BACKGROUND:No consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire.METHODS:We reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions - verbs, nouns, response options, terms and phrases describing back pain - were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators.RESULTS:The questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. "Back pain" was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as "complete relief". The use of words to describe midpoints was found to be confusing. The word "expect" held different and shifting meanings for participants. Thus paired items comparing "hope" and "realistically expect" were chosen to evaluate 5 different aspects of treatment expectations (back pain / back dysfunction and global effects / impact of back pain on specific areas of life / sleep, mood, and energy / coping). "Impact of back pain" on various areas of life was found to be a consistently meaningful concept, and more global than "interference".CONCLUSIONS:Cognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained.

This thesis comprises three phases with a combined aim which was to investigate the effect of position on the lumbar intervertebral disc (IVD). The effect of position on the lumbar IVD in asymptomatic subjects and subjects with discogenic low back pain (DLBP) was explored using positional Magnetic Resonance Imaging (pMRI). Convenience samples of 11 asymptomatic and 34 DLBP subjects were recruited to have sagittal and axial pMRI scans performed in sitting (Neutral, Flexed and Extended), standing and lying (Supine and Prone extension) positions. The sagittal plane migration of the nucleus pulposus (NP) of each lumbar IVD in each position was measured from the sagittal and axial pMRI scans. Within and between group inferential analysis was performed using nonparametric tests. Both the asymptomatic and DLBP subjects’ demonstrated that position had statistically significant effects on the sagittal plane NP migration. Both groups demonstrated significantly greater posterior sagittal plane NP migration in Neutral and Flexed sitting positions compared to the other positions. However, between group comparisons identified that the asymptomatic subjects also demonstrated significantly greater posterior sagittal plane NP migration than the DLBP subjects. This pattern was more common in the upper lumbar IVDs (L1/2 and L2/3) between positions and less common in the lower IVDs (L4/5 and L5/S1) between positions. New knowledge regarding the behaviour of the lumbar IVD emerged from this research. The differences detected between the asymptomatic and DLBP subjects suggest that some current theories regarding DLBP may be incorrect. The results also support imaging of DLBP subjects in sitting positions as opposed to current supine positions. Although the limitations of the study reduce generalisation of the results, the implications for clinical practice, imaging and suggestions for further research from this work are important to improve understanding and conservative management of DLBP.

