Measuring the impact of chronic low back pain on everyday functioning: content validity of the Roland Morris disability questionnaire

Prevalence of Lower Back Pain in Portuguese Equestrian Riders

Lower back pain is prevalent in equestrian athletes, but its prevalence and associated factors are unknown in the Portuguese equestrian population. A questionnaire regarding lower back pain and possible associated factors was answered by 347 respondents. Of the respondents, 214 (61.7%) stated having experienced lower back pain in the past 12 months and therefore completed the Roland Morris disability questionnaire. Among the latter, 63.1% stated that lower back pain impaired their performance. The probability of suffering from lower back pain was higher in individuals with higher weekly riding workloads, who reported equestrianism as their main occupation, and who performed daily stable duties. Considering a Roland Morris disability score of 4 as the cut-off value for dysfunction, this sample had an average score of 5.39 ± 4.42. Individuals who stated equestrianism was their main occupation showed a significantly higher risk (OR = 1.759, p = 0.041) of exhibiting a score ≥ 4 than those who stated equestrianism as a hobby. Age (p = 0.029), body mass index (p = 0.047), and daily performance of stable duties (p = 0.030) were also associated with a higher Roland Morris disability score. Further research is needed to understand the full impacts of lower back pain in Portuguese equestrian athletes.

Effects of a Mat Pilates Exercise Program Associated with Photobiomodulation Therapy in Patients with Chronic Nonspecific Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Trial

OBJECTIVE

To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP).

METHODS

Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]).

RESULTS

Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores.

CONCLUSION

The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance.

Prevalence and Risk Factors Associated with Chronic Occupational Low Back Pain among Healthcare Professionals Working at Hospitals: Exploratory Survey Study

Objective  This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method  An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results  Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion  We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

How Well Do Seven Self-Report Measures Represent Underlying Back Pain Impact?

BACKGROUND

The extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others.

AIMS

To determine if different self-report back pain impact measures represent an underlying pain latent variable and estimate associations with it.

METHOD

Seven pain impact measures completed by Amazon Mechanical Turk adults are used to estimate internal consistency reliability and associations: Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), short form of the Örebro Musculoskeletal Pain Questionnaire (OMPQ), Subgroups for Targeted Treatment (STarT) Back Tool, the Graded Chronic Pain Scale (GCPS) disability score, PEG (Pain intensity, interference with Enjoyment of life, interference with General activity), and Impact Stratification Score (ISS).

RESULTS

The sample of 1,874 adults with back pain had an average age of 41 and 52% were female. Sixteen percent were Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White. Internal consistency reliability estimates ranged from 0.710 (OMPQ) to 0.923 (GCPS). Correlations among the measures ranged from 0.609 (RMDQ with OMPQ) to 0.812 (PEG with GCPS). Standardized factor loadings on the pain latent variable ranged from 0.782 (RMDQ) to 0.870 (ISS).

CONCLUSIONS

Scores of each measure can be estimated from the others for use in research.

Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial

BACKGROUND

Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied.

AIM

To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP.

METHODS

Sixty-three women (≥ 65 years) with chronic NSLBP were randomly assigned to intervention (IG) or control (CG) groups. IG received individualized mat-Pilates sessions (45 min, twice weekly), while CG followed a home-based general exercise program. Primary outcomes included visual analog scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), timed up-and-go (TUG), and Berg Balance Scale (BBS) at baseline, 10 weeks, and 6 months post-intervention. Repeated measures multivariate analysis of covariance (MANCOVA) was used, adjusted for exercise adherence and analgesic use.

RESULTS

IG significantly improved in VAS and RMDQ scores at 10 weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up.

CONCLUSIONS

A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed.

TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION

NCT04752579/February 12, 2021.

Efficacy of stepped care treatment for chronic discogenic low back pain patients with Modic I and II changes

Objective

This study investigated whether patients with Modic changes (MC) of types I, I/II, and II would respond to an anti-inflammatory-based, stepped care treatment with three treatment steps: first, oral administration of NSAIDs, 2 × 200 mg celecoxib daily for two weeks; second, an intradiscal steroid injection (ID) with dexamethasone and cefazolin; and third, oral treatment with antibiotics (AB), 3 × 1 g amoxicillin daily for 100 days.

Design

This was an observational clinical study based on analyses of categorical data of patient-reported outcome measurements.

Subjects

Subjects were consecutive patients with chronic low back pain (CLBP), diagnosed by assessment of anamnestic signs of inflammation; a pain score ≥6 on the Numeric Pain Rating Scale (NPRS); a mechanical assessment; MC I, I/II, or II based on MRI; and lack of response to conservative treatment.

Methods

From January 1, 2015, to December 31, 2021, 833 eligible patients were selected for the stepped care treatment. A total of 332 patients completed requested follow-up questionnaires at baseline and 12 months (optional at 3 and 6 months). Primary outcomes were pain (at least 50 % pain relief) and/or a minimum of 40 % improvement in functionality as measured by the Roland Morris Disability Questionnaire (RMDQ) or the Oswestry Disability Questionnaire (ODI). Secondary outcome measures were use of pain medication and return to work.

