Patient-reported disability in the general Japanese population was associated with medical care visits for low back pain, regardless of pain intensity

Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis

BACKGROUND

During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults.

METHODS

Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI).

RESULTS

Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed.

CONCLUSION

Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.

Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants

BACKGROUND

The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

METHODS

PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

RESULTS

The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

CONCLUSIONS

Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.

Determinants of healthcare utilisation for low back pain: A population-based study in Ethiopia

Low back pain (LBP) remains one of the major public health problems worldwide. However, in low-income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population-based cross-sectional study was conducted in South-West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log-binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9-38.1, while the annual prevalence rate was 30%, 95% CI: 27.9-32.2. Of those with a 1-year history of healthcare utilisation, while 7.4%, 95% CI: 4.9-10.3 rural and 36.6%, 95% CI: 29.5-44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3-2.7 rural and 6.8%, 95% CI: 3.1-10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.

Relationship between healthcare seeking and pain expansion in patients with nonspecific chronic low back pain

Objectives

Low back pain (LBP) is the most prevalent musculoskeletal problem, which implies a high rate of chronicity. The chronicity of symptoms can lead to pain expansion. The main objective of this study was to assess whether there were differences between patients with nonspecific chronic LBP (CLBP) who sought healthcare compared to those who did not in terms of pain expansion.

Methods

Ninety individuals participated in the study and were divided into three groups: 30 patients who sought care; 30 patients who did not seek care; and 30 asymptomatic individuals. The primary variable analyzed was pain expansion. Secondary physical and psychological variables were assessed later, and a regression analysis was performed.

Results

Patients who sought help showed significant differences in pain expansion and pain intensity compared with the group who did not seek help, with a medium effect size (0.50–0.79). The regression model for the care-seeking group showed that dynamic balance with the left leg and depression were predictors of percentage pain surface area (34.6%). The combination of dynamic balance, range of movement in flexoextension and depression were predictors of widespread pain (48.5%).

Conclusion

Patients who soughtcare presented greater pain expansion than patients whodidnot. A combination of functional and psychological variables can significantly predict pain expansion in patients with nonspecific CLBP who seek help.

The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia

INTRODUCTION AND OBJECTIVES

Low back pain (LBP) is a highly prevalent and disabling public health problem globally. However, little is known about factors affecting health care utilisation for optimal management of the pain, and there is no validated instrument to derive epidemiological data for a better understanding of these factors. The aim of this study was to develop and validate an instrument used to measure determinants of health care utilisation for LBP in Ethiopia.

METHODS

The relevant domains of potential determinants of health care utilisation for LBP were identified following a comprehensive review of the literature. Items relating to each domain were then generated by considering the context of Ethiopia, and where necessary, existing items were adapted. The instrument was then translated, and an expert panel reviewed the instrument for content validity, clarity and any other suggestions. Using the data collected from 1303 adults with LBP, factorial validity was assessed by conducting principal component and parallel analyses. Internal consistency reliability was also assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate temporal stability of the instrument.

RESULTS

Parallel analysis showed that there were six components with Eigenvalues (obtained from principal component analysis) exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00.

CONCLUSIONS

This study demonstrated that the newly developed instrument has an overall good level of content and factorial validity, internal consistency reliability, and temporal stability. In this way, this instrument is appropriate for measuring determinants of health care utilisation among people with LBP in Ethiopia.

Reduction in anxiety during treatment with exercise and duloxetine is related to improvement of low back pain-related disability in patients with non-specific chronic low back pain

Background:

Non-invasive treatment is generally recommended for patients with non-specific chronic low back pain (CLBP). However, the impact of combination therapy with physical exercise and a serotonin-norepinephrine reuptake inhibitor has not been clarified in patients with non-specific CLBP. This study assessed the efficacy of combination treatment with exercise and duloxetine on non-specific CLBP and aimed to identify factors that contributed to improvement of LBP-induced disability.

Methods:

This prospective study was conducted on consecutive outpatients with non-specific CLBP. Patients received a supervised home-based exercise program and duloxetine administration for 15 weeks. The Roland-Morris Disability Questionnaire (RDQ), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS) were assessed at baseline and 15 weeks. Multiple logistic regression modeling was used to identify factors associated with an improvement in RDQ.

