Dissertations / Theses on the topic 'Adolescent low back pain'

This thesis was initiated by an awareness of the impact of low back pain in Western society in general and Australian society in particular. The studies and experiments in this thesis contribute towards an understanding of chiropractic as a professional entity in Victoria and the nature of its clinical practice. The issue of male adolescent LBP has been explored and in addition to an epidemiological description of this clinical entity, its anthropometric dimensions have been documented. The qualitative review of the literature provides ample justification for the management of patients with LBP by chiropractors, using manual or manipulative techniques. The observational study of the Victorian context in which chiropractors are educated, registered, and entitled to practice, demonstrates that Victorian chiropractors are appropriate providers of manipulative health care. They perform the role of primary contact, primary health care providers with diagnostic, treatment and management skills focussed mainly on musculoskeletal conditions, but with a small proportion of practice based in the health or preventive context, and are well placed to provide the manual and manipulative services required in the management of LBP patients. The profession is shown to have strategies in place to ensure continued legal and community acceptance. The strategies include those at entry level to the profession, such as the legislative provisions of government and the competencies required for registration as instilled during the professional education process, and those which are more of the nature to maintain the integrity of professional practice, such as the " standards of practice" concept. These are important characteristics given it is shown that the Victorian chiropractic profession is not homogenous with respect to educational standards, has a disparate gender balance, the presence of a few non-registered 'chiropractors', and a disparity in utilisation patterns with a significant tail to the right. However the chiropractic profession is shown to hold a position of strength and leadership in the Australian context with respect to the provision of manipulative health care. Indeed, it could be said that chiropractors are at the leading edge of the quality process with respect to the provision of manipulative health care in Australia. The description of chiropractic practice shows a patient base of all ages, including adolescents, presenting with a range of possible diagnoses, often funded by a third party, and with a high proportion of return visits suggestive of patient compliance and satisfaction. It is convincingly demonstrated that persons with work-related LBP attend to chiropractors in Victoria and are effectively managed with the aim being the restoration of optimal spinal function and, in the case of work-injured patients, an early return to work. This thesis includes utilisation data which suggest only a minority of Victorian chiropractors practice outside the responsible parameters described above. The case-mix data and patient profiles presented in this thesis are congruent and complement each other, suggesting a high level of patient satisfaction indicated by the high proportion of return visits by regular patients and a faster, return-to-work by work-injured claimants. The point and sample prevalence of LBP in a population of suburban male adolescents is described and shown to be similar to those found in comparable Western societies. The data for a sample of traditional Australian male adolescents describes the LBP experience for the first time in such a population and emphasises the wide variance between societies which is now being identified in the literature. The LBP experience of a typical suburban Australian male adolescent is identified and described in terms of chronicity, frequency and episode duration. Typically the male adolescent with LBP has a chronic (> 90 d) problem with frequent episodes of pain (from 2 or 3 times a month to 2 or 3 times week) which last a few hours. The pain is a little limiting but allows the performance of the Activities of Daily Living. While some limitation of general sporting activity due to pain is experienced, school attendance is generally not compromised. A particular clinical instrument, the Metrecom computerised electro-goniometer, is studied and found to be appropriate for use in gathering anthropometric dimensions to test hypotheses relating to an association between anthropometric dimensions and LBP in a male adolescent population. The applied level of uncertainty of the instrument is within acceptable limits for these dimensions. The anthropometric study tests the broad null hypothesis that the mean of specific anthropometric dimensions would be equal among samples of male adolescents drawn from the Australian population. The actual groups are a Melbourne 'Pain' group, a Melbourne 'No Pain' group, and a 'Traditional No Pain' group. The pain group reported either current LBP or a positive history of LBP, while the 'no pain' groups denied either current or historical LBP. The alternate hypothesis will be shown to be proven for the dimensions 'sitting height', 'upper body' length, 'pelvic height', and the ratio of the 'upper:lower' body segment in a population of male adolescents with idiopathic or mechanical LBP. This thesis meets its objectives of describing the chiropractic profession and its practise in the Victorian context, demonstrates the prevalence of LBP in a male adolescent population, and identifies particular anthropometric dimensions associated with those who report a LBP experience. The fact that a number of anthropometric dimensions are detectable in adolescence may allow the development of appropriate screening programs which in turn may lead to the design and introduction of suitable prophylactic interventional programs for persons found to be potentially prone to idiopathic or mechanical LBP, at the least reducing the severity and at most reducing the onset of this expensive problem in adulthood. The ratio of the upper body segment to the lower body segment would appear to be most appropriate indicator; it is robust in that it is a prime dimension, easily accessible, and with a low level of measurement uncertainty. Most importantly it would appear to hold validity throughout adolescence as it does not have a linear relationship with age.

