我国南方腰痛和膝痛患病率低于北方:汕头COPCORD研究报告

目的验证20世纪80年代中国-国际抗风湿联盟(ILAR-China)调查所见,我国南方腰痛(LP)、膝痛(KP)患病率低于北方的结果,并且探讨相关危险因素.方法用社区控制风湿病规划(COPCORD)第Ⅰ、Ⅱ期询问表,对澄海市区16岁以上居民2040名进行调查.有风湿症状者进行体检,疑似关节炎者进行X线和实验室检查.结果风湿痛总患病率为18.1%;KP 7.5%,其中55%为膝骨关节炎;LP患病率11.5%,其中69%为腰椎骨关节炎.平房居民KP患病率为5.6%,LP 7.9%;而楼房居民KP9.1%,LP 16.2%.KP、LP 患病率均低于北京所见.结论我国南方KP和LP患病率明显低于北方,推测与气候因素有关.楼房居民KP、LP患病率高于平房居民,可能和人体功率学有关.     

Smartphone apps for the self-management of low back pain: A systematic review

Guidelines for low back pain (LBP) often recommend the use of self-management such as unsupervised exercise, booklets, and online education. Another potentially useful way for patients to self-manage LBP is by using smartphone applications (apps). However, to date, there has been no rigorous evaluation of LBP apps and no guidance for consumers on how to select high-quality, evidence-based apps. This chapter reviews smartphone apps for the self-management of LBP and evaluates their content quality and whether they recommend evidence-based interventions.This chapter shows that generally app developers are selecting interventions that are endorsed by guidelines, although their quality is low. There are many apps available for the self-management of LBP, but their effectiveness in improving patient outcomes has not been rigorously assessed. App developers need to work closely with healthcare professionals, researchers, and patients to ensure app content is accurate, evidence based, and engaging.     

Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain: a review of the literature

Abstract

Osteitis condensans ilii (OCI) is a benign pathology causing chronic back and hip pain. Although the definitive cause is uncertain, mechanical stress is a significant factor in the development of the disease. Bilateral involvement of the sacroiliac joint is typical. We describe a case of unilateral OCI with unilateral sclerosis observed at radiography in a 34-year-old patient presenting with chronic back and hip pain, together with a review of the literature.     

Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines

Given the scale and cost of the low back pain problem, it is imperative that healthcare professionals involved in the care of people with low back pain have access to up-to-date, evidence-based information to assist them in treatment decision-making. Clinical guidelines exist to promote the consistent best practice, to reduce unwarranted variation and to reduce the use of low-value interventions in patient care. Recent decades have witnessed the publication of a number of such guidelines. In this narrative review, we consider three selected international interdisciplinary guidelines for the management of low back pain. Guideline development methods, consistent recommendations and inconsistencies between these guidelines are critically discussed.     

Prevalence of low back pain as the primary pain site and factors associated with low health-related quality of life in a large Japanese population: a pain-associated cross-sectional epidemiological survey

Abstract

Objectives. This study aimed to estimate the prevalence, magnitude, and direction of the associations among disability, pain intensity, number of pain sites, and health-related quality of life (HRQoL) in patients reporting low back pain (LBP) as their primary pain.

Methods. In January 2009, an Internet survey was performed for randomly selected adults aged 20–79 years who were registered as Internet research volunteers. Of 20 044 respondents, individuals with LBP as the primary pain were analyzed for associations among disability, number of pain sites, and HRQoL. Factors associated with low HRQoL were examined using multiple logistic regression modeling.

Results. Of the 20 044 respondents, 25.2 % (n = 5060) reported LBP and 13.5 % (n = 2696) reported LBP as their primary pain. Among those with LBP as the primary pain, HRQoL decreased with increase in disability and number of pain sites. In multivariate analyses, disability [adjusted odds ratio (aOR), 2.93–4.58], number of pain sites (aOR, 1.42–6.12), pain intensity ≥7 (aOR, 1.88), and age ≥60 years (aOR, 1.55) were associated with low HRQoL.

Conclusions. Approximately 13.5 % of patients reported LBP as their primary pain. Disability with absence from social activity and ≥7 pain sites were strongly associated with low HRQoL.     

Evaluating and managing acute low back pain in the primary care setting

Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations.     

