Risk factors for recurrent episodes of work-related low back disorders in an industrial population

Occupational and Health-Related Risk Factors for Incident and Recurrent Back Disorders in Danish Fishers-A Register-Based Study

BACKGROUND

Fishers are at risk of back disorders due to their physically demanding work. The aim was to investigate risk factors for back disorders in fishers in Denmark.

METHODS

All male Danish registered fishers between 1994 and 2017 were included. ICD-10 codes classified back disorders (M40-M54* and DM99.1-4*). A multistate model on a cause-specific cox regression model was conducted.

RESULTS

Of 13,165 fishers included, 16% had a hospital contact with an incident back disorder, and 52% at least had 1 recurrent episode. Having worked in another occupation (HR 1.14; 95% CI: 1.02, 1.27) and another musculoskeletal disorder (HR 1.84; 95% CI: 1.69, 2.01) were significant risk factors for the incident back disorder. No risk factors were seen for recurrent episodes.

CONCLUSIONS

Risk factors for incident and recurrent back disorders were different; thus, episode-specific initiatives are needed to reduce back disorders among fishers.

Identifying domains of health-related quality of life: the perspective of individuals with low back pain

BACKGROUND

Identifying the most relevant HRQOL domains for LBP from the perspective of individuals with lived experience with LBP is necessary to prioritize domains that will be most informative for evaluating the impact of pain and interventions while overcoming the burden of using long-form assessment tools. This study aimed to identify which domains of HRQOL are most important from the perspective of individuals with chronic LBP.

METHODS

Semi-structured interviews were conducted with 26 individuals with LBP. Participants first responded to questions related to the impact of their LBP on their HRQOL. Then, using a card sorting method, they were asked to select and indicate HRQOL domains that were most relevant to them from a list of 18 cards that represented different HRQOL domains. Participants were asked to explain the reasoning for their selection.

RESULTS

Participants identified physical activity restriction (50%), severity of pain (31%), social activity restriction (23%), and work performance restriction (23%) as the most important domains. The most frequently selected HRQOL domains during card sorting were social function (69%), pain intensity (62%), physical function (58%), fatigue (58%), and pain interference (42%).

CONCLUSION

The most important domains of HRQOL perceived by participants were pain intensity, social function, physical function, fatigue, and pain interference. Identifying these domains will inform clinical decision-making and guide treatment choices for health care providers.

The Patient-Reported Outcome Measures Used with Low Back Pain and the Attitude of Primary Healthcare Practitioners in Saudi Arabia toward Them

Background and objectives: The use of appropriate outcome measures can help guide multidimensional low back pain (LBP) management, elucidate the efficacy/effectiveness of interventions, and inform clinicians when selected targets have been achieved and this can be used for educational or research purposes. Aim: This study aimed to explore and describe the use, attitudes, knowledge, and beliefs regarding patient-reported outcome measures used by healthcare practitioners practising in Saudi Arabia who are frequently involved in the healthcare of individuals with LBP. Materials and Methods: A cross-sectional design was undertaken using a web-based survey. An electronic invitation to participate was sent to primary care physicians and physical therapists practising in Saudi Arabia. The survey included three sections: demographic data, a list of the most commonly used patient-reported outcome measures with LBP patients, and statements regarding attitudes, knowledge, and beliefs about outcome measures. Results: A total of 156 practitioners participated: 45 primary care physicians and 111 physical therapists. The numeric pain rating and visual analogue scales were the outcome measures most frequently reported as being often used by both primary care physicians and physical therapists. The majority of participants reported often using 1-2 patient reported outcome measures (PROMs). While most participants indicated that they were confident at selecting the most appropriate PROM, fewer were familiar with the concept of the minimally important clinical difference. A lack of Arabic versions of PROMs was reported as a barrier to using them to assess pain. Conclusions: This study shows that, although primary care physicians and physical therapists in Saudi Arabia frequently use patient-reported outcome measures in their clinical management of patients with LBP, there is a noticeable gap in the knowledge and use of the multidimensional outcome measures for LBP management among the participants. This highlights a need for professional training on the use of standardised outcome measures related to LBP.

Developing theory-informed knowledge translation strategies to facilitate the use of patient-reported outcome measures in interdisciplinary low back pain clinical practices in Quebec: mixed methods study

Background

There is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings.

Objectives

to 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice.

Methods

We invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention.

Results

Eighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader.

