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Scaff SP, Hancock MJ, Munhoz TDS, Maher CG, Saragiotto BT. Exercises for the prevention of non-specific low back pain. Cochrane Database Syst Rev 2024; 7:CD014146. [PMID: 39041371 PMCID: PMC11264324 DOI: 10.1002/14651858.cd014146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effects of exercise alone or exercise plus education compared with inactive control or education alone to prevent non-specific LBP.
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Affiliation(s)
- Simone Ps Scaff
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Mark J Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Tatiane da Silva Munhoz
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | | | - Bruno T Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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2
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Hasenoehrl T, Steiner M, Ebenberger F, Kull P, Sternik J, Reissig L, Jordakieva G, Crevenna R. "Back Health 24/7/365"-A Novel, Comprehensive "One Size Fits All" Workplace Health Promotion Intervention for Occupational Back Health among Hospital Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:772. [PMID: 38929018 PMCID: PMC11203411 DOI: 10.3390/ijerph21060772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Projects for workplace health promotion (WHP) for back pain traditionally focus exclusively on work-related but not on leisure-time stress on the spine. We developed a comprehensive WHP project on the back health of hospital workers regardless of the physical characteristics of their work and compared its effects on sedentary and physically active hospital workers. METHODS Study assessments were carried out before and six months after participation in the WHP intervention. The primary outcome parameter was back pain (Oswestry Disability Index, ODI). Anxiety (Generalized Anxiety Disorder-7), work ability (Work Ability Index), depression (Patient Health Questionnaire-9), stress (Perceived Stress Scale-10), and quality of life (Short Form-36) were assessed via questionnaires as secondary outcome parameters. Physical performance was measured via the 30 seconds Sit-to-Stand test (30secSTS). RESULTS Sixty-eight healthcare workers with non-specific back pain were included in the evaluation study of the WHP project "Back Health 24/7/365". After six months, back pain, physical performance, and self-perceived physical functioning (SF-36 Physical Functioning subscale) improved significantly in both groups. Not a single parameter showed an interaction effect with the group allocation. CONCLUSIONS A comprehensive WHP-intervention showed significant positive effects on hospital workers regardless of the physical characteristics of their work.
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Affiliation(s)
- Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Margarete Steiner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Felix Ebenberger
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Philipp Kull
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Julia Sternik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lukas Reissig
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Waehringer Straße 13, 1090 Vienna, Austria
| | - Galateja Jordakieva
- 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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3
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Slaughter PR, Rodzak KM, Fine SJ, Ice CC, Wolf DN, Zelik KE. Evaluation of U.S. Army Soldiers wearing a back exosuit during a field training exercise. WEARABLE TECHNOLOGIES 2023; 4:e20. [PMID: 38487775 PMCID: PMC10936316 DOI: 10.1017/wtc.2023.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 03/17/2024]
Abstract
Back overuse injuries are a significant problem in the U.S. Army, responsible for nearly a quarter of musculoskeletal injuries. Back exosuits are wearable devices that relieve musculoskeletal strain, make lifting easier, and could potentially reduce Soldier overuse injuries. But published studies have not evaluated exosuits during realistic field operations to assess acceptability to Soldiers. We tested a back exosuit on field artillery Soldiers during a field training exercise. Afterward, Soldiers completed a survey to quantify their satisfaction, intent to use, and performance impact of the exosuit. Feedback was overwhelmingly positive: Approximately 90% of Soldiers reported that exosuits increased their ability to perform their duties, and 100% said that if the exosuit were further developed and made available to them, they would be likely to wear it. These numerical survey results indicated that exosuits can provide a practical and acceptable way to assist lifting and augment physical performance during realistic Army operations without interfering with other duties.
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Affiliation(s)
- P. R. Slaughter
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - K. M. Rodzak
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - S. J. Fine
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - C. C. Ice
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - D. N. Wolf
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - K. E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States
- Department of Physical Medicine & Rehabilitation, Vanderbilt University, Nashville, Tennessee, United States
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Ramirez V, Ghezelbash F, Shirazi-Adl A, Bazrgari B. Trunk muscle forces and spinal loads during heavy deadlift: Effects of personalization, muscle wrapping, muscle lever arm, and lumbopelvic rhythm. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3680. [PMID: 36606738 DOI: 10.1002/cnm.3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/23/2022] [Accepted: 01/03/2023] [Indexed: 05/12/2023]
Abstract
Heavy deadlift is used as a physical fitness screening tool in the U.S. Army. Despite the relevance of such a screening tool to military tasks performed by Service Members, the biomechanical impact of heavy deadlift and its risk of low-back injury remain unknown. A kinematics-driven musculoskeletal model of spine was implemented to investigate biomechanics of the lower back in a volunteer (23 years old, height of 1.82 m, and body mass of 98.8 kg) during a 68 kg deadlift. In search of protective mechanisms, effects of model personalization and variations in trunk musculature and lumbopelvic rhythm were also investigated. The net moment, compression and shear forces at the L5-S1 reached peaks of 684 Nm, 17.2 and 4.2 kN, respectively. Geometrical personalization and changes in lumbopelvic rhythm had the least effects on predictions while increases in muscle moment arms (40%) had the largest effects that caused, respectively, 32% and 36% decrease in the maximum compressive and shearing forces. Initiating wrapping of back muscles at farther distances from the spine had opposing effects on spinal loads; peak compression at the L5-S1 decreased by 12% whereas shear increased by 19%. Despite mechanisms considered, spinal loads during heavy deadlift exceed the existing evidence concerning the threshold of injury for spinal segments, suggesting the vulnerability to injury. Chronic exposure to such high-spinal loads may lead to (micro) fractures, degeneration, pathoanatomical changes and finally low-back pain.
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Affiliation(s)
- Vanessa Ramirez
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Ecole Polytechnique, Montréal, Québec, Canada
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Ecole Polytechnique, Montréal, Québec, Canada
| | - Babak Bazrgari
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
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5
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Alemi MM, Simon AA, Geissinger J, Asbeck AT. Modeling the Metabolic Reductions of a Passive Back-Support Exoskeleton. J Appl Physiol (1985) 2022; 132:737-760. [PMID: 35023764 DOI: 10.1152/japplphysiol.00171.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite several attempts to quantify the metabolic savings resulting from the use of passive back-support exoskeletons (BSEs), no study has modeled the metabolic change while wearing an exoskeleton during lifting. The objectives of this study were to: 1) quantify the metabolic reductions due to the VT-Lowe's exoskeleton during lifting; and 2) provide a comprehensive model to estimate the metabolic reductions from using a passive BSE. In this study, 15 healthy adults (13M, 2F) of ages 20 to 34 years (mean=25.33, SD=4.43) performed repeated freestyle lifting and lowering of an empty box and a box with 20% of their bodyweight. Oxygen consumption and metabolic expenditure data were collected. A model for metabolic expenditure was developed and fitted with the experimental data of two prior studies and the without-exoskeleton experimental results. The metabolic cost model was then modified to reflect the effect of the exoskeleton. The experimental results revealed that VT-Lowe's exoskeleton significantly lowered the oxygen consumption by ~9% for an empty box and 8% for a 20% bodyweight box, which corresponds to a net metabolic cost reduction of ~12% and ~9%, respectively. The mean metabolic difference (i.e., without-exo minus with-exo) and the 95% confidence interval were 0.36 and (0.2-0.52) [Watts/kg] for 0% bodyweight, and 0.43 and (0.18-0.69) [Watts/kg] for 20% bodyweight. Our modeling predictions for with-exoskeleton conditions were precise, with absolute freestyle prediction errors of <2.1%. The model developed in this study can be modified based on different study designs, and can assist researchers in enhancing designs of future lifting exoskeletons.
