Association between sedentary behavior and low back pain; A systematic review and meta-analysis

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

OBJECTIVE

To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).

RESULTS

We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.

CONCLUSION

Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

Prevalence of chronic musculoskeletal pain among different occupational groups of a large German chemical company: results of a cross-sectional study

Objectives. This study aimed to examine the prevalence of chronic musculoskeletal pain among employees of a large German chemical company and how it varies depending on occupational group. Methods. Cross-sectional data were collected between 2019 and 2022 during a voluntary occupational health check-up, including a written questionnaire. Chronic musculoskeletal pain was defined as lasting at least 3 months in the past year. Occupational group was operationalized either by self-reported work area or by the International Standard Classification of Occupations 2008 (ISCO-08). Associations between occupational group and chronic musculoskeletal pain were analyzed using robust Poisson regression. Results. The final sample included 13,705 employees. The 12-month prevalence of chronic musculoskeletal pain was 18.6% for the whole sample, and 22.0, 21.9, 20.2 and 15.0% for employees in the work areas other, office, research/laboratory and production/craft, respectively. Regression analyses showed that the prevalence was 24.1% (p < 0.001) lower for employees in production/craft and 11.2% (p < 0.05) lower for employees in research/laboratory compared to office employees in the fully adjusted model. Conclusions. The high prevalence of chronic musculoskeletal pain underscores the importance of both the prevention and management of chronic musculoskeletal pain. Thereby, workplace-specific needs-based offerings could play an important role.

Global, regional, and national burdens of low back pain in women of childbearing age from 1990 to 2021: an analysis based on the global burden of disease study 2021

BACKGROUND

Low back pain (LBP) is very common in women of child bearing age (WCBA) and is a major burden on individuals and society, but studies about it have not been reported.

METHODS

Trend analyses were based on data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. We investigated global trends in the number of prevalence cases, prevalence and the years lived with disability (YLDs), and the YLDs rate for LBP in the WCBA. We used joint point regression analyses to report average annual changes and identify the most variable years in the global trend. Simultaneously, we further analyzed these trends by stratifying them by the region, nation, and age.

RESULTS

Globally, the number of the prevalence and the YLDs for LBP increased substantially from 1990 to 2021(the prevalence: 39.65%) (the YLDs: 39.53%), whereas the prevalence and the YLDs rate of WCBA LBP decreased (the prevalence: AAPC: -0.1355 [95% CI -0.1419 to -0.1288) (the YLDs: AAPC: -0.1365 [95% CI -0.1427 to -0.1302]). Regionally, the prevalence and the YLDs rate of LBP among WCBA in the medium socio-demographic index region showed an increasing trend(the prevalence: AAPC: 0.1291 [95% CI: 0.118 to 0.1396]) (the YLDs: AAPC: 0.1371 [95% CI: 0.1251 to 0.1499]). Nationally, Thailand and Vietnam were the countries with the largest increases in YLD rates(Thailand: AAPC: 0.7742 [95% CI: 0.7589 to 0.7904]) (Vietnam: AAPC: 0.7364 [95% CI: 0.7263 to 0.7468]). In age patterns, the highest prevalence and YLDs rates of LBP were found among women in the 45-49 age group(the prevalence: 14,412.77 per 100,000 in 2021 [95% UI: 10,482.27 to 19,077.3]) (the YLDs: 1,639.56 per 100,000 population (95% UI: 1,035.24 to 2,494.9]).

CONCLUSION

Despite declines in the prevalence and YLDs of WCBA LBP, the burden remains high. Age- and region-specific prevention and healthcare strategies should be optimized to meet the needs of WCBA and reduce the burden of disease.

Incidence of chronic pelvic pain after childbirth and its causal association with C-section

ABSTRACT

This study aimed to report the incidence of chronic pelvic pain in women 12 to 24 months postpartum, to identify the independently associated factors, and to conduct a causal inference with C-section as the exposure. This was a cross-sectional study nested within 2 distinct prospective cohorts from 2 Brazilian cities. Chronic pelvic pain was the dependent variable. Independent variables were collected. Fisher exact test or Pearson χ2 test and t test or Wilcoxon rank-sum test were performed as appropriate, with P-values adjusted. Data were assumed to be missing at random, and multivariate imputation by chained equations was performed. Sensitivity analysis was conducted using complete cases. Multicollinearity was assessed by computing the variance inflation factor. Binomial logistic regression was used to obtain an interpretable model. Odds ratios and 95% confidence intervals were used as measurements. A directed acyclic graph was used for causal inference. A total of 2160 women were included. The incidence of chronic pelvic pain was 12.7%. C-sections doubled the odds of developing chronic pelvic pain (CPP). Additional factors associated with increased odds included city of birth, feelings of discrimination, severe symptoms of anxiety, dissatisfaction with the care received during childbirth, and mental suffering. Women who underwent C-sections had a 6.1% higher incidence of CPP compared to those who did not undergo the procedure. The incidence of CPP postpartum is high, and there is a potential causal effect of C-sections. City of birth, discrimination, anxiety, dissatisfaction with the care, and mental suffering were also associated with an increased odds.

Prevalence of piriformis syndrome and its associated risk factors among university students in Pakistan: a cross-sectional study

OBJECTIVE

To determine the prevalence of piriformis syndrome (PS) among undergraduate university health sciences students aged 18 to 25 and assess the significant predictors of PS regardless of its type and severe PS in particular.

DESIGN

A cross-sectional study.

SETTING

The study was conducted at a tertiary care hospital of a public university in Pakistan from December 2023 to May 2024.

PARTICIPANTS

A total of 190 subjects enrolled in the study who met the eligibility criteria, which included being an undergraduate health sciences student (medical and allied health specialities), aged 18 up to 25 years, and willing to participate in the study. Participants were selected using multistage random sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of PS in addition to associated risk factors as a primary outcome measures. Secondary outcome measures included the severity of PS.

RESULTS

Of the total, 119 (62.6%) were female, 114 (60.0%) were between 22 and 25 years old, and 125 (65.8%) had standard body mass index. The prevalence of PS was (61.1%), whereas half suffered from severe PS, and the remaining half had mild and moderate PS. We found that factors such as casual sitting positions, sitting duration and International Physical Activity Questionnaire (IPAQ) score (physical activity) were associated with odds of PS in the crude and adjusted regression analyses. When stratified by severity of PS, factors such as writing positions, casual sitting positions, sitting duration and IPAQ score (physical activity) were associated with odds of severe PS in the crude and adjusted regression analyses.

CONCLUSIONS

Students have a high prevalence of PS, with an increased likelihood of buttock pain associated with prolonged sitting, poor posture and physical inactivity. Future research that includes several factors related to students' social and psychological backgrounds is required.

Healthy Lifestyle Care vs Guideline-Based Care for Low Back Pain: A Randomized Clinical Trial

Importance

An unhealthy lifestyle is believed to increase the development and persistence of low back pain, but there is uncertainty about whether integrating support for lifestyle risks in low back pain management improves patients' outcomes.

Objective

To assess the effectiveness of the Healthy Lifestyle Program (HeLP) compared with guideline-based care for low back pain disability.

Design, Setting, and Participants

This superiority, assessor-blinded randomized clinical trial was conducted in Australia from September 8, 2017, to December 30, 2020, among 346 participants who had activity-limiting chronic low back pain and at least 1 lifestyle risk (overweight, poor diet, physical inactivity, and/or smoking), referred from hospital, general practice, and community settings. Statistical analysis was performed from January to December 2021.

Interventions

Participants were block randomized to the HeLP intervention (n = 174; 2 postrandomization exclusions) or guideline-based physiotherapy care (n = 172), stratified by body mass index, using a concealed function in REDCap. HeLP integrated healthy lifestyle support with guideline-based care using physiotherapy and dietetic consultations, educational resources, and telephone-based health coaching over 6 months.

