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Maurer E, Klinger C, Lorbeer R, Rathmann W, Peters A, Schlett CL, Nikolaou K, Bamberg F, Notohamiprodjo M, Walter SS. Long-term effect of physical inactivity on thoracic and lumbar disc degeneration-an MRI-based analysis of 385 individuals from the general population. Spine J 2020; 20:1386-1396. [PMID: 32360761 DOI: 10.1016/j.spinee.2020.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The correlation between physical inactivity, thoracolumbar disc degeneration, and back pain remains unclear. PURPOSE This study investigated the relationship between short- and long-term physical inactivity and degenerative changes of the thoracic and lumbar spine in a southern German cohort from the general population over a time period of 14 years. STUDY DESIGN/SETTING This study was designed as a cross-sectional case-control study, nested in a prospective cohort from the "Cooperative Health Research in the Region of Augsburg/Kooperative Gesundheitsforschung in der Region Augsburg" (KORA) study. PATIENT SAMPLE All participants in the population-based KORA study were assessed using a physical activity questionnaire to establish a baseline in 1999-2001 (exam 1), within an initial follow up questionnaire in 2006-2008 (exam 2), and a second follow-up questionnaire between 2013 and 2014 (exam 3). A subsample of this group (400 subjects) underwent full body MR scan performed on a 3T magnetic resonance imaging scanner current with exam 3. OUTCOME MEASURE Data regarding physical inactivity over a time period of 14 years and back pain, and quantification of thoracic and lumbar disc degeneration on magnetic resonance imaging. METHODS Quantification of thoracic and lumbar disc degeneration was performed using the Pfirrmann score. Physical activity was grouped as no physical activity, irregularly for 1 hour, regularly for 1 hour, or regularly for ≥2 hours. This was used to calculate another variable "physical inactivity," with the options of irregular activity ≤1 hour per week or regularly ≥1 hour. Physical labor, walking, and cycling activity were additionally investigated. Correlations between physical inactivity measurements and thoracic and lumbar disc degeneration were analyzed via linear regression models adjusted for age, sex, BMI, hypertension, diabetes, and back pain. RESULTS In total, 385 individuals (mean age: 56 years, SD ± 9.19; 58.2% male) were included in this study. Mean summed Pfirrmann score was 2.41 (SD ± 4.19) in the thoracic and 1.78 (SD ± 1.81) in the lumbar spine. The level of current exercise in our cohort varied with 113 (29.4%) subjects exercising regularly ≥2 hours per week, 118 (30.7%) regularly 1 hour per week, 57 (14%) irregularly for about 1 hour per week, and 97 (25.2%) stated not to exercise at exam 3. Disc degeneration was more apparent in those with irregular activity <1 hour compared to those with regular activity of ≥1 hour and more per week (p<.01) and in those with no activity compared to those with regular activity of ≥2 (p<.001) measured using exam 3. Less physical activity over a time period of 14 years correlated with an increase of disc degeneration of the thoracic and lumbar spine after adjustment for age, sex, BMI, hypertension and diabetes mellitus (p<.05). There was no statistically significant association between physical labor, walking activity, or cycling activity with disc degeneration. Additionally, no significant correlations between degree of disc degeneration (p=.990), degree of physical inactivity (p=.158), and back pain were observed. CONCLUSION Degree of physical inactivity as measured over a time period of 14 years demonstrated a strong correlation with disc degeneration of the thoracic and lumbar spine.
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Affiliation(s)
- Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany
| | - Christian Klinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian-University Hospital, Marchioninistraße 15, 81377 Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mike Notohamiprodjo
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; DIE RADIOLOGIE, Sonnenstrasse 17, 80331 Munich, Germany.
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
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James P, Morgant R, Merviel P, Saraux A, Giroux-Metges MA, Guillodo Y, Dupré PF, Muller M. How to promote physical activity during pregnancy : A systematic review. J Gynecol Obstet Hum Reprod 2020; 49:101864. [PMID: 32663651 DOI: 10.1016/j.jogoh.2020.101864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sedentary lifestyles and physical inactivity have been shown to increase during pregnancy and are a cause of obstetric comorbidity. The objective of this study was to conduct a systematic review of interventions aiming to promote physical activity during pregnancy. MATERIAL AND METHODS Databases were searched from January 2008 to September 2019. Selection criteria included randomized controlled trials evaluating the efficacy of interventions promoting physical activity during pregnancy. RESULTS In total, 256 articles were extracted from databases. 202 articles were excluded. Finally, 15 articles were included in the study. 5633 patients were included from various populations. Six studies rated physical activity (PA) as the primary outcome. Five studies suggested promoting physical activity through individual interviews which in two studies showed an increase in PA. Three studies evaluated an intervention based on group interviews and one of these reported a significant increase in PA. Two studies evaluated the use of a Smartphone application to promote physical activity but they did not conclude that they were effective because they were designed with low statistical power. CONCLUSION The practice of regular PA during pregnancy reduces obstetrical comorbidity. However, interventions seem to have a low impact on the promotion of PA during pregnancy. New intervention strategies need to assessed, such as the use of mobile health interventions.
