Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question

Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT Study

BACKGROUND

Numerous studies have examined associations between overweight and obesity and risk of low back pain (LBP), but the exact magnitude of these associations is not yet clear. The purpose of this work was to assess such sex-specific associations in a community-based setting in Norway, taking into account potential relationships with other risk factors.

METHODS

A cohort study was conducted combining data from two waves of the Trøndelag Health Study, HUNT3 (2006-2008) and HUNT4 (2017-2019). Separate analyses were performed of risk of chronic LBP in HUNT4 among 14,775 individuals without chronic LBP in HUNT3, and of recurrence or persistence in HUNT4 among 5034 individuals with chronic LBP in HUNT3. Relative risks were estimated in generalised linear models for overweight and obesity compared to normal weight. Body size classification was based on values of BMI computed from measurements of height and weight. Chronic LBP was defined as LBP persisting at least 3 months during last year.

RESULTS

After adjustment for age, smoking, physical activity in leisure time and work activity, analysis of risk among women produced relative risks 1.11 (95% CI 1.00-1.23) for overweight, 1.36 (95% CI 1.20-1.54) for obesity class I and 1.68 (95% CI 1.42-2.00) for obesity classes II-III. Relative risks among men were 1.10 (95% CI 0.94-1.28) for overweight, 1.36 (95% CI 1.13-1.63) for obesity class I and 1.02 (95% CI 0.70-1.50) for obesity classes II-III, the last estimate being based on relatively few individuals. Analyses of recurrence or persistence indicated similar relationships but with smaller magnitude of relative risks and no drop in risk among obesity classes II-III in men. The change in BMI from HUNT3 to HUNT4 hardly differed between individuals with and without chronic LBP in HUNT3.

CONCLUSIONS

Risk of chronic LBP increases with higher values of BMI in both sexes, although it is uncertain whether this applies to very obese men. Very obese women carry a particularly large risk. Probabilities of recurrence or persistence of chronic LBP among those already afflicted also increase with higher values of BMI. Adjustment for other factors does not influence relationships with overweight and obesity to any major extent.

Epidemiology of low back pain: frequency, risk factors, and patterns in South-South Nigeria

Introduction

Low back pain (LBP) is a prevalent musculoskeletal condition that poses significant public health challenges. However, its epidemiology in Sub-Saharan Africa, especially in rural settings, remains largely unexplored. This study aimed to determine the epidemiology of LBP in a Nigerian Teaching Hospital.

Material and methods

This was a retrospective review of the records of all LBP cases seen at the rheumatology clinic from 2018 to 2022 in a Teaching Hospital in South-South Nigeria. The sociodemographic and clinical data, including disability scores, was extracted from the patients' medical records. The data was analyzed using IBM SPSS version 25, and the level of significance was set at p < 0.05.

Results

Among 1,580 patients, 319 (20.2%) reported LBP. The mean age was 59.51 ±10.21, and the peak age incidence was 51-60 years. Low back pain was more prevalent in females (61.4%). Work-related factors (47.3%) such as heavy lifting (26.3%), prolonged sitting (19.4%), and poor posture (27.9%) were the prominent risk factors. Sedentary behavior (11.5%) and obesity (16.9%) contributed. Common clinical manifestations included difficulty standing or bending (73%), walking difficulties (67.7%), sleep disturbances (51.4%), and radicular pain (45.8%). Common etiologies were spondylosis (66.5%), spondylolisthesis (22.3%), disc prolapse (19.4%), spinal canal stenosis (15.4%), muscle spasm (12.2%), and tuberculous spondylitis (9.7%). Acute and chronic LBP constituted 12.2% and 79.9% of cases, respectively. In terms of disability, 33.5% had minimal, 44.5% had moderate, 15.4% had severe, and 6.6% had crippling disabilities.

Conclusions

Mechanical causes were the most implicated in LBP. Work-related factors and lifestyle choices contribute to the occurrence of LBP. Adjusting posture and lifestyle modification reduces LBP risk. Understanding its epidemiology is crucial for optimizing care and implementing preventive strategies.

Biportal endoscopic discectomy versus tubular microscopic discectomy for treating single-level lumbar disc herniation in obese patients: a multicenter, retrospective analysis

PURPOSE

In microscopic lumbar discectomy in obese patients, a correlation is found between the operation time and increase in estimated blood loss according to the increase in body mass index; however, no studies have investigated the outcomes of biportal endoscopic lumbar discectomy in obese patients. Therefore, this study aimed to compare the clinical and radiographic outcomes of microscopic and endoscopic discectomy in obese patients with lumbar herniated discs.

METHODS

In this multicenter, retrospective study, clinical and radiological data were compared and analyzed in 73 obese patients with a body mass index of > 30 kg/m2 who underwent microscopic or biportal endoscopic lumbar discectomy. Clinical data on the visual analog scale (VAS), Oswestry disability index (ODI), and EuroQol-5D (EQ-5D) scores were measured, and radiological data were obtained using magnetic resonance imaging (MRI).

RESULTS

This study enrolled 43 patients who underwent microscopic discectomy and 30 who underwent biportal endoscopic discectomy. The VAS, ODI, and EQ-5D scores in both groups improved after surgery compared with those before surgery, although there was no difference between the two groups. Although there was a difference in the incidence of recurrent disc herniation confirmed by MRI after surgery, no difference was found in the number of patients requiring surgery between the two groups.

CONCLUSION

In obese patients with lumbar disc herniation that was not improved with conservative treatment, no significant clinical or radiological differences in outcomes were noted between microscopic and biportal endoscopic surgery methods. In contrast, minor complications were less common in the biportal group.

Associations between visceral fat chronic low back pain and central sensitization in patients with lumbar spinal stenosis

BACKGROUND

Pain sensitization may be one of the mechanisms contributing to chronic low back pain (CLBP).

OBJECTIVE

To evaluate the association between visceral fat, CLBP, and central sensitization (CS); describe the relationship between low back pain (LBP) intensity and CS; and identify possible correlation between visceral fat and LBP intensity.

METHODS

Patients with CLBP were divided using their CS inventory (CSI) scores into low- (CSI < 40) and high-CSI (CSI ⩾ 40) subgroups. We compared computed tomography (CT) measurements and scores for association with pain according to the visual analogue scale (VAS) between the two groups.

RESULTS

The low-CSI and the high-CSI groups had 47 patients (67.1%; 21 men, 26 women) and 23 patients (32.9%; 11 men and 12 women), respectively. The high-CSI group had a significantly higher mean VAS score (p< 0.01) and estimated mean visceral fat area (p< 0.05) than the low-CSI group. There was a moderate positive correlation between VAS score and visceral fat (standardised partial regression coefficient: 0.659, p< 0.01) in the high-CSI group according to multiple linear regression analysis adjusted for age and sex.

CONCLUSIONS

Visceral fat is associated with CLBP, regardless of sex or age, and may be a potential therapeutic target for CLBP with CS.

Scoliosis and skeletal muscle mass are strongly associated with low back pain-related disability in humans: An evolutionary anthropology point of view

OBJECTIVES

To clarify the potential risk factors and etiology of low back pain (LBP)-related disability, including structural changes of the spine (spinal scoliosis) and body composition components in a population with a high prevalence of LBP.

