The Swedish back school in chronic low back pain. Part II. Factors predicting the outcome

The aim of the study was to analyse the factors predicting the outcome of the Swedish back school and spontaneous recovery in chronic low back pain. The predicting variables describing the treatment group (n = 95) and the control group (n = 93) at the initiation of study included sociodemographic factors, variables related to work, severity of low back pain, and a number of clinical measurements and evaluations. The Oswestry Low Back Pain Disability Questionnaire was used for judging recovery factors. It was found that the best predictor for the outcome of the treatment and for spontaneous recovery was work satisfaction.     

The meaning of chronic low back pain.

Chronic pain is experienced by 30% of individuals who suffer from pain in industrial countries. Chronic low back pain is of particular interest to the occupational health nurse. The incidence and financial cost can be documented, but the effects on an individual's life and family are not as easily recognized. This qualitative study using phenomenology describes the meaning of chronic low back pain to individuals. This study indicates that chronic low back pain dominated the lives of the individuals. The primary areas of focus were altered lifestyle and overall quality of life.     

Short-term outcomes of a back school program for chronic low back pain

OBJECTIVE: To assess the short-term outcome of a back school program for patients suffering from chronic, nonspecific low back pain (LBP). DESIGN: Quasi-experimental cohort study with a waiting list control group. SETTING: Dutch rehabilitation department. PARTICIPANTS: Experimental group (n = 14) participating in the back school program and a waiting list control group (n = 10). INTERVENTION: A back school program aimed to achieve optimal functional capacity and functional health status by teaching participants to react appropriately to overload signals. MAIN OUTCOME MEASURES: Functional capacity assessed by the RAND-36 instrument; functional health status assessed by the Roland-Morris Disability Questionnaire; and static and dynamic lifting capacity, endurance, and range of motion assessed by objective measures. RESULTS: The experimental group significantly improved in functional capacity and functional health status, with a large power, likely attributable to adequate reactions to signals of overload. Significant differences existed between the 2 groups, with large powers for the main outcomes. CONCLUSION: The back school program improved the functional capacity and functional health status of patients with chronic, nonspecific LBP.     

Treating chronic low back pain. I. Admissions to initial follow-up

For a normative study of chronic low back pain (CLBP), 702 consecutive admissions to a large multidisciplinary CLBP treatment program were assessed at admission, discharge, and 1-month follow-up, using a variety of psychological and functional performance instruments. Both univariate and multivariate approaches to appraising success are evaluated. Psychological profiles demonstrated a substantial degree of disability at admissions, which is significantly reduced at follow-up. Both behavioral and cognitive aspects of performance, as evidenced by objective assessments of patients' physical abilities and verbalizations, improved as a direct function of length of stay in the treatment program and continued to show modest improvement through follow-up. Composite indices of improvement demonstrated favorable outcomes for no less than four in every ten, and as high as nine in every ten participants. Because of the large sample size, relationships both within and across measurement domains can be assessed statistically: the separate sets of outcome measures, with the exception of psychological profiles, are generally independent of each other.     

The effect of the Swedish Back School in chronic idiopathic low back pain. A prospective controlled study

A prospective controlled study of the effect of the Swedish Back School in chronic idiopathic Low Back Pain was conducted. Forty-eight patients entered the study. There were no significant pre-treatment differences between the experimental group members who attended the four lessons of the Back School, and the control group who received four detuned shortwave applications to the low back. Forty-three patients (21 in the experimental and 22 in the control group) completed the study. Subjects were repeatedly tested for one year. The following assessments were made: 1) subjective scores of pain and functional capacity, and 2) objective measurements of spinal mobility. After one year, no statistically significant differences between the two groups were observed. Given the proven efficacy of the Back School in (sub)acute Low Back Pain, it should be administered when it is most beneficial, i.e. in the early phase of Low Back Pain.     

Pain intensity measurement in chronic low back pain.