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Affiliation(s)
- Mohammad Mehdi Alemi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.,Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Athulya A Simon
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Jack Geissinger
- Department of Computer Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Alan T Asbeck
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
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Bomberg H, Lorenzana D, Schlickeiser J, Dünki A, Farshad M, Eichenberger U. [Noninvasive Treatments for Acute and Chronic Back Pain]. PRAXIS 2022; 111:797-813. [PMID: 36285410 DOI: 10.1024/1661-8157/a003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
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Affiliation(s)
- Hagen Bomberg
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - David Lorenzana
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - Jannis Schlickeiser
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | - Alexandro Dünki
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | | | - Urs Eichenberger
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
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7
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Price JW. Osteopathic model of the development and prevention of occupational musculoskeletal disorders. J Osteopath Med 2021; 121:287-305. [PMID: 33635956 DOI: 10.1515/jom-2020-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Context The direct and indirect costs of work-related musculoskeletal disorders are significant. Prevention is the most effective way to control these costs. To do that, we must understand how these disorders develop. Objectives To use the five models of osteopathic care to illustrate how cellular processes and neural reflexes interact to create work-related musculoskeletal pathology and to provide evidence-informed musculoskeletal injury and disability prevention recommendations. Methods A literature review of electronic databases (Google Scholar, PubMed, OVID, Cochrane Central Register of Controlled Trials, PEDro, and OSTMED.DR) from inception to October 16, 2019 and hand-search of publication references was performed for systematic reviews, cohort studies, case-control studies, and randomized controlled trials. The search terms reflected topics related to occupational injury and injury prevention, and included supplementary laboratory studies and narrative reviews related to the biological aspects of musculoskeletal injury. The eligible studies contained the following criteria: (1) the population of working age; (2) exposures to known risk factors, musculoskeletal disorders, and psychosocial factors; (3) written in English; (4) full text papers published in peer-reviewed journals; and (5) systematic review, cohort study, case-control study, and randomized controlled trial methodology. Studies were excluded if they included outcomes of productivity and costs only or outcomes that were assessed through qualitative methods only. Results The literature search resulted in 1,074 citations; 26 clinical studies and 14 systematic reviews were used in this review. A comprehensive workplace musculoskeletal disorder prevention program should match demands to capacity, correct dysfunctional movement patterns, and limit tissue vulnerability (biomechanical-structural model); restore alpha-gamma balance, tonic-phasic synergistic function, and autonomic balance (neurological model); maximize physiologic reserve (metabolic-energy model) component of a prevention program; optimize respiration and circulation (respiratory-circulatory model); and address cognitive distortions (behavioral-biopsychosocial model). Conclusions The presented osteopathic model of the development and prevention of work-related musculoskeletal disorders suggests that a combination of preventive interventions will be more effective than any single preventive intervention.
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Affiliation(s)
- James William Price
- Ascension St. Vincent Occupational Medicine Clinic, Evansville, IN, USA.,College of Osteopathic Medicine, Marion University, Indianapolis, IN, USA
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Sibson BE, Tobolsky VA, Kistner TM, Holowka NB, Jemutai J, Sigei TK, Ojiambo R, Okutoyi P, Lieberman DE. Trunk muscle endurance, strength and flexibility in rural subsistence farmers and urban industrialized adults in western Kenya. Am J Hum Biol 2021; 34:e23611. [PMID: 33988283 DOI: 10.1002/ajhb.23611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES High trunk muscle endurance, strength, and moderate flexibility reportedly help maintain musculoskeletal health, but there is evidence for tradeoffs among these variables as well as sex differences in trunk muscle endurance and strength. To test if these observations extend similarly to both men and women in nonindustrial and industrial environments, we investigated intra-individual associations and group and sex differences in trunk muscle endurance, strength, and flexibility among 74 (35 F, 39 M; age range: 18-61 years) adults from the same Kalenjin-speaking population in western Kenya. We specifically compared men and women from an urban community with professions that do not involve manual labor with rural subsistence farmers, including women who frequently carry heavy loads. METHODS Trunk muscle endurance, strength, and flexibility were measured with exercise tests and electromyography (EMG). RESULTS We found a positive correlation between trunk extensor strength and endurance (R = .271, p ≤ .05) and no associations between strength or endurance and flexibility. Rural women had higher trunk extensor and flexor endurance, EMG-determined longissimus lumborum endurance, and trunk extensor strength than urban women (all p ≤ .05). Rural women had higher trunk extensor and flexor endurance than rural men (both p ≤ .05). Urban women had lower trunk flexor and extensor endurance than urban men (both p ≤ .01). CONCLUSIONS High levels of physical activity among nonindustrial subsistence farmers, particularly head carrying among women, appear to be associated with high trunk muscle endurance and strength, which may have important benefits for helping maintain musculoskeletal health.
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Affiliation(s)
- Benjamin E Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Victoria A Tobolsky
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Timothy M Kistner
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Nicholas B Holowka
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Anthropology, University at Buffalo, Buffalo, New York, USA
| | | | - Timothy K Sigei
- Department of Mathematics, Physics, and Computing, Moi University, Eldoret, Kenya
| | - Robert Ojiambo
- Division of Biomedical Sciences, University of Global Health Equity, Butaro, Rwanda
| | - Paul Okutoyi
- Department of Orthopaedics, Moi University Medical School, Eldoret, Kenya
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
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9
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[Psychosocial factors in the prevention of pain]. Schmerz 2021; 35:21-29. [PMID: 33534105 DOI: 10.1007/s00482-020-00523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The question of pain prevention is becoming increasingly important, both in society and in science. According to the International Society for the Study of Pain, general areas for which pain prevention measures can be recommended have been defined. These approaches are mostly limited to unspecific recommendations with the aim of improving general health behaviour. Common to all of them is that they essentially address psychosocial and psychobehavioral aspects. In contrast to genetic factors or other non-modifiable environmental factors, psychosocial and psychobehavioral aspects are potentially modifiable variables, making them possible starting points for prevention programs. Furthermore, recent studies provide important knowledge about psychological and social risk factors of pain chronification and thus offer new approaches for future pain prevention strategies. At the same time, the efficacy and successful implementation of such programs is so complex that valid statements on effectiveness and benefit can only be made through care-related evaluation. This review addresses psychological and social factors in the prevention of pain. A selective literature search was carried out to this end. Based on selected studies, psychological and social predictors of pain development are presented and their potential for future pain prevention programs discussed. The article concludes with a discussion of possible implications.
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10
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Hoflinger F, Rodacki ALF, Tavares JM, Fadel Neto MI, Paulo AC, Fowler NE, Rodacki CLN. A cross-sectional analysis of the muscle strength, spinal shrinkage, and recovery during a working day of military police officers. J Occup Health 2021; 63:e12297. [PMID: 34953000 PMCID: PMC8709899 DOI: 10.1002/1348-9585.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Military personnel has a large prevalence of back pain, especially those involved in patrolling routines, as they wear heavy protective equipment. Patrolling includes long periods of sustaining the protective equipment in a sitting or in a motor vehicle (motorcycle or car). Thus, understanding spinal loading of military police officers after patrolling by car (CAR; n = 14), motorcycle (MOT; n = 14), and administrative (ADM; n = 14) routines is relevant to establish preventive strategies. METHODS The torque of the trunk and working and anthropometric characteristics were assessed to explain spinal loading using stature variation measures. Precise stature measures were performed before and after a 6 h journey (LOSS) and 20 min after a resting posture (RECOV). The trunk extensor (PTE BM-1 ) and flexor (PTF BM-1 ) muscles' isometric peak torque were measured before the working journey. RESULTS The LOSS was similar between CAR and MOT (4.8 and 5.8 mm, respectively) after 6 h of patrolling. The ADM presented the lowest LOSS (2.8 mm; P < .05). No changes in RECOV between groups were observed (P > .05). Vibration may explain the greater spinal loading involved in patrolling in comparison to the ADM. A GLM analysis revealed that BMI was the only explanatory factor for stature loss. No independent variables explained RECOV. The ability of the trunk muscles to produce force did not influence LOSS or RECOV. CONCLUSIONS Military police officers involved in patrolling may require greater post-work periods and strategies designed to reduce the weight of the protective apparatus to dissipate spinal loading. The external load used in patrolling is a relevant spinal loading factor.