Abstract The etiology of musculoskeletal disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain (NP), shoulder pain (SP), and low back pain (LBP) increases drastically during adolescence. Potentially modifiable risk factors of NP, SP, and LBP should be identified at that age. First, this study evaluated the prevalence of NP, SP, LBP and peripheral pains (upper or lower extremities) and the prevalence of multiple pains. Second, the study determined the role of a set of potentially modifiable risk factors for adolescents’ NP, SP, and LBP (physical activity, inactivity, sedentary activities in cross-sectional study design and quantity and quality of sleep in follow-up study design). The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting of 9,479 children with an expected date of birth between July 1, 1985 and June 30, 1986 in the two northernmost provinces of Finland, Oulu and Lapland. NP, SP, and LBP were common at the ages 16 and 18, while medical consultations for these pains were less frequent. The prevalence of pain increased with age. Peripheral pains were rare. Surprisingly many adolescents reported multiple musculoskeletal pains. Girls were more likely to report pain than boys. Both low and high level of physical activity, some risk sport activities, high amount of sedentary activities, and insufficient quantity and quality of sleep increased the risk of NP, SP, and LBP in adolescence. It may be possible to reduce the occurrence of musculoskeletal pain by having a positive impact on potentially modifiable risk factors, such as physical activity, sedentary activities and sleep hygiene. Therefore, intervention studies focusing on these factors are needed in the future
Tiivistelmä Useimmiten tuki- ja liikuntaelinsairauksien tarkka syy jää epäselväksi ja kipu on niiden pääasiallinen ilmentymä. Niska-, hartia- ja alaselkäkipujen esiintyvyys väestössä nousee merkittävästi teini-iässä. Tämän vuoksi niska-, hartia- ja alaselkäkivun riskitekijöitä tulisikin tutkia nuoruudessa, jotta niihin päästäisiin vaikuttamaan ajoissa. Tässä väitöskirjassa selvitettiin niska-, hartia-, alaselkä- ja laaja-alaisten tuki- ja liikuntaelinkipujen esiintyvyyttä nuorilla. Päätavoite oli kuitenkin tutkia liikunnan, eri urheilulajien, liikkumattomuuden, istumisen ja unen laadun ja määrän yhteyttä niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Tutkimusaineisto muodostui Pohjois-Suomen syntymäkohortin 1986 nuorista, joiden laskettu syntymäaika oli 1.7.1985–30.6.1986. Nuorille lähetettiin 16-vuotiaana postikysely, joka sisälsi tuki- ja liikuntaelinoirekyselyn, kysymyksiä liikunnan, istumisen ja unen määrästä ja laadusta, sekä muista elämäntavoista. Kahden vuoden kuluttua, 18-vuotiaana lähetettiin toinen kysely joka sisälsi mm. tuki- ja liikuntaelinoirekyselyn. Tulokset osoittavat että niska-, hartia- ja alaselkäkivut olivat yleisiä nuoruudessa, joskin hoitoa vaativat kivut ja raajojen kipuoireilu olivat harvinaisia. Laaja-alaiset tuki- ja liikuntaelinkivut olivat odotettua yleisempiä. Tytöt oireilivat enemmän kuin pojat ja oireilu lisääntyi iän myötä. Hyvin aktiivinen liikunnan harrastaminen (6h/vko tai enemmän ripeää liikuntaa) ja erityisesti tietyt riskilajit olivat yhteydessä suurempaan niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Samoin suuri istumisen määrä, riittämätön uni ja huono unen laatu lisäsivät kipujen todennäköisyyttä. Nuorten tuki- ja liikuntaelinkipuja voitaisiin mahdollisesti vähentää vaikuttamalla muunneltavissa oleviin riskitekijöihin, kuten vähentämällä istumista, lisäämällä terveysliikuntaa, sekä parantamalla unitottumuksia. Tämän takia jatkossa tarvitaan näihin riskitekijöihin kohdistuvia interventiotutkimuksia

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.

