Evaluation der Neuen Rückenschule

Background

According to the biopsychosocial approach of the German new back school the core objectives are sustainable improvement of physical and psychosocial health resources. Subjects with non-specific low back pain were investigated to evaluate the desired physical effects.

Methods

Coordinative and postural motor exercises were evaluated by means of surface electromyography (EMG). Applying a modified waiting group design 56 participants were examined 3 months before the start, at the beginning and at the end of the new back school program as well as 3 and 12 months after completion and the results were compared to a healthy control group (n=56) matched for age and body mass index (BMI).

Results

Initially significant group differences were found in 18?% of all statistical calculations of the static and 6?% of the dynamic test situations. Considering the trunk muscles the most frequent significant alterations from normative data were found in the lumbar multifidus muscle (static tests 29?% and dynamic tests 7?%). No relevant changes in the number of statistical results could be detected directly after completion of the new back school program. Nevertheless, at 12 months follow-up the number of significant differences to the normative data of the control group dropped by one third to 12?% of all calculations with static loads.

Conclusion

The adjustment effects at 12 months follow-up indicate a delayed positive influence of the new back school program on muscular physiological parameters. Individuals with chronic non-specific back pain showed a long-term profit from participation in the new back school program due to the initiated orientation to a modified more active lifestyle.     

Evaluation der Neuen Rückenschule

Background

Results related to the outcome of the classical back schools are inconsistent. Accordingly, a reformulation of the program integrating psychological and social aspects was performed as a necessary step for the development of the new back school in Germany. The aim of this study was to assess the effectiveness and sustainability of the new back school in subjects with non-specific back pain in the prevention setting.

Material and methods

In a modified waiting design, individuals were investigated with respect to demographical, pain-related and psychological characteristics 3 months before the start, at the start and at the end of the back school and as well as 12 months after completion. In addition, predictors for a successful participation were analyzed.

Results

A total of 88 subjects with back pain initially participated in the study. In the short and long-term course, low to moderate effects were detected; however, during follow-up a reduction of pain showed high effects. Depression as assessed by the hospital anxiety and depression scale (HADS) and passive coping strategies assessed using the coping strategies questionnaire (CSQ) were identified as predictors for response to the intervention.

Conclusion

On the basis of the sample studied, the new back school proved to be an effective treatment for short and long-term reduction of pain-related stress and associated psychological aspects. Maladaptive, passive coping strategies and higher depression scores were associated with a higher probability of success in terms of pain reduction and functional improvement.     

Verhaltensbeobachtung zur Erfolgsmessung einer Rückenschule zur Prävention chronischer Schmerzen

Sixteen experienced and 15 inexperienced observers watched videotapes showing participants of a back school program perform simple tasks to assess the functional adequacy of their posture. They had received basis or more extensive observer training. Intraclass correlation coefficients were computed as a measure of intra-and interobserver reliability. When individual judgments were compared, it was found that the judgments of the experienced observers were more reliable than those of the inexperienced observers. The additional observers training did not lead to a significant augmentation of reliability. By selecting the most reliable items two alternative measures of overall posture were constructured whose reliability coefficients ranged fromr=0.89 to 0.93 for the group of experienced observers. The reliability of the judgments by the more extensively trained inexperienced observers was also satisfactory. The observation method presented here can thus be regarded as a reliable and potentially valid instrument for assessing the outcome of back school programs.     

Echokardiographie für den Internisten

Im Rahmen der internistischen Sprechstunde stellt sich ein 75-j?hriger Patient vor. Er klagt über zunehmende Atemnot, welche früher nur bei st?rkerer k?rperlicher Belastung eingesetzt h?tte. Zurzeit liegt eine Belastbarkeit mit einem Stockwerk Treppensteigen vor, dann Abbruch wegen Atemnot und Ersch?pfung der peripheren Muskulatur. Innerhalb der letzten 5 Monate ist eine langsame Gewichtszunahme von insgesamt 5 kg aufgetreten. Seit 2–3 Jahren besteht eine Nykturie, deren Frequenz von zun?chst einmal pro Nacht nach Aussage des Patienten innerhalb der letzten Monate zugenommen hat. Bei dem Patienten ist ein arterieller Hypertonus bekannt, die aktuell gemessenen Blutdruckwerte liegen bei 164/92 mmHg. Dieser wird mit einer Dreifachkombination aus Angiotensin-converting-Enzym-(ACE-)Hemmer, Calciumantagonist und β-Blocker behandelt.     

Risikofaktoren für Rückenschmerzen bei Kindern und Jugendlichen in Industrienationen

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.     

Kommunikation und Befundaustausch zwischen Hausärzten und Orthopäden bei Rückenschmerzen

Introduction

Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate the level of communication between general practitioners (GPs) and orthopaedic surgeons.

Material and methods

In this retrospective observational study referrals from GPs and corresponding response letters from orthopaedic surgeons were analyzed. GPs were asked to provide reasons for referral and to rate the quality of the response letters.

Results

A total of 12 out of 82 GPs from the teaching network of the Medical School of Göttingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 months, 34% (n=312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral contrary to their self-perception. Most referrals (61%) were initiated by patients and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back, GPs received a response letter for only one-third (114/312) of the patients. GPs rated most of them as satisfactory, however, 59% were unsatisfied with the treatment recommendations. Only 10% of the letters contained psychosocial details. The information provided in the orthopaedic response letters was heterogeneous and only partly fulfilled the criteria set by the Interdisciplinary Society for Orthopaedic Pain Management.

Conclusion

Incomplete and scant information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest that current health care system and referral forms do not promote effective communication about the patient. This might explain the satisfaction of GPs with the orthopaedic response letters despite the lack of information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment options for chronic low back pain in ambulatory care.     