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Affiliation(s)
- P James
- JAMES Pandora, Resident, Centre Hospitalier Universitaire Brest, France.
| | - R Morgant
- Dr MORGANT Romain, Cabinet de traumatologie du TER, Clinique du TER, 56270, Ploemeur, France
| | - P Merviel
- Pr MERVIEL Philippe, Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHRU Brest - Hôpital Morvan, France
| | - A Saraux
- Pr SARAUX Alain, Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - M A Giroux-Metges
- Pr GIROUX-METGES Marie-Agnès, Service des EFR, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - Y Guillodo
- Dr GUILLODO Yannick, Service de Rhumatologie, CHRU Brest, France
| | - P F Dupré
- Dr DUPRE Pierre-François, Chirurgie Oncologique Gynécologique et mammaire, CHRU Brest, France
| | - M Muller
- Dr MULLER Matthieu, Service Gynécologie-Obstétrique, Centre Hospitalier des Pays de Morlaix, France
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Zolotovskaya IA, Davydkin IL. [Antiresorptive-cytokine effects of the chondroprotective therapy in patients with lower back pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:65-71. [PMID: 32490621 DOI: 10.17116/jnevro202012004165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA). MATERIALS AND METHODS Using the envelope method, 231 patients were randomized into two groups: group 1 (n=116, main) received nonsteroidal anti-inflammatory drugs (NSAIDs) and chondrogard, group 2 (n=115, comparison) received only NSAIDs. The 2-month study included 3 visits (V): V1 - at the beginning of the study, V2 - after 10 days, V3 - after 60 days with the assessment of blood parameters: transforming growth factor β1 (TFR β1), interleukin (IL)-1β and IL-6, beta-Crosslaps, bone matrix formation indicator P1NP (n-terminal propeptide procollagen type 1), and determination of the level of deoxypyridinoline (DPID) in the urine. RESULTS AND CONCLUSION At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (p<0,001) and DPID (p<0,001), which may indicate the presence of its own antiresorptive-cytokine effect in chondroitin sulfate.
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Braun C, Voigt-Radloff S. [Treatment of non-specific low back pain: Evidence map of systematic reviews from 2015 to 2019]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:12-21. [PMID: 32151527 DOI: 10.1016/j.zefq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low back pain represents a major healthcare challenge in Germany and worldwide. The research field is highly dynamic. The aim of this evidence map was to create a compact overview of current systematic reviews on interventions for non-specific low back pain. METHODS Medline (PubMed), the Cochrane Database of Systematic Reviews and Epistemonikos were systematically searched from March 2015 to March 2019 for systematic reviews addressing any interventions for acute, subacute or chronic non-specific low back pain and reporting at least one patient-relevant outcome. Key information on the characteristics and conclusions of the included reviews were extracted and aspects of the methodological quality of the included reviews were assessed independently by two reviewers. The data were tabulated. RESULTS The search identified 1,436 records. 53 systematic reviews were included in the evidence map. The quality of the reviews and of the studies included therein varied. The reviews addressed a variety of different interventions, with considerable heterogeneity of their characteristics and methodological aspects. Many reviews found evidence for positive effects of the studied interventions, some found evidence for no effect, but the quantity and quality of the evidence were often judged as insufficient for formulating robust conclusions. Relatively few data were available on adverse events. CONCLUSION This evidence map provides a compact resource for the use of current systematic reviews on interventions for non-specific low back pain. The methodological deficits of many reviews require a careful approach towards their findings and conclusions and suggest a need for methodologically rigorous reviews.
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Affiliation(s)
- Cordula Braun
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland.
| | - Sebastian Voigt-Radloff
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Bernard S, Gentilcore-Saulnier E, Massé-Alarie H, Moffet H. Is adding pelvic floor muscle training to an exercise intervention more effective at improving pain in patients with non-specific low back pain? A systematic review of randomized controlled trials. Physiotherapy 2020; 110:15-25. [PMID: 32349867 DOI: 10.1016/j.physio.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pelvic floor muscles (PFM) contribute to optimal control of the lumbopelvic spine. PFM function appears altered in some people with nonspecific low back pain (LBP). OBJECTIVE To systematically review if adding PFM training (PFMT) to another exercise intervention can be more effective at improving pain and function in people with nonspecific LBP than without PFMT. DATA SOURCES The authors conducted a literature search on Medline, Embase, CINAHL, Cochrane Central and Web of Sciences up to October 2018. ELIGIBILITY CRITERIA: (1) Participants with nonspecific LBP; (2) additional PFMT to an exercise intervention; (3) comparison to the same intervention without PFMT; (4) included minimally one planned outcome; and (5) a randomized controlled trial. Two reviewers performed screening, data extraction (primary outcome; pain severity, secondary outcome; physical function) and risk of bias assessment. SYNTHESIS METHODS Meta-analysis was performed using mean difference and 95% confidence intervals. RESULTS Six studies were included (n=200 participants). Participants with PFMT had lower pain severity in comparison with the group without PFMT (mean difference: -0.61, 95%CI [-0.91, -0.31], P<0.0001 and low heterogeneity: I2=0%). Subgroup analysis shows significant effect for interventions lasting longer than 8-weeks. No difference was found for function. Overall risk of bias was unclear. LIMITATIONS Small groups and high heterogenicity limit our findings. CONCLUSION There is very low-quality evidence that there is a small benefit of adding PFMT to another exercise intervention on pain severity in nonspecific LBP. Longer duration for an integrated lumbopelvic exercise program including PFMT is likely to impact pain outcomes positively. PROSPERO REGISTRATION CRD42018114601.
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Affiliation(s)
- Stéphanie Bernard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada
| | - Evelyne Gentilcore-Saulnier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada; Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, 2915, avenue du Bourg-Royal, Québec, Québec G1C 3S2, Canada
| | - Hugo Massé-Alarie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada
| | - Hélène Moffet
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada.