Abstract Low back pain (LBP) is a common condition already in adolescence and seems to predict future symptoms. Most of the previous longitudinal studies on LBP have been conducted in adult populations. Among adolescents, LBP has been linked most convincingly to psychosocial factors and smoking. We are not aware of any previous studies on clustering of potential risk factors in adolescent LBP. The main objective of this study was to analyze the potential associations of mainly modifiable psychosocial and lifestyle factors with LBP in adolescence. The factors evaluated were overweight, smoking, physical workload, family’s socioeconomic status, and the co-occurrence of psychosocial and lifestyle factors. The present study used the database of the 16- to 18-year-old adolescent subcohort, Oulu Back Study (n=1,987), of the Northern Finland Birth Cohort 1986. Moreover, we evaluated whether the associations differ depending on the presence of LBP symptoms at baseline of the two-year follow-up period. LBP was common among cohort adolescents as, on average, every second adolescent reported LBP, girls reporting more symptoms. As a whole, more associations were found among girls than boys. Overweight was associated with new LBP in the follow-up, but the association was not strong. Prolonged habitual smoking was associated with LBP, particularly with symptoms at baseline and follow-up. High exposure to awkward trunk postures and an overall physically demanding job were especially associated with new LBP in the follow-up. Family’s socioeconomic status was not consistently associated with LBP. At 16 years, four latent class clusters of psychosocial and lifestyle factors were found in both genders. Clusters characterized by behavioural problems were associated with LBP among both genders. Especially girls with the combination of emotional and behavioural problems were at the greatest risk of seeking care for new LBP. The results of this study indicate that LBP in adolescence is associated with both psychosocial and lifestyle factors. The information obtained may be utilized for improving preventive measures and individual care for adolescent LBP
Tiivistelmä Alaselkäkipu on yleistä jo nuorilla, ja varhain koetut oireet ennustavat myöhempiä selkäkipuoireita. Suurin osa alaselkäkivun seurantatutkimuksista on tehty aikuisväestöllä. Nuorten alaselkäkivun on esitetty vakuuttavimmin liittyvän psykososiaalisiin ongelmiin ja tupakointiin. Alaselkäkipuun liittyvien tekijöiden mahdollista kasautumista ei ole nuorilla tutkittu aiemmin. Tämän väitöstutkimuksen tarkoituksena oli selvittää, ovatko pääasiassa muunneltavissa olevat psykososiaaliset ja elämäntapatekijät yhteydessä nuoruudessa esiintyvään alaselkäkipuun. Arvioitavina tekijöinä olivat ylipaino, tupakointi, fyysinen työkuormitus, sosioekonomiset tekijät, sekä psykososiaalisten ja elämäntapatekijöiden kasautuminen. Tutkimusaineisto koostui Pohjois-Suomen syntymäkohortti 1986:n osaotoksesta (Oulun selkätutkimus), johon kuului 1987 16–18-vuotiasta nuorta. Mahdollisia yhteyksiä arvioitiin erikseen sen mukaan, raportoivatko nuoret seurannan alussa alaselkäkipuoireita vai ei. Alaselkäkipu oli nuorilla yleistä, ja tytöillä yleisempää kuin pojilla. Keskimäärin joka toinen nuori raportoi oireita. Tutkittujen tekijöiden ja alaselkäkivun välisiä yhteyksiä todettiin selvemmin tytöillä. Ylipaino ennusti seurannassa ilmaantuvaa alaselkäkipua, mutta yhteys ei ollut vahva. Säännöllinen tupakointi oli yhteydessä alaselkäkipuun ja etenkin toistuviin oireisiin. Tutkituista työkuormitustekijöistä etenkin hankalat työasennot ja fyysisesti monella tapaa raskaaksi luokiteltava työ altistivat seurannassa uudelle alaselkäkivulle. Sosioekonomiset tekijät eivät olleet selkeästi yhteydessä alaselkäkipuun. Latenttien luokkien analyysi tunnisti seurannan alkuvaiheessa neljä erilaista ryhmää (klusteria) psykososiaalisten ja elämäntapatekijöiden perusteella molemmilla sukupuolilla. Sekä tytöillä että pojilla alaselkäkipua esiintyi erityisesti niissä ryhmissä, joissa esiintyi runsaasti käyttäytymishäiriöitä. Tunne-elämän ja käyttäytymisen ongelmat ennustivat alaselkäkivun vuoksi hoitoon hakeutumista tytöillä. Tulosten perusteella nuorten alaselkäkipuun liittyy sekä psykososiaalisia että elämäntapatekijöitä. Tuloksia voidaan hyödyntää alaselkäkivun ennaltaehkäisyn ja nuorten yksilöllisen hoidon suunnittelussa