This study investigated the psychometric properties of eight pain intensity measures used with chronic low back pain patients. All measures were similar in terms of scale distribution and rates of incorrect responses, with all scales apart from the Pain Rating Index significantly correlated. Principal axis factoring of data from 92 patients indicated the presence of one general factor on which all pain intensity measures except the Pain Rating Index loaded. The 101-point Numeric Rating Scale and the Box Scale had the strongest relationship, with loadings of 0.90. The Numeric Rating Scale and the Box Scale appear to be the scales of choice for the measurement of pain intensity in the low back pain patient.     

CE feature. Part 2. Nontechnologic strategies for coping with chronic low back pain

Nontechnologic interventions of relaxation, distraction, therapeutic touch, and spirituality can relieve chronic low back pain. Awareness of nontechnologic strategies by nurses is needed to facilitate patient-centered intervention.     

Treating chronic low back pain. II. Long-term follow-up

Appraisal of chronic low back pain (CLBP) treatment outcome is incomplete unless results can be shown to be stable over an extended follow-up period. This paper concentrates on methods by which the long-term trends of objective outcome assessments can be studied and predictions developed given incomplete data. Employment and litigation status, self-rating of pain, activities, medications, and hospitalizations related to pain were periodically assessed in up to 210 graduates of a CLBP treatment program, over a period of 6 months to 5 years following treatment. Favorable outcomes were achieved by many of the respondents, and a good degree of stability in outcomes was observed in several of the measures. Few indicators were found which adequately predict long-term outcomes, however. Attrition in the sample and other possible systematic sources of bias are discussed.     

慢性下腰痛患者社会心理因素分析

目的探讨慢性下腰痛(CLBP)患者的心理特征.方法对65例慢性下腰痛(CLBP)患者进行了明尼苏达多相人格问卷 (MMPI),症状自评量表(SCL-90)测评,并与对照组比较.统计学处理采用t检验.结果慢性下腰痛患者MMPI测试在疑病症、抑郁症、歇斯底里及精神衰弱量表得分上与对照组有显著性差异 (P<0.01),SCL-90测试在躯体化、人际关系、强迫症、忧郁、焦虑、恐怖及精神病性等因子上与对照组均有显著性差异(P<0.05 ),病例组呈心身症特征.结论慢性下腰痛患者呈"疑病-抑郁癔病"神经三联征民主自由特征,其它尚有焦虑、强迫行为和一般适应障碍增多等.建议临床专科医师或治疗师在CLBP 的处理中应同样重视患者的心理和躯体成份.     

Gender-specific aspects in chronic low back pain rehabilitation

Gender-specific Aspects in Chronic Low Back Pain Rehabilitation.Little is known about gender differences in utilisation, outcomes and evaluation of orthopaedic rehabilitation for chronic low back pain. The purpose of this article is to review and analyse the literature on rehabilitation and recovery of men and women with chronic back pain. In Western societies, chronic back pain is one of the most common causes for utilising medical rehabilitation services. In general no significant gender differences in the prevalences of back pain are found, but men are more sick-listed and early retired due to musculoskeletal diseases. Also, more men than women participate in medical rehabilitation programmes. National and international studies pinpoint the fact that differences exist between women and men with regard to participating in an orthopaedic rehabilitation programme. Additionally there is some evidence that different physical and psychological therapy services have different effects on health status of women and men. Mixed results are available regarding gender differences concerning the outcomes of rehabilitation programmes. Rehabilitation activities after discharge from in-patient programmes and these being performed within the home setting are primary indicators of recovery. Gender differences have been identified regarding various types of activities, apparently because especially family roles interfere with activity. Further research must be conducted so as to increase the understanding of women's and men's experiences relative to orthopaedic diseases and orthopaedic rehabilitation services.     

Paralumbar muscle activity in chronic low back pain

Muscle spasm is often considered to be a prominent feature operating in chronic low back spin syndrome (LBP). The present study compared levels of paralumbar muscle activity, determined by an electromyogram (EMG), for LBP patients and normal subjects during periods of rest and voluntary muscular contraction. The resting state EMG measure did not differ in the 2 groups. However, when attempting to relax the low back while contracting other muscle groups, LBP patients exhibited higher mean levels of low back muscle activity as compared to the non-pain group. These results would suggest that such "cocontraction relaxation" procedures may provide a viable behavioral technique for assessing and possibly treating functional backache thought to be symptomatic of muscle spasm. Previous studies employing feedback and progressive relaxation techniques have trained subjects to reduce muscle tension in the resting state. Results of the present study suggest that the acquisition of "resting level" relaxation may be of little benefit to patients who exhibit excessive muscular tension while performing daily tasks. Rather, to maximize the likelihood of beneficial results, training would be better directed at relaxation of the low back during activity of other muscle groups.     