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Affiliation(s)
| | - André Luiz Felix Rodacki
- Department of Physical EducationParaná Federal UniversityCentro Politécnico – Rua Cel. Francisco H. dos SantosCuritibaPRBrazil
| | - Janny M. Tavares
- Department of Physical EducationParaná Federal UniversityCentro Politécnico – Rua Cel. Francisco H. dos SantosCuritibaPRBrazil
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11
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The Effectiveness of Lumbar Supports. Orthop Nurs 2020; 39:402-407. [PMID: 33234911 DOI: 10.1097/nor.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonspecific back pain is a common complaint, especially among older people. Traditionally, nonspecific back pain has been associated with heavy physical activities. However, static activities such as prolonged sitting and standing are contributing factors to nonspecific lumbar pain as well. Lumbar orthoses, such as belts, have been used for heavy physical activity to alleviate or even prevent back pain; however, studies have been inconclusive as to their effectiveness. Furthermore, the use of lumbar orthosis for prolonged sitting and standing is questionable. This case study and review examines the general effectiveness of lumbar orthosis for a variety of activities, including prolonged standing and sitting. The findings provide implications for orthopaedic nurses in occupational settings.
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12
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Vinstrup J, Jakobsen MD, Madeleine P, Andersen LL. Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study. BMC Musculoskelet Disord 2020; 21:715. [PMID: 33129282 PMCID: PMC7603727 DOI: 10.1186/s12891-020-03731-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/20/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs. METHODS By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure. RESULTS Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively. CONCLUSIONS Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.
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Affiliation(s)
- Jonas Vinstrup
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, DK, Denmark.
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, DK, Denmark
| | - Pascal Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, DK, Denmark
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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13
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Karimi A, Dianat I, Barkhordari A, Yusefzade I, Rohani-Rasaf M. A multicomponent ergonomic intervention involving individual and organisational changes for improving musculoskeletal outcomes and exposure risks among dairy workers. APPLIED ERGONOMICS 2020; 88:103159. [PMID: 32678778 DOI: 10.1016/j.apergo.2020.103159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/10/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
A field intervention study was implemented to evaluate the effects of individual (physical exercise programme and worker ergonomics training) and organisational changes (optimising work-rest schedule and revised task procedure) on musculoskeletal outcomes and their exposure risks among milking workers in a dairy plant. A questionnaire survey (including the Cornell Musculoskeletal Discomfort Questionnaire [CMDQ]) and direct observations of working postures by using the Quick Exposure Check (QEC) method were used at baseline and 12-month follow-up. Shoulder, lower back and neck discomfort were found to be the most common problems. The results showed significant improvements in the frequency (neck, shoulder, lower back, forearm and knee symptoms), severity (shoulder, lower back and knee symptoms) and interference with work (particularly due to lower back symptoms) as well as in the exposure risks to musculoskeletal problems (using the QEC method) after the intervention. The findings support the effectiveness of implemented multiple component intervention for improving musculoskeletal health and exposure risks in the studied occupational group.
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Affiliation(s)
- Azim Karimi
- Department of Occupational Health Engineering, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Iman Dianat
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Abdullah Barkhordari
- Department of Occupational Health Engineering, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Iman Yusefzade
- Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Marzieh Rohani-Rasaf
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Alemi MM, Madinei S, Kim S, Srinivasan D, Nussbaum MA. Effects of Two Passive Back-Support Exoskeletons on Muscle Activity, Energy Expenditure, and Subjective Assessments During Repetitive Lifting. HUMAN FACTORS 2020; 62:458-474. [PMID: 32017609 DOI: 10.1177/0018720819897669] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to explore the efficacy of two different passive back-support exoskeleton (BSE) designs during repetitive lifting in different postures. BACKGROUND Although BSEs have been proposed as a potential intervention for reducing physical demands, limited information is available about the impacts of different exoskeleton designs in diverse work scenarios. METHOD Eighteen participants (gender-balanced) performed lab-based simulations of repetitive lifting tasks. These tasks were performed in 12 different conditions, involving two BSEs and a control condition, two levels of lifting symmetry (symmetric and asymmetric), and two postures (standing and kneeling). Outcome measures described muscle activity and energy expenditure, along with perceived discomfort, balance, and usability. RESULTS Using both BSEs significantly reduced peak activity of the trunk extensor muscles (by ~10%-28%) and energy expenditure (by ~4%-13%) in all conditions tested. Such reductions, though, were task dependent and differed between the two BSEs. In most of the tested conditions, using BSEs positively affected subjective responses regarding perceived exertion and usability. CONCLUSION Our results suggest that the beneficial effects of a BSE are task specific and depend on the specific BSE design approach. More work is needed, though, to better characterize this task specificity and to determine the generalizability of BSE effects on objective and subjective outcomes for a wider range of conditions and users. APPLICATION Our results provide new evidence to guide the selection and application of passive BSE designs in diverse lifting tasks.
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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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18
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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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20
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Central adiposity and mechanical, perceptual and physiological loading during long duration, repetitive lifting. Clin Biomech (Bristol, Avon) 2018; 60:170-176. [PMID: 30380444 DOI: 10.1016/j.clinbiomech.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is an absence of information regarding the impact of central adiposity on loading during long duration, repetitive lifting, and very limited information of the impact of elevated body mass on mechanical loading of the lumbar spine. This information is important in evaluation of the validity of injury prevention standards and interventional approaches in this segment of the population. METHODS This study evaluated the mechanical, physiological, and perceptual loading during repetitive lifting in participants with central adiposity compared to participants with normal body mass index. Videography, accelerometry, heart rate and perceived exertion measures were used to examine alternations in kinematic, kinetic, and exertional parameters during a 1-hour lifting task (3 × 20-min sets; 4 lifts/min; self-selected mass). FINDINGS Low back torque [+69.1 (11.5) Nm], compressive force [+1036.6 (153.6) N] and heart rate [+7.0 (3.5)%] were substantially elevated in participants with central adiposity, however perceived exertion and self-selected mass did not differ between groups. With central adiposity a compensatory mechanism was observed, involving a reduction in trunk vertical displacement [-5.8 (1.9) cm], hip flexion [-6.4 (3.1) deg] and lower-trunk flexion [-10.0 (2.7) deg], which attenuated expected increases to work [9.8 (2.3)%], power [9.5 (4.0)%] and physiological effort. INTERPRETATION While mechanical loading increases secondary to elevated body mass are expected, these results provide new insight into origins of such increases for individuals with a central adiposity somatotype. The differences in mechanical, physiological and perceived loading support provision of individual-specific injury prevention strategies, as well as revision of existing mechanical- and physiological-based ergonomic standards.
