Obesity and recovery from low back pain: a prospective study to investigate the effect of body mass index on recovery from low back pain

INTRODUCTION

We describe a prospective cohort study to investigate any association between recovery from low back pain and body mass index (BMI) in patients with low back pain undergoing physiotherapy.

PATIENTS AND METHODS

A total of 140 patients with low back pain and no evidence of neurological deficit were divided into three groups based on their BMI. All patients underwent a back-specific physiotherapy programme for 6 or 12 weeks. Recovery parameters such as pain intensity (visual analogue scale scores) and physical impairment index scores were measured. The range of motion of the lumber spine was also recorded. These variables were compared pre- and post-treatment.

RESULTS

Mean age of the patients was 38 years (range, 18–67 years) with 62% males and 38% females. The treatment resulted in significant improvements in all the recovery parameters (P < 0.005, paired t-test). No significant association was detected between the BMI of subjects and percentage changes in pain intensity, physical impairment index, and range of motion of the lumbar spine. A comparative analysis of the after treatment recovery parameter scores in normal (BMI ≤ 24.9 kg/m²), overweight (BMI 25–29.9 kg/m²) and obese (BMI ≥ 30 kg/m²) patients revealed no significant differences in the mean pain intensity and mean self-experienced impairment and disability scores amongst the groups.

CONCLUSIONS

This study demonstrates that BMI does not influence the overall recovery from low back pain in patients undergoing physiotherapy treatment.     

Generalized joint laxity as a predictor of recovering from low back pain during pregnancy – A prospective study

BackgroundLow back pain (LBP) is a common musculoskeletal problem during pregnancy. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. Individuals with generalized joint laxity (GJL) were expected to have more injuries on lumbar discs and require prolonged healing time. Therefore, this study aims to investigate whether the test of GJL before the pregnancy could predict the prognosis of pregnancy-related LBP.Methods375 women were recruited from January 2017 to October 2017 in antenatal clinics. Those who suffered the LBP during pregnancy were analyzed and further grouped based on whether they recovered from LBP after deliver. The variables such as age, GJL level using Beighton score, and parity were recorded and examined for the risk analysis of unrecovered LBP. Also, the cut-off point for the Beighton score was determined by the receiver operating characteristic (ROC) curve, and the Pearson correlation between GJL levels and pain intensities was investigated.Results324 pregnant women completed this study. The mean age of included participants was 29.4 ± 4.6 years. Thereinto, 210 women (64.8%) had LBP during their pregnancy. Of these, 51 women (24.3%) failed to recovery from LBP 2 years after delivery. Beighton score (≥6), LBP in a previous pregnancy, back pain, and high physical demand were risk factors for LBP without recovery (all P < 0.001). Besides, there was a significant correlation between HGS values and the intensities of LBP (r = ?0.564, P = 0.002).ConclusionsBeighton score is a straightforward and reliable indicator of GJL, and the evaluation before pregnancy using it could help screen high risks for pregnancy-related LBP. The present findings may help encourage pregestational exercise targeted at trunk extensors to help alleviate and even avoid the intensities of LBP during pregnancy.     

Isometric lifting strength as a predictor of industrial back pain reports

The objective of our investigation was to study isometric lifting strength in a population of industrial workers who perform a great variety of manual tasks, and to determine whether isometric strength is predictive of future back problems in such a population. Of 3,020 study subjects, 2,178 (72%) underwent strength testing in three standard lifting positions. During a 4-year follow-up period, 172 subjects tested reported back problems. When examining each isometric lift separately as a predictor of industrial back pain reports, those with greater isometric strength were at significantly greater risk than were weaker workers. However, after controlling for the effects of age, only a slight trend remained. For the blue collar workers in this study, isometric lifting strength testing was ineffective in identifying individuals at risk for industrial back problems.     

