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Jacob L, Koyanagi A, Smith L, Shin JI, Haro JM, Garthe T, Kostev K. Prevalence of and factors associated with long-term sick leave in working-age adults with chronic low back pain in Germany. Int Arch Occup Environ Health 2022; 95:1549-1556. [PMID: 35181802 DOI: 10.1007/s00420-022-01841-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/01/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There are little data on the impact of chronic low back pain (CLBP) on long-term sick leave. Thus, the aim was to investigate the prevalence of and the factors associated with long-term sick leave in working-age adults with CLBP in Germany. METHODS This retrospective study included adults aged 18-65 years diagnosed for the first time with CLBP in one of 1193 general practices in Germany between 2000 and 2019. CLBP was defined as the presence of two diagnoses of low back pain with > 90 days between them. Long-term sick leave was assessed in the year following the first diagnosis of low back pain, and was defined as > 42 days of absence from work for health-related reasons. In Germany, employees on sick leave lasting > 42 days are not paid by the employer anymore but by the health insurance fund. Finally, an adjusted logistic regression model was used to assess the association between predefined variables (e.g., age, sex, and comorbidities) and long-term sick leave. RESULTS A total of 59,269 working-age adults were included in this study [mean (SD) age 32.8 (11.5) years; 41.4% women]. The prevalence of long-term sick leave in the sample was 49.1%. Long-term sick leave was significantly associated with young age, male sex, and several physical and psychiatric comorbidities (e.g., reaction to severe stress and adjustment disorder, gastritis and duodenitis, and depression). CONCLUSIONS Based on these results, public health measures are urgently needed to mitigate the deleterious effects of CLBP on work participation in Germany.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, Korea
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt, Germany.
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Characteristics of lumbar disc degeneration and risk factors for collapsed lumbar disc in Korean farmers and fishers. Ann Occup Environ Med 2021; 33:e16. [PMID: 34754477 PMCID: PMC8203835 DOI: 10.35371/aoem.2021.33.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background Few studies have investigated the risk factors for lumbar intervertebral disc degeneration among hard physical workers involved in heavy lifting. In this study, we aimed to identify the characteristics of lumbar intervertebral disc degeneration and evaluate the relationship between collapsed lumbar disc and potential risk factors in farmers and fishers. Methods This study included 203 farmers (103 men and 100 women) and 166 fishers (95 men and 71 women) aged 40–69 years who had undergone lumbar magnetic resonance imaging and were enrolled in the Korea Farmer's Knee Cohort and the Jeonnam Fishers' Cohort. We evaluated each of the 5 lumbar discs using the Pfirrmann grading system and classified collapsed lumbar intervertebral disc (cLD) as a case with ≥ 1 grade 5 at any disc level. We investigated potential risk factors, such as gender, age, body mass index (BMI), working hours per day, working months per year, and cumulative heavy lifting working time (CLWT). The odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. Results The prevalence of cLD was 19.8% (23.7% among fishers, 21.2% among fishers with farming, and 17.2% among farmers). cLD correlated with factors such as age and occupation. Gender, CLWT and the working time matrix were not significantly associated with cLD. The OR of cLD adjusted by gender, age, BMI, and working time matrix was 1.26 (95% CI: 0.69–2.30) for ≥ 5,000 hours CLWT compared to that for < 2,000 hours CLWT. The OR of cLD adjusted by gender, age, BMI, CLWT, and working time matrix was 2.08 (95% CI: 1.06–4.06) for fishers compared to that for farmers. Conclusions Heavy lifting did not show a significant association with cLD in farmers and fishers. However, there is possibility that fishers are at a higher risk of lumbar disc collapse than farmers.