Results

At 1 year of follow-up, 179 (53.6 %) of 332 patients reported improvement according to the responder criteria. Of the 138 patients that had received only NSAIDs, 88 (63.8 %) had improved. In addition, 50 (56.8 %) of the 183 patients that had received ID had improved, and 41 (38.7 %) of the 106 patients treated with AB had improved. None of the patients reported complications. 12.0 % of patients using AB stopped preterm due to undesirable side effects.

Conclusion

Treatment with a stepped care model for inflammatory pain produced clinically relevant, positive reported outcomes on pain and/or function. Our stepped care model appears to be a useful, safe, and cost-saving treatment option that is easily reproducible. Further studies, including randomized controlled trials and analyses of subgroups, may help to develop a more patient-tailored approach and further avoidance of less-effective treatments and costs.

Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System: A Randomized Clinical Trial

Importance

Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems.

Objective

To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP.

Design, Setting, and Participants

This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020. Data analysis was conducted from January to December 2022.

Interventions

Risk-stratified care, in which participants received physiotherapy treatment tailored for their risk category (low, medium, or high), or usual care, in which care was determined by participants' general practitioners and may have included a referral to physiotherapy.

Main Outcomes and Measures

The primary outcome was the Roland Morris Disability Questionnaire (RMDQ) score at 1 year, with planned secondary outcomes of Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores. Raw downstream health care utilization was also reported within each group.

Results

Analysis included 270 participants (99 [34.1%] female participants; mean [SD] age, 34.1 [8.5] years). Only 21 patients (7.2%) were classified as high risk. Neither group was superior on the RMDQ (least squares [LS] mean ratio of risk-stratified vs usual care: 1.00; 95% CI, 0.80 to 1.26), the PROMIS PI (LS mean difference, -0.75 points; 95% CI -2.61 to 1.11 points), or the PROMIS PF (LS mean difference, 0.05 points; 95% CI, -1.66 to 1.76 points).

Conclusions and Relevance

In this randomized clinical trial, using risk stratification to categorize and provide tailored treatment for patients with LBP did not result in better outcomes at 1 year compared with usual care.

Trial Registration

ClinicalTrials.gov Identifier: NCT03127826.

Neuromodulation of the Autonomic Nervous System in Chronic Low Back Pain: A Randomized, Controlled, Crossover Clinical Trial

Chronic pain is a societal concern influencing the autonomic nervous system. This system can be captured with automated pupillometry. The direct connection between the epidermal cells and the brain is presented as part of the central nervous system, reflecting the modulation of the autonomic system. This study's aim was to investigate if tape containing magnetic particles (TCMP) has an immediate effect on the autonomic nervous system (ANS) and influences chronic low back pain. Twenty-three subjects completed this study. Subjects were randomized to either receive the control tape (CT) or TCMP first. Each subject underwent a pain provocative pressure test on the spinous process, followed by the skin pinch test and automated pupillometry. Next, the TCMP/control tape was applied. After tape removal, a second provocative spinous process pressure test and skin pinch test were performed. Subjects returned for a second testing day to receive the other tape application. The results demonstrate that TCMP had an immediate significant effect on the autonomic nervous system and resulted in decreased chronic lower back pain. We postulate that this modulation by TCMP s has an immediate effect on the autonomic system and reducing perceived pain, opening a large field of future research.

Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis

to analyze the effectiveness of digital self-care in the management of pain and functional disability among people with spine musculoskeletal disorders. a systematic literature review, developed with the PRISMA checklist, of randomized clinical trials of people with spine musculoskeletal disorders and digital interventions accessed by means of computers, smartphones or other portable devices. Databases researched: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cumulative Index to Nursing and Allied Health Literature and Physiotherapy Evidence Database. The descriptive synthesis of the results and by means of meta-analyses (fixed-effects model) was performed with the Review Manager software. The methodological quality was evaluated with the Physiotherapy Evidence Database scale. a total of 25 trials were selected (5,142 participants), which showed statistically significant improvements (p <0.05) in 54% (12/22) in the pain levels and 47% (10/21) in functional disability in the Intervention Group. The meta-analyses showed moderate effects on pain intensity and small effects on functional disability. There was a predominance of medium quality studies. the digital care interventions showed a beneficial result in pain intensity and in functional disability, mainly for chronic low back pain. Digital care emerges as promising to support self-management of the spine musculoskeletal conditions. PROSPERO registry number CRD42021282102.

Effectiveness of polarized polychromatic light therapy on myofascial trigger points in chronic non-specific low back pain: a single blinded randomized controlled trial

Background

Phototherapy has been used for the treatment of chronic low back pain. However, the effect of linear polarized polychromatic light (PL) has not been examined on myofascial trigger points in patients with chronic non-specific low back pain (NSLBP).

Objectives

To investigate the effectiveness of PL on pain intensity, pain sensitivity of active myofascial trigger points (MTrPs) in gluteus medius (GM) and quadratus lamborum (QL) muscles, back disability, and lumbar range of motion in chronic NSLBP.

