Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Low Back Pain Recurrence in Occupational Environments Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions. Pelvis-Thorax Coordination in the Transverse Plane During Walking in Persons With Nonspecific Low Back Pain Is Work Status of Low Back Pain Patients Best Described by an Automated Device or by a Questionnaire? Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects The effect of exercise on the intensity of low back pain in pregnant women. Stretching in the Rehabilitation of Low-Back Pain Patients Evidence-based medicine and the challenge of low back pain: where are we now? Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Level of Distress in a Recurrent Low Back Pain Population Referred for Physical Therapy Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers Effects of dynamic office chairs on trunk kinematics, trunk extensor EMG and spinal shrinkage Reliability and Validity of a New Objective Tool for Low Back Pain Functional Assessment Decreased limits of stability in response to postural perturbations in subjects with low back pain. Patient perceptions of physical therapy within a trial for back pain treatments (UK BEAM) [ISRCTN32683578]. Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. The Association Between Physical Workload and Low Back Pain Clouded by the “Healthy Worker” Effect: Population-Based Cross-Sectional and 5-Year Prospective Questionnaire Study Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study
OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Study Design . Prospect i ve assessment of return to work after low back pain . Objective . To determine which factors or combination of factors best predict recurrence of low back pain ( defined 4 different ways ) when returning to full-duty work . Summary of Background Data . Recurrent back pain is one of the more costly health problems facing industry today . Few systematic evaluations of the various factors suspected of exacerbating low back pain have been reported in the literature . Methods . A total of 206 workers who reported low back pain were evaluated as they returned to full-duty work .  Five types of assessment s were performed including : 1 ) a  low back kinematic functional assessment s  , 2 )  evaluation of job physical dem and s  , 3 )  psychosocial assessment of the job environment , 4 )  self-reported impairment including perception of symptoms and psychological measures  , and 5 )  personal ( individual ) factors . One year after return to full duty workers were interviewed to assess who had a recurrence of low back pain according to 4 different definitions of low back pain ( symptom reports , medical visits , self-reported lost days , and employer-reported lost days due to back pain ) . Multiple logistic regression models were developed to assess the best combinations of predictors . Results . The most liberal definition of recurrence , recurrent symptoms , had a significantly greater recurrence rate at 58 % than all other outcome measures ( P = 0.0001 ) . The medical visit recurrence rate of 36 % was significantly greater than the more conservative lost time measures ( P = 0.0001 ) . The recurrence rate for self-reported lost time was 15 % , whereas the more conservative employer confirmed lost time measure was significantly lower at 10 % ( P = 0.0077 ) . Multivariate predictive models associated with the various recurrence definitions yielded sensitivities varying between 78 % and 80 % and specificity between 73 % and 80 % . Conclusion . Recurrence is greatly dependent on how one defines recurrence with symptom reporting yielding 5.5 times as many recurrences compared with employer confirmed lost time . In general , more quantitative measures of worker musculoskeletal function yielded the best predictions of recurrence when predicting the more restrictive definitions of recurrence ( employer confirmed lost time ) BACKGROUND Low back disorders are a prevalent problem in society today and may lead to chronic debilitating low back pain . Developing our underst and ing of temporal muscle and kinematic patterns during manual material h and ling tasks may provide insight for preventing the cascading series of events leading to chronic low back pain . METHODS Sixty-two low back pain patients and 61 asymptomatic participants performed a variety of lifting exertions  that varied in lift origin horizontal and vertical distance , lift asymmetry , and weight . Electromyographic activity of 10 trunk muscles as well as trunk and pelvic kinematics was recorded during each exertion . Differences in muscle activation and kinematic parameters were compared between low back pain patients and asymptomatic participants as a function of experimental conditions . FINDINGS Both the left and right erector spinae activated significantly earlier and were on significantly longer in low back pain patients compared to asymptomatic participants . The horizontal and vertical location of the lift influenced the EMG and kinematic differences between the low back pain patients and asymptomatic participants . INTERPRETATION These finding indicate that low back pain patients would be exposed to increase muscle activity result ing in higher spine loads for a greater length of time compared to asymptomatic participants . The longer exposure time to increased spine load may lead to greater risk of future low back injury and cascading events leading to debilitating low back pain . The longer muscle activation time suggests that low back pain patients have changed their motor program from an open to a closed loop system Study Design . Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants . Objectives . To gain insight into the consequences of low back pain for gait and to identify clinical ly useful measures for characterizing the quality of walking in patients with low back pain . Summary of Background Data . Gait studies in patients with low back pain have reported a decrease in walking velocity . In normal gait , in-phase pelvis-thorax coordination ( synchronicity ) evolves toward antiphase coordination ( counterrotation ) as walking velocity increases . This study examined the effect of walking velocity on  pelvis and thorax rotations  in patients with low back pain . Methods .  Amplitudes of pelvis and thorax rotations  were calculated , and spectral analyses were performed . Pelvis-thorax coordination was characterized in terms of relative Fourier phase , and coupling strength was assessed by means of cross-spectral analysis . Results . In comparison with healthy participants , relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher , whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h . No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations . Conclusion . In comparison with healthy participants , the gait of patients with low back pain was characterized by a more rigid , less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations . This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations , and that conservative therapy should use methods aim ed at improving intersegmental coordination Study Design . A prospect i ve cohort study of patients with subacute occupational back pain . Objectives . To study the relation between a marketed opto‐electric device measuring trunk kinematics , a widely used specific functional capacity question naire , and work status in back pain patients , and to assess the responsiveness to change in work status of the opto‐electric device and the question naire . Summary of Background Data . Several instruments have been developed to evaluate the functional capacities of patients with back pain , but the relation between these instruments and work status has rarely been studied . Methods . The relation between the opto‐electric device , the question naire , and work status in patients with back pain was evaluated . The study population was a prospect i ve cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks . All data were compiled blindly on the same day , at study entry ( 4 weeks after work accident ) , and at 12 , 24 , and 52 weeks after the work accident . The validity of the question naire and opto‐electric device scores was assessed with partial correlation analyses , st and ardized response mean , logistic regression analyses , and receiver operating characteristics curves . Results . The correlation between the question naire and opto‐electric device scores was low . The question naire scores were significantly related to work status , but the opto‐electric device scores were not . The question naire was responsive to change in work status , whereas the opto‐electric device was not . Conclusions . The opto‐electric device scores were not related to either functional capacity scores ( question naire ) or work status in patients with low back pain , and the opto‐electric device was not responsive to change in work status . Conversely , the question naire was related to work status and was responsive to change in work status BACKGROUND Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain ( cLBP ) . Osteopathy is a discipline emphasizing the conservative treatment of the disease in an olistic vision . We design ed a r and omized controlled study to investigate whether Osteopathic Manipulative Treatment ( OMT ) combined with specific exercises ( SE ) is more effective than SE alone in obese patients with cLBP . METHODS nineteen obese females with cLBP , r and omized into 2 groups :  SE + OMT and SE were studied during the forward flexion of the spine using an optoelectronic system . A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest . OUTCOME MEASURES kinematic of the thoracic and lumbar spine and pelvis during forward flexion , pain according to a visual analogue scale ( VAS ) , Rol and Morris Disability Question naire and Oswestry Low Back Pain Disability Question naire . RESULTS significant effects on kinematics were reported only for OMT + SE with an improvement in thoracic range of motion of nearly 20 % . All scores of the clinical scales used improved significantly . The greatest improvements occurred in the OMT + SE group . CONCLUSIONS combined rehabilitation treatment including Osteopathic Manipulative Treatment ( OMT + SE ) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP . Such results are to be attributed to OMT , since they were not evident in the SE group . We also observed a reduction of disability and pain . The clinical results should be considered preliminary due to the small sample size The effect of  low back pain , with or without nerve root signs , on the joint coordination and kinematics of the lumbar spine and hips during everyday activities , such as picking up an object from the floor , are largely unknown . An experimental study was design ed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute low back pain , while picking up an object in a sitting position . A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips . Sixty participants with subacute low back pain , with or without straight leg raise signs , and twenty healthy asymptomatic participants were recruited . The ranges of motions of lumbar spine and hips were determined . Movement coordination between the two regions was examined by cross-correlation . Results showed that mobility was significantly reduced in subjects with back pain , who compensated for limited motion through various strategies . The contribution of the lumbar spine relative to that of the hip was , however , found to be similar in all groups . The lumbar spine – hip joint coordination was substantially altered in subjects with back pain , in particular , those with a positive straight leg raise sign . We conclude that changes in the lumbar and hip kinematics were related to back pain and limitation in straight leg raise . Lumbar – hip coordination was mainly affected by the presence of positive straight leg raise sign when picking up an object in a sitting position OBJECTIVE To investigate the effect of exercise during pregnancy on the intensity of  low back pain  and kinematics of spine . METHOD A prospect i ve r and omized study was design ed . 