Prevalence of low back pain after transfemoral amputation related to physical activity and other prosthesis-related parameters

Background:?Although clinical experience indicates that prolonged use of a prosthesis after transfemoral amputation (TFA) is related to a higher incidence of low back pain (LBP), few data are available to substantiate this impression. Therefore, in a TFA population, we investigated the prevalence of LBP and its relationship with years since amputation, as well as the level of daily physical activity and other prosthesis-related parameters.

Method:?Questionnaires were sent to 490 subjects with TFA. Of these, 240 questionnaires could be used for analysis.

Results:?Trauma and tumours were the most frequent reasons for amputation. The majority of the study group was aged under 30 years at the time of surgery, had been using a prosthesis more than 10 years, and had a moderately active life. Serious LBP (i.e. frequent or permanent LBP) was reported in 26.3% of the participants. No relationship was found between LBP and years since amputation or physical activity.

Conclusion:?The data show that the prevalence of LBP in our study group is higher than in the general population, and higher in the female than in the male participants. The initial assumption that there is a higher and increasing length of time since amputation and physical activity level is not confirmed in this study.     

Prevalence of low back pain among physical therapists in Edmonton,Canada

Questionnaires were sent to 462 physical therapists in Edmonton, Canada, to determine the prevalence of work-related low back pain (LBP) and to characterize those who reported pain. Of the 311 (67·3%) valid questionnaires returned, 49·2% reported back pain due to work. The occurrence rates of work-related LBP among physical therapists in Edmonton was higher than that of the general population reported in Canada (27%), Great Britain (27%), and the United States (26·29%). There was no significant difference (p ≤ 005) between those with and without work-related LBP. The initial onset of work-related LBP frequently occurred within the first 5 years of practice as a physical therapist, and before the age of 30. Hospitals and private practices were the most prevalent work settings in which injury occurred. Patient handling, bending, stooping, lifting, carrying, pushing, and pulling were the commonly described activities causing precipitation of injury. The severity of back discomfort had been sufficient to require 13·7% of therapists to stop their work. Despite LBP, 35·3% of the pain sufferers continued to work. Over half (55·4%) of the respondents with current work-related LBP demonstrated little or no disability.     

Physical and functional measures related to low back pain in individuals with lower-limb amputation: an exploratory pilot study

For this study, we compared the physical impairments and functional deficits of individuals with lower-limb amputation (LLA) for those with and without low back pain (LBP). Nineteen participants with LLA were placed into two groups based on visual analog scores of LBP. We assessed functional limitations, iliopsoas length, hamstring length, abdominal strength, back extensor strength, and back extensor endurance. Data analysis included correlations and t-tests. We found significant correlations between pain score and functional limitations, iliopsoas length, and back extensor endurance. We also detected significant differences in functional limitations, iliopsoas length, back extensor strength, and back extensor endurance between those with and without LBP. We saw significant differences in back extensor strength and back extensor endurance between those with transtibial and transfemoral amputations. Differences exist in physical measures of individuals with LLA with and without LBP. Clinicians should consider these impairments in individuals with amputation who experience LBP. Because of the participants' characteristics, these findings may be applicable to veterans with LLA.     

Effects of Kinesio Taping on peak torque and muscle activity in women with low back pain presenting fears and beliefs related to physical activity

BackgroundKT is an elastic taping that has been widely used as an adjunct to conventional physiotherapy. The purpose of this study was to evaluate the effects of Kinesio Taping on peak torque, muscle fatigue index and muscle activity of erector spinae in women with low back pain presenting fears and beliefs related to physical activity.MethodsThis is a pilot controlled clinical trial. The subjects were divided into two groups according to the Fear Beliefs Avoidance Questionnaire (FABQ): Group A (Patients with no fears and/or beliefs related to physical activity) and Group B (Patients with fears and/or beliefs related to physical activity). The Kinesio Taping was applied in "I" in order to facilitate erector spinae. An isokinetic dynamometer and a surface electromyography were used to evaluate the outcomes. The evaluations were performed without and with the KT.ResultsSample of 16 women equally divided into two groups with similar characteristics regarding age, weight, height, body mass index, functional capacity and pain levels in the evaluations without and with Kinesio Taping. There were within-groups and between-groups differences in the peak torque (p ≤ .05), with better results in the Group B. No differences were found on muscle fatigue index and muscle activity in both groups (p > .05).ConclusionIt was concluded that Kinesio Taping had immediate effects in the peak torque of the erector spinae of women with nonspecific chronic low back pain presenting fears and beliefs related to physical activity. It is suggested that such results occurred by placebo effect.NCTRBR-5xh3ch     

