Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. A longitudinal study on the predictive validity of the fear–avoidance model in low back pain Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? A comparison of high intensity aerobic exercise and passive modalities for the treatment of workers with chronic low back pain: a randomized, controlled trial. A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial) Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Do Physical Therapists in the United Kingdom Recognize Psychosocial Factors in Patients With Acute Low Back Pain? Fear of Movement/(Re)Injury Predicting Chronic Disabling Low Back Pain: A Prospective Inception Cohort Study The Role of Physical Fitness as Risk Indicator of Increased Low Back Pain Intensity Among People Working With Physically and Mentally Disabled Persons: A 30-Month Prospective Study Low Back Pain in a General Population. Natural Course and Influence of Physical Exercise–A 5-Year Follow-up of the Musculoskeletal Intervention Center-Norrtälje Study Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial. Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study The efficacy of lumbar traction in the management of patients with low back pain Active Therapy for Chronic Low Back Pain: Part 3. Factors Influencing Self-Rated Disability and Its Change Following Therapy It's time for change with the management of non-specific chronic low back pain Potential Risk Factors of Persistent Low Back Pain Developing from Mild Low Back Pain in Urban Japanese Workers The Predictive Relationship of Physical Activity on the Incidence of Low Back Pain in an Occupational Cohort A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867) Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study
Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain ( LBP ) . However , no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain . Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population . This prospect i ve cohort study recruited 101 consenting patients with sub-acute LBP ( < 6 weeks ) who completed the Rol and Morris Disability Question naire ( RMDQ ) , the Visual Analogue Scale , and resumption of full ‘ normal ’ activity question ( Y/N ) , at baseline and 3 months .  Physical activity  was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall question naire . Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ ( p > 0.05 ) or RMDQ change ( p > 0.05 ) over 3 months . A self-report of a return to full ‘ normal ’ activities was significantly associated with greater RMDQ change score at 3 months ( p < 0.001 ) . Paired t-tests found no significant change in activity levels measured with the RT3 ( p = 0.57 ) or the recall question naire ( p = 0.38 ) from baseline to 3 months . Conclusions These results question the predictive role of physical activity in LBP recovery , and the assumption that activity levels change as LBP symptoms resolve . The importance of a patient ’s perception of activity limitation in recovery from acute LBP was also highlighted . Trial registration Clinical Trial Registration Number , Background Activity advice and prescription are commonly used in the management of low back pain ( LBP ) . Although there is evidence for advising patients with LBP to remain active , facilitating both recovery and return to work , to date no research has assessed whether objective measurements of free living physical activity ( PA ) can predict outcome , recovery and course of LBP . Methods An observational longitudinal study will investigate  PA  levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP . Each participant 's  PA level , functional status , mood , fear avoidance behaviours , and levels of pain , psychological distress and occupational activity  will be measured on three occasions during for 1 week periods at baseline , 3 months , and 1 year .  Physical activity levels  will be measured by self report , RT3 triaxial accelerometer , and activity recall question naires . The primary outcome measure of functional recovery will be the Rol and Morris Disability Question naire ( RMDQ ) . Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population . Discussion This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery . The results will assess whether occupational , psychological and behavioural factors affect the relationship between free living PA and LBP recovery . Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.Trial registration [ Clinical Trial Registration Number , ACTRN12609000282280 The aim of this paper was to study the physical performance , pain , pain behavior and disability in patients with subacute low back pain ( LBP ) . The patients were blue-collar workers and had been sick-listed for 8 weeks due to subacute low back pain . A total of 103 patients were r and omized , 51 of them to the intervention group and the other to a control group .  