Main Outcomes and Measures

The primary outcome was low back pain disability (Roland Morris Disability Questionnaire [RMDQ] score; 0-24 scale, where higher scores indicate greater disability) at 26 weeks. Secondary outcomes were weight, pain intensity, quality of life, and smoking. Analyses were performed by intention to treat. We estimated the complier average causal effect (CACE) as sensitivity analyses.

Results

The sample of 346 individuals (mean [SD] age, 50.2 [14.4] years; 190 female participants [55%]) had a baseline mean (SD) RMDQ score of 14.7 (5.4) in the intervention group and 14.0 (5.5) in the control group. At 26 weeks, the between-group difference in disability was -1.3 points (95% CI, -2.5 to -0.2 points; P = .03) favoring HeLP. CACE analysis revealed clinically meaningful benefits in disability among compliers, favoring HeLP (-5.4 points; 95% CI, -9.7 to -1.2 points; P = .01). HeLP participants lost more weight (-1.6 kg; 95% CI, -3.2 to -0.0 kg; P = .049) and had greater improvement in quality of life (physical functioning score; 1.8, 95% CI, 0.1-3.4; P = .04) than control participants.

Conclusions and Relevance

Combining healthy lifestyle management with guideline-based care for chronic low back pain led to small improvements in disability, weight, and quality of life compared with guideline-based care alone, without additional harm. Targeting lifestyle risks in the management of chronic low back pain may be considered safe and may offer small additional health benefits beyond current guideline-based care.

Trial Registration

http://anzctr.org.au Identifier: ACTRN12617001288314.

Assessment of prevalence and factors associated with perceived lower back pain among the bicycle rickshaw pullers in Dhaka

Lower back pain (LBP) is a prevalent issue affecting individuals globally. This study explored factors associated with LBP among rickshaw pullers in Dhaka, Bangladesh. A cross-sectional study was conducted with 299 bicycle rickshaw pullers in Mirpur from July to November 2019. Data were collected using a pilot-tested semi-structured questionnaire employing convenience sampling, and analyzed with SPSS. All the participants were males (mean age: 36.69 ± 9.61 years; age ranges: 18-58 years). 33% of the participants self-reported LBP. The LBP was significantly associated with older age (>40 years), lower educational qualification, stressful working environment, heavy object lifting, and mental stress during work. There is a need for strategies to prevent and manage LBP, especially in those who are older that could include more training on better postures and lifting heavy loads, improvements in vehicles, and enhanced health and wellbeing.

Establishing consensus on biopsychosocial factors associated with pediatric chronic pain: A modified Delphi study

A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.

Low back pain in China: Disease burden and bibliometric analysis

BACKGROUND

Low back pain has become a global problem. Since many traditional Chinese therapies are helpful for low back pain, the current status of low back pain in China may provide some insights to this issue.

AIM

To demonstrate the disease burden of low back pain in China and the response of Chinese scholars to this issue.

METHODS

The burden of low back pain in China was estimated using the Global Burden of Disease Study 2021 released by the American Institute for Health Metrics and Evaluation. The incidence, prevalence and disability-adjusted life years were analyzed. We also performed a bibliometric analysis to analyzed the publication trend, changes of cooperation models and research topics on low back pain.

RESULTS

Prevalence of low back pain increased from 69.61 million in 1990 to 102.96 million in 2021. New cases increased by a stunning 44.50 million in 2021. Low back pain led to an increase of 4.16 per 1000000 population in terms of disability-adjusted life years from 1990 to 2021. But the increase in China was slower than that of world average. As a response, publications of low back pain published by Chinese scholars were stably raised. From 1990 to 2023, domestic cooperation significantly increased, while international cooperation and no cooperation decreased. However, domestic cooperation decreased between 2021 and 2023. The number of studies on prevention and treatment of low back pain reduced from 1990 to 2023, while the mechanism, etiology and other aspects of low back pain augmented.

CONCLUSION

The burden of low back pain in China is heavy. Together with the government, Chinese institutions of medical science should do more in declining the impacts of low back pain.

Physical Inactivity and Sedentariness in Older Hearing Loss patients: Restoration With Hearing Aids

OBJECTIVES

Hearing loss causes numerous functional deficits. However, few studies have been conducted to assess the association between hearing loss and physical inactivity. This study aimed to evaluate the physical activity and sedentary behavior of hearing loss patients and their relation with the use of hearing aids.

MATERIALS AND METHODS

We extracted participants over 60 years of age with information on hearing status and physical activities from the eighth Korea National Health and Nutritional Examination Survey conducted from 2019 to 2020. We classified them into four groups: a normal hearing group (≤25 dB), a mild hearing loss group (>25 dB and ≤40 dB), a moderate hearing loss group (>40 dB and ≤50 dB), and a non-serviceable hearing group (>50 dB). Additionally, we extracted hearing aid users with hearing levels exceeding 50 dB.

RESULTS

After adjusting other factors, the non-serviceable hearing group walked less frequently than the moderate (p = 0.004) and mild hearing loss group (p < 0.001) and walked less and sat more than the normal hearing group (walking frequency: p < 0.001; walking time: p = 0.020; and sitting time: p = 0.034). Also, the hearing aid users walked more frequently (p = 0.003) and for longer (p = 0.045) than the non-serviceable hearing group.

CONCLUSION

Hearing loss is associated with reduced walking and a sedentary lifestyle. The use of hearing aids is associated with improved physical activity. Appropriate interventions, including hearing aids, should be provided to hearing loss patients.

LEVEL OF EVIDENCE

3 (individual cross-sectional study) Laryngoscope, 134:5109-5115, 2024.

Inflammation is associated with pain and fatigue in older adults

Introduction

Increasing evidence suggests that inflammation may play a pivotal role in the development of chronic pain and fatigue in aging individuals. This study investigated the relationship between three inflammatory markers (IL-6, CRP, and TNFα) and pain and fatigue, both cross-sectionally and longitudinally, in a sample of older adults from the Saint Louis Personality and Aging (SPAN) study.

Methods

SPAN study participants provided blood samples at two in-person sessions approximately 2 years apart for the analysis of the inflammatory biomarkers IL-6, CRP, and TNFα. Pain and fatigue were assessed using the RAND-36 Health Status Inventory. Correlations (with false discovery rate correction for multiple testing) and follow-up linear regressions including potentially confounding demographic (e.g., annual household income) and health (e.g., BMI, medication use) covariates were used to estimate cross sectional and longitudinal associations. Analytic ns ranged from 533 to 815.

Results

Cross-sectional analyses revealed that higher IL-6 and CRP were associated with greater reported pain and fatigue, even after accounting for covariates (βs > .098, ps < .05). TNFα was associated with greater fatigue only (β = .100, p = .012). Longitudinally, CRP and IL-6 predicted future pain and fatigue, although only the relationship between CRP and future fatigue survived the inclusion of covariates (β = .104, p = .022). Both pain and fatigue predicted higher levels of IL-6 and CRP approximately 2 years later, although only the associations with IL-6 survived the inclusion of covariates (βs > .12, ps < .01).

Discussion

Our study adds to a growing body of literature showing that inflammation is associated with greater pain and fatigue in older adults. Our longitudinal data showing temporal bidirectional associations is consistent with evidence from non-human animal models that heightened inflammation causally contributes to fatigue and also suggests that the experience of pain and fatigue may contribute to inflammation. It will be important for future work to identify how lifestyle factors associated with pain and fatigue (e.g., physical activity) may contribute to these associations.