Low Back Pain (LBP) is a condition that most people experience at least once in their lifetime and for which many will seek physiotherapeutic intervention. Recently published and internationally recognised clinical guidelines for the management of LBP recommend the use of spinal manual and manipulative therapy techniques alongside exercise, advice, education and pharmaceutical therapies, particularly in the early stages. Other areas of development in the last decade include classification systems, clinical prediction rules (CPR’s), patient-reported outcome measures (PROMS’s) and minimum clinically important difference (MCID) thresholds. Additionally, sympathetic nervous system (SNS) measures of treatment responses are now recognised as providing quantifiable indicators of peripheral, spinal and central effects of manual therapy interventions although research in the lumbar spine is very limited with none providing data on a patient population. The aims of the study were; to determine the reliability and stability of the Biopac System in recording skin conductance (SC) activity levels and calculate the smallest real difference (SRD) statistic; to generate data on the magnitude of SC response to two commonly utilised treatments for LBP; and to observe the changes in a clinical population receiving guideline-endorsed physiotherapy treatment for the management of acute and sub-acute LBP. Furthermore, clinical data analysis sought to identify correlations of SC measures to PROM’s and evaluate the feasibility of using SC responses as a predictive tool for therapeutic outcome. The ability of the Biopac System to reliably record SNS activity was established by using SC measurements with 12 participants on two occasions, one-week apart. Data was recorded within a natural, non-laboratory setting. Results established that SC measurements could be reliably recorded between data sessions with a measurement variability of; ICC=0.99 (p<0.005) with an SRD value of 0.315 μmho’s (4.633%). In conclusion, any SC change above the SRD could be regarded as an SNS change that is independent of any measurement error or variability thus representing a real change ascribable to the intervention under investigation. The pre-clinical investigation compared the magnitude of SC response (SCR) of two, independently administered, specific MT techniques, applied, after randomisation, to the Lumbar 4/5 segment of 50 asymptomatic healthy volunteers. Treatments included; a rotatory lumbar manipulation technique or a repeated McKenzie extension in lying exercise. Findings revealed that both techniques produced statistically significant changes in SNS activity in the lower limbs (> SRD) with manipulative technique SCR’s (76%) that were twice the size of the McKenzie repeated extension in lying exercise (EIL) technique (35.7%)( p=0.0005). Only the manipulation technique had a lasting effect that was carried into the final rest period (p=0.012) but the SNS response was not a side-specific phenomenon (p= 0.76). The final clinical study recruited 60 acute and sub-acute LBP patients (symptoms of up to 12 weeks duration) who received guideline-recommended physiotherapy treatment within a hospital-based musculoskeletal out-patient physiotherapy department. SCRs were recorded throughout all treatment episodes with standardised, validated PROM’s used for comparison of status at inception, mid-point and at discharge. Functional impairment was determined using the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) with pain intensity evaluated with the Narrative Pain Rating Score (NPRS). A preliminary comparison, between the asymptomatic population and a random selection from the patient population, revealed that patients had treatment SCR’s that were significantly greater (three-fold) than those of the asymptomatic groups (manipulation, p=0.003; EIL exercises p=0.001). Analysis of the patient data indicated that pre-treatment/baseline SC activity levels in the inception data capture point were lower than at discharge (18 µMho’s; p<0.0005) but, conversely, that treatment SC levels were initially high, but diminished in magnitude by discharge (230 to 172 µMho’s; p<0.0005) representing a SCR reduction of 125%. Correlational analyses of change scores of maximum SCR’s to PROM’s, from inception to discharge suggested weak positive correlations of SCR treatment responses to functional disability score improvements (rho 0.278) and pain intensity reductions (rho=0.229) that were significant for function (p=0.033) but not significant for pain (p=0.080). The final analyses indicated that there were trends in the magnitude of response to specific elements of treatment with manipulation having the largest SCR (266%). Further evaluative analysis of SC readings as a predictor, at inception, of functional outcome, at discharge indicated that a critical/cut-off value of 195% may indicate those patients least and most likely to respond positively to MT treatment. Preliminary logistic regression analysis indicated that the 195% SCR value was excellent at identifying poor responders but less successful at identifying good responders, functionally, to treatment. Nonetheless, SCR was a better predictor of outcome than duration of symptoms and patient age. Characteristically, patients achieving the 195% value were most likely to have higher functional disability and pain intensity scores at inception but by discharge had required fewer treatments, had greater overall functional improvement and lower pain intensities than those not achieving this threshold. In conclusion, SC activity levels and SCR’s may be a reliable, stable, alternative and objective measure of LBP patients’ SNS status and changes that occur as a result of symptom abatement throughout a course of physiotherapy treatment. SC readings may (indirectly) reflect the state of dorsal horn (DH) sensitisation and of the central nervous system (CNS) processing system and its facilitatory capacity to activate the descending pain inhibitory system (DPIS). Further research, in patient populations (including chronic LBP patients), is recommended to verify these findings and validate the 195% SCR cut-off point. Definitive RCT’s are indicated to further the understanding of guideline-endorsed physiotherapy treatment (a complex intervention –MRC, 2000) and to determine whether the SNS activity measurements can be used to help classify, predict, and ultimately, direct the care of patients with LBP.

Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise. All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness. There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline. The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention. The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.

Thesis (MScPhysio (Physiotherapy))--Stellenbosch University, 2008. / The prevalence of low back pain (LBP) in United Arab Emirates (UAE) is estimated to be about 57% in males and 64% in females. Low back pain is commonly treated by primary care physicians and physiotherapists in the UAE. are increasingly used for clinical assessment, to demonstrate and reflect on the effectiveness of an intervention. Oswestry Disability Index (ODI) is Self-reported outcome measure that widely used and recommended for LBP. ODI Arabic version was developed and validated in women population. To date no UAE Arabic version of the ODI exists which has been cross-culturally adapted, validated and published in the peer-reviewed literature. . Objective The objectives are, to cross-culturally adapt the Arabic version of the ODI developed in Tunisia to devise a pre-final ODI-UAE Arabic version; to pre-test the pre-final ODI-UAE Arabic version in a target group of patients to devise the final ODI-UAE Arabic version; and to determine the reliability and construct validity of the final ODI-UAE Arabic version. Study design Culture adaptation, reliability and validity testing. Methodology The cross culture adaptation of the ODI Arabic version developed in Tunisia was performed in accordance with the published guidelines. For reliability 108 clients of UAE nationals with LBP were consecutively selected and completed the final ODI-UAE Arabic version, at baseline and 48 hours, and test–retest reliability and internal consistency were calculated. For validity 108 completed the final ODI-UAE Arabic version, VAS, and the Squat test at baseline and 4 weeks follow up; construct validity, items frequency response, response to change and floor and ceiling were evaluated. Results The ODI-UAE (9 questions) had high level of test–retest with ICC of 0.99; the mean at baseline and 48 hours was (0.68); Cronbach's alpha was 0.99. Strong positive correlation with VAS r =>0.70 (p = <0.01), and moderate inverse correlation between ODI and Squat r =>0.65 (p = <0.01).The results of the maximum frequency response were less than 80% for the entire 9 question. The effect size and the SRM of ODI-UAE, VAS and Squat test at baseline and 4 weeks were identical comparable the effect size, were 1.66, 1.85, and 1.59 respectively. ODI-UAE demonstrated absence of floor and ceiling effect; less than 15% of the respondents achieved the lowest or highest possible score respectively (0 -11.5) or (87-100%). Conclusion The ODI-UAE Arabic version is an easy to understand, reliable and valid condition-specific outcome measure for the measurement of the limitation of functional ability cause by LBP in the United Arab Emirates national population.

Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenobosch, 2010. / Background: Low back pain (LBP) has a high prevalence worldwide. LBP is significantly associated with a range of poor socio-demographic circumstances which should be addressed in preventive programs. Despite this there is a dearth of information about the prevalence and associated factors among low-income communities in South Africa. It is speculated that the burden of LBP may be most significant in these underprivileged communities. Objective: The objective of this study was to assess the prevalence of LBP among the lowincome communities in the Cape Town Metropole and to establish associated factors in order to make recommendations for management. Study design: A cross-sectional study was conducted among the visitors of eight community health centres (CHCs) in the Cape Town Metropole. Methodology: A new measurement tool was developed based on existing validated outcome measures and initial testing of the psychometric properties of the questionnaire was conducted. The questionnaire was administered to 489 eligible subjects. Descriptive analysis was used to describe the sample and logistic regression analytical techniques were applied to determine associated factors. Main findings: Lifetime prevalence for LBP was 76.49% (n=358). About 37% (n=133) suffered from chronic LBP. LBP was significantly associated with belonging to the black ethnic group, any co-morbidity, poor perceived general health, and any type of pain medication. Lifting weights > 20 kg and kneeling and squatting were physical factors significantly associated with LBP. Severe psychological distress was significantly associated with acute and chronic LBP. Having a better or same perceived general health compared to a year ago, was protective for LBP. Conclusion: LBP has a high prevalence among the low income communities, visiting the CHCs, in the Cape Town Metropole. Multiple factors were associated with LBP, which imply that a tailormade multidisciplinary program addressing lifestyle issues, self management strategies, medication use, chronic diseases and psychosocial factors may be required for this population to combat LBP.

This paper describes and tests a largely ignored but important preliminary step for comparative effectiveness research: retrospective evidence syntheses to first establish a knowledge base of condition-based medical conditions. By aggregating and organizing what is already known about a treatment or system, gaps in knowledge can be identified and future research designed to meet those gaps.An information synthesis process may also discover that few knowledge gaps in the knowledge base yet exist, the gaps are negligible, and / or treatment effectiveness and study quality is stable across many years, but is simply not clinically important. A consistent finding of low effectiveness is evidence against more research, including exclusion of a treatment from future comparative effectiveness studies. Though proponents of weak treatments or systems may choose to proceed with further research, use of public funds or resources that eventually increase costs to the public are unwarranted.By first establishing a treatment or system knowledge base, at least three comparative effectiveness research decisions are conceivable: (1) treatment or system should be included in future comparative effectiveness trials to establish relative effectiveness for a given condition, (2) has promise but requires more research in a prospective CER trial, or (3) the treatment is less effective than others for a given condition, making future research unnecessary. Thus, a "retroactive comparative effectiveness research method," rCER, is proposed here to identify which treatments are worth including in future prospective trials and which are known to have small to modest effect sizes and are not worth the time and expense of a closer look.The rCER method herein showed that for non-surgical low back pain any treatments did not improve greatly upon the normal and natural pain trajectory for acute low back pain. Therefore, any advantage in pain reduction by any treatment of acute low back pain over back pain's normal course of resolution without care, is quite small, and as such, the incremental cost for the marginal improvement over no treatment becomes quite large. While the quality of non-surgical low back pain studies over the past 34 years has steadily increased, the effect size has not, leading to the conclusion that future research on non-surgical low back pain treatment is unwarranted.