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
A prevalência de dor lombar e cervical na adolescência é tão elevada quanto nos adultos e seu início, na adolescência, aumenta o risco de desenvolver dor crônica na vida adulta. Existem poucos estudos que tenham investigado como são os hábitos posturais dos adolescentes durante o tempo que estão em atividades passivas em casa e se esses hábitos estão associados à dor lombar e à dor cervical. Objetivo: Investigar a prevalência de dor lombar (DL) e de dor cervical (DC) em adolescentes e suas associações com hábitos posturais domiciliares enquanto estão assistindo a TV e/ou usando o computador. Métodos: Estudo transversal com adolescentes de uma escola pública de ensino médio do Rio de Janeiro. Os estudantes responderam questões relativas a variáveis sociodemográficas, ao estilo de vida, aos hábitos posturais (ilustrações), ao tempo assistindo a TV, ao tempo usando o computador, ao tempo usando o videogame e sobre a presença da DL e da DC. Foi utilizada regressão logística multivariada para analisar a associação entre hábitos posturais domiciliares e dor lombar e cervical. Resultados: Foram 1102 participantes. A prevalência de DL foi de 46,8% (18,2% dor lombar crônica [DLC] e 28,6% dor lombar aguda [DLA]. A prevalência de dor cervical aguda (DCA) foi de 32,9%. Posturas slump (excessivamente relaxadas) ao assistir a TV e ao usar o computador de mesa estiveram associadas com DLC (RC [razão de chances] 3,22, IC 95% 1,38 7,5 e RC 1,7, IC 95% 1,06 2,73). Participantes que assistiam a TV sentados na cama tiveram uma RC de 2,14 (IC 95% 1,06 4,32) para DLA e os que usavam o notebook em decúbito ventral na cama tiveram uma RC de 2,26 (IC 95% 1,02 5,01) para DLA. Os participantes que assistiam a TV em decúbito dorsal por 2 horas ou mais tiveram uma RC de 6,21 (IC 95% 1,45 26,52) para DCA. Aqueles que disseram que mudavam de postura com frequência, ao usar o computador de mesa por 2 horas ou mais, tiveram uma RC de 0,34 (IC 95% 0,14 0,85) para DCA. Conclusão: Os nossos achados apoiam a elevada prevalência de DL e de DC na adolescência e adicionam a associação com os hábitos posturais domiciliares.
The prevalence of low back and neck pain in teenagers is as high as in adults, and when it starts in adolescence, there is an increased risk of developing chronic pain in adulthood. There is a lack of studies investigating how the home postural habits of the teenagers are while in passive activities at home and if such habits are associated with low back and neck pain. Purpose: To investigate the prevalence of low back pain (LBP) and neck pain (NP) and their association with home posture habits watching TV and using a computer in adolescents. Methods: Crosssectional study with public high school adolescents in Rio de Janeiro, Brazil. Students answered questions regarding sociodemographic variables, lifestyle, posture habits (illustration), time watching TV, time using computer, time playing videogame and the presence of LBP and NP. Multivariate logistic regression was used to investigate the association between home posture habits and LBP and NP. Results: There were 1102 participants. The prevalence of LBP was 46,8% (18,2% chronic low back pain [CLBP] and 28,6% acute low back pain [ALBP]). The prevalence of acute neck pain (ANP) was 32,9%. Slump postures while watching TV and using a desktop computer were associated with CLBP (OR 3,22, 95% CI 1,38 7,5 and OR 1,7, 95% CI 1,06 2,73 respectively). Participants who watched TV seated on a bed yielded an OR of 2,14 (95% CI 1,06 4,32) for ALBP and who used the notebook lying belly down on a bed yielded an odds ratio (OR) of 2,26 (95% CI 1,02 5,01) for ALBP. The ones who watched TV lying supine on a bed for 2 hours or more yielded an odds ratio (OR) of 6,21 (95% CI 1,45 26,52) for ANP. Who frequently changed their positions while using a computer and used it for 2 hours or more yielded an OR of 0,34 (95% CI 0,14 0,85) for ANP. Conclusion: Our findings support the high prevalence of LBP and NP in adolescence and add the association with inappropriate home postural habits.

