Cortical function and sensorimotor plasticity predict future low back pain after an acute episode: the UPWaRD prospective cohort study

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes (UPWaRD) study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N=120) participated in a prospective cohort study with six-month follow-up. Candidate predictors were selected from the neurobiological (e.g. sensorimotor cortical excitability assessed by sensory and motor evoked potentials, Brain Derived Neurotrophic Factor genotype), psychological (e.g. depression and anxiety), symptom-related (e.g. LBP history) and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with presence of low back pain at six months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress and pain catastrophizing were the strongest predictors (R2=0.47) of pain intensity at six months. Older age and higher pain catastrophizing were the strongest predictors (R2=0.30) of disability at six months. When LBP outcome was dichotomised, sensory cortex and corticomotor excitability, BDNF genotype, depression and anxiety, LBP history and baseline pain intensity, accurately discriminated those who did and did not report LBP at six months (c-statistic 0.91). This study identifies novel risk factors for future LBP after an acute episode that can predict an individuals pain intensity and level of disability at six-month follow-up, and accurately discriminate between those who will and will not report LBP at six months.

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Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

Physical Therapy ◽

10.2522/ptj.20150335 ◽

2016 ◽

Vol 96 (7) ◽

pp. 1049-1056 ◽

Cited By ~ 10

Author(s):

Corey B. Simon ◽

Trevor A. Lentz ◽

Mark D. Bishop ◽

Joseph L. Riley ◽

Roger B. Fillingim ◽

...

Keyword(s):

Working Memory ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Pain Catastrophizing ◽

Future Research ◽

Low Back ◽

Cross Sectional ◽

Daily Pain

Abstract Background Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. Objective The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. Design This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Method Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Results Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R2=.07, standardized beta=−.308, P=.041) and movement-evoked pain intensity (R2=.14, standardized beta=−.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. Limitations The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Conclusion Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.

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McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097327 ◽

2017 ◽

Vol 52 (9) ◽

pp. 594-600 ◽

Cited By ~ 14

Author(s):

Alessandra Narciso Garcia ◽

Lucíola da Cunha Menezes Costa ◽

Mark J Hancock ◽

Fabrício Soares de Souza ◽

Geórgia Vieira Freschi de Oliveira Gomes ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Treatment Effect ◽

Controlled Trial ◽

Low Back ◽

End Of Treatment ◽

Mckenzie Method ◽

Secondary Outcomes

BackgroundThe McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is one of the exercise approaches recommended by low back pain (LBP) guidelines. We investigated the efficacy of MDT compared with placebo in patients with chronic LBP.MethodsThis was a prospectively registered, two-arm randomised placebo controlled trial, with a blinded assessor. A total of 148 patients seeking care for chronic LBP were randomly allocated to either MDT (n=74) or placebo (n=74). Patients from both groups received 10 treatment sessions over 5 weeks. Patients from both groups also received an educational booklet. Clinical outcomes were obtained at the end of treatment (5 weeks) and 3, 6 and 12 months after randomisation. Primary outcomes were pain intensity and disability at the end of treatment (5 weeks). We also conducted a subgroup analysis to identify potential treatment effect modifiers that could predict a better response to MDT treatment.ResultsThe MDT group had greater improvements in pain intensity at the end of treatment (mean difference (MD) −1.00, 95% CI −2.09 to −0.01) but not for disability (MD −0.84, 95% CI −2.62 to 0.93). We did not detect between-group differences for any secondary outcomes, nor were any treatment effect modifiers identified. Patients did not report any adverse events.ConclusionWe found a small and likely not clinically relevant difference in pain intensity favouring the MDT method immediately at the end of 5 weeks of treatment but not for disability. No other difference was found for any of the primary or secondary outcomes at any follow-up times.Trial registration numberClinicalTrials.gov (NCT02123394)

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Double-blind, pragmatic, randomized placebo-controlled trial of 8-week self-administered at-home behavioral skills-based virtual reality (VR) for chronic low back pain (during COVID-19) (Preprint)

10.2196/preprints.26292 ◽

2020 ◽

Author(s):

