Does educational attainment increase the risk of low back pain when genetics are considered? A population-based study of Spanish twins

Background Context

There is limited research investigating educational attainment as a risk factor for low back pain (LBP), with the influence of gender commonly being neglected. Furthermore, genetics and early shared environment explain a substantial proportion of LBP cases and need to be controlled for when investigating risk factors for LBP.

Are people with chronic low back pain meeting the physical activity guidelines? A co-twin control study

Background

Despite a large amount of research investigating physical activity (PA) levels in people with chronic low back pain (LBP), no study has investigated whether people with chronic LBP are meeting the World Health Organization (WHO) PA guidelines. Furthermore, with genetics and the early shared environment substantially influencing the presence of LBP and PA engagement, these factors could confound the association between LBP and PA and need to be controlled for.

Has the prevalence of neck pain and low back pain changed over the last 5 years? A population-based national study in Spain

Background contextNo study has determined time trends of neck pain and low back pain (NP&LBP) in the 20th century in Spain.PurposeTo estimate current 1-year prevalence of NP&LBP using data from the 2009 European Health Survey and to analyze the time trends in the prevalence of NP&LBP from 2005 to 2010.Study designPopulation-based national study.Patient sampleA total of 51,666 subjects were finally included.Outcome measuresThe 2006 Spanish National Health Survey (SNHS) and the 2009 European Health Interview Survey for Spain (EHISS).MethodsWe analyzed data from the 2006 SNHS (n=29,478) and the 2009 EHISS (n=22,188). We considered the presence of NP, LBP, and both NP&LBP. We analyzed sociodemographic features, self-perceived health status, lifestyle habits, and comorbid diseases using logistic regression models.ResultsIn 2009, the 1-year prevalence was 5.2% (95% confidence interval 4.8–5.5) for NP, 7.9% (7.4–8.3) for LBP, and 10.6% (10.2–11.1) for NP&LBP. Women increased the probability of NP and NP&LBP but decreased the probability of LBP. The prevalence of all pain localizations increased with age. Not practicing exercise or being obese was associated with lower NP and higher NP&LBP. One-year prevalence of NP decreased from 2006 (7.57%) to 2009 (5.18%) (prevalence ratio [PR] 0.66, 0.60–0.72; men: 0.68, 0.61–0.75; women: 0.66, 0.60–0.72). The prevalence of LBP did not change (PR 0.93, 0.86–101) from 2006 (8.34%) to 2009 (7.86%). The prevalence of NP&LBP decreased from 12.53% in 2006 to 10.61% in 2009 (PR 0.81, 0.75–0.86; men: 7.73% to 6.36%, PR 0.80, 0.70–0.90; women: 17.15% to 14.69%, PR 0.81, 0.74–0.87).ConclusionsThe prevalence of NP and NP&LBP, but not LBP, has decreased in the last years in Spain. NP&LBP were associated with similar sociodemographic and lifestyle habits in 2009 compared with 2006.     

Does unspecific low back pain really exist?

Only 20 % of low back pain or sciatica is of a specific origin. These specific pain conditions include tumours, spondylitis, rheumatic and metabolic diseases as well as radicular syndromes. By far the most pain from discs, facet and sacroiliac joints, ligaments and muscles must be considered as unspecific, because no anamnestic information or clinical signs exist (radiological changes included) to assign pain to structural or functional correlates. In addition, the therapeutic consequences from the assignment of structural changes to pain remain unclear. In acute pain situations the specificity of the pain is not important because of the fast relief of the disease, in chronic pain situations, fear avoidance beliefs and pain behaviour seem to be much more important than structural and functional changes.     

Is undergraduate physiotherapy study a risk factor for low back pain? A prevalence study of LBP in physiotherapy students

Background  

Following reports of high prevalence of low back pain (LBP) in young physiotherapists [17–22], we investigated whether LBP was a problem for undergraduate physiotherapy students.     

Does elite swimming accelerate lumbar intervertebral disc degeneration and increase low back pain? A cross-sectional comparison

Purpose

The aim was to elucidate elite swimming’s possible influence on lumbar disc degeneration (DD) and low back pain (LBP).

