Title: Effect comparison of educational-movement therapy "stabilization function"of a trunk and traditional rehabilitation therapeutic approach for patients with nonspecific low back pain. Nonspecific low back pain is a main cause of disability and the principal cause for injury-related lost work-days. The various therapies for nonspecific low back pain have been elaborated in many studies. The recommended therapeutic guideline for primary care of patients with nonspecific low back pain is early mobilization combined with a specific rehabilitation therapeutic approach. One such specific rehabilitation therapeutic approach is "trunk stabilization" therapy. The objective of this dissertation is to compare a therapeutic approach involving "stabilization exercises" with the traditional clinical approach that has been clinically proven to be most efficacious for patients with acute nonspecific low back pain. This study compares the effects of the prescribed therapies on 24 patients with non- specific acute low back pain. The test subjects (men and women with an average age 41.2 years) were allocated into two simple randomized subgroups. The test subjects received 2 outpatient therapy sessions per week for 4 weeks. Pre-test and post-test spine shape and range of motion examination were determined using...

No description available.

No description available.

Bakgrund: Smärta i ländryggen är ett vanligt förekommande problem i samhället. Diagnoserna Spondylolys och Spondylolisthes är tillstånd som kan generera smärta och nedsatt funktion i ryggen hos de som drabbas. Det saknas idag tydliga riktlinjer vad gäller fysioterapeutiska behandlingsåtgärder för denna patientgrupp. Syfte: Var att kartlägga de aktuella konservativa behandlingsmetoder inom det fysioterapeutiska fältet som idag används för att rehabilitera patienter med spondylos och spondylolisthes. Metod: En systematisk litteraturöversikt med randomiserade kontrollerade studier och fallstudier. Sökningar har genomförts i databaserna CINAHL och PUBMED. Resultat: Av totalt 9 studier var 5 stycken randomiserade kontrollerande studier och resterande 4 studier var fallstudier. Totalt antal deltagare var 2071. Diagnosen spondylolys var enbart representerat hos 1 av artiklarna och diagnosen spondylolisthes var representerat i 8 av artiklarna. Behandlingsmetoder för Spondylolys bestod av vila från aktivitet i 2–3 månader, behandling med korsett och individanpassad fysioterapi. Behandlingsalternativen för spondylolisthes var individanpassad fysioterapi i form av träning kombinerat med en kognitiv behandlingsstrategi. Styrketräning för ryggen och specifika stabilitetsövningar samt kontrollövningar för bålen. Träning i kombination med mobilisering av ryggen. Individanpassad fysioterapi bestående av hemövningar, råd och utbildning kring aktivitet samt receptfria läkemedel. Stabilitetsövningar för ländryggen i kombination med värmebehandling och stretching. Konklusion: Det finns en rad olika typer av fysioterapeutiska interventioner som samtliga beskriver en god effekt på de patienter som ingår i de inkluderade studierna men det går inte att dra några slutsatser kring vilken intervention som är mest effektiv i denna systematiska litteraturöversikt då för få artiklar inkluderats som undersöker och jämför samma typ av intervention / Background: Low back pain is a common problem in society. The diagnoses Spondylolysis and Spondylolisthesis are conditions that generate pain and impaired function in the back. There are currently no clear guidelines regarding physiotherapeutic treatment measures for this group. Aim: To map the current conservative treatment methods in the field of physiotherapy that are currently used to rehabilitate patients with spondylosis and spondylolisthesis. Method: A systematic literature review of randomized controlled trials and case studies. Searches have been performed in the databases CINAHL and PUBMED. Results Of a total of 9 studies, 5 were randomized control studies and the remaining 4 studies were case studies. The total number of participants was 2071. Diagnosing spondylolysis was only represented in 1 of the articles and diagnosing spondylolisthesis was represented in 8 of the articles. Treatment methods for Spondylolysis consisted of rest from activity for 2-3 months, handling with a corset and individually tailored physiotherapy. The treatment options for spondylolisthes were individualized physiotherapy in the form of exercise combined with a cognitive treatment strategy. Strength training for the back and specific stability exercises as well as control exercises for the torso. Training in combination with mobilization of the back. Individualized physiotherapy consisting of home exercises, advice and training on activity as well as over-the-counter medicines. Stability exercises for the lumbar spine in combination with heat treatment and stretching. Conclusion: There are a number of different types of physiotherapeutic interventions, all of them can describe a good effect on the patients, but it is not possible to draw any conclusions about which intervention is most effective in this systematic literature review, because the articles that are included donot compare the same type of intervention.

Aim Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns. - Subject and methods German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected. - Results In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/ knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level. - Conclusion This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.

Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide and is directly associated with "physical" risk factors prevalent in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a promising ergonomic intervention to mitigate LBP risk, by reducing muscular exertion and spine loading. The purpose of this work was to help better understand both the "intended" and "unintended" consequences of BSE use on physical risk factors for LBP, as an essential prerequisite for the safe and effective implementation of this technology in actual workplaces. The first study assessed the effects of using two BSEs on objective and subjective responses during repetitive lifting involving symmetric and asymmetric postures. Wearing both BSEs significantly reduced peak levels of trunk extensor muscle activity and reduced energy expenditure. Such reductions, though, were more pronounced in the symmetric conditions and differed between the two BSEs tested. The second study quantified the assistive torque profiles of two passive BSEs using a computerized dynamometer, with both human subjects and a mannequin. Clear differences in torque magnitudes were evident between the BSEs, though both generated more assistive torques during flexion than extension. The third study estimated the effects of BSE use on lumbosacral compressive and shear forces during repetitive lifting using an optimization-based model. Using both BSEs reduced peak compression and anteroposterior shear forces, but these effects differed between tasks and BSE designs. Reductions in composite measures of trunk muscle activity did not correspond consistently with changes in spine forces when using a BSE. The fourth study quantified the effects of two passive BSEs on trunk stability and movement coordination during repetitive lifting. Some adverse effects on stability were evident for pelvis and thorax movements and coupling of these body segments, suggesting that caution is needed in selecting a BSE for a given MMH task. Overall, we found that the efficacy of BSEs is design- and task-specific. Important safety features of the exoskeletons were also identified, providing insights on their performance boundaries. Overall, the BSEs tested were more effective and safer in tasks closer to the mid-sagittal plane and with moderate degrees of trunk flexion. / Doctor of Philosophy / Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide, and the risk of LBP is related to "physical" risk factors common in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a new ergonomic intervention that may reduce the risk of occupational LBP, by reducing muscular efforts and loads on the spine. For the safe use of BSEs, though, it is critical to better understand both the "intended" and "unintended" consequences of this emerging technology. In this dissertation, such consequences of BSE use were evaluated in the context of repetitive lifting tasks. The first study assessed the efficacy of two BSEs in terms of physical demands during repetitive lifting tasks involving a range of torso bending and twisting. Wearing both BSEs reduced the physical demands on back muscles and decreased energy consumption. Larger reductions, though, were observed in forward bending and such reductions differed between the two BSEs tested. The second study measured the amount of support provided by two BSEs using a new measurement method, which was examined for both human subjects and a mannequin. Clear differences in the BSE support were evident between the BSEs, and both devices generated more support during torso forward bending than returning upright. The third study estimated the effects of BSE use on low back loadings during repetitive lifting using a computational model. Using both BSEs reduced loads on the low back region, though such reductions were task-specific and depended on the BSE design. The fourth study quantified the effects of the BSE use on torso stability and movement patterns during repetitive lifting. Some adverse effects on stability were evident for lower and upper torso, suggesting that caution is needed in selecting a BSE for a given MMH task. Findings from this work show the potential benefits of BSEs for use in MMH tasks, yet such benefits can depend on the BSE design and the MMH task they are used for. Further, BSE use can lead to adverse effects, especially with tasks involving extreme working postures.