Beth Darnall ◽

Laura Garcia ◽

Brandon Birckhead ◽

Parthasarathy Krishnamurthy ◽

Ian Mackey ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

User Satisfaction ◽

Pain Catastrophizing ◽

Controlled Trial ◽

Low Back ◽

Average Pain Intensity ◽

Average Pain

BACKGROUND Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. OBJECTIVE To conduct a double-blind, parallel arm, single cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. METHODS A national online convenience sample of individuals with self-reported non-malignant low back pain > 6 months duration and with average pain intensity > 4/10 was enrolled and randomized 1:1 to one of two 56-day VR programs: (1) EaseVRx (pain relief skills immersive VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were change in average pain intensity and pain-related interference with activity, stress, mood, and sleep (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. RESULTS The study sample was 179 adults (female: 77%; Caucasian: 91%; at least some college education: 92%; mean age: 51.5 years, SD=13.1; average pain intensity: 5/10, SD=1.2; back pain duration >5 years: 67%). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx vs. Sham VR (p<0.0001). Both groups improved significantly for all five primary outcomes; EaseVRx was superior to Sham VR for all primary outcomes except pain-related sleep interference. For EaseVRx, large pre-post effect sizes ranged from 1.06-1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. A greater proportion of participants in the EaseVRx group achieved > 30% reduction in pain intensity (EaseVRx: 65.5%; Sham VR: 40.5%), and 46% of EaseVRx achieved >50% reduction in pain. Physical function and sleep disturbance significantly improved for both treatment groups with superior improvements found for EaseVRx (p=0.0019 and p=.0353, respectively). Pain catastrophizing, pain self-efficacy, prescription opioid use (morphine milligram equivalent; MME) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (p<0.01) but not for Sham VR. CONCLUSIONS EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand non-pharmacologic treatment for chronic low back pain. CLINICALTRIAL ClinicalTrials.gov, NCT04415177 https://clinicaltrials.gov/ct2/show/NCT04415177 INTERNATIONAL REGISTERED REPORT RR2-25291

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Auto-Targeted Neurostimulation Is Not Superior to Placebo in Chronic Low Back Pain: A Fourfold Blind Randomized Clinical Trial

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.e707 ◽

2016 ◽

Vol 5;19 (5;19) ◽

pp. E707-E719

Author(s):

Jo Nijs

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Health Beliefs ◽

Pain Catastrophizing ◽

Controlled Trial ◽

Trigger Points ◽

Low Back ◽

Mechanical Pressure ◽

Randomized Controlled

Background: Myofascial trigger points (MTrPs) are common in people with musculoskeletal pain and may play a role in chronic nonspecific low back pain (CLBP). One of the potential treatments of MTrPs is the Nervomatrix Soleve® auto-targeted neurostimulation device, providing targeted transcutaneous electrical nerve stimulation (TENS) to MTrPs in the lower back muscles. To date, no controlled studies have evaluated the effectiveness of this device for the pain management of this population. Objective: To examine whether the Nervomatrix Soleve® auto-targeted neurostimulation device is superior over placebo for the treatment of CLBP. Study Design: A fourfold-blind randomized controlled trial was conducted. Setting: Brussels University Hospital, health care centers and pharmacies around Belgium. Methods: Participants with CLBP for at least 3 months were randomly assigned to the experimental (the Nervomatrix Soleve® auto-targeted neurostimulation device providing TENS-stimulation and mechanical pressure) or placebo group (the Nervomatrix Soleve® autotargeted neurostimulation device providing mechanical pressure alone without current). The treatment protocol in both groups consisted of 6 treatment sessions per patient. Participants were evaluated at baseline prior to the intervention, immediately following treatment, and at one month follow-up. Pain and pain behavior (steps climbed) were assessed as primary outcome measures. Secondary outcome measures were pain functioning, health beliefs, symptoms of central sensitization, pain catastrophizing, and kinesiophobia. Results: In total, 39 participants were included in the study. Participants in both groups improved significantly for pain and functioning, but no significant differences were observed between groups. These improvements were not clinically meaningful for any of the reported measures. The health beliefs changed significantly in both groups (P < 0.05), with superior results at follow-up in the placebo group. Limitations: The follow-up period is limited to one month. Conclusions: Treatment of MTrPs with the Nervomatrix Soleve® auto-targeted neurostimulation device in patients with CLBP does not result in a better outcome than placebo-treatment in terms of pain, pain behavior, functioning, central sensitization, pain catastrophizing, and health beliefs. Key words: Low back pain, chronic pain, randomized controlled trial, electric stimulation therapy, trigger points