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21
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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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22
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Zadro JR, Shirley D, Duncan GE, Ferreira PH. Familial factors predicting recovery and maintenance of physical activity in people with low back pain: Insights from a population-based twin study. Eur J Pain 2018; 23:367-377. [PMID: 30176096 DOI: 10.1002/ejp.1311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unknown how familial factors influence the recovery from low back pain (LBP) and the maintenance activity behaviours. We aimed to investigate whether individual and within-family physical activity (PA) and sedentary behaviour influenced recovery from LBP, and maintenance of PA and sedentary behaviour in people with and without LBP. METHODS Longitudinal logistic regression analyses were performed on adult twins from the Washington State Twin Registry. First, individual and within-family (based on co-twin data) sufficient PA (at least 75 min of vigorous-intensity PA, or 150 min of moderate-intensity PA per week) and high leisure sitting time (≥3 hr/day) were our exposure variables (baseline). LBP within the past 3 months at follow-up defined non-recovery (outcome). Second, within-family sufficient PA and high leisure sitting time were our exposure variables(baseline) and our outcomes were individual PA and sitting time at follow-up. All analyses were adjusted for follow-up length (range: 1-7 years) and confounding variables. RESULTS Individual and within-family PA and sitting time were not associated with recovery. Within-family PA and sitting time predicted individual maintenance of PA (OR = 1.47, 95% CI: 1.17-1.84, n = 1,388 twins) and sitting time (OR = 1.41, 95% CI: 1.10-1.82, n = 1,534). Within-family PA and sitting time had the strongest effects on those without (OR = 1.79, 95% CI: 1.33-2.41, n = 788) and with LBP (OR = 1.90, 95% CI: 1.32-2.76, n = 698), respectively. CONCLUSION Having active family members increased the likelihood of continuing to be active (particularly for those without LBP), while having sedentary family members increased the likelihood of maintaining sedentary behaviours (particularly for those with LBP). SIGNIFICANCE This study was the first to investigate how familial activity behaviours influence recovery from LBP and ongoing activity behaviours. People with LBP living within a sedentary family likely require specific interventions to reduce their sedentary behaviours.
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Affiliation(s)
- Joshua Robert Zadro
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Debra Shirley
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Glen E Duncan
- Elson S. Floyd College of Medicine, Department of Nutrition and Exercise Physiology, Washington State University, Spokane, Washington
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Sowah D, Boyko R, Antle D, Miller L, Zakhary M, Straube S. Occupational interventions for the prevention of back pain: Overview of systematic reviews. JOURNAL OF SAFETY RESEARCH 2018; 66:39-59. [PMID: 30121110 DOI: 10.1016/j.jsr.2018.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/12/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION We conducted an overview of systematic reviews of interventions for the prevention of low back pain (LBP) that can be conducted in a workplace setting. METHODS An electronic literature search was performed in Medline, EMBASE, and the Cochrane Library. Published peer-reviewed systematic reviews and meta-analyses, which described interventions for the primary or secondary prevention of LBP applicable to a workplace setting, were eligible for inclusion. The methodological quality of the included systematic reviews was assessed with the AMSTAR tool. The primary outcome of interest was the incidence of LBP; secondary outcomes were LBP-associated absenteeism, activity interference, and costs related to LBP. RESULTS Twenty-eight eligible articles published between 1994 and 2016 were included in a qualitative synthesis following our screening of abstracts and full-text articles. The AMSTAR rating revealed 14 reviews of high, 10 of moderate, and 4 of low methodological quality. The identified interventions included workplace modifications (6 reviews, 10 studies, 6,751 subjects); shoe insoles (4 reviews, 6 studies, 2,356 subjects); and lumbar supports and other assistive devices (15 reviews, 18 studies, 60,678 subjects). Educational interventions investigated were back schools (10 reviews, 30 studies, 9,973 subjects); manual material handling techniques/advice (6 reviews, 24 studies, 10,505 subjects); and other forms of instruction including pamphlets, booklets, and other media (four reviews, 14 studies, 11,991 subjects). Exercise interventions, investigated in 12 reviews (35 studies, 19,330 subjects), showed moderate quality evidence of effectiveness for exercise interventions alone or in conjunction with educational interventions; no other type of intervention was consistently effective in the prevention of LBP or LBP-associated outcomes of interest. CONCLUSIONS Our overview provides evidence of effectiveness for exercise with or without educational interventions in the prevention of LBP. PRACTICAL APPLICATIONS Exercise interventions with or without educational interventions that can be applied in the workplace have the potential to prevent LBP.
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Affiliation(s)
- Daniel Sowah
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Robert Boyko
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - David Antle
- EWI Works International Inc., Edmonton, Alberta, Canada.
| | - Linda Miller
- EWI Works International Inc., Edmonton, Alberta, Canada.
| | - Michael Zakhary
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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24
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Moreno Catalá M, Schroll A, Laube G, Arampatzis A. Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population. Front Neurosci 2018; 12:436. [PMID: 30018531 PMCID: PMC6037821 DOI: 10.3389/fnins.2018.00436] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of the study was to investigate the athletic-based specificity of muscle strength and neuromuscular control of spine stability in chronic non-specific low-back pain (LBP). Thirty elite athletes and 29 age-matched non-athletes with (15 athletes and 15 non-athletes) and without LBP (15 athletes and 14 non-athletes) participated in the study. Muscle strength was measured during maximal isometric trunk flexion and trunk extension contractions. The neuromuscular control of spine stability was analyzed by determining trunk stiffness, trunk damping, and onset times of the lumbar and thoracic erector spinae muscles after sudden perturbations (quick release experiments) as well as maximum Lyapunov exponents (local dynamic stability) using non-linear time series analysis of repetitive lifting movements. LBP was assessed using the visual analog scale. We found lower maximal trunk extension moments (p = 0.03), higher trunk damping (p = 0.018) and shorter onset times (p = 0.03) of the investigated trunk muscles in LBP patients in both athletes and non-athletes. Trunk stiffness and the local dynamic stability did not show any differences (p = 0.136 and p = 0.375, respectively) between LBP patients and healthy controls in both groups. It can be concluded that, despite the high-level of training in athletes, both athletes and non-athletes with LBP showed the same deconditioning of the lumbar extensor muscles and developed similar strategies to ensure spine stability after sudden perturbations to protect the spine from pain and damage. The findings highlight that specific training interventions for the trunk muscles are not only crucial for individuals of the general population, but also for well-trained athletes.
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Affiliation(s)
- María Moreno Catalá
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Gunnar Laube
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
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Marich AV, Lanier VM, Salsich GB, Lang CE, Van Dillen LR. Immediate Effects of a Single Session of Motor Skill Training on the Lumbar Movement Pattern During a Functional Activity in People With Low Back Pain: A Repeated-Measures Study. Phys Ther 2018; 98:605-615. [PMID: 29660077 PMCID: PMC6692703 DOI: 10.1093/ptj/pzy044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 04/04/2018] [Indexed: 11/13/2022]
Abstract
Background People with low back pain (LBP) may display an altered lumbar movement pattern of early lumbar motion compared to people with healthy backs. Modifying this movement pattern during a clinical test decreases pain. It is unknown whether similar effects would be seen during a functional activity. Objective The objective of this study was to examine the lumbar movement patterns before and after motor skill training, effects on pain, and characteristics that influenced the ability to modify movement patterns. Design The design consisted of a repeated-measures study examining early-phase lumbar excursion in people with LBP during a functional activity test. Methods Twenty-six people with chronic LBP received motor skill training, and 16 people with healthy backs were recruited as a reference standard. Twenty minutes of motor skill training to decrease early-phase lumbar excursion during the performance of a functional activity were used as a treatment intervention. Early-phase lumbar excursion was measured before and after training. Participants verbally reported increased pain, decreased pain, or no change in pain during performance of the functional activity test movement in relation to their baseline pain. The characteristics of people with LBP that influenced the ability to decrease early-phase lumbar excursion were examined. Results People with LBP displayed greater early-phase lumbar excursion before training than people with healthy backs (LBP: mean = 11.2°, 95% CI = 9.3°-13.1°; healthy backs: mean = 7.1°, 95% CI = 5.8°-8.4°). Following training, the LBP group showed a decrease in the amount of early-phase lumbar excursion (mean change = 4.1°, 95% CI = 2.4°-5.8°); 91% of people with LBP reported that their pain decreased from baseline following training. The longer the duration of LBP (β = - 0.22) and the more early-phase lumbar excursion before training (β = - 0.82), the greater the change in early-phase lumbar excursion following training. Limitations The long-term implications of modifying the movement pattern and whether the decrease in pain attained was clinically significant are unknown. Conclusions People with LBP were able to modify their lumbar movement pattern and decrease their pain with the movement pattern within a single session of motor skill training.
