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1.
Se-Woong Chun Chai-Young Lim Keewon Kim Jinseub Hwang Sun G. Chung 《The spine journal》2017,17(8):1180-1191
Background Context
Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP.Purpose
This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP.Study Design
Systematic review and meta-analysis.Patient Sample
The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded.Methods
A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors.Results
A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: ?0.94, 95% CI: ?1.19 to ?0.69), with sufficient homogeneity based on significance level of .1 (I2=45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: ?0.33, 95% CI: ?0.46 to ?0.21), without statistical heterogeneity (I2=0%, p=.916).Conclusions
This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC. 相似文献2.
Ian D. Coulter Cindy Crawford Eric L. Hurwitz Howard Vernon Raheleh Khorsan Marika Suttorp Booth Patricia M. Herman 《The spine journal》2018,18(5):866-879
Background Context
Mobilization and manipulation therapies are widely used to benefit patients with chronic low back pain. However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies.Purpose
The present study aims to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic low back pain.Study Design/Setting
This is a systematic literature review and meta-analysis.Outcome Measures
The present study measures self-reported pain, function, health-related quality of life, and adverse events.Methods
We identified studies by searching multiple electronic databases from January 2000 to March 2017, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation or mobilization therapies with sham, no treatment, other active therapies, and multimodal therapeutic approaches. We assessed risk of bias using Scottish Intercollegiate Guidelines Network criteria. Where possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates. This project is funded by the National Center for Complementary and Integrative Health under Award Number U19AT007912.Results
Fifty-one trials were included in the systematic review. Nine trials (1,176 patients) provided sufficient data and were judged similar enough to be pooled for meta-analysis. The standardized mean difference for a reduction of pain was SMD=?0.28, 95% confidence interval (CI) ?0.47 to ?0.09, p=.004; I2=57% after treatment; within seven trials (923 patients), the reduction in disability was SMD=?0.33, 95% CI ?0.63 to ?0.03, p=.03; I2=78% for manipulation or mobilization compared with other active therapies. Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy (SMD=?0.43, 95% CI ?0.86 to 0.00; p=.05, I2=79%; SMD=?0.86, 95% CI ?1.27 to ?0.45; p<.0001, I2=46%). Mobilization interventions, compared with other active comparators including exercise regimens, significantly reduced pain (SMD=?0.20, 95% CI ?0.35 to ?0.04; p=.01; I2=0%) but not disability (SMD=?0.10, 95% CI ?0.28 to 0.07; p=.25; I2=21%). Studies comparing manipulation or mobilization with sham or no treatment were too few or too heterogeneous to allow for pooling as were studies examining relationships between dose and outcomes. Few studies assessed health-related quality of life. Twenty-six of 51 trials were multimodal studies and narratively described.Conclusion
There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option. 相似文献3.
European Spine Journal - There is anecdotal evidence that many patients who undergo reduction mammoplasty (RM) procedures, to relieve symptoms of large breasts, also report improvement in existing... 相似文献
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Michael F. Knox Lucy S. Chipchase Siobhan M. Schabrun Rick J. Romero Paul W.M. Marshall 《The spine journal》2018,18(10):1934-1949
Background context
Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting.Purpose
This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP.Study design
A systematic review of studies was carried out.Patient sample
No patient sample was required.Outcome measures
Between group standardized mean differences and 95% confidence intervals for APAs ad CPAsMethods
A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted.Results
Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses.Conclusions
There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown. 相似文献7.
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Background
Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain. 相似文献9.
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Background
Low back pain (LBP) is the most prevalent musculoskeletal condition and one the most common causes of disability in the developed nations. Anecdotally, there is a general assumption that LBP prevalence in Africa is comparatively lower than in developed countries. The aim of this review was to systematically appraise the published prevalence studies conducted on the African continent to establish the prevalence of LBP in Africa. 相似文献11.