Conclusion

The routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients’ outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs’ ability to integrate PROMs into clinical decision-making and to engage patients in their care.

Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain

BACKGROUND

Physical deconditioning in combination with societal and emotional factors has been hypothesized to compromise complete recovery from low back pain (LBP). However, there is a lack of longitudinal studies designed to specifically investigate physical activity as an independent prognostic factor. We conducted a prognostic study to investigate whether levels of leisure time physical activity are independently associated with clinical outcomes in people seeking care for chronic and persistent LBP.

METHODS

A total of 815 consecutive patients presenting with LBP to an outpatient spine centre in secondary care were recruited. Separate multivariate linear regression analyses were performed to investigate whether levels of leisure time physical activity (i.e., sedentary, light and moderate-to-vigorous leisure time physical activity levels) predict pain and disability at 12-month follow-up, after adjusting for age, pain, episode duration, disability, neurological symptoms, depression and fear of movement.

RESULTS

Final models showed evidence of an association between baseline physical activity and 12-month outcomes (p < 0.001). In both models, the moderate-to-vigorous physical activity group reported less pain and disability compared with the sedentary group.

CONCLUSIONS

Our findings suggest that physical activity levels may have a role in the prognosis of LBP. Specific domains of physical activity warrant further investigation to better understand this association.

Does a patient's physical activity predict recovery from an episode of acute low back pain? A prospective cohort study

Background

Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain.

Method

The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population. This prospective cohort study recruited 101 consenting patients with sub-acute LBP (< 6 weeks) who completed the Roland Morris Disability Questionnaire (RMDQ), the Visual Analogue Scale, and resumption of full ‘normal’ activity question (Y/N), at baseline and 3 months. Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall questionnaire.

Results

Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ (p > 0.05) or RMDQ change (p > 0.05) over 3 months. A self-report of a return to full ‘normal’ activities was significantly associated with greater RMDQ change score at 3 months (p < 0.001). Paired t-tests found no significant change in activity levels measured with the RT3 (p = 0.57) or the recall questionnaire (p = 0.38) from baseline to 3 months.

Conclusions

These results question the predictive role of physical activity in LBP recovery, and the assumption that activity levels change as LBP symptoms resolve. The importance of a patient’s perception of activity limitation in recovery from acute LBP was also highlighted.

Trial registration

Clinical Trial Registration Number, ACTRN12609000282280

Physical and psychological maltreatment in childhood and later health problems in women: an exploratory investigation of the roles of perceived stress and coping strategies

OBJECTIVE

This retrospective, cross-sectional study investigated the association between childhood physical and psychological maltreatment and self-reported physical health concerns in adult women. The mediating roles of perceived stress and coping strategies were examined.

METHODS

Participants were 235 women (aged 18-59 years) recruited from the community. Semi-structured interviews and questionnaires were used to assess self-reported childhood maltreatment and current perceived stress, coping strategies, and health status. Data were analyzed using structural equation modeling.

RESULTS

After controlling for a history of child sexual abuse and relevant demographic variables, child physical and psychological maltreatment were significantly associated with greater physical health concerns. Support was found for models in which perceived stress and emotion-focused coping partially mediate the relation between maltreatment and health problems; problem-focused and avoidance coping did not operate as mediators. Multi-mediation model testing indicated that emotion-focused coping and perceived stress together better explain the relationship between child maltreatment and physical health than either variable alone.

CONCLUSION

Findings suggest that child maltreatment is an important risk factor for adverse health outcomes in later life and that current stress and coping strategies may influence this relationship. Implications for the physical health of maltreatment survivors are discussed.

PRACTICE IMPLICATIONS

The management of perceived stress and the use of adaptive emotion-focused coping responses in the everyday lives of maltreated women may be particularly useful points of intervention in order to mitigate physical health concerns in adulthood.

The relationship between physical activity and low back pain outcomes: a systematic review of observational studies

Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain (NSLBP), the link between levels of physical activity and outcomes is unclear. This systematic review investigated the relationships between free living activity levels after onset of low back pain (LBP) and measures of pain, and disability in patients with NSLBP. Cohort and cross-sectional studies were located using OVID, CINAHL, Medline, AMED, Embase, Biomed, PubMed-National Library of Medicine, Proquest and Cochrane Databases, and hand searches of reference lists. Studies were included if a statistical relationship was investigated between measures of free living physical activity (PA) in subjects with LBP and LBP outcome measures. Twelve studies (seven cohort and five cross-sectional) were included. One prospective study reported a statistically significant relationship between increased leisure time activity and improved LBP outcomes, and one cross-sectional study found that lower levels of sporting activity were associated with higher levels of pain and disability. All other studies (n = 10) found no relationship between measures of activity levels and either pain or disability. Heterogeneity of study designs, particularly in terms of activity measurement, made comparisons between studies difficult. These data suggest that the activity levels of patients with NSLBP are neither associated with, nor predictive of, disability or pain levels. Validated activity measurement in prospective research is required to better evaluate the relationships between PA and LBP.

Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?

BACKGROUND

Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.

OBJECTIVE

The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.

DESIGN

This was an observational prospective cohort study (2005-2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.

METHODS

Therapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.

RESULTS

Higher percentages of adherence were associated with fewer functional limitations (beta=-0.21, P=.023) and fewer treatment sessions (beta=-0.27, P=.005).

LIMITATIONS

The relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.

CONCLUSIONS

The results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.

Predictors of stable return-to-work in non-acute, non-specific spinal pain: low total prior sick-listing, high self prediction and young age. A two-year prospective cohort study

BACKGROUND

Non-specific spinal pain (NSP), comprising back and/or neck pain, is one of the leading disorders in long-term sick-listing. During 2000-2004, 125 Swedish primary-care patients with non-acute NSP, full-time sick-listed 6 weeks-2 years, were included in a randomized controlled trial to compare a cognitive-behavioural programme with traditional primary care. This prospective cohort study is a re-assessment of the data from the randomized trial with the 2 treatment groups considered as a single cohort. The aim was to investigate which baseline variables predict a stable return-to-work during a 2-year period after baseline: objective variables from function tests, socioeconomic, subjective and/or treatment variables. Stable return-to-work was a return-to-work lasting for at least 1 month from the start of follow-up.

METHODS

Stable return-to-work was the outcome variable, the above-mentioned factors were the predictive variables in multiple-logistic regression models, one per follow-up at 6, 12, 18 and 24 months after baseline. The factors from univariate analyzes with a p-value of at most .10 were included. The non-significant variables were excluded stepwise to yield models comprising only significant factors (p < .05). As the comparatively few cases made it risky to associate certain predictors with certain time-points, we finally considered the predictors which were represented in at least 3 follow-ups. They are presented with odds ratios (OR) and 95% confidence intervals.

RESULTS

Three variables qualified, all of them represented in 3 follow-ups: Low total prior sick-listing (including all diagnoses) was the strongest predictor in 2 follow-ups, 18 and 24 months, OR 4.8 [1.9-12.3] and 3.8 [1.6-8.7] respectively, High self prediction (the patients' own belief in return-to-work) was the strongest at 12 months, OR 5.2 [1.5-17.5] and Young age (max 44 years) the second strongest at 18 months, OR 3.5 [1.3-9.1].

CONCLUSIONS

In primary-care patients with non-acute NSP, the strong predictors of stable return-to-work were 2 socioeconomic variables, Low total prior sick-listing and Young age, and 1 subjective variable, High self-prediction. Objective variables from function tests and treatment variables were non-predictors. Except for Young age, the predictors have previously been insufficiently studied, and so our study should widen knowledge within clinical practice.

Indicators of adherence to physiotherapy attendance among Saudi female patients with mechanical low back pain: a clinical audit

Background

Among current musculoskeletal interventions used to treat low back pain (LBP), physiotherapy exercise has the highest evidence of effectiveness in avoiding recurrence and chronic disability. However, effectiveness of physiotherapy is thought to be directly related to the patients' adherence to physiotherapy. Since adherence is reported to be directly influenced by socio-cultural factors, this study was conducted to investigate factors related to patients' adherence in a group of Saudi female patients with LBP.

Methods

A retrospective chart review was conducted on female LBP patients referred to the department of physiotherapy at a local tertiary hospital over a 12 month period. A total of 98 charts were reviewed. Two physiotherapists specialized in musculoskeletal rehabilitation collected information from the medical files. Data were classified in three categories: patients' personal demographics, patients' medical condition and history, and type of physiotherapy administered. Contingency tables and chi-square test were computed to test for differences in proportions. Spearman rank correlation coefficient was calculated to examine relationships among variables.