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Herman PM, Edgington SE, Sorbero ME, Hurwitz EL, Goertz CM, Coulter ID. Visit Frequency and Outcomes for Patients Using Ongoing Chiropractic Care for Chronic Low-Back and Neck Pain: An Observational Longitudinal Study. Pain Physician 2021; 24:E61-E74. [PMID: 33400439 PMCID: PMC8667562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic spinal pain is prevalent and long-lasting. Although provider-based nonpharmacologic therapies, such as chiropractic care, have been recommended, healthcare and coverage policies provide little guidance or evidence regarding long-term use of this care. OBJECTIVE To determine the relationships between visit frequency and outcomes for patients using ongoing chiropractic care for chronic spinal pain. STUDY DESIGN Observational 3-month longitudinal study. SETTING Data collected from patients of 124 chiropractic clinics in 6 United States regions. METHODS We examined the impact of visit frequency and patient characteristics on pain (pain 0-10 numeric rating scale) and functional outcomes (Oswestry Disability Index [ODI] for low-back pain and Neck Disability Index [NDI] for neck pain, both 0-100 scale) using hierarchical linear modeling (HLM) in a large national sample of chiropractic patients with chronic low back pain (CLBP) and/or chronic neck pain (CNP). This study was approved by the RAND Human Subjects Protection Committee and registered under ClinicalTrials.gov Identifier: NCT03162952. RESULTS One thousand, three hundred, sixty-two patients with CLBP and 1,214 with CNP were included in a series of HLM models. Unconditional (time-only) models showed patients on average had mild pain and function, and significant, but slight improvements in these over the 3-month observation period: back and neck pain decreased by 0.40 and 0.44 points, respectively; function improved by 2.7 (ODI) and 3.0 points (NDI) (all P < 0.001). Adding chiropractic visit frequency to the models revealed that those with worse baseline pain and function used more visits, but only visits more than once per week for those with CLBP were associated with significantly better improvement. These relationships remained when other types of visits and baseline patient characteristics were included. LIMITATIONS This is an observational study based on self-reported data from a sample representative of chiropractic patients, but not all patients with CLBP or CNP. CONCLUSIONS This 3-month window on chiropractic patients with CLBP and/or CNP revealed that they were improving, although slowly; may have reached maximum therapeutic improvement; and are possibly successfully managing their chronic pain using a variety of chiropractic visit frequencies. These results may inform payers when building coverage policies for ongoing chiropractic care for patients with chronic pain.
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Affiliation(s)
| | | | | | - Eric L Hurwitz
- RAND Corporation, Santa Monica, CA; Office of Public Health Studies, University of Hawaii, M?noa, Honolulu, HI
| | | | - Ian D Coulter
- RAND Corporation, Santa Monica, CA; 2University of California Los Angeles, School of Dentistry, Los Angeles, CA; Southern California University of Health Sciences, Whittier, CA
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van Tilburg ML, van Westrienen PE, Pisters MF. Demographic and health-related factors associated with reduced work functioning in people with moderate medically unexplained physical symptoms: a cross-sectional study. BMC Public Health 2020; 20:1316. [PMID: 32867731 PMCID: PMC7457349 DOI: 10.1186/s12889-020-09415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medically unexplained physical symptoms (MUPS) are a leading cause of reduced work functioning. It is not known which factors are associated with reduced work functioning in people with moderate MUPS. Insight in these factors can contribute to prevention of reduced work functioning, associated work-related costs and in MUPS becoming chronic. Therefore, the aim of this study was to identify which demographic and health-related factors are associated with reduced work functioning, operationalized as impaired work performance and absenteeism, in people with moderate MUPS. METHODS Data of 104 participants from an ongoing study on people with moderate MUPS were used in this cross-sectional study. Ten independent variables were measured at baseline to determine their association with reduced work functioning: severity of psychosocial symptoms (four domains, measured with the Four-Dimensional Symptom Questionnaire), physical health (RAND 36-Item Health Survey), moderate or vigorous physical activity (Activ8 activity monitor), age, sex, education level and duration of complaints. Two separate multivariable linear regression analyses were performed with backward stepwise selection, for both impaired work performance and absenteeism. RESULTS Absenteeism rate rose with 2.5 and 0.6% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'depression' (B = 0.025, SE = 0.009, p = .006) and domain 'somatization' (B = 0.006, SE = 0.003, p = .086), respectively. An R2 value of 0.118 was found. Impaired work performance rate rose with 0.2 and 0.5% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'distress' (B = 0.002, SE = 0.001, p = .084) and domain 'somatization' (B = 0.005, SE = 0.001, p < .001), respectively. An R2 value of 0.252 was found. CONCLUSIONS Severity of distress, probability of a depressive disorder and probability of somatization are positively associated with higher rates of reduced work functioning in people with moderate MUPS. To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.
