Magister Scientiae (Physiotherapy) - MSc(Physio) / Lower back pain (LBP) is one of the most common work-related health problems in economically developed countries and the most prevailing musculoskeletal condition that causes disability in the developing nations. School teachers are susceptible to LBP due to the nature of their daily work routine which is physically demanding and include common activities such as long hours of sitting, standing and bending that have been identified as risk factors for LBP. The aim of the study was to determine the role of work-related activities in the prevalence of LBP amongst primary school teachers in the Dar-es-Salaam region of Tanzania. To achieve this goal, the study sought to meet the following three objectives: to determine the prevalence of LBP among primary school teachers; to determine the work-related physical activities contributing to LBP among primary school teachers, and to determine and explore the application of kinetic handling principles in their daily work environment. The study was conducted in eighty randomly selected primary schools from the Temeke, Ilala and Kinondoni districts. A sequential explanatory mixed method approach was utilised. A cross-sectional descriptive design was employed. A self-administered questionnaire consisting of three sections (socio-demographic information; the Nordic Back Pain Questionnaire and the Oswestry Lower back pain Questionnaire) was completed by two hundred and eighty six primary school teachers with a mean age of 41.2 years (SD=9.9), 78.7% female and 21.3% male. Thirty primary school teachers participated in the participant observation of the application of kinetic handling principles in their daily work environment and focus group discussions. Results of the study found that 17.1% of the teachers had LBP during the past week while 82.9% experienced LBP during the past year. In addition, 30.8% of the teachers had referred pain, mostly to the thigh area (43.9%). Less than fifty percent (43.5%) of the participants had severe pain in sitting (76 – 100mm on the VAS scale) while 26.9% was not able to sit for more than an hour while teaching due to LBP. A significant relationship was found for severe functional disability and gender (p=0.032). The study demonstrated poor application of kinetic handling principles at work. Factors impeding teachers’ efforts to implement best practices and back care techniques in their daily teaching activities were work environment (poor facilities and equipment; heavy workload and staff shortage) and uncertainty about desired practice. In order to address the higher prevalence of lower back pain the study recommended, inter alia, improvement of the work environment for teachers by providing proper office furniture, re-assessment of education standards such as students /class ratio, students/desk ratio and number of teachers for schools and lastly, the implementation of health education and health promotion strategies to prevent LBP amongst primary school teachers.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Lack of adherence to the correct working conditions exposes workers to ergonomics-related hazards and eventually work-related musculoskeletal disorders (WRMDs) which are estimated at 160 million per year globally. Literature shows that with modernization by use of computers, administrators are exposed to prolonged sitting and long working hours which predisposes them to ergonomic hazards. Low back pain and neck pain are the leading work-related musculoskeletal disorders with a lifetime prevalence of 70 - 80% and 50 - 60% respectively.Both low back pain and neck pain have a multifactorial aetiology that includes work-related and individual related factors. Lack of reporting of work-related injuries has led to paucity of statistical literature with regards to work-related low back pain and neck pain, especially in the developing countries. The aim of this study was to determine the prevalence of ergonomics related low back pain and neck pain, and describe the effect of a knowledge-based ergonomic intervention among administrators in Aga Khan University Hospital, Nairobi (AKUH, N). A mixed method design was used in this study using a survey and two focus group discussions(FGD). A self-administered questionnaire that is in four sections was administered to 208 participants. The questionnaire sought the prevalence of musculoskeletal disorders, the knowledge of participants with regards to low back pain and neck pain as well as the work-related and individual risk factors related to the same. The dissemination of the study results involved a one hour knowledge-based ergonomic session given to all interested participants, based on the information from the survey. Two FGD with purposive selection of eight participants were held to explore their experience on the value of the information provided.The statistical package for social sciences (SPSS) version 20 was used to capture and analyze the quantitative data. Descriptive statistics was used to summarize the study findings in the form of means, frequencies, standard deviations and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<0.05). For the qualitative data, the tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes were generated. Thematic content analysis was used to generate the themes. The aim of the study, confidentiality and the participants‘ freedom to withdraw from the study were explained. Informed consent was also obtained before the survey and FGD and referral was made where necessary. The findings of the current study revealed that the study participants were knowledgeable about ergonomics-related low back pain and neck pain however this knowledge was not directly translated into behaviour. Low back pain (LBP) had the highest twelve month prevalence at 75.5% followed by neck pain at 67.8%, and LBP showed significant associations at p< 0.05 with some work-related and individual risk factors. The results of the FGDs showed that most participants had positive behavioural and attitudinal change post the knowledge-based ergonomic intervention despite the challenges they met in implementing the behavioural change. These results therefore show the need for continual education about ergonomics to create awareness on the predisposing factors to work-related LBP and neck pain, hence promoting a healthier quality of life amongst employees through adherence to healthy work behavioural practice.