Spinal mechanical load: a predictor of persistent low back pain? A prospective cohort study

Prospective inception cohort. To assess the prognostic value of spinal mechanical load, assessed with the 24-hour schedule (24HS), in subjects with acute non-specific low back pain (ALBP) and to examine the influence of spinal mechanical load on the course of ALBP. In view of the characteristics of the natural course of ALBP, this should be viewed as a persistent condition in many patients rather that a benign self-limiting disease. Therefore, secondary prevention could be beneficial. Spinal mechanical load is a risk factor for ALBP and possibly a (modifiable) prognostic factor for persistent (i.e. recurrent and/or chronic) LBP. One hundred patients from primary care with ALBP were eligible for inclusion. At 6 months, 88 subjects completed the follow-up. For the follow-up assessment a research assistant, unaware of our interest in the prognostic factors, contacted the subjects by telephone. Questionnaires were completed focusing on changes in demographic data and on the course and current status of ALBP. Persistent LBP occurred in 60% subjects. After multivariate regression analysis smoking (harmful) and advanced age (protective) were associated with persistent LBP. Differences in 24HS scores at baseline and follow-up were univariate-related to persistent LBP. Spinal mechanical load, quantified with the 24HS, is not a prognostic factor for persistent LBP. Modification of spinal mechanical load in terms of 24HS scores could be beneficial for secondary prevention in patients with acute LBP.     

Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population

Background  

It has previously been shown that low back pain (LBP) often presents already in the teenage years and that previous LBP predicts future LBP. It is also well documented that there is a large degree of comorbidity associated with LBP, both in adolescents and adults. The objective of this study is to gain a deeper insight into the etiology of low back pain and to possibly develop a tool for early identification of high-risk groups. This is done by investigating whether different types of morbidity in adolescence are associated with LBP in adulthood.     

A prospective follow-up study of low back pain in the community

STUDY DESIGN: Opportunistic prospective follow-up study. OBJECTIVE: To describe the natural history of low back pain in the community and to model the factors predictive of recovered versus persistent low back pain. SUMMARY OF BACKGROUND DATA: A two-phase questionnaire was mailed to adults in the Bradford Metropolitan Health District in 1994. Valid respondents were surveyed again in 1997. Analysis is based on the combined results of these two surveys. METHODS: Unifactorial and multifactorial statistics were analyzed based on 1455 adults, with and without low back pain. RESULTS: One third of respondents reported no lifetime low back pain. Average lifetime prevalence was 59% and average annual prevalence 41%. Of those who reported lifetime low back pain, 42% reported persistent annual low back pain, 18% reported a first episode in 1997, resulting in a 4% population incidence rate, and 40% reported intermittent low back pain. The likelihood of having had low back pain increased significantly with age. Those who reported a new case of low back pain in 1997 were significantly more likely to be 25-34 years of age, and these persons were most likely to report acute low back pain with very little disability. Those with persistent low back pain were significantly more likely to report chronic low back pain with some disability. Logistic regression modeling was unable to predict recovered versus persistent low back pain, given the person, pain, and treatment factors available. CONCLUSIONS: Results showed that low back pain is a mutable problem with acute episodes blending into longer periods resulting in more disability as time progresses. A wide range of demographic, pain, consultation, and treatment factors were not predictive of low back pain recovery.     

Radiotherapy for pain in chronic, degenerative low back pain syndrome--results of a prospective randomized study

AIM OF STUDY: A low-dose radiotherapy with 5 Gy on the lumbar spine in patients with chronic low back pain was investigated. METHOD: 31 patients with non-radicular low back pain since three years at the age of at least 50 years (64.3 years on average) were treated. A psychosomatic etiology of pain was excluded. 5 Gy or 0.5 Gy (placebo dose) were applied in five fractions to the lumbar spine including the facet joints. The pain was evaluated by means of the Oswestry-Disability-Score before, six weeks after therapy, and every three months during the follow-up (22.4 months on average). Drug therapy, physiotherapy, and physical treatment were continued. RESULTS: According to the randomised distribution, 18 patients were treated with 5 Gy and 13 patients with 0.5 Gy. The Friedman-Test did not reveal any significant difference (p > 0.05) of the Oswestry-Disability-Index before and after therapy for both single questions and the sum of questions in both groups. CONCLUSION: No significant decrease of the Disability Index after radiotherapy on the lumbar spine with 5 Gy could be demonstrated in the verum and placebo group. The authors do not recommend radiotherapy in cases of chronic low back pain. Individual successes have to be attributed to conservative treatment or placebo effects.     