Randomized trial of a self‐management program for primary care patients with acute low back pain: Short‐term effects

Objective

We evaluated the effect of a self‐management program (SMP) on primary care patients with acute low back pain (ALBP) from low income, inner city neighborhood health centers and an emergency department of a public teaching hospital.

Methods

We randomized 211 primary care patients who visited a physician for ALBP (<90 days duration) to usual care or an SMP. The SMP consisted of 3 group sessions and telephone followup that focused on understanding back pain, increasing physical activity, and dealing with fears and frustrations.

Results

Of the eligible patients, 52% expressed interest in participation and 39% of all eligible patients were randomized into the study. Among patients in the treatment group, 28.3% attended at least 1 group class, 62.3% received the intervention by mail, telephone, and audiotapes, and 9.4% received no intervention. Interviewers, blinded to the treatment given, collected data at baseline and at 4 months following randomization. Compared with the control group, the intervention group reported significantly better emotional functioning (P < 0.01), increased self efficacy to manage ALBP (P = 0.03), and less fear of movement (P = 0.05) after 4 months.

Conclusion

This SMP produced short‐term improvements in emotional functioning and self efficacy to manage symptoms among patients with ALBP living in the inner city. However, methods of program delivery other than group classes are needed to reach a greater portion of the inner city patients.

     

Development of a booster intervention for graded sensorimotor retraining (RESOLVE) in people with persistent low back pain: A nested,randomised, feasibility trial

Introduction

Low back pain contributes to an increasing global health burden exacerbated by unsustained improvements from current treatments. There is a need to develop, and test interventions to maintain initial improvements from low back pain treatments. One option is to implement a booster intervention. This study aimed to develop and test the feasibility of implementing a booster intervention delivered remotely to supplement the benefits from a complex intervention for chronic low back pain.

Method

This study was nested in the RESOLVE trial. The booster intervention was developed by an expert group, including a clinical psychologist, exercise physiologist and physiotherapists, and based on a motivational interviewing framework. We developed a conversational flow chart to support the clinician to guide participants towards achieving their pre-specified personal goals and future low back pain self-management. Participants with chronic low back pain who were aged over 18 years and fluent in English were recruited. The booster intervention was delivered in one session, remotely, by telephone. The intervention was considered feasible if: participants were able to be contacted or <3 contacts were necessary to arrange the booster session; there were sufficient willing participants (<15% of sample unwilling to participate); and participants and research clinicians reported a perceived benefit of >7/10.

Results

Fifty participants with chronic non-specific low back pain were recruited to test the feasibility of implementing the booster intervention. Less than three contact attempts were necessary to arrange the booster session, only one participant declined to participate. Participants perceived the session to be beneficial; on a 0 to 10 scale of perceived benefit, the average score recorded was 8.3 (SD 2.0). Clinicians also reported a moderate perceived benefit to the participant; the average score recorded by clinicians was 6.3 (SD 1.6).

Conclusion

We developed a step by step, simple booster intervention that was perceived to be beneficial to participants with chronic low back pain. The booster can feasibly be delivered remotely following a complex intervention.     

Acute low back pain self‐management intervention for urban primary care patients: Rationale,design, and predictors of participation

Objectives

To describe the rationale and design of a self‐management program for low‐income, urban, primary care patients with acute low back pain. Issues related to recruitment and protocol delivery, and attendance patterns and predictors of program attendance are described.

Methods

Two hundred eleven adult patients (73% female; 60% African American) were recruited from primary care neighborhood health centers. Focus groups were conducted for program development, and participants then completed a baseline interview and were randomized into groups receiving either usual care or a self‐management intervention.

Results

Twenty‐nine percent of the intervention group attended the self‐management class. Significant predictors of attendance included being older, reporting less income, and not working for pay. Attendees did not differ from nonattendees on back pain severity, symptoms, health‐related quality of life, self‐management processes, or satisfaction with care.

Conclusion

Effective minimal‐contact behavioral interventions are needed to reach larger portions of the patient population.

     

Optimising management of low back pain through the pain and disability drivers management model: Findings from a pilot cluster nonrandomised controlled trial

Introduction

Low back pain (LBP) remains the leading cause of disability. The Low Back Pain and Disability Drivers Management (PDDM) model aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the feasibility of conducting a pragmatic controlled trial of the PDDM model and to explore its effectiveness compared to clinical practice guidelines' recommendations for LBP management.

