腰椎稳定性训练对曼性非特异性腰痛患者的治疗效果

目的分析探讨腰椎稳定性训练方法对于慢性非特异性腰痛病人的临床效果。方法将我院于2006-2009年收治的30例慢性的非特异性的腰痛患者作为本组实验的研究对象,将30患者随机分成对照组与实验组各15例,对照组患者进行磁热治疗,实验组患者则采取腰椎稳定性的训练方法进行治疗,对两组患者治疗前后疼痛和功能障碍的程度进行评价。结果两组患者经过相应的治疗,疼痛与功能障碍均有了一定的改善,但实验组腰痛患者疼痛与功能障碍的改善情况同对照组相比更加明显,P〈O．05。结论腰椎稳定性训练方法是治疗慢性非特异性腰痛的一种有效方法,可以减轻患者的疼痛程度,改善患者的功能障碍,具有很高的临床应用价值。     

Low back pain and risk factors among Taxi drivers in Turkey: a cross-sectional study

Background: Taxi drivers have an increased risk of low back pain due to both physical and occupational conditions. This study aims to determine the prevalence of low back pain and occupational risk factors among taxi drivers working in Izmir, Turkey. Methods: This study was conducted with 447 taxi drivers at randomly selected taxi stands between April and September 2021. The questionnaire included demographic, individual, and work-related questions; the Nordic Musculoskeletal Questionnaire; and the Back Pain Functional Scale (BPFS). Results: The prevalence of low back pain in the last year was 49.7%. In multivariate logistic regression analyses, the risk factors for low back pain included having a body mass index of25-29.9 kg/m² (OR= 1.67, 95% CI 1.01-2.76) or >30 kg/m² (OR= 2.15, 95% CI 1.19-3.87), no physical activity (OR= 1.66, 95% CI1.06-2.62), years of work >10 (OR= 3.23, 95% CI1.89-5.53), no weekly rest period (OR= 3.11, 95% CI 1.42-6.81), having no lumbar support on the driver''s seat (OR=1.67, 95% CI 1.05-2.66), or undecisive job satisfaction (OR= 2.07, 95% CI 1.17-3.66). Being undecided about job satisfaction (OR= 2.34, 95% CI 1.15-4.92) and not having physical activity (OR= 2.10 CI 1.08-4.08) were found to be risk factors for reduced BPFS scores. Conclusion: A strong correlation was found between the frequency of low back pain and the BPFS score and occupational factors. Early detection and management of low back pain are critical to avoid increased low back pain and related injuries among taxi drivers.     

Effectiveness of workplace accommodations for a corporate telephone operator with a full left-arm prosthesis: A case study

A corporate telephone operator and voice mail programmer was involved in a serious automobile accident resulting in left-arm amputation and through rehabilitation received a full left-arm prosthesis. Upon returning to work in her previous job capacity, some work activities and work area configurations were identified as problematic during task performance. Work methods and work area configuration were evaluated regarding their appropriateness for supporting return to work and long-term accommodation. Job activity analysis determined all reaches, clearances, and forces and their compliance with recommended criteria. A body part comfort/discomfort survey (BPCDS) was administered pre- and post-accommodation to elicit information regarding workplace problem areas and provide a measure to assess accommodation effectiveness. Workstation, support equipment, work area, seating, task assignments, and work methods were modified to more appropriately support operator task performance. Comparison of pre- and post-accommodation BPCDS indicates a significant reduction in operator discomfort with residual discomfort associated with the orthopedic prosthesis. This case study illustrates the use of the principles and techniques of industrial ergonomics to develop workplace accommodations. The area of ergonomics, medical ergonomics,is an example of the development of reasonable accommodations for physically challenged workers in the spirit of compliance with the Americans with Disabilities Act (ADA).     

Interventions to prevent back pain and back injury in nurses: a systematic review

A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. Ten relevant databases were searched; these were examined and reference lists checked. Two reviewers applied selection criteria, assessed methodological quality and extracted data from trials. A qualitative synthesis of evidence was undertaken and sensitivity analyses performed. Eight randomised controlled trials and eight non-randomised controlled trials met eligibility criteria. Overall, study quality was poor, with only one trial classified as high quality. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. This review highlights the need for high quality randomised controlled studies to examine the effectiveness of interventions to prevent back pain and injury in nursing populations. Implications for future research are discussed.     