Psychosocial aspects of chronic low back pain

In many patients with chronic low back pain, no close correlation is found between the objective physical impairment and the subjective intensity of pain or the resulting disability. The process of chronification is the result of a complex interaction between somatic and psychosocial factors, as many epidemiologic and clinical studies could proof. DISCUSSION: Currently, these results are still neglected in clinical practise of diagnosis and therapeutic concepts.     

慢性下腰痛的治疗方法评价

目的:慢性下腰痛治疗方法较多,对其有效性和安全性的评价很重要。资料来源:应用计算机检索Medline和Ovid数据库1990-01/2004-11期间的相关文章,检索词“chroniclowbackpain,rehabilitation/ther-apy”,并限定文章语言为English。资料选择:选取随机对照试验,不限制盲法条件。选取平行对照试验,对照组为安慰对照、假性处理对照或以不同疗法进行对照,治疗组以药物、物理因子、按摩、针刺、运动等方法进行治疗。资料提炼:共收集到26篇关于慢性下腰痛治疗的研究原著,20个试验符合纳入标准,另有1个手术疗效观察性试验被特别纳入,排除的5篇试验中,2篇因系重复的同一研究,3篇为Meta分析研究。资料综合:21个试验包括3358例患者,其中4个试验为药物疗法,1个试验为物理疗法,2个试验为按摩疗法,3个试验为针刺疗法,3个试验为运动疗法,4个试验为综合疗法,4个试验为外科疗法。结论:按摩疗法、激光疗法和运动疗法对慢性下腰痛具有明显的疗效,基本上是安全的,对于非特异慢性下腰痛来说,多学科综合疗法最为有效。关节神经切断术和椎间盘内电热疗法分别对慢性关节源和椎间盘源的腰痛具有确切的疗效,无明显损害作用。     

Comprehensive rehabilitation of patients having chronic low back pain.

Seventy-two patients having chronic back pain, representative of high-risk demographic and personality populations, received a broad range of therapeutic modalities designed around the theme of self-regulation. The self-regulation principle was used in: (1) biofeedback training for teaching self-regulated muscle relaxation; (2) psychological counseling emphasizing self-control techniques for the management of stress and anxiety, including assertion training; (3) patient-regulated medication program; (4) patient involved case conferences; (5) physical therapy program emphasizing reconditoning; (6) comprehensive vocational rehabilitation services; (7) a series of educational lectures; (8) a therapeutic milieu designed for relaxation, recreation and socialization. Utilizing a success criteria of functional physical activity at discharge (average length of stay, 45 days) and levels of vocational restoration (employable, in training, or employed at 30 days postdischarge), 57 of the patients demonstrated unimpaired physical functioning levels and 59 of the patients were at success levels of vocational restoration.     

A comprehensive treatment approach to chronic low back pain.

A comprehensive treatment program for chronic disability related to back disease has been presented. This program has used not only more traditional methods of medical care for the structural disabilities of chronic mechanical back disorders, but has used principles of active patient participation in the improvement process. The patients are educated in the manifestations of pain behavior in the phase II treatment program emphasis on pain sources is downgraded to allow positive reinforcement for healthy behavior to develop. By use of an organized team approach, a significant number of patients can be processed; and an overall reduction in use of alternative medical resources has occurred.     

The relationship between paraspinal EMG and chronic low back pain

Two models of the relationship between paraspinal EMG and low back pain have been proposed. Specific predictions arising from these are listed and the literature relating to them reviewed. Recent research on patterns of EMG rather than absolute levels is also discussed. It is concluded that there is no consistent evidence that low back pain patients have elevated paraspinal EMG, or that its reduction is likely to be an active ingredient in biofeedback therapy. Research on paraspinal EMG patterns is still preliminary, and therefore treatment based on their modification is experimental.