Hand grip strength in the adult Malaysian population

PURPOSE: To measure the hand grip strength of Malaysians aged 18 to 65 years. METHODS: Between January and April 2003, 412 subjects (200 women and 212 men) were recruited from staff, students, and visitors of the University of Malaya Medical Centre. Socioeconomic, general health, and lifestyle data were collected from each subject using a standard questionnaire. Weight and height were measured prior to testing. Standardised positioning and instructions based on several hand grip protocols were used. Data were collected using the LIDO kinetic work set. RESULTS: 93% of the subjects were right-hand dominant and 7% were left-hand dominant. Hand grip strength was significantly correlated with hand dominance, gender, occupation, height, and weight, but not body mass index. No significant differences in grip strength were noted with regard to race or level of income. Men were stronger than women in all age-groups, with a ratio of 1.75:1. In both right- and left-hand dominant groups, the dominant hand was consistently stronger than the non-dominant side, with a ratio of 1.12:1 in the right-hand dominant group and 1.05:1 in the left-hand dominant group. The strongest hand grip strength in the right-hand dominant group occurred in the age-group of 25 to 34 years; in the left-hand dominant group it was in the age-group of 18 to 24 years. In western populations, the mean grip strength can be as much as 1.5 times greater than in the Malaysian population. CONCLUSION: Data derived from western populations cannot be applied to a comparable Malaysian population. Gender, hand dominance, age, occupation, weight, and height must be considered when establishing normal values for grip strength.     

Prognosis of acute low back pain: design of a prospective inception cohort study

Background  

Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain.     

经皮内镜腰神经根减压术后疼痛症状改善进展的研究

目的观察评估经皮脊柱内镜腰神经根减压术(PELD)术后腰腿疼痛症状的早期改善进展。 方法对解放军总医院2015年1月至2016年1月连续93例中84例PELD治疗腰背痛及神经根性疼痛症状的患者,前瞻性记录术后12周(各1周1次)的腰背痛视觉模拟评分(VAS)和下肢痛VAS,观察评估两种疼痛症状的改善进展并比较两者的改善度,用术后12周时腰背痛及下肢痛VAS、功能障碍指数评分(ODI)和改良MacNab疗效评定标准评价手术疗效。 结果腰背痛症状术后VAS评分相邻两周间比较,差异无统计学意义(P> 0.05);下肢痛症状术后VAS评分的术后2周与术后1周比较[(2.96 ± 1.97)分 vs (2.10 ± 1.29)分]、术后4周与术后3周比较[(2.04 ± 1.62)分 vs (2.46 ± 1.97)分],差异有统计学意义(P<0.05);余下相邻两周间比较,差异无统计学意义(P > 0.05);下肢痛术后12周VAS改善度与腰背痛VAS改善度比较[(6.64 ± 1.47)分 vs (3.36 ± 1.38)分],差异有统计学意义(P < 0.05);术后12周时ODI、腰背痛VAS、下肢痛VAS均较术前显著降低[(12.82 ± 6.39)分 vs (53.64 ± 11.73)分、(1.16 ± 1.06)分 vs (4.52 ± 0.65)分、(1.29 ± 1.30)分 vs (7.93 ± 0.81)分],改良MacNab疗效评定标准评价优良率为86%。 结论PELD术后早期12周,腰背痛的症状改善平稳,下肢痛的症状改善在术后2周、术后3周出现波动,下肢痛症状比腰背痛症状改善更快,手术疗效显著。     

