Measuring the Prevalence and Incidence of Low Back Pain Disorders Among American Workers in the Aerospace and Defense Industry

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases

ABSTRACT

Identifying nonspecific low back pain (LBP) in medico-administrative databases is a major challenge because of the number and heterogeneity of existing diagnostic codes and the absence of standard definitions to use as reference. The objective of this study was to evaluate the sensitivity and specificity of algorithms for the identification of nonspecific LBP from medico-administrative data using self-report information as the reference standard. Self-report data came from the PROspective Québec Study on Work and Health , a 24-year prospective cohort study of white-collar workers. All diagnostic codes that could be associated with nonspecific LBP were identified from the International Classification of Diseases, Ninth and Tenth Revisions ( ICD-9 and ICD-10 ) in physician and hospital claims. Seven algorithms for identifying nonspecific LBP were built and compared with self-report information. Sensitivity analyses were also conducted using more stringent definitions of LBP. There were 5980 study participants with (n = 2847) and without (n = 3133) LBP included in the analyses. An algorithm that included at least 1 diagnostic code for nonspecific LBP was best to identify cases of LBP in medico-administrative data with sensitivity varying between 8.9% (95% confidence interval [CI] 7.9-10.0) for a 1-year window and 21.5% (95% CI 20.0-23.0) for a 3-year window. Specificity varied from 97.1% (95% CI 96.5-97.7) for a 1-year window to 90.4% (95% CI 89.4-91.5) for a 3-year window. The low sensitivity we found reveals that the identification of nonspecific cases of LBP in administrative data is limited, possibly due to the lack of traditional medical consultation.

Is there an interdependence between paraspinal muscle mass and lumbar disc degeneration? A MRI based study at 2520 levels in 504 patients

INTRODUCTION

Low back pain is one of the most common cause for outpatient visits. Though few studies have shown the vital role of paraspinal muscles in lumbar spine pathology, literature is scarce regarding the influence of the paraspinal muscles in disc degeneration. We aimed to analyse the correlation between paraspinal muscles and disc degeneration.

METHODS

This is a Level III Prospective Cohort Study done in MRI of lumbosacral spine in 504 patients at 2520 levels from L1-2 to L5-S1. The parameters assessed were age, Pfirrmann grade for disc degeneration and paraspinal muscle (Multifidus and Erector Spinae) mass assessed by the gross cross sectional area of the muscle.The values and their correlation was analyzed using SPSS software.

RESULTS

The study included a total of 504 patients (231 males and 273 females) with a mean age of 52.00 ± 15.00 (22-80) years. The mean GCSA in cm² of the paraspinal muscles at L1-L2, L2-L3,L3-L4,L4-L5,L5-S1 were 16.177 ± 2.72, 17.275 ± 2.16, 16.900 ± 3.07, 16.800 ± 2.63, 13.426 ± 2.42 respectively. We found that the age of the patient is directly proportional to the disc degeneration and inversely proportional to GCSA of paraspinal muscle. There was a significant negative correlation between disc degeneration and paraspinal muscle mass.

CONCLUSION

We found that the paraspinal muscle mass reduces and Pfirrman's Grade increases as age advances. Also patients with disc degeneration tend to have wasting of paraspinal muscles and vice versa. Hence, strengthening the paraspinal muscles should be emphasised to prevent back pain and to stall the degeneration cascade.

Experience of Pain and Satisfaction with Pain Management in Patients After a Lumbar Disc Herniation Surgery

PURPOSE

The descriptive study was performed to assess patients' pain experienced in the early postoperative period of a lumbar disc herniation surgery and their satisfaction with the pain management administered.

DESIGN

This was a descriptive and cross-sectional study conducted from May 8 to November 8, 2017.

METHODS

Data collection was performed during interviews through the Patient Information Form (20 questions), Turkish version of clinical quality indicators in the Postoperative Pain Management questionnaire (19 questions). The questionnaire included 14 items and 3 subdimensions named nursing interventions, pain management, and the environment. The remaining 5 questions were related to pain management satisfaction and pain severity. Questionnaire items scored on a 1 to 5 Likert scale. The higher the total score obtained from the questionnaire is the satisfaction with pain management increases.

FINDINGS

The mean score obtained from the total questionnaire was 51.4 (standard deviation: 6.6).Characteristics of patients with lumbar disc herniation did not influence the total score obtained from the instrument and its sub-dimensions (P > .05). Overall satisfaction with pain management was high (mean: 8.3; standard deviation: 1.6) on the 0 to 10 visual analog scale. There was a statistically significant difference between the length of hospital stay, the type of anesthesia used, having more pain than expected, and the satisfaction score of patients (P < .05). As the length of procedure increases, the average and current pain scores increase as well (P < .05).

CONCLUSIONS

Results of this study indicate that despite pain experienced after the lumbar disc herniation surgery, patients' satisfaction with pain management was high. Encouraging nurses to implement systematic and evidence-based practices in pain management may help alleviate patients' pain after surgery and reduce variety of pain management practices among nurses.

Prevalence of facet joint arthritis and its association with spinal pain in mountain population - A cross-sectional study

Introduction:

People living in the mountains are subject to tough terrain and climbing biomechanics which lead to degeneration of the spine and Facet joint arthritis (FJA).

