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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Channak S, Klinsophon T, Janwantanakul P. The effects of chair intervention on lower back pain, discomfort and trunk muscle activation in office workers: a systematic review. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:1722-1731. [PMID: 33970803 DOI: 10.1080/10803548.2021.1928379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives. The chair is a standard piece of workstation equipment in an office. Previous studies showed that a suitable chair may reduce musculoskeletal symptoms. This review investigated the effect of chair intervention on lower back pain (LBP), discomfort and trunk muscle activation among office workers. Methods. Five electronic databases from 1980 to May 2020 were searched for relevant randomized and non-randomized controlled trials. The methodological quality of the included studies was assessed using the 13-item Cochrane risk of bias tool. Quality of evidence was assessed and rated according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. Results. Two randomized controlled trials, 10 repeated-measures studies and two prospective cohort studies were included in this review. Nine studies were rated as high quality. The results indicated very low-quality to low-quality evidence for the conflicting effect of chair intervention on pain and discomfort reduction as well as trunk muscle activation among office workers. When stratified by chair type, the level of evidence for health benefits derived from any type of chair was still of very low to low quality. Conclusion. Unless supplementary high-quality studies provide different evidence, chair interventions are not recommended to reduce LBP or discomfort and activate trunk muscles.
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Affiliation(s)
- Sirinant Channak
- Faculty of Allied Health Sciences, Chulalongkorn University, Thailand
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Roman-Liu D, KamiŃska J, Tokarski T. Effectiveness of workplace intervention strategies in lower back pain prevention: a review. INDUSTRIAL HEALTH 2020; 58:503-519. [PMID: 32968038 PMCID: PMC7708737 DOI: 10.2486/indhealth.2020-0130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to identify effective work place intervention strategies for the prevention of low back pain (LBP). The study focused on interventions to two major groups: personal interventions and technical interventions. Data basis were searched for with inclusion criteria: study design based on randomised controlled trial; outcome measures including non-specific LBP occurrence expressed by prevalence or intensity; intervention met the definition of the technical and/or personal (physical exercises, behavioural training, educational) intervention programme. Eighteen papers were selected for full analysis. The diversification of quantitative indicators of differences between control and intervention groups were carried out using Cohen's d index. The results of analysis showed strong differences in effects among intervention strategies, as well as among different cases within similar intervention strategies. LBP severity before intervention and the length of intervention were discussed as potentially influencing factors. The results of the analysis suggest that the most effective strategies for LBP prevention include technical modifications of the workstand and education based on practical training. Behavioural and physical training seems to be of lesser importance. LBP severity before intervention and the time when the measurements of outcome measures take place play an important role in the effectiveness of intervention.
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Affiliation(s)
- Danuta Roman-Liu
- Central Institute for Labour Protection, National Research Institute (CIOP-PIB), Poland
| | - Joanna KamiŃska
- Central Institute for Labour Protection, National Research Institute (CIOP-PIB), Poland
| | - Tomasz Tokarski
- Central Institute for Labour Protection, National Research Institute (CIOP-PIB), Poland
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Godley E, Smith MA. Efficacy of acupressure for chronic low back pain: A systematic review. Complement Ther Clin Pract 2020; 39:101146. [PMID: 32379678 DOI: 10.1016/j.ctcp.2020.101146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Establish the utility of acupressure for chronic low back pain (CLBP). DESIGN A systematic review of English articles using PubMed and Embase was conducted from 01/2004-01/2020. Search terms included: "acupressure" and "chronic pain" or "low back pain". Articles included were randomized control trials evaluating acupressure in adult patients with CLBP. RESULTS 150 studies met initial criteria; 6 were included (n = 468). The average total treatment length was 4 weeks. The main treatment outcomes were changes in pain, disability, and sleep. All studies found a clinically significant reduction (, ≥30% decrease) in pain for the treatment groups. All studies found a clinically significant and/or statistically significant improvement in disability in at least one of the treatment groups. All studies found a statistically significant improvement in sleep. No study found significant adverse events. CONCLUSION Acupressure is a feasible, effective, safe, low cost nonpharmacologic method to treat CLBP.
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Affiliation(s)
- Erica Godley
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA; University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI, 48109, USA
| | - Michael A Smith
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA; University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI, 48109, USA.
