Self-reported awareness and coping behaviors of low back pain among institutional caregivers for people with intellectual,autistic and associated multiple disabilities

This study aimed to investigate the self-reported knowledge and coping behaviors for low back pain (LBP) among institutional caregivers for people with intellectual, autistic and associated multiple disabilities and to gather information about factors that affect these coping behaviors in the workplace. A cross-sectional survey was conducted to recruit 1073 caregivers (response rate of 89.5%) from 15 medium to large disability welfare institutions in this study. This study specifically developed a scale to examine objective (10 question items) and subjective knowledge (one question item) of LBP and its coping behaviors (10 question items). The mean score of objective knowledge of LBP was 7.15 (range of 0–10; over 70% correct). A total of 54.2% of respondents expressed that they had a low level of subjective knowledge of LBP, and 45.8% or respondents had a high level. The study also found that many objective knowledge items need to be improved in future health promotion initiatives regarding LBP. Without adjusting for other factors, the study indicated that those caregivers with more subjective LBP knowledge were more likely to adopt higher levels of LBP coping behaviors than their counterparts (OR = 1.536, 95% CI = 1.152–2.046). After adjusting for demographics, working conditions and health status factors, LBP knowledge was not statistically correlated with LBP coping behaviors. Caregivers who worked more days per week (OR = 1.984, 95% CI = 1.408–2.795), had break time on duty (OR = 2.457, 95% CI = 1.5–4.025), exercised regularly (OR = 1.594, 95% CI = 1.115–2.28), had poor health status (OR = 0.497, 95% CI = 0.249–0.995), or had a history of LBP (OR = 1.433, 95% CI = 1.008–2.039) were more likely to adopt higher levels of coping behaviors than their counterparts. This study highlights that institutional managers should pay attention to factors that influence LBP coping behaviors in caregivers, and future studies should examine the effects of the characteristics of care recipients and caregivers’ families on caregivers’ perception of LBP.     

Low back pain in patients with multiple sclerosis: A systematic review and the prevalence in a French multiple sclerosis population

PurposeThe prevalence and management of back pain in MS patients was assessed by a systematic review, and the results of a survey on the characteristics of low back pain in a sample of French MS patients are reported.MethodsA systematic search was conducted according to the PRISMA guidelines. The outcomes of interest included the prevalence of back pain, severity of pain and impact on daily activities. Moreover, the prevalence of low back pain and its consequences on daily living in a large French MS population were assessed.ResultsFourteen studies were included in the systematic review. The prevalence of back pain in MS patients ranged from 8.6 to 50%, but that of low back pain in particular ranged from 41.6 to 52.4%. Concerning the survey, 237 patients participated in the online questionnaire. The prevalence of low back pain in the French MS patients was 76.4%. The patients with chronic low back pain had more limitations in their daily life activities than those without chronic low back pain.ConclusionPatients with MS commonly suffer from low back pain, but it is still an underdiagnosed cause of pain that reduces one's ability to perform activities in daily life.     

The interference of low back pain on everyday functions of life in care workers for persons with intellectual,autistic, and associated multiple disabilities: The Brief Pain Inventory short form (BPI-SF) survey

Low back pain is a critical public health problem; this condition significantly affects the quality of life and has a major socioeconomic impact. The present study aimed to investigate the interference of low back pain with everyday functions of life in disability care workers, and to examine the influencing factors of the interference, such as workers’ demographic, lifestyle habits, self-reported health status, working conditions and previous pain experience. The Wong-Baker FACES Pain Rating Scale and Brief Pain Inventory – Short Form were used to identify the pain severity and life interference of 677 participants who had experienced low back pain conditions in the previous year. The results indicated that the mean score of the pain severity was 3.78 ± 1.82, 78.9% subjects experienced mild pain (score 2–4), 13.7% subjects experienced moderate pain, and 5.3% subjects experienced severe pain. More than twenty percent of the respondents reported that low back pain moderately or severely interfered with their daily functions. Many working conditions and pain experienced significantly correlated with the score of pain interference in the care workers after controlling for factors of healthy lifestyle and health status (R² = 41.7%). These findings may garner attention from health welfare authorities and lead to improvements in health promotion initiatives to prevent low back pain from interfering with the daily activities of care workers for people with intellectual, autistic and associated disabilities.     