The purpose of the study is to examine the relationship between the location of the initial onset of back pain as revealed by the subject's pain drawing and the site of maximum muscle tension at rest, while jaw-clenching and during a cold stressor, in men and women. Subjects were 30 males and 30 females divided into three groups of 10 males and 10 females each and designated according to back pain history as no back pain (NBP), upper back pain onset (UBP) and lower back pain onset (LBP). Six bipolar, bilateral electromyographic (EMG) recording sites were instrumented on each subject. EMG levels were recorded from the forehead, forearm, upper back, lower back, thighs and ankles under conditions of rest, jaw-clenching and a cold stressor. Seven hypotheses predicted that EMG levels would distinguish groups and gender of the subjects and that interactions would exist between site of pain onset and EMG elevations.

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.

Bakgrund: Manuella behandlingstekniker såsom stretching och ledmobilisering används inom veterinärmedicinsk fysisk rehabilitering av hund. Det råder inte konsensus angående vid vilka indikationer som mobilisering och manipulation kan användas med förväntad positiv effekt eller med vilken dosering. Det saknas också evidens för bland annat effekten av stretching av muskulatur på ledrörlighet och smärta hos hund med ospecificerade smärttillstånd i rörelseapparaten. Syfte: Syftet var att undersöka den akuta effekten av statisk stretching av m.iliopsoas och hamstrings på muskellängd, funktion och smärta hos hund med ospecificerad ländryggssmärta. Metod: Studien genomfördes som en Single-Case Experimental Design (SCED). De tre deltagande hundarna med av veterinär diagnostiserad ospecificerad ländryggssmärta rekryterades via författarens verksamhet. Deltagande hundägare utförde interventionen i form av statisk stretching under tre veckor. Datainsamlingen utfördes medelst mätningar av muskellängd två gånger per vecka under baslinje- och interventionsfas samt att hundägarna fick fylla i enkäten Canine Brief Pain Inventory – S (CBPI – S) en gång per vecka. Resultaten presenterades i diagramform och text.  Resultatsammanfattning: Hos en av tre deltagare uppmättes ökad muskellängd och för två av tre deltagare visade resultaten minskad skattad smärtintensitet och ökad skattad funktion. Slutsats: Statisk stretching som intervention för hundar med ospecificerad ländryggssmärta kan i den aktuella studien inte visa på entydig effekt vad gäller förändring av muskellängd, skattad smärtintensitet och skattad funktion. / Background: Manual therapies such as stretching and joint mobilization are used in veterinary physical rehabilitation of dogs. No consensus exists in which indication mobilization and manipulation can be used with expected positive effect or in what dosage. There is a lack of evidence regarding the effects of stretching of musculature on joint mobility and pain in dogs with unspecified pain conditions in the musculoskeletal system. Objective: The aim of this study was to explore the acute effect of static stretching of m.iliopsoas and hamstrings on muscle length, function and pain in dogs with unspecified lower back pain.  Method: This study was conducted as a Single-Case Experimental Design (SCED). The three participating dogs, veterinary diagnosed with unspecified lower back pain, were recruited through the author’s business. The participating dog owners carried out the intervention consisting of static stretching during three weeks. The data collection was conducted by measuring muscle length twice a week during baseline and intervention phases and the participating dog owners filling in the questionnaire Canine Brief Pain Inventory – S (CBPI –S) once a week. The results were presented in diagrams and text. Results: Increased muscle length was measured in one out of three participants and two out of three participants showed reduced estimated pain intensity and increased estimated function. Conclusion: The current study showed no conclusive results regarding the effect of static stretching on muscle length, estimated pain intensity and estimated function in dogs with unspecified lower back pain.

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.