Recordings of physical performance and complaints of LBP were done before and after treatment in the intervention group . The proportion of patients with no complaints of LBP was significantly greater in the intervention group than in the control group at the one-year follow-up . The patients who intra-individually improved their physical performance also intra-individually decreased their complaints of LBP . The intra-individual improvements were suggested to be important for the individual return to work Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing & NA ; Recently , fear – avoidance models have been quite influential in underst and ing the transition from acute to chronic low back pain ( LBP ) . Not only has pain‐related fear been found to be associated with disability and increased pain severity , but also treatment focused at reducing pain‐related fear has shown to successfully reduce disability levels . In spite of these developments , there is still a lack in well‐ design ed prospect i ve studies examining the role of pain‐related fear in acute back pain . The aim of the current study was to prospect ively test the assumption that pain‐related fear in acute stages successfully predicts future disability .  Subjects were primary care acute LBP patients consulting because of a new episode of LBP ( ≤3 weeks ) . They completed question naires on background variables , fear – avoidance model variables and LBP outcome ( Grade d Chronic Pain Scale , GCPS ) at baseline , 3 , 6 , and 12 months follow‐up and at the end of the study . Two‐hundred and twenty‐two acute LBP patients were included , of whom 174 provided full follow‐up information ( 78.4 % ) . A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS . Of the  fear – avoidance model  variables , only negative affect added to this model . Our results do not really support the longitudinal validity of the fear – avoidance model , but they do feed the discussion on the role of pain‐related fear in early stages of LBP & NA ; Few studies have investigated whether prognostic indicators , which contribute to the transition from acute to chronic low back pain ( LBP ) , are also those which contribute to continuing persistence of chronic LBP . We compared the contribution of physical , psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration . Data from two large prospect i ve cohort studies of consecutive patients consulting with LBP in general practice s were merged , providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow‐up . There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability , assessed by Rol and Morris Disability Question naire , during the year of follow‐up . Adjusted associations between potential prognostic indicators and disability at 12 months were carried out in the two LBP subgroups . The final multivariable regression models showed that being non‐employed , having widespread pain , a high level of Chronic Pain Grade , and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups . Fear of pain was significantly associated with disability in chronic LBP . Importantly , beyond baseline disability , the effect size of the other prognostic indicators for poor outcome was rather low . These findings must continue to challenge research ers to identify useful early predictors of outcome in persons with disabling back pain , as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance BACKGROUND In recent years , disability due to chronic low back pain ( LBP ) has steadily increased in all industrialized countries . In the treatment of chronic LBP , the objectives are to reduce pain , to improve function and minimize avoiding behavior .  Exercise therapy is a management strategy that is widely used as a treatment for LBP . AIM The aim of this study was to investigate the effects of high- intensity aerobic exercise on pain , disability , anxiety or depression in people with chronic LBP . DESIGN This was a r and omized controlled trial SETTING Institute of Occupational Medicine , Department of Physical Medicine and Rehabilitation - Outpatient Ward POPULATION Kosovo power plant workers . METHODS Participants with chronic low back pain , excluding those with " red flag " criteria were assigned r and omly to one of the two treatment groups : an aerobic exercise group ( N.=50 ) , and an passive modalities group ( N.