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group . All filled a question naire between 17 - 22 weeks of gestation and 12 weeks later for assessment of their back pain intensity . Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test , respectively , at the same times . Weight gain during pregnancy , Pregnancy length and neonatal weight were recorded . RESULT Low back pain intensity was increased in the control group . The exercise group showed significant reduction in the intensity of low back pain after exercise ( p<0.0001 ) . Flexibility of spine decreased more in the exercise group ( p<0.0001 ) . Weight gain during pregnancy , pregnancy length and neonatal weight were not different between the two groups . CONCLUSION Exercise during second half of the pregnancy significantly reduced the intensity of low back pain , had no detectable effect on lordosis and had significant effect on flexibility of spine The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematic ally applied , aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients . The effect(s ) of the proposed stretching maneuver was evaluated . Twenty-eight chronic low-back pain patients were r and omly assigned to one of two groups . The control group underwent a multimodal rehabilitation program , and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation . The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors , with corresponding significant increase in back muscle myoelectric signals . Also , a significant decrease in their pain level was reported after 2 weeks of continuous treatment . The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group Low  back pain  has long been described as a challenge for both primary care physicians and specialists . Management of  low back pain  has also been criticized as frequently arbitrary , inappropriate , or ineffective . Contributing factors have been an inadequate evidence base and a need for more rigorous appraisal s of the available literature . Evidence -based medicine , an approach to clinical problem solving , is predicated on the premise that high- quality health care will result from practice s consistent with the best evidence . In contrast to the traditional medical paradigm that placed a heavy reliance on expert opinion , authority , and un systematic clinical observations , evidence -based medicine emphasizes the need for rigorous critical appraisal s of the scientific literature to inform medical decision making . Evidence -based medicine places strong weight on the requirement for valid studies , particularly r and omized controlled trials , to appropriately evaluate the effectiveness of health care interventions . Because of the rapidly increasing volume of medical literature , however , most clinicians are unable to keep up-to- date with all the new data . Two types of preprocessed evidence that can aid busy clinicians in medical decision making are systematic review s and evidence -based clinical practice guidelines . Like primary studies , systematic review s and clinical practice guidelines must adhere to high method ologic st and ards to reduce error and bias . As in other areas of medicine , the approach to the management of low back pain has been positively affected by the availability of more clinical trials and better use of critical appraisal techniques to evaluate and apply research findings . In addition to more rigorous primary studies , an increasing number of high- quality systematic review s and evidence -based clinical practice guidelines for low back pain are also available . Although some research gaps and method ologic shortcomings persist , the richer evidence base has greatly improved our underst and ing of what does and does not work for low back pain . Despite these advances , the best available evidence often does not inform everyday clinical decisions for low back pain . Nonetheless , there is widespread agreement that adherence to evidence -based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care . This article review s basic principles of evidence -based medicine , discusses evidence -based medicine in the context of low back pain management , and summarizes some useful evidence -based medicine re sources OBJECTIVE To determine whether body balance is perturbed more in low back pain patients than in healthy subjects , under the concept of posturo-kinetic capacity . DESIGN Comparison of posturographic and respiratory parameters between low back pain and healthy subjects . BACKGROUND It has been demonstrated that respiratory movements constitute a perturbation to posture , compensated by movements of the spine and of the hips , and that low back pain is frequently associated with a loss of back mobility . METHOD Ten low back pain patients and ten healthy subjects performed five posturographic tests under three different respiratory rate conditions : quiet breathing ( spontaneous ) , slow breathing ( 0.1 Hz ) and fast breathing ( 0.5 Hz ) . RESULTS Intergroup comparison showed that the mean displacements of the center of pressure were greater for the low back pain group , especially along the antero-posterior axis , where respiratory perturbation is primarily exerted . Inter-condition comparison showed that in slow and fast breathing relatively to quiet