Glucocorticoid receptors, fibromyalgia and low back pain

Recently, fibromyaglia (FMS) was shown to be a disorder associated with an altered functioning of the stress response system. FMS patients display a hyperreactive pituitary adrenocorticotropic hormone (ACTH) release in response to corticotropin-releasing hormone (CRH) and to insulin-induced hypoglycemia. We suggested that negative feedback of cortisol could be deranged. Therefore we investigated the properties and function of the glucocorticoid receptors (GR) in FMS patients and compared the results with those of healthy persons and patients with chronic low back pain (LBP a localized pain condition). Forty primary FMS patients (F:M = 36:4), 28 LBP patients (25:3) and 14 (12:2) healthy, sedentary control persons were recruited for the study.

Urinary free cortisol excretion in FMS and LBP patients was lower compared to controls. Only FMS patients displayed lower CBG and basal serum cortisol concentrations when compared to controls. However, plasma free cortisol concentrations were similar in the three groups.

There was no difference in the number of GR per cell among the three groups (FMS: 6498 ± 252, LBP: 6625 ± 284, controls: 6576 ± 304), but the dissociationh constant (K_d) of the FMS (14.5 ± 0.9 nmol/l) and LBP (14.7 ± 13 nmol/l) subjects was significantly higher than that of the controls (10.9 ± 0.8 nmol/l) (p < .05).

The maximal stimulation of the lymphocytes, as measured by the maximal thymidine incorporation (in the absence of cortisol) in the FMS group was approximately 1.5 times higher (p < .05) than in the control or LBP group. The ED₅₀ (the cortisol concentration giving 50% inhibition of the thymidine incorporation), however, was identical in all three groups.

We conclude that FMS patients have a mild hypocortisolemia, increased cortisol feedback resistance in combination probably with a reduced CRH synthesis or release in the hypothalamus. The role of the GR and mineralocorticoid receptor (MR) in the CRH regulation in the FMS patients remains to be solved.     

Disruption of cortical synaptic homeostasis in individuals with chronic low back pain

Objective

Homeostatic plasticity mechanisms regulate synaptic plasticity in the human brain. Impaired homeostatic plasticity may contribute to maladaptive synaptic plasticity and symptom persistence in chronic musculoskeletal pain.

Family developmental risk factors among adolescents with disabilities and children of parents with disabilities

This paper investigates how the learning environments and family dynamics differ if households have a child with a disability or a parent with a disability. Using data from the National Longitudinal Survey of Youth 1997, results indicate that children with disabilities experience similar learning environments as other children, but have somewhat weaker relationships with their parents. In two-parent families, maternal disability lowers parents' school involvement and is associated with a less enriching home environment. Paternal disability reduces maternal monitoring and positive family activities possibly because mothers divert care-giving resources from their children to their male partners. Children in mother-headed households experience learning environments and family dynamics that are similar regardless of their own disability status or that of their mothers, but these outcomes are markedly inferior to those of children growing up in two-parent households. Future research on adolescent development should consider the disability status of children and parents, with particular attention to patterns of gendered care-giving in American families.     

慢性下腰痛患者腰部肌肉放电的均衡性

目的：观察慢性下腰痛患者腰部肌肉放电的均衡性。 方法：实验于2007-05在沈阳体育学院重点实验室完成。以14名健康受试者和14名慢性下腰痛患者为观察对象,让其在静力性收缩的条件下观察腰部肌肉放电的情况。使用表面肌电技术测量受试者腰部3个节段(L1,L2,L5)两侧最长肌、髂腰肋肌、多裂肌的放电情况,令受试者躯干分别在40%最大随意收缩和80%最大随意收缩的情况做等长收缩30 s,观察受试者腰部脊柱两侧肌肉的疲劳时的失衡情况。 结果：慢性下腰痛患者腰部肌肉的最大随意收缩仅仅是对照组最大随意收缩的55%,与对照组相比慢性下腰痛患者腰部肌肉疲劳程度较低, 可能与他们并没有产生真正的最大随意收缩有关;慢性下腰痛患者腰部两侧肌肉失衡程度较大。 结论：下腰痛患者出现疼痛时,其腰部两侧的肌肉活动重新分布;同时表面肌电可能成为一种无创伤地检测肌肉失衡的有效工具。     