=51 ) . Data on low back pain intensity ( visual analogue scale ) , disability ( Oswestry Low Back Pain Disability Question naire ) , fingertip-to-floor distance , and psychosocial factors ( Hospital Anxiety and Depression Scale ) were collected at baseline and after 12-weeks follow-up points . RESULTS At 12-week follow-up , significant improvements in pain intensity and disability had occurred in the exercise group . We have verified significant improvements in comparison with basic values in pain intensity ( 6 ± 2.6 vs. 2 ± 1.7 , diff . of mean=3.9 , P < 0.001 ) , disability ( 31 ± 17.4 vs. 15.8 ± 12.7 , diff . of mean=15.2 , P<0.001 ) , anxiety and depression ( 21.1 ± 8.2 vs. 14 ± 6.7 , diff . of mean=7.1 , P < 0.001 ) , and fingertip- to-floor distance ( 27.8 ± -9.1 vs. 14.2 ± -5.7 , P<0.001 ) . Whereas , differences in average pain , disability , anxiety and depression and fingertip-to-floor distance are not significant in the control group . CONCLUSION High intensity aerobic exercise  reduces pain , disability and psychological strain in patients with chronic low back pain . CLINICAL REHABILITATION IMPACT This research is important for the fact that High Intensity Aerobic Exercise Programs are not so exploited in the current available literature for the treatment of LBP . Therefore , this is another modest contribution which can reinforce the need for more frequent use of High Intensity Aerobic Exercise Programs in the treatment of LBP Background Chronic low back pain ( CLBP ) is a persistent disabling condition with rising significant healthcare , social and economic costs . Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery . While international clinical guidelines and systematic review s for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost , barriers to their delivery include space and time restrictions in healthcare setting s and poor patient attendance . The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP . Walking may be an ideally suited form of individualized exercise prescription as it is easy to do , requires no special skills or facilities , and is achievable by virtually all ages with little risk of injury , but its effectiveness for LBP is unproven . Methods and design This study will be an assessor-blinded r and omized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy , which will act as the control group , in people with chronic low back pain . A sample of 246 patients will be recruited in Dublin , Irel and through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP . Patients will be r and omly allocated to one of the three groups in a concealed manner . The main outcomes will be functional disability , pain , quality of life , fear avoidance , back beliefs , physical activity , satisfaction and costs , which will be evaluated at baseline , and 3 , 6 and 12 months [ follow-up by pre-paid postage ] . Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants ' experiences of the interventions and trial participation , and to inform interpretation of the quantitative data . Planned analysis will be by intention to treat ( quantitative data ) and thematic analysis ( qualitative data ) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registration Current controlled trial IS RCT Aims : To assess dose-response relations between occupational exposures to physical and psychosocial factors and the risk of  low back pain .  Methods : A cohort of 523 subjects , working in nursing homes and homes for the elderly , was followed prospect ively for one year . Physical load for different occupations was assessed by quantitative observations at the workplace . Information on low back pain and other factors was gathered with question naires administered at baseline and at one year . Two outcome measures of low back pain incidence were used : any new episode of pain lasting for at least a few hours during follow up ( LBP ) ; and any new episode of disabling pain that interfered with daily activities during follow up ( LBP/D ) . Hierarchical regression analysis with a spline function was used to estimate dose-response relations . Results : The risk of LBP was not associated with physical factors , controlling for confounders ; but this outcome was inversely associated with age and weakly , though imprecisely , associated with two psychosocial factors — low decision authority and high work dem and s. In contrast , the risk of LBP/D was positively associated with age and not associated with the psychosocial factors . Trunk flexion over 45 degrees was monotonically associated with the risk of LBP/D ; the estimated relative risk was 3.18 ( 95 % CI 1.13 to 9.00 ) for 1 hour and 45 minutes of bending per week ( 90th centile ) , relative to 30 minutes per week . The hierarchical estimates of effect were more stable than were the maximum likelihood estimates . Conclusion : Occupational exposure to trunk flexion over 45 degrees appears to be a risk factor for low back pain with disability among persons employed in nursing homes and homes for the elderly in the Netherl and 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 cross-sectional , descriptive vignette survey of practicing , musculoskeletal physical therapists . Objectives . The aim of this study was to determine if musculoskeletal physical therapists , in the United Kingdom , recognize when patients with low back pain ( LBP ) are at risk of chronicity due to psychosocial factors . A secondary aim was to explore the advice they give to patients about  work and activities .  