A previous history and earlier age of onset of low back pain are associated with chronic low back pain in adults. As such, preventing low back pain in adolescence may have a positive impact in adulthood. The objectives of this study were to determine the incidence of low back pain in a cohort of adolescents and to ascertain whether it was associated with increased growth spurt, decreased muscle flexibility and trunk strength, physical activity, and work. A prospective cohort design with urban high school students was conducted in Montreal, Canada; 502 students were evaluated at three separate times, six months apart. The students completed a questionnaire which addressed health issues of a musculoskeletal nature as well as lifestyle and psychosocial variables. They were also measured for: height, weight, leg and back flexibility, and trunk strength. Questions on low back pain referred to the previous six months and a frequency of occurrence of at least once a week was considered to represent positive reporting. Cumulative incidence of low back pain was then defined as the sum of incident reporting in the two six-month periods, excluding those who reported low back pain at study entry. A multivariate analysis (general estimating equations analysis) was used to model the repeated measures dichotomous outcome as a function of age, gender, smoking status and the repeated measures exposure variables: increased growth, flexibility, strength, activity, work. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed substantial back pain over the course of the year (cumulative incidence 17%). Risk factors associated with development of low back pain were: high growth (relative risk 3.00, 95% confidence interval (C.I.) 1.47--6.11), smoking (relative risk 2.47, C.I. 1.31--4.66), working (relative risk 2.19, C.I. 1.12--4.28), and tight quadriceps femoris (relative risk 1.04, C.I. 1.01--1.07). We conclude that low back pain in adole

Includes abstract.
Includes bibliographical references.
Traditionally, non-specific low back pain (NSLBP) has been described as an important public health issue among adults but a rare phenomenon in the young. However, recent epidemiological studies have provided evidence that NSLBP affects all age groups. In adolescents, the literature has shown that the prevalence has increased tremendously during the past two decades. The reasons for this remain unclear. In addition, there is substantial evidence to suggest some adolescents will experience severe episodes of recurrent NSLBP associated with adverse consequences such as long-term chronicity into adulthood, reduced health-related quality of life, and school absenteeism. In-spite of such evidence, no studies have been conducted in Zimbabwe to investigate the subjective presence of NSLBP symptoms among school-aged adolescents and to screen adolescents in schools affected by the condition in an attempt to identify the associated risk factors. The aim of the study was to estimate the prevalence (lifetime and point) and the one-year prevalence of recurrent NSLBP. In addition, the study aimed at identifying the individual risk factors associated with the report of recurrent NSLBP. A further aim was to compare the health-related quality of life between adolescents with recurrent NSLBP and those without.

La lombalgie (LBP) touche 80% de la population mondiale adulte et devient chronique dans 10 à 15% des cas. Pour la grande majorité des cas adultes (85%), aucune cause ne peut être clairement identifiée pour expliquer ces douleurs et l’on parle alors de lombalgie chronique « non-spécifique » (NSCLBP). Chez l’enfant et l’adolescent, la prévalence de la NSCLBP est semblable à celle de l’adulte. Malgré la faible incidence de pathologies graves associées, la lombalgie de l’enfant et de l’adolescent implique, souvent dans sa prise en charge diagnostique, une exposition augmentée aux radiations et un stress parental important. Cependant, la présence d’anomalies radiologiques est aussi fréquente dans la population asymptomatique que dans la population avec NSCLBP. Ceci remet en question l’intérêt clinique de la radiologie pour dépister une cause possible de NSCLBP. Dans ce contexte, il est nécessaire d’identifier de nouveaux outils, si possible non-irradiants et peu coûteux, pour identifier des caractéristiques spécifiques aux enfants et adolescents souffrant de NSCLBP et ainsi améliorer la compréhension de cette pathologie.L’analyse électromyographique (EMG) de l’activité des muscles paravertébraux lombaires s’est avérée cliniquement pertinente dans la population adulte pour discriminer les patients souffrant de NSCLBP des participants asymptomatiques. Plusieurs paramètres EMG enregistrés lors de différentes tâches ont été identifiés chez l’adulte