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Affiliation(s)
- Andrej V Marich
- Program in Physical Therapy, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Vanessa M Lanier
- Program in Physical Therapy, School of Medicine, Washington University in St Louis
| | - Gretchen B Salsich
- Department of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, School of Medicine, Washington University in St Louis
| | - Linda R Van Dillen
- Program in Physical Therapy and Department of Orthopaedic Surgery, School of Medicine, Washington University in St Louis, 4444 Forest Park Blvd, Campus Box 8502, St Louis, MO 63108 (USA)
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Shiri R, Coggon D, Falah-Hassani K. Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. Am J Epidemiol 2018; 187:1093-1101. [PMID: 29053873 DOI: 10.1093/aje/kwx337] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to assess the effect of exercise in population-based interventions to prevent low back pain (LBP) and associated disability. Comprehensive literature searches were conducted in multiple databases, including PubMed, Embase, and the Cochrane Library, from their inception through June 2017. Thirteen randomized controlled trials (RCTs) and 3 nonrandomized controlled trials (NRCTs) qualified for the meta-analysis. Exercise alone reduced the risk of LBP by 33% (risk ratio = 0.67, 95% confidence interval: 0.53, 0.85; I2 = 23%, 8 RCTs, n = 1,634), and exercise combined with education reduced it by 27% (risk ratio = 0.73, 95% confidence interval: 0.59, 0.91; I2 = 6%, 6 trials, n = 1,381). The severity of LBP and disability from LBP were also lower in exercise groups than in control groups. Moreover, results were not changed by excluding the NRCTs or adjusting for publication bias. Few trials assessed health-care consultation or sick leave for LBP, and meta-analyses did not show statistically significant protective effects of exercise on those outcomes. Exercise reduces the risk of LBP and associated disability, and a combination of strengthening with either stretching or aerobic exercises performed 2-3 times per week can reasonably be recommended for prevention of LBP in the general population.
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Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - David Coggon
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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Lane C, Mayer J. Posterior Chain Exercises for Prevention and Treatment of Low Back Pain. ACSM'S HEALTH & FITNESS JOURNAL 2017. [DOI: 10.1249/fit.0000000000000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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White MI, Dionne CE, Wärje O, Koehoorn M, Wagner SL, Schultz IZ, Koehn C, Williams-Whitt K, Harder HG, Pasca R, Hsu V, McGuire L, Schulz W, Kube D, Wright MD. Physical Activity and Exercise Interventions in the Workplace Impacting Work Outcomes: A Stakeholder-Centered Best Evidence Synthesis of Systematic Reviews. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2017; 7:61-74. [PMID: 27112715 PMCID: PMC6816510 DOI: 10.15171/ijoem.2016.739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/08/2016] [Indexed: 01/08/2023]
Abstract
Background: The prevention of work disability is beneficial to employees and employers, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability. Objective: To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes. Methods: Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process. Results: Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts.
Conclusion: The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1–2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.
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Affiliation(s)
- M I White
- Canadian Institute for the Relief of Pain and Disability, Vancouver, Canada, and Department of Family Practice, University of British Columbia, Vancouver, Canada.
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Jakobsen MD, Sundstrup E, Brandt M, Andersen LL. Factors affecting pain relief in response to physical exercise interventions among healthcare workers. Scand J Med Sci Sports 2016; 27:1854-1863. [PMID: 28028866 DOI: 10.1111/sms.12802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/19/2022]
Abstract
The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain.
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Affiliation(s)
- M D Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - E Sundstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - M Brandt
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Health Science and Technology, Physical Activity and Human Performance group, SMI, Aalborg University, Aalborg, Denmark
| | - L L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Health Science and Technology, Physical Activity and Human Performance group, SMI, Aalborg University, Aalborg, Denmark
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Melendez-Torres GJ, O'Mara-Eves A, Thomas J, Brunton G, Caird J, Petticrew M. Interpretive analysis of 85 systematic reviews suggests that narrative syntheses and meta-analyses are incommensurate in argumentation. Res Synth Methods 2016; 8:109-118. [PMID: 27860329 PMCID: PMC5347877 DOI: 10.1002/jrsm.1231] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/06/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022]
Abstract
Using Toulmin's argumentation theory, we analysed the texts of systematic reviews in the area of workplace health promotion to explore differences in the modes of reasoning embedded in reports of narrative synthesis as compared with reports of meta‐analysis. We used framework synthesis, grounded theory and cross‐case analysis methods to analyse 85 systematic reviews addressing intervention effectiveness in workplace health promotion. Two core categories, or ‘modes of reasoning’, emerged to frame the contrast between narrative synthesis and meta‐analysis: practical–configurational reasoning in narrative synthesis (‘what is going on here? What picture emerges?’) and inferential–predictive reasoning in meta‐analysis (‘does it work, and how well? Will it work again?’). Modes of reasoning examined quality and consistency of the included evidence differently. Meta‐analyses clearly distinguished between warrant and claim, whereas narrative syntheses often presented joint warrant–claims. Narrative syntheses and meta‐analyses represent different modes of reasoning. Systematic reviewers are likely to be addressing research questions in different ways with each method. It is important to consider narrative synthesis in its own right as a method and to develop specific quality criteria and understandings of how it is carried out, not merely as a complement to, or second‐best option for, meta‐analysis. © 2016 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd.
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Affiliation(s)
- G J Melendez-Torres
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - J Thomas
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - G Brunton
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - J Caird
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - M Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
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Bogaert I, De Martelaer K, Beutels M, De Ridder K, Zinzen E. Posture analysis among Flemish secondary school teachers: difference between the use of chalkboards and electronic school boards during classroom teaching. ERGONOMICS 2016; 59:1487-1493. [PMID: 26853262 DOI: 10.1080/00140139.2016.1139751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to (i) make a posture analysis of teachers during theoretical classroom teaching; (ii) to estimate the risk for the development of musculoskeletal problems (MSP); (iii) test the hypotheses that an electronic school board (EB) has more ergonomic advantages for teachers. Thirty-five secondary school teachers, of which 15 used an EB and 20 used chalkboards, were selected by convenience sampling and filmed during 30 min of a theoretical course. Posture analysis of back, arms, legs and risk assessment was performed using the Ovako Working Posture Analysis System. Most of the teachers' postures did not indicate a higher risk for MSP. However, some postures may be harmful when accumulated for several hours of teaching a day; especially, long periods of standing and standing with a bended back. Results also indicated that currently the use of an EB does not improve teachers' posture. Practitioner Summary: The relationship between objectively measured physical work load and risk for injuries among teachers was not analysed so far. In this study teachers' posture was analysed using the OWAS method. Prolonged standing and forward bending were identified as risk postures. Also, using an electronic school board currently does not improve posture.