breathing , the mean displacement of the center of pressure along the antero-posterior axis was significantly increased only for the low back pain group . CONCLUSION According to the results , respiration presented a greater disturbing effect on body balance in low back pain subjects . RELEVANCE This study provides information on the causes of the impaired body balance associated with chronic low back pain , which could be used to improve treatment strategy Study Design . Recruitment phase of a r and omized clinical trial . Objectives . To review the published literature on the use of the  distress risk assessment method in different back pain population s and healthcare setting s and compare results with those obtained from the current trial . Summary of Background . Psychological distress in low back pain is commonplace , and distress increases the relative risk of poor outcome with physical treatment alone . The  Distress and Risk Assessment Method  is a tool for use in the clinical setting to assist in the identification of distress and clinical decision-making . Methods . The  Distress Risk Assessment Method and Rol and Morris Disability Question naire were used to assess eligibility of patients with recurrent low back pain for recruitment into a r and omized clinical trial examining different physical therapy approaches . Results . In total , 221 patients were assessed , result ing in 212 correctly complete question naires . Of those 212 , 71 ( 33 % ) showed evidence of marked distress ( 41 depressed and 30 somatic ) . Functional disability , measured using the Rol and Morris Disability Question naire , was higher for the distressed group ( mean 14.1 , SD 4.8 , range 3–23 ) than the nondistressed group ( mean 8.0 , SD 5.1 , range 0–21 ) . Distress and anxiety measured using the distress risk assessment method were correlated to self-reported back-related functional disability . Conclusions . Distress associated with low back pain is common with one third of patients referred for physical therapy at the units studied exhibiting a level of distress that increased their relative risk of poor outcome by 3 to 4 times . Clinical ly , screening this group of patients may help indicate when liaison with other professionals is appropriate and possibly identify those patients who may be too distressed to respond to physical therapy intervention alone Context Lumbar supports are commonly used to prevent low back pain , but evidence on their effectiveness is lacking . Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits , with or without worker-directed use of a lumbar support . Over 12 months , participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only . Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence , but not absenteeism , among workers with previous low back pain . The Editors Low back pain is a common problem that results in high medical expenses , work absenteeism , and disability ( 1 ) . The reported 1-year prevalence ranges from 15 % to 40 % in a general population ( 2 ) and from 44 % to 72 % among home care workers ( 3 , 4 ) . Various ergonomic aids are marketed for the prevention of low back pain . Workers frequently use lumbar supports to prevent back pain ( 5 ) , but the effectiveness of such supports remains unclear . Recent systematic review s of the sparse evidence on lumbar supports ( 6 , 7 ) concluded that no evidence exists for the effectiveness of  lumbar supports  in the primary prevention of low back pain in the workplace , but 2 of the 4 included r and omized , controlled trials ( 8 , 9 ) reported that lumbar supports might be effective in workers with a history of low back pain ( secondary prevention ) . However , these findings were derived from subgroup analyses , and evidence from direct research on secondary prevention was not available . In cohort studies , a history of low back pain proved to be a strong predictor for the incidence of new episodes of low back pain ( 1012 ) . Home care workers with a history of low back pain may therefore be well suited to secondary preventive measures . In a previous uncontrolled feasibility study , we found that home care workers who had frequent episodes of low back pain reported adherence rates of 61 % to 81 % with lumbar supports and a 45 % decrease in pain intensity when using lumbar supports ( 13 ) . We design ed the current trial to evaluate the effectiveness of adding worker-directed use of lumbar supports to a short course on healthy working methods to reduce low back pain and work absenteeism among home care workers with a history of low back pain . Methods Design Our r and omized , controlled trial included 2 groups . The control group received a short refresher course on healthy working methods provided by their employer at the start of their employment ( Appendix ) ; primary and secondary care for the management of low back pain was available as usual ( 14 ) . The intervention group received a lumbar support in addition to usual care . The intervention and data collection continued for 12 months after enrollment . The Medical Ethical Committee of the Erasmus University Medical Center , Rotterdam , the Netherl and s , approved the study . Participants All participants were recruited from employees of a large home care organization in Rotterdam . During staff meetings , all present team members completed a brief survey about study inclusion criteria that was distributed and collected by the team managers . We included persons who performed medical care or domestic tasks as a home care worker , were experiencing low back pain symptoms at the time of inquiry or had experienced 2 or more episodes ( on 2 consecutive days ) of low back pain symptoms in the 12 months before the inquiry , did not have specific low back pain ( for example , due to rheumatoid arthritis