Summary of Background Data . Psychosocial factors have been shown to be important in the progression from acute LBP to chronic disability . Early identification of individuals at risk of developing chronic disability is important to enable targeted intervention . Methods . Three vignettes were written based on acute LBP patients attending for physical therapy  and incorporated into a self-completed postal question naire sent to a simple r and om sample of musculoskeletal physical therapists in the United Kingdom ( n = 900 ) . After one reminder , 20 % of nonresponders were sent a further question naire ( n = 80 ) . Data were analyzed using the Statistical Package for the Social Sciences ( SPSS version 11 ) . Results . The response rate was 57.7 % ( n = 518 ) with 453 meeting all inclusion criteria . The sample consisted of physical therapists working in the musculoskeletal field across all practice setting s. Most correctly rated the chronicity risk of the low- and high-risk patient vignettes . Advice to restrict work and activity was common . Conclusions . Most physical therapists recognize when patients are at high risk of developing chronicity , yet many recommend the patient limit their activity levels and not work . Advice to “ not work ” is associated with more severe perceived spinal pathology , suggesting persistence of the biomedical model for LBP Study Design . Prospect i ve inception cohort study . Objective . To investigate prospect ively whether pain-related fear predicts future perceived disability and participation in patients with acute low back pain ( LBP ) . Summary of Background Data . There are indications that fear of movement/(re)injury , as measured by the Tampa Scale for Kinesiophobia , is present early in an episode of LBP , and that it might be a predictor of future perceived disability and participation . Methods . A cohort of 555 patients with acute LBP included by general practitioners and physical therapists in primary care setting s was followed for 6 months . Results . Results indicate that baseline fear of movement/(re)injury was predictive of future perceived disability and , to a lesser extent ( and together with duration and radiation ) , of participation . Conclusions . The results suggest that interventions aim ed at reducing pain-related fear in the acute stage of LBP might prevent restrictions of activity and participation because of pain , and might be a way of preventing the transition from acute to chronic LBP Study Design . A prospect i ve cohort study . Objective . To study if low level of physical fitness was associated with increased  low back pain ( LBP ) intensity at 30-month follow-up . Summary of Background Data . The evidence of low physical fitness as a risk factor for LBP is inconclusive due to contradictory results . Methods . Study participants were 327 employees ( women = 271 , men = 56 ) at institutions for physically and mentally disabled persons . Physical fitness was measured by tests of : back extension and flexion endurance , flexibility and balance ; and by self-assessed aerobic fitness , muscle strength , endurance , flexibility and balance , using visual analogue scales .  Low back pain , lifestyle parameters , and physical and psychosocial work factors were assessed by question naires at baseline and at follow-up . Outcome was defined as an increase above 2 steps in average LBP intensity during the previous year ( 0–10 ) . Results . Persons with low level back endurance showed an insignificantly higher risk of increased LBP intensity ( OR = 2.4 , P = 0.076 ) , whereas persons with medium level back endurance were at significantly higher risk ( OR = 2.7 , P = 0.034 ) compared with those with high level back endurance . The general association between isometric back extension endurance and increased LBP intensity was insignificant ( P = 0.067 ) . Persons with medium level self-assessed aerobic fitness were at lower risk of increased LBP intensity compared with those with high level ( OR = 0.37 , P = 0.02 ) , although the general association of aerobic fitness was insignificant ( 0.066 ) . Performance-based back flexion endurance , flexibility , and balance ; and self-assessed muscle strength , endurance , flexibility , and balance were not associated with increased LBP intensity . Conclusion . The significant association between medium level back extension endurance and increased LBP intensity supports the finding of other studies that particularly back extension endurance is an important physicalfitness component in preventing LBP and that the subcomponents of physical fitness are related in different ways to LBP Study Design . A 5-year prospect i ve cohort study was conducted of men and women seeking care for a new period of low back pain ( LBP ) . Objectives . To study the natural course of pain and disability due to LBP during a 5-year follow-up period , and to investigate the possible influence of regular physical exercise on recovery . Summary of Background Data . LBP is major health problem , but its natural course is not very well studied . Several studies have investigated the role of physical exercise on LBP disorders , with inconsistent results . Methods . At