Associations of objectively measured sitting and standing with low-back pain intensity: a 6-month
                    follow-up of construction and healthcare workers

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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Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2678-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Annika Taulaniemi ◽

Markku Kankaanpää ◽

Kari Tokola ◽

Jari Parkkari ◽

Jaana H. Suni

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomised Controlled Trial ◽

Pain Intensity ◽

Physical Functioning ◽

Healthcare Workers ◽

Controlled Trial ◽

Secondary Analysis ◽

Low Back ◽

Randomised Controlled

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

10.1101/2021.07.14.21260552 ◽

2021 ◽

Author(s):

Luke Christopher Jenkins ◽

Wei-Ju Chang ◽

Valentina Buscemi ◽

Matthew Liston ◽

Peter Humburg ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Pain Catastrophizing ◽

Acute Episode ◽

Sensory Cortex ◽

Low Back ◽

Depression And Anxiety ◽

Baseline Pain Intensity

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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Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03731-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jonas Vinstrup ◽

Markus D. Jakobsen ◽

Pascal Madeleine ◽

Lars L. Andersen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Prospective Cohort ◽

Healthcare Workers ◽

Assistive Devices ◽

Patient Transfer ◽

Back Injury ◽

Low Back ◽

Physical Exposure

Abstract Background Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs. Methods By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure. Results Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively. Conclusions Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

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Physical Exposure during Patient Transfer and Risk of Back Injury & Low-back Pain: Prospective Cohort Study

10.21203/rs.3.rs-16870/v1 ◽

2020 ◽

Author(s):

Jonas Vinstrup ◽

Markus D Jakobsen ◽

Pascal Madeleine ◽

Lars L Andersen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Prospective Cohort ◽

Healthcare Workers ◽

Assistive Devices ◽

Patient Transfer ◽

Back Injury ◽

Low Back ◽

Physical Exposure

Abstract BackgroundWork-related musculoskeletal disorders (MSDs) are more common among healthcare workers compared with most other professions. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly used assistive devices and to investigate associations between accumulated physical exposure during patient transfer and risk of MSDs.MethodsBy applying an exposure matrix based on measure¬ments of electromyography and trunk flexion on a large (n=1285) prospective cohort, intensity of low-back pain (LBP) and risk of back injury at 1-year follow-up were modelled using a linear model and logistic regressions, respectively. The cohort was divided into groups based on physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.ResultsExposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p=0.0085). No differ-ence was found between the moderate and high exposure groups (p=0.2967). Likewise, we find no associations between physical exposure and risk of back injury at 1-year follow-up, with a prevalence of 11%, 13% and 11% for the three groups, respectively. ConclusionsLow physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associ¬ated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the prevalence of MSDs among healthcare workers.

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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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Individualised exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability

10.1101/2021.12.16.21267900 ◽

2021 ◽

Author(s):

Johannes Fleckenstein ◽

Philipp Floessel ◽

Tilman Engel ◽

Laura Klewinghaus ◽

Josefine Stoll ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Meta Analysis ◽

Group Analysis ◽

Low Back ◽

Short Term ◽

Long Term Follow Up

Objective To investigate the effects of individualised exercise interventions consisting with or without combined psychological intervention on pain intensity and disability in patients with chronic non-specific low back pain. Design Systematic review with meta-analysis and meta-regression. Data sources Five databases (PubMed, Cochrane Central, EMBASE, Clarivate Web of Science, and Google Scholar) were searched up to 31 March 2021. Selection criteria Randomised controlled trials were eligible if they included participants with chronic non-specific low back pain, compared at least one individualised/personalised/stratified exercise intervention with or without psychological treatment to any control / comparator group, and if they assessed at least pain intensity or disability as outcome measure. Results Fifty-eight studies (n = 9099 patients, 44.3 years, 56% female) compared individualised to other types of exercise (n = 44; 62%), usual care (n = 16; 23%), advice to stay active, or true controls. The remaining studies had passive controls. At short-term follow-up, low-certainty evidence for pain intensity (SMD -0.33 [95%CI -0.47 to -0.18]) and very low-certainty evidence for disability (-0.16 [-0.30 to -0.02]) indicates effects of individualised exercise compared to other exercises. Very low-certainty evidence for pain intensity (-0.35; [-0.53 to -0.17])) and low-certainty evidence for disability (-0.12; [-0.22 to -0.02]) indicates effects compared to passive controls. At long-term follow-up, moderate-certainty evidence for pain intensity (-0.14 [-0.23 to -0.06]) and disability (-0.23 [-0.33 to -0.12]) indicates effects compared to passive controls exercises. All findings stayed below the threshold for minimal clinically important difference (MCID). Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Sensitivity analyses indicated that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Sub-group analysis of pain outcomes suggested that individualised exercise treatment is probably more effective in combination with psychological interventions (-0.32 [-0.51 to -0.14]), a clinically important difference Conclusion We found very low to moderate-certainty evidence that individualised exercise is effective for treatment of chronic non-specific low back pain. Individualised exercise seems superior to other active treatments and sub-group analysis suggests that some forms of individualised exercise (especially motor-control based treatments) combined with behavioural therapy interventions enhances the treatment effect. Certainty of evidence was higher for long-term follow-up. In summary, individualised exercise can be recommended from a clinical point of view.

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