Results:

Forty-two patients were enrolled. Overall, scores on the RDQ, NRS, and PCS (total score, magnification, helplessness) were significantly reduced at 15 weeks (p < 0.01 for all). An improvement of disability was confirmed in 22 patients (52%). A higher HADS depression score before and after the intervention was significantly associated with a lack of improvement in disability (p < 0.01). Further, a reduction in HADS anxiety score over 15 weeks was a significant factor associated with an improvement in disability (odds ratio: 1.99;95% CI: 1.26-3.65).

Conclusions:

Supervised exercise plus duloxetine resulted in favorable outcomes and an improvement of LBP-related disability in approximately 50% of patients. A reduction in anxiety over treatment was associated with the improved disability.

Lumbar mechanical traction: a biomechanical assessment of change at the lumbar spine

BACKGROUND

Lumbar traction is a traditional treatment modality for chronic low back pain (CLBP) in many countries. However, its effectiveness has not been demonstrated in clinical practice because of the following: (1) the lack of in vivo biomechanical confirmation of the mechanism of lumbar traction that occurs at the lumbar spine; (2) the lack of a precise delivery system for traction force and, subsequently, the lack of reproducibility; and (3) few randomized controlled trials proving its effectiveness and utility.

METHODS

This study was planned as a preparatory experiment for a randomized clinical trial, and it aimed (1) to examine the biomechanical change at the lumbar area under lumbar traction and confirm its reproducibility and accuracy as a mechanical intervention, and (2) to reconfirm our clinical impression of the immediate effect of lumbar traction. One hundred thirty-three patients with non-specific CLBP were recruited from 28 orthopaedic clinics to undergo a biomechanical experiment and to assess and determine traction conditions for the next clinical trial. We used two types of traction devices, which are commercially available, and incorporated other measuring tools, such as an infrared range-finder and large extension strain gauge. The finite element method was used to analyze the real data of pelvic girdle movement at the lumbar spine level. Self-report assessments with representative two conditions were analyzed according to the qualitative coding method.

RESULTS

Thirty-eight participants provided available biomechanical data. We could not measure directly what happened in the body, but we confirmed that the distraction force lineally correlated with the movement of traction unit at the pelvic girdle. After applying vibration force to preloading, the strain gauge showed proportional vibration of the shifting distance without a phase lag qualitatively. FEM simulation provided at least 3.0-mm shifting distance at the lumbar spine under 100 mm of body traction. Ninety-five participants provided a treatment diary and were classified as no pain, improved, unchanged, and worsened. Approximately 83.2% of participants reported a positive response.

CONCLUSION

Lumbar traction can provide a distractive force at the lumbar spine, and patients who experience the application of such force show an immediate response after traction.

TRIAL REGISTRATION

University Hospital Medical Information Network - Clinical Trial Registration: UMIN-CTR000024329 (October 13, 2016).

Method for measuring tri-axial lumbar motion angles using wearable sheet stretch sensors

BACKGROUND

Body movements, such as trunk flexion and rotation, are risk factors for low back pain in occupational settings, especially in healthcare workers. Wearable motion capture systems are potentially useful to monitor lower back movement in healthcare workers to help avoid the risk factors. In this study, we propose a novel system using sheet stretch sensors and investigate the system validity for estimating lower back movement.

METHODS

Six volunteers (female:male = 1:1, mean age: 24.8 ± 4.0 years, height 166.7 ± 5.6 cm, weight 56.3 ± 7.6 kg) participated in test protocols that involved executing seven types of movements. The movements were three uniaxial trunk movements (i.e., trunk flexion-extension, trunk side-bending, and trunk rotation) and four multiaxial trunk movements (i.e., flexion + rotation, flexion + side-bending, side-bending + rotation, and moving around the cranial-caudal axis). Each trial lasted for approximately 30 s. Four stretch sensors were attached to each participant's lower back. The lumbar motion angles were estimated using simple linear regression analysis based on the stretch sensor outputs and compared with those obtained by the optical motion capture system.

RESULTS

The estimated lumbar motion angles showed a good correlation with the actual angles, with correlation values of r = 0.68 (SD = 0.35), r = 0.60 (SD = 0.19), and r = 0.72 (SD = 0.18) for the flexion-extension, side bending, and rotation movements, respectively (all P < 0.05). The estimation errors in all three directions were less than 3°.

CONCLUSION

The stretch sensors mounted on the back provided reasonable estimates of the lumbar motion angles. The novel motion capture system provided three directional angles without capture space limits. The wearable system possessed great potential to monitor the lower back movement in healthcare workers and helping prevent low back pain.