baseline , a total of 790 subjects seeking care for LBP were interviewed about physical exercise during leisure time . Over 5 years , 3 follow-up assessment s were made by postal question naire . At all measuring points , pain intensity ratings and disability scores were compared between men and women , and among 3 exercise categories . Results . The pain intensity and disability scores were improved after 5 years for both men and women . The most prominent improvements occurred after 6 months , but less so thereafter . There were no significant differences between men and women with regard to individual changes at the 5-year follow-up concerning the pain intensity or disability scores . There were no significant differences , either for women or men , between low , median , or high intensity exercise groups regarding pain intensity or disability values for the individual change at the 5-year follow-up . Conclusions . Over a 5-year period , both men and women who had sought care for LBP reported a decrease in pain and disability ; however , only a few were fully restored . In this study , we found no effect of nonspecific physical exercise on recovery from LBP in men and women OBJECTIVE To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain ( LBP ) in reducing pain and disability . DESIGN R and omized controlled trial . SETTING A physiotherapy outpatient setting in Hong Kong . PARTICIPANTS Patients with chronic LBP ( N=46 ) were recruited and r and omly assigned to either a control ( n=22 ) or an intervention ( n=24 ) group . INTERVENTIONS An 8-week intervention ; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group . MAIN OUTCOME MEASURES Visual analog pain scale , Aberdeen Low Back Pain Disability Scale , and physical fitness measurements were taken at baseline , 8 weeks , and 12 months from the commencement of the intervention . Multivariate analysis of variance was performed to examine between-group differences . RESULTS Both groups demonstrated a significant reduction in pain ( P<.001 ) and an improvement in disability ( P<.001 ) at 8 weeks and 12 months ; however , no differences were observed between groups . There was no significant difference in LBP relapse at 12 months between the 2 groups ( χ(2)=2.30 , P=.13 ) . CONCLUSIONS The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP The aim of this study was to evaluate the effect of a transfer technique education programme ( TT ) alone or in combination with physical fitness training ( TTPT ) compared with a control group , who followed their usual routine . Eleven clinical hospital wards were cluster r and omised to either intervention ( six wards ) or to control ( five wards ) . The intervention cluster was  individually r and omised to TT ( 55 nurses ) and TTPT ( 50 nurses ) , control ( 76 nurses ) . The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues . The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks . Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not , when compared to a control group , show any statistical differences according to self-reported low back pain ( LBP ) , pain level , disability and sick leave at a 12-month follow-up . However , the individual r and omised intervention subgroup ( transfer technique/physical training ) significantly improved the LBP-disability ( p = 0.001 ) . Although weakened by a high withdrawal rate , teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered . Other priorities such as physical training may be taken into consideration . The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP . However , physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition Design . Cross-sectional analysis of the factors influencing  self-rated disability associated with chronic low back pain and prospect i ve study of the relationship between changes in each of these factors and in disability following active therapy . Objectives . To examine the relative influences of pain , psychological factors , and physiological factors on self-rated disability . Summary of Background Data . In chronic LBP , the interrelationship between physical impairment , pain , and disability is particularly complicated , due to the influence of various psychological factors and the lack of unequivocal methods for assessing impairment . Investigations using new “ belief ” question naires and “ sophisticated ” performance tests , which have shown promise as discriminating measures of impairment , may assist in clarifying the situation . Previous studies have rarely investigated all these factors simultaneously . Methods . One hundred forty-eight patients with cLBP completed question naires and underwent tests of mobility , strength , muscle activation , and fatigability , and ( in a subgroup ) erector spinae size and fiber size/type distribution . All measures were repeated after 3 months active therapy . Relationships between each factor and self-rated disability ( Rol and and Morris question naire ) at baseline , and between the