METHODS

In this cross-sectional study, two self-reported validated questionnaires were used to collect back pain and disability data in an ethnically homogeneous family-based population sample (N = 1078). The scoliosis angle of trunk rotation was measured by a scoliometer on three spinal levels while the patient was bent forward. Body composition parameters, including relative to weight (WT), fat, relative skeletal muscle mass (SMM/WT), and total body water were determined by bioelectrical impedance analysis. Statistical analysis was conducted, accounting for the familial composition of the sample.

RESULTS

The mixed multiple regression analyses with several LBP-related phenotypes as dependent variables consistently showed significant independent associations with scoliosis and SMM/WT, irrespective of other covariates. The odds ratios (OR)/95% CI for scoliosis ranged between 1.40 (1.19-1.64) and 1.51 (1.27-1.80), and from 0.61(0.51-0.72), to 0.71(0.58-0.87) for SMM/WT, depending on the LBP phenotype. The genetic components of the respective correlations between the LBP-phenotypes and scoliosis or SMM/WT were negligible.

CONCLUSIONS

The associations between LBP-related conditions and postured scoliosis and SMM/WT were consistent and significant and therefore may serve as markers in predicting the development of LBP-related disability. We interpret the origin of these correlations as the evolutionary event due to the imperfect spine anatomy adaptation to a vertical posture resulting from a quick transition to bipedalism from a quadrupedal ancestor.

Effects of progressive neuromuscular stabilization exercise on the support surface on patients with high obesity with lumbar instability: A double-blinded randomized controlled trial

BACKGROUND

Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability.

METHODS

This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface.

RESULT

Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate.

CONCLUSION

Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.

Prevalence of neck/shoulder pain among public hospital workers in China and its associated factors: a cross-sectional study

Studies have reported that neck and/or shoulder pain (NSP) was prevalent and a non-ignorable occupational health problem in healthcare providers. Considering data deficiency on NSP, we aimed to investigate the prevalence and sick leave absence of NSP among public hospital workers in Shandong, China and to explore the associated factors for chronic NSP. A self-administered questionnaire including the Dutch Musculoskeletal Questionnaire and Modified Nordic Musculoskeletal Questionnaire was filled in by 30,520 hospital workers in 37 hospitals selected randomly from among all public hospitals of Shandong, China. The 12-month prevalence of NSP lasting for at least 3 months and sick leave absence due to NSP among 29,547 public hospital workers was 15.6% and 11.4%, respectively, most frequently reported in tertiary hospital workers (27.4% and 18.9%) and clinicians (19.1% and 15.2%). Log-binomial regression analysis revealed that chronic NSP was significantly associated with hospital level, employment position, contract/temporary employment status (vs. permanent), workload (long work hours per week), ergonomic factors (bending the neck forward for long periods of time, twisting the neck for long periods of time) and computer-related factors (prolonged computer-using time daily, the keyboard too close to the edge of the desk).

Consequences of bariatric surgery on outcomes in rheumatic diseases

Obesity is associated with numerous comorbidities including some rheumatic conditions. Through adipose-derived inflammation, obesity has been shown to induce increased initiation, progression, and worse responses on outcomes of rheumatic diseases. Bariatric surgery is being increasingly used thanks to its positive effects on major comorbidities such as type 2 diabetes mellitus and hypertension. Consequently, surgically induced weight and adipose tissue losses might play a role in the course of rheumatic conditions. The present narrative literature review aims to provide rheumatologists with an update on both the positive and negative effects of bariatric surgery on the rheumatic outcomes reported in the literature. Current evidence seems to show improved outcomes in obese populations with rheumatic disorders after bariatric surgery. However, rigorous prospective controlled studies with long follow-up are needed. Bariatric procedures have deleterious effects on bone and are associated with an increased risk of fractures.

Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia

BACKGROUND

The purpose was to measure the prevalence and related risk factors of low back pain (LBP) among health care workers (HCWs) at different levels of health care in southwestern Saudi Arabia.

METHODS

A cross-sectional study using a self-administered questionnaire was conducted among HCWs providing primary, secondary and tertiary health care services in the Aseer region, southwestern Saudi Arabia. The questionnaire collected data regarding having LBP in the past 12 months, socio-demographics, work conditions and history of chronic diseases, regular physical exercise and overexertional back trauma. Univariate and multivariable logistic regression analyses were performed.

RESULTS

Out of 740 participants, the overall prevalence of LBP in the past 12 months amounted to73.9% (95% CI: 70.7-77.0). The prevalence of LBP with neurological symptoms reached 50.0%. The prevalence of LBP necessitating medications and or physiotherapy was 40.5%, while the prevalence of LBP requiring medical consultation was 20%. Using multivariable logistic regression, the following risk factors were identified: working in secondary and tertiary hospitals (aOR = 1.32, 95% CI:1.01-1.76), increased BMI (aOR = 1.10, 95% CI:1.01-3.65), and positive history of overexertional back trauma (aOR = 11.52, 95% CI:4.14-32.08). On the other hand, practising regular physical exercise was a significant protective factor (aOR = 0.61, 95% CI: 0.42-0.89).

CONCLUSIONS

LBP is a common problem among HCWs. Many preventable risk factors have been identified, including exertional back trauma, increased BMI and lack of regular physical exercise. Occupational health and safety programmes to build ergonomically safe working conditions and encourage regular physical exercise are needed.

Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regarding additional risk factors that further predispose this already high-risk patient population to poor surgical outcomes following elective posterior lumbar fusion (PLF). The aim of the study is to identify independent risk factors for poor 30-day perioperative outcomes in morbidly obese patients undergoing elective PLF.

METHODS

We identified 22 909 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective PLF. There were 1861 morbidly obese patients. Baseline patient demographics and medical comorbidities were collected. Univariate analysis was performed to compare perioperative complication rates between non-morbidly obese and morbidly obese patients. The 5 most common complications in the morbidly obese group were then selected for multivariate regression analysis to identify independent risk factors for poor 30-day outcomes.

RESULTS

Morbidly obese patients had a higher perioperative complication rate. The 5 most common complications were prolonged hospitalization, blood transfusion, readmission, wound complications, and reoperation. Independent risk factors for these complications were age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4 levels, and extended operative time (ie, operative time ≥318 minutes).

CONCLUSIONS

Morbidly obese patients are at higher risk of perioperative complications following elective PLF. Modifiable risk factors for the most common complications are obesity and preoperative steroid use.

Prevalence and factors associated with low back pain among nurses at a regional hospital in KwaZulu-Natal, South Africa

Background

Low back pain (LBP) is a public health problem worldwide and is a common cause of work-related disorder among workers, especially in the nursing profession. Recruitment and retention of nurses is a challenge, and the nursing shortage has been exacerbated by the burden of occupational injuries such as LBP and related disabilities. The physiotherapy clinical records revealed that caseload of nurses presenting for the management of LBP was increasing. The prevalence and factors associated with LBP were unclear.

Methods

A cross-sectional study design with an analytic component was implemented. Data were collected utilising a self-administered questionnaire to determine the prevalence and factors associated with LBP among nurses at a regional hospital. Bivariate analyses were performed to determine the factors associated with LBP.

Results

The point prevalence of current LBP in nurses was 59%. The highest prevalence was recorded among enrolled nurses (54%), respondents aged 30–39 (46%), overweight respondents (58%) and those working in obstetrics and gynaecology (49%). Bending (p = 0.002), prolonged position (p = 0.03) and transferring patients (p = 0.004) were strongly associated with LBP. Nurses with more than 20 years in the profession reported a high prevalence of LBP. The prevalence of LBP was higher among the participants who were on six-month rotations (76%) compared with those on yearly rotation (16%).