Results

Subjects who attended their scheduled appointments were classified as adherent (40%), and those who failed to attend 2 consecutive scheduled appointments and got discharged were classified as non-adherent (60%). Factors that significantly correlated with adherence included: age (r = 0.7, p < 0.05), initial pain intensity (r = 0.5, p < 0.05), and subjective report of improvement (r = 0.7, p < 0.01). Adherence did not correlate with the type of LBP, patient occupation, experience or nationality of the physiotherapist.

Conclusion

This study reveals an alarming level of non-adherence to physiotherapy among patients with LBP. It remains unclear as to what level of adherence is required to achieve beneficial effect of treatment. It is quite evident however, that early withdrawal from treatment would not allow the therapeutic benefits of the treatment to be realized. Future research should be directed toward developing strategies to improve adherence.

Recurrence of medically certified sickness absence according to diagnosis: a sickness absence register study

INTRODUCTION

Sickness absence is a major public health problem. Research on sickness absence focuses on interventions aimed at expediting return to work. However, we need to know more about sustaining employees at work after return to work. Therefore, this study investigated the recurrence of sickness absence according to diagnosis.

METHODS

We analyzed the registered sickness absence data of 137,172 employees working for the Dutch Post and Telecom. Episodes of sickness absence were medically certified, according to the ICD-10 classification of diseases, by an occupational physician. The incidence density (ID) and recurrence density (RD) of medically certified absences were calculated per 1,000 person-years in each ICD-10 category.

RESULTS

Sickness absence due to musculoskeletal disorders had the highest recurrence (RD = 118.7 per 1,000 person-years), followed by recurrence of sickness absence due to mental disorders (RD = 80.4 per 1,000 person-years). The median time to recurrent sickness absence due to musculoskeletal disorders was 409 days after the index episode. Recurrences of sickness absence due to musculoskeletal disorders accounted for 37% of the total number of recurrent sickness absence days. For recurrences of sickness absence due to mental disorders this was 328 days and 21%, respectively. Unskilled employees with a short duration (<5 years) of employment had a higher risk of recurrent sickness absence.

CONCLUSIONS

Interventions to expedite return to work of employees sick-listed due to musculoskeletal or mental disorders should also aim at reducing recurrence of sickness absence in order to sustain employees at work.

Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study

BACKGROUND

Activity advice and prescription are commonly used in the management of low back pain (LBP). Although there is evidence for advising patients with LBP to remain active, facilitating both recovery and return to work, to date no research has assessed whether objective measurements of free living physical activity (PA) can predict outcome, recovery and course of LBP.

METHODS

An observational longitudinal study will investigate PA levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP. Each participant's PA level, functional status, mood, fear avoidance behaviours, and levels of pain, psychological distress and occupational activity will be measured on three occasions during for 1 week periods at baseline, 3 months, and 1 year. Physical activity levels will be measured by self report, RT3 triaxial accelerometer, and activity recall questionnaires. The primary outcome measure of functional recovery will be the Roland Morris Disability Questionnaire (RMDQ). Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population.

DISCUSSION

This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery. The results will assess whether occupational, psychological and behavioural factors affect the relationship between free living PA and LBP recovery. Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.

TRIAL REGISTRATION

[Clinical Trial Registration Number, ACTRN12609000282280].

Patients at risk for long-term sick leave because of low back pain

BACKGROUND CONTEXT

Ten percent of patients with low back pain (LBP) are not able to resume work within 3 months of sick leave, accounting for 90% of all medical and indemnity costs.

PURPOSE

To quantify the relative contribution of sociodemographic, clinical, occupational, and psychological risk factors in determining the non-return to work after 3 months of compensated LBP and to develop a screening tool to identify patients who require further guidance and rehabilitation.

STUDY DESIGN/SETTING

A 6-month prospective cohort study of disabled workers applying for compensation benefit because of LBP during a 6-month period in the Belgian compulsory health insurance system.

PATIENT SAMPLE

Three hundred and forty-six patients.

OUTCOME MEASURES

Patients unable to resume work within 3 months of sick leave were classified as bad outcomes.

METHODS

Consecutively, injured workers applying for income replacement benefits between October 2003 and March 2004 because of LBP were followed 6 months after the start of the sick leave period. All subjects underwent a standardized physical examination and completed a battery of 12 self-report questionnaires.