Hatha yoga, integrating the segmental stabilization exercise model, can improve trunk muscle endurance in healthy adults

Introduction

Low back pain is a very common symptom worldwide and an increasingly important public health problem. Exercises to stabilize the lumbar spine and pelvis have been shown to be effective in preventing or reducing the risk of low back pain. Hatha yoga practice is now increasingly appearing in prevention research and has the potential to improve trunk muscle endurance. The prevention research on endurance training of trunk muscle lacks evidence. The aim of this study was to investigate the effectiveness of a professional and scientifically based exercise program to improve and balance trunk muscle endurance in healthy adults.

Methods

A non-randomized control study was conducted. Participants were healthy adults without low back pain or injury who had not performed exercises to improve trunk muscle endurance prior to participation in the study. An analysis of the proposed exercise program's effectiveness was conducted. The participants were divided into two groups: the exercise group (EG) performed a three-month hatha yoga exercise program (60 min twice a week) that included the spinal and pelvic segmental stabilization exercise model, or the control group (CG), in which participants were asked to maintain their previous lifestyle during the study period. Trunk muscle endurance was measured at baseline (PRE) and after completion of the exercise program (POST) in both groups. The changes in the measured variables were analyzed (PRE-POST analysis, EG-CG comparison).

Results

Seventy-two subjects (nEG = 36, age 32.2 ± 6.8 years; nCG = 36, age 29.9 ± 7.8 years) participated in the study. After the exercise program, the EG participants had significantly better results in endurance in three of the four trunk muscle groups (p < 0.05), but not in any of the endurance ratios.

Conclusion

Hatha yoga when integrating the segmental stabilization exercise model can significantly improve the endurance of at least three of the four major trunk muscle groups. For clinical relevance, the long-term effects of the proposed exercise program should be investigated in individuals with low back pain.

Getting up for brain health: Association of sedentary behavior breaks with cognition and mental health in children

Children spend most of their waking hours sedentary and reducing this behavior has been challenging. Interrupting prolonged episodes of sedentary behavior with active breaks can provide mental and cognitive health benefits. Considering the multifactorial nature of these health aspects, this study aimed to verify the role of body mass index (BMI), cardiorespiratory fitness (CRF), and moderate to vigorous physical activity (MVPA) in the relationship between the break in sedentary time with cognitive and mental health in children. This is a cross-sectional study with 129 children (62 boys), aged between 6 and 11 years (mean 8.73 ± 1.53) from a public school in southern Brazil. For the assessment of fluid intelligence, psychologists applied Raven's Colored Progressive Matrices test. Mental health was measured using the Strengths and Difficulties Questionnaire. Sedentary breaks were measured using accelerometers, and CRF was determined using the 6-min walk test. Generalized linear regression analyses were used to verify associations of sedentary breaks with fluid intelligence and mental health, according to children's BMI, CRF, and MVPA. All models were adjusted for sex, age, somatic maturation, and total time of accelerometer use. Our results indicated that sedentary breaks were associated with fluid intelligence in overweight/obese (β = 0.108; p = 0.021) and physically inactive children (β = 0.083; p = 0.010). Regarding mental health, no association was identified with sedentary breaks. In conclusion, sedentary breaks should be encouraged for the benefits of fluid intelligence, especially in children who do not meet physical activity recommendations and are overweight.

Association Between Objective Sleep and Clinical Outcomes in Older Adults With Low Back Pain Receiving Physical Therapy Care: A Secondary Analysis of a Responsiveness Study

BACKGROUND/OBJECTIVES

Sleep seems to be associated with worse low back pain (LBP) outcomes in older adults; however, studies investigating the association of objective sleep with future changes in LBP outcomes are lacking. The objectives of this study are as follows: (a) to investigate the association between objectively measured sleep with changes in clinical outcomes in older adults with LBP receiving physical therapy care and (b) to examine the cross-sectional association between sleep and pain catastrophizing.

METHODS

This was a prospective cohort study. We recruited older adults (≥60 years old) with chronic LBP undergoing physical therapy treatment. At baseline, we assessed participants' sleep (actigraphy for 10-14 days), pain intensity, disability, pain catastrophizing, and covariates. After 8 weeks, we reassessed pain intensity, disability, and self-perceived recovery. We ran linear regression models and Spearman coefficient tests.

RESULTS

Fifty-eight participants were included, and 51 completed follow-up assessments (60.8% women; mean age 70.1 ± 5.6 years). We found no associations between sleep quantity and efficiency with changes in pain intensity, disability, and self-perceived recovery after 8 weeks of physical therapy care. We found a correlation between sleep fragmentation and pain catastrophizing (r = .30; 95% confidence interval: [.03, .54]).

CONCLUSION

Objective sleep quantity and efficiency may not be associated with changes in LBP outcomes after physical therapy care in older adults. Among the sleep domains evaluated, sleep fragmentation may be the sleep domain with the strongest association with pain catastrophizing. Significance/Implications: Objectively measured sleep might not be a prognostic factor for LBP improvement in older adults. Future studies should explore the association between sleep fragmentation and pain catastrophizing.

Global burden of low back pain and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

Background

This study aimed to examine the evolving trends in the global burden of low back pain (LBP) from 1990 to 2021 and predicted disease burden until 2035.

Materials and methods

LBP-related data were obtained from the Global Health Data Exchange (GHDx) query tool. All estimates and their 95% uncertainty intervals (UIs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool in Global Burden of Disease, Injury, and Risk Factor Study (GBD) 2021. Data processing and visualization were conducted using The R Programming Language software version 4.3.2 and Joinpoint 4.7.

Results

In 2021, approximately 628.8 million people worldwide were affected by LBP, with approximately 266.9 million new incident cases and age-standardized incidence rate (ASIR) of 3176.6 per 100,000. Compared with 1990, although the ASIR and age-standardized disability-adjusted life years rate (ASDALYsR) decreased, absolute numbers increased significantly. Projections for 2035 reveal a continued decline in ASIR and ASDALYsR for LBP. The LBP burden varied by the sociodemographic index quintile and GBD region, with the highest ASIR and ASDALYsR observed in Central Europe and the greatest decrease in East Asia. Globally, women bear a higher burden of LBP than men, with middle-aged populations experiencing the heaviest burden. Occupational ergonomic factors, high body mass index, and smoking remain the primary risk factors for LBP, with occupational ergonomic factors contributing the most to the overall burden.

Conclusion

Despite a projected decline in incidence, the global burden of LBP persists, exhibiting significant regional and gender disparities. To mitigate its future burden, precise and effective prevention and control strategies targeting high-risk factors are imperative.

Frequency of physical activity during leisure time and variables related to pain and pain medication use in Spanish adults: A cross-sectional study

BACKGROUND

Physical inactivity has been identified as a risk factor for pain.

OBJECTIVE

The main objective was to analyze the relationships between leisure time physical activity frequency (PAF) and pain prevalence, pain level, pain impairment, daily life pain impairment, and analgesic use in Spanish adults. In addition, risk factors such as sex, body mass index, marital status and social class were assessed for these pain variables in addition to PAF.

METHOD

Cross-sectional study based on data from the 2014 and 2020 European Health Surveys in Spain residents. The Chi-square test was used to analyze the relationship of dependence between the variables of interest. A correlation study calculating Spearman's rho and a multiple logistic regression were performed to assess risk factors for pain variables.

RESULTS

20,113 and 19,196 subjects with a median age of 49 and 52 years old in 2014 and 2020 European Health Surveys, respectively, were analyzed. Dependence relationships were found between PAF and pain variables (p<0.001). The prevalence of: pain, high levels of pain, pain impairment, high level of pain impairment and use analgesic were higher in the inactive population than in the rest of the PAF levels (36.7-53%) vs (18.6-44.3%), p<0.05. Weak correlations were found between PAF and pain variables (-0.177 ≤ Rho ≤ -0.107) (p<0.001). Logistics regression show that being active or very active reduces the odds of pain, the intensity of pain and being affected in daily activities due to pain by 0.524 to 0.776 times. Likewise, being active or very active reduces the odds of taking pain medication by 0.661 to 0.755 times. Also age, low social class, being a woman, and being obese increase of odds of pain, pain affectation and use of analgesics in both surveys by 1.008 to 2.202 times.