changes in each factor and changes in disability following therapy , were examined . Results . Stepwise linear regression showed that the most significant predictors of disability at baseline were , in decreasing order of importance : pain ; psychological distress ; fear-avoidance beliefs ; muscle activation levels ; lumbar range of motion ; gender . Only changes in pain , psychological distress , and fear-avoidance beliefs significantly accounted for the changes in disability following therapy . Conclusion . A combination of pain , psychological and physiological factors was best able to predict baseline disability , although its decrease following therapy was determined only by reductions in pain and psychological variables . The active therapy programm — in addition to improving physical function — appeared capable of modifying important psychological factors , possibly as a result of the positive experience of completing the prescribed exercises without undue harm Low back pain ( LBP ) is the second greatest cause of disability in the USA.1 USA data supports that in spite of an enormous increase in the health re sources spent on LBP disorders , the disability relating to them continues to increase.2 The management of LBP is underpinned by the exponential increase in the use of physical therapies , opiod medications , spinal injections as well as disc replacement and fusion surgery.2 This is maintained by the underlying belief that LBP is fundamentally a patho-anatomical disorder and should be treated within a biomedical model.1 This is in spite of calls over a number of years to adopt a bio-psycho-social approach , and evidence that only 8–15 % of patients with LBP have an identified patho-anatomical diagnosis , result ing in the majority being diagnosed as having non-specific LBP.3 Of this population , a small but significant group becomes chronic and disabled , labelled non-specific chronic low back pain ( NSCLBP ) , consuming a disproportionate amount of healthcare re sources .4 1 . Over the past decade , the traditional biomedical view of LBP has been greatly challenged . This is a result of : the failure of simplistic single-dimensional therapies to show large effects in patients with NSCLBP5–8 ; 2 . the results of clinical trials testing commonly prescribed interventions demonstrating that no management approaches are clearly superior5–7 9 ; 3 . the stories of NSCLBP patients relating their own ongoing pain experiences of multiple failed treatments , conflicting diagnoses , lost hope and ongoing suffering10 ; 4 . the indisputable evidence supporting the multidimensional nature of NSCLBP as a disorder , where disability levels are more closely associated with cognitive and behavioural aspects of pain rather than sensory and biomedical ones11 12 ; 5 . positive outcomes in r and omised controlled trials ( RCTs ) are best predicted by changes in psychological distress , fear avoidance beliefs , self-efficacy in Study Design Two-year , prospect i ve cohort data from the Japan epidemiological research of occupation-related back pain study in urban setting s were used for this analysis . Objective To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain . Summary of Background Data Although psychosocial factors are strongly indicated as yellow flags of low back pain ( LBP ) leading to disability , the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers . Methods At baseline , 5,310 participants responded to a self-administered question naire including questions about individual characteristics , ergonomic work dem and s , and work-related psychosocial factors ( response rate : 86.5 % ) , with 3,811 respondents completing the 1-year follow-up question naire . The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period . Incidence was calculated for the participants with mild LBP during the past year at baseline . Logistic regression was used to explore risk factors associated with persistent LBP . Results Of 1,675 participants who had mild LBP during the preceding year , 43 ( 2.6 % ) developed persistent LBP during the follow-up year . Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP : interpersonal stress at work [ adjusted odds ratio ( OR ) : 1.96 and 95 % confidence interval ( 95%CI ) : 1.00–3.82 ] , job satisfaction ( OR : 2.34 , 95%CI : 1.21–4.54 ) , depression ( OR : 1.92 , 95%CI : 1.00–3.69 ) , somatic symptoms ( OR : 2.78 , 95%CI : 1.44–5.40 ) , support from supervisors ( OR : 2.01 , 95%CI : 1.05–3.85 ) , previous sick-leave due to LBP ( OR : 1.94 , 95%CI : 0.98–3.86 ) and family history of LBP with disability ( OR : 1.98 , 95%CI : 1.04–3.78 ) . Conclusions Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers . It may be necessary to take psychosocial factors into account , along with physical work dem and s , to reduce LBP related disability Objective : Quantify the relationship between physical activity and development of  incident low back pain ( LBP ) .  