Methods

A pilot cluster nonrandomised controlled trial. Participants included physiotherapists and their patients aged 18 years or older presenting with a primary complaint of LBP. Primary outcomes were the feasibility of the trial design. Secondary exploratory analyses were conducted on LBP-related outcomes such as pain severity and interference at 12-week follow-up.

Results

Feasibility of study procedures were confirmed, recruitment exceeded our target number of participants, and the eligibility criteria were deemed suitable. Lost to follow-up at 12 weeks was higher than expected (43.0%) and physiotherapists' compliance rates to the study protocol was lower than our predefined threshold (75.0% vs. 57.5%). A total of 44 physiotherapists and 91 patients were recruited. Recommendations for a larger scale trial were formulated. The PDDM model group demonstrated slightly better improvements in all clinical outcome measures compared to the control group at 12 weeks.

Conclusion

The findings support the feasibility of conducting such trial contingent upon a few recommendations to foster proper future planning to determine the effectiveness of the PDDM model. Our results provide preliminary evidence of the PDDM model effectiveness to optimise LBP management.

Clinical Trial Registration

Clinicaltrial.gov , NCT04893369.     

Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults

OBJECTIVES: To determine the efficacy of a complementary analgesic modality, percutaneous electrical nerve stimulation (PENS), for the treatment of chronic low back pain (CLBP) in community-dwelling older adults. DESIGN: Randomized, controlled clinical trial. SETTING: University of Pittsburgh Pain Evaluation and Treatment Institute. PARTICIPANTS: Thirty-four English speaking, community-dwelling adults aged 65 and older with CLBP of at least moderate intensity experienced every day or almost every day. INTERVENTION: Subjects were randomized to receive twice-weekly PENS and physical therapy (PT) or sham PENS and physical therapy for 6 weeks. MEASUREMENTS: At baseline, immediately after the 6-week intervention period, and 3 months later, the primary outcome measures pain intensity and pain-related disability were assessed. The secondary outcome measures physical performance (timed chair rise, functional reach, gait speed, static and isoinertial lifting), psychosocial factors (mood, sleep, and life control), and cognitive function (measures of attention, concentration, and mental flexibility) were also collected. RESULTS: Subjects randomized to PENS plus PT displayed significant reductions in pain intensity measures from pre- to posttreatment (P <.001), but the sham PENS plus PT group did not (P =.94). These pain reduction effects were maintained at 3-month follow-up. Similarly, significant reductions in pain-related disability were observed at posttreatment (P =.002) for the PENS plus PT group and were maintained at follow-up, but the sham PENS plus PT group did not show reductions in pain-related disability (P =.81). Of the secondary outcome measures, psychosocial function, timed chair rise, and isoinertial lifting endurance also improved significantly at posttreatment for the PENS plus PT group, and their improvement was sustained at 3-month follow-up, but the sham PENS plus PT did not display significant changes on these measures after treatment. CONCLUSION: This preliminary study suggests that PENS may be a promising treatment modality for community-dwelling older adults with CLBP, as demonstrated by reduction in pain intensity and self-reported disability, and improvement in mood, life control, and physical performance. Larger studies with longer duration of follow-up are needed to validate these findings and support the use of PENS in clinical practice.     

A double-blind,multicentre, randomised clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain

 The efficacy and tolerability of aceclofenac was compared with diclofenac resinate in a double-blind, multicentre randomised study in patients with acute low back pain suffering from degenerative spinal disorders. The study included 227 patients randomised to receive either aceclofenac 2 × 100 mg daily or diclofenac resinate 2 × 75 mg daily for up to 10 days. The primary objective was to demonstrate the clinical non-inferiority of the analgesic efficacy of aceclofenac compared with diclofenac resinate, as assessed by changes from baseline in the visual analogue scale (0–100 mm) pain score, at rest and at visit 3 (final visit on day's 8–10). Secondary objectives included the time to early cure (resolution of pain) and global assessment of tolerability. Mean change in pain score at rest, and as visit 3, compared with baseline, was 61.6 mm (SD 24.5) for the aceclofenac group (n = 100) and 57.3 mm (SD 22.8) for the diclofenac resinate group (n = 105) in the per-protocol population. Similar changes were observed in the intention-to-treat population. Between-group differences of 4.5 mm and 5.5 mm for the per-protocol and intention-to-treat populations, respectively, demonstrated clinical non-inferiority of aceclofenac compared with diclofenac resinate. Furthermore, there was evidence for superiority of aceclofenac over diclofenac resinate in terms of statistical significance, as the one-sided 97.5% confidence interval was above −10 mm and 0 mm. In the intention-to treat population, a total of six aceclofenac-treated patients discontinued their medication owing to early cure, compared with only one patient receiving diclofenac resinate. Seventeen aceclofenac- (14.9%), and 18 diclofenac resinate-treated patients (15.9%) reported at least one adverse event. However, the total number of adverse events reported was lower in patients receiving aceclofenac (22 versus 31 in the diclofenac resinate group). In conclusion, non-inferiority of the analgesic efficacy of aceclofenac compared with diclofenac resinate was demonstrated in patients with localised, uncomplicated acute lumbosacral pain. For the reduction in pain levels from baseline there was also evidence for superiority of aceclofenac compared with diclofenac resinate in terms of statistical significance, although this difference was not considered clinically relevant. The results also showed a trend towards a better safety and tolerability profile of aceclofenac over diclofenac resinate from a clinical point of view. Received: 28 June 2002 / Accepted: 12 December 2002     