Prevalence of low back pain among Irish radiographers

BACKGROUNDAccording to the literature, low back pain (LBP) is one of the top ten diseases and injuries contributing to disability-adjusted life years worldwide. To the best of the authors’ knowledge there are no studies investigating the prevalence of LBP among radiographers working in Ireland or have compared prevalence rates with the national population or other cohorts of radiographers or healthcare professionals. This study aimed to determine the prevalence of LBP among radiographers working or who have previously worked in Ireland and to identify any causative factors.METHODSA cross-sectional study in the form of an online questionnaire was developed. Participation was advertised online via social media platforms. Inclusion criteria included qualified radiographers working in Ireland or who had recently worked in Ireland. Section A of the questionnaire focussed on acquiring demographic data. Section B comprised eight questions relating to LBP, including current and previous experiences, causative factors and consequences.Further details on any episodes of LBP in the previous year, whether work and leisure activities had been affected, whether any extracurricular activities caused LBP, and whether a participant sought professional advice. Section C (six questions) used a 5-point ordinal scale to collect information on the frequency of specific tasks performed by radiographers in their daily roles. Section D involved exploratory questions, including whether LBP has forced a career change if they knew anyone who has changed their career as a result of LBP, reaction to the amount of manual handling required for radiographers, whether they thought manual handling training was sufficient, thoughts on the availability of assistive transfer devices, reasons for not following correct patient transfer guidelines, and finally whether they were concerned about LBP affecting their future.RESULTS151 radiographers participated in this study, and the point prevalence rate of LBP was 50%, with 12 months prevalence rate of 75%. Regarding activity levels, 25% (n=37) reported reduced work activity, and a further 43%(n=65) reduced leisure activities due to LBP. 37% (n=56) have sought medical advice from a doctor, physiotherapist, or other HCP concerning their LBP in the last year. 68% (n=104) of respondents who have LBP confirmed it was not a result of any extracurricular activities.CONCLUSIONThe prevalence of LBP among radiographers in Ireland was high and 4.7 times higher than the period prevalence rate recorded in the general population. LBP rates were similar to radiographers working in other jurisdictions. Data from this study may help manage LBP and monitor any interventions' effectiveness.     

Prevalence of low back pain in the population

Studies on selected populations lead to biased estimates of the prevalence of back pain and associated factors. In order to obtain a valid picture of the prevalence of back pain this review article focuses on epidemiological studies in the general population. These studies can be divided into general health surveys and surveys with specific reference to back pain. General health surveys including questions on the prevalence of back pain have the greatest methodological differences because of different aims. Due to these different aims, different target populations and different methods these studies depict point prevalences between 0.8% and 41% and 1-year prevalences between 15% and 56%. These general health surveys are contrasted with epidemiological studies especially designed to evaluate the prevalence of back pain. In these studies the point prevalence ranges between 14% and 42% and the lifetime period prevalence between 51% and 84%. Depending on the study reviewed the highest prevalence is found at age 50 to 64. This prevalence pattern may be explained by several effects that are discussed in this article. Severe forms of back pain increase even in the higher age groups, especially in women. Beside this effect the reviewed articles show either no difference between men and women or only a slightly higher prevalence in women. The problems faced by epidemiological studies on back pain, resulting from different definitions of "the back", severity, chronicity and different methodology, are discussed in detail.     

A clinical contrast: physical therapists with low back pain treating patients with low back pain

Abstract

Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.     

Working with pain clinics and other consultants concerning low back pain

Although primary care physicians are able to manage low back pain, often it is necessary to refer to other specialists. This article reviews how primary care physicians can refer to pain clinics and work with consultants.     

体力活动对慢性非特异性腰痛患者疼痛和姿势控制的影响

摘要 目的：探索体力活动对慢性非特异性腰痛（chronic non-specific low back pain, CNSLBP）患者的疼痛和姿势控制能力的影响。 方法：根据是否符合世界卫生组织建议的体力活动标准,受试者被分为体力活动达标组和体力活动不达标组,每组分别纳入31例CNSLBP患者。采集患者的基本信息,评估患者的腰痛程度和姿势控制能力（包括腰部屈伸活动度、闭眼单腿站和下肢Y平衡测试）。 结果：与缺乏体力活动的CNSLBP患者相比,体力活动达标的患者疼痛症状较轻,姿势控制功能更佳,包括过去一周最严重疼痛评分（P<0.01）、过去一周平均疼痛评分（P<0.01）、腰部屈伸活动范围（P<0.05）、静态平衡（P<0.05）和大部分的Y平衡测试。 结论：常参加体力活动的CNSLBP患者疼痛强度较缺乏体力活动者轻,姿势控制功能也优于缺乏体力活动者。     

Evaluation of the physical management of low back pain

ERICA (European Research Into Consumer Affairs) is engaged in research into problems faced, notably by the underprivileged, in the countries of the European Economic Community (EEC). An early project investigated dial-a-ride systems for the transport of disabled people in six EEC countries. The object was to discover their successes and failures and pass on the information. In spite of national differences, many of the problems were the same. So, since the aim of all ERICA's research is action, the first step has been to publish guidelines for any voluntary organization or local authority aiming to set up a dial-a-ride.     