Conclusion

A high proportion of nurses reported to have LBP. Occupational factors are strongly associated with LBP. Education programmes on prevention and workplace interventions are required in order to reduce occupational injuries.

Obesity as a Risk Factor for Low Back Pain: A Meta-Analysis

STUDY DESIGN

A meta-analysis.

OBJECTIVE

To update the current knowledge about the association between overweight, obesity, and low back pain (LBP) risk, we conducted a meta-analysis of published cohort studies.

SUMMARY OF BACKGROUND DATA

The association between obesity and LBP risk has been the research focus in the past decade. However, available data from studies on the association between obesity and LBP remains debatable.

METHODS

An extensive English language literature retrieval regarding the association between overweight, obesity, and the risk of LBP incidence was conducted on PubMed and EMBASE databases through December 2015. Meta-analysis for all the included literature was performed by STATA 12.0 to summarize test performance with Forest plots after a heterogeneity test. Moreover, subgroup and sensitivity analyses were performed to examine the potential candidate-effect factors.

RESULTS

A total of 10 cohort studies including 29,748 subjects satisfied the predefined eligibility criteria. The pooled odds ratio (OR) for overweight and obesity compared with normal weight was 1.15 [95% confidence interval (CI), 1.08-1.21) and 1.36 (95% CI, 1.18-1.57), respectively. Moreover, subgroup analysis proved that increased body mass index was associated with an increased incidence of LBP in both men (overweight: pooled OR=1.16, 95% CI, 1.04-1.31; obesity: pooled OR=1.36, 95% CI, 1.15-1.61) and women (overweight: pooled OR=1.24, 95% CI, 1.04-1.50; obesity: pooled OR=1.40, 95% CI, 1.08-1.82). There was no evidence of publication bias.

CONCLUSIONS

Our findings consistently show that overweight and obesity are risk factors for LBP in men and women. Maintaining a healthy body weight may be one of the factors preventing the occurrence of LBP.

LEVEL OF EVIDENCE

Level 1.

Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study

Background

Although previous research suggests a relationship between chronic low back pain (cLBP) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals. The aim of this study therefore was to examine the relationship of regional and total body adiposity to pain and disability in cLBP individuals.

Methods

A preliminary explorative study design of seventy (n = 70) adult men and women with cLBP was employed. Anthropometric and adiposity measures were collected, including body mass index, waist-to-hip ratio, total body adiposity and specific ultrasound-based abdominal adiposity measurements. Self-reported pain and disability were measured using a Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) questionnaires respectively. Relationships between anthropometric and adiposity measures with pain and disability were assessed using correlation and regression analyses.

Results

Significant correlations between abdominal to lumbar adiposity ratio (A-L) variables and the waist-to-hip ratio with self-reported pain were observed. A-L variables were found to predict pain, with 9.1–30.5 % of the variance in pain across the three analysis models explained by these variables. No relationships between anthropometric or adiposity variables to self-reported disability were identified.

Conclusions

The findings of this study indicated that regional distribution of adiposity via the A-L is associated with cLBP, providing a rationale for future research on adiposity and cLBP.

Risk factors associated with chronic low back pain in Syria

BACKGROUND

We aimed to identify risk factors associated with chronic low back pain (C-LBP) in Syria.

MATERIALS AND METHODS

We conducted the study in a busy outpatient neurology clinic in Damascus city from October 2011 to August 2012. We enrolled all eligible adults presenting with C-LBP along with those who denied any back pain as a controls. We considered C-LBP any LBP lasting over 3 months. We developed our own questionnaire. A clinical nurse interviewed each person and filled in the results.

RESULTS

We had a total of 911 subjects; 513 patients and 398 controls. We found that C-LBP increased with age. Having a sibling with C-LBP was a strong predictor of C-LBP. In women obesity, but not overweight, was a risk factor. Number of children was a risk factor for mothers. Higher level of education decreased the chance of C-LBP in women. Sedentary job increased the risk of C-LBP.

CONCLUSION

This study sheds some light on risk factors for C-LBP in our population and might help find possible preventive measures.

A Comparison of Anthropometric Measures for Assessing the Association between Body Size and Risk of Chronic Low Back Pain: The HUNT Study

Background

Previous work indicates that overweight and obese individuals carry an increased risk of experiencing chronic low back pain (LBP). It is not known, however, how the association with body size depends on the choice of anthropometric measure used.

Objective

This work compares relationships with LBP for several measures of body size. Different results may indicate underlying mechanisms for the association between body size and risk of LBP.

Methods

In a cohort study, baseline information was collected in the community-based HUNT2 (1995–1997) and HUNT3 (2006–2008) surveys in Norway. Participants were 10,059 women and 8725 men aged 30–69 years without LBP, and 3883 women and 2662 men with LBP at baseline. Associations with LBP at end of follow-up were assessed by generalized linear modeling, with adjustment for potential confounders.

Results

Relationships between waist-hip-ratio and occurrence of LBP at end of follow-up were weak and non-significant after adjustment for age, education, work status, physical activity, smoking, lipid levels and blood pressure. Positive associations with LBP at end of follow-up were all significant for body weight, BMI, waist circumference and hip circumference after similar adjustment, both in women without and with LBP at baseline, and in men without LBP at baseline. After additional mutual adjustment for anthropometric measures, the magnitude of the association with body weight increased in women without LBP at baseline (RR: 1.130 per standard deviation, 95% CI: 0.995–1.284) and in men (RR: 1.124, 95% CI 0.976–1.294), with other measures showing weak associations only.

Conclusion

Central adiposity is unlikely to play a major role in the etiology of LBP. Total fat mass may be one common factor underlying the associations observed. The association with body weight remaining after mutual adjustment may reflect mechanical or structural components behind the relationship between overweight or obesity and LBP.

Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins

PURPOSE

To investigate the relationship between different measures of obesity and chronic low back pain (LBP) using a within-pair twin case-control design that adjusts for genetics and early shared environment.

METHODS

A cross-sectional association between lifetime prevalence of chronic LBP and different measures of obesity (body mass index-BMI; percent body fat; waist circumference; waist-hip ratio) was investigated in 1128 female twins in three stages: (i) total sample analysis; (ii) within-pair case-control analysis for monozygotic (MZ) and dizygotic (DZ) twins together; (iii) within-pair case-control analysis separated by DZ and MZ. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

BMI (OR 1.12; 95% CI 1.02-1.26) and percent body fat (OR 1.15; 95% CI 1.01-1.32) were weakly associated with lifetime prevalence of chronic LBP in the total sample analysis but were absent when shared environment and genetic factors were adjusted for using the within-pair case-control analysis. Greater waist-hip ratios were associated with smaller prevalence estimates of chronic LBP in the within-pair case-control analysis with both MZ and DZ twins (OR 0.67; 95% CI 0.47-0.94). However, this association did not remain after the full adjustment for genetic factors in the MZ within-pair case-control analysis.

CONCLUSIONS

BMI, percent of fat mass and greater depositions of fat and mass around the hips are associated with increases in chronic LBP prevalence in women but these associations are small and appear to be confounded by the effects of genetics and early shared environment. Therefore, our results do not support a causal direct relationship between obesity and chronic LBP.