Percutaneously-quantified advanced glycation end-products (AGEs) accumulation associates with low back pain and lower extremity symptoms in middle-aged low back pain patients

Advanced glycation end-products (AGEs) have been reported as a possible biomarker of ageing and metabolic diseases; however, its role in the clinical progression of these diseases remains unclear. We aimed to evaluate how AGEs are associated with clinical symptoms and comorbidities in lower back pain (LBP) patients. This prospective cohort study enrolled 636 LBP patients. They were subjected to quantified AGE (qAGE) analysis using skin autofluorescence, and their clinical symptoms and comorbidities, such as diabetes, renal failure with haemodialysis treatment, and osteoporosis, were measured. LBP, lower extremity pain, and numbness were evaluated using a visual analogue scale (VAS). The measured qAGE was significantly higher in subjects with any comorbidity. Age also showed a strong positive correlation with qAGE. qAGE and VAS for leg numbness were positively correlated. Furthermore, in LBP patients under 50-years-old, qAGE was positively correlated with VAS for LBP, lower extremity pain, and numbness. In conclusion, qAGE, as measured by skin autofluorescence measurement, was significantly higher in LBP patients with diabetes and dialysis, as well as in osteoporosis patients. Furthermore, qAGE showed potential as a biomarker for LBP, lower extremity pain, and numbness in patients under 50-years-old. If accumulated AGEs are identified at a young age, researchers should be vigilant for the development of osteoporosis and LBP-related clinical symptoms later in life.     

Job burnout amongst the institutional caregivers working with individuals with intellectual and developmental disabilities: Utilization of the Chinese version of the Copenhagen Burnout Inventory survey

Burnout has been considered important to understand the well-being of people who work with individuals with intellectual disabilities (ID) and developmental disabilities (DD). To identify personal and workplace characteristics associated with burnout, this study aimed to utilize the Chinese version of the Copenhagen Burnout Inventory to provide a burnout profile of caregivers who served individuals with ID/DD and evaluate the potential factors associated with burnout in this group. A purposive sampling method and a self-administered structured questionnaire were employed to recruit 276 caregivers from 4 different disability institutions for study participation. The results revealed that the average personal burnout score (PBS) and work-related burnout score (WBS) were 44.0 (SD = 16.8) and 34.2 (SD = 15.9). These burnout scores were higher compared with general full time employees in Taiwan. The results showed that that 17.8% of the staff were moderately burnt out (PBS score: 50–70), and 7.6% of the staff were in the highest exhausted level (PBS score ≧ 70) of PBS. With regard to the WBS score, 20.7% were moderately burnt out (PBS score: 50–70), and 5.1% of the staff were in the highest exhausted level (WBS score ≧ 70). Finally, a multiple regression analysis reported that the factors of self-report health status and WBS significantly predicted higher respondent PBS (R² = 0.642). The study highlights the need to improve the psychological health and well-being of the caregivers who work with individuals with ID/DD and the need for the institutions to strengthen supportive healthy working environments to decrease staff burnout.     

Value of repeat CT scans in low back pain and radiculopathy

We assessed the clinical value of repeat spine CT scan in 108 patients aged 18–60 years who underwent repeat lumbar spine CT scan for low back pain or radiculopathy from January 2008 to December 2010. Patients with a neoplasm or symptoms suggesting underlying disease were excluded from the study. Clinical data was retrospectively reviewed. Index examinations and repeat CT scan performed at a mean of 24.3 ± 11.3 months later were compared by a senior musculoskeletal radiologist. Disc abnormalities (herniation, sequestration, bulge), spinal stenosis, disc space narrowing, and bony changes (osteophytes, fractures, other changes) were documented. Indications for CT scan were low back pain (60 patients, 55%), radiculopathy (46 patients, 43%), or nonspecific back pain (two patients, 2%). A total of 292 spine pathologies were identified in 98 patients (90.7%); in 10 patients (9.3%) no spine pathology was seen on index or repeat CT scan. At repeat CT scan, 269/292 pathologies were unchanged (92.1%); 10/292 improved (3.4%), 8/292 worsened (2.8%, disc herniation or spinal stenosis), and five new pathologies were identified. No substantial therapeutic change was required in patients with worsened or new pathology. Added diagnostic value from repeat CT scan performed within 2–3 years was rare in patients suffering chronic or recurrent low back pain or radiculopathy, suggesting that repeat CT scan should be considered only in patients with progressive neurologic deficits, new neurologic complaints, or signs implying serious underlying conditions.     