or vertebral fractures ) , and were not pregnant at the start of the study . Because of a possible association between lumbar supports and increased blood pressure and heart rate , we excluded workers receiving medical treatment for high blood pressure ( 15 ) . Employees who met the inclusion criteria received detailed information about the trial , and those who agreed to participate provided written consent . R and omization In the Netherl and s , home care workers provide 1 of 8 functions , each of which requires different skills and tasks . To ensure a balance in workload and working conditions between the 2 study groups , we stratified r and omization by these 8 functions . We also stratified r and omization by low back pain experience at baseline ( current pain vs. past pain ) . The r and omization process used a computer-generated r and om-number table with 16 strata ( 2 low back pain by 8 workplace functions ) , arranged in blocks of 8 within each stratum . After baseline measurements were completed , colleagues who were not otherwise involved in the study and who were blinded to participants ' baseline characteristics used the r and om-number table to allocate each participant to 1 of the study groups . Intervention All participants in the intervention group were instructed to wear the lumbar supports on working days on which they had or expected they might develop low back pain . Participants could select 1 of 4 types of lumbar supports , supplied by Bauerfeind B.V. , Haarlem , the Netherl and s. LumboTrain and LumboTrain Lady are individually adjustable , hook- and -loop fastening , fully elastic supports that are available in 5 sizes for men or women . LumboLoc and LordoLoc are more structured supports , with integrated stays in the back , that have individually adjustable hook- and -loop fastenings and are available in 6 sizes . Participants chose the lumbar support on the basis of fit and wearing comfort , and they were not given advice to direct their choice from among the 4 available supports . When measured by the research er for the lumbar support , the participants were advised to wear the support for a few days in a row , regardless of low back pain , in order to become accustomed to it . The expected duration of wearability of the lumbar supports was 1 year . The costs of the lumbar supports were 75 for LumboTrain and LumboTrain Lady , 56 for LumboLoc , and 50 for LordoLoc . Outcome Measures Our primary outcome measures were the number of days that participants reported low back pain per month and the number of calendar days of sick leave that participants took during the 12-month intervention . Secondary outcome measures were the average severity of low back pain in the previous week , rated on a scale of 0 to 10 ( 16 ) , and functional status in the previous week , measured by using a Dutch translation of the Quebec Back Pain Disability Scale ( on which 0 corresponds to no disablement and 100 corresponds to fully disabled ) ( 17 , 18 ) . Participants used a calendar to record the days per month on which they experienced low back pain . The intervention group was also asked to record on the calendar whether they had worn the lumbar support ;  thus , the calendars also served as a monitor for adherence to therapy . The calendars were collected for review after 1 , 3 , 6 , 9 , and 12 months . The number of calendar days of sick leave was derived from the staff register and was provided by the home care organization at the end of the study ; this information covered 15 months , from 3 months before the start of the study until the end of the intervention . We could gather only general data on sick leave because employees are not obliged to specify their illness for the employer when they report themselves ill , and registration by a company doctor starts from 6 consecutive weeks of sick leave . We collected information on self-reported , low back painrelated sick leave ; however , this was not a predetermined outcome , and the results should be interpreted cautiously . We administered a question naire at baseline to obtain information on the secondary outcome measures and demographic characteristics ; history of low back pain ; job characteristics ( among others , the Job Content Question naire , Dutch translation [ 19 ] ) ; and other possible confounders , such as additional work ( hours per week and type ) , preference for study group assignment , confidence in pain reduction with use of the lumbar support ( scale of 0 to 10 ) , and confidence in improved functioning ( scale of 0 to 10 ) . Follow-up question naires were administered at 3 , 6 , 9 , and 12 months to measure the secondary outcomes . In the intervention group , these question naires also measured the general satisfaction with the lumbar support ( scale of 0 to 10 ) , several items on comfort of wearing ( 5-point Likert scale ) , and adherence to use of the lumbar support ( 7-point Likert scale ) . We recorded spontaneously reported side events and asked participants about side effects in the question naires . Statistical Analysis We estimated that with a power of 80 % , a significance level of 0.05 , and an SD of 20 days , we would need 140 participants in each study group to demonstrate a difference of 7 days of low back pain per year or sick leave per year between the 2 groups . To prevent inadequate power because of participant withdrawal or low adherence to therapy , we sought to enroll 400 home health care workers . We used a longitudinal marginal model with generalized estimating equation estimates to analyze the data , according to intention-to-treat principles . For the primary outcomes ( number of days of low back pain and number of days of sick leave ) , we used a negative-binomial count data model with a log-link and an exchangeable correlation structure . Covariates ( history of low back pain , body mass index , additional work , and pregnancy during follow-up ) were added to the model separately and were used in the final model if they statistically significantly contributed to the model ( P < 0.05 ) . The scale scores of the secondary outcomes were analyzed by using a normal distributed model and an exchangeable correlation structure . To investigate model misspecification and the effect of missing data , we performed sensitivity analyses in which we used various structures for the working correlation to estimate the models and used multiple imputation techniques to analyze 5 imputed data sets for missing data ( 20 ) . For all analyses , we used SAS , Seated work has been shown to constitute a risk factor for  low-back pain .  