Individual and occupational determinants of low back pain according to various definitions of low back pain

OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.     

Specified diagnosis in 532 cases of back pain

In the city of Malmö, Sweden, a project was started to improve the rehabilitation of patients with back pain. Among 532 patients with back pain who were on sick leave for an average of 98 days the year preceding the consultation, very few specific diagnoses were made in spite of a thorough clinical and radiological examination. Only five of the patients were cured by surgery. During the same period 103 patients were operated on for disc herniation or nerve root stenosis at the Orthopaedic Department at Malmö General Hospital. Thus the routines for somatic diagnosis of the medical service in Malmö are adequate and an improvement would have very little effect on the expenditures for sick leave and early retirement. As suggested in this paper social and psychological factors are of greater importance in the rehabilitation and we should focus less on the physical problems of the patient.     

Interrelations of risk factors and low back pain in scaffolders

OBJECTIVES—To assess with a cross sectional study the interrelations between physical, psychosocial, and individual risk factors and different end points of low back pain.
METHODS—In total, 229 scaffolders and 59 supervisors completed a questionnaire about manual handling of materials, awkward back posture, strenuous arm position, perceived exertion, psychosocial load, need for recovery, and general health. Physical load at the worksite was also measured with many frequent observations. Interrelations between risk factors and their relation with four end points of low back pain were investigated.
RESULTS—Interrelations were strong among self reported determinants of physical load but showed an inverted trend for both age and total working experience, which could indicate the presence of a healthy worker effect. Weak relations existed between variables of psychosocial and physical load. The multivariate analyses showed a significant relation between high manual handling of materials, moderate perceived general health, high job demands, and low back pain in the past 12 months. Chronic low back pain was significantly correlated with high perceived exertion and moderate perceived general health. Severe low back pain was significantly correlated with awkward back postures, high need for recovery, and high job demands. Finally, low back pain with perceived disability was significantly related to strenuous shoulder positions and moderate perceived general health. All end points of low back pain were consistently associated with physical load whereas psychosocial aspects showed a more diverse pattern.
CONCLUSIONS—The findings of this study suggest that work related risk factors may vary according to different definitions of low back pain. Distinct patterns of risk factors might enhance different expressions of it. Scaffolders are a group at high risk of developing persistent forms of low back pain.


Keywords: interrelations; low back pain; risk factors     

护理人员下背痛危险因素分析

目的：探讨护理作业人员职业性下背痛患病情况及其危险因素。方法：采用横断面调查方法对本市场规模相近的三所医院的752名护士进行问卷调查，内容涉及下背痛病史、症状及其相关影响因素。结果：护理作业人员下背痛患病率高达56.9％，Logistic回归分析提示：个体生物因素如年龄、体重、妊娠次数；家庭因素如家庭人口数、子女数、婚姻状况、承担家务劳动量；职业性因素，如工作紧张、疲劳、轮班、工龄；社会心理因素，如认为工作脏累、责任和压力大、工作条件和工资待遇不满意、工作紧张等；既往患病史的有无等与下背痛患病有关。结论：下背痛是护理人员常见疾患，其患病危险因素来自多个方面。     

护理人员下背痛调查及其影响因素的初步探讨

目的探讨护理作业人员职业性下背痛现患状况及其影响因素。方法采用现况调查的方法对某市规模相近的3所医院的486名护士进行问卷调查,内容包括下背痛患病率及其可能相关影响因素。结果护理作业人员下背痛患病率高达60.3%,多元Logistic回归分析提示:工龄、弯腰时间、工作疲劳感、轮班频率等因素与下背痛有关。结论下背痛是护理人员常见疾患,其患病危险因素来自多个方面。     

Randomized study of the application of single motor unit biofeedback training to chronic low back pain

The application of single motor unit biofeedback training (SMUBT) techniques was compared to traditional therapies in treating chronic low back pain (CLBP). Thirty-six volunteers (who experienced daily pain for 7 years in the T8 to S1 area) were randomly assigned to one of three treatments; SMUBT, relaxation training, or an educational program. The pain level and electromyographic activity of all subjects were assessed by a person blind to the treatment; before, immediately after, and 90 days after treatment. The SMUBT group reported immediately decreased pain which was maintained at 90 days, the relaxation group showed no changes, while the education group reported decreased pain at 90 days. The EMG results showed decreased amplitude and bilateral differences for the SMUBT and education groups. A 4-year follow-up revealed the SMUBT group remained symptom free. Implications and discussion of the results concludes the paper.     