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Wasmann KA, Wijsman P, van Dieren S, Bemelman W, Buskens C. Partially randomised patient preference trials as an alternative design to randomised controlled trials: systematic review and meta-analyses. BMJ Open 2019; 9:e031151. [PMID: 31619428 PMCID: PMC6797441 DOI: 10.1136/bmjopen-2019-031151] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/12/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCT) are the gold standard to provide unbiased data. However, when patients have a treatment preference, randomisation may influence participation and outcomes (eg, external and internal validity). The aim of this study was to assess the influence of patients' preference in RCTs by analysing partially randomised patient preference trials (RPPT); an RCT and preference cohort combined. DESIGN Systematic review and meta-analyses. DATA SOURCES MEDLINE, Embase, PsycINFO and the Cochrane Library. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RPPTs published between January 2005 and October 2018 reporting on allocation of patients to randomised and preference cohorts were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. The main outcomes were the difference in external validity (participation and baseline characteristics) and internal validity (lost to follow-up, crossover and the primary outcome) between the randomised and the preference cohort within each RPPT, compared in a meta-regression using a Wald test. Risk of bias was not assessed, as no quality assessment for RPPTs has yet been developed. RESULTS In total, 117 of 3734 identified articles met screening criteria and 44 were eligible (24 873 patients). The participation rate in RPPTs was >95% in 14 trials (range: 48%-100%) and the randomisation refusal rate was >50% in 26 trials (range: 19%-99%). Higher education, female, older age, race and prior experience with one treatment arm were characteristics of patients declining randomisation. The lost to follow-up and cross-over rate were significantly higher in the randomised cohort compared with the preference cohort. Following the meta-analysis, the reported primary outcomes were comparable between both cohorts of the RPPTs, mean difference 0.093 (95% CI -0.178 to 0.364, p=0.502). CONCLUSIONS Patients' preference led to a substantial proportion of a specific patient group refusing randomisation, while it did not influence the primary outcome within an RPPT. Therefore, RPPTs could increase external validity without compromising the internal validity compared with RCTs. PROSPERO REGISTRATION NUMBER CRD42019094438.
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Affiliation(s)
- Karin A Wasmann
- Department of Surgery, Amsterdam UMC-Location AMC, Amsterdam, Netherlands
| | - Pieta Wijsman
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - Susan van Dieren
- Department of Statistics and Epidemiology, Amsterdam UMC-Location AMC, Amsterdam, Netherlands
| | - Willem Bemelman
- Department of Surgery, Amsterdam UMC-Location AMC, Amsterdam, Netherlands
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Guo P, Wang JW, Tong A. Therapeutic effectiveness of neuromuscular electrical stimulation for treating patients with chronic low back pain. Medicine (Baltimore) 2018; 97:e13197. [PMID: 30508900 PMCID: PMC6283192 DOI: 10.1097/md.0000000000013197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
This retrospective study investigated the effectiveness and safety of neuromuscular electrical stimulation (NMES) for patients with chronic low back pain (CLBP).A total of 72 patients with CLBP were included in this retrospective study. All patients received usual care, and were assigned to a NMES group (n = 36) and a control group (n = 36). In addition, patients in the NMES group also received NMES for a total of 4 weeks. The primary outcome was pain intensity, measured by numerical rating scale (NRS). The secondary outcome was disability, assessed by the Roland-Morris Disability Questionnaire (RMDQ), and the Quebec Back Pain Disability Scale (QBPDS). The outcomes were evaluated before and after 4-week treatment.After 4-week treatment, the patients in the NMES group did not show better effectiveness in pain intensity relief, as measured by NRS (P = .11); and disability improvement, as evaluated by the RMDQ (P = .14), and QBPDS (P = .33), when compared with the patients in the control group. Additionally, no adverse events related to the NNES were recorded.The results of this study did not show promising effectiveness of NMES for patients with CLBP after 4-week treatment.
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Affiliation(s)
- Peng Guo
- Second Ward of Orthopedic Department
| | | | - An Tong
- First Ward of Orthopedic Department, The People's Hospital of Yan’an, Yan’an, China
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Pirbalouti MG, Shariat A, Sangelaji B, Taghavi M, Kamaliyeh NG. Prevalence of musculoskeletal disorders and its relation to depression among workers in kindergarten. Work 2018; 58:519-525. [PMID: 29254133 DOI: 10.3233/wor-172648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Working in a closed environment for more than 7-8 hours can affect both psychological and physical health among kindergarten workers. OBJECTIVE To determine the prevalence of musculoskeletal disorders (MSD) and depression as well as the correlation between them, if any, among kindergarten workers. METHODS In a cross-sectional observation, one hundred and five healthy female staff members (age: 34.27±7.01 year, working duration: 7.42±0.81 hr/d, BMI: 24.50±2.61 kg/m2 (mean±SD)), who have had at least one year of working experience, were selected randomly from 10 kindergartens. The subjects completed both the Cornell musculoskeletal and Patient Health (PHQ-9) questionnaires to enable the assessments of MSD and depression scores accordingly. The correlation between both questionnaires was then measured to find any links. To assess the reliability of Farsi-language versions of the Cornell questionnaire and PHQ-9, the Inter-class Correlation Co-efficient (ICC) was measured through test-retest with 1-week delay and the prevalence of MSD and depression were subsequently assessed as well. RESULTS The Inter-class Correlation Co-efficient (ICC) illustrated that the Farsi version of MSD instruments showed high levels of repeatability. The ICC coefficient was (0.932-0.987, p < 0.001) for the Cornell questionnaire and the Cronbach alpha for PHQ-9 questionnaire was 0.861. The highest severity of pain was related to lower back (30.5%), and after it, neck (27.6%), right shoulder (27.6%) and left shoulder (25.7%) pain, respectively. The results of PHQ-9 questionnaire indicated that 41.9% (n = 44) of subjects had a severe depression. There was a significant (r = 0.338, p < 0.01) relation between depression and MSD. CONCLUSIONS Prevalence of depression and severity of physical pain was an issue among staff in kindergartens. More study will be needed to define all aspects of this issue.
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Affiliation(s)
- Mohammad Ghasemi Pirbalouti
- Department of Psychology, Faculty of Humanities, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Arghavan Shariat
- Department of Psychology, Faculty of Humanities, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Bahram Sangelaji
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Maryam Taghavi
- Department of Psychology, Faculty of Humanities, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Nayereh Ghasemi Kamaliyeh
- Department of Resource Management and Consumer Studies, Faculty of Human Ecology, University Putra Malaysia
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Tanriverdi S, Saritaş S. The effect of acupressure on postoperative pain of lumbar disc hernia: A quasi-experimental study. Complement Ther Clin Pract 2018; 32:12-16. [PMID: 30057038 DOI: 10.1016/j.ctcp.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/09/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Seher Tanriverdi
- Department of Surgical Nursing, Mardin Artuklu University High Health School, Mardin, Turkey.
| | - Serdar Saritaş
- Department of Surgical Nursing, Inonu University, Faculty of Nursing, Malatya, Turkey.
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Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther 2018; 22:144-153. [PMID: 28939263 PMCID: PMC5883995 DOI: 10.1016/j.bjpt.2017.09.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of exercise, ergonomic modification, and a combination of training exercise and ergonomic modification on the scores of pain in office workers with neck, shoulders, and lower back pain. METHODS Participants (N=142) in this randomized controlled trial were office workers aged 20-50 years old with neck, shoulders, and lower back pain. They were randomly assigned to either the ergonomic modification group, the exercise group, the combined exercise and ergonomic modification group, or the control group (no-treatment). The exercise training group performed a series of stretching exercises, while the ergonomic group received some modification in the working place. Outcome measures were assessed by the Cornell Musculoskeletal Disorders Questionnaire at baseline, after 2, 4, and 6 months of intervention. RESULTS There was significant differences in pain scores for neck (MD -10.55; 95%CI -14.36 to -6.74), right shoulder (MD -12.17; 95%CI -16.87 to -7.47), left shoulder (MD -11.1; 95%CI -15.1 to -7.09) and lower back (MD -7.8; 95%CI -11.08 to -4.53) between the exercise and control groups. Also, significant differences were seen in pain scores for neck (MD -9.99; 95%CI -13.63 to -6.36), right shoulder (MD -11.12; 95%CI -15.59 to -6.65), left shoulder (MD -10.67; 95%CI -14.49 to -6.85) and lower back (MD -6.87; 95%CI -10 to -3.74) between the combined exercise and ergonomic modification and control groups. The significant improvement from month 4 to 6, was only seen in exercise group (p<0.05). CONCLUSION To have a long term effective on MSDs, physical therapists and occupational therapists should use stretching exercises in their treatment programs rather than solely rely on ergonomic modification. CLINICAL TRIAL ID NCT02874950 - https://www.clinicaltrials.gov/ct2/show/NCT02874950.
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Affiliation(s)
- Ardalan Shariat
- Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mahmoud Danaee
- Academic Development Center, University of Malaya, Kuala Lumpur, Malaysia
| | - Mehdi Kargarfard
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | | | - Shamsul Bahri Mohd Tamrin
- Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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