Methods

Forty-two participants of both genders with chronic NSLBP were randomly allocated into two equal groups: group A (Linear polarized polychromatic light (PL): 21 participants received polarized light therapy in the range of red and near-infrared rays on myofascial trigger points of bilateral GM and QL muscles for 5 min/point followed by stretching and strengthening exercises for 4 weeks. Group B (Sham PL): 21 participants received the same program but with sham linear polarized polychromatic light therapy. Numeric pain rating scale, pressure algometer, and Roland-Morris Disability Questionnaire were used to measure pain intensity, pain sensitivity (as represented by pain pressure threshold (PPT) of MTrPs of the target muscles and back disability respectively. Further, lumbar flexion, extension, and bilateral rotation were examined with a tape measure, while bilateral side bending were examined with a universal goniometer.

Results

After the intervention program, significant improvements (p < 0.05) in pain intensity, PPT of MTrPs of left GM (Effect Size (ES): 1.23) and bilateral QL muscles (ES Rt QL: 0.9; Lt QL: 1.56) were found in group A in comparison with group B. Nevertheless, the two groups displayed similar improvements (p > 0.05) in lumbar range of motion and back disability.

Conclusion

Linear polarized polychromatic light therapy in the range of red and near-infrared rays improves pain intensity and pain sensitivity of myofascial trigger points in chronic NSLBP.

Trial registration

PACTR, PACTR202111577053926. Registered 22 June 2019-Prospectively registered.

Core muscle functional strength training for reducing the risk of low back pain in military recruits: An open-label randomized controlled trial

BACKGROUND

Core muscle functional strength training (CMFST) has been reported to reduce injuries to the lower extremity. However, no study has confirmed whether CMFST can reduce the risk of low back pain (LBP).

OBJECTIVE

This study identified the effects of CMFST on the incidence of LBP in military recruits.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

We performed a prospective, open-label, randomized, controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program. Participants were randomly assigned to either the core group or the control group. In additional to normal basic combat training, recruits in the core group underwent a CMFST program for 12 weeks, while recruits in the control group received no extra training.

MAIN OUTCOME MEASURES

At the beginning of the study and at the 12th week, the number of participants with LBP was counted, and lumbar muscle endurance was measured. In addition, when participants complained of LBP, they were assessed using the visual analog scale (VAS) and Roland Morris Disability Questionnaire (RMDQ).

RESULTS

A total of 588 participants were included in the final analysis (295 in the core group and 293 in the control group). The incidence of LBP in the control group was about twice that of the core group over the 12-week study (20.8% vs 10.8%, odds ratio: 2.161-2.159, P < 0.001). The core group had better lumbar muscle endurance at 12 weeks than the control group ([200.80 ± 92.98] s vs [147.00 ± 84.51] s, P < 0.01). There was no significant difference in VAS score between groups, but the core group had a significantly lower RMDQ score at week 12 than the control group (3.33 ± 0.58 vs 5.47 ± 4.41, P < 0.05).

CONCLUSION

This study demonstrated that the CMFST effectively reduced the incidence of LBP, improved lumbar muscle endurance, and relieved the dysfunction of LBP during basic military training.

Crosswalking the Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Pain Intensity Scores to the Roland-Morris Disability Questionnaire and the Oswestry Disability Index

OBJECTIVE

To link scores from 2 condition-specific measures for chronic low back pain (CLBP), the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ), to Patient Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity scores.

DESIGN

Ordinary least squares regression analyses of existing data to link the PROMIS scores with the ODI and RMDQ.

SETTING

Not applicable.

PARTICIPANTS

Samples of adults with CLBP (N=2279) obtained from the Center for Excellence in Research for Complementary and Integrative Health (CERC) Study (n=1677), the Assessment of Chiropractic Treatment for Low Back Pain and Smoking Cessation in Military Active Duty Personnel (ACT) (n=384), and the pain subsample of the PROMIS 1 Wave 2 Pain and Depression study (PROMIS 1 W2) (n=218).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

PROMIS physical function, pain interference, and pain intensity (CERC, ACT, and PROMIS 1 W2), ODI (CERC and PROMIS 1 W2), and RMDQ (ACT and PROMIS 1 W2).

RESULTS

In predicting PROMIS scores, the ODI model R² values ranged from 0.26-0.56 and the RMDQ model R² values ranged from 0.13-0.50. ODI and RMDQ models were the least precise in predicting the PROMIS pain intensity score (R² value range, 0.13-0.41) relative to the other PROMIS scores. Models with the 3 PROMIS scores as predictors yielded R² values ranging from 0.64-0.68 and 0.46-0.58 for the ODI and RMDQ, respectively. Models using combined data from 2 studies (ie, PROMIS 1 W2 and ACT, or PROMIS 1 W2 and CERC) tended to be more precise than models using only a single study sample.

CONCLUSIONS

Model results reported here can be used to translate PROMIS physical function, pain interference, and pain intensity scores to and from the ODI and RMDQ. The empirical linkages can facilitate comparisons across CLBP interventions and broaden interpretation of study results.