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Hasenöhrl T, Windschnurer T, Dorotka R, Ambrozy C, Crevenna R. Prescription of individual therapeutic exercises via smartphone app for patients suffering from non-specific back pain : A qualitative feasibility and quantitative pilot study. Wien Klin Wochenschr 2020; 132:115-123. [PMID: 32060724 PMCID: PMC7080705 DOI: 10.1007/s00508-020-01616-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
Background The purpose of this qualitative study was the assessment of the feasibility and acceptance of orthopedists prescribing individualized therapeutic exercises via a smartphone app to patients suffering from non-specific back pain. Methods A total of 27 patients (mean age 44.8 ± 13.2 years) diagnosed with acute non-specific back pain were prescribed individually chosen therapy exercises via a smartphone app. Before the patients started and after 4 weeks of exercising all participants went through an assessment protocol consisting of questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], International Physical Activity Questionnaire [IPAQ], Work Ability Index [WAI], Visual Analogue Scale [VAS] back pain, sociodemographic parameters), assessment of functional parameters (handgrip strength, timed up and go test). With 16 randomly chosen patients semi-structured interviews were undertaken at the end of the intervention period. Interview transcripts were analyzed using thematic analysis. Power analysis and a priori sample size calculations were undertaken with the quantitative data. Results From the interviews four thematic categories emerged: prior exercise experience, evaluation of exercise intensity, communication with physician via smartphone app, and variability of exercise location. Quantitative analysis of secondary data showed significant improvements in back pain (ODI) as well as quality of life domains “physical functioning”, “bodily pain” and “vitality” (SF-36) of which “bodily pain” was sufficiently powered with the current sample size. Conclusion The prescription of therapeutic exercises via smartphone app to patients suffering from non-specific back pain is feasible and well-accepted in patients at all ages. Pilot data additionally pointed towards efficacy of the intervention.
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Affiliation(s)
- Timothy Hasenöhrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Windschnurer
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ronald Dorotka
- Orthopaedic City Center-medCLINIC, Dominikanerbastei 3, 1010, Vienna, Austria
| | - Clemens Ambrozy
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Cho HJ, Kim SJ, Park SE, Park JW. Physical activity level and temporomandibular disorders in South Koreans. Community Dent Oral Epidemiol 2020; 48:225-231. [PMID: 31994225 DOI: 10.1111/cdoe.12519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large-scale national database established through a nationwide survey. METHODS Data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross-sectional study. Data on sociodemographic characteristics, TMD-related variables, and general physical activity level were collected. Participants were divided into moderate- and low-intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates. RESULTS The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017-1.854) for people doing moderate-intensity exercises and 0.797 (0.629-1.008) among people doing low-intensity exercises. Those who did moderate-intensity exercises had significantly more TMD pain. This was higher in the 30- to 39-year age group (OR: 1.991, 95% CI: 1.137-3.488), with significantly higher risk for TMD pain in those who did moderate-intensity exercise, whereas low-intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409-0.958). CONCLUSIONS Moderate-intensity physical activity is associated with more TMD pain. Patients with TMD should avoid high-intensity level exercises and continue low-intensity exercises to prevent pain aggravation.
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Affiliation(s)
- Hyun-Jae Cho
- Department of Preventive Dentistry and Public Oral Health, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Seon-Jip Kim
- Department of Preventive Dentistry and Public Oral Health, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Seo Eun Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Ji Woon Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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Kawasaki T, Tozawa R. Grit in Community-Dwelling Older Adults with Low Back Pain Is Related to Self-Physical Training Habits. PM R 2020; 12:984-989. [PMID: 31901016 DOI: 10.1002/pmrj.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/30/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Self-management is an effective way to manage chronic low back pain (LBP) and is frequently recommended. However, the psychological aspects, including grit (ie, perseverance and passion for long-term goals), of the habit of self-management remain unclear. OBJECTIVE To investigate the relationship between grit and the self-directed exercise. DESIGN Cross-sectional observational study. SETTING Community-dwelling older adults. PARTICIPANTS Fifty-nine older adults with LBP (30 men, 29 women; mean age 72 ± 5 years, range 65-82 years). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Primary outcome measures included grit scores on the Short Grit Scale and the number of months performing self-directed exercise. Correlation and multiple regression analyses were performed to determine the relationship between participants' grit and duration of self-directed exercise. RESULTS A significant positive correlation between grit and the duration of self-directed exercise habits was observed (r = 0.49, P < .001). Furthermore, in multiple regression analysis, grit was a significant factor of the duration of self-directed exercise. CONCLUSION Low grit was associated with reduced self-directed exercise in individuals with LBP self-directed exercise.
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Affiliation(s)
- Tsubasa Kawasaki
- Institute of Sports Medicine and Science, School of Human and Social Sciences, Tokyo International University, Kawagoe-City, Japan
| | - Ryosuke Tozawa
- Department of Physical Therapy, Faculty of Health Science, Ryotokuji University, Urayasu-City, Japan
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Mather L, Ropponen A, Mittendorfer-Rutz E, Narusyte J, Svedberg P. Health, work and demographic factors associated with a lower risk of work disability and unemployment in employees with lower back, neck and shoulder pain. BMC Musculoskelet Disord 2019; 20:622. [PMID: 31878915 PMCID: PMC6933729 DOI: 10.1186/s12891-019-2999-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations. Methods All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004–2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations. Results Being male, 19–28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29–0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated. Conclusions Among those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability.
