A Path Analysis of the Effects of Biopsychosocial Factors on the Onset of Nonspecific Low Back Pain in Office Workers

Objective

The purpose of this study was to develop a conceptual model for the association between various biopsychosocial factors and nonspecific low back pain (LBP) in a sample of office workers.

The Effect of Chronic Pain Intensity on the Stability Limits in Patients With Low Back Pain

Objective

The purpose of this study was to evaluate if the intensity of recurrent chronic pain would modify postural performance in reaching the functional limits of stability (LOS) in chronic low back pain (CLBP) patients.

Methods

Three groups of subjects were investigated. Healthy persons comprised the asymptomatic group (n = 32) while CLBP patients (n = 36) were divided into 2 subgroups, according to the reported intensity of resting pain on a numerical rating scale: patients with low (LP) and high pain (HP) levels. The maximal displacement of the center of pressure (COP) indexing the LOS magnitude and the COP mean velocity indexing the performance in reaching LOS were calculated on a Kistler force plate during forward and backward voluntary body lean with eyes open (EO) or closed (EC).

Results

The forward LOS was lower in both the LP (P < .01) and HP (P < .01) subgroups than in the asymptomatic under EO and EC conditions, while no differences between the LP and HP groups were found. The backward LOS was lower in the HP group than in asymptomatic but only with EC (P = .01). Eye closure caused an increase in forward (P = .02) and backward (P = .001) COP velocity in the LP group and forward COP velocity in the asymptomatic (P = .04) only. With EC, the only intergroup difference was lower forward COP velocity in the HP than LP group (P = .04).

Conclusion

Subjects with CLBP had reduced forward LOS regardless the pain level. However, the higher level of pain was associated with slower execution of voluntary leaning tasks, with EC only.     

Prevalence,Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis

Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies.PerspectiveDespite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.     

Pain Profiles and Psychosocial Distress Symptoms in Workers with Low Back Pain

Purpose:

The current study investigated the pain profiles of patients with subacute non-specific low back pain attending an outpatient return-to-work rehabilitation programme. Differences in symptoms of distress (depression and anxiety) and return to work between the pain-profile groups were assessed.

Methods:

Sixty-five volunteers who met the eligibility criteria and had complete follow-up data were included in the analysis. The mean age was 38.8 years (minimum 18, maximum 64); 38 (58.5%) were men. The median time since onset of low back pain was 30 days. Cluster analysis was used to categorize patients into groups according to pain severity scores (VAS).

Results:

Two distinct clusters—severe pain and moderate pain—emerged. There were significant differences in depressive and anxiety symptoms between the pain profiles. Further, return-to-work rates varied significantly between the two groups (31% in the severe pain cluster compared to 90% in the moderate pain cluster).

Conclusion:

Although both groups showed significant improvements in depression and anxiety symptoms over time, the severe pain cluster scored higher at discharge (higher scores indicating worse outcomes). These results highlight the importance of early identification of sub-groups at risk so that rehabilitation interventions can be focused with the goal of minimizing long-term disability.     

Pain and Pain-Related Disability Associated With Proprioceptive Impairment in Chronic Low Back Pain Patients: A Systematic Review

ObjectiveThe purpose of this study was to systematically review the evidence on the correlation between lumbar proprioception and clinical low back pain (LBP) characteristics.MethodsThe literature was investigated through a systematic review. Six electronic databases (EMBASE, Scopus, Elsevier, PubMed, ProQuest, and Google Scholar) and reference lists of the relevant articles were searched from inception until December 2017. Studies that investigated the correlation between lumbar proprioception and pain and disability in patients with chronic nonspecific LBP were included in the analytical review.ResultsFive studies (204 patients) were included. Lumbar proprioception was measured via active or passive joint repositioning error or threshold to detection of passive motion. Four of the studies were rated as medium and only 1 as high quality. Four studies had investigated the correlation between proprioception and functional disability scores, all of which found them to be weakly correlated. Although no significant correlation was reported between pain and joint repositioning error (measured in all included studies), one had reported a fair to moderate correlation between pain and threshold to detection of passive motion.ConclusionCurrent literature shows that although LBP pain-related disability is poorly to moderately correlated with proprioceptive functioning, the relationship between pain intensity and proprioception seems to be more complex.     

