Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis

A cognitive behavioral approach was previously compared to a biomechanical approach (the McKenzie method) for the treatment of patients with back and neck pain in a randomized trial. Few differences between the treatment interventions were found. The aim of this secondary analysis was to determine if any clinical characteristics distinguished those patients who responded best to the McKenzie approach. Treatment success was defined as 50% reduction in original functional disability scores (Roland-Morris Disability Questionnaire or Northwick Park Neck Pain Questionnaire); failure to achieve this was defined as treatment failure. A liberal definition of success was 50% improvement retained at either 6 or 12 months, whereas a strict definition of success was 50% improvement at both 6 and 12 months. Ten variables were screened by univariate regression analysis to see if they predicted success. Any significant variables (P < 0.1) underwent multiple regression analysis. Only 21 and 16 patients out of 102 were deemed treatment successes according to the liberal and strict definitions, respectively. With the liberal definition, only centralization (P = 0.065), spine region (back rather than neck pain) (P = 0.089), and duration of pain (P = 0.001) emerged as predictors from the univariate regression analysis. With the strict definition, only the latter two variables emerged: spine region (P = 0.026) and duration of pain (P <0.01). All these variables were retained in the multiple regression analysis. In this study, duration of pain was the strongest predictor of success, although back pain and centralization had some predictive ability.     

Comparison of the BackJoy SitSmart Relief and Spine Buddy LT1 H/C Ergonomic Chair Supports on Short-Term Neck and Back Pain

Objective

The purpose of this study was to perform a needs assessment to determine whether short-term use of BackJoy SitSmart Relief and Spine Buddy LT1 H/C chair supports influences neck, upper back, and lower 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.     

Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part I

Objectives

The purpose of this article is to report on the Center of Excellence for Research on Complementary and Alternative Medicine at RAND Corporation. The overall project examined the appropriateness of chiropractic spinal manipulation and mobilization for chronic low back pain and chronic cervical pain using the RAND and University of California Los Angeles Appropriateness Method, including patient preferences and costs, to acknowledge the importance of patient-centered care in clinical decision-making.

The Risk of Bias and Sample Size of Trials of Spinal Manipulative Therapy for Low Back and Neck Pain: Analysis and Recommendations

Objective

The purpose of this study was to evaluate changes in methodological quality and sample size in randomized controlled trials (RCTs) of spinal manipulative therapy (SMT) for neck and low back pain over a specified period. A secondary purpose was to make recommendations for improvement for future SMT trials based upon our findings.

Methods

Randomized controlled trials that examined the effect of SMT in adults with neck and/or low back pain and reported at least 1 patient-reported outcome measure were included. Studies were identified from recent Cochrane reviews of SMT, and an update of the literature was conducted (March 2013). Risk of bias was assessed using the 12-item criteria recommended by the Cochrane Back Review Group. In addition, sample size was examined. The relationship between the overall risk of bias and sample size over time was evaluated using regression analyses, and RCTs were grouped into periods (epochs) of approximately 5 years.

Results

In total, 105 RCTs were included, of which 41 (39%) were considered to have a low risk of bias. There is significant improvement in the mean risk of bias over time (P < .05), which is the most profound for items related to selection bias and, to a lesser extent, attrition and selective outcome reporting bias. Furthermore, although there is no significant increase in sample size over time (overall P = .8), the proportion of studies that performed an a priori sample size calculation is increasing statistically (odds ratio, 2.1; confidence interval, 1.5-3.0). Sensitivity analyses suggest no appreciable difference between studies for neck or low back pain for risk of bias or sample size.

Conclusion

Methodological quality of RCTs of SMT for neck and low back pain is improving, whereas overall sample size has shown only small and nonsignificant increases. There is an increasing trend among studies to conduct sample size calculations, which relate to statistical power. Based upon these findings, 7 areas of improvement for future SMT trials are suggested.     