Analysis of staff reports on the frequency of challenging behaviour in people with severe or profound intellectual disabilities

The main goal of this study was to investigate whether staff members vary in their frequency reports on challenging behaviour concerning the same client. Because staff's approaches of challenging behaviour are affected by a range of staff characteristics, we hypothesised that these staff characteristics could explain this variability between staff members. We used questionnaires to investigate the influence of staff's age, gender, experience in working with people with intellectual disabilities, working hours, professional qualifications, sort of education, and their emotional reactions and beliefs regarding the challenging behaviour. This study involved 152 staff members and 51 clients with severe or profound intellectual disabilities who displayed self-injurious behaviour, stereotyped behaviour, and/or aggressive/destructive behaviour. A part of the variability between staff's reports on the frequency of challenging behaviour was indeed explained by differences between the staff members. Working hours, internal attribution, gender, and experience in working with people with severe or profound intellectual disabilities turned out to be influencing variables. Summarising, staff members differ in their reports on the frequency of challenging behaviour. To get an accurate picture of a client's challenging behaviour, perceptions of several staff members are needed.     

The development of a self-report measure to assess the location and intensity of pain in people with intellectual disabilities

The performance of a target group of 20 people with intellectual disability (ID) and a comparison group of 20 people who did not have ID was investigated on a series of tasks involving the judgement of the location of pain (on a bodymap) and the intensity of pain (on an analogue colour scale) in response to a series of photographs of simulated painful experiences. The results of the study indicated that: (1) there were no differences between the target and comparison groups in judging pain location for 93% of test items; (2) the performance of the target group in judging pain location was stable over time; (3) people with ID rated the pain images as more intense than the comparison group on all the 'mild' pain stimuli and 36% of the 'severe' pain stimuli; (4) the performance of the target group in judging pain intensity was logically consistent for 65% of comparisons (clear trends towards significance being apparent for a further 10% of items); (5) the performance of the target group in judging pain intensity was stable over time; and (6) the performance of the target group was unrelated to indicators of cognitive ability.     

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

OBJECTIVE: Alexithymia, a lack of emotional awareness, was positively associated with self-reported low back pain (LBP) in cross-sectional studies. We assessed the association of alexithymia with 7.5-year incidence of LBP prospectively in a cohort study of 1207 San Francisco transit operators. METHODS: Alexithymia was measured by the 20-item Toronto Alexithymia Scale (TAS-20). LBP was assessed by physician-confirmed diagnoses from administrative workers' compensation data. Cox proportional hazards analyses controlled for demographic, behavioral, and physical and psychosocial job factors measured by questionnaire and interview. RESULTS: Of all drivers, 27.7% (n=334) filed compensated claims for LBP injuries with workers' compensation insurance during the 7.5-year observation time. The hazard ratios from the fully adjusted model were 0.73 (0.56-0.96) for the TAS-20 scale and 0.82 (0.69-0.98) for the subscale "difficulty describing feelings." Alexithymia scores did not predict the duration of compensated work disability. CONCLUSION: In contrast to previous cross-sectional positive associations between alexithymia and LBP, alexithymia is negatively associated with compensated LBP claims. We hypothesize that shame and reporting behavior may explain these inconsistent results.     

Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities

Background The population of people with intellectual disabilities (ID) is increasing and their health needs impact on primary and secondary healthcare specialities. One important aspect of their physical health is bone health as people with ID have increased risk factors associated with osteoporosis. It has been identified that this population has an increased prevalence of low bone mineral density (BMD), osteoporosis and osteopenia. The main contributory factors for low BMD are age, use of antiepileptics, immobility and diagnosis of Down's syndrome. Methods A literature search of electronic databases was undertaken. Studies that included people with ID were reviewed for the prevalence of osteoporosis and osteopenia. A cross‐sectional survey was conducted in a community sample (n = 149) to screen for risk factors for osteoporosis. Results The majority of studies identified increased prevalence of osteoporosis and osteopenia with associated low BMD. In most studies individuals with ID presented with more than two risk factors. In our survey, we identified an increased prevalence of risk factors associated with osteoporosis, namely use of antiepileptics (64%), immobility (23%), history of falls (20%) and fractures (11%). We found that 54% of our sample fulfilled the criteria for screening. Of those who went on to have scans, 55% had osteoporosis and 33% had osteopenia. Conclusion We conclude that we should be screening for the risk factors associated with low BMD in adults with ID. If these are present further investigations should take place and those found to have osteoporosis and osteopenia should have treatment at an early stage to prevent morbidity and improve their quality of life.     

A double-blind, randomized trial of duloxetine versus placebo in the management of chronic low back pain

Background:  Duloxetine has demonstrated analgesic effect in chronic pain states. This study assesses the efficacy of duloxetine in chronic low back pain (CLBP).
Methods:  Adult patients with non-radicular CLBP entered this 13-week, double-blind, randomized study comparing duloxetine 20, 60 or 120 mg once daily with placebo. The primary measure was comparison of duloxetine 60 mg with placebo on weekly mean 24-h average pain. Secondary measures included Roland-Morris Disability Questionnaire (RMDQ-24), Patient's Global Impressions of Improvement (PGI-I), Brief Pain Inventory (BPI), safety and tolerability.
Results:  Four hundred four patients were enrolled, 267 completed. No significant differences existed between any dose of duloxetine and placebo on reduction in weekly mean 24-h average pain at end-point. Duloxetine 60 mg was superior to placebo from weeks 3–11 in relieving pain, but not at weeks 12–13. Duloxetine 60 mg demonstrated significant improvement on PGI-I, RMDQ-24, BPI-average pain and BPI-average interference. Significantly more patients taking duloxetine 120 mg (24.1%) discontinued because of adverse events, versus placebo (8.5%).
Conclusions:  Duloxetine was superior to placebo on the primary objective from weeks 3–11, but superiority was not maintained at end-point. Duloxetine was superior to placebo on many secondary measures, and was well-tolerated.     

Environmental risk factors associated with the persistence of conduct difficulties in children with intellectual disabilities and autistic spectrum disorders

We investigated the association between exposure to environmental risks in early childhood and the prevalence and persistence of conduct difficulties (CD) in children with intellectual disability (ID) who did not have autistic spectrum disorder (ASD), children with ASD and typically developing (TD) children. Results indicated that: (1) exposure to risk was associated with elevated prevalence of CD at age three and, for TD children and children with ID, increased risk of CD persisting to ages five and seven; (2) at all levels of risk, children with ASD were more likely to show persistent CD than other children; (3) children with ID were no more likely to show persistent CD than TD children at low levels of exposure to environmental risk.     

A comparison of natural and non-natural soundscapes on people with severe or profound intellectual and multiple disabilities

Background Previous research indicates that there is a relationship between the auditory environment and the core affects (or mood) of people with severe or profound intellectual disability. We conducted a systematic study to further explore this relationship.

Method Thirteen participants with severe or profound intellectual disability and challenging behaviour were presented with 5 different soundscapes (Beach, Forest, Urban, Music, and Silence) in a dedicated room. Direct support professionals made core affect observations before and after each trial.

Results A trend was visible in the core affect observations, with a prominent and consistent increase in the frequency of observations of a Relaxed core affect across conditions. However, a greater increase in the frequency of observations of a Relaxed core affect and a greater decrease in the frequency of observations of an Interested core affect were associated with the natural conditions (Forest and Beach) rather than the non-natural conditions (Urban and Music).

Conclusion This pilot study could serve an important role in raising awareness and stimulating further research regarding the auditory environments of people with severe or profound intellectual disability.