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A Randomized Clinical Trial Comparing the Effectiveness of Electroacupuncture versus Medium-Frequency Electrotherapy for Discogenic Sciatica

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/9502718 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Xue Zhang ◽

Yang Wang ◽

Zhao Wang ◽

Chao Wang ◽

Wentao Ding ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Rating Scale ◽

Leg Pain ◽

Secondary Outcome ◽

Low Back ◽

Medium Frequency

Objective. To investigate the short- and long-term effects of electroacupuncture (EA) compared with medium-frequency electrotherapy (MFE) on chronic discogenic sciatica.Methods. One hundred participants were randomized into two groups to receive EA (n=50) or MFE (n=50) for 4 weeks. A 28-week follow-up of the two groups was performed. The primary outcome measure was the average leg pain intensity. The secondary outcome measures were the low back pain intensity, Oswestry Disability Index (ODI), patient global impression (PGI), drug use frequency, and EA acceptance.Results. The mean changes in the average leg pain numerical rating scale (NRS) scores were 2.30 (1.86–2.57) and 1.06 (0.62–1.51) in the EA and MFE groups at week 4, respectively. The difference was significant (P<0.001). The long-term follow-up resulted in significant differences. The average leg pain NRS scores decreased by 2.12 (1.70–2.53) and 0.36 (−0.05–0.78) from baseline in the EA and MFE groups, respectively, at week 28. However, low back pain intensity and PGI did not differ significantly at week 4. No serious adverse events occurred.Conclusions. EA showed greater short-term and long-term benefits for chronic discogenic sciatica than MFE, and the effect of EA was superior to that of MFE. The study findings warrant verification. This trial was registered under identifierChiCTR-IPR-15006370.

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The Understanding persistent Pain Where it ResiDes study of low back pain cohort profile

10.1101/2021.11.24.21266794 ◽

2021 ◽

Author(s):

Luke C Jenkins ◽

Wei-Ju Chang ◽

Valentina Buscemi ◽

Matthew Liston ◽

Michael Nicholas ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Catastrophizing ◽

Persistent Pain ◽

Moderate Physical Activity ◽

Low Back ◽

Baseline Characteristics

Background: Despite chronic low back pain (LBP) being considered a biopsychosocial condition for diagnosis and management, few studies have investigated neurophysiological and neuro-biological risk factors thought to underpin the transition from acute to chronic LBP. The aim of this cohort profile is to describe the methodology, compare baseline characteristics between acute LBP participants and pain-free controls, and compare LBP participants with or without completed follow-up. Methods: 120 individuals experiencing acute LBP and 57 pain-free controls were recruited to participate in the Understanding Persistent Pain Where it Resides (UPWaRD) study. Screening was conducted via email and phone. Neuro-biological, psychological, and sociodemographic data were collected at baseline, three- and six-months. LBP status was assessed using the numerical rating scale and Roland-Morris disability questionnaire at three and six-month follow-up. Results: 95 participants (79%) provided outcome data at three-month follow-up and 96 participants (80%) at six-months. Participants who did not complete follow-up at three- and six-months within the UPWaRD LBP cohort had higher psychological distress, higher pain interference, higher levels of moderate physical activity, and reported occupational difficulties due to pain (P = <0.05). Compared to controls, LBP participants in the UPWaRD cohort were older, had a higher BMI, a higher prevalence of comorbidities and higher medication usage. Higher depression, anxiety and stress, lower pain self-efficacy and higher pain catastrophizing during acute LBP were correlated with higher six-month pain and disability (P = < 0.01). Conclusions: This cohort profile reports baseline characteristics of the UPWaRD LBP and pain-free control cohort.

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An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19

Journal of Medical Internet Research ◽

10.2196/26292 ◽

2021 ◽

Vol 23 (2) ◽

pp. e26292

Author(s):

Laura M Garcia ◽

Brandon J Birckhead ◽

Parthasarathy Krishnamurthy ◽

Josh Sackman ◽

Ian G Mackey ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

User Satisfaction ◽

Pain Catastrophizing ◽

Controlled Trial ◽

Low Back ◽

Average Pain Intensity ◽

Average Pain

Background Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. Objective We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. Methods A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between–within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. Results The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre–post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. Conclusions EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. Trial Registration ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID) RR2-10.2196/25291

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Morning Bright Light Treatment for Chronic Low Back Pain: Potential Impact on the Volatility of Pain, Mood, Function, and Sleep

Pain Medicine ◽

10.1093/pm/pnz235 ◽

2019 ◽

Vol 21 (6) ◽

pp. 1153-1161

Author(s):

John W Burns ◽

James Gerhart ◽

Muneer Rizvydeen ◽

Momoko Kimura ◽

Helen J Burgess

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Negative Affect ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Bright Light ◽

Light Treatment ◽

Low Back ◽

Bright Light Treatment

Abstract Objectives Most treatment outcome studies for people with chronic low back pain (CLBP) have based analyses on and reported only the mean levels of these factors. However, high levels of pain, mood, function, and sleep volatility may represent unique factors contributing to diminished quality of life. Our goal was to determine whether bright light treatment affected both mean levels of pain, mood, function, and sleep and reduced volatility in these outcomes. Methods US military veterans with CLBP (N = 22) underwent an open trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at their home and a 30-day follow-up. Participants completed daily diary measures at 12 Pm and 6 Pm every day during the three study epochs. Results Using location scale modeling, results suggested that, in addition to being associated with changes in mean levels of pain intensity, pain interference, negative affect, and sleep quality, bright light treatment was also related to reductions in the volatility of pain intensity and negative affect, reductions that were largely maintained during follow-up. Conclusions Changes in mean levels and volatility were independent factors, suggesting that bright light treatment was related to participants experiencing fewer “pain flares.” These findings underscore the potential importance of volatility as a future treatment target.

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Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm9061726 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1726

Author(s):

Scott D. Tagliaferri ◽

Clint T. Miller ◽

Jon J. Ford ◽

Andrew J. Hahne ◽

Luana C. Main ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Muscle Strength ◽

Pain Intensity ◽

Self Report ◽

Low Back ◽

Strength And Conditioning ◽

Leg Muscle ◽

Trunk Extension

Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC; n = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; n = 20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; p < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; p = 0.001) and endurance (9.1 (1.7, 16.4) reps; p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts; p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; p < 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.

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Associations of objectively measured forward bending at work with low-back pain intensity: a 2-year follow-up of construction and healthcare workers

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105861 ◽

2019 ◽

Vol 76 (9) ◽

pp. 660-667 ◽

Cited By ~ 1

Author(s):

Lars-Kristian Lunde ◽

Markus Koch ◽

Suzanne Lerato Merkus ◽

Stein Knardahl ◽

Morten Wærsted ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Healthcare Workers ◽

Construction Workers ◽

Low Back ◽

Significance Level ◽

Forward Bending ◽

Objectively Measured

ObjectivesThis study aimed to determine possible associations between objectively measured forward bending at work (FBW) and low-back pain intensity (LBPi) among Norwegian construction and healthcare workers.MethodsOne-hundred and twenty-five workers wore two accelerometers for 3–4 consecutive days, during work and leisure to establish duration of ≥30° and ≥60° forward bending. The participating workers reported LBPi (0–3) at the time of objective measurements and after 6, 12, 18 and 24 months. We investigated associations using linear mixed models with significance level p≤0.05 and presented results per 100 min.ResultsThe duration of ≥30° and ≥60° FBW was not associated with average LBPi during follow-up, neither for the total sample nor stratified on work sector. Furthermore, analyses on all workers and on construction workers only found no significant association between ≥30° or ≥60° FBW and change in LBPi over the 2-year follow-up. For healthcare workers we found a consistent significant association between the duration of ≥30° FBW at baseline and the change in LBPi during follow-up, but this was not found for ≥60° FBW.ConclusionsThis study suggests that objectively measured duration of FBW in minutes is not associated with average levels of, or change in LBPi in construction workers over a 2-year period. In healthcare workers, exposure to ≥30° FBW was associated with change in LBPi, while we did not find this for ≥60° FBW. Results may indicate that the associations between FWB and LBP vary depending on type of work tasks, gender or sector-specific factors.

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