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Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Körperliche Aktivität während der Schwangerschaft wirkt sich positiv auf die Gesundheit von Mutter und Kind aus. Trotzdem werden Schwangere häufig gewarnt, sich aufgrund der abnehmenden Muskelkraft, den nachgiebigeren Bändern und Sehnen sowie der verschlechterten Stabilität beim Sport verletzen zu können. Um Verletzungen während der Schwangerschaft vorbeugen zu können, wird in dieser Arbeit erstmalig der Einfluss von Schwangerschaft auf den Muskel-Sehnen-Komplex der unteren Extremitäten untersucht. Weiterhin werden der Effekt auf das statische Gleichgewicht und der Einsatz eines Schwangerschaftsgurtes als potentielle Präventionsmaßnahme gegen Sturzunfälle überprüft. Zur Untersuchung des Muskel-Sehnen-Komplexes wurde die Morphologie des m. vastus lateralis, die Muskelkraft der Knieextensoren und die Eigenschaften der Patellasehne am Anfang und am Ende der Schwangerschaft sowie ein halbes Jahr nach der Entbindung mittels Ultraschall und Dynamometrie analysiert. Das Gleichgewicht wurde anhand der Grenzen der Stabilität nach anterior und posterior und anhand des Körperschwankens im ruhigen Stand auf einer Kraftmessplatte bei Schwangeren in den unterschiedlichen Schwangerschaftstrimestern und bei Nicht-Schwangeren mit und ohne Schwangerschaftsgurt beurteilt. Diese Arbeit liefert relevante Erkenntnisse, die für die Beurteilung des Verletzungsrisikos von Schwangeren und für die Entwicklung geeigneter präventiver Maßnahmen nützlich sind. Es wurde zum wiederholten Male bestätigt, dass Schwangerschaft zu einer Verschlechterung der posturalen Stabilität führt. Ein Schwangerschaftsgurt stellt jedoch keine geeignete Methode zur Verbesserung der Stabilität dar. Während Muskelmorphologie und Sehnensteifigkeit keinen negativen Einfluss zeigen, könnte die zunehmende Sehnenruhelänge zu einer vergrößerten Gelenkbeweglichkeit beitragen und das Risiko für Verletzungen und Stürze erhöhen. / Physical activity during pregnancy has beneficial effects on maternal and fetal health. However, pregnant women are frequently cautioned when exercising since a loss in muscle strength, an increased compliance of ligaments and tendons as well as impairments in postural stability are assumed to lead to injuries in pregnant women. This thesis investigates for the first time the effect of pregnancy on the muscle-tendon unit of the lower extremities for the prevention of injuries during pregnancy. Furthermore, this thesis analyzes the effect of pregnancy on static postural stability and examines whether a maternity support belt is an appropriate method for fall prevention in pregnant women. To investigate the muscle-tendon unit, the morphology of the vastus lateralis muscle, muscle strength of the knee extensors and the properties of the patellar tendon were analyzed in the early and late stage of pregnancy as well as six months after delivery by means of ultrasound and dynamometry. Balance ability was assessed determining the limits of stability in the anterior and posterior directions and the postural sway during motionless upright standing on a force plate in pregnant women in different trimesters of pregnancy and in non-pregnant women with and without maternity support belt. This thesis provides relevant evidence for the assessment of the risk of injury in pregnant women and the development of appropriate prevention strategies. It confirmed that pregnancy is accompanied by impaired postural stability. However, a maternity support belt is not an appropriate method to improve stability. While muscle morphology and tendon stiffness were not negatively affected during pregnancy, the increase in tendon rest length might contribute to an increased joint mobility that may increase the fall and injury risk.