Work-related musculoskeletal disorders (WMSDs) due to overexertion and consequently the low back pain (LBP) are one of the most prevalent sources of nonfatal occupational injuries and illnesses in all over the world. In the past several years, the industrial exoskeletons especially the passive ones have been proposed as alternative intervention and assistive devices, which are capable of reducing the risk of WMSDs and LBP. However, more research is warranted to validate the applicability of these exoskeletons. In addition, because the majority of previous studies have been limited to specific lifting tasks using only one type of lift assistive exoskeleton, more research is needed to examine the effect of alteration of different lift-assistive exoskeletons on reducing the activity of back muscles and metabolic reduction. The main objective of this dissertation is to render an overview of three studies that attempt to improve the literature by providing comprehensive biomechanical evaluations and metabolic assessments of three passive lift-assistive exoskeletons (VT-Lowe's Exoskeleton (developed in ARLab at VT), Laevo and SuitX). This dissertation has been composed of three related studies. The first study aimed to investigate and examine the capability of a novel lift assistive exoskeleton, VT-Lowe's exoskeleton, in reducing the peak and mean activity of back and leg muscles. Findings revealed that the exoskeleton significantly decreased the peak and mean activity of back muscles (IL(iliocostalis lumborum) and LT(longissimus thoracis)) by 31.5% and 29.3% respectively for symmetric lifts, and by 28.2% and 29.5% respectively for asymmetric lifts. Furthermore, the peak and mean EMG of leg muscles were significantly reduced by 19.1% and 14.1% during symmetric lifts, and 17.4% and 14.6% during asymmetric lifts. Interestingly, the VT-Lowe's exoskeleton showed higher reduction in activity of back and leg muscles compared to other passive lift-assistive exoskeletons available in the literatures. In the second study, the metabolic cost reduction associated with the use of VT-Lowe's exoskeleton during freestyle lifting was theoretically modelled, validated and corresponding metabolic savings were reported. The metabolic cost and the oxygen consumption results supported the hypothesis that the VT-Lowe's exoskeleton could significantly reduce the metabolic demands (~7.9% on average) and oxygen uptake (~8.7% on average) during freestyle lifting. Additionally, we presented a prediction model for the metabolic cost of exoskeleton during repetitive freestyle lifting tasks. The prediction models were very accurate as the absolute prediction errors were small for both 0% (< 1.4%) and 20% (< 0.7%) of body weight. In the third study, the biomechanical evaluation, energy expenditure and subjective assessments of two passive back-support exoskeletons (Laevo and SuitX) were examined in the context of repetitive lifting tasks. The experimental lifting tasks in this study were simulated in a laboratory environment for two different levels of lifting symmetry (symmetric vs. asymmetric) and lifting posture (standing vs. kneeling). Results of this study demonstrated that using both exoskeletons during dynamic lifting tasks could significantly lower the peak activity of trunk extensor muscles by ~10-28%. In addition, using both exoskeletons could save the energy expenditure by ~4-13% in all conditions tested by partially offsetting the weight of the torso. Such reductions were, though, task-dependent and differed between the two tested exoskeletons. Overall, the results of all three studies in this dissertation showed the capability of passive lift-assistive exoskeletons in reducing the activity of back and leg muscles and providing metabolic savings during repetitive lifting tasks. / Doctor of Philosophy / Low back pain (LBP) due to overexertion is known as one of the most important sources of nonfatal occupational injuries especially for the workers or manual material handlers who are involved in frequent or repetitive lifting tasks. Every year, many workers are temporarily or permanently disabled due to overuse injuries at workplace. In the past several years, industrial exoskeletons have gained growing interest among biomechanist, roboticist, and other human factor researchers as potential assistive devices to reduce the risk of LBP. In general, the industrial exoskeletons are either “passive or “active”; Active exoskeletons are powered by mechanical/electrical motors and actuators, however, the passive exoskeletons often work using cheaper devices such as gas or metal springs, elastic elements, etc. The exoskeletons discussed in this dissertation are categorized as passive rigid lower-back exoskeletons and they function by storing energy in a spring when the wearer bends and returning the stored energy when the wearer lifts. This dissertation consists of three studies that attempt to provide comprehensive biomechanical evaluations and metabolic assessments of three passive lift-assistive exoskeletons (i.e., VT-Lowe’s Exoskeleton, Laevo and SuitX). The first study examined the efficacy of a novel lift-assistive exoskeleton, VT-Lowe’s exoskeleton, in reducing the peak and mean activity of back and leg muscles. The results of this study demonstrated that the exoskeleton reduced the peak and mean activity of back and leg muscles for symmetric and asymmetric lifting tasks. VT-Lowe’s exoskeleton also showed higher reduction in activity of back muscles compared to other passive lift-assistive exoskeletons available in the literature. In the second study, the metabolic cost reduction with VT-Lowe’s exoskeleton was theoretically modeled and the modeling outcomes were compared to metabolic costs measurements when the exoskeleton was worn. The experimental findings of this study supported the applicability of the exoskeleton by significantly reducing the metabolic cost and oxygen uptake during the freestyle repetitive lifting tasks. Moreover, the prediction metabolic cost model of the exoskeleton showed high accuracy as the absolute prediction errors were within 1.5%. In the third study, the biomechanical evaluation, energy expenditure and subjective assessments of two passive back-support exoskeletons (Laevo and SuitX) were examined in repetitive lifting tasks. The lifting tasks of this study were simulated in a laboratory environment for two different levels of lifting symmetry (symmetric vs. asymmetric) and lifting posture (standing vs. kneeling). Findings of this study showed that both exoskeleton significantly lowered the peak activity of back muscles during the dynamic lifting tasks. Moreover, using both exoskeletons provided metabolic cost savings in all of the studies conditions. Overall, results obtained from the three studies in this dissertation verified the capability of these passive lift- vi assistive exoskeleton in reducing the activity of back and leg muscles and providing the metabolic savings during repetitive lifting tasks.