Magnitude,validity and responsiveness of dynamometer measured neck retraction strength in patients referred with neck pain to out-patient physical therapy

[Purpose] The magnitude, validity, and reliability of dynamometer measures of neck retraction strength have been reported but not for individuals referred with neck complaints to physical therapy. The purpose of this study, therefore, was to describe neck retraction strength and its responsiveness and validity as a correlate of neck pain and disability among patients referred for physical therapy. [Participant and Methods] Twenty-six consecutive patients referred with neck pain participated. Their neck retraction strength was measured with a handheld dynamometer using a standardized procedure. Neck pain and disability were quantified using a numeric pain rating scale and the Neck Disability Index, respectively. [Results] Measurements of neck retraction strength increased significantly over the episode of care from 76.5 N to 119.5 N (standardized response mean=1.57 N). The correlation of retraction strength with neck pain was significant (r_s=−0.550); however, the correlation between retraction strength and Neck Disability Index scores was not significant (r_s=0.155). [Conclusion] Neck retraction strength measured with a hand-held dynamometer was informative and responsive for patients treated with neck pain. Retraction strength was correlated significantly with neck pain but not neck disability. This apparent inconsistency warrants further investigation.     

Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain

Objectives

Chronic low back pain (CLBP) and chronic neck pain (CNP) are the most common types of chronic pain, and chiropractic spinal manipulation is a common nonpharmacologic treatment. This study presents the characteristics of a large United States sample of chiropractic patients with CLBP and CNP.

Efficacy of spinal manipulative therapy for low back pain of less than three months' duration

OBJECTIVES: To review the efficacy of spinal manipulation for low back pain of less than 3 months duration.Data sources Randomized clinical trials on spinal manipulative therapy for low back pain were identified by searching EMBASE, CINAHL, MEDLINE, and the Physiotherapy Evidence Database (PEDro).Study selection Outcome measures of interest were pain, return to work, adverse events, disability, quality of life, and patient satisfaction with therapy.Data extraction Methodological assessment of the trials was performed using the PEDro scale. Trials were grouped according to the type of intervention, outcome measures, and follow-up time. Where there were multiple studies with sufficient homogeneity of interventions, subjects, and outcomes, the results were analyzed in a meta-analysis using a random effects model.Data synthesis Thirty-four papers (27 trials) met the inclusion criteria. Three small studies showed spinal manipulative therapy produces better outcomes than placebo therapy or no treatment for nonspecific low back pain of less than 3 months duration. The effects are, however, small. The findings of individual studies suggest that spinal manipulative therapy also seems to be more effective than massage and short wave therapy. It is not clear if spinal manipulative therapy is more effective than exercise, usual physiotherapy, or medical care in the first 4 weeks of treatment. CONCLUSIONS: Spinal manipulative therapy produces slightly better outcomes than placebo therapy, no treatment, massage, and short wave therapy for nonspecific low back pain of less than 3 months duration. Spinal manipulative therapy, exercise, usual physiotherapy, and medical care appear to produce similar outcomes in the first 4 weeks of treatment.     

癌症患者的疼痛程度与疼痛信念的相关性研究

目的 了解癌症患者的疼痛程度和疼痛信念,探讨两者的关系.方法 对203例癌症患者的疼痛程度、疼痛信念进行问卷调查.结果 癌症患者以轻度疼痛居多,最认同的疼痛信念是“感到疼痛很神秘”;“感到疼痛很神秘”“认为会持续疼痛”“认为疼痛不可解除”与疼痛程度呈正相关.结论 癌症患者越持有“感到疼痛很神秘“认为会持续疼痛～认为疼痛不可解除”的疼痛信念,疼痛程度越严重.     

The usefulness of clinical measures of psychologic factors in patients with spinal pain

Objective

The purposes of this study were to investigate whether a screening procedure could capture important psychologic factors with minimum burden to the patient and to investigate whether correlations exist among the various psychologic factors.

Methods

A screening procedure consisting of the 11-item Tampa Scale for Kinesiophobia, a 2-question coping strategies screen, and the depression and anxiety subscales of the Bournemouth Disability Questionnaire was provided to consecutive patients with neck pain (NP) or low back pain (LBP) as part of the usual initial assessment process at a busy spine center, which includes chiropractic and physical therapy. Correlations and associations between these variables were determined.