CONCLUSIONS

Physical inactivity was related to a higher prevalence of: pain, higher levels of pain, higher pain involvement and higher analgesic use. In addition, lower social class, being female, older age, and obesity were factors for higher odds of pain, pain involvement, and analgesic use in both surveys.

Social determinants of health and youth chronic pain

OBJECTIVES

To identify the relationships between social determinants of health (SDOH) and chronic pain among U.S. youth (referring to children and adolescents).

METHODS

Data including a national sample of U.S. youth were retrieved from the 2022 National Survey of Children's Health. Twenty indicators within five SDOH-related domains (e.i., economic stability, social and community context, neighborhood and built environment, health care access and quality, and education access and quality) were included. The presence of chronic pain was assessed using a self-reported question, answered by the main caregiver. Associations of SDOH-related indicators and youth chronic pain were estimated using multi-variable logistic regression models, while adjusting for covariates (e.g., age, sex, ethnicity, weight status, and movement behaviors).

RESULTS

Data from 30,287 U S. youth aged 6-17 years (median [SD] age, 11.59 [3.30] years; 14,582 girls [48.97 %]) were collected. In 7.5 % of the final sample size, caregivers reported that they had chronic pain. Youth grow up in conditions with diverse SDOH profiles, including food insufficiency (OR = 1.46, 95 % CI: 1.01 to 2.10) and parental unemployment (OR = 1.56, 95 % CI: 1.15 to 2.12); low school engagement (OR = 1.48, 95 % CI: 1.14 to 1.92) and low school safety (OR = 1.65, 95 % CI: 1.14 to 2.39); limited access to quality health care (OR = 2.56, 95 % CI: 2.12 to 3.09), a high frequency of hospital visits (OR = 4.76, 95 % CI: 1.82 to 12.44), and alternative health care (OR = 2.57, 95 % CI: 2.07 to 3.20); bullying victimization (OR = 1.37, 95 % CI: 1.11 to 1.68) and community-based adverse childhood experiences (OR = 1.64, 95 % CI: 1.32 to 2.05); and disadvantageous amenity characteristics (OR = 1.38, 95 % CI: 1.05 to 1.79); resulted in higher odds of presenting chronic pain.

CONCLUSIONS

Different indicators included in the SDOH domains were associated with a higher probability of presenting chronic pain in U.S youth. These findings have implied relationships between the SDOH and chronic pain in youth, requiring a comprehensive approach to addressing health equity to prevent and reduce the presence of youth chronic pain.

Efficacy of Back Bracing in Treating Chronic Low Back Pain

Chronic low back pain (CLBP) negatively impacts quality of life and contributes to a significant economic burden. One conservative management strategy for CLBP is lumbar back bracing. Despite the benefits of back bracing for improving pain and function, there remains hesitance to use the therapy long term due to unfounded fear related to muscle weakness, deconditioning, or joint contracture.

OBJECTIVE

The purpose of this study was to examine the outcomes for patients with CLBP who were managed with lumbar back bracing and physical therapy.

METHODS

This was a single-site, retrospective chart review.

RESULTS

Patients were included in the study if they were treated for CLBP with back bracing for at least one hour daily and physical therapy for twelve weeks. Pain was assessed at three, six, and twelve months using the 11-point Visual Analogue Scale (VAS). Function was assessed at three months using the Oswestry Disability Index (ODI). The VAS score reduced from 6.28 +/- 2.32 to 3.96 +/- 2.66 at three months (p < 0.001) for 198 patients. At six and twelve months, the VAS score reduced to 3.74 +/- 2.73 (p < 0.001) and 3.23 +/- 2.29 (p < 0.001), respectively. The total ODI score for 199 patients improved from 46.56 +/- 15.30 to 33.13 +/- 19.99 (p < 0.001) at three months.

CONCLUSION

Back bracing in combination with physical therapy is effective for treating low back pain.

Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial

BACKGROUND

Neck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts, have emerged as promising solutions to address this concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and/or low back pain in office workers.

METHODS

This study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported neck and/or low back pain during the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models.

RESULTS

The recovery rate from neck and/or low back pain was 100% for the intervention group, and 86% for the control group. The median recovery duration of participants who reported pain during the 6-month period was 1 month in the intervention group and 3 months in the control group. The intervention group had a higher probability of recovery compared to the control group (HRadj 4.35, 95% CI 1.87-10.11; p < 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11-2.12).

CONCLUSIONS

A dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, a potentially relevant reduction in the recurrence of neck and low back pain could not be statistically confirmed. A power analysis was not conducted for this secondary analysis, and future studies should be designed with adequate sample sizes to explore the recurrence of pain with greater statistical power.

TRIAL REGISTRATION

This trial is retrospectively registered under the Thai Clinical Trials Registry: TCTR20230623002 (23/06/2023).

Causal impacts of smoking on pain conditions and the mediating pathways: a mendelian randomization study

Smoking is a risk factor for multiple diseases. We performed mendelian randomization (MR) analyses to investigate the causal association of smoking initiation on pain conditions and the potential mediating pathways. Genetic associated with smoking initiation at the genome-wide significance level were selected as instrumental variables. Genetic associations with 10 pain conditions were derived from the FinnGen and UK Biobank study. Multivariable MR analysis was conducted to explore the mediation effects of depression, insomnia and sedentary behavior. A series of sensitivity analyses were conducted to assess the stability of our research findings. Genetic liability to smoking initiation was associated with an increased risk of angina pectoris, dorsalgia, low back pain, pain in limb, pain in joint, pain in thoracic spine and sciatica in both FinnGen and UK Biobank study. These causal associations were largely mediated by major depression (2.9- 39.5%), sedentary behavior (13.0- 31.2%), insomnia (10.3- 33.1%) and combination of all three mediators (30.2- 65.3%). The effects of smoking on outcomes were partly attenuated after adjusting for depression, sedentary behavior and insomnia respectively, and the direct effect of smoking initiation on pain was diminished toward null after adjusting for combined three mediators. These results were robust to sensitivity analyses. Our findings illustrated the causal effect of smoking and a broad range of pain conditions, and major depression, sedentary behavior and insomnia mediate many of these associations.

Immediate and acute effects of Kinesio taping on back muscle endurance, low back flexibility, and balance among sedentary individuals: A randomized controlled trial

INTRODUCTION

Sedentary lifestyles is linked to a reduction in back muscle strength, endurance, and balance, consequently increasing the risk of experiencing low back pain. Kinesio taping has been shown to be effective in enhancing endurance, flexibility, and balance. This study aimed to investigate the effects of Kinesio taping on measures of lumbar function in sedentary individuals.

METHOD

Forty-four sedentary young adults were randomly assigned into intervention and control groups. The intervention group received Kinesio tape to the lumbar region while the control group received health education. The Schober's test, Single-leg stance test, Y Balance Test, and Biering-Sorensen test were performed at baseline and 30 min and 24 h after the taping intervention.

RESULTS

There was a statistically significant increase in static balance (single-leg stance test) in the intervention group compared to the control group (p ≤ 0.05). In the Y Balance Test and Biering-Sorensen test, there was no significant difference between the intervention group and control group, though there was a significant increase in both groups from baseline to 24 h after taping. Though low back flexibility (Schober's test) significantly decreased in the intervention group, there was no significant difference between the two groups.

CONCLUSION

Kinesio taping can immediately improve static balance in people with sedentary behavior. The application of Kinesio tape had no impact on dynamic balance, low back flexibility, or low back muscle endurance.

Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

BACKGROUND

Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.

METHOD

A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.

RESULTS

Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.

CONCLUSION

Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Influence of Physical Activity, Physical Fitness, Age, Biological Maturity and Anthropometric Variables on the Probability of Suffering Lumbar, Neck and Shoulder Pain in Spanish Adolescents from the Region of Murcia

Background: Back pain in adolescents is a common injury, mainly affecting the lumbar, cervical and sometimes shoulder region. This has been related to various factors, such as lifestyle habits or physical capacity, but no previous research has shown conclusive results. The aims of this study was to analyze the risk of suffering lumbar, neck and shoulder pain according to anthropometric and physical fitness variables, physical activity level, age and biological maturity in adolescents, as well as the influence of sex in the study results. Methods: A descriptive cross-sectional study was performed, including a sample of 2015 adolescents (boys: n = 1006, mean age = 14.41 ± 1.35 years-old; girls: n = 1009, mean age = 14.48 ± 1.41 years-old). The participants underwent an anthropometric evaluation and physical fitness tests were carried out, including a 20 m shuttle run, a counter movement jump, a horizontal jump, a 20 m sprint and push-up tests, followed by the completion of lumbar, neck and shoulder pain questionnaires. Results: Higher values in age and peak height velocity (PHV) showed an increase in the risk of suffering lumbar, neck and shoulder pain (OR = 0.79-1.55; p = 0.000-0.025). The anthropometric variables related to adiposity showed an increase in the risk of suffering back pain, with significant incidence in the lumbar region (OR = 1.32-1.60; p = 0.000); while muscle mass showed a protective effect (OR = 0.59; p = 0.000). Regarding the fitness tests, a better physical fitness seemed to protect adolescents from suffering from the analyzed back pains in the general sample and in the boys sample (OR = 0.56-1.60; p = 0.000), while in the girls sample the influence of the physical fitness was less relevant. Conclusions: Both anthropometry and physical fitness may influence the occurrence of back pain in adolescents, with some variations in their importance according to sex.

Cognitive functional therapy for lower back pain: A meta-analytical assessment of pain and disability outcomes in randomized controlled trials

BACKGROUND

Cognitive functional therapy (CFT) aims to address low back pain (LBP) comprehensively by considering physical, psychological, and social factors.

OBJECTIVE

The objective was to evaluate the effectiveness of CFT in reducing pain and disability in individuals with LBP over various time intervals.

METHOD

A comprehensive literature search was conducted to identify relevant randomized controlled trials (RCTs) assessing the effects of CFT on LBP.

RESULTS

In this study, 1510 records were initially identified, and 7 studies were included in the analysis. Disability scores were significantly reduced after CFT had been applied for 6 to 8 weeks (SMD =-0.46, 95% CI [-0.74, -0.19]), 12 weeks to 3 months (SMD =-0.54, 95% CI [-0.72, -0.36]), 6 months (MD =-5.82, 95% CI [-9.82, -1.82]), and 12 months (SMD =-0.4, 95% CI [-0.55, -0.26]). There were also significant reductions in pain scores observed after 12 weeks to 3 months (SMD =-0.49, 95% CI [-0.68, -0.3]), 6 months (MD =-0.75, 95% CI [-1.5, -0.0001]), and 12 months (SMD =-0.27, 95% CI [-0.42, -0.12]).

CONCLUSION

CFT showed potential for improving disability scores for individuals with LBP across various time intervals. However, its impacts on pain scores varied.

Replacing sedentary time or light physical activity with moderate physical activity is associated with a lower prevalence of back pain: a cross-sectional study using isotemporal analysis: Isotemporal substitution and LBP prevalence

BACKGROUND

Evidence shows that lack of physical activity and sedentary time are associated with higher prevalence of low back pain (LBP).

OBJECTIVE

To investigate the association between replacing sedentary time and light physical activity with a higher physical activity level with the prevalence of LBP.

METHODS

Two hundred and sixty-six individuals from a city in southeastern Brazil were recruited to this cross-sectional study. Sedentary behavior and physical activity level were evaluated using an ActiGraph GT3X tri-axial accelerometer during 7 days. The prevalence of LBP was assessed using the Nordic questionnaire. Isotemporal substitution using logistic regression analyses were performed to investigate the association between replacing an activity with another in the prevalence of LBP.

RESULTS

Replacing time spent in sedentary behavior with moderate physical activity slightly reduced the prevalence of LBP (odds ratio [OR]= 0.97; 95% CI: 0.95, 0.98). In addition, replacing time spent in light physical activity with moderate physical activity also slightly reduced the prevalence of LBP (OR= 0.97; 95% CI: 0.95, 0.98). There was no association for replacing sedentary time and light or moderate physical activity with vigorous physical activity on the prevalence of LBP.

CONCLUSIONS

The results suggest a small protective effect for LBP when replacing time in sedentary activities or light physical activity with moderate physical activity.

Modulatory effect of sedentary behaviour on obesity and chronic low back pain: a cross-sectional study using data from the National Health and Nutrition Examination Survey

OBJECTIVE

To explore whether sedentary behaviour could modulate the association between overweight or obesity and chronic low back pain (CLBP).

DESIGN

A retrospective cross-sectional study.

SETTING AND PARTICIPANTS

A total of 4289 participants in the US cohort from the National Health and Nutrition Examination Survey were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

CLBP was the outcome.

RESULTS

After adjusting for confounding factors, an increased risk of CLBP was identified in people who were overweight (OR 1.41, 95% CI 1.13 to 1.76) and obesity (OR 1.48, 95% CI 1.01 to 2.18). No significant association between sedentary behaviour time and CLBP was observed. In body mass index (BMI)<25 kg/m2 vs BMI≥30 kg/m2 group, sedentary behaviour time showed a modulatory effect on obesity and CLBP (p=0.047). In the sedentary behaviour time >4.5 hours group, the risk of CLBP was increased as BMI elevation, indicating sedentary behaviour time >4.5 hours played a modulatory role in the relationship between obesity and CLBP.

CONCLUSION

Obesity was significantly associated with an increased risk of CLBP, and sedentary behaviour time modulated the association between obesity and CLBP. The findings might provide a reference for the lifestyle modifications among individuals with obesity and reducing sedentary behaviour is recommended for this population.

Germ aversion is a risk factor for chronic low back pain and shoulder pain under the COVID-19 pandemic: an internet-based panel study

The COVID-19 pandemic has increased germ aversion, an aversive affective response to a high likelihood of pathogen transmission. While psychological factors are associated with chronic pain, the relationship between germ aversion and chronic pain remains unexplored. This study aimed to examine the relationship between germ aversion and new-onset and prognosis of chronic pain using longitudinal data collected during the COVID-19 pandemic. We conducted web-based surveys of full-time workers at baseline and after three months. Data were collected on demographic characteristics, psychological factors, and chronic pain. Germ aversion was assessed using a modified Perceived Vulnerability to Disease scale. We analyzed responses from 1265 panelists who completed the survey twice. The prevalence of chronic low back pain (CLBP) and chronic neck and shoulder pain (CNSP) was associated with sex, short sleep duration, psychological distress, loneliness, and germ aversion. Stratified analyses showed that germ aversion was a risk factor for CLBP at three months in both individuals with and without CLBP at baseline, and for CNSP at three months in those with CNSP at baseline, even after adjustment for confounders. In conclusion, this preliminary study suggests that high germ aversion is a risk factor for CLBP and CNSP in young and middle-aged workers.