In developing a method of quantifying stability in the lumbar spine Cholewicki and McGill (1996) have also broached the notion of sufficient stability, where too much stiffness (and stability) would hinder motion. Thus people highly skilled at maintaining stability may use different and optimal strategies, where <i>sufficient</i> stability is maintained. The purpose of this work was to explore the contributors to <i>sufficient</i> stability, how they coordinate and relate to injury mechanisms. This work represents a cascade of investigations where. 1) To explore the balance of various sources of stiffness and their effect on the critical load and post-buckling behaviour, simulations were undertaken where the buckled configuration of the spine was predicted and its stability in this new configuration was assessed. 2) The various sources of stiffness contributing to stability in the lumbar spine have been in some cases found to be deficient. The question of how these deficiencies place individuals at risk of instability, if at all, remains unresolved. A challenged breathing task was used to determine if there was a difference in stabilizing potential between healthy individuals and low back pain sufferers. Given that differences in stabilizing potential are apparent, several tasks which included a predetermined motor strategy, such as 3)pressurizing the abdomen and 4) abdominal hollowing vs. muscle bracing, were evaluated to determine if individuals can utilize motor strategies to augment stability. The stabilizing potential of abdominal pressure (IAP) and its interaction with muscle activation was evaluated. Some individuals are more skilled at stabilizing their lumbar spine than others. Some consciously controlled motor strategies are better stabilizers than others. These strategies highlight the relative contributions of various components (posture, passive tissue, muscle activation, and load) in that no single muscle dominates stability and IAP appears to augment stability beyond muscle activation alone. The margin of safety is considerable and depends on the task at hand, but it is possible to speculate on which tissues are at greatest risk of injury.

Aims: The aim of this study was to investigate Core Stability Exercise (CSE) induced changes in trunk sagittal acceleration as a measure of performance in participants following an acute onset of non-specific low back pain (LBP). Methodology: A Lumbar Motion Monitor (LMM) was used to measure trunk sagittal acceleration. The LMM was demonstrated to be reliable [Intra-Class Correlation (ICC) for average sagittal acceleration (0.96, 95% CI 0.90-0.98) and peak sagittal acceleration (0.89, 95% CI 0.75-0.96) with a 95% limit of agreement for the repeated measure of between -100.64 and +59.84 Deg/s2 ]. Pain was measured using the Visual Analogue Scale (VAS) and disability was measured with the Roland Morris Disability Questionnaire (RMDQ). Results: Differences in mean trunk sagittal acceleration between control and experimental groups at time points were assessed using a regression analysis (ratio of geometric means [95%CI]) and demonstrated to be not statistically significant (3 weeks (20%) 1.2 [0.9 to 1.6], p=0.2; 6 weeks (10%) 1.1 [0.8 to 1.5], p=0.7; 3 months (20%) 1.2 [0.8 to 1.9], p=0.9). Similarly, differences in mean pain score (3 weeks (30%) 1.3 [0.8-2.2], p= 0.3); 6 weeks (20%) 1.2 [0.7-2.0], p=0.6; 3 months (0%) 1.0 [0.5-1.9], p=1.0) and difference in mean disability score (6 weeks (0%) 1.0 [0.7-1.5], p= 1.0, 3 months (30%) 1.3 [0.8-1.9], p= 0.3) between groups were also not statistically significant. Conclusions: This work does not infer that CSE are definitively effective in reducing pain, improving subjective disability and improving trunk performance after an onset acute of non-specific LBP. However, there is a suggestion of clinical importance and a possible mechanism by which they may work. Further investigation into this mechanism may provide future effective management strategies for intervention of acute non-specific low back pain with optimistic cost implications for healthcare delivery in general and Physiotherapy in particular.

<p>Uvod: Mikrodiskektomija je jedan od savremenih hirur&scaron;kih metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 mu&scaron;karaca i 104 žene), različitih profesija, prosečne životne dobi 50.20 &plusmn; 10.26 godina (raspon 29&ndash;69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, preme&scaron;teni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvr&scaron;ena prema njihovim biolo&scaron;ko-demografskim, socio-ekonomskim, psiholo&scaron;kim i funkcionalnim obeležjima, uz kori&scaron;ćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Kori&scaron;ćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholo&scaron;kih karakteristika Spilbergerovi testovi za trenutnu i op&scaron;tu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću &Scaron;oberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod mu&scaron;karaca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p&lt;0.01) kod mu&scaron;karaca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lo&scaron;iji kod starijih osoba. Navika pu&scaron;enja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pu&scaron;ača nego kod nepu&scaron;ača (p&lt;0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psiholo&scaron;ki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno če&scaron;će prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pu&scaron;enja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psiholo&scaron;ki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.</p> / <p>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 &plusmn; 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober&#39;s and Thomayer&#39;s tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p&lt;0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p&lt;0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.</p>