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Affiliation(s)
- Lisa Mather
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ho-A-Tham N, Vanlandewijck Y, de Donder L, Wittoek R, Ting-A-Kee B, Basantram R, Dankaerts W. Prevalence of musculoskeletal complaints in urban communities in multi-ethnic Suriname: a cross-sectional study with the COPCORD methodology (stage 1, phase 1 and 2). Clin Rheumatol 2019; 39:1065-1075. [PMID: 31802349 DOI: 10.1007/s10067-019-04842-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/19/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVES Musculoskeletal complaints (MSCs) are a major burden worldwide. In Suriname, a South American developing country, the epidemiology of MSCs and its related disorders is still unknown. Therefore, a cross-sectional survey was carried out to determine prevalence and risk factors of MSCs in urban areas of Suriname. METHODS This is the first Community Oriented Program for the Control of Rheumatic Diseases survey in a Caribbean Community. Trained interviewers collecting self-reported data conducted this house-to-house community-based survey. Data was analyzed using SPSS version 23 and Stata version 14.1. RESULTS The prevalence of MSCs was 62.1% with a higher prevalence rate among women compared with men (resp. 64.3% vs. 58.6%) (Odds ratio = 1.185; p ≤ 0.05). The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. The prevalence of MSCs was also associated with women, low educational level, smoking, alcohol use, high-intensity physical activity level, and body mass index (≥ 25 kg/m2). The highest prevalence of MSCs was found among African descendants (Maroons (68.8%) and Creoles (68.0%)), followed by the Indigenous (65.0%) and Asian descendants (Hindustani (64.3%) and Javanese (49.5%)). Most persons with MSCs (75.7%) reported multisite complaints with lower back, knee, and shoulder being the most frequently reported sites. In our study population, MSCs were not considered disabling (mean Health Assessment Questionnaire Disability Index score of 0.23). CONCLUSIONS The prevalence of MSCs in this urban multi-ethnic Surinamese community is high; therefore, future research is needed to further explore the burden of MSCs in Suriname.Key Points• Musculoskeletal complaints are highly prevalent in different ethnic groups in an urban Surinamese community; almost two-thirds of the population reported MSCs with the highest prevalence rate among women and African descendants.• The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45 years) and moderate to heavy physical workload. Gender, educational level, smoking, alcohol use, high-intensity physical activity, and body mass index were also significantly associated with musculoskeletal complaints.
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Affiliation(s)
- N Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname. .,Department of Rehabilitation Sciences, Research Group for Musculoskeletal rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Y Vanlandewijck
- Department of Rehabilitation Sciences, Research Group of Adapted Physical Activity and Psychomotor Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - L de Donder
- Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - R Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Ting-A-Kee
- Department of Pathology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - R Basantram
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - W Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Huang R, Ning J, Chuter VH, Taylor JB, Christophe D, Meng Z, Xu Y, Jiang L. Exercise alone and exercise combined with education both prevent episodes of low back pain and related absenteeism: systematic review and network meta-analysis of randomised controlled trials (RCTs) aimed at preventing back pain. Br J Sports Med 2019; 54:766-770. [PMID: 31672696 DOI: 10.1136/bjsports-2018-100035] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to investigate which prevention strategies for low back pain (LBP) are most effective. DESIGN We completed a Bayesian network meta-analysis to summarise the comparative effectiveness of LBP prevention strategies. The primary outcomes were an episode of LBP and LBP-associated work absenteeism represented as ORs with associated 95% credibility intervals (CrIs). We ranked all prevention strategies with surface under the cumulative ranking curve (SUCRA) analysis. DATA SOURCES PubMed, EMBASE and CENTRAL databases were searched along with manual searches of retrieved articles. We only included randomised controlled trials (RCTs) that reported an episode of LBP and/or LBP-associated work absenteeism evaluating LBP prevention strategies were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Data were independently extracted by two investigators, and RCT quality was assessed using the Cochrane Risk of Bias tool. RESULTS AND SUMMARY Forty RCTs were included. Exercise combined with education (OR: 0.59, CrI: 0.41 to 0.82) and exercise alone (OR: 0.59, CrI: 0.36 to 0.92) both prevented LBP episodes; exercise combined with education and education alone both had large areas under the curve (SUCRA: 81.3 and 79.4, respectively). Additionally, exercise (OR: 0.04, CrI: 0.00 to 0.34) prevented LBP-associated work absenteeism, with exercise and the combination of exercise and education ranking highest (SUCRA: 99.0 and 60.2, respectively). CONCLUSIONS Exercise alone and exercise combined with education can prevent episodes of LBP and LBP-related absenteeism. TRIAL REGISTRATION NUMBER PROSPERO 42017056884.