Methods : This nested prospect i ve cohort study utilized an objective measure of physical activity in 68 participants with 30 incident cases of LBP .  Physical activity was divided into tertiles and quartiles . Univariate and multivariate relative risks and hazard ratios were calculated . Results : Comparing highest to middle tertile of light activity demonstrated a statistically significant relative risk of 3.68 for developing incident LBP . Lowest and highest tertile of minutes of moderate/vigorous activity yielded statistically significant relative risks of 4.60 and 6.14 , respectively . Multivariate analyses demonstrated similar associations . Conclusions : Moderate amounts of physical activity were protective for the development of LBP  in this cohort , after adjustment for risk factors . This nonlinear relationship suggests higher levels of activity do not confer increased LBP prevention Abstract Psychological factors consistent with fear‐avoidance models are associated with the development of chronic low back pain ( LBP ) . As a result , grade d activity ( GA ) and grade d exposure ( GX ) have been suggested as behavioral treatment options . This clinical trial compared the effectiveness of treatment‐based classification ( TBC ) physical therapy alone to TBC augmented with GA or GX for patients with acute and sub‐acute LBP . Our primary hypothesis was that GX would be most effective for those with elevated pain‐related fear . In total , 108 patients enrolled in this clinical trial and were r and omly assigned to receive TBC , GA , or GX . Outcomes were assessed by a blinded evaluator at 4 weeks and by mail at 6 months . The primary outcomes for this trial were disability and pain intensity , and the secondary outcomes were fear‐avoidance beliefs , pain catastrophizing , and physical impairment . There were no differences in 4‐week and 6‐month outcomes for reduction of disability , pain intensity , pain catastrophizing , and physical impairment . GX and TBC were associated with larger reductions in fear‐avoidance beliefs at 6 months only . Six‐month reduction in disability was associated with reduction in pain intensity , while 6‐month reduction in pain intensity was associated with reductions in fear‐avoidance beliefs and pain catastrophizing . This trial suggests that supplementing TBC with GA or GX was not effective for improving important outcomes related to the development of chronic LBP Summary Several new studies have indicated that an active approach to patients with chronic disabling low back pain ( LBP ) seems effective . Some of these studies emphasize the importance of dealing with the patient 's total situation in comprehensive multidisciplinary programs — the bio-psycho-social model . However , these programs are expensive . The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of : ( 1 ) return-to-work rate , ( 2 ) days of sick leave , ( 3 ) health-care contacts , ( 4 ) pain and disability scores , and ( 5 ) staying physically active . The subjects included 132 patients r and omized to the study , of whom 123 started one of the treatment programs . They had all had at least 6 months of chronic LBP . The patients were r and omized into one of three programs : group 1 — a full-time , intensive 3-week multidisciplinary program , including active physical and ergonomic training and psychological pain management , followed by 1 day weekly for the subsequent 3 weeks ; group 2 — active physical training , twice a week for 6 weeks , for a total of 24h ; group 3 — psychological pain management combined with active physical training , twice a week for 6 weeks , also for a total of 24h . The results presented here are based on data collected 4 months following treatment , which shows an 86 % response rate . The initial examination and the follow-up evaluation were performed by a blinded observer . The results show that 4 months after treatment , the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate , health-care contacts , pain and disability scores , and staying physically active . In conclusion , it seems that although the multidisciplinary program is initially expensive compared to the less intensive programs , the savings in sick pay , early retirement pensions , and health care contacts make it economically worthwhile . Long-term follow-up will show whether this effect continues
That is , persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability .
Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity .
Persons with acute or subacute back pain appear to vary in the levels of physical activity independent of disability .
Persons with chronic back pain with high levels of disability will likely have low levels of physical activity
It is often assumed that patients with pain-related disability due to low back pain ( LBP ) will have reduced physical activity levels , but recent studies have provided results that challenge this assumption .
The aim of our systematic review was to examine the relationship between  physical activity  and disability in LBP .