pour caractériser les participants NSCLBP. Les paramètres EMG des muscles lombaires les plus couramment rapportés dans la littérature sont : un temps de maintien réduit ainsi qu’une fatigue musculaire accélérée pendant le test d’endurance des muscles extenseurs du tronc, la réduction ou l’absence du phénomène de flexion-relaxation (FRP) pendant la tâche de flexion maximale du tronc ainsi qu’un pattern atypique supportant l’hypothèse de précaution pendant la marche à différentes vitesses. Si ces caractéristiques EMG spécifiques aux patients souffrant de NSCLBP ont été bien établies chez l’adulte, la question est désormais de savoir ce qu’il en est chez l’enfant et l’adolescent souffrant de NSCLBP.Dans ce contexte clinique, l’objectif de ce travail doctoral était d’évaluer les caractéristiques EMG décrites ci-dessus dans une cohorte d’enfants et d’adolescents souffrant de NSCLBP en comparaison à des participants asymptomatiques (CTRL). Pour y répondre, plusieurs études complémentaires ont été effectuées.Dans leur ensemble, les travaux de cette thèse de doctorat ont montré que les phénomènes EMG reportés dans une population adulte avec NSCLBP ne sont pas retrouvés dans une population pédiatrique avec NSCLBP. Ces résultats remettent en question le diagnostic et la prise en charge actuelle des enfants et adolescents souffrant de NSCLBP, qui est, à ce jour, calquée sur le modèle adulte. Des études supplémentaires sont cependant nécessaires pour confirmer ces résultats sur une cohorte plus importante. Il serait aussi intéressant d’évaluer une même cohorte à partir de l’enfance jusqu’à l’âge adulte afin d’évaluer quels facteurs pourraient prédire l’apparition des phénomènes rapportés dans la littérature adulte
The majority of the worldwide population (80%) suffers from low back pain (LBP) over life. LBP becomes chronic (CLBP) in 10 to 15% of (all) adult cases yielding important functional and socio-economic adverse repercussions. The majority of LBP (85%) is classified as “non-specific” (NSCLBP), i.e. with an absence of any identified cause. LBP prevalence on children and adolescents is comparable to adults. Despite the low incidence of serious associated diseases, the fear of missing them increased patient’s exposure to radiation. However, an absence of significant correlation between radiology changes in the lower spine and low back pain was reported for school children. In this context, it is necessary to identify new tools, if possible non-irradiating and inexpensive, to identify specific characteristics of children and adolescents suffering from NSCLBP and thus improve the understanding of this pathology.An interesting tool, highlighted in adult population, is to evaluate surface electromyography (EMG) of low back muscles. Existing EMG phenomena were reported to discriminate adults with and without NSCLBP: reduced trunk muscle endurance, absence of flexion-relaxation phenomenon and guarding hypothesis during gait at different velocities. These EMG characteristics have not yet been confirmed for children and adolescents suffering of NSCLBP.This clinical context justifies the present doctoral work. The aim was to evaluate EMG characteristics in children and adolescents with NSCLBP in comparison with control participants. To achieve these objectives, several complementary studies were successively conducted.Taken together, the results of this doctoral work showed that the EMG characteristics frequently reported for NSCLBP in adults were absent or reduced in children and adolescent suffering from NSCLBP. These findings are inconsistent with the existing literature on adults and might affect the future therapeutic management of children and adolescents with NSCLBP, which is, to date, an imitation of the adult model. It would be interesting to confirm these results on the basis of a larger cohort and to reassess the same children and adolescents in adulthood to identify whether the EMG phenomenon, as known in NSCLBP adults, appears over time

Sammanfattning Syfte och frågeställningar: Syftet med föreliggande studie var att beskriva prevalens av ryggsmärta hos ett slumpmässigt urval av svenska ungdomar ur SIH-studien 2004, Skola-Idrott-Hälsa en nationell studie om barns och ungdomars hälsa och omgivande faktorers betydelse för deras fysiska aktivitet. Dessutom var syftet att beskriva köns- och åldersskillnader samt hur stor andel av de med generell ryggsmärta 2004 som hade rapporterat ryggsmärta 3 år tidigare. Vidare var syftet att koda ryggsmärtan i fyra olika fält markerad på smärtteckning, och undersöka om skillnader förelåg mellan barn och ungdomar med ländryggsbesvär och de utan ryggbesvär i fysisk aktivitet, fysisk inaktivitet samt psykologiska faktorer såsom stress, nedstämdhet och trötthet. Metod: Barn