Low back pain and obesity

Introduction:

Low back pain poses a significant problem in clinics and public health. It presents one of the main problems with adults, since 70-80% of adults experience it at least once in their lifetime. Causes of the low back pain are numerous and often unknown.

Objectives:

The aim of the study is to find the most prevalent age group, pain localisation, and the frequency of physical therapy sessions in obese and non-obese subjects with LBP.

Materials and Methods:

The study has been conducted by the Physical Rehabilitation Service of the Occupational Medicine Institute, during one year period. The total number of patients studied was 101 and all were Kosovo Energy Corporation (KEC) employees. The study was retrospective.

Results:

Looking at the body weight index, out of 101 patients, 69.3% are classified as non-obese and 30.7% as obese. Using T-Test we have found a difference of high statistical significance between the average number of the physical therapy sessions applied in relation to the examined groups (T-Test=2.78, P=0.0065, so, P<0.01).

Conclusion:

Obesity and age have no direct influence in back pain, but they could prolong healing. Professional occupation and binding position are factors that affect back pain. Physical workload can cause the manifestation of sciatica; whereas psycho-social factors can prolong the overall healing process.

Typing performance and body discomfort among overweight and obese office workers: A pilot study of keyboard modification

Obesity in the workplace is associated with loss of productivity, high medical care expenses, and increased rates of work-related injuries and illness. Thus, effective, low-cost interventions are needed to accommodate the size of today's obese office worker while alleviating potential physical harm associated with musculoskeletal disorders. Utilizing a sample of 22 overweight and obese office workers, this pilot study assessed the impact of introducing an alternative, more ergonomically-sound keyboard on perceptions about design, acceptability, and usability; self-reported body discomfort; and typing productivity. Data were collected using self-reported questionnaires and objective typing tests administered before and after the intervention. The intervention duration was six weeks. After switching from their standard work keyboard to an alternative keyboard, all participants reported significant decreases in lower back discomfort (t = 2.14, P = 0.044); although obese participants reported significant decreases in both upper (t = 2.46, P = 0.032) and lower (t = 2.39, P = 0.036) back discomfort. No significant changes were observed in overall typing performance scores from baseline to follow-up. Findings suggest that such interventions may be introduced into the workforce with positive gains for workers without reducing short-term worker productivity.

Clinical and radiological predictive factors to be related with the degree of lumbar back muscle degeneration: difference by gender

BACKGROUND

The prediction of lumbar back muscle degeneration is important because chronic low back pain and spino-pelvic imbalance have been known to be related to it. However, gender difference should be considered because there are different quality and volume of muscles between genders. The purpose of this study was to search for clinical and radiological factors to predict the degree of lumbar back muscle degeneration according to gender difference.

METHODS

We reviewed 112 patients (44 men and 68 women) with spinal stenosis who underwent a decompressive surgery between 1 January 2009 and 31 December 2011. Degrees of lumbar back muscle degeneration were classified into three categories by the fatty infiltration at each L3-4 disc level on the axial view of T1 magnetic resonance imaging (MRI). Age, sex, bone marrow density score, and body mass index (BMI) were obtained from chart reviews. Lumbar lordosis, sacral slope, pelvic tilt (PT), and pelvic incidence were calculated with lumbar spine standing lateral radiographs. The degrees of spinal stenosis and facet arthropathy were checked with MRI. Student t-test, chi-square test, or Fisher exact test were used to compare clinical and radiological parameters between genders. Analysis of variance (ANOVA) and linear regression analysis were used to search for a relationship between lumbar back muscle degeneration and possible predictive factors in each gender group.

RESULTS

Many clinical and radiological parameters were different according to gender. The age, BMI, and PT in the female group (p = 0.013, 0.001, and 0.019, respectively) and the PT in the men group (p = 0.018) were predictive factors to be correlated with lumbar back muscle degeneration.

CONCLUSIONS

The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only.

Does physical activity influence the relationship between low back pain and obesity?

BACKGROUND CONTEXT

Evidence supporting an association between obesity and low back pain (LBP) continues to grow; yet little is known about the cause and effect of this relationship. Even less is known about the mechanisms linking the two. Physical activity is a logical suspect, but no study has demonstrated its role.

PURPOSE

This study was designed to examine the interrelationship between physical activity, obesity, and LBP. The specific aims were to determine if obesity is a risk factor for LBP in the U.S. population, measure the strength of any observed association, and evaluate the role of physical activity in modulating this association.

STUDY DESIGN/SETTING

A cross-sectional U.S. population-based study.

PATIENT SAMPLE

A cohort of 6,796 adults from the 2003-2004 National Health and Nutrition Examination Survey.

OUTCOME MEASURES

Demographic information, an in-depth health questionnaire, physical examination details, and 7-day free-living physical activity monitoring using accelerometry (ActiGraph AM-7164; ActiGraph, Pensacola, FL, USA).

METHODS

LBP status was determined by questionnaire response. Body mass index (BMI) was calculated during physical examination and divided here into four groups (normal weight <25, overweight 25-30, obese 31-35, and ultraobese 36+). Summary measures of physical activity were computed based on intensity cutoffs, percentile intensities, and bout. Demographics, social history, and comorbid health conditions were used to build adjusted weighted logistic regression models constructed using Akaike Information Criterion. All displayed estimates are significant at level <.05. No external funding was received to support this study. None of the authors report conflicts of interest directly related to the specific subject matter of this manuscript.

RESULTS

In the U.S. population, the risk of low LBP increases in step with BMI from 2.9% for normal BMI (20-25) to 5.2% for overweight (26-30), 7.7% for obese (31-35), and 11.6% for ultraobese (36+). Smoking is consistently the strongest predictor of LBP across the BMI spectrum (odds ratio 1.6-2.9). Physical activity also modulates these risks. In the overall model, the best physical activity predictors of LBP are in the moderate and high intensity ranges with small effects (odds ratio 0.98 and 0.996 per standard deviation increase, respectively). When broken down by BMI, time spent in sedentary and moderate activity ranges demonstrate more robust influences on LBP status in the overweight, obese, and ultraobese groups.

CONCLUSIONS

Increased BMI is a risk factor for back pain in Americans. More important, the role of physical activity in mitigating back pain risk is shown to be of greater consequence in the overweight and obese populations.

No relationship between body mass index and changes in pain and disability after exercise rehabilitation for patients with mild to moderate chronic low back pain

STUDY DESIGN

A retrospective multicenter study.

OBJECTIVE

To investigate the relationship between body mass index (BMI) and changes in pain and disability resulting from exercise-based chronic low back pain (cLBP) treatment.

SUMMARY OF BACKGROUND DATA

Past research has shown evidence of a relationship between BMI, a measurement of obesity, and cLBP. Exercise is a known beneficial treatment for cLBP. However, it is unclear if exercise-induced changes in pain and disability are related to baseline levels of, or changes in, BMI.

METHODS

One hundred and twenty-eight (n = 128) males and females with cLBP performed 8 weeks of exercise, consisting of 3 to 5 exercise sessions (minimum of 1 supervised session) per week. Outcome measures included BMI and self-reported pain and disability. BMI was calculated as weight divided by height squared (kg/m). Pain was measured using the visual analogue scale and disability was measured using the Oswestry Disability Index. Correlation, regression, covariance and likelihood ratios analyses were used to examine the relationship between BMI and self-reported pain and disability changes.