Methods

Lumbar spine MRI was performed on a group of elite swimmers and compared to a matched Finnish population-based no-sport group.

Results

One hundred elite swimmers and 96 no-sport adults, mean age 18.7/20.8, respectively, participated. Overall, the two groups had similar prevalence of DD. Swimmers had more DD in the upper lumbar spine but tended to have less DD at the lowest level. Prevalence of bulges and disc herniations were similar, but swimmers had significantly more bulges at L4–5. The swimmers reported less LBP, although not significantly (N.S.). If degenerative findings were present, the association between them and LBP was stronger in the no-sport group.

Conclusion

Elite swimmers and controls had similar prevalence of DD and LBP, although the pattern of DD differed between the groups. In case of DD, swimmers reported less LBP, although N.S.

     

Does pregnancy increase the risk of cholecystectomy following bariatric surgery? A cross-sectional cohort study

BackgroundReproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported.ObjectivesTo explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve gastrectomy (LSG).SettingA university hospital.MethodsA cross-sectional cohort study of reproductive aged women (18–45 yr) who underwent LSG. The association between pregnancy and cholecystectomy was evaluated with Cox regression analysis.ResultsOf 1056 women of childbearing age who underwent LSG during 2006–2017, 128 (12.1%) subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9 years for women who did and did not conceive, respectively (P < .001). The median time from procedure to conception was 509 (374–1031) days. Overall, 117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy among those who conceived was higher than among those who did not (18.8% versus 10.0%, P = .005). In an unadjusted analysis, pregnancy was associated with an increased risk of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P < .0001). The association between pregnancy and cholecystectomy persisted after controlling for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92], P < .0001). Among those who experienced pregnancy, lower gestational weight gain was the only factor found to be associated with cholecystectomy after surgery (P = .05).ConclusionsPregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG. Thus, the desire for future pregnancy should be considered before LSG.     

Does frailty predict increased risk of falls and fractures? A prospective population-based study

Summary

A frailty concept that includes psychological and cognitive markers was prospectively shown to be associated with increased risk of multiple falls and fractures among 1,509 community dwelling older adults, especially in those aged 75 and over. The predictive ability of frailty is not superior to falls history.

Introduction

The concept of frailty has been defined with or without psychological and cognitive markers. Falls are associated with multiple risk factors, including cognitive and mood disorders. The purpose of this study was to investigate the association of a comprehensive concept of frailty and its components with falls and fractures in community-dwelling older adults and to compare its predictive ability with having a history of falls.

Methods

One thousand five hundred nine participants in the Longitudinal Aging Study Amsterdam aged ≥65 were assessed to determine fall history and the prevalence of nine frailty markers, including cognitive and psychological factors. The number of falls and time to second fall were prospectively registered for 1 year. Fractures were registered for 6 years.

Results

Frailty was significantly associated with time to second fall: hazard ratio of 1.53 [95 % confidence interval (CI), 1.07–2.18] and area under the receiver operating characteristic curve (AUC) of 0.58 (CI, 0.53–0.62). In participants aged ≥75, frailty was associated with ≥2 falls: odds ratio (OR) of 1.74 (CI, 1.19–2.55) and AUC of 0.62 (CI, 0.55–0.68). Frailty, adjusted for age and sex, was significantly associated with ≥2 fractures: OR of 3.67 (CI, 1.47–9.15). The AUCs for falls history (aged ≥75) ranged from 0.62 (CI, 0.58–0.67) for ≥1 falls to 0.67 (CI, 0.59–0.74) for ≥3 falls.

Conclusions

A concept of frailty including psychological and cognitive markers is associated with both multiple falls and fractures. However, frailty is not superior to falls history for the selection of old persons at increased risk of recurrent falls.     

Is occupational low back pain on the rise?