Which physical activities and sports can be recommended to chronic low back pain patients after rehabilitation?

BackgroundPhysical exercise is widely prescribed in rehabilitation programmes for low back pain (LBP). The LBP patient often asks whether this physical activity should be maintained and, in some cases, whether he/she should resume or take up a sport.PurposeTo answer these two questions by performing a review of literature on the efficacy and safety of post-rehabilitation physical activities and sport in LBP.MethodA systematic search of computerized databases from 1990 to 2011 was performed using grade 1 to 4 studies articles in English or French.ResultsOf the 2583 initially identified articles, 121 articles were analysed. Globally, physical activities like swimming, walking and cycling, practiced at moderate-intensity help to maintain fitness and control pain. Inconsistent results were found for avoiding recommendations according to the nature of PA. Sport activities, except ballgames, can be easily resume or take up as tennis, horse riding, martial arts, gymnastics, golf and running which can be performed at a lower intensity or lower competitive level.Discussion and conclusionModerate but regular physical activity helps to improve fitness and does not increase the risk of acute pain in chronic LBP patients. The resumption of a sport may require a number of adaptations; dialogue between the therapist and the sports trainer is therefore recommended.     

Decline in physical activity, disability and pain-related fear in sub-acute low back pain.

AIM OF INVESTIGATION: To evaluate whether a perceived decline in the level of physical activity after the onset of pain (PAD) is more appropriate in the explanation of disability as compared to the actual level of physical activity (PAL) in patients with sub-acute back pain. METHODS: Patients with 4-7 weeks of non-specific low back pain (LBP) participated in this study. Their habitual physical activity level before the back pain started (H-PAL), their actual level of physical activity (PAL) and their perceived decline in the level of physical activity after the onset of pain (PAD) were assessed. The association between these physical activity related variables and perceived disability (QBPDS), fear of movement/(re)injury (TSK), pain catastrophizing (PCS) and pain intensity (VAS) was examined. The role of PAD as a mediator in the association between fear of movement/(re)injury and disability was examined by three linear regression analyses. RESULTS: 123 patients (66 male and 57 female) with a mean age of 44.1 years (SD=10.3) participated in this study. PAD was significantly correlated with disability, fear of movement/(re)injury, pain catastrophizing and pain intensity. PAD and PAL appeared more important in the explanation of disability in the subgroup of patients who were physically active before their back pain started. Generally, PAD indeed mediated the association between fear of movement/(re)injury and disability. CONCLUSIONS: The perceived decline in physical activity, rather than the current physical activity itself is important in the evaluation of the impact of activity related changes on disability in low back pain.     

护理人员腰痛相关因素调查

目的 探讨护理人员腰痛及疼痛程度的影响因素.方法 对广州市一家三级甲等医院502名护理人员进行问卷调查.结果 调查对象中过去1年里出现腰痛者307例(61.16％),最近1周有腰痛症状者173例(34.46％).最近1周存在腰痛的调查对象中轻度疼痛者占23.70％,中度及重度疼痛者分别为61.85％和14.45％.已婚者较未婚者的患病率高;所在的工作科别不同,患病率及疼痛程度也不同;工龄越长,疼痛程度越重.结论 护理人员腰痛的患病率与婚姻状况及工作科别有关;疼痛程度与工作科别及工龄有关.     

Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis

It is often assumed that patients with pain-related disability due to low back pain (LBP) will have reduced physical activity levels, but recent studies have provided results that challenge this assumption. The aim of our systematic review was to examine the relationship between physical activity and disability in LBP. The literature search included 6 electronic databases and the reference list of relevant systematic reviews and studies to May 2010. To be included, studies had to measure both disability (eg, with the Roland Morris Disability Questionnaire) and physical activity (eg, by accelerometry) in patients with non-specific LBP. Two independent reviewers screened search results and extracted data, and authors were contacted for additional data. Correlation coefficients were pooled using the random-effects model. The search identified 3213 records and 18 studies were eligible for inclusion. The pooled results showed a weak relationship between physical activity and disability in acute or subacute (<3 months) LBP (r = −0.08, 95% confidence interval = −0.17 to 0.002), and a moderate and negative relationship in chronic (>3 months) LBP (r = −0.33, 95% confidence interval = −0.51 to −0.15). That is, persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability. Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity.     