RESULTS

No baseline relationships between BMI and self-reported pain (r = -0.083, P = 0.349) and disability (r = 0.090, P = 0.314) were observed. There was no relationship observed between baseline BMI (P = 0.938, P = 0.873), or changes in BMI (P = 0.402, P = 0.854), with exercise-related changes in pain and disability, respectively. No relationships between baseline BMI or BMI changes with pain and disability at baseline or after exercise were observed on the basis of pain and disability subgroups. BMI was not a predictor of exercise-based pain and disability changes.

CONCLUSION

There was no significant relationship between BMI and self-reported pain and disability in cLBP participants. BMI was not a predictor of exercise-induced changes in pain and disability. The reliance on BMI as a sole measurement of obesity in cLBP research may be unwarranted.

Prevalence of low back pain and associated risk factors amongst adult patients presenting to a Nigerian family practice clinic, a hospital-based study

Background

Low back pain (LBP) is a common health problem with concomitant disability which has assumed a public health importance in our setting.

Objectives

The aim of this study was to determine the prevalence of LBP and associated risk factors amongst adult patients attending the General Outpatients’ Clinic of the University College Hospital in Ibadan, Nigeria.

Method

This was a cross-sectional study of 485 respondents. A semi-structured questionnaire was used to obtain information on socio-demography, lifestyle, occupation and other risk factors associated with LBP.

Results

There were 288 (59.4%) female and 197 (40.6%) male respondents. The point prevalence of LBP was 46.8%. Occupational activities, previous back injury and tobacco smoking were significant associated factors for the total population. For the female respondents, logistic regression analysis showed that a waist circumference of 88 cm or more, dysmenorrhea, previous back injury and being engaged in an occupation were the most significant factors associated with LBP. However, previous back injury was the most significant factor associated with LBP for the male respondents.

Conclusion

The prevalence of LBP amongst adult patients in our setting is high, with preventable and treatable predisposing factors. Public health efforts should be directed at educating people on occupational activities and lifestyle habits.

Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register

STUDY DESIGN

A cohort study based on the Swedish Spine Register.

OBJECTIVE

To determine the association between body mass index (BMI) and outcome of lumbar spine surgery for spinal stenosis.

SUMMARY OF BACKGROUND DATA

Several small studies have sought to evaluate the importance of obesity in relation to results after surgery for lumbar spinal stenosis (LSS), but the findings are inconsistent and relatively weak.

METHODS

All patients who underwent surgery for LSS from January 1, 2006, to June 30, 2008, with a completed 2-year follow-up in the Swedish Spine Register were included. Logistic regression was used to assess the association between BMI and different outcomes.

RESULTS

Of the 2633 patients enrolled, 819 (31%) had normal weight, 1208 (46%) were overweight, and 606 (23%) were obese. On average, all 3 BMI groups achieved significant improvements after surgery. A higher BMI, however, was associated with greater odds of dissatisfaction after surgery and inferior results at the 2-year follow-up. After adjusting for differences in baseline characteristics, the obese group demonstrated inferior function and quality of life as measured by the Oswestry Disability Index (ODI) and the EuroQol Group Index (EQ-5D), respectively. At the 2-year follow-up, obese patients had a mean ODI of 33 (95% confidence interval [CI], 31-34) and mean EQ-5D of 0.56 (95% CI, 0.54-0.59) compared with a mean ODI of 25 (95% CI, 24-26) and mean EQ-5D of 0.64 (95% CI, 0.62-0.66) in the normal weight group. When compared with the normal weight patients, the adjusted odds ratio for dissatisfaction was 1.73 in the obese group (95% CI, 1.36-2.19). Differences between the normal weight and overweight groups were modest and therefore could not be considered clinically relevant.

CONCLUSION

Obese patients achieved significant pain reduction, better walking ability, and improved quality of life after surgical treatment of LSS. Nevertheless, obesity was associated with a higher degree of dissatisfaction and poorer outcomes after surgery for LSS.

The influence of excess body mass on adult gait

BACKGROUND

This study aimed to assess the presentation of gait for adults who are overweight, independent of the confounding influence of velocity.

METHODS

Cross sectional study design. Twenty-five adults of a healthy weight were matched by age, gender, height and velocity to twenty-five adults who were overweight. Participants traversed a 10m walkway embedded with 2 AMTI force platforms (AMTI BP400600 Force Platforms: Advanced Mechanical Technologies, Inc., Watertown, MA, USA) and running between 2 CODA Dual CX1 sensors (CODA CX1: Charnwood Dynamics, Barrow on Soar, Leicestershire, England). Temporal-spatial parameters, maximum ground reaction forces, maximum joint powers, and three dimensional kinematic and kinetic parameters at the 7 events of the gait cycle were assessed.

FINDINGS

With velocity accounted for, relatively few changes in the presentation of gait were seen for adults who were overweight. Alterations included increased stance phase duration, hip flexion, knee flexion, hip abduction, and knee varus for overweight adults. A reduction in hip abductor moment normalised for body mass was noted for overweight adults. Absolute maximum ground reaction forces were increased while maximum hip power absorption was reduced for overweight adults.

INTERPRETATION

Changes were seen at the hip and knee during the swing phase of gait. During swing there is a stronger association with soft tissue injury as compared to joint injury. Overweight individuals were seen to adopt few alterations during the stance phase to accommodate for the increased absolute ground reaction forces. As a result the joint surfaces of overweight adults are exposed to increased loading.

Skew-symmetric Random Effect Models with Application to a Preventive Cohort Study: Improving Outcomes in Low Back Pain Patients

BACKGROUND

To investigate the respective contribution of various biologic and psychosocial factors, especially Health Related Quality of Life (HRQOL) as a main outcome, in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL.

METHODS

In a prospective cohort study For 24 weeks, 150 patients were assessed at an outpatient clinic in Korea consulting for low back and confirmed disc herniation duration at inclusion and treated with treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back intensity levels were measured on a visual analog scale (0-10), back function was evaluated with the Oswestry Disability Index (0-100), disability assessed by HRQOL assessed by the short form 36 health survey (0-100 in 8 different sub-categories).

RESULTS

Out of 150 patients, 128 completed the 24 weeks of traditional therapy. Patients reported improvements SF-36 outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI = 2.8 to 3.8). According to the results of our modeling, low back intensity level, back function and BMI measures had significant effects on quality of life during study. Interpreting the coefficients of modeling, the impact of the decreasing acute LBP episode on HRQOL by VAS and ODI outcomes, was high and important.

CONCLUSIONS

This study highlights the large contribution of integrative package therapy as an effective preventive method for improving LBP patient's HRQOL.

Duration of fluoroscopic-guided spine interventions and radiation exposure is increased in overweight patients

BACKGROUND

The impact of patient body mass index (BMI) on image-guided spine interventions remains unknown. Higher BMI is known to complicate the acquisition of radiographic images. Therefore it can be hypothesized that the patient's body habitus can influence the delivery of a spinal injection.

OBJECTIVE

To quantify the impact of patient BMI on the length of fluoroscopy and procedure times during spine interventions.

DESIGN

Secondary analysis of 2 prospective observational studies.

SETTING

All injections were performed in an outpatient university setting.

PARTICIPANTS

A total of 209 patients in whom spine injections were performed (99 women), with a mean age of 54.6 years.