Results

Data were collected on 95 patients with NP and 260 patients with LBP. Statistically significant correlations and associations were found between all measures in both cohorts with the exception of depression and coping in patients with NP. Statistically significant associations were found among all measures in both cohorts with the exception of depression and coping and coping and fear in patients with NP.

Conclusion

This study showed that a screening procedure may provide useful clinical information regarding psychologic factors that are of potential relevance in patients with NP and LBP.     

Factorial validity of the short-form McGill pain questionnaire (SF-MPQ).

Although widely used, there have been few investigations of the factorial validity of the short-form McGill Pain Questionnaire (SF-MPQ; Melzack, 1987). Confirmatory factor analysis was performed on item responses to the SF-MPQ obtained from 188 patients with chronic back pain. Consistent with the original structure proposed by Melzack (1987), results indicated that the SF-MPQ is best represented by a two-factor solution. However, these findings are contrary to results obtained by Burckhardt and Bjelle (1994) who, using their Swedish version of the SF-MPQ, obtained a three-factor solution. Potential explanations for the disparity between the results of the two studies are explored and recommendations for continuing clinical and research applications are offered.     

Prevalence and risk factors associated with low back pain in Iranian surgeons

Objectives

Low back pain (LBP) is a common and costly occupational injury among health care professionals. The purpose of this study was to investigate the prevalence and risk factors of LBP in surgeons and to analyze how individual and occupational characteristics contribute to the risk of LBP.

Methods

A cross sectional study was conducted on 250 randomly selected surgeons including 112 general surgeons, 95 gynecologists and 43 orthopedists from 21 hospitals at northern Iran. A structured questionnaire including demographic, lifestyle, occupational characteristics as well as prevalence and risk factors of LBP was used. Visual analogue scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively.

Results

Point, last month, last six months, last year and lifetime prevalence of LBP was 39.9%, 50.2%, 62.3%, 71.7% and 84.8%, respectively. The highest point prevalence was related to the gynecologists with 44.9%, and the lowest for general surgeons (31.7%). Age, body mass index, smoking, general health, having an assistant, job satisfaction, using preventive strategies and years of practice were found to be correlated with the prevalence of LBP (P < .05 in all instances except for age and job satisfaction). Prolonged standing, repeated movements and awkward postures were the most prevalent aggravating factors (85.2%, 50.2% and 48.4%, respectively). Rest was found to be the most relieving factor (89.5%).

Conclusions

The results of this study demonstrate that the prevalence of LBP amongst surgeons appears to be high and highlights a major health concern. Further large scale studies, including other specialties and health professions such as physical therapy, chiropractic, and general medicine, should be performed.     

妊娠相关下腰痛预防与管理的最佳证据总结

目的检索并获取妊娠相关下腰痛预防及管理的相关证据,为临床提供参考。方法系统检索相关网站、数据库关于妊娠相关下腰痛预防及管理的所有证据,包括指南、最佳临床实践信息册、证据总结、系统评价及专家共识等,检索时限为建库至2020年9月。由2名研究员独立对文献进行质量评价并通过专家论证会对证据推荐级别进行评定。结果共纳入20篇文献,包括1篇临床决策、2篇指南、12篇系统评价及5篇随机对照试验,总结出27条关于妊娠相关下腰痛预防与管理的最佳证据,包括评估与诊断、日常生活管理、多学科管理、药物管理与非药物管理5个方面。结论该研究总结、形成了多学科合作的妊娠相关下腰痛预防与管理方案,证据转化时应充分结合临床环境、孕妇意愿,有针对性的选择最佳证据,降低妊娠相关下腰痛发生率、减轻疼痛。     

Shoe orthotics for the treatment of chronic low back pain: a randomized controlled pilot study

Objectives

The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain.

Methods

The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.

Results

This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time.

Conclusions

This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results.     

