventionsgruppen hade signifikant mer minskning av aktivitetstolerans och rörelserelaterade funktionsnedsättningar(0,25, 95%CI=0.04-0.46, p=0,02) och relaterade till dynamiska vardagsaktiviteter (0,35, 95%CI=0,17–0,69, p=0,04) jämfört med kontrollgrupp. Interventionsgruppen använde mindre sällan manuell terapi (18,4% vs. 30,1%, p <0,05) samt fysiska modaliteter (4,9% vs 10,8%, p <0.05). Konklusion: BättreRygg😊 kan bidra till bättre behandlingsresultat av LBP, ökat användande av beteendemedicinska åtgärder och minskat användande av manuell terapi och fysiska modaliteter.

Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability.  Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP.  Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting.  At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue).  A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading.  Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established.  In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading.   Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF).  The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.   A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors.  A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks.  A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks.  Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified.  Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue.  Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.   Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks.  The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting.  The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP.  Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design. / Ph. D.