Back Pain Intensity Underestimated

A quality assurance program conducted by German physicians and physiotherapists about back pain is described. The results of the program documented that this common disorder was underestimated in over half of the cases.     

Occupational Low Back Pain in Primary and High School Teachers: Prevalence and Associated Factors

ObjectiveThe purposes of this study were to investigate the prevalence of and risk factors for low back pain (LBP) in teachers and to evaluate the association of individual and occupational characteristics with the prevalence of LBP.MethodsIn this cross-sectional study, 586 asymptomatic teachers were randomly selected from 22 primary and high schools in Semnan city of Iran. Data on the personal, occupational characteristics, pain intensity, and functional disability as well as the prevalence and risk factors of LBP were collected using different questionnaires.ResultsPoint, last month, last 6 months, annual, and lifetime prevalence rates of LBP were 21.8%, 26.3%, 29.6%, 31.1%, and 36.5%, respectively. The highest prevalence was obtained for the high school teachers. The prevalence of LBP was significantly associated with age, body mass index, job satisfaction, and length of employment (P < .05 in all instances). Prolonged sitting and standing, working hours with computer, and correcting examination papers were the most aggravating factors, respectively. Rest and participation in physical activity were found to be the most relieving factors.ConclusionThe prevalence of LBP in teachers appears to be high. High school teachers were more likely to experience LBP than primary school teachers. Factors such as age, body mass index, length of employment, job satisfaction, and work-related activities were significant factors associated with LBP in this teacher population.     

Risk Factors for Low Back Pain and Sciatica

So far, eight prospective studies and 50 cross-sectional or retrospective studies have focused on risk factors for low back syndromes. Half of these have been published during the 1980s. Hard physical work and, in particular, frequent lifting and postural stress are likely to result in disc degeneration, low back pain and sciatica. Physical strain may also have prophylactic effects, as physical leisure activity and muscular strength are negatively associated with the risk of low back pain. Much evidence points to driving motor vehicles being causally associated with low back pain and sciatica. A probably causal relationship exists between body height and risk of sciatica, but height is not necessarily predictive of other types of low back pain. Obesity, smoking, psychological distress and poor general health also carry increased risk of low back pain, but their causal role is questionable. Although none of the suspected risk factors can be described as having been conclusively investigated epidemiologically, the results of published studies show that there are modifiable factors contributing to low back pain. The overall potential of primary prevention is great if adequate tools for intervention can be developed.     

The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study

BackgroundChronic low back pain is one of the most common musculoskeletal disorders in different countries.AimsThis study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics.DesignA case-control and cross-sectional study.SettingsTwo physiotherapy centers in Tehran, Iran.ParticipantsThis study included 502 patients with acute, subacute and chronic LBP.MethodThis study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ², and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis.ResultsIt was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05).ConclusionsPersonal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.     

Self-Efficacy and Fear Avoidance Beliefs in Chronic Low Back Pain Patients: Coexistence and Associated Factors

A cross sectional study was conducted with the objective to assess the coexistence of self-efficacy and fear avoidance beliefs and establish the associated factors. Data collection was performed (215 individuals with lower back pain at three health services and two industries). The following instruments were used: Tampa Scale for Kinesiophobia, Beck's Depression Inventory, Piper's Fatigue Scale, Oswestry Disability Index, and the Chronic Pain Self-Efficacy Scale. Wilks' lambda test was performed, followed by MANOVA model to assess the effect of self-efficacy beliefs and fear avoidance on independent variables. Most subjects were women (65.1%), 45 years of age or younger (50.7%), with a family income between $450 and $1,350 per month (49.3%). Depression was present in 21.4%, fatigue in 29.3%, and disability in 68%. The average (standard deviation) of self-efficacy was 180.8 (60.4), and fear avoidance was 42.0 (11.5). A significant negative correlation was observed between the total score of both beliefs. The Wilks' lambda test showed that gender, income, depression, disability, and fatigue were significant and were included in the model. In the Manova analysis, low self-efficacy was associated with lower income, fatigue, depression, and level of disability (p < .001). High fear avoidance was associated to the male gender, lower income, depression, and level of disability (p < .001). The analysis of the confidence areas showed that a reduced self-efficacy and increased fear avoidance are related to an increased level of disability (p < .001). Specific intervention strategies must be implemented change these beliefs.     