Amabile Borges Dario Anelise Moreti Cabral Lisandra Almeida Manuela Loureiro Ferreira Kathryn Refshauge Milena Simic Evangelos Pappas Paulo Henrique Ferreira 《The spine journal》2017,17(9):1342-1351
Background
Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP); however, its effectiveness has not been investigated.Purpose
The aim of this review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP.Study Design
This is a systematic review with meta-analysis.Methods
Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared with a control group. Trials deemed clinically homogeneous were grouped in meta-analyses.Results
Eleven studies were included (n=2,280). In chronic LBP, telehealth interventions had no significant effect on pain at short-term follow-up (four trials: 1,089 participants, weighted mean difference [WMD]: ?2.61 points, 95% confidence interval [CI]: ?5.23 to 0.01) or medium-term follow-up (two trials: 441 participants, WMD: ?0.94 points, 95% CI: ?6.71 to 4.84) compared with a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms.Conclusion
There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (eg, apps) and telehealth as an adjunct to usual care remain understudied. 相似文献12.
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Nicholas Henschke Christopher G. Maher Kathryn M. Refshauge 《European spine journal》2007,16(10):1673-1679
To describe the accuracy of clinical features and tests used to screen for malignancy in patients with low back pain. A systematic
review was performed on all available records on MEDLINE, EMBASE, and CINAHL electronic databases. Studies were considered
eligible if they investigated a cohort of low back pain patients, used an appropriate reference standard, and reported sufficient
data on the diagnostic accuracy of tests. Two authors independently assessed methodological quality and extracted data to
calculate positive (LR+) and negative (LR−) likelihood ratios. Six studies evaluating 22 different clinical features and tests
were identified. The prevalence of malignancy ranged from 0.1 to 3.5%. A previous history of cancer (LR+ = 23.7), elevated
ESR (LR+ = 18.0), reduced hematocrit (LR+ = 18.2), and overall clinician judgement (LR+ = 12.1) increased the probability
of malignancy when present. A combination of age ≥50 years, a previous history of cancer, unexplained weight loss, and failure
to improve after 1 month had a reported sensitivity of 100%. Overall, there was poor reporting of methodological quality items,
and very few studies were performed in community primary care settings. Malignancy is rare as a cause of low back pain. The
most useful features and tests are a previous history of cancer, elevated ESR, reduced hematocrit, and clinician judgement. 相似文献
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Chung-Wei Christine Lin Marion Haas Chris G. Maher Luciana A. C. Machado Maurits W. van Tulder 《European spine journal》2011,20(7):1024-1038
Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective
and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed
treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic
reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating
treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included.
Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of
the economic evaluation, the treatment comparators, and the relative cost-effectiveness of the treatment comparators. Twenty-six
studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation
or cognitive-behavioural therapy were cost-effective in people with sub-acute or chronic LBP. Massage alone was unlikely to
be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation
for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found
evidence supporting the cost-effectiveness of the guideline-endorsed treatments of interdisciplinary rehabilitation, exercise,
acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP. There is little or inconsistent
evidence for other treatments endorsed in the guideline. 相似文献
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Hans Heneweer Filip Staes Geert Aufdemkampe Machiel van Rijn Luc Vanhees 《European spine journal》2011,20(6):826-845
The objective of the study is to systematically evaluate the available evidence on the association between physical activity
(i.e. occupational load and non-occupational physical activities) and low back pain (LBP). A systematic approach was used
to explore the literature between 1999 and 2009. Studies were selected for inclusion following a comprehensive search of Medline,
Embase and CINAHL. The methodological quality of each study was assessed. Studies were considered to be of ‘high quality’
if they met the cut-off criterion of 60% of the maximum available quality score. Thirty-six cohort or case–control studies
were retrieved. Heavy workload and the accumulation of loads or frequency of lifts were moderate to strong risk factors for
LBP. Strong associations were found for flexed, rotated and the awkward positions of the lumbar spine. Inconsistent results
were found for leisure time physical activities, sports and physical exercise. Studies focusing on daily habitual physical
activities (e.g. domestic activities and commuting) in association with LBP are lacking. In conclusion, the occurrence of
LBP is related to the nature and intensity of the physical activities undertaken. However, physical activities can be subdivided