METHODS

The fluoroscopy times for 202 participants and total procedure times for 137 participants were recorded. Additional participant characteristics, including age, gender, BMI, and actual procedures performed, also were collected. Analysis of covariance and linear and nonlinear model analysis were performed to assess the effect of BMI on fluoroscopy and procedure times.

MAIN OUTCOME MEASUREMENTS

Fluoroscopy time and procedure duration times.

RESULTS

Participants had a mean age of 54.6 years, 51% were men, and 77% (n = 155) were overweight (BMI ≥25). Participants received the following interventions: 40 zygapophyseal joint injections, 33 medial branch nerve blocks, 113 transforaminal epidural injections, and 16 combined zygapophyseal joint injections and epidural injections. Gender, procedure number, and procedure type did not differ between groups. The overweight group demonstrated a 30% increase in mean fluoroscopy time and a 35% increase in mean procedure time. Controlling for other variables, we found that differences in fluoroscopy time and procedure time were significant (P = .032 and P = .031, respectively) between the 2 groups.

CONCLUSIONS

Significantly prolonged procedure time and fluoroscopy time in overweight patients increase the risks associated with spine interventions, not only to the patients but also to the operating room staff exposed to ionizing radiation.

Prognostic factors of prolonged disability in patients with chronic low back pain and lumbar degeneration in primary care: a cohort study

STUDY DESIGN

A cohort study with 1-year follow-up.

OBJECTIVE

To identify prognostic factors in patients with chronic nonspecific low back pain (LBP).

SUMMARY OF BACKGROUND DATA

The factors (e.g., sociodemographical, low back-related, radiological, and biological) associated with persistent pain and disability for patients with chronic nonspecific LBP are uncertain. Furthermore, sparse information exists about the relationship between biological factors like impaired fasting glucose tolerance and chronic nonspecific LBP.

METHODS

The participants consisted of 250 patients with nonspecific LBP of more than 6 months duration and degenerative lumbar osteoarthritis. The patients were originally recruited for a randomized controlled trial from the clinics of general practitioners, physiotherapists, and chiropractors. Potential predictors were evaluated at baseline. The outcome was absolute level of pain-related disability (Roland-Morris Disability Questionnaire [RMDQ]) at 1 year. The association between potential prognostic factors and the outcome was analyzed with multivariate linear backward regression.

RESULTS

At baseline and 1 year, the RMDQ scores were 9.5 and 5.1 points, respectively. Mean (SD) baseline values for body mass index (BMI), EuroQol (EQ)-index, EQ-visual analogue scale were 25.4 (4.3), 0.60 (0.3), and 61.2 (20.8), respectively. Higher pain-related disability levels (1-year RMDQ score) were associated with 6.1 mmol/L or more fasting glucose level at baseline (β, 3.7; 95% confidence interval [CI], 1.2-6.1; P = 0.00), baseline pain-related disability (β 0.2; 95% CI, 0.1-0.4; P = 0.00), BMI (β, 0.2; 95% CI, 0.1-0.3; P < 0.03), EQ-index (β, -4.5; 95% CI, 6.9 to 2.1; P = 0.00), and EQ-visual analogue scale (β, 0.3; 95% CI, -0.6 to -0.0; P = 0.03). However, a limited number of patients had 6.1 mmol/L or more of fasting glucose level at baseline (13/250 patients). The imaging findings, modic changes, and high intensity zones had no predictive ability.

CONCLUSION

Increased pain-related disability at 1 year was seen in patients with impaired fasting glucose tolerance, greater pain-related disability, higher BMI, and lower quality of life at baseline.

"The more pain I have, the more I want to eat": obesity in the context of chronic pain

Providers frequently report pain as a barrier to weight loss, and initial evidence suggests individuals with chronic pain and obesity experience reduced treatment success. However, scant evidence informs our understanding of how this comorbidity negatively influences treatment outcome. More effective programs might be designed with (i) insight into the patient's experience of comorbid chronic pain and obesity and (ii) improved understanding of the behavioral linkages between the experience of pain, engagement in health behaviors, and obesity treatment outcomes. Thirty adult primary care patients with mean BMI = 36.8 (SD 8.9) and average 0-10 pain intensity = 5.6 (SD 1.9) participated in semistructured, in-depth interviews. Transcriptions were analyzed using the constant comparative method. Five themes emerged indicating that patients with comorbid chronic pain and obesity experience: depression as magnifying the comorbid physical symptoms and complicating treatment; hedonic hunger triggered by physical pain and associated with depression and shame; emotional or "binge" eating in response to pain; altered dietary choices in response to pain; and low self-efficacy for physical activity due to pain. Individuals with chronic pain and obesity may be less responsive to traditional interventions that fail to address the symbiotic relationship between the two conditions. These individuals are at-risk for depressive symptoms and eating and activity patterns that sustain the comorbidity and make treatment problematic, and they may respond to pain with behaviors that promote weight gain, poor health and low mood. Further research is needed to examine behavioral mechanisms that promote comorbid pain and obesity, and to develop targeted treatment modules.

The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load?

Background

Low back pain (LBP) represents a major socioeconomic burden for the Western societies. Both life-style and work-related factors may cause low back pain. Prospective cohort studies assessing risk factors among individuals without prior history of low back pain are lacking. This aim of this study was to determine risk factors for developing low back pain (LBP) among health care workers.

Methods

Prospective cohort study with 2,235 newly educated female health care workers without prior history of LBP. Risk factors and incidence of LBP were assessed at one and two years after graduation.

Results

Multinomial logistic regression analyses adjusted for age, smoking, and psychosocial factors showed that workers with high physical work load had higher risk for developing LBP than workers with low physical work load (OR 1.8; 95% CI 1.1–2.8). In contrast, workers with high BMI were not at a higher risk for developing LBP than workers with a normal BMI.

Conclusion

Preventive initiatives for LBP among health care workers ought to focus on reducing high physical work loads rather than lowering excessive body weight.

Differences in comorbidities on low back pain and low back related leg pain

OBJECTIVE

Investigate the influence of external factors such as depression and BMI among subjects with primary severe low back pain (LBP) and low back related leg pain (LBLP).

BACKGROUND

The report of disability in patients with LBP may be significantly influenced by confounding and moderating variables. No similar studies have examined the influence of these factors on LBLP.

METHODS

This study included 1,448 consecutive subjects referred to a tertiary spine clinic. Unconditional binary logistic regression was used to determine the influence of comorbidities on the relationship between self-reported back and leg pain. A change in estimate formula was used to quantify this relationship.

RESULTS

Among those subjects with primary LBP the unadjusted odds ratio was 8.58 (95% CI 4.87, 15.10) and when adjusting for BMI, depression and smoking was 5.94 (95% CI 3.04, 11.60) resulting in a 36.7% change due to confounding by these comorbidities. Among those with primary LBLP, the unadjusted odds ratio was 4.49 (95% CI 2.78, 7.27) and when adjusting for BMI and depression was 4.60 (95% CI 2.58, 8.19) resulting in a 1.7% change due to confounding by these comorbidities.

CONCLUSION

The disability statuses of the patients with primary LBP in this study were more significantly affected by comorbidities of BMI, depression and smoking than patients with report of LBLP. However, these comorbidities contribute little to the relationship of primary low back related leg pain and Oswestry scores ≥ 40.