This is attributed to the prolonged and monotonous low-level mechanical load imposed by a seated posture . To evaluate the potential health effects with respect to the low back of office chairs with a movable seat and back rest , trunk kinematics , erector spinae EMG , spinal shrinkage and local discomfort were assessed in 10 subjects performing simulated office work .  On three separate occasions subjects performed a 3 h task consisting of word processing , computer-aided design and reading . Three chairs were used , one with a fixed seat and back rest and two dynamic chairs , one with a seat and back rest movable in a fixed ratio with respect to each other , and one with a freely movable seat and back rest .  Spinal shrinkage measurements showed a larger stature gain when working on the two dynamic chairs as compared with working on the chair with fixed seat and back rest . Trunk kinematics and erector spinae EMG were strongly affected by the task performed but not by the chair type . The results imply that dynamic office chairs offer a potential advantage over fixed chairs , but the effects of the task on the indicators of trunk load investigated were more pronounced than the effects of the chair Study Design . Classification and functional assessment model for nonspecific low back pain ( LBP ) patients and controls on the basis of kinematic analysis parameters . Objective . Develop a logistic regression model using kinematic analysis variables to ( 1 ) discriminate between LBP patients and controls and ( 2 ) obtain objective parameters for LBP functional assessment . Summary of Background Data . Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales . Objective functional techniques have been developed , which usually involve the application of external loads or the analysis of highly st and ardized trunk flexion-extension maneuvers . Few studies have used everyday activities such as sit-to-st and or lifting an object from the ground . They have shown that the motion patterns of LBP patients differ from those of healthy subjects . Nevertheless , very few studies have tried to correlate objective findings to the results of subjective scales , and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities . Methods . Sixteen controls and 39 LBP patients performed a sit-to-st and task , and lifted three different weights from a st and ing position . The vertical forces exerted and the relative positions of the lower limb and the cervical , thoracic , lumbar , and sacroiliac regions were recorded . Reliability was determined from repetitions of the tests performed by the control group . Binary logistic regression analyses were computed . The results of the selected regression equation were correlated to the Oswestry Disability Index scale results , to check the validity of the procedure for the measurement of functional disability . Results . Reliability of the parameters was good . The selected regression model used two variables , and correctly classified 97.3 % of the patients . High correlations were found between the results of this regression equation and the Oswestry Disability Index scale . Conclusion . It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks . This kind of analysis can produce objective and reliable indexes about the patients ' degree of functional impairment BACKGROUND Low back pain is associated with abnormal movement strategies due to changes in neuromuscular control . A plausible contributing factor to low back pain is poor control of trunk muscles , thus underst and ing motor control alterations in this population can guide rehabilitation . Quantification of postural responses following support surface translations is one way to examine motor control impairments in people with low back pain . METHODS Twenty-four healthy subjects [ mean 33 ( SD 11 ) years ] who had no low back pain and 26 subjects [ mean 39 ( SD 13 ) years ] with chronic , recurrent low back pain were instructed to st and with feet placed on separate force plates , which were mounted on a moveable platform . The platform was translated unexpectedly in one of 12 directions for a total of 72 trials . For both the sagittal and frontal planes , the net center of pressure displacement was derived and the total body center of mass was calculated by combining kinematic and anthropometric data . FINDINGS For sagittal plane responses , subjects with low back pain had reduced and delayed sagittal plane center of pressure responses ( P<0.01 ) compared to the subjects without low back pain . In contrast , the sagittal plane center of mass responses were larger in magnitude ( P=0.03 ) yet similarly delayed in onset ( P=0.04 ) for the low back pain group . Frontal plane responses did not differ between groups . INTERPRETATION Subjects with low back pain have altered automatic postural coordination , both in terms of magnitude and timing of responses , indicating alterations in neuromuscular control OBJECTIVES To explore the views of participants in a r and omized controlled trial of