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Affiliation(s)
- Inge Bogaert
- a Faculty of Physical Education and Physiotherapy, Department of Movement Education and Sport Training , Vrije Universiteit Brussel , Brussels , Belgium
| | - Kristine De Martelaer
- a Faculty of Physical Education and Physiotherapy, Department of Movement Education and Sport Training , Vrije Universiteit Brussel , Brussels , Belgium
| | - Michèle Beutels
- a Faculty of Physical Education and Physiotherapy, Department of Movement Education and Sport Training , Vrije Universiteit Brussel , Brussels , Belgium
| | - Karolien De Ridder
- a Faculty of Physical Education and Physiotherapy, Department of Movement Education and Sport Training , Vrije Universiteit Brussel , Brussels , Belgium
| | - Evert Zinzen
- a Faculty of Physical Education and Physiotherapy, Department of Movement Education and Sport Training , Vrije Universiteit Brussel , Brussels , Belgium
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Kusnezov NA, Yazdanshenas H, Garcia E, Shamie AN. Epidemiology of musculoskeletal injury in the California film and motion picture industry. REVIEWS ON ENVIRONMENTAL HEALTH 2016; 31:251-257. [PMID: 26812757 PMCID: PMC5237630 DOI: 10.1515/reveh-2015-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Musculoskeletal injury exerts a significant burden on US industry. The purpose of this study was to investigate the frequency and characteristics of musculoskeletal injuries in the California (CA) film and motion picture (FMP) industry which may result in unforeseen morbidity and mortality. METHODS We reviewed the workers' compensation (WC) claims database of the Workers' Compensation Insurance Rating Bureau of California (WCIRB) and employment statistics through the US Bureau of Labor Statistics (BLS). We analyzed the frequency, type, body part affected, and cause of musculoskeletal injuries. RESULTS From 2003 to 2009, there were 3505 WC claims of which 94.4% were musculoskeletal. In the CA FMP industry, the most common injuries were strains (38.4%), sprains (12.2%), and fractures (11.7%). The most common sites of isolated injury were the knee (18.9%), lower back (15.0%), and ankle (8.6%). Isolated musculoskeletal spine injuries represented 19.3% of all injuries. The most common causes of injury were work-directed activity (36.0%) and falls (25.5%). CONCLUSION We present the first report on the unique profile of musculoskeletal injury claims in the FMP industry. This data provides direction for improvement of workplace safety.
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Goode AP, Coeytaux RR, McDuffie J, Duan-Porter W, Sharma P, Mennella H, Nagi A, Williams JW. An evidence map of yoga for low back pain. Complement Ther Med 2016; 25:170-7. [PMID: 27062965 DOI: 10.1016/j.ctim.2016.02.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 12/21/2015] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Yoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP). METHODS We searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies. RESULTS Three eligible systematic reviews were identified that included 10 RCTs (n=956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n=10) unpublished trial and one large (n=320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n=6 trials; standardized mean difference [SMD] -0.48; 95% CI, -0.65 to -0.31; I(2)=0% and n=5; SMD -0.33; 95% CI, -0.59 to -0.07; I(2)=48%, respectively). Long-term effects for back specific disability were also identified (n=5; SMD -0.35; 95% CI, -0.55 to -0.15; I(2)=20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP. CONCLUSION Evidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.
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Affiliation(s)
- Adam P Goode
- Department of Orthopedic Surgery, Duke University Medical Center, 2200 West Main Street, Durham, NC 27705, United States; Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, United States.
| | - Remy R Coeytaux
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, United States.
| | - Jennifer McDuffie
- Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States.
| | - Wei Duan-Porter
- Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States.
| | - Poonam Sharma
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States.
| | - Hillary Mennella
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States.
| | - Avishek Nagi
- Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States.
| | - John W Williams
- Durham Center for Health Services Research in Primary Care and Evidence Synthesis Program, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, United States.
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Wages NP, Beck TW, Ye X, Hofford CW. Examination of the resting mechanomyographic mean frequency responses for the postural tonus muscles following resistance exercise. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/1/015002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Frederiksen P, Karsten MMV, Indahl A, Bendix T. What Challenges Manual Workers' Ability to Cope with Back Pain at Work, and What Influences Their Decision to Call in Sick? JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:707-16. [PMID: 25808992 DOI: 10.1007/s10926-015-9578-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Although back pain (BP) is a very common cause for sickness absence, most people stay at work during BP episodes. Existing knowledge on the factors influencing the decision to stay at work despite pain is limited. The aim of this study was to explore challenges for coping with BP at work and decisive factors for work attendance among workers with high physical work demands. METHODS Three focus groups (n = 20) were conducted using an explorative inductive method. Participants were public-employed manual workers with high physical work demands. All had personal BP experience. Thematic analysis was used for interpretation. Results were matched with the Flags system framework to guide future recommendations. RESULTS Workers with BP were challenged by poor physical work conditions and a lack of supervisor support/trust (i.e. lack of adjustment latitude). Organization of workers into teams created close co-worker relationships, which positively affected BP coping. Workers responded to BP by applying helpful individual adjustments to reduce or prevent pain. Traditional ergonomics was considered inconvenient, but nonetheless ideal. When pain was not decisive, the decision to call in sick was mainly governed by workplace factors (i.e. sick absence policies, job strain, and close co-workers relationships) and to a less degree by personal factors. CONCLUSION Factors influencing BP coping at work and the decision to report sick was mainly governed by factors concerning general working conditions. Creating a flexible and inclusive working environment guided by the senior management and overall work environment regulations seems favourable.
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Affiliation(s)
- Pernille Frederiksen
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup University Hospital, Ndr. Ringvej 57, 2600, Glostrup, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Mette Marie V Karsten
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup University Hospital, Ndr. Ringvej 57, 2600, Glostrup, Denmark
- Department of Anthropology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Aage Indahl
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
- Uni Health, University of Bergen, Bergen, Norway
| | - Tom Bendix
- Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup University Hospital, Ndr. Ringvej 57, 2600, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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McEvoy C, Wiles L, Bernhardsson S, Grimmer K. Triage for Patients with Spinal Complaints: A Systematic Review of the Literature. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 22. [PMID: 26343816 DOI: 10.1002/pri.1639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 05/20/2015] [Accepted: 07/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to provide a systematic overview of the past decade of literature on processes of triage for patients with spinal pain, outcomes measured and markers of effectiveness. METHODS A systematic search of the literature with narrative synthesis of findings was conducted. Studies in English language of any design concerning spinal triage programmes for adults with acute or chronic spinal complaints were considered for inclusion. Electronic database searches were conducted in OVID, Medline, Embase, CINAHL, Health Source Nursing, Scopus and Web of Science. Additional references were sourced through pearling reference lists, and expert input. Findings were synthesized descriptively. RESULTS Of 216 potentially relevant records, 21 papers (20 studies) were included. There was little commonality in triage activities/programmes and outcomes, although physiotherapists were common members of triage programmes. Positive outcomes were reported most commonly for wait times, with several studies also reporting high levels of patient and physician satisfaction. Outcomes such as surgical conversion rates and selection accuracy were less clear. DISCUSSION Spinal triage programmes have the potential to improve efficiency of care for outpatients with spinal complaints. The evidence gaps in health outcomes, service models and cost effectiveness should be addressed by more robust prospective research designs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Claire McEvoy
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Louise Wiles
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Susanne Bernhardsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden
| | - Karen Grimmer
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
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Fricton J, Anderson K, Clavel A, Fricton R, Hathaway K, Kang W, Jaeger B, Maixner W, Pesut D, Russell J, Weisberg MB, Whitebird R. Preventing Chronic Pain: A Human Systems Approach-Results From a Massive Open Online Course. Glob Adv Health Med 2015; 4:23-32. [PMID: 26421231 PMCID: PMC4563888 DOI: 10.7453/gahmj.2015.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Chronic pain conditions are the top reason patients seek care, the most common reason for disability and addiction, and the biggest driver of healthcare costs; their treatment costs more than cancer, heart disease, dementia, and diabetes care. The personal impact in terms of suffering, disability, depression, suicide, and other problems is incalculable. There has been much effort to prevent many medical and dental conditions, but little effort has been directed toward preventing chronic pain. To address this deficit, a massive open online course (MOOC) was developed for students and healthcare professionals. "Preventing Chronic Pain: A Human Systems Approach" was offered by the University of Minnesota through the online platform Coursera. The first offering of this free open course was in the spring of 2014 and had 23 650 participants; 53% were patients or consumers interested in pain. This article describes the course concepts in preventing chronic pain, the analytic data from course participants, and postcourse evaluation forms.