Factor analysis of responses to thermal, electrical, and mechanical painful stimuli supports the importance of multi-modal pain assessment

During the last decade, a multi-modal approach has been established in human experimental pain research for assessing pain thresholds and responses to various experimental pain modalities. Studies have concluded that differences in responses to pain stimuli are mainly related to variation between individuals rather than variation in response to different stimulus modalities.In a factor analysis of 272 consecutive volunteers (137 men and 135 women) who underwent tests with different experimental pain modalities, it was determined whether responses to different pain modalities represent distinct individual uncorrelated dimensions of pain perception. Volunteers underwent single painful electrical stimulation, repeated painful electrical stimulation (temporal summation), test for reflex receptive field, pressure pain stimulation, heat pain stimulation, cold pain stimulation, and a cold pressor test (ice water test).Five distinct factors were found representing responses to 5 distinct experimental pain modalities: pressure, heat, cold, electrical stimulation, and reflex-receptive fields. Each of the factors explained approximately 8% to 35% of the observed variance, and the 5 factors cumulatively explained 94% of the variance. The correlation between the 5 factors was near null (median ρ = 0.00, range −0.03 to 0.05), with 95% confidence intervals for pairwise correlations between 2 factors excluding any relevant correlation. Results were almost similar for analyses stratified according to gender and age.Responses to different experimental pain modalities represent different specific dimensions and should be assessed in combination in future pharmacological and clinical studies to represent the complexity of nociception and pain experience.     

The structure, reliability and validity of pain expression: evidence from patients with shoulder pain

The present study examined psychometric properties of facial expressions of pain. A diverse sample of 129 people suffering from shoulder pain underwent a battery of active and passive range-of-motion tests to their affected and unaffected limbs. The same tests were repeated on a second occasion. Participants rated the maximum pain induced by each test on three self-report scales. Facial actions were measured with the Facial Action Coding System. Several facial actions discriminated painful from non-painful movements; however, brow-lowering, orbit tightening, levator contraction and eye closing appeared to constitute a distinct, unitary action. An index of pain expression based on these actions demonstrated test-retest reliability and concurrent validity with self-reports of pain. The findings support the concept of a core pain expression with desirable psychometric properties. They are also consistent with the suggestion of individual differences in pain expressiveness. Reasons for varying reports of relations between pain expression and self-reports in previous studies are discussed.     

护士预防职业性腰背痛行为量表的汉化及信度效度检验

目的:汉化英文版护士预防职业性腰背痛行为量表,并对其进行信度和效度检验,旨在为我国护理人员预防职业性腰背痛行为的评估提供测量工具.方法:严格遵循量表引进原则,采用Brislin双人直译-回译的翻译模式对英文版护士预防职业性腰背痛行为量表进行直译和回译,采用专家咨询法进行跨文化调适,并通过对573名临床护士进行问卷调查,...     

Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings

In psychological health treatment studies it has been shown that differences between therapists account for some of the non‐specific effect of treatment but this phenomenon has not so far systematically been investigated in musculoskeletal disorders. In this study we evaluated and compared the size and potential influence of the ‘practitioner effect’ (or ‘therapist effect’) in three randomised treatment trials of low back pain and neck pain patients in primary care. We calculated the proportion of variance in outcomes attributable to differences across practitioners, i.e. the practitioner–variance partition coefficient (p–vpc). As measures of outcome, we focused on self‐reported disability as the primary outcome, but we also investigated assessed psychological outcomes. The p–vpc for the disability measures ranged from 2.6% to 7.1% across trials and time points (post treatment and follow up). Estimates differed between treatment subgroups within trials; being highest in treatment subgroups assigned to psychosocial‐based interventions. A ‘practitioner effect’ does exist and is more pronounced in treatments involving greater psychosocial emphasis. This has implications for both practice and research in this clinical area. It highlights the importance of patient–practitioner interactions, and the need to address practitioner effects in designing and analysing outcome studies in low back pain and neck pain in primary care.     

Effects of Holding an External Load on the Standing Balance of Older and Younger Adults With and Without Chronic Low Back Pain

Objective

The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP).