Psychology and low back pain

The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study

BACKGROUND

Chronic low back pain is one of the most common musculoskeletal disorders in different countries.

AIMS

This study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics.

DESIGN

A case-control and cross-sectional study.

SETTINGS

Two physiotherapy centers in Tehran, Iran.

PARTICIPANTS

This study included 502 patients with acute, subacute and chronic LBP.

METHOD

This study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ², and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis.

RESULTS

It was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05).

CONCLUSIONS

Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.

Lower Back Pain as an Occupational Hazard Among Ugandan Health Workers

Background: Lower back pain is a public health concern affecting 70–85% of the world's population. There is paucity of published data on the prevalence, disability and risk factors for lower back pain among health workers in Uganda.

Objective: To determine the frequency rate (note that is it implicit that frequency is a rate like incidence so including rate seems redundant here. This is bounded by zero and infinity. In contrast, prevalence is bounded by 0 and 1 and is thus a proportion not a rate) of lower back pain and its associated risks amongst health professionals in the Arua District of Uganda.

Methods: Cross-sectional descriptive study of 245 consecutive participants conducted during February-April 2020. We stratified risks as individual or work related and analyzed the data using IBM SPSS version 25. Chi-square was used to measure the significance of association between categorical variables at 95% confidence interval, regarding a p ≤ 0.05 as significant.

Results: The mean age of participants was 40.87 years ± 8.74 (SD), with female predominance (69.8%). Majority were either general nurses or midwives (64.9%) and more than half had practiced for over 6–10 years. The frequency rate of lower back pain was 39.6% (n = 97). Individual factors associated with LBP were; cigarette smoking (X² = 33.040; P ≤ 0.001), alcohol consumption (X² = 13.581; P ≤ 0.001), age (X² = 14.717; P = 0.002), and female gender (X² = 4.802; P = 0.028). The work related factors significantly associated with lower back pain were: being a nurse/midwife (X² = 9.829; P = 0.007), working in the outpatient department (X² = 49.752; P ≤ 0.001), bending (X² = 43.912; P ≤ 0.001), lifting (X² = 33.279; P < 0.001), over standing (X² = 40.096; P ≤ 0.001), being in awkward positions (X² = 15.607; P= < 0.001), and pushing patients (X² = 21.999; P ≤ 0.001).

Conclusion: The frequency rate of low back pain was high amongst health workers and its main associated individual and work related factors could have been prevented. Health workers should strike a balance between caring for their personal back-health and meeting clients' needs while manually handling patients. Ergonomic structuring, job organization, back health care courses and use of assistive equipment could reduce such occupational hazards in our low resourced settings.

Agreement of clinical examination for low back pain with facet joint origin

Background:

Low back pain (LBP) with facet joint origin is a common diagnosis of patients referred to physical therapy clinic. An expert consensus of diagnostic criteria has been proposed. However, the reliability of the assessment has not been proved.

Objective:

To test the degrees of agreement between two physical therapists for nine physical examination items and the diagnosis of facet joint origin.

Methods:

The examination according to diagnostic criteria was performed independently by two physical therapists in 45 patients with chronic LBP. The percent agreements and Kappa coefficients of each examination item and diagnostic conclusion were calculated.

Results:

The percent agreements of nine examined items ranged from 73.3–91.1%. The Kappa coefficients, widely ranged from 0.250–0.690 (p=0.48 to <0.001), showed statistically significant agreements for all examination items. The low level of agreements was partly due to improper distributions of test results. The agreement of conclusion was 86.7% and Kappa coefficient was 0.492 (p=0.001) which reflected good agreement of facet diagnosis.

Conclusion:

There were adequate agreements for clinical examination of LBP with facet joint origin. The low level of agreement suggested the clinicians to have operational definition and rigorous training sessions although the examinations seemed to be routinely performed.

Predictors of functional improvement in people with chronic low back pain following a graded Pilates-based exercise programme

BACKGROUND

Several studies have investigated subgroups of patients with low back pain (LBP) most likely to benefit from Pilates or movement control exercises, but none have determined prognostic factors specifically for chronic LBP. This prospective cohort study aimed to determine predictors of change in disability in people with chronic LBP following a Pilates-based exercise programme and reports summarised integrated prediction statistics to aid clinical utility for determination of subgroups likely to benefit or not benefit from treatment.

METHODS

Healthy adults (n = 55) with non-specific chronic LBP undertook a graded 6-week programme involving two 1-hour Pilates sessions/week (1 mat and 1 equipment-based) led in small groups by a trained Pilates instructor. Predictors of change in Patient-Specific Functional Scale (PSFS) were identified through regression analysis and used to develop clinical prediction statistics.

RESULTS

Clinically important improvement (n = 14 of 48 analysed) was predicted by four variables: gradual rather than sudden onset of LBP, PSFS <3.7 points, absence of aberrant motions on forward bending, and body mass index >24.5 kg/m². Presence of ≥3 improved probability of success from 29% to 73%. Failure to improve (n = 18) was predicted by three variables: sudden onset of low back pain, patient-specific functional score ≥3.7, and difference between left and right active straight leg raise >7°. Presence of all three increased probability of failure from 38% to 80%.

CONCLUSIONS

A combination of five, easily measured variables were able to predict disability outcome following a graded programme of Pilates-based exercises in people with chronic LBP. Two common movement deficits were inversely related to positive changes in function which may call into question the structural mechanism of improvements observed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616001588482.