The impact of lumbar scoliosis on pain, function and health-related quality of life in postmenopausal women

The impact of adult scoliosis on pain, function and health-related quality of life (QOL) has not been clearly defined. A population-based study using widely applied screening tools could better reflect the impact of adult scoliosis. In this study, a visual analog pain scale assessment (VAS) for lumbar and leg pain, an Oswestry disability index (ODI) and a standard version of the Medical Outcome Study Short Form-36 (SF-36) questionnaire were sent by mail to 261 women of age 50 years and older, consecutively evaluated with dual-energy radiograph absorptiometry (DXA) scan images. 138 patients (32 with lumbar curves 10° or bigger) returned the questionnaires. Differences in lumbar VAS, leg VAS, ODI and SF-36 values between groups of patients with curves <10°, 10°-19° and ≥20° were evaluated. Correlation analyses of the Cobb angle, age and body mass index (BMI) with VAS, ODI and SF-36 values, and multivariate regression analysis were performed. Patients with curves <10°, 10°-19° and ≥20° had no significant differences in lumbar or leg VAS, ODI or SF-36 values. ODI values correlated with age and BMI; SF-36 values correlated with BMI only; lumbar and leg VAS values did not correlate with lumbar curvature, age or BMI. Regression disclosed that Cobb angle values did not influence ODI, SF-36 or VAS values. In postmenopausal women with mild and moderate lumbar curves, Cobb angle had no influence on pain, function and QOL; age and BMI had small effect.

PDA+: A Personal Digital Assistant for Obesity Treatment - an RCT testing the use of technology to enhance weight loss treatment for veterans

BACKGROUND

Obese adults struggle to make the changes necessary to achieve even modest weight loss, though a decrease in weight by as little as 10% can have significant health benefits. Failure to meet weight loss goals may in part be associated with barriers to obesity treatment. Wide-spread dissemination of evidence-based obesity treatment faces multiple challenges including cost, access, and implementing the programmatic characteristics on a large scale.

AIMS

The PDA+: A Personal Digital Assistant for Obesity Treatment randomized controlled trial (RCT) was designed to test whether a PDA-based behavioral intervention enhances the effectiveness of the existing group weight loss treatment program at VA Medical Centers Managing Overweight/Obese Veterans Everywhere (MOVE!). We also aim to introduce technology as a way to overcome systemic barriers of traditional obesity treatment.

METHODS/DESIGN

Veterans enrolled in the MOVE! group at the Hines Hospital VAMC with BMI ≥ 25 and ≤ 40 and weigh < 400 pounds, experience chronic pain (≥ 4 on the NRS-I scale for ≥ 6 months prior to enrollment) and are able to participate in a moderate intensity exercise program will be recruited and screened for eligibility. Participants will be randomized to receive either: a) MOVE! treatment alone (Standard Care) or b) Standard Care plus PDA (PDA+). Those randomized to PDA+ will record dietary intake, physical activity, and weight on the PDA. In addition, they will also record mood and pain intensity, and receive biweekly telephone support for the first 6-months of the 12-month study. All participants will attend in-person lab sessions every three months to complete questionnaires and for the collection of anthropomorphic data. Weight loss and decrease in pain level intensity are the primary outcomes.

DISCUSSION

The PDA+ trial represents an important step in understanding ways to improve the use of technology in obesity treatment. The trial will address barriers to obesity care by implementing effective behavioral components of a weight loss intervention and delivering high intensity, low cost obesity treatment. This RCT also tests an intervention approach supported by handheld technology in a population traditionally considered to have lower levels of technology literacy.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00371462.

History of spine surgery in older obese patients

GOAL

To study the interaction of obesity and age in patients with multiple spine surgeries.

METHODS

Data on the body mass index (BMI) of 956 patients were collected and classified into four groups: non-obese (BMI <30 kg/m(2)), obese-class I (BMI ≥30 kg/m(2)), obese-class II (BMI ≥35 kg/m(2)) and obese-class III (BMI ≥40 kg/m(2)). Patients' age was categorized into the following age groups: ≤40, 41-65 and ≥66. T-test and Chi-square test were applied using SPSS v16.

RESULTS

In lumbar patients aged ≥66 years with previous spine surgery, the average number of previous spine surgeries significantly increased with increasing obesity from 1.4 in nonobese patients to 1.7, 2.5 and 3.5 in obese class I, II and III patients. In lumbar decompression and fusion patients aged ≥66 years with previous spine surgery, the average number of previous spine surgeries significantly increased with increasing obesity from 1.7 in nonobese patients to 1.6, 2.0 and 3.5 in obese class I, II and III patients. A similar trend was noted in lumbar microdiskectomy patients aged ≥66 years but it was statistically nonsignificant due probably to small numbers.

CONCLUSION

Obesity is associated with an increased number of previous spine surgeries in patients over 65 years of age undergoing lumbar surgery.

Evidence and practice in the self-management of low back pain: findings from an Australian internet-based survey

OBJECTIVES

Low back pain (LBP) is common, but sufferers pursue a range of management options and only some seek professional advice. This study examines how Australian consumers report that they manage LBP, with emphasis on the extent to which their practices match clinical recommendations and guidelines.

METHODS

A self-reported cross-sectional online survey comprising 29 questions in English (see Supplemental Digital Content 1, http://links.lww.com/CJP/A13) was conducted in February 2009. The internet-based survey sample was matched with national population proportions; 1220 respondents were screened and 1001 met the inclusion criteria (age >18 y and having suffered from back pain in the previous 6 mo).

RESULTS

A total of 570 (57%) participants had experienced LBP, of whom half (307; 54%) sought healthcare advice. Although 126 (41%) respondents reported receiving advice to exercise or stretch, only 107 (19%) reported that their initial response was to follow this advice. One-third maintained normal activity levels and 15% took bed rest, mostly for less than 1 day. A large proportion of respondents were overweight or obese (391, 68%); only 8% were active currently undertaking a weight loss regime. Taking analgesic medication was the most common initial action to LBP (449, 78% respondents); paracetamol was the predominant choice. Under-dosing was evident among users of over-the-counter analgesics.

CONCLUSIONS

The self-care choices that some people with LBP are making are not in line with the current evidence-based guidelines. This may lead to delayed recovery and the risk of medication-related problems. The provision of education about the nonpharmacologic management options for LBP, optimal information about appropriate medicines choices, and about medication contraindications is essential.

The impact of body mass index on the prevalence of low back pain: the HUNT study

STUDY DESIGN

A cross-sectional population-based study.

OBJECTIVE

To examine the association between body mass index and chronic low back pain, with adjustment for potential confounders.

SUMMARY OF BACKGROUND DATA

Although many studies have investigated this association, it is still unclear whether there is a general relationship between body mass index and low back pain which applies to all populations.

METHODS

This study is based on data collected in the HUNT 2 study in the county of Nord-Trøndelag in Norway between 1995 and 1997. Among a total of 92,936 persons eligible for participation, 30,102 men and 33,866 women gave information on body mass index and indicated whether they suffered from chronic low back pain (69% participation rate). A total of 6293 men (20.9%) and 8923 women (26.3%) experienced chronic low back pain. Relations were assessed by logistic regression of low back pain with respect to body mass index and other variables.

RESULTS

In both sexes, a high body mass index was significantly associated with an increased prevalence of low back pain. In men the estimated OR per 5 kg/m increase in body mass index was 1.07 (95% CI: 1.03-1.12) and in women 1.17 (95% CI: 1.14-1.21), after adjustment for age, with a significantly stronger association in women. Additional adjustment for education, smoking status, leisure time physical activity, employment status, and activity at work hardly affected these associations. No interactions were found with most other factors.