STUDY DESIGN: A retrospective analysis of back pain claim data from two sources, a workers' compensation provider and Washington State Department of Labor and Industries. The Workers' Compensation Provider claim data were examined over a 9-year period, 1987-1995, and the Washington claim data were examined over a 5-year period, 1991-1995. In addition, a third source of data, reports of back pain from the the Bureau of Labor Statistics, was examined over a 4-year period, 1992-1995. OBJECTIVES: To characterize occupational low back pain trends in the United States. More specifically, trends in back pain rates and costs as well as back injury rates from the Bureau of Labor Statistics were discerned. SUMMARY OF BACKGROUND DATA: The literature often refers to a recent rise in occupational low back pain. However, the question is: Do empirical data support this notion? METHODS: Retrospective analysis of workers' compensation provider, Washington State, and Bureau of Labor Statistics data. RESULTS: The U.S. estimate of the annual low back pain claim rate decreased 34% between 1987 and 1995, although the trend was not monotonic. There was a sharper decrease in the U.S. estimate of the annual low back pain claim costs during this time (58%). In 1995, however, occupational low back pain remained a major problem in the U.S.: an estimated $8.8 billion was spent on low back pain claims, and the rate of filing low back pain claims was 1.8 per 100 workers. CONCLUSIONS: Evidence of a rise in occupational low back pain was not discerned for the 8-year period studied. Data from three sources support this finding. However, occupational back pain remains a major problem in the U.S.     

Is volition the missing link in the management of low back pain?

Patients with nonspecific chronic low back pain are typically prescribed a regimen of regular physical exercises to improve pain and function, increase workability, and prevent pain recurrence. However, adherence to home exercise programs is often partial at best. Patients often fail to translate their intention to exercise (motivation) into action (implementation). Volition is the mental activity by which intentions are implemented. In this review, we argue that volition may be crucial to the successful rehabilitation of patients with low back pain. Obstacles to the implementation of intentions are described, as well as factors that promote implementation, most notably the conscious formation of implementation intentions.     

How is recovery from low back pain measured? A systematic review of the literature

Recovery is commonly used as an outcome measure in low back pain (LBP) research. There is, however, no accepted definition of what recovery involves or guidance as to how it should be measured. The objective of the study was designed to appraise the LBP literature from the last 10 years to review the methods used to measure recovery. The research design includes electronic searches of Medline, EMBASE, CINAHL, Cochrane database of clinical trials and PEDro from the beginning of 1999 to December 2008. All prospective studies of subjects with non-specific LBP that measured recovery as an outcome were included. The way in which recovery was measured was extracted and categorised according to the domain used to assess recovery. Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs. There were nine single-item recovery rating scales. Eleven studies used a global change scale that included an anchor of ‘completely recovered’. Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance. In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently. This lack of consistency makes interpretation and comparison of the LBP literature problematic. It is likely that the failure to use a standardised measure of recovery is due to the absence of an established definition, and highlights the need for such a definition in back pain research.     

Does coronary endarterectomy increase the risk of coronary bypass?

BACKGROUND: With increased incidence of angioplasty and stent implantation, patients referred for coronary bypass (CABG) typically have more advanced and diffuse coronary disease. Thus, more patients may require endarterectomy in order to achieve complete revascularization. We compared our results in patients undergoing CABG with or without coronary endarterectomy. METHODS: Between 1993 and 1999, 2372 patients underwent isolated CABG in our department. A retrospective analysis was performed to compare patients requiring coronary endarterectomy of the LAD (group 1, n = 88), endarterectomy of arteries other than the LAD (group 2, n = 143), to those not requiring endarterectomy (group 3, n = 2071). Patients undergoing CABG without the use of cardiopulmonary bypass were excluded. Group 1 had a higher incidence of proximal LAD stenosis (p = 0.001) than group 3, while group 2 had a higher incidence of peripheral vascular disease (p = 0.02), preoperative MI (p = 0.03) and LV dysfunction (p = 0.001). RESULTS: Operative mortality was 10% in group 1 (p < 0.001) and 4% in group 2 (p = NS) compared to 3% in group 3. Incidence of perioperative MI was 12% in group 1 (p = 0.001) and 8% in group 2 (p = 0.001) compared to 2% in group 3. CONCLUSIONS: Patients requiring endarterectomy of the LAD are at increased risk of operative mortality. This was not true for patients requiring endarterectomy of arteries other than the LAD. In both groups there was an increased risk of perioperative myocardial infarction.