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Affiliation(s)
- Rongzhong Huang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China.,Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Ning
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
| | - Vivienne H Chuter
- School of Health Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Jeffrey Bruce Taylor
- Physical Therapy, High Point University, High Point, North Carolina, USA.,Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Demoulin Christophe
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Zengdong Meng
- Department of Orthopedics, First People's Hospital of YunNan Province, YunNan, China
| | - Yu Xu
- Statistical Laboratory, Chongqing Chuangxu Lifescience Institute, Chongqing, China
| | - Lihong Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
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Comparison of Whole-Body Electromyostimulation versus Recognized Back-Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5745409. [PMID: 31687394 PMCID: PMC6794965 DOI: 10.1155/2019/5745409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/16/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Abstract
Background Low back pain (LBP) affects almost everyone at least once in their lifetime. Various meta-analyses show promising effects on pain reduction for conventional exercise. However, the lack of time and, especially for pain patients, a fear of movement (“kinesiophobia”) as well as functional limitations often oppose participation in such activities. In contrast, the advantage of novel training technologies like whole-body electromyostimulation (WB-EMS) lies particularly in a joint-friendly, time-effective, and highly customized training protocol and might be an alternative option for LBP patients. A meta-analysis of individual patient data and a comparison of WB-EMS against a passive control group confirmed the proof principle. Thus, the aim of this randomized controlled trial is to compare WB-EMS with a recognized back-strengthening exercise protocol to determine the corresponding effects on chronic, nonspecific LBP in people suffering from this. Methods and Findings This randomized, controlled multicenter study is focused on novel and time-effective training technologies and LBP. In this contribution, the focus is primarily on the comparison of WB-EMS against a comparable conventional exercise training (CT). One hundred ten nonspecific chronic LBP patients, 40–70 years old, were randomly allocated to the intervention arms (WB-EMS: 55 vs. CT: 55). Both groups completed a 12-week program (WB-EMS: 1 × 20 min/week vs. CT: 1 × 45 min/week) specifically dedicated to LBP. The selection of the content of the active control group was based on the principles of WB-EMS training, which uses electrical stimulation to train mainly strength and stabilization in a very short time. Exercises were similar in all groups, with the focus on strengthening and stabilizing the trunk. Outcome measures were assessed by a four-week pain diary (before and during the last four weeks of intervention) as well as an isometric maximum strength measurement of the trunk muscles at baseline and after 12 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Secondary study endpoints were maximum isometric strength of the back and the abdominals. The mean pain intensity of LBP decreased significantly in both groups (WB-EMS: −22.3 ± 20.9% vs. CT: −30.2 ± 43.9%; p < 0.001), however, without significant intergroup difference (p=0.160). A similar result was observed for “maximum isometric strength of trunk muscles.” The increase in back strength (WB-EMS: 15.6 ± 24.9% vs. CT: 23.0 ± 30.9%) was highly significant in both groups (p=0.001), and similar changes were observed for the trunk flexors (WB-EMS: 17.6 ± 24.8% vs. CT: 18.1 ± 24.8%). Also, at the secondary endpoint, no significant difference in pairwise comparison was observed in both cases (extension: p=0.297; flexion: p=0.707). Conclusion In summary, both, WB-EMS and conventional back-strengthening protocol are comparably effective in reducing nonspecific chronic LBP in this dedicated cohort. The result is particularly positive in terms of time effectiveness and offers an adequate alternative for people with limited time resources or other barriers to conventional training methods.
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Kaartinen S, Aaltonen S, Korhonen T, Latvala A, Mikkelsson M, Kujala UM, Kaprio J. Is diversity of leisure-time sport activities associated with low back and neck-shoulder region pain? A Finnish twin cohort study. Prev Med Rep 2019; 15:100933. [PMID: 31338280 PMCID: PMC6626109 DOI: 10.1016/j.pmedr.2019.100933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 11/25/2022] Open
Abstract
This study investigates cross-sectional and longitudinal associations between the diversity of leisure-time sport activities and the frequencies of low back pain (LBP) and neck-shoulder region pain (NSP) in twins, including a cross-sectional within-pair design to adjust for potential familial confounding. Finnish twins born in 1975–79 (FinnTwin16 study) reported participation in leisure-time sport activities at the mean ages of 17 (1992–96) (n = 5096, 54% females) and 34 years (2010−12) (n = 3731, 57% females). Diversity assessed as the number of sport activities was categorized as 1, 2, 3, 4, and ≥ 5, excluding inactive individuals. The frequencies of LBP (n = 3201) and NSP (n = 3207), reported at age 34, were categorized as never/seldom, monthly, or weekly pain. Cross-sectional and longitudinal individual-based associations between the number of sport activities and the frequency of LBP and NSP were investigated with multinomial logistic regression analyses, adjusting for multiple confounders. Cross-sectionally, participation in ≥5 sport activities, compared to 1 sport, was associated with significantly less weekly LBP (OR = 0.63, 95%CI = 0.43–0.90), but not with NSP. Longitudinally, participation in several sport activities in adolescence had no significant association with LBP or NSP in adulthood. Cross-sectional within-pair analyses were conducted among twin pairs discordant for LBP (n = 507) and NSP (n = 579). The associations between monozygotic and dizygotic twin pairs were similar in LBP-discordant pairs but differed within NSP-discordant pairs. Participation in ≥5 sport activities in adulthood may be associated with less weekly LBP, but not with monthly LBP or the frequency of NSP. However, within-pair analyses for NSP suggest confounding due to shared familial factors. Participation in more sport activities is associated with less low back pain (LBP). More sport activities is not associated with neck-shoulder pain (NSP). Shared familial factors may confound the association between sport activities and NSP. Number of sport activities in adolescence did not predict LBP or NSP in adulthood.