Bakgrund: Ländryggsmärta är en mycket vanligt förekommande smärtproblematik världen över och har stor påverkan på olika faktorer som exempelvis antalet funktionsjusterade levnadsår och förlorade levnadsår till följd av funktionshinder. Ett verktyg som har potential inom fysioterapin är virtual reality (VR), där metoden har testats  vid behandling av bland annat smärtproblematik, rörelserädsla och funktionsnedsättning. I dagsläget saknas enighet inom forskningen om hur upplägget för behandlingsstudier för kroniska ländryggsbesvär ska designas samt hur VR-tekniken med tillhörande applikationer har tillämpats och med vilken målsättning.  Syfte:  Syftet med denna studie var att redogöra för hur behandlingsstudier med VR för kroniska ländryggsbesvär är designade och strukturerade samt hur VR-applikationerna är tillämpade. Metod: Sökningarna utfördes systematiskt och skedde i databaserna Pubmed, Scopus och CINAHL. Arbetet följer PRISMAs riktlinjer för rapportering av scoping reviews.  Resultat: I denna scoping review inkluderades 18 studier.Resultatet tyder på att VR headset med eller utan kontroller, ihop med olika typer av arm-, ben- eller huvudrörelser var det mest använda i studierna. Huvudsakligen användes applikationer som innehöll olika uppgiftsspecifika aktiviteter samt att efterlikna rörelser av en virtuell avatar och racing- och skjutspel med styrning av bålrörelser. Spelen innehöll även patientutbildning om smärta, smärthantering och psykologiska behandlingsprinciper, Vanligast förekommande var ett behandlingsupplägg på 30 minuter per session, fem gånger i veckan, över en interventionsperiod på fyra veckor, där mätning av smärta och mätningstillfällen av utfallsmått sker vid början och slutet av interventionsperioden. Virtual reality som behandlingsmetod har även påvisat en begränsad mängd negativa sidoeffekter som yrsel och illamående/åksjuka. Konklusion: VR har visat potential att vara ett behandlingshjälpmedel för att kunna bidra till att behandla långvariga ryggbesvär. Mer forskning behövs om design och tillämpning av applikationer och interventioner utifrån önskade behandlingseffekter vid användning av VR för kroniska ländsryggsbesvär.

Résumé : La douleur lombaire (DL) est l’une des conditions musculosquelettiques les plus fréquentes et coûteuses au Canada. La prévalence annuelle de DL aigüe varierait de 19 % à 57 %, et un patient sur quatre souffrirait de récurrence dans la même année. La présente étude vise donc à produire une analyse descriptive de l’épidémiologie de la DL récurrente à l’échelle de la population. Une nouvelle approche méthodologique est proposée afin d’optimiser l’identification de vrais cas incidents de DL récurrente à partir d’une analyse secondaire de données administratives. Puisque 10 % des patients ayant de la DL seraient responsables de 80 % des coûts qui y sont associés, nous avons également déterminé la tendance séculaire des coûts d’interventions médicales des patients récurrents incidents entre 2003 et 2008. En utilisant le fichier des services médicaux rémunérés à l’acte de la Régie de l’assurance maladie du Québec, des cohortes prévalentes ont été construites à partir de 401 264 dossiers de patients ayant consulté au moins trois fois pour de la DL entre 1999 et 2008. Onze ans d’historique médical des 81 329 patients de la cohorte de 2007 ont ensuite été analysés afin d’exclure les patients ayant eu des consultations antérieures de DL. Une valeur prédictive positive et un coefficient de Kappa élevés ont permis d’identifier une clairance optimale pour récupérer les cas véritablement incidents. Les coûts de consultations ont ensuite été calculés pour tous les patients incidents de 2003 à 2007 à partir des manuels de facturation. Nous avons observé une prévalence annuelle de la DL récurrente de 1,64 % en 2000 chez les hommes diminuant à 1,33 % en 2007. Cette baisse a majoritairement eu lieu dans le groupe d’âge des 35-59 ans. Les femmes âgées (> 65 ans) étaient 1,4 fois plus à risque de consulter un médecin de manière récurrente que les hommes du même âge. L’incidence annuelle de la DL en 2007 était de 242 par 100 000 personnes. Les hommes de 18 à 34 ans étaient 1,2 fois plus à risque que les femmes de développer un premier épisode récurrent et les personnes âgées 1,9 fois plus à risque que les jeunes. L’incidence annuelle a diminué de 12 % entre 2003 et 2007 pendant que les coûts totaux augmentaient de 1,4 %. La médiane des coûts était la plus élevée chez les femmes âgées et tendait à augmenter dans le temps. Ces analyses secondaires suggèrent de s’intéresser particulièrement à la DL chez les personnes très âgées, et de déterminer si la baisse de fréquence de consultations récurrentes observée dans le temps est liée à une meilleure gestion de la DL ou à un problème d’accessibilité. Les coûts devraient faire l’objet d’un suivi continu pour limiter les hausses. // Abstract : Low back pain (LBP) is one of the most frequent and costly musculoskeletal health conditions in Canada. Annual prevalence was found to vary between 19 % and 57 % and likely one out of four patients experience a LBP recurrence within