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Affiliation(s)
- James Fricton
- University of Minnesota, Minneapolis, HealthPartners Institute for Education and Research, Minnesota Head and Neck Pain Clinic, St Paul, International Myopain Society, Nine Mile Falls, Washington, United States (Dr Fricton)
| | | | - Alfred Clavel
- HealthPartners Institute for Education and Research, Minnesota Head and Neck Pain Clinic, St Paul, United States (Dr Clavel)
| | - Regina Fricton
- Statistical Analysis, Edina, Minnesota, United States (Ms Fricton)
| | - Kate Hathaway
- University of Minnesota, Minneapolis, Minnesota School of Professional Psychology, Minneapolis, St Catherine University, Minneapolis, United States (Dr Hathaway)
| | - Wenjun Kang
- Bioinformatics, Education Management, University of Chicago, Illinois, United States (Mr Kang)
| | | | - William Maixner
- University of North Carolina, Chapel Hill, United States (Dr Maixner)
| | - Daniel Pesut
- University of Minnesota, Minneapolis, United States (Pesut)
| | - Jon Russell
- Department of Medicine, Division of Clinical Immunology, University of Texas Health Science Center, Houston, Texas, United States (Dr Russell)
| | - Mark B Weisberg
- Minnesota Head and Neck Pain Clinic, St Paul, United States (Dr Weisberg)
| | - Robin Whitebird
- HealthPartners Institute for Education and Research, United States (Dr Whitebird)
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Schaafsma FG, Anema JR, van der Beek AJ. Back pain: Prevention and management in the workplace. Best Pract Res Clin Rheumatol 2015; 29:483-94. [PMID: 26612243 DOI: 10.1016/j.berh.2015.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.
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Affiliation(s)
- Frederieke G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands; Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
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Non-specific low back pain: occupational or lifestyle consequences? Wien Klin Wochenschr 2015; 127 Suppl 5:S277-81. [DOI: 10.1007/s00508-015-0770-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Wurzelbacher SJ, Bertke SJ, Lampl MP, Bushnell PT, Meyers AR, Robins DC, Al-Tarawneh IS. The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs. Am J Ind Med 2014; 57:1398-412. [PMID: 25223846 DOI: 10.1002/ajim.22372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. METHODS Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. RESULTS For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. CONCLUSIONS The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees.
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Affiliation(s)
- Steven J. Wurzelbacher
- National Institute for Occupational Safety and Health; Division of Surveillance, Hazard Evaluations, and Field Studies
| | - Stephen J. Bertke
- National Institute for Occupational Safety and Health; Division of Surveillance, Hazard Evaluations, and Field Studies
| | - Michael P. Lampl
- Ohio Bureau of Workers' Compensation; Division of Safety and Hygiene
| | - P. Timothy Bushnell
- National Institute for Occupational Safety and Health; Division of Surveillance, Hazard Evaluations, and Field Studies
| | - Alysha R. Meyers
- National Institute for Occupational Safety and Health; Division of Surveillance, Hazard Evaluations, and Field Studies
| | - David C. Robins
- Ohio Bureau of Workers' Compensation; Division of Safety and Hygiene
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Varcin L, Claus A, van den Hoorn W, Hodges P. Manual handling: differences in perceived effort, success rate and kinematics between three different pushing techniques. ERGONOMICS 2014; 58:268-277. [PMID: 25343518 DOI: 10.1080/00140139.2014.970586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the perceived effort, success rates and kinematics for three push strategies in a simulated lateral patient transfer (horizontal slide). Thirteen healthy subjects (four males) completed three repetition pushing loads of 6, 10 and 14 kg in random order; with a spontaneous push strategy, then with a straight-back bent-knees (squat) strategy and the preparatory pelvic movement ('rockback') strategy in random order. Perceived effort and kinematic parameters measured at the onset of movement and at maximum push excursion were compared between strategies and between loads with repeated measures ANOVA. The spontaneous and 'rockback' strategies achieved the pushing task with less perceived effort across all loads than the squat push (P < 0.001). Only 3/13 participants were successful on all attempts at pushing the 14 kg load using a squat strategy, which contrasted with 12/13 participants when the spontaneous strategy or the 'rockback' strategy was used. Forward movement of the pelvis and forward trunk inclination may be positively associated with lower perceived effort in the push task. Practitioner Summary: In a manual-handling task that simulated a lateral patient transfer (horizontal slide), perceived effort and success rates of three push strategies were compared. A straight-back bent-knees push (squat) strategy demonstrated greater perceived effort and lower success rates than a spontaneous push strategy, or a push strategy with preparatory 'rockback' pelvic movement.
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Affiliation(s)
- Lynn Varcin
- a School of Health and Rehabilitation Sciences, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland , Brisbane , Australia
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Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J 2014; 14:2299-319. [PMID: 24462537 DOI: 10.1016/j.spinee.2014.01.026] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/12/2013] [Accepted: 01/14/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Great effort has been made toward limiting low back pain (LBP). Recent focus has included factors involved with secondary and tertiary prevention, with less attention given to primary prevention. PURPOSE This review provided a current estimate of the incidence of LBP and risk factors associated with either first-time LBP or transition to LBP from a baseline of a pain-free state. STUDY DESIGN A systematic review and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT SAMPLE Studies included subjects aged 18 years or older, from longitudinal, observational, cohort designs that included baseline risk factors to an outcome of either first-time LBP or transition to LBP from a baseline of a pain-free state. OUTCOME MEASURES Risk factors and incidence rates were reported using descriptive analysis and the PRISMA guidelines. METHODS Electronic search strategies in PubMed, CINAHL/SPORTDiscus, and Cochrane Central Register of Controlled Trials were combined with a hand search to identify articles for inclusion. Studies were classified based on the population studied (community vs. occupational based) and type of LBP outcome (first ever vs. transition from a baseline pain-free state). RESULTS A total of 41 studies were included for review. Meta-analytical incidence rates for first-time LBP and transition to pain from a pain-free state were similar (∼25%), regardless of community or occupational populations. Risk factors for first-time LBP or transition to LBP from a baseline of a pain-free state were psychosocial and physically related. No consistent risk factor emerged as predictive of first-time LBP, although prior LBP was a consistent predictor of future incident LBP. Significant heterogeneity was found across studies in most models, which limits these findings. CONCLUSIONS The results of this study suggest that incidence of LBP is similar in community and occupational settings regardless of LBP definition. There were multiple diverse physical and psychosocial risk factors for first-time LBP. A history of LBP was the most consistent risk factor for transition to LBP from a baseline of a pain-free state.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, 833 Montlieu Ave., High Point, NC 27262, USA.