RESULTS

Forty-seven percent of the population had not resumed work 3 months after the start of the sick leave period. The risk factors for sickness absence more than 3 months were Oswestry disability index (odds ratio for each point increase: 1.04; 95% confidence interval: 1.02-1.06), fear of avoidance severity score (odds ratio for each point increase: 1.05; confidence interval: 1.02-1.09), blue collar worker (odds ratio: 2.18; confidence interval: 1.21-3.92), LBP for less than 12 weeks before sick leave (odds ratio: 0.32; confidence interval: 0.17-0.64), and pain behavior (odds ratio for each point increase: 1.72; confidence interval: 1.25-2.39). A multivariate screening test based on five questions identified 80% of the patients unable to resume work after 3 months of sick leave (specificity: 56.6; cut off: 0.4).

CONCLUSIONS

A questionnaire comprising a limited set of items allows a practical screening of LBP patients unlikely to resume work.

Validation of the Brazilian-Portuguese version of the Gesture Behavior Test for patients with non-specific chronic low back pain

OBJECTIVE

To develop a Brazilian version of the gesture behavior test (GBT) for patients with chronic low back pain.

METHODS

Translation of GBT into Portuguese was performed by a rheumatologist fluent in the language of origin (French) and skilled in the validation of questionnaires. This translated version was back-translated into French by a native-speaking teacher of the language. The two translators then created a final consensual version in Portuguese. Cultural adaptation was carried out by two rheumatologists, one educated patient and the native-speaking French teacher. Thirty patients with chronic low back pain and fifteen healthcare professionals involved in the education of patients with low back pain through back schools (gold-standard) were evaluated. Reproducibility was initially tested by two observers (inter-observer); the procedures were also videotaped for later evaluation by one of the observers (intra-observer). For construct validation, we compared patients' scores against the scores of the healthcare professionals.

RESULTS

Modifications were made to the GBT for cultural reasons. The Spearman's correlation coefficient and the intra-class coefficient, which was employed to measure reproducibility, ranged between 0.87 and 0.99 and 0.94 to 0.99, respectively (p < 0.01). With regard to validation, the Mann-Whitney test revealed a significant difference (p < 0.01) between the averages for healthcare professionals (26.60; SD 2.79) and patients (16.30; SD 6.39). There was a positive correlation between the GBT score and the score on the Roland Morris Disability Questionnaire (r= 0.47).

CONCLUSIONS

The Brazilian version of the GBT proved to be a reproducible and valid instrument. In addition, according to the questionnaire results, more disabled patients exhibited more protective gesture behavior related to low-back.

After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought

STUDY DESIGN

Inception cohort study.

OBJECTIVE

To provide the first reliable estimate of the 1-year incidence of recurrence in subjects recently recovered from acute nonspecific low back pain (LBP) and to determine factors predictive of recurrence in 1 year.

SUMMARY OF BACKGROUND DATA

Previous studies provide potentially flawed estimates of recurrence of LBP because they do not restrict the cohort to those who have recovered and are therefore eligible for a recurrence.

METHODS

We identified 1334 consecutive patients who presented to primary care with acute LBP; of these 353 subjects recovered before 6 weeks and entered the current study. The primary outcome measure was recurrence of LBP in the next year. Specifically, an episode of recurrence was defined in 2 ways: recall of recurrence at the 12-month follow-up and report of pain at the 3- or 12-month follow-up. Risk factors for recurrence were assessed at baseline. Pain intensity was assessed at 6 weeks, 3 months, and 12 months and recurrence at 12 months. Factors that could plausibly affect recurrence were chosen a priori and evaluated using a multivariable regression analysis.

RESULTS

Recurrence of LBP was found to be much less common than previous estimates suggest, ranging from 24% (95% CI = 20%-28%) using "12-month recall" definition of recurrence, to 33% (95% CI = 28%-38%) using "pain at follow-up" definition of recurrence. However, only 1 factor, previous episode(s) of LBP, was consistently predictive of recurrence within the next 12 months (odds ratio = 1.8-2.0, P = 0.00-0.05).

CONCLUSION

This study challenges the assumption that the majority of subjects will have a recurrence of LBP in a 1-year period. After the resolution of an episode of acute LBP, about 25% of subjects will have a recurrence in the next year. It is difficult to predict who will have a recurrence within the next year.

Prevalence and risk factors associated with low back pain among health care providers in a Kuwait hospital

STUDY DESIGN

A cross-sectional survey among health professionals working in a Kuwait hospital.

OBJECTIVE

To investigate the prevalence and factors associated with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

The literature suggests that health professionals are exposed to occupational risk factors that predispose them to developing LBP. These rates are not well established in Middle Eastern countries such as Kuwait.