into separate types and intensities and the ultimate physical load is the sum of all these activities. This makes it difficult
to designate one particular activity as the cause of LBP. 相似文献
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《The spine journal》2023,23(5):629-641
Background contextCurrently, there are no published studies that compare nonpharmacological, pharmacological and invasive treatments for chronic low back pain in adults and provide summary statistics for benefits and harms.PurposeThe aim of this review was to compare the benefits and harms of treatments for the management of chronic low back pain without radiculopathy and to report the findings in a format that facilitates direct comparison (Benefit-Harm Scale: level 1 to 7).DesignSystematic review and meta-analysis of randomized controlled trials, including trial registries, from electronic databases up to 23rd May 2022.Patient sampleAdults with chronic nonspecific low back pain, excluding radicular pain, in any clinical setting.Outcome measuresComparison of pain at immediate-term (≤2 weeks) and short-term (>2 weeks to ≤12 weeks) and serious adverse events using the Benefit-Harm Scale (level 1 to 7).MethodsThis was a registered systematic review and meta-analysis of randomized controlled trials. Interventions included nonpharmacological (acupuncture, spinal manipulation), pharmacological and invasive treatments compared to placebo. Best evidence criteria was used. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal.ResultsThe search retrieved 17,362 records. Three studies provided data on the benefits of interventions, and 30 provided data on harms. Studies included interventions of acupuncture (n=8); manipulation (n=2); pharmacological therapies (n=9), including NSAIDs and opioid analgesics; surgery (n=8); and epidural corticosteroid injections (n=3). Acupuncture (standardized mean difference (SMD) -0.51, 95%CI -0.88 to -0.14, n=1 trial, moderate quality of evidence, benefit rating of 3) and manipulation (SMD -0.39, 95%CI -0.56 to -0.21, n=2 trials, moderate quality of evidence, benefit rating of 5) were effective in reducing pain intensity compared to sham. The benefit of the other interventions was scored as uncertain due to not being effective, statistical heterogeneity preventing pooling of effect sizes, or the absence of relevant trials. The harms level warnings were at the lowest (eg, indicating rarer risk of events) for acupuncture, spinal manipulation, NSAIDs, combination ingredient opioids, and steroid injections, while they were higher for single ingredient opioid analgesics (level 4) and surgery (level 6).ConclusionsThere is uncertainty about the benefits and harms of all the interventions reviewed due to the lack of trials conducted in patients with chronic nonspecific low back pain without radiculopathy. From the limited trials conducted, nonpharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions. However, more research is needed. There were high harms ratings for opioids and surgery. 相似文献
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Chung-Wei Christine Lin Marion Haas Chris G. Maher Luciana A. C. Machado Maurits W. van Tulder 《European spine journal》2011,20(7):1012-1023
Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back
pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim
of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We
searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies
to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible
for inclusion. Two reviewers independently screened search results and extracted data. Eleven studies were included; the majority
of which conducted a cost-effectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual
GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective
than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more cost-effective
than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise
and/or spinal manipulation was more cost-effective than guideline-based GP care alone. In conclusion, GP care alone did not
appear to be the most cost-effective treatment option for low back pain. GPs can improve the cost-effectiveness of their treatment
by referring their patients for additional services, such as advice and exercise, or by providing the services themselves. 相似文献
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Low back pain in relation to lumbar disc degeneration 总被引：18，自引：0，他引：18
STUDY DESIGN: Cross-sectional magnetic resonance imaging (MRI) study. OBJECTIVES: To study the relation of low back pain (LBP) to disc degeneration in the lumbar spine. BACKGROUND DATA: Controversy still prevails about the relationship between disc degeneration and LBP. Classification of disc degeneration and symptoms varies, hampering comparison of study results. METHODS: Subjects comprised 164 men aged 40-45 years-53 machine drivers, 51 construction carpenters, and 60 office workers. The data of different types of LBP, individual characteristics, and lifestyle factors were obtained from a questionnaire and a structured interview. Degeneration of discs L2/L3-L5/S1 (dark nucleus pulposus and posterior and anterior bulge) was assessed with MRI. RESULTS: An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration. An increased risk of sciatic pain was found in relation to posterior bulges, but local LBP was not related to disc degeneration. The risks of LBP and sciatic pain were strongly affected by occupation. CONCLUSIONS: Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation. 相似文献