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Affiliation(s)
- Sara Kaartinen
- Department of Public Health, P.O. Box 20 (Tukholmankatu 8 B), FI-00014, University of Helsinki, Helsinki, Finland
| | - Sari Aaltonen
- Department of Social Research, P.O. Box 54, University of Helsinki, FI-00014 Helsinki, Finland.,Institute of Molecular Medicine (FIMM), P.O. Box 20, University of Helsinki, FI-00014 Helsinki, Finland
| | - Tellervo Korhonen
- Department of Public Health, P.O. Box 20 (Tukholmankatu 8 B), FI-00014, University of Helsinki, Helsinki, Finland.,Institute of Molecular Medicine (FIMM), P.O. Box 20, University of Helsinki, FI-00014 Helsinki, Finland
| | - Antti Latvala
- Department of Public Health, P.O. Box 20 (Tukholmankatu 8 B), FI-00014, University of Helsinki, Helsinki, Finland.,Institute of Molecular Medicine (FIMM), P.O. Box 20, University of Helsinki, FI-00014 Helsinki, Finland
| | - Marja Mikkelsson
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850 Lahti, Finland.,Faculty of Medicine and Life Sciences, P.O. Box 100, University of Tampere, FI-33014 Tampere, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, P.O. Box 35, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Jaakko Kaprio
- Department of Public Health, P.O. Box 20 (Tukholmankatu 8 B), FI-00014, University of Helsinki, Helsinki, Finland.,Institute of Molecular Medicine (FIMM), P.O. Box 20, University of Helsinki, FI-00014 Helsinki, Finland
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Monnier A, Larsson H, Nero H, Djupsjöbacka M, Äng BO. A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees. BMJ Open 2019; 9:e025150. [PMID: 31092646 PMCID: PMC6530317 DOI: 10.1136/bmjopen-2018-025150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course. DESIGN Prospective observational cohort study with weekly follow-ups. PARTICIPANTS Fifty-three SwAF marines entering the training course. OUTCOMES Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports. RESULTS During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time. CONCLUSIONS Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.
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Affiliation(s)
- Andreas Monnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Swedish Armed Forces, Military Academy Karlberg, Stockholm, Sweden
| | - Helena Larsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden
| | - Håkan Nero
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mats Djupsjöbacka
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, University of Gävle, Gävle, Sweden
| | - Björn O Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research, Uppsala University, Falun, Sweden
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Walking more than 90minutes/week was associated with a lower risk of self-reported low back pain in persons over 50years of age: a cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J 2019; 19:846-852. [PMID: 30448632 DOI: 10.1016/j.spinee.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Physical activity, such as muscle strengthening and aerobic exercise, has been found to be effective for low back pain (LBP). However, the association between weekly walking duration and LBP in the general population remains poorly understood. OBJECT This study aimed (1) to analyze the association between walking and LBP and (2) to examine this association according to walking duration and overall walking days per week in a general population over 50years of age using a representative sample of Korean adults. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Data from the Korea National Health and Nutrition Examination Surveys V and VI, performed from 2010 to 2015. OUTCOME MEASURES Multiple logistic regression analysis was performed to determine the association between walking days and duration and LBP. Analysis was restricted to participants aged over 50years who responded to surveys on LBP and walking activity. METHODS National health and nutrition examination surveys were performed in the Korean general population (N=48,482) from 2010 to 2015. LBP status was surveyed using a self-reported questionnaire form ("Have you complained of LBP for more than 30days during the past 3 months?"). Daily walking activity (low-intensity activity) was evaluated using the following two questions: (1) "During the last 7days, on how many days did you walk for at least 10 minutes at a time? This includes at work and at home, walking to travel from place to place, and any other walking that you have done solely for recreation, sport, exercise, or leisure." (2) "How much time did you usually spend walking on each of those days?" Walking duration per day was classified into two categories: over 30min/day and over 1h/day. Overall walking days per week were categorized into <3, 3-4, and ≥5days/week. Basic characteristics, comorbidities, socioeconomic status, and other variables were used to create multiple logistic regression models. No sources of funding and no conflicts of interest were associated with this study. RESULTS Walking for more than 3days per week for over 30 minutes at a time was negatively associated with LBP in the unadjusted (adjusted odds ratio [aOR]: 0.65, p<.001) and fully adjusted logistic regression models (aOR: 0.79, p<.001). Similarly, walking for more than 5days per week for over 1 hour at a time was negatively associated with LBP in the unadjusted (aOR: 0.62, p<.001) and fully adjusted logistic regression models (aOR: 0.76, p<.001). The risk of LBP decreased with increasing walking days and duration. CONCLUSIONS Our study showed that longer walking duration was associated with a lower risk of LBP using a cross-sectional health survey in the Korean general population. Regular walking with a longer duration for more than 3days/week is significantly associated with a lower risk of LBP in the general population aged over 50years.