Prevalence of psychopathology in acute and chronic low back pain patients

This study assessed the differential prevalence rates of psychopathology in chronic and acute low back pain patients. Psychopathology was assessed with the Structured Clinical Interview for the DSM-III-R (SCID). The results showed that chronic low back pain patients (n=90), had much higher rates of psychopathology than did patients in the acute back pain group (n=90), and much higher than general population base rates. In particular, chronic low back pain patients had high rates of major depression, substance abuse, and personality disorders. Moreover, the chronic low back patients also had high rates of premorbid psychopathology. It was concluded that psychopathology is a major concomitant of chronic low pack pain, and that treating the psychological problems, along with the physical aspects of the chronic low back pain may increase the patient's chance of a successful therapeutic outcome.     

The role of the supervisor in successful adjustment to work with a disabling condition: Issues for disability policy and practice

Results from an investigation of the role of supervisors in the process of adjusting to work with a disabling condition are presented. Workers with disabling conditions were interviewed about the responsiveness of their workplaces to their needs. Analyses showed that successful adjustment to work was related to the ability to complete job requirements, get along with others at work, see a future at work and feel good about work. Many supervisory behaviors were associated with these factors including the extent to which supervisors treat workers fairly, allow workers to participate in decisions related to their work and utilize the workers' skills. Implications for the development of workplace policy and disability management efforts are discussed.     

ICU病房护理人员职业相关腰背痛及其危险因素

目的探讨ICU病房护理人员职业相关腰背痛（OLBP）的发生情况及相关的危险因素。方法以某市5家综合性医院ICU病房护士为观察组，普通病房护士为对照组进行横断面调查，发放OLBP问卷调查，并对其中一家医院ICU病房进行现场录像，采用Win OWAS和Bless Pro2．0软件做姿势负荷和生物力学负荷计算。结果ICU病房护士OLBP现患率（87％）、发作频率（每月1次以上者占48％）以及因OLBP误工率（7％）与对照组（分别为60％、32％、2％）比较均明显升高，差异有统计学意义（P〈0．01，P〈0．05）。ICU病房护士典型护理操作危险姿势发生频率依次为观察引流（99％）、在床上搬抬患者（90％）、静脉操作（75％）、吸痰（75％）、调整输液量（6％）；调整输液量、吸痰、静脉操作、观察引流量、在床上搬抬患者的腰椎间盘压力（Fc）比值为100：155：199：301：418。结论ICU病房护士OLBP患病率高，高频率弯腰、扭转姿势和在床上搬抬患者是主要的危险因素。     

Right-to-know training of workers with IQ less than 70: A pilot study

Chemical emergencies occur frequently in the workplace. Laws and regulations have been enacted to reduce the risk of injuries to workers, including workers with an IQ less than 70. These regulations require employers to educate their workers about the nature and hazards of toxic substances in the workplace, about methods to reduce exposure, and about appropriate responses in case of an accident or an emergency. From May to August 1996, a project examined the responses of 58 Goodwill Industries employees before and after their attendance at a mandatory “Right-to-Know” training program. Responses to five questions relating to the safe use of chemicals were analyzed. A combination of quantitative and qualitative evaluations determined that for the 28 subjects with IQ < 70, the program did not achieve its goals. However, the program did provide fuller information for the 30 subjects with IQ > 70. The findings of this pilot study show the need to develop training programs tailored to meet the needs and conditions of workers with IQ < 70. Am. J. Ind. Med. 32:417–420, 1997. © 1997 Wiley-Liss, Inc.     

Disability management and the cardiac rehabilitation patient: Job simulation and transitional work strategies

Medical advances and treatment interventions among patients with coronary heart diseases have not resulted in more timely return to work outcomes among cardiac rehabilitation programs. This article reviews vocational rehabilitation outcomes among persons with coronary heart disease, and the importance of employer-based disability management concepts. Job simulation, transitional work strategies, and ergonomic job site modifications, when integrated within the cardiac rehabilitation protocol, may yield promising results. The article discusses an experimental research project at the University of Cincinnati Medical Center that addresses worker-work environment interaction, encourages direct employer involvement, and promotes employer accommodation under the Americans with Disabilities Act.     