| | - Adam P Goode
- Department of Community and Family Medicine, Duke University, Durham, NC 27707, USA
| | - Steven Z George
- Department of Physical Therapy, University of Florida, 355 Tigert Hall, Gainesville, FL 32611, USA
| | - Chad E Cook
- Department of Physical Therapy, Walsh University, 2020 East Maple St, North Canton, OH 44720, USA
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Traeger AC, Moseley GL, Hübscher M, Lee H, Skinner IW, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Pearce G, McAuley JH. Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial. BMJ Open 2014; 4:e005505. [PMID: 24889854 PMCID: PMC4054624 DOI: 10.1136/bmjopen-2014-005505] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is the leading cause of disability worldwide. Of those patients who present to primary care with acute LBP, 40% continue to report symptoms 3 months later and develop chronic LBP. Although it is possible to identify these patients early, effective interventions to improve their outcomes are not available. This double-blind (participant/outcome assessor) randomised controlled trial will investigate the efficacy of a brief educational approach to prevent chronic LBP in 'at-risk' individuals. METHODS/ANALYSIS Participants will be recruited from primary care practices in the Sydney metropolitan area. To be eligible for inclusion participants will be aged 18-75 years, with acute LBP (<4 weeks' duration) preceded by at least a 1 month pain-free period and at-risk of developing chronic LBP. Potential participants with chronic spinal pain and those with suspected serious spinal pathology will be excluded. Eligible participants who agree to take part will be randomly allocated to receive 2×1 h sessions of pain biology education or 2×1 h sessions of sham education from a specially trained study physiotherapist. The study requires 101 participants per group to detect a 1-point difference in pain intensity 3 months after pain onset. Secondary outcomes include the incidence of chronic LBP, disability, pain intensity, depression, healthcare utilisation, pain attitudes and beliefs, global recovery and recurrence and are measured at 1 week post-intervention, and at 3, 6 and 12 months post LBP onset. ETHICS/DISSEMINATION Ethical approval was obtained from the University of New South Wales Human Ethics Committee in June 2013 (ref number HC12664). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings. TRIAL REGISTRATION NUMBER https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612001180808.
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Affiliation(s)
- Adrian C Traeger
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia, Sydney, New South Wales, Australia Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Hopin Lee
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Ian W Skinner
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nicholas Henschke
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Kathryn M Refshauge
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, University of Sydney, Sydney, New South Wales, Australia
| | - Chris J Main
- Arthritis Care UK National Primary Care Centre, Keele University, North Staffordshire, UK
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Garry Pearce
- Department of Rehabilitation Medicine, Greenwich Hospital, Sydney, New South Wales, Australia
| | - James H McAuley
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia
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Darlow B, Perry M, Stanley J, Mathieson F, Melloh M, Baxter GD, Dowell A. Cross-sectional survey of attitudes and beliefs about back pain in New Zealand. BMJ Open 2014; 4:e004725. [PMID: 24859999 PMCID: PMC4039787 DOI: 10.1136/bmjopen-2013-004725] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure. DESIGN Population-based cross-sectional survey. SETTING Postal survey. PARTICIPANTS New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. Participants listed on the Electoral Roll with an overseas postal address were excluded. 602 valid responses were received. MEASURES Attitudes and beliefs about back pain were measured with the Back Pain Attitudes Questionnaire (Back-PAQ). The interaction between attitudes and beliefs and (1) back pain experience and (2) health professional exposure was investigated. RESULTS The lifetime prevalence of back pain was reported as 87% (95% CI 84% to 90%), and the point prevalence as 27% (95% CI 24% to 31%). Negative views about the back and back pain were prevalent, in particular the need to protect the back to prevent injury. People with current back pain had more negative overall scores, particularly related to back pain prognosis. There was uncertainty about links between pain and injury and appropriate physical activity levels during an episode of back pain. Respondents had more positive views about activity if they had consulted a health professional about back pain. The beliefs of New Zealanders appeared to be broadly similar to those of other Western populations. CONCLUSIONS A large proportion of respondents believed that they needed to protect their back to prevent injury; we theorise that this belief may result in reduced confidence to use the back and contribute to fear avoidance. Uncertainty regarding what is a safe level of activity during an episode of back pain may limit participation. People experiencing back pain may benefit from more targeted information about the positive prognosis. The provision of clear guidance about levels of activity may enable confident participation in an active recovery.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Meredith Perry
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Markus Melloh
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - G David Baxter
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Cho KH, Beom JW, Lee TS, Lim JH, Lee TH, Yuk JH. Trunk muscles strength as a risk factor for nonspecific low back pain: a pilot study. Ann Rehabil Med 2014; 38:234-40. [PMID: 24855618 PMCID: PMC4026610 DOI: 10.5535/arm.2014.38.2.234] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 10/12/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
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Affiliation(s)
- Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Won Beom
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Tae Sung Lee
- Department of Rehabilitation Medicine, Yuseong Wellness Rehabilitation Hospital, Daejeon, Korea
| | - Jun Ho Lim
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Tae Heon Lee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ji Hyun Yuk
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs. Spine J 2014; 14:571-83. [PMID: 23608562 DOI: 10.1016/j.spinee.2013.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/18/2013] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. PURPOSE The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. STUDY DESIGN/SETTING The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. METHODS In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. RESULTS After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings. CONCLUSION The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors.
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Mroz TM, Carlini AR, Archer KR, Wegener ST, Hoolachan JI, Stiers W, Shore RA, Castillo RC. Frequency and cost of claims by injury type from a state workers' compensation fund from 1998 through 2008. Arch Phys Med Rehabil 2014; 95:1048-1054.e6. [PMID: 24480333 DOI: 10.1016/j.apmr.2013.11.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/06/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine which work-related injuries are the most frequent and costly. DESIGN Secondary analysis of workers' compensation claims data. SETTING Data were provided by a large, Maryland workers' compensation insurer from 1998 through 2008. PARTICIPANTS Not applicable. INTERVENTIONS None. MAIN OUTCOMES MEASURES For 45 injury types, the number of claims and compensation amount was calculated for total compensation and for medical and indemnity compensation separately. RESULTS Back and knee injuries were the most frequently occurring single injury types, whereas heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost of injury (mean cost × number occurrences), back, knee, and shoulder injuries were the most expensive single injury types. CONCLUSIONS Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries.
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Affiliation(s)
- Tracy M Mroz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Anthony R Carlini
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Jordan I Hoolachan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - William Stiers
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Rebecca A Shore
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Renan C Castillo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
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Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med 2013; 11:527-34. [PMID: 24218376 PMCID: PMC3823723 DOI: 10.1370/afm.1518] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain. METHODS Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework. RESULTS Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity. CONCLUSIONS Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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A Health- and Resource-Oriented Perspective on NSLBP. ISRN PAIN 2013; 2013:640690. [PMID: 27335880 PMCID: PMC4893409 DOI: 10.1155/2013/640690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/04/2013] [Indexed: 12/19/2022]
Abstract
Nonspecific low back pain (NSLBP) is an important health issue of our time. Personal as well as economic factors, like suffering pain and experiencing disability on the one hand and enormous and still increasing costs to the economy and society on the other hand, display the importance of the matter. Tremendous research has been conducted in the last few decades on NSLBP. A PubMed search (June 17, 2013) on “low back pain” provided 22,980 hits, and when specifying for “low back pain, systematic review,” 3,134 hits were still generated. Most research has been done examining the development, risk factors, or therapeutic measures of NSLBP, but hardly any literature exists on resources related to NSLBP. The aims of this review are twofold. In order to shade light on the salutogenetic approach of NSLBP, and thus to focus on health instead of illness, the first aim is to facilitate the understanding of which therapeutic measures enhance the ability to cope with chronic NSLBP and enable (more) normal functioning in life. The second aim is to stimulate the understanding of resources protecting against the onset of NSLBP or against the development of chronic NSLBP and its resulting work absence.
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