Manualmedizinische Denkansätze für die Behandlung des tiefen Rückenschmerzes

Zusammenfassung Der tiefe Rückenschmerz ist ein Krankheitsbild, das schwierig zu diagnostizieren ist. Eine angemessene und kosteneffektive Behandlung erfordert eine genaue Diagnose. Die manualmedizinische Annäherung an den tiefen Rückenschmerz schließt die komplexen Wechselbeziehungen zwischen Struktur und Funktion ein. Behandlungsmethoden, die auf konservative Art die myofasziale, ligamentäre und artikuläre Integrität wiederherstellen, können die Inzidenz des failed back syndrome verringern. Durch das Erkennen der anatomischen und physiologischen Veränderungen, die diese Funktionsstörungen hervorrufen, verbessert die Anwendung osteopathischer manipulativer Therapie das Behandlungsergebnis und die Lebensqualität des Patienten wesentlich.Liebe Leserinnen und Leser,wir möchten Ihnen heute eine Veröffentlichung in englischer Sprache anbieten.Prof. Paul R. Rennie vom Department of Osteopathic Manipulative Medicine, Touro University Nevada, hat uns den Artikel Osteopathic reasoning for the treatment of low back pain (Manualmedizinische Denkansätze für die Behandlung des tiefen Rückenschmerzes) zur Publikation eingereicht. Es ist ein Versuch, in Einzelfällen einen aus den USA oder Großbritannien eingereichten Beitrag im Original zu veröffentlichen. Der Sinn einer Veröffentlichung im Original liegt z. B. auch darin, kennenzulernen, wie Fachtermini im Englischen gebraucht werden, die dann bei Eindeutschung oder deutscher Übersetzung oft nicht mehr dem ursprünglichen Sinn voll entsprechen. So ist im vorliegenden Falle der Herausgeber der Meinung, dass das amerikanische osteopathic reasoning dem deutschen manualmedizinische Denkansätze entspricht.Es ist nicht beabsichtigt, zukünftig die deutschsprachige Zeitschrift für Manuelle Medizin durch Veröffentlichung englischsprachiger Beiträge zu füllen. Wir werden weiterhin interessante Publikation aus dem Englischen übersetzen und in der Manuellen Medizin zweitpublizieren. Für eine Verbreitung der in der Manuellen Medizin publizierten Ergebnisse sind die jeweils beigefügten englischen Kurzfassungen erforderlich. Sollte die Leserschaft die Publikation einzelner englischsprachiger Artikel grundsätzlich ablehnen, so soll dies nicht wieder vorkommen. Ihre Meinung zu allen Facetten der Gestaltung unserer Zeitschrift ist den Herausgebern wichtig.L. Beyer, R. Kayser     

Qualitätsindikatoren für die Versorgung von Patienten mit Rückenschmerzen

Introduction

Low back pain (LBP) is an epidemiologically and economically relevant health care problem appropriate for quality assurance approaches. Therefore an expert panel (AQUIK) of the National Association of Statutory Health Insurance Physicians has proposed three quality indicators (QI) for monitoring the quality of ambulatory care for LBP. The aim of this article is to present and evaluate the proposed QIs.

Material and methods

The three proposed QIs relating to red flags, imaging and sick leave certificates were evaluated with regard to the underpinning evidence, epidemiology and feasibility. Guidelines and original research as well results from surveys and observational studies evaluating adherence to LBP guidelines were used for assessment.

Results

The expert panel concluded that only the recording of red flags is a relevant and feasible QI. Despite a two-stage expert method the epidemiology of LBP, feasibility and existing routine health care data were not sufficiently taken into account. The author’s conclusion differs in two instances. The red flag concept is not sufficiently clinically validated and recordable to be used as a QI. Otherwise imaging is considered a suitable QI given the observed overuse and the availability of billing data.

Conclusion

Deriving valid and pragmatic QI from LBP guidelines for evaluating care for LBP is difficult. The core messages of guidelines are only recommendations with limited precision and transferability to individual patients. For pragmatic reasons definition of an upper or lower proportion of patients receiving a given health care service is recommended instead of tedious individual evaluation. Reasonable estimates can be based on data from research on health care services. Because of this uncertainty QIs should be evaluated before they are used as a steering instrument.     

Schmerzbewältigung für Rheumapatienten

Ohne Zusammenfassung     

Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport

Background

Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes.

Methods

The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months.

Results

We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF).

Conclusion

Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.

     

Die Muskulatur als Ursache für Rückenschmerzen

Zusammenfassung Die Funktion der Muskulatur scheint eine wichtige Rolle bei der Entstehung und Aufrechterhaltung chronischer Rückenschmerzen zu spielen. Eine muskuläre Insuffizienz, wie sie bei Rückenpatienten in vielen Untersuchungen nachgewiesen werden konnte, belastet die passiven, schmerzauslösenden Anteile der Wirbelsäule. Dabei spielt die funktionelle Instabilität der Wirbelsäule eine große Rolle. In den letzten Jahren konnten diese Veränderungen durch Oberflächen-EMG mittels Spektralanalyse, Untersuchung von Muskelfasertyp und -größe sowie durch Analyse der Körperkoordination nachgewiesen werden. Da viele Patienten mit chronischen Rückenschmerzen neben muskulärer Insuffizienz auch psychosoziale Probleme haben und ein ausgeprägtes Schon- und Vermeidungsverhalten zeigen, sind therapeutisch neben einem muskulären Training auch psychotherapeutische Maßnahmen notwendig.     

Modifizierung der 1982 ACR-Kriterien für den SLE

Ohne Zusammenfassung