CONCLUSION

This large population-based study indicates that obesity is associated with a high prevalence of low back pain. Further studies are needed to determine if the association is causal.

Effect of obesity and low back pain on spinal mobility: a cross sectional study in women

BACKGROUND

obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific chronic low back pain (cLBP). However, the relationship between obesity and cLBP remains to date unsupported by an objective measurement of the mechanical behaviour of the spine and its morphology in obese subjects. Such analysis may provide a deeper understanding of the relationships between function and the onset of clinical symptoms.

PURPOSE

to objectively assess the posture and function of the spine during standing, flexion and lateral bending in obese subjects with and without cLBP and to investigate the role of obesity in cLBP.

STUDY DESIGN

Cross-sectional study

PATIENT SAMPLE

thirteen obese subjects, thirteen obese subjects with cLBP, and eleven healthy subjects were enrolled in this study.

OUTCOME MEASURES

we evaluated the outcome in terms of angles at the initial standing position (START) and at maximum forward flexion (MAX). The range of motion (ROM) between START and MAX was also computed.

METHODS

we studied forward flexion and lateral bending of the spine using an optoelectronic system and passive retroreflective markers applied on the trunk. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.

RESULTS

obesity was characterized by a generally reduced ROM of the spine, due to a reduced mobility at both pelvic and thoracic level; a static postural adaptation with an increased anterior pelvic tilt. Obesity with cLBP is associated with an increased lumbar lordosis.In lateral bending, obesity with cLBP is associated with a reduced ROM of the lumbar and thoracic spine, whereas obesity on its own appears to affect only the thoracic curve.

CONCLUSIONS

obese individuals with cLBP showed higher degree of spinal impairment when compared to those without cLBP. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis.

The association between obesity and low back pain: a meta-analysis

This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.

The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain

Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p<0.01), but no significant difference was found between the two groups (p>0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP.

Factors predicting dropout in student nursing assistants

BACKGROUND

The dropout rate among student nursing assistants (NAs) in Danish health and social care education is high at >20%.

AIMS

To explore if recent low back pain (LBP) history is a predictor of dropout among NA students, taking into account conventional risk factors for LBP, general health and physical fitness.

METHODS

Prospective study with 14-month follow-up (the duration of the education) in two schools of health and social care in the Region of Copenhagen, Denmark. Participants completed a comprehensive questionnaire, and their physical fitness (balance, back extension endurance, back flexion endurance and sagittal flexibility) was assessed at baseline. Dropout was defined as failure to complete NA education.

RESULTS

A total of 790 subjects, 87% of those invited, completed the questionnaire; 612 subjects also completed the physical tests and were included in the present study and 500 (83%) were women. Recent LBP was not an independent predictor of school dropout. However, only among women who had LBP were other factors (a history of previous exposure to heavy physical workload, a low mental health score and failure to pass the back extension endurance test) associated with risk of dropout, OR (95% CI)=2.5 (1.2-5.3). Among men, only low height was significantly associated with dropout risk.

CONCLUSIONS

A recent LBP history was not an independent single predictor of dropout from NA education but was a risk factor in combination with other factors.

Common injuries in athletes with obesity and diabetes

Musculoskeletal injuries and diseases are common in persons with obesity and diabetes mellitus. High body mass index is associated with an increased risk for musculoskeletal injuries, diseases, and disability. There is a significant positive correlation between the level of obesity and musculoskeletal injuries, and disability and health-related costs. The prevalence of obesity and diabetes is inversely proportional to health-related quality of life.

IMPACT OF BODY HABITUS ON PERIOPERATIVE MORBIDITY ASSOCIATED WITH FUSION OF THE THORACOLUMBAR AND LUMBAR SPINE

OBJECTIVE

Spinal fusion is performed in patients ranging from young and healthy to aged and frail. Although recent population trends in the United States are toward obesity, no large-scale study has evaluated how body habitus affects mortality, complications, and resource utilization for lumbar spine fusion. Such information is important for patient selection and to confirm the safety of such procedures in this population.

METHODS

Data for 244 170 patients who underwent thoracolumbar or lumbar spine fusion for degenerative disease between 1988 and 2004 were collected from the Nationwide Inpatient Sample database, and subjects were grouped by surgical approach and body habitus. Multivariate logistic regression evaluated group effects on selected postoperative complications, length of stay, resource utilization, and discharge disposition.

RESULTS

This study confirms that body habitus affects perioperative morbidity sustained by patients undergoing thoracolumbar or lumbar spine fusion. Demographic heterogeneity exists for race, geography, and number of diseased levels among body habitus groups, prompting application of multivariate logistic regression for outcomes. For all approaches, higher body mass index associated with increased transfusion requirements and likelihood of discharge to assisted living. Furthermore, morbidly obese patients undergoing posterior fusion sustained more wound complications and postoperative infections.

CONCLUSION

This nationwide study describes inpatient complications encountered during fusion surgery in patients who are obese. For a given surgical approach, patients with higher body mass index sustain increased transfusion requirements and utilize more resources during thoracolumbar and lumbar spine fusion. Nevertheless, the findings of equivalent mortality, length of stay, and other complication rates suggest that patients who are obese remain safe surgical candidates.

Tubular microsurgery for lumbar discectomies and laminectomies in obese patients: operative results and outcome

STUDY DESIGN

This is a retrospective single-center case study involving 115 obese and nonobese patients who underwent minimally invasive lumbar surgery between 2004 and 2007.

OBJECTIVE

The purpose of this study was to evaluate the effect of minimally invasive spinal surgery in obese and nonobese patients by operative results and patient outcomes.

SUMMARY OF BACKGROUND DATA

Spinal surgery in obese patients is associated with increased complications, blood loss, and operative times. The potential benefits of minimally invasive lumbar surgery in obese patients are discussed.

METHODS

All patients underwent 1-level lumbar microdiscectomy or laminectomy using tubular retractors. Data were collected on patient demographics, comorbidities, smoking habits, operative results, and clinical outcomes, and compared for obese and nonobese patients. Operative results included operative times, blood loss, length of stay, and perioperative complications. Clinical outcomes were assessed by using pre- and postoperative visual analog scale and Macnab outcome criteria at most recent follow-up.

RESULTS

In this study, 31% of 115 patients were classified as obese. Obese patients tended to undergo surgery at a younger age. Obesity, comorbidities, and age did not have an impact on patient outcome at a mean follow-up of 15.9 months. No significant differences were seen between obese versus nonobese patients in terms of incision lengths, operative time, blood loss, and complication rates. In obese patients, all parameters and operative results compared favorably to reported historical results of patients undergoing open lumbar surgery. Overall, favorable outcome was seen in 92% and 84% of obese and nonobese lumbar microdiscectomy patients, respectively, and in 75% of laminectomy patients. Postoperative visual analog scale did not show any significant difference.

CONCLUSION

This is the first study comparing operative results from tubular microsurgery between obese and nonobese patients. No major differences were detected in outcome, operative and perioperative data including complication rates. With tubular microsurgery, obese patients experienced the same or equally beneficial outcome, compared to nonobese patients, while incision lengths, blood loss, operative times, and length of stay were less when compared to open procedures. Other comorbidities and age had no significant impact on perioperative complications and clinical outcome.