physical treatments for low back pain  about the treatment packages they received in the trial . METHODS Within a r and omized controlled trial that found small to moderate benefits from adding a manipulation package or an exercise programme to general practice care , we elicited participants ' views on the treatment using an open question in participant question naires . These data were analysed using an adapted framework approach . RESULTS We received a total of 1259 comments from 1334 participants . Participants r and omized to usual general practice care reported dissatisfaction with receiving only ' usual care ' , which consisted of providing analgesic medication without providing an explanation for their pain . Those r and omized to a manipulation package felt the intervention was appropriate to their needs and commonly reported striking benefits . Participants assigned to the exercise programme developed a sense of self-reliance in managing back pain , although some failed to be sufficiently motivated to continue their exercise regimen outside the classes . CONCLUSIONS This qualitative analysis has found much clearer differences between the groups than the main quantitative analysis . This suggests that some of the added value from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement . Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value of such treatments to individual patients Study Design . Systematic Review . Objectives . To assess the effects of massage therapy for nonspecific low back pain . Summary of Background Data . Low back pain is one of the most common and costly musculoskeletal problems in modern society . Proponents of massage therapy cl aim it can minimize pain and disability , and speed return to normal function . Methods . We search ed MEDLINE , EMBASE , CINAHL from their beginning to May 2008 . We also search ed the Cochrane Central Register of Controlled Trials ( The Cochrane Library 2006 , issue 3 ) , HealthSTAR and Dissertation abstract s up to 2006 . There were no language restrictions . References in the included studies and in review s of the literature were screened . The studies had to be r and omized or quasi-r and omized trials investigating the use of any type of massage ( using the h and s or a mechanical device ) as a treatment for nonspecific low back pain . Two review authors selected the studies , assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group , and extracted the data using st and ardized forms . Both qualitative and meta-analyses were performed . Results . Thirteen r and omized trials were included . Eight had a high risk and 5 had a low risk of bias . One study was published in German and the rest in English . Massage was compared to an inert therapy ( sham treatment ) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups . In 8 studies , massage was compared to other active treatments . They showed that massage was similar to exercises , and massage was superior to joint mobilization , relaxation therapy , physical therapy , acupuncture , and self-care education . One study showed that reflexology on the feet had no effect on pain and functioning . The beneficial effects of massage in patients with chronic low back pain  lasted at least 1 year after the end of the treatment . Two studies compared 2 different techniques of massage . One concluded that acupuncture massage produces better results than classic ( Swedish ) massage and another concluded that Thai massage produces similar results to classic ( Swedish ) massage . Conclusion . Massage might be beneficial for patients with subacute and chronic nonspecific low back pain , especially when combined with exercises and education . The evidence suggests that acupuncture massage is more effective than classic massage , but this need confirmation . More studies are needed to confirm these conclusions , to assess the impact of massage on return-to-work , and to determine cost-effectiveness of massage  as an intervention for low back pain BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain Study Design . A population -based cross-sectional and 5-year prospect i ve question naire study . Objective . To investigate self-reported physical workload as a risk factor for low back pain . Summary of Background Data . Both physical and psychosocial workplace factors are considered risk factors for low back pain . However , today no consensus has been reached regarding the exact role of these factors in the genesis of low back pain . Methods . Question naire data were collected at baseline for 1397 ( and after 5 years for 1163 ) men and women aged 31–50 years at baseline .  Low back pain ( “ any low back pain within the past year , ” “ low back pain ≤ 30 days in total during the past year , ” “ low back pain > 30 days in total during the past year ” ) was analyzed in relation to physical workload ( sedentary , light physical , and heavy physical work ) using logistic regression and controlling for age , gender , and social group . The proportions of workers changing between the workload groups over the 5-year period were analyzed in relation to low back pain status . Results . At baseline no statistically significant differences in low back pain outcomes were found for workers exposed to sedentary , light physical , or heavy physical work . This was true for all age , gender , and social groups . At follow-up there was a statistically significant dose – response association between any low back pain and longst and ing low back pain within the past year and increasing physical workload  at baseline also after controlling for age , gender , and social group . Subjects with heavy physical workload at baseline changed statistically significantly more often to sedentary work if they experienced low back pain for more than 30 days out of the