Associations between lifestyle-related risk factors and back pain: a systematic review and meta-analysis of Mendelian randomization studies

BACKGROUND

Mendelian randomization (MR) studies have an advantage over conventional observational studies when studying the causal effect of lifestyle-related risk factors on back pain. However, given the heterogeneous design of existing MR studies on back pain, the reported causal estimates of these effects remain equivocal, thus obscuring the true extent of the biological effects of back pain lifestyle-risk factors.

PURPOSE

The purpose of this study was to conduct a systematic review with multiple meta-analyses on the associations between various lifestyle factors and low back pain.

METHODS

We conducted a PRISMA systematic review and specifically included MR studies to investigate the associations between lifestyle factors-specifically, BMI, insomnia, smoking, alcohol consumption, and leisure sedentary behavior-and various back pain outcomes. Each meta-analysis synthesized data from three or more studies to assess the causal impact of these exposures on distinct back pain outcomes, including chronic pain, disability, and pain severity. Quality of studies was assessed according to STROBE-MR guidelines.

RESULTS

A total of 1576 studies were evaluated and 20 were included. Overall, the studies included were of high quality and had a low risk of bias. Our meta-analysis demonstrates the positive causal effect of BMI (OR IVW-random effects models: 1.18 [1.08-1.30]), insomnia(OR IVW-random effects models: 1.38 [1.10-1.74]), smoking(OR IVW-fixed effects models: 1.30 [1.23-1.36]), alcohol consumption(OR IVW-fixed effects models: 1.31 [1.21-1.42]) and leisure sedentary behaviors(OR IVW-random effects models: 1.52 [1.02-2.25]) on back pain.

CONCLUSION

In light of the disparate designs and causal effect estimates presented in numerous MR studies, our meta-analysis establishes a compelling argument that lifestyle-related risk factors such as BMI, insomnia, smoking, alcohol consumption, and leisure sedentary behaviors genuinely contribute to the biological development of back pain.

Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform

PURPOSE

Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings.

METHODS

The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews.

RESULTS

Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs.

CONCLUSIONS

Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

Exploring Musculoskeletal Complaints in a Needle Manufacturing Industry: A Cross-Sectional Study

Musculoskeletal disorders (MSD) encompass a variety of conditions affecting muscles, joints, and nerves. In Portugal, MSDs are the most prevalent occupational health problem in companies. Based on the relevance of work-related MSD (WMSD), this study aims to assess the prevalence of MSD complaints in a needle manufacturing industry in Northern Portugal, following a cross-sectional approach. Thus, 526 workers from five departments (i.e., operator, tuning, maintenance, administration, and logistics) answered a sociodemographic questionnaire and the Nordic Musculoskeletal Questionnaire (NMQ). Within the last 12 months, females exhibited a higher frequency of complaints than males across all body parts except for ankles/feet. The body parts eliciting the most percentage of complaints for both genders include the lower back (54.2%), neck (42.2%), shoulders (39.0%), ankles/feet (38.2%), and wrists/hands (35.7%). No significant association was found between Body Mass Index (BMI) and body part complaints. Tuners reported the highest complaint rate, with occupations as substantial predictors of complaints in certain body parts. Likewise, complaints tend to increase with age. The findings advocate for ergonomic interventions that are gender-, age-, and job-sensitive.

Exploring the Real-Time Variability and Complexity of Sitting Patterns in Office Workers with Non-Specific Chronic Spinal Pain and Pain-Free Individuals

Chronic spinal pain (CSP) is a prevalent condition, and prolonged sitting at work can contribute to it. Ergonomic factors like this can cause changes in motor variability. Variability analysis is a useful method to measure changes in motor performance over time. When performing the same task multiple times, different performance patterns can be observed. This variability is intrinsic to all biological systems and is noticeable in human movement. This study aims to examine whether changes in movement variability and complexity during real-time office work are influenced by CSP. The hypothesis is that individuals with and without pain will have different responses to office work tasks. Six office workers without pain and ten with CSP participated in this study. Participant's trunk movements were recorded during work for an entire week. Linear and nonlinear measures of trunk kinematic displacement were used to assess movement variability and complexity. A mixed ANOVA was utilized to compare changes in movement variability and complexity between the two groups. The effects indicate that pain-free participants showed more complex and less predictable trunk movements with a lower degree of structure and variability when compared to the participants suffering from CSP. The differences were particularly noticeable in fine movements.

Prevalence of Low Back Pain and Its Associated Factors Among Medical Students at Nineveh University in Iraq: A Cross-Sectional Study

Background Low back pain (LBP) is a common problem encountered in medical practice, leading to limitations in daily activities and causing social and economic hardships. Objectives This study aimed to assess the prevalence of LBP and its associated factors among medical students at Nineveh University in Iraq. Methods Between December 2022 and January 2023, a cross-sectional study was conducted among medical students at Nineveh University. A modified version of the Standard Nordic Questionnaire was used for data collection. Results Out of 308 students, 229 (74.4%) experienced LBP at some point in their lives. In addition, 209 (67.9%) reported having LBP during the last 12 months, 148 (48.1%) during the previous seven days, and 126 (40.9%) at the time of answering the survey. Factors significantly associated with LBP during the last 12 months were being in the fifth-stage academic year (p=0.047), family history of LBP (p=0.003), and history of trauma (p=0.006). On the multivariable logistic regression analysis, factors significantly associated with LBP during the last 12 months were family history of LBP (p=0.02) and history of trauma (p=0.01). Conclusions The prevalence of LBP among medical students at Nineveh University was comparatively high. A family history of LBP and a history of trauma were factors significantly associated with LBP during the last 12 months. Managing this health concern should be a priority for the administration of medical schools.

Musculoskeletal pain intensity and perceptions during distance learning: A cross-sectional study

Technological developments and the pandemic have popularized the distance learning model at universities. In this educational model, students spend more time in front of screens, and screen-related health conditions have become important. This cross-sectional study of 177 undergraduate students was designed to investigate the effect of block and traditional scheduling in online distance education (ODE) on their musculoskeletal pain and to investigate their perceptions of block scheduling. A two-stage method was used: a quantitative design to compare pain levels, and a qualitative design to determine the students' perceptions of block scheduling using an online survey. Pain intensity was assessed using the Numeric Rating Scale (NRS-11). Data were collected in the university health sciences department. Pain intensity following the block and traditional lessons was analyzed using a paired t-test. Students in the block schedule had significantly more pain, with a large effect size on the whole trunk and upper limbs. Pain levels were also clinically meaningful for the upper (5.73 ± 2.75), lower (5.59 ± 2.87), and neck (4.92 ± 2.60) regions. Students reported positive experiences with block scheduling in ODE such as saving time (43%) and maintaining subject integrity (26%), but also negative experiences such as distraction (56%), fatigue (33%), pain (17%), and boredom (11%). Block scheduling in ODE could cause clinically significant neck and back pain. In distance learning, keeping the course duration short and ensuring student mobility in the classroom are important.

Exploring the impact of occupational factors on low back pain in ride-sharing motorbike drivers in Bangladesh: A comprehensive cross-sectional analysis

Objective

Low back pain (LBP) is a major global public health issue, prevalent among various occupational groups worldwide. However, existing studies have predominantly focused on sedentary workers in developed nations, leaving a gap in understanding LBP prevalence and associated factors among occupational cohorts in low- and middle-income countries like Bangladesh. This study aimed to determine the prevalence and occupational factors contributing to LBP among ride-sharing motorbike drivers (RSMD) in Bangladesh.

Methods

A cross-sectional study was conducted in Dhaka city from May 20 to August 08, 2023. Data were collected from Bangladeshi adult RSMD using a paper-based questionnaire developed by Eriksen et al. Chi-square or Fisher's Exact tests compared categorical variables with and without LBP, and multiple logistic regression analyses were performed with LBP as the dependent variable and various predictors to compute adjusted odds ratios with a 95% confidence interval.