och ungdomar 12, 15 och 18 år svarade i enkät på frågan: har du ont i ryggen idag, och markerade ryggsmärta på en smärtteckning. Denna kodades och smärtan kartlades utifrån 4 anatomiska lokalisationer, eller fält: 1)nacke, 2)bröstrygg, 3)ländrygg och 4)smärta i fler än ett fält på ryggen. Den kodade ryggsmärtan presenterades och köns- och åldersskillnader beskrevs. Fält 3)ländrygg studerades separat och sambandet mellan faktorer i SIH-studiens enkät som representerar fysisk aktivitet och fysisk inaktivitet samt stress, trötthet och nedstämdhet jämfört med individer utan ryggsmärta. Resultat: Ryggsmärta rapporterades av 23%, 274 individer, av alla i studien och fler flickor än pojkar rapporterade ryggsmärta, skillnaden var signifikant p<0,001. Ryggsmärta rapporterades av 23% redan år 2001. Ländryggen var den vanligaste smärt-lokalisationen hos både pojkar och flickor och rapporterades av 46% av individerna som hade ryggsmärta. Fler flickor 60% än pojkar 40% rapporterade ländryggssmärta. Smärtan ökade mest från årskurs 6 till 9 hos individerna med ländryggsmärta och smärta i fler än ett fält på ryggen. Färre individer med ländryggssmärta tävlade i idrott eller deltog i idrottsförening. Större andel individer med ländryggsmärta chattade/surfade och spelade dataspel än individerna utan ryggsmärta (p=0,047). Unga med ländryggsmärta rapporterade mer stress, trötthet och nedstämdhet (p<0,001).  Slutsats: Ryggsmärta rapporterades av 23% av alla individer i SIH-studien 2004. Ländryggen var den vanligaste smärtlokalisationen hos både pojkar och flickor och smärtan ökade främst från årskurs 6 till 9. Fler flickor än pojkar rapporterade ryggsmärta. Mindre andel individer med ländryggssmärta tävlade i drott eller deltog i idrottsförening och de unga med ländryggssmärta uppgav mer stress, trötthet och nedstämdhet än individer utan ryggsmärta. Signifikant fler individer med ländryggssmärta ägnade mer tid att chatta/surfa på internet och spela dataspel på helgerna än individerna utan ryggsmärta (p=0,047).
Abstract. Purpose and Issues: The aim of the present study was to describe the prevalence of back pain in a random sample of Swedish adolescents in the SIH-survey 2004, a national survey about health in children and adolescents and possible factors of importance of physical activity in their surrounding. The aim was also to describe the gender and age distribution and if those with back pain in 2004 had back pain 3 years earlier. Furthermore, the aim was to encode back pain in four different fields, marked on a paindrawing, and examine whether there were differences between children and adolescents with low back pain and those without back pain and physical activity, physical inactivity, and psychological factors such as stress, depression and fatigue.  Method: Children and adolescents 12, 15 and 18 years old answered the question in a questionnaire: Do you have a sore back today, and highlighted back pain on a paindrawing. The coded backpain was mapped by four anatomical locations, or fields: 1) neck, 2) thoracic spine, 3) lumbar and 4) pain in more than one field at the back. The coded back pain and gender and age distribution were described. Field 3) lumbar spine, were studied separately and relationships between factors in the SIH-study questionnaire that represents physical activity and physical inactivity and stress, fatigue and depression compared with individuals without back pain. Results: Back pain was reported by 23%, 274 individuals, of all participating in the study and significantly more girls than boys reported back pain. Back pain was reported by 23% already in 2001. The lower back was the most common location of pain in both boys and girls and was reported by 46% of individuals who reported back pain. More girls 60% than boys 40% reported low back pain. The pain increased most from grades 6 to 9 in individuals with low back pain and pain in more than one field at the back. Less number of individuals with low back pain were competing in sports and participated in a sports-club. Young people with low back pain reported significantly more stress, fatigue and depression (p<0,001). Conclusion: Back pain was reported by 23% of all individuals participating in the SIH-study 2004. The lower back was the most common location of pain in both boys and girls and the pain increased primarily from grades 6 to 9. Less number of individuals with low back pain competed in sports and participated in a sports-club. Individuals with low back pain reported significantly more stress, fatigue and depression than individuals without back pain (p<0,001). Significantly more individuals with low back pain played computer games and chatted/surfed on the internet during weekends than individuals without backpain (p=0,047).