Towards an ICF Core Set for chronic musculoskeletal conditions: commonalities across ICF Core Sets for osteoarthritis,rheumatoid arthritis,osteoporosis, low back pain and chronic widespread pain

The objective of the study was to identify commonalities among the International Classification of Functioning, Disability and Health (ICF) Core Sets of osteoarthritis (OA), osteoporosis (OP), low back pain (LBP), rheumatoid arthritis (RA) and chronic widespread pain (CWP). The aim is to identify relevant categories for the development of a tentative ICF Core Set for musculoskeletal and pain conditions. The ICF categories common to the five musculoskeletal and pain conditions in the Brief and Comprehensive ICF Core Sets were identified in three steps. In a first step, the commonalities across the Brief and Comprehensive ICF Core Sets for these conditions were examined. In a second and third step, we analysed the increase in commonalities when iteratively excluding one or two of the five conditions. In the first step, 29 common categories out of the total number of 120 categories were identified across the Comprehensive ICF Core Sets of all musculoskeletal and pain conditions, primarily in the component activities and participation. In the second and third step, we found that the exclusion of CWP across the Comprehensive ICF Core Sets increased the commonalities of the remaining four musculoskeletal conditions in a maximum of ten additional categories. The Brief ICF Core Sets of all musculoskeletal and pain conditions contain four common categories out of a total number of 62 categories. The iterative exclusion of a singular condition did not significantly increase the commonalities in the remaining. Based on our analysis, it seems possible to develop a tentative Comprehensive ICF Core Set across a number of musculoskeletal conditions including LBP, OA, OP and RA. However, the profile of functioning in people with CWP differs considerably and should not be further considered for a common ICF Core Set.     

Incidence of low back pain and potential risk factors among pharmacists: A population-based cohort study in Taiwan

Low back pain (LBP) is one of the most common symptoms of work-related musculoskeletal disorders in pharmacists. This can impede the physical functions of the body and lead to incapacitation, resulting in significant social and economic burden. This study aimed to investigate the incidence and risk factors that correlate with LBP in Taiwanese pharmacists.A retrospective cohort study was conducted among all registered pharmacists aged 20 to 40 years using the National Health Insurance Research Database (2000–2013) in Taiwan. The LBP diagnosis was confirmed with one episode of hospitalization or at least three claimed outpatient visits for LBP. Data on workplace characteristics as well as comorbidities were also collected for the analyses. A Cox proportional hazard regression was used to estimate the risk factors for LBP.The incidence rate of LBP among pharmacists was 16.60% in this study. Older pharmacists (28.49%; P < .01) and those who worked at district hospitals (23.51%; P < .01) showed a higher proportion of LBP. Furthermore, after adjustment for selected potential confounding factors, female pharmacists [adjusted hazard ratio (aHR): 1.12, 95% confidence interval (95% CI): 1.01–1.24, P = .0354] and pharmacists with diabetes (aHR: 1.55; 95% CI: 1.20–2.01; P = .0008) and gout (aHR: 1.70; 95% CI: 1.37–2.09; P < .0001) had significantly higher risks of LBP.In conclusion, age was positively correlated with LBP, and the workplace was an important factor in the development of LBP in pharmacists. We suggest that pharmacists who work in district hospitals should pay more attention to the development of LBP.