Pain Self‐Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain

The purpose of this study was to investigate cross‐sectional associations of pain self‐efficacy and fear of movement with pain intensity and disability in Italian patients with chronic low back pain (CLBP). One hundred and three adult outpatients with nonspecific CLBP were included in the study. Socio‐demographic and clinical characteristics were assessed, together with Italian versions of self‐reported questionnaires to measure the four constructs of interest. Multiple linear regression models were built with psychosocial constructs as main determinants, and pain intensity and disability as outcomes. Potential confounding of socio‐demographic and clinical characteristics was assessed. Pain self‐efficacy and fear of movement displayed moderate correlations with pain intensity (r = ?0.41 and 0.42, respectively) and disability (?0.55 and 0.54). Association models adjusted for pain intensity showed that both pain self‐efficacy (β = ?0.35, 95% CI = ?0.5; ?0.2, R² = 41%) and fear of movement (β = 0.65, 95% CI = 0.36; 0.93, R² = 40%) are significantly and strongly associated with disability. Pain self‐efficacy was no longer significantly associated with pain intensity when disability was added as a confounder to the model, whereas fear of movement retained its significant association (β = 0.06, 95% CI = 0.00;0.11, R² = 30%). No other variables acted as confounders in these associations. Pain self‐efficacy and fear of movement are very similarly associated with main outcomes in this sample of Italian patients with CLBP. The results of this study suggest that both psychosocial constructs should be considered in clinical management. Future studies should investigate whether these findings can be replicated in other samples, in longitudinal designs and if other variables not measured in this study confound the associations.     

Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain

Background

Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA.

Disability Determination: Validity With Occupational Low Back Pain

Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. PERSPECTIVE: Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.     

A Systematic Review of the Effectiveness of Core Stability Exercises in Patients with Non-Specific Low Back Pain

BackgroundLow back pain affects millions of people worldwide and can be a difficult condition to manage clinically. Many cases do not have a discernable etiology, further increasing the complexity of finding an effective intervention. Core stabilization exercises (CSE) strengthen the musculature that provides stability to the spine and show promising outcomes.PurposeTo examine the efficacy of CSE exercises in the treatment of NSLBP in adult patients.Study SelectionStudies were included if they had patients diagnosed with NSLBP, used CSE as a treatment for NSLBP, and were a clinical trial. Exclusion criteria were studies that did not utilize an objective pain scale, patients who had a specific diagnosed pathology contributing to the NSLBP or received treatment for their NSLBP within the prior six months.MethodsThe literature was systematically searched in the PubMed, Sports Medicine & Education Index, and CINHAL databases, using the search terms core stabilization, low back pain, and exercise. The initial search yielded 229 articles and was refined using search terms ‘NOT analysis’ in order to target randomized control trials and exclude meta-analyses to narrow the search. Full-text of the articles were assessed for eligibility by utilizing inclusion and exclusion criteria that were included in this review. Articles were assessed for quality using the PEDro scale and relevant data were extracted.ResultsFive moderate-quality studies (PEDRO range: 5-8) support CSE is an effective method to decrease pain, improve functionality, and increase core strength in patients with NSLBP. Although there are other commonly used methods to treating NSLBP, CSE have shown to be a beneficial method to treating NSLBP.ConclusionGrade B evidence suggests core stabilization exercises can be considered a favorable method for treating pain in patients with NSLBP.Level of Evidence1b