Aims:

The goal of present study was (1) to know the prevalence of facet joint arthritis on CT scans in mountain population in regard to (a) different levels in spine (b) age (c) sex (2) to know if there is any significant association between FJA and spinal pain at that corresponding level.

Materials and Methods:

Bilateral Facet joints of 210 participants (age range, 18 to 97 years) who underwent MDCT imaging for reasons other than spinal pain, were graded and statistically analysed with SPSS software in this study. FJA was defined as at least one joint affected by facet joint disease (grade 2).

Results:

In our study, Seventy two men (68.5%) and eighty four women (80%) had Facet Joint arthritis. The difference between men and women in the prevalence of FJA was not statistically significant (P = 0.058). The increasing age demonstrated a higher prevalence of facet joint arthritis with statistical significance (P = 0.000). In dorsal and lumbar spine region, there was a statistically significant difference in prevalence of FJA according to spinal level. The prevalence of FJA grade 2 in cervical and dorsal spine region was associated with spinal pain in both men (P = 0.000) and women (P = 0.000). However, no statistically significant association was found between FJA grade 2 and spinal pain in lumbar spine region in both males (P = 0.680) and females (P = 0.680) as well as in total population (P = 0.513).

Conclusions:

People residing and actually ambulating in the mountain regions and exposed to the terrain have higher prevalence of Facet joint arthritis as compared to general population and this may be an independent risk factor for development of facet joint arthritis. However, a statistically significant relation between FJA and spinal pain exists only in cervical and dorsal spine.

Low Back Pain among Workers in a Paint Factory

BACKGROUND

Back pain is common among factory workers and is responsible for about 25% of workers' compensation cases. However, data on back pain among workers from paint industry in Saudi Arabia are limited.

OBJECTIVES

The objective of this study is to estimate the prevalence of low back pain and to evaluate the associated risk factors among workers of a paint factory.

MATERIALS AND METHODS

This cross-sectional study used a self-administered questionnaire to elicit data regarding demography, job characteristics and prevalence of low back pain in the past 12 months among workers of a paint factory (n = 102) in the Eastern Province of Saudi Arabia. In addition, a scale of low back pain risk was generated for each department by occupational health professionals using interviews and observations.

RESULTS

The annual prevalence of low back pain was 44.1%, and it was more common among Saudi workers (67.9%) compared with non-Saudi workers (35.1%). Multivariate analysis indicated significant associations between low back pain and nationality (relative risk [RR] = 1.93; 95% confidence interval [CI] = 1.29-2.88), smoking (RR = 1.85; 95% CI = 1.20-2.83) and aerobic exercise (RR = 2.37; 95% CI = 1.19-4.71). Spearman rank correlation showed correlation between the symptom pain scale and smoking (r s = 0.259; P = 0.008), and exercise was associated with lower pain scale scores (r s = -0.241, P = 0.015).

CONCLUSION

This study found that low back pain is common among paint factory workers in the Eastern Province of Saudi Arabia. Nationality and smoking are risk factors for low back pain and are associated with each other. Many workers did not exercise, and lack of exercise was associated with an increased risk of low back pain. Reducing smoking and increasing exercise in addition to workplace ergonomic intervention may reduce this frequently occurring problem.

Effectiveness of Multidisciplinary Group-Based Intervention versus Individual Physiotherapy for Improving Chronic Low Back Pain in Nursing Staff: A Clinical Trial with 3- and 6-Month Follow-Up Visits from Tehran, Iran

Study Design

Clinical trial.

Purpose

To evaluate the effectiveness of a multidisciplinary group-based intervention on improving pain and disability among Iranian nurses with chronic low back pain in Tehran, Iran.

Overview of Literature

Although low back pain (LBP) is one of the most important health problems, the challenge remains on how to find an effective intervention to reduce pain and related disabilities.

Methods

Overall, 136 eligible nurses with chronic mechanical LBP were classified into two groups. The intervention group (n=66 participants) participated in a physiotherapy educational program (for 120 minutes) plus a health educational program based on predictive constructs of the social cognitive theory (for 120 minutes). These interventions were delivered by a physiotherapist and a health education specialist. The control group (n=70 participants) participated in a physiotherapy educational program (for 120 minutes). Disability rate, pain severity, and back pain prevention behavior were measured initially and at 3- and 6-month follow-up visits using the visual analogue scale, Roland-Morris Disability, and Nursing Low Back Pain Preventive Behaviors Questionnaire. Data were analyzed by SPSS ver. 16.

Results

There were statistically significant differences between the two groups in the main outcome measures immediately after the educational program and at 3- and 6-month follow-up visits. Preventive behaviors of participants in the intervention group were improved at 3- and 6- month follow-up visits (p<0.001). The mean scores of predictive constructs regarding LBP preventive behaviors in the intervention group were improved after 3 and 6 months (p<0.001). Finally, in the intervention group, pain severity and disability were decreased significantly.

Conclusions

This study showed that a multidisciplinary educational program intervention can be an effective approach for reducing LBP and related disabilities among nurses.