The intensity of work recovery in low back pain

The intensity of work recovery in LBP has been studied using the National Health Register. Nine hundred forty men, 40-47 years old, were selected randomly from the census register of the city of G?teborg, Sweden. Sickness absence data were obtained from the Health Register, in which all sickness absence from age 16 is recorded. The rate of return to work decreases as expected with an increase in absence period. Different rates were found for different diagnoses, however, with low return intensities in patients with sciatica compared with those with back pain, ie, return to work was slower in patients with sciatica. Men with manual work had a significantly longer average sickness absence than white-collar workers. The intensity of work recovery was lower in blue-collar workers during the first 20 days of absence, while the reverse was true after 20 days of sickness absence, ie, the white-collar workers who were absent more than 20 days had a slower rate of recovery than blue-collar workers who had been absent for 20 days. Data as presented here can be used to study the effect of intervention (for example, manual therapy) on the natural course of work recovery. It also can be used, as above, to study differences in sickness absence patterns between different diagnoses and work groups.     

A controlled, prospective study to evaluate the effectiveness of a back school in the relief of chronic low back pain

Ninety-two chronic low back pain patients were randomly allocated to two groups to evaluate the effectiveness of a back school compared with an exercise-only regimen according to specified outcome variables. The data from 78 patients with 7 years mean duration of symptoms was analyzed. Three assessments were made: before treatment and 6 and 16 weeks after treatment. Changes in patients' levels of pain, functional disability, and other related variables were compared in the two groups. Almost all variables showed an improvement at 6 weeks. At 16 weeks, functional disability and pain levels showed a significant difference. Back school patients continued to make an improvement. This method of managing low back pain makes maximal use of limited resources and appears to be effective, especially in the longer term.     

Predictors of isokinetic back muscle strength in patients with low back pain

STUDY DESIGN: Testing for trunk muscle strength was performed on 105 patients with chronic low back pain. OBJECTIVES: To investigate prediction of isokinetic back muscle strength in patients with low back pain. SUMMARY OF BACKGROUND DATA: The clinical evaluation of patients with chronic low back pain often in difficult because of discrepancy between disability and impairment. The isokinetic trunk device was developed as a tool for objective assessment of back muscle strength. However, the performance of patients depends on radiologic abnormalities of the spine, conditions of the back muscles, and various psychosocial factors. Studies are warranted that address how these variables influence back muscle strength. METHODS: The patients with chronic low back pain were tested by an isokinetic trunk muscle strength test (Cybex TEF, Ronkonkoma, NY). In addition, the following variables were recorded: gender, age, body mass index, emotional distress, pain on exertion, self-efficacy for pain, degenerative changes of the lumbar spine, cross-sectional area, and density of the erector spinae muscles. The three latter variables were estimated by computed tomography scans. The sum of the total work performed during isokinetic extension strength test was the dependent variable in a multiple regression analysis, and anthropometric, demographic, psychological, and radiologic factors were independent variables. RESULTS: Gender, cross-sectional muscle area, and pain on exertion were the most powerful predictors of isokinetic back muscle strength. The final regression model, which included these variables, could account for approximately 40% of the variability in back muscle strength. CONCLUSION: For assessing the results of an isokinetic trunk muscle strength test, cross-sectional muscle area, gender, and pain on exertion should be taken into account.     

Physical characteristics of the back are not predictive of low back pain in healthy workers: A prospective study

Background  

In the working population, back disorders are an important reason for sick leave and permanent work inability. In the context of fitting the job to the worker, one of the primary tasks of the occupational health physician is to evaluate the balance between work-related and individual variables. Since this evaluation of work capacity often consists of a physical examination of the back, the objective of this study was to investigate whether a physical examination of the low back, which is routinely performed in occupational medicine, predicts the development of low back pain (LBP).