Low back pain and musculoskeletal symptoms among Kansas farmers

BACKGROUND: Farming continues to rank as one of the most dangerous occupations in the United States. The purpose of this study was to determine the prevalence of low back pain and other musculoskeletal disorders (MSDs) among the farmers and to examine the factors associated with occupational back pain. Farmers in a predominately corn and soybean growing region of Kansas served as the study sample. METHODS: Questionnaires were mailed out to 499 active farmers of a Farmers' Cooperative in Southeast Kansas. The self-administered questionnaire was used to determine the prevalence of self-reported symptoms of back pain and other MSDs and to determine the strength of associations between back pain and work factors. RESULTS: The participation rate was 57.2%. The low back was the anatomical area with the highest prevalence of self-reported work-related pain (37.5%), followed by the shoulders (25.9%), knees (23.6%), and neck (22.4%). Close to 60% of the farmers reported that they experienced farm work-related MSD symptoms in at least one of the nine body areas in the previous year. Nearly one quarter of the farmers reported seeing a physician for their low back symptoms, and one in five farmers had to modify their work habits due to low back symptoms during the previous year. CONCLUSIONS: Low back pain and other musculoskeletal conditions are a significant problem for Kansas farmers. This group of Kansas farmers experienced low back pain at a much higher rate than the general working population and higher than other groups of farmers previously studied.     

Low back pain and lumbar angles in Turkish coal miners

BACKGROUND: This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. METHODS: Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The severity of low back pain was evaluated with 10 mm visual analog scale (VAS). Modified oswestry low back pain disability questionnaire (MOSW) was used to measure functional disability. Sacral horizontal angle (SHA), lumbosacral angle (LSA), and lumbar lordosis were measured through Cobb method. RESULTS: The prevalance of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P < 0.001). The mean VAS score was higher in Group I than in Group II (P < 0.05). There was no difference in MOSW scores between the two Groups. The mean SHA was lower in Group I than in Group II (P = 0.02). No statistically significant difference was determined in lumbar angles of underground and surface workers with low back pain (P > 0.05). CONCLUSIONS: The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.     

Overdiagnosis and overtreatment of low back pain: Long-term effects

Low back pain and subsequent disability remain a concern in terms of both cost and impact upon industry let alone the adverse effects on the patients involved. The causes of low back pain remain elusive. There has been extensive focus on the intervertebral disc with treatment ranging from passive modalities to multiple surgery. Current experience suggests that misinformation, inadequate patient examination, medication abuse, over use of passive modalities, focus on pain rather than function and excessive reliance on radiological imaging and specialist referrals are contributing factors. Indeed, one is drawn to the conclusion that low back disability may well be an iatrogenic disorder in many cases.     

Industrial back belts and low back pain: Mechanisms and outcomes

The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States. The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of low back pain and disability in the workplace. At the present time, neither the suspected mechanisms of action nor the efficacy of these devices in the primary, secondary, and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials. As a result, generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established. Based on this review it is recommended that further well-controlled, prospective, randomized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment. During the interim, the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider. These devices should not be provided as an alternative to appropriate administrative and/or engineering controls.     

Occupational low back pain: Recovery curves and factors associated with disability

Review of the literature shows significant variation in the rates of recovery from an episode of low back pain (LBP). Two hundred and seven workers filing a “First Report of Injury” form with the Vermont Department of Labor and Industry were contacted 3 months post-injury to determine time until first return-to-work, work status, lost workdays, and factors such as pain intensity and satisfaction with health care. Overall, 69.4% of the workers had first returned to work within 1 week, 85.9% within 1 month, and 93.7% by 3 months. Three months post-injury, 8.7% of these workers were not working (disabled) due to their LBP. On a scale of 0–10, the disabled reported substantially more pain in the past few days (p=.0001) and a higher level of “worst pain since injury” (p=.004). Those disabled were less likely to feel they had received the right treatment for their LBP (p=.05). Researchers and clinicians need a clear understanding of recovery curves to assess the effectiveness of any interventions.