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Zheng YL, Wang XF, Chen BL, Gu W, Wang X, Xu B, Zhang J, Wu Y, Chen CC, Liu XC, Wang XQ. Effect of 12-Week Whole-Body Vibration Exercise on Lumbopelvic Proprioception and Pain Control in Young Adults with Nonspecific Low Back Pain. Med Sci Monit 2019; 25:443-452. [PMID: 30644383 PMCID: PMC6342063 DOI: 10.12659/msm.912047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nonspecific low back pain (NSLBP) accounts for a large proportion of low back pain cases. The present study aimed to investigate the effect of the whole-body vibration (WBV) exercise on lumbar proprioception in NSLBP patients. It was hypothesized that WBV exercise enhances lumbar proprioception. MATERIAL AND METHODS Forty-two patients with NSLBP performed an exercise program 3 times a week for a total of 12 weeks of WBV. The lumbar proprioception was measured by joint position sense. Outcomes were lumbar angle deviation and visual analogue scale (VAS) score. RESULTS After the 12-week WBV exercise, lumbar flexion angle deviation was reduced from 3.65±2.26° to 1.90±1.07° (P=0.0001), and extension angle deviation was reduced from 3.06±1.85° to 1.61±0.75° (P=0.0001), significantly lower than baseline. After participating in the 12-week WBV exercise, a significant pain reduction was observed (P=0.0001). Men in the whole group (n=32) indicated significantly lower angle deviations in flexion and extension, whereas women (n=10) indicated significantly lower flexion angle deviation (P=0.037), and no significant difference was found in extension angle deviation (P=0.052). However, by subdividing the entire group (n=42) into poor and good proprioceptive groups, WBV exercise presented significant enhancement of lumbar proprioceptive ability in the poor flexion proprioception subgroup, poor extension proprioception subgroup, and good extension proprioception subgroup (each P=0.0001), but not in the subgroup with good flexion proprioceptive ability (P=0.165). CONCLUSIONS Lumbar flexion and extension proprioception as measured by joint position sense was significantly enhanced and pain was significantly reduced after 12-week WBV exercise in NSLBP patients. However, the patients with good flexion proprioceptive ability had limited proprioceptive enhancement.
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Affiliation(s)
- Yi-Li Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China (mainland)
| | - Xiao-Feng Wang
- Department of Spinal Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou Affiliated Hospital of Zhejiang Chinese Medicine University, Wenzhou, Zhejiang, China (mainland)
| | - Bing-Lin Chen
- College of Medical Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Wei Gu
- Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China (mainland)
| | - Xin Wang
- Department of Rehabilitation Medicine, Affiliated to Traditional Chinese Medicine Faculty, Changhai Hospital, Shanghai, China (mainland)
| | - Bing Xu
- Department of Spinal Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou Affiliated Hospital of Zhejiang Chinese Medicine University, Wenzhou, Zhejiang, China (mainland)
| | - Juan Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Ya Wu
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China (mainland)
| | - Chang-Cheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Xiao-Chen Liu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland).,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China (mainland)
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Shebib R, Bailey JF, Smittenaar P, Perez DA, Mecklenburg G, Hunter S. Randomized controlled trial of a 12-week digital care program in improving low back pain. NPJ Digit Med 2019; 2:1. [PMID: 31304351 PMCID: PMC6550254 DOI: 10.1038/s41746-018-0076-7] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Low back pain (LBP) is the leading cause of disability throughout the world and is economically burdensome. The recommended first line treatment for non-specific LBP is non-invasive care. A digital care program (DCP) delivering evidence-based non-invasive treatment for LBP can aid self-management by engaging patients and scales personalized therapy for patient-specific needs. We assessed the efficacy of a 12-week DCP for LBP in a two-armed, pre-registered, randomized, controlled trial (RCT). Participants were included based on self-reported duration of LBP, but those with surgery or injury to the lower back in the previous three months were excluded. The treatment group (DCP) received the 12-week DCP, consisting of sensor-guided exercise therapy, education, cognitive behavioral therapy, team and individual behavioral coaching, activity tracking, and symptom tracking - all administered remotely via an app. The control group received three digital education articles only. All participants maintained access to treatment-as-usual. At 12 weeks, an intention-to-treat analysis showed each primary outcome-Oswestry Disability Index (p < 0.001), Korff Pain (p < 0.001) and Korff Disability (p < 0.001)-as well as each secondary outcome improved more for participants in the DCP group compared to control group. For participants who completed the DCP (per protocol), average improvement in pain outcomes ranged 52-64% (Korff: 48.8-23.4, VAS: 43.6-16.5, VAS impact on daily life: 37.3-13.4; p < 0.01 for all) and average improvement in disability outcomes ranged 31-55% (Korff: 33.1-15, ODI: 19.7-13.5; p < 0.01 for both). Surgical interest significantly reduced in the DCP group. Participants that completed the DCP had an average engagement, each week, of 90%. Future studies will further explore the effectiveness of the DCP for long-term outcomes beyond 12 weeks and for a LBP patient population with possibly greater baseline pain and disability. In conclusion, the DCP resulted in improved LBP outcomes compared to treatment-as-usual and has potential to scale personalized evidence-based non-invasive treatment for LBP patients.
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Affiliation(s)
- Raad Shebib
- 1Hinge Health, Inc, San Francisco, CA USA.,2Department of Rehabilitation Services, Kaiser Permanente, San Francisco, CA USA
| | - Jeannie F Bailey
- 3Department of Orthopaedic Surgery, University of California, San Francisco, CA USA
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Abstract
Globally, in 2016, low back pain (LBP) contributed 57.6 million of total years lived with disability. Low Back Pain Guidelines regularly recommend the use of physical exercise for non-specific LBP. Early non-pharmacological treatment is endorsed. This includes education and self-management, and the recommencement of normal activities and exercise, with the addition of psychological programs in those whose symptoms persist. The aim of physical treatments is to improve function and prevent disability from getting worse. There is no evidence available to show that one type of exercise is superior to another, and participation can be in a group or in an individual exercise program. Active strategies such as exercise are related to decreased disability. Passive methods (rest, medications) are associated with worsening disability, and are not recommended. The Danish, United States of America, and the United Kingdom Guidelines recommend the use of exercise on its own, or in combination with other non-pharmacological therapies. These include tai chi, yoga, massage, and spinal manipulation. Public health programs should educate the public on the prevention of low back pain. In chronic low back pain, the physical therapy exercise approach remains a first-line treatment, and should routinely be used.