one year. The body of knowledge on the prevalence of recurrent LBP is still limited. This study sought to present a descriptive analysis on the epidemiology of recurrent LBP in a medical population. A new methodology is also proposed to identify true cases of incident recurrent LBP. Since 10 % of LBP patients have been reported to generate 80 % of the costs, we will sought to determine the secular trend of medical costs for the incident cohorts of 2003 to 2008. Using the Canadian province of Quebec medical administrative physicians’ claims database, 401 264 prevalent claims-based recurrent LBP patients were identified between 1999 to 2008 for having consulted at least three times for LBP in a period of 365 days. The medical history of 81 329 prevalent patients in 2007 was screened for a retrospective period of 11 years. High positive predictive values and Kappa statistics were used to determine the optimal clearance period for capturing true incidence cases among patients with no prior encounters for LBP. Physicians’ claims manuals were then used to apply a price for every intervention provided to LBP incident patients in their index year and follow-up years. We observed a decrease from 1.64 % to 1.33 % in the LBP annual prevalence between 2000 and 2007 for men. This decrease was mostly observed between 35 and 59 years of age. Older women (≥ 65 years) were 1.4 times more at risk to consult a physician for LBP in a recurrent manner than older men. The annual incidence in 2007 of adult claims-based recurrent LBP was 242 per 100 000 persons. Males of 18 to 34 years of age were found 1.2 times more at risk than their counterparts. Altogether, elderlies were 1.9 times more at risk than young adults to consult in a recurrent manner for LBP. The annual incidence decreased by 12 % between 2003 and 2007, while the direct costs increase by 1.4 %. The median cost for consultations was highest for elder women and increasing in time. These secondary analyses emphasize the importance to keep the watch on the elders in regards to LBP, and to determine if the timely decrease in morbidity is related to improvements in LBP management or to a medical accessibility issue. Also, costs will need to be surveyed on a regular basis to limit the impact of future increases.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Background: Low back pain (LBP) is the most prevalent musculoskeletal condition experienced by human beings and the most common cause of disability in developed nations. Psychosocial factors, involving aspects of social and psychological behaviour, have previously been documented as potential risk factors in the development of adult LBP. However, more research is required to fully understand the role of psychosocial risk factors on the prevalence of LBP amongst adolescents. Objective: To determine the prevalence of LBP and to identify selected psychosocial risk factors associated with LBP amongst Grade 12 learners in the Greater Durban area. Methods: A population-based study was conducted amongst a stratified random sample of 20 public secondary schools in all three educational districts in the Greater Durban area. Data was collected by means of a structured questionnaire administered to the sample population consisting of Grade 12 learners. Using an exploratory research design, the individuals reported on demographics as well as prevalence, severity, frequency and chronicity of LBP. In addition, data was obtained regarding various psychosocial risk factors including depression, exam stress and anxiety, socio-economic status, family history of LBP, smoking, alcohol and drug abuse amongst the respondents. Results: The prevalence of LBP was 57.42% with a median frequency of 8 times a month. About a third (33.9%) of the respondents experienced difficulty bending whilst 35% reported that their LBP spread down to the legs below their knees. The daily activity most affected by LBP was having a good night‟s sleep (50.6%), followed closely by playing sports (47.4%) and concentrating in class (46.6%). The majority of the respondents that suffered from LBP had taken pain relief medication (47.1%) whilst only 21% of the respondents had missed school because of LBP. With regards to the psychosocial risk factors under investigation, three of the risk factors did not show any association to LBP. They included socio-economic status, smoking and recreational drug use. In contrast, five psychosocial risk factors showed an 6 association to LBP. They included alcohol abuse, family history, exam stress, anxiety and depression. Finally, after adjusting for all other risk factors for adolescent LBP, depression and high exam stress showed the strongest correlation with the occurrence of LBP amongst Grade 12 learners in the Greater Durban area. Conclusion: LBP amongst adolescents is a common problem that increases with age, representing a risk for LBP in adulthood. The researcher is of the opinion, that this illustrates the need for further investigations with more profound studies on the risk factors so that more light can be shed on how to manage this ever-growing problem.