past year . Conclusions . Having a sedentary job might have a protective or neutral effect in relation to low back pain , whereas having a heavy physical job constitutes a significant risk factor . Because of migration between exposure groups ( the “ healthy-worker ” effect ) , longitudinal studies are necessary for investigating the associations between physical workload and low back pain BACKGROUND AND PURPOSE The purpose of this r and omized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization-enhanced general exercise approach with a general exercise-only approach . SUBJECTS Fifty-five patients with recurrent , nonspecific back pain ( stabilization-enhanced exercise group : n=29 , general exercise-only group : n=26 ) and no clinical signs suggesting spinal instability were recruited . METHODS Both groups received an 8-week exercise intervention and written advice ( The Back Book ) . Outcome was based on self-reported pain ( Short-Form McGill Pain Question naire ) , disability ( Rol and -Morris Disability Question naire ) , and cognitive status ( Pain Self-Efficacy Question naire , Tampa Scale of Kinesiophobia , Pain Locus of Control Scale ) measured immediately before and after intervention and 3 months after the end of the intervention period . RESULTS Outcome measures for both groups improved . Furthermore , self-reported disability improved more in the general exercise-only group immediately after intervention but not at the 3-month follow-up . There were generally no differences between the 2 exercise approaches for any of the other outcomes . DISCUSSION AND CONCLUSION A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain . Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability STUDY DESIGN A systematic review of r and omized and nonr and omized controlled trials . SUMMARY OF BACKGROUND DATA Lumbar supports are used in the treatment of low back pain , but also to prevent the onset ( primary prevention ) or recurrences of a low back pain episode ( secondary prevention ) . OBJECTIVES To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain .  METHODS The Medline , Cinahl , and Current Contents data bases ; the Cochrane Controlled Trials Register up to September 1999 ; and the Embase data base up to September 1998 were all search ed . References of identified trials and systematic review s were review ed and the Science Citation Index used to identify additional trials . Method ologic quality assessment and data extraction were performed by two review ers independently . A quantitative analysis was performed in which the strength of evidence was classified as strong , moderate , limited or conflicting , and no evidence . RESULTS Five r and omized and two nonr and omized preventive trials and six r and omized therapeutic trials were included in the review . Only 4 of the 13 studies were of high quality . There was moderate evidence that lumbar supports are not effective for primary prevention . No evidence was found on the effectiveness of lumbar supports for secondary prevention . The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain . CONCLUSIONS There continues to be a need for high quality r and omized trials on the effectiveness of lumbar supports . One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance Background In the currently available research publications on electrical therapy of low back pain , generally no control groups or detailed r and omization were used , and such studies were often conducted with relatively small groups of patients , based solely on subjective question naires and pain assessment scales ( lacking measurement methods to objectify the therapeutic progress ) . The available literature also lacks a comprehensive and large-scale clinical study . The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods . The study assesses the influence of individual electrotherapeutic treatments on reduction of pain , improvement of the range of movement in lower section of the spine , and improvement of motor functions and mobility . Material / Methods The 127 patients qualified for the therapy ( ultimately , 123 patients completed the study ) and assigned to 6 comparison groups : A – conventional TENS , B – acupuncture-like TENS , C – high-voltage electrical stimulation , D – interferential current stimulation , E – diadynamic current , and F – control group . Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain , and an improvement of functional ability of patients suffering from low back pain  on the basis of an analysis of both subjective and objective parameters . The TENS currents and high voltage were helpful , but not as effective . The use of diadynamic currents appears to be useless . Conclusions Selected electrical therapies ( interferential current , TENS , and high voltage ) appear to be effective in treating chronic low back pain
The most commonly reported outcome was range of motion .
Interpretation : The literature to date offers limited and inconsistent evidence of kinematic/kinetic measures in low back pain patients that could be used clinical ly .
HighlightsCurrent low back pain assessment relies on subjective measures .Use of objective measures ( kinematics/kinetics ) is encouraged in low back pain assessment .This review highlights the heterogeneity of studies with low back pain and healthy subjects .
Background : Currently , there is a widespread reliance on self‐reported question naires to assess low back pain patients .
However , it has been suggested that objective measures of low back pain patients ' functional status should be used to aid clinical assessment .
The aim of this study is to systematic ally review which kinematic /kinetic parameters have been used to assess low back pain patients against healthy controls and to propose clinical kinematic/kinetic measures .