METHODS

A self-administered survey was conducted with health professionals in an urban orthopedic hospital.

RESULTS

The response rate to the survey was 60% (n = 344). Lifetime prevalence of LBP in the sample was 70.9%, and point prevalence of LBP was 21.5%. Factors associated with acute LBP included direct patient contact (P = 0.015), performing patient lifts and/or transfers (P = 0.016), low job satisfaction (P = 0.039), and poor self-reported health status (P = 0.019). The prevalence ratio (PR) of reporting acute LBP was also found to increase as a function of the number of daily lifts/transfers performed (PR: 1.4; 95% CI: 1.27 to 1.70). Other factors generally associated with LBP, such as age, sex, professional experience, smoking and exercise, were not found to be significantly associated with LBP in this study.

CONCLUSION

No causal relationships can be inferred using these cross-sectional data. However, results suggest that direct patient contact that includes lifting and/or transferring patients may be an important risk factor. Further research is warranted to evaluate effectiveness of back education and prevention programs among hospital staff in Kuwait.

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

STUDY DESIGN

Best evidence synthesis.

OBJECTIVE

To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population.

SUMMARY OF BACKGROUND DATA

The evidence on burden and determinants of neck has not previously been summarized.

METHODS

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis.

RESULTS

We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing.

CONCLUSION

Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain.

Are back supports plus education more effective than education alone in promoting recovery from low back pain?: Results from a randomized clinical trial

STUDY DESIGN

Randomized clinical trial.

OBJECTIVES

To evaluate the effectiveness of a back support plus education versus education alone in promoting recovery from a work-related low back disorder (WR-LBD) while simultaneously considering personal, health, and occupational factors and the impact of occupational factors on recovery.

SUMMARY OF BACKGROUND DATA

No randomized studies of active industrial workers with low back disorders exist regarding the effectiveness of back supports plus education.

METHODS

A total of 433 actively employed hourly union workers who had a recent diagnosis of a WR-LBD: 1) those who wore a specially designed back support plus received education on back health; and 2) those who received education on back health only. Demographic, health, medical, and occupational factors were obtained through interview or abstraction of computer files; individual ergonomic exposures were measured with a lumbar motion monitor. Outcomes evaluated over a 12-month period included: self-reported measures of back pain, back pain disability level, physical health, mental health, and administrative measures of recurrence, lost work time, and medical care utilization.

RESULTS

There was no difference between the study groups with respect to mental or physical health, low back pain, back pain disability, neurogenic symptoms, lost work time, likelihood of recurrence of an episode of a back disorder, or other administrative measures of healthcare utilization or lost work time. However, significant decreases in low back pain, low back pain disability, neurogenic symptoms, and an increase in physical health were observed over the 12 months of observation in both study groups. The only occupational variable found to influence was plant group whereby service parts operations workers in the back support plus education group experienced a lower likelihood of WR-LBD recurrence.

CONCLUSION

Although there was no overall effect on self-reported recovery or administrative measures or lost work time between the study groups, a back support plus health education may have some value in preventing recurrent WR-LBD in industrial workers who work in psychosocial environments and perform manual material handling tasks similar to those found in parts distribution centers.

Participation in occupational health longitudinal studies: predictors of missed visits and dropouts

PURPOSE

The purpose of this study is to determine whether demographics, health, and job factors influence continued participation of employed persons in a longitudinal intervention study of tertiary prevention for work-related low-back disorders (WR-LBDs).

METHODS

Four hundred fifty-four actively employed persons had enrolled in an intervention study of back supports and education to promote recovery from a WR-LBD. Baseline values were examined according to whether individuals continued in the study, missed a visit, or dropped out; frequency of missed visits; and early or late dropouts at follow-up intervals of 1, 2, 6, and 12 months.

RESULTS

Workers who did not complete all study visits were significantly more likely to be younger and have poorer self-reported health. Individuals with a greater percentage of body fat dropped out early. Significantly more missed visits were observed among those who had arthritis and longer duration of low-back pain symptoms. Job factors did not influence study participation.

CONCLUSIONS

Continued participation in a longitudinal study of working adults was influenced by age, health status, and factors related to the primary condition targeted by the intervention study. Strategies aimed at those who report lower levels of health and symptoms related to the condition under study may promote follow-up participation in longitudinal studies. Thus, even among actively employed persons, one should not assume that all workers are "healthy."