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Affiliation(s)
- Mark L van Tilburg
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. .,Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, the Netherlands. .,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.
| | - Paula Elisabeth van Westrienen
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Martijn F Pisters
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
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Di Pierro F, Bergomas F, Marraccini P, Ingenito MR, Ferrari L, Vigna L. Pilot study on non-celiac gluten sensitivity: effects of Bifidobacterium longum ES1 co-administered with a gluten-free diet. MINERVA GASTROENTERO 2020; 66:187-193. [PMID: 32397695 DOI: 10.23736/s1121-421x.20.02673-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bifidobacterium longum ES1 is a strain probiotic, colonizing the human gut and capable of a degradative action on gliadin. In an attempt to find new nutritional solutions aimed at improving the quality of life of patients with non-celiac gluten sensitivity (NCGS) we evaluated the effectiveness of this strain, in association with a gluten-free diet, comparing its efficacy versus diet therapy alone. METHODS The experimental design included a non-randomized, open-label, 1:1 intervention study in parallel groups. Enrolled patients with symptoms attributable to NCGS, and with negative diagnoses of both wheat allergy and celiac disease, were included in this three-month trial divided into four outpatient visits (baseline, T1, T2 and T3). Fifteen patients for each group completed the experimental protocol. RESULTS Our results showed that a combination of diet and probiotic determined a more significant reduction in the frequency and intensity of intestinal and extra-intestinal symptoms, and a clear improvement in stool consistency. CONCLUSIONS Although the study was carried out on a small number of patients, the results of our pilot trial suggest that a combined strategy of naturally gluten-free diet therapy with administration of the probiotic strain ES1 appears to offer a greater advantage than the dietary regime alone in improving the clinical symptomatic picture and in stabilizing the intestinal microbiota.
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Affiliation(s)
| | - Francesca Bergomas
- Obesity and Work Center, Occupational Medicine Unit, Department of Preventive Medicine, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Paolo Marraccini
- Obesity and Work Center, Occupational Medicine Unit, Department of Preventive Medicine, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Maria R Ingenito
- Obesity and Work Center, Occupational Medicine Unit, Department of Preventive Medicine, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Lorena Ferrari
- Obesity and Work Center, Occupational Medicine Unit, Department of Preventive Medicine, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Luisella Vigna
- Obesity and Work Center, Occupational Medicine Unit, Department of Preventive Medicine, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
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Prediction of Chronic Lower Back Pain Using the Hierarchical Neural Network: Comparison with Logistic Regression-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:medicina55060259. [PMID: 31181815 PMCID: PMC6630563 DOI: 10.3390/medicina55060259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022]
Abstract
Background: Many studies have reported on the causes of chronic lower back pain (CLBP). The aim of this study is to identify if the hierarchical neural network (HNN) is superior to a conventional statistical model for CLBP prediction. Linear models, which included multiple regression analysis, were executed for the analysis of the survey data because of the ease of interpretation. The problem with such linear models was that we could not fully consider the influence of interactions caused by a combination of nonlinear relationships and independent variables. Materials and Methods: The subjects in our study were 96 people (30 men aged 72.3 ± 5.6 years and 66 women aged 71.9 ± 5.4 years) who participated at a college health club from 20 July 2016 to 20 March 2017. The HNN and the logistic regression analysis (LR) were used for the prediction of CLBP and the accuracy of each analysis was compared and examined by using our previously reported data. The LR verified the fit using the Hosmer-Lemeshow test. The efficiencies of the two models were compared using receiver performance analysis (ROC), the root mean square error (RMSE), and the deviance (-2 log likelihood). Results: The area under the ROC curve, the RMSE, and the -2 log likelihood for the LR were 0.7163, 0.2581, and 105.065, respectively. The area under the ROC curve, the RMSE, and the log likelihood for the HNN were 0.7650, 0.2483, and 102.787, respectively (the correct answer rates were HNN = 73.3% and LR = 70.8%). Conclusions: On the basis of the ROC curve, the RMSE, and the -2 log likelihood, the performance of the HNN for the prediction probability of CLBP is equal to or higher than the LR. In the future, the HNN may be useful as an index to judge the risk of CLBP for individual patients.
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