The disabling role of fluctuations in physical activity in patients with chronic low back pain

Patients with chronic low back pain (CLBP) often report a disabling decrease in their activity level due to pain. The nature of the association between disability, activity, and pain over time is however, unclear. An intriguing issue here is whether a high level of pain-related disability is associated with a low activity level or are changes in the level of activity over time pain provoking and thus more disabling? The objectives of this study were to investigate associations between disability, pain intensity, pain-related fear, and characteristics of physical activity in patients with CLBP. A total of 42 patients with CLBP were recruited from the Pain Clinic of the Maastricht University Hospital. Each pain patient carried an electronic diary for one week, in which questions about current pain intensity, and the level of physical activity were completed at 8 moments a day. Disability was scored by the Quebec Back Pain Disability Scale (QBPDS), Fear of movement by the Tampa Scale for Kinesiophobia (TSK). To explain the level of disability regression analyses were performed with disability as dependent variable and pain intensity, pain-related fear, and consecutively the level of physical activity in daily life and fluctuations in physical activity as independent variables. Results, based on 34 patients, showed that activity fluctuations (β = 0.373, p < 0.05) rather than the mean activity level over time (β = ?0.052, ns) contributed significantly in explaining disability. The results are discussed in the light of current theories, previous research, and clinical implications.     

Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation.

OBJECTIVE: To evaluate the frequency and extent of prosthetic use by people with lower limb amputation and identify factors that facilitate prosthetic use. DESIGN AND SETTING: Five-year follow-up survey using the Prosthetic Profile of the Amputee (PPA) questionnaire and Dillman's mailing strategy. SUBJECTS: Adults with unilateral transtibial and transfemoral amputation (n = 396) who had completed a prosthetic training program. MAIN OUTCOME MEASURES: Frequency of prosthetic wear, in hours per week, and active prosthetic use for locomotion indoors and outdoors. RESULTS: Eighty-five percent of the respondents (mean age 62.9+/-15.9yrs) were prosthetic wearers; 53% used their prosthesis for locomotion indoors, and 64% outdoors. Ability to don the prosthesis (p < .001), locomotor capabilities with the prosthesis (p < .001), walking distances (p < .001), automaticity of gait (p < .05), and assistive devices used (p < .001) were the main factors related to the three outcome measures. People with transfemoral amputation reported greater difficulties in donning their prosthesis (p < .01) and a significantly higher rate of falls (p < .001). CONCLUSION: The majority of people with lower limb amputation wear their prosthesis daily. With the exception of resources (prosthetic laboratory and means of transportation), all enabling factors investigated were significantly associated with the outcome measures.     

Paralumbar muscle activity in chronic low back pain

Muscle spasm is often considered to be a prominent feature operating in chronic low back spin syndrome (LBP). The present study compared levels of paralumbar muscle activity, determined by an electromyogram (EMG), for LBP patients and normal subjects during periods of rest and voluntary muscular contraction. The resting state EMG measure did not differ in the 2 groups. However, when attempting to relax the low back while contracting other muscle groups, LBP patients exhibited higher mean levels of low back muscle activity as compared to the non-pain group. These results would suggest that such "cocontraction relaxation" procedures may provide a viable behavioral technique for assessing and possibly treating functional backache thought to be symptomatic of muscle spasm. Previous studies employing feedback and progressive relaxation techniques have trained subjects to reduce muscle tension in the resting state. Results of the present study suggest that the acquisition of "resting level" relaxation may be of little benefit to patients who exhibit excessive muscular tension while performing daily tasks. Rather, to maximize the likelihood of beneficial results, training would be better directed at relaxation of the low back during activity of other muscle groups.     

The relationship between psychological distress and free-living physical activity in individuals with chronic low back pain

The aim of this cross-sectional pilot-study was to investigate the relationship between psychological distress and free-living physical activity (PA) in individuals with chronic low back pain (CLBP). Thirty-eight participants with non-specific CLBP (29 = distressed; 9 = non-distressed) were recruited. PA levels were measured using an accelerometer (activPAL? activity monitor) over a one week period. The following parameters of physical activity were recorded: time upright (standing or walking), time standing, time walking, and step count. Psychological distress was assessed using a modified version of the distress risk assessment method (DRAM) which is a combination of somatic anxiety and depressive symptoms. The Distressed group spent significantly less time upright over a mean 24 h day (?1.47 h, 95% CI ?2.70 to ?0.23 h, p < 0.05), attributable to 1.01 h less standing and 0.46 h less walking. Depressive symptoms were a statistically significant independent predictor of time upright (β = ?0.49, p < 0.05). This pilot-study found that individuals with CLBP and elevated levels of distress spend less time upright than their non-distressed counterparts. Clinically, when treating individuals with CLBP and elevated distress levels, free-living PA may be low and interventions aimed at increasing upright activity may be appropriate.