Results

The one-month prevalence of LBP was 58.8%. Regression analysis revealed elevated adjusted odds of experiencing LBP among participants with hypertension, those using multiple ride-sharing operators, commuter and older bike users, and non-users of riding kits. Additionally, increased adjusted odds of LBP were observed among participants of higher age, higher body mass index, and those covering longer distances per week.

Conclusion

This study underscores a significantly higher prevalence of LBP among RSMD in Bangladesh, with occupational factors strongly predicting LBP. Implementing strategies such as regular physical exercise, weight reduction, using sports and newer motorbikes, and reducing working hours per week may help mitigate the prevalence of LBP within this cohort.

Determinants of sedentary behavior in community-dwelling older adults with type 2 diabetes based on the behavioral change wheel: a path analysis

BACKGROUND

Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review.

METHODS

This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data.

RESULTS

Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: β = 0.426, β = -0.171, β = -0.209, and β = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: β = -0.180, β = -0.163, and β = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2/df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000.

CONCLUSION

Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population.

Healthcare burden changes by restricted physical activities in lumbar spinal stenosis and spondylolisthesis: a retrospective large cohort study during the COVID-19 pandemic

BACKGROUND

Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period.

METHODS

We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient's diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables.

RESULTS

Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160).

CONCLUSION

Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.

Pay-for-performance and low back pain with interaction of overwork: findings from the cross-sectional Korean working conditions survey

Background

Pay-for-performance (PFP) is a type of incentive system where employees receive monetary rewards for meeting predefined standards. While previous research has investigated the relationship between PFP and health outcomes, the focus has primarily been on mental health. Few studies have explored the impact of PFP on specific physical symptoms like pain.

Methods

Data from the Korean Working Conditions Survey (KWCS) was analyzed, encompassing 20,815 subjects with information on PFP and low back pain (LBP). The associations between types of base pay (BP) and PFP with LBP were examined using multivariate logistic regression models, taking into account a directed acyclic graph (DAG). The interaction of overtime work was further explored using stratified logistic regression models and the relative excess risk for interaction.

Results

The odds ratio (OR) for individuals receiving both BP and PFP was statistically significant at 1.19 (95% CI 1.04-1.35) compared to those with BP only. However, when the DAG approach was applied and necessary correction variables were adjusted, the statistical significance indicating a relationship between PFP and LBP vanished. In scenarios without PFP and with overtime work, the OR related to LBP was significant at 1.54 (95% CI 1.35-1.75). With the presence of PFP, the OR increased to 2.02 (95% CI 1.66-2.45).

Conclusion

Pay-for-performance may influence not just psychological symptoms but also LBP in workers, particularly in conjunction with overtime work. The impact of management practices related to overtime work on health outcomes warrants further emphasis in research.

Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials

Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration-PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as "overall LBP improvement" outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.

Risk factors for low back pain in the Chinese population: a systematic review and meta-analysis

BACKGROUND

In China, the world's largest developing country, low back pain (LBP) is a common public health issue affecting workability. This meta-analysis aimed to systematically assess the risk factors of LBP in the Chinese population.

METHODS

Four English language and four Chinese databases were searched, and cross-sectional studies on the risk factors for LBP in Chinese populations were identified and collected. The search timeframe covered the period from the establishment of the database to November 2023. Two researchers independently reviewed the literature, extracted the data, and evaluated the risk of bias. Begg's and Egger's tests were used to evaluate publication bias.

RESULTS

Fifteen cross-sectional studies involving 86,575 people were included. Seven risk factors for LBP were identified. Six risk factors were statistically significant: Cigarette smoking (odds ratio [OR] = 1.55; 95% confidence interval [CI]: 1.15, 2.08, P = 0.004, I2 = 72%), body mass index (BMI) ≥ 28 kg/m² (OR = 4.51; 95% CI: 3.36, 6.07, P < 0.00001, I2 = 8%), female sex (OR = 1.54; 95% CI: 1.25, 1.90, P < 0.0001, I2 = 63%), vibration exposure at work (OR = 1.65; 95% CI: 1.16, 2.34, P = 0.006, I2 = 84%), working overtime (OR = 2.57; 95% CI: 1.12, 5.91, P = 0.03, I2 = 85%), and lack of exercise (OR = 2.48; 95% CI: 1.62, 3.78, P < 0.0001, I2 = 0%). One risk factor that was not statistically significant was standing for long periods (OR = 1.02; 95% CI: 0.82, 1.26, P = 0.88, I2 = 73%).

CONCLUSIONS

This study found that smoking, a BMI ≥ 28 kg/m², female sex, vibration exposure at work, working overtime, and lack of exercise may be risk factors for LBP in the Chinese population. Because the included studies were cross-sectional and the certainty of the evidence was very low, the results need to be interpreted cautiously. Multicentre, high-quality studies should be conducted in the future. To reduce the prevalence of LBP, the Chinese government and hospitals must develop early screening programs and implement effective preventive and interventional measures.

TRIAL REGISTRATION

This study is registered in the PROSPERO database (No. CRD42023447857).

Predisposition and Working Conditions for the Occurrence of Lumbar Syndrome in Medical Workers of the Clinical Center of Montenegro during the COVID-19 Pandemic

Background: Lumbar pain is a condition of discomfort in the lower back caused by numerous factors, lasting for short or longer periods of time. Healthcare professionals, regardless of the type of care they are engaged in, are at risk of lumbar pain. This is the first study that deals with the problem of lumbar syndrome in health workers in Montenegro. Methods: This cross-sectional study included full-time health workers employed in the Clinical Center of Montenegro who were involved in the treatment of COVID-19 patients during 2020 and 2021. The survey consisted of general questions for collecting socio-demographic and COVID-19 engagement data; the Modified Nordic questionnaire was used for the analysis of musculoskeletal symptoms, and the EQ-5D-questionnaire was used to measure the quality of life associated with health. Results: The one-year prevalence of lumbar pain was 68.1%. Factors associated with lumbar pain were as follows: a higher degree of physical inactivity (each subject with a higher degree of physical inactivity had a 24% higher chance of occurrence of lumbar pain); a higher degree of load and over-engagement during the COVID-19 pandemic (each subject with a higher degree of workload had a nearly 50% higher chance of occurrence of lumbar pain); duration of engagement during the COVID-19 pandemic (subjects engaged up to a month were 4 times more likely to develop lumbar pain, and subjects engaged for 1-3 months were 3.5 times more likely to develop lumbar pain compared to those who were not engaged in COVID-19 treatment). This study also confirms that lumbar syndrome affects the quality of life of health workers. Conclusions: Lumbar syndrome is highly prevalent among healthcare professionals in the Clinical Center of Montenegro, especially in the population of nurses, where evidence-based preventive measures are needed.

The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019

Background

Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging.

Methods

The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data.

Results

Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence.

Conclusions

In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Effectiveness of Back care education Programme among school children: a systematic review of randomized controlled trials

STUDY DESIGN

Systematic review of Randomised controlled trials.

OBJECTIVES

With the increasing incidence of back pain among children and its untold implications to their future, back education tailored in an effective way would be indicated. However literature appears unsettled. This study aims to review available literature to determine the effect of school-based back education in preventing and managing low back pain in school children.

METHODS

Randomized controlled trials carried out on elementary and secondary school children of ages 6 to 18 years and published in English language were included. Back education taught in hospitals or other settings were excluded. Primary outcome was back pain prevalence and secondary outcomes were constituted from the study characteristics of selected studies which includes: back behavior, knowledge, postural habits, physical activity, fear-avoidance beliefs, back pack carriage, pain intensity, skills and self efficacy. Databases searched were PEDro, HINARI, PubMed, Cochrane, and Google Scholar. Available stiudies from 2000 to March 2022 were retrieved. Quality of studies were assessed using the PEDro scale. Obtained studies were descriptively analyzed.