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Affiliation(s)
- Edward A Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand.
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Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Röbl-Mathieu M, Schiffner U, Vetter K, Weißenborn A, Wöckel A. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd 2018; 78:1262-1282. [PMID: 30655650 PMCID: PMC6294644 DOI: 10.1055/a-0713-1058] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.
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Affiliation(s)
- Berthold Koletzko
- Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, LMU – Ludwig-Maximilians-Universität, München, Germany
- Deutsche Gesellschaft für Kinder- und Jugendheilkunde e. V. (DGKJ), Berlin, Germany
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Monika Cremer
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Maria Flothkötter
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Christine Graf
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Deutsche Sporthochschule Köln, Köln, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Claudia Hellmers
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Hochschule Osnabrück, Osnabrück, Germany
- Deutsche Gesellschaft für Hebammenwissenschaft e. V. (DGHWi), Münster, Germany
| | - Mathilde Kersting
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Forschungsdepartment Kinderernährung, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Krawinkel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Institut für Ernährungswissenschaft, Justus-Liebig-Universität Gießen, Gießen, Germany
- Deutsche Gesellschaft für Ernährung e. V. (DGE), Bonn, Germany
| | - Hildegard Przyrembel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Marianne Röbl-Mathieu
- Mitglied der Ständigen Impfkommission am Robert Koch-Institut (STIKO), Berlin, Germany
| | - Ulrich Schiffner
- Poliklinik für Zahnerhaltung und Präventive Zahnheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Deutsche Gesellschaft für Kinderzahnheilkunde e. V. (DGKiZ), Würzburg, Germany
| | - Klaus Vetter
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Nationale Stillkommission, Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Anke Weißenborn
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Achim Wöckel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Frauenklinik und Poliklinik Universitätsklinikum Würzburg, Würzburg, Germany
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Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, Skou ST, Andersen TE, Hartvigsen J. GLA:D ® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord 2018; 19:418. [PMID: 30497440 PMCID: PMC6267880 DOI: 10.1186/s12891-018-2334-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.
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Affiliation(s)
- Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Applied Health Services, University College Lillebaelt, Niels Bohrs Alle 1, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Sandbäcksgatan 7/3, University Hospital Campus, Linköping University, 581 83 Linköping, Sweden
| | | | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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Park SM, Kim GU, Kim HJ, Kim H, Chang BS, Lee CK, Yeom JS. Low handgrip strength is closely associated with chronic low back pain among women aged 50 years or older: A cross-sectional study using a national health survey. PLoS One 2018; 13:e0207759. [PMID: 30475880 PMCID: PMC6261108 DOI: 10.1371/journal.pone.0207759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/06/2018] [Indexed: 12/19/2022] Open
Abstract
Object This study aimed to analyze the association between low handgrip strength (HGS) and low back pain (LBP) according to physical activity (PA) in the general population aged over 50 years. Methods Nationwide health surveys and examinations were performed in a cross-sectional representative of the Korean general population (n = 7,550 in 2014, n = 7,380 in 2015). Chronic LBP status was determined by self-reported survey responses with respect to the occurrence of LBP for more than 30 days during the previous 3 months. Maximal HGS was determined as the maximal strength of the dominant hand, and low HGS was defined as measurement in the lower 20th percentile of HGS measurements for the general population. High PA was defined as muscle-strengthening exercise for at least 3 days within 1 week. Demographics, medical history, and other variables were used to analyze adjusted weighted logistic regression models with propensity score matching. After propensity score matching, 429 participants were included in each group. Results Analysis was confined to those aged 50–89 years who responded to the chronic LBP survey and had no missing data on HGS. Low HGS and LBP showed significant association in the crude logistic regression model. In the multiple logistic regression model, after adjusting for confounding factors, low HGS was significantly associated with LBP in women with low PA (adjusted odds ratio [aOR]: 1.75, p = 0.047). In the logistic regression model after propensity score matching, low HGS was also significantly related to LBP in women with low PA (aOR: 3.12, p = 0.004). Conclusions Our study showed the relationship between low HGS and LBP using a cross-sectional Korean population-based health survey. Low HGS in women aged over 50 years with low PA was significantly associated with the presence of LBP.
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Affiliation(s)
- Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Gang-Un Kim
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Choon-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Jin S. Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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The Global Spine Care Initiative: model of care and implementation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:925-945. [PMID: 30151805 DOI: 10.1007/s00586-018-5720-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine care; (2) an evidence-based model that could be applied globally; and (3) implementation suggestions. METHODS The Global Spine Care Initiative (GSCI) meetings and literature reviews were synthesized into a seed document and distributed to spine care experts. After three rounds of a modified Delphi process, all participants reached consensus on the final model of care and implementation steps. RESULTS Sixty-six experts representing 24 countries participated. The GSCI model of care has eight core principles: person-centered, people-centered, biopsychosocial, proactive, evidence-based, integrative, collaborative, and self-sustaining. The model of care includes a classification system and care pathway, levels of care, and a focus on the patient's journey. The six steps for implementation are initiation and preparation; assessment of the current situation; planning and designing solutions; implementation; assessment and evaluation of program; and sustain program and scale up. CONCLUSION The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. These slides can be retrieved under Electronic Supplementary Material.
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