RESULTS

A total 8420 studies were retrieved and 8 studies (with 1239 participants) were included in this review. Four studies each assessed back knowledge and back behavior, and two assessed back pain prevalence. There were improvements in back knowledge and back behaviour, but effectiveness of back care education on back pain prevalence was not conclusive. Forms of education used involved the indirect method of conditioning the environment and the direct method which made use of theory, practical lessons and educational books and materials.

CONCLUSION

Back care education programmes in schools are effective in improving back care knowledge, behavior and reduction in low back pain frequency. Reduction in back pain prevalence is not conclusive. Back care education could be incorporated as part of schools' education programmes. Limitations include exclusion of non English language studies and inconsistent outcome measures.

FUNDING SOURCE

None.

REGISTRATION

This review protocol was registered under the International platform of Registered systematic review and meta-analysis protocol (INPLASY) with the registration number; INPLASY202310044 and DOI number; https://doi.org/10.37766/inplasy2023.1.0044.

Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study

The correction of postural weaknesses through the better positioning of the pelvis is an important approach in sports therapy and physiotherapy. The pelvic position in the sagittal plane is largely dependent on the muscular balance of the ventral and dorsal muscle groups. The aim of this exploratory study was to examine whether healthy persons use similar muscular activation patterns to correct their pelvic position or whether there are different motor strategies. The following muscles were recorded in 41 persons using surface electromyography (EMG): M. trapezius pars ascendens, M. erector spinae pars lumbalis, M. gluteus maximus, M. biceps femoris, M. rectus abdominis, and M. obliquus externus. The participants performed 10 voluntary pelvic movements (retroversion of the pelvis). The anterior pelvic tilt was measured videographically via marker points on the anterior and posterior superior iliac spine. The EMG data were further processed and normalized to the maximum voluntary contraction. A linear regression analysis was conducted to assess the relationship between changes in the pelvic tilt and muscle activities. Subsequently, a Ward clustering analysis was applied to detect potential muscle activation patterns. The differences between the clusters and the pelvic tilt were examined using ANOVA. Cluster analysis revealed the presence of four clusters with different muscle activation patterns in which the abdominal muscles and dorsal muscle groups were differently involved. However, the gluteus maximus muscle was involved in every activation pattern. It also had the strongest correlation with the changes in pelvic tilt. Different individual muscle patterns are used by different persons to correct pelvic posture, with the gluteus maximus muscle apparently playing the most important role. This can be important for therapy, as different muscle strategies should be trained depending on the individually preferred motor patterns.

Relationship between Fear-Avoidance Beliefs and Reaction Time Changes Prior to and following Exercise-Induced Muscle Fatigue in Chronic Low Back Pain

Background

Reaction time is a reliable indicator of the velocity and efficiency of neuromuscular control and may be associated with fear-avoidance beliefs. However, the effect of exercise-induced muscle fatigue on reaction time in chronic low back pain (cLBP) and its relationship with fear-avoidance beliefs remains poorly understood.

Objectives

This study aimed to reveal the relationship between fear-avoidance beliefs and reaction time changes before and after exercise-induced muscle fatigue in cLBP.

Methods

Twenty-five patients with cLBP were tested by the Biering-Sorensen test (BST) to induce exhaustive muscle fatigue. Total reaction time (TRT), premotor time (PMT), and electromechanical delay (EMD) of dominated deltoid muscle were recorded by surface electromyography during the arm-raising task with visual cues before and after muscle fatigue. The mean difference (MD) of TRT (MDTRT), PMT (MDPMT), and EMD (MDEMD) was calculated from the changes before and after muscle fatigue. Fear-avoidance beliefs questionnaire (FABQ) was applied to evaluate fear-avoidance beliefs before muscle fatigue. In addition, the duration time of BST was recorded for each subject.

Results

TRT and PMT of dominated deltoid muscle were prolonged after exercise-induced muscle fatigue (Z = 3.511, p < 0.001; t = 3.431, p = 0.001), while there was no statistical difference in EMD (Z = 1.029, p = 0.304). Correlation analysis showed that both the MDTRT and MDPMT were positively correlated with FABQ (r = 0.418, p = 0.042; r = 0.422, p = 0.040).

Conclusions

These findings suggested that we should pay attention to both muscle fatigue-induced reaction time delay in cLBP management and the possible psychological mechanism involved in it. Furthermore, this study implied that FABQ-based psychotherapy might serve as a potential approach for cLBP treatment by improving reaction time delay. This trial is registered with ChiCTR2300074348.

Having chronic back pain did not impact COVID-19 outcome in a low-income population - a retrospective observational study

INTRODUCTION

Chronic back pain (CBP) is a major cause of years lived with disability. Social inequalities increase the prevalence and burden of CBP. Management of CBP was affected by restricted access to non-pharmacological treatments and outdoor activities during COVID-19 pandemic.

OBJECTIVE

To determine the prevalence of CBP among patients with COVID-19 as well as the impact of having CBP in COVID-19 outcome in our low-income population.

METHODS

Retrospective cohort of individuals with confirmed COVID diagnosis from May 2020 - March 2021, at Hospital Regional UNIMED (HRU) in Fortaleza, Ceará, Brazil. Data included comorbidities and household income.

RESULTS

Among 1,487 patients, 600 (40.3%) were classified as having CBP. Mean age as well as income were similar in CBP and non-CBP groups, with more women in the CBP group. Hypertension and asthma, but not diabetes, were more prevalent in those with CBP. Need for emergency care, hospitalization, and admission to intensive care unit were similar regardless of having CBP. Dyspnea was more common in CBP vs. non-CBP groups, with 48.8% vs. 39.4% percentages, respectively (p = 0.0004).

CONCLUSION

Having CBP prior to COVID did not impact the acute clinical outcome of COVID individuals of a low-income population.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Occupation-based demographic, clinical, and psychological presentation of spine pain: A retrospective analysis of 71,727 patients from urban India

BACKGROUND

Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain.

OBJECTIVE

To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain.

METHODS

This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups.

RESULTS

The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups.

CONCLUSION

Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation.

Reallocating desk workers' sitting time to standing or stepping: associations with work performance

BACKGROUND

Studies have suggested that sitting time at work may lead to underperformance but they may underestimate the benefits to desk workers' performance of reducing occupational sitting time without considering the relative effects of the specific activities replaced.

AIMS

To estimate differences in work performance (presenteeism, absenteeism and engagement) when occupational sitting time is reallocated to standing/stepping in desk workers.

METHODS

Data for middle-aged desk workers were from a Japan-wide online survey (n = 2228). Self-report proportion of occupational sitting and standing/stepping, work hours and work performance indicators, including absolute (ratings relating only to self) and relative (ratings of self, compared to others) presenteeism and absenteeism, and dimensions of work engagement, were collected. Partition and isotemporal substitution models were used to investigate the associations of occupational sitting and standing/stepping time with work performance, including their reallocation effects.

RESULTS

In partition models, longer occupational sitting time was associated with a lower absolute presenteeism score (i.e. less productivity), lower absolute absenteeism (i.e. longer-than-expected work hours), and lower engagement. Longer occupational standing/stepping time was associated with lower absolute absenteeism and more engagement. Isotemporal substitution models showed that each hour of occupational sitting reallocated to standing/stepping was favourably associated with overall work engagement (B = 0.087; 95% confidence interval 0.051, 0.122) and its dimensions (B ranged from 0.078 to 0.092), but was not associated with presenteeism or absenteeism.

CONCLUSIONS

These findings suggest that management support and practical initiatives to encourage desk workers to replace portions of their sitting time with standing/stepping may contribute to enhanced work engagement.

Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

METHODS

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

RESULTS

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

CONCLUSIONS

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.