Trabalho apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Objectivos: Analisar a prevalência de dores lombares em crianças e adolescentes, uma vez que o seu conhecimento é indispensável no âmbito da intervenção preventiva e reabilitativa. Métodos: Foi utilizado o questionário nórdico (Sjolie, 2003), traduzido e validado para a população portuguesa (Festas, 2010). Foram inquiridos 126 alunos do 5º, 6º, 7º e 8º ano, do Agrupamento Vertical de Escolas Dr. Vieira de Carvalho – 152055,com idades compreendidas entre os 10 e 15 anos. Resultados: A prevalência de vida da dor lombar em crianças e adolescentes é realmente elevada (68,3%), sendo mais significativa no sexo feminino. Conclusão: Existe uma elevada prevalência de dor lombar, sendo assim de importância fulcral a prevenção nesta área, incidindo logo nas camadas mais jovens. Objectives: Analyze prevalence of low back pain in children and teenagers, since its awareness becomes truly important in its prevention and rehabilitation. Methods: Nordic questionnaire was used (Sjolie, 2003), translated and validated for the Portuguese population (Festas, 2010). The sample was composed by 126 students, from 5º, 6º, 7º and 8º level, from the Agrupamento Vertical de Escolas Dr. Vieira de Carvalho – 152055, with ages between 10 and 14 years old. Results: The life prevalence of low back pain in children and teenagers was really high (68.3%) and more significant in females. Conclusion: There is a high prevalence of low back pain in children and teenagers, so it is of great importance the prevention in this area, focusing immediately on young ages.

O estudo das relações entre níveis de aptidão física relacionada à saúde e a ocorrência de dores nas costas e alterações posturais em adolescentes é importante, pois permite o estabelecimento de critérios de saúde. Sendo assim, o objetivo geral deste estudo é verificar a associação entre a ocorrência de dor e alteração postural da coluna lombar e os níveis de aptidão física relacionada à saúde em adolescentes de 10 a 16 anos de idade. A amostra foi composta por 467 adolescentes (260 meninos e 207 meninas) de 10 a 16 anos de idade, provenientes de uma escola da cidade de Porto Alegre. A definição da amostra foi por critério de conveniência. O estudo é do tipo correlacional e preditivo, com delineamento transversal. Os componentes da aptidão física relacionada à saúde analisados foram a flexibilidade (sentar-e-alcançar) e a força/resistência abdominal (número de abdominais em um minuto – sit up´s). A avaliação da dor lombar foi realizada através de questionário e a postura da coluna lombar verificada através de fotografias, a partir da marcação de pontos de referência. Foram realizados testes de encurtamento muscular (isquiotibiais e flexores de quadril - através de goniometria), de flexibilidade lombar (teste de Schober modificado), medidas antropométricas (peso e estatura) e calculado o IMC. Para a descrição dos dados foi utilizado a freqüência de ocorrência. Para as associações entre as variáveis categóricas foi utilizado e teste qui-quadrado e para predizer as variáveis dependentes dor lombar e alteração postural da coluna lombar foi utilizado a regressão logística binária, com método enter. Para todas as análises estatísticas foi utilizado o programa SPSS for Windows 13.0 e adotado o nível de significância de 5%. Os resultados demonstraram que houve elevada prevalência de hiperlordose lombar (78%) e de dor lombar (54,2%) na amostra estudada e a ocorrência de ambas se associaram ao sexo feminino. Não houve associação entre a ocorrência de dor e alteração postural da coluna lombar. As variáveis capazes de predizer a ocorrência de alteração postural da coluna lombar foram sexo, mobilidade lombar, força/resistência abdominal, postura da coluna cervical, flexibilidade e estatura. Quanto à ocorrência de dor lombar, as variáveis capazes de predizê-la foram sexo, idade e flexibilidade. Considerando os resultados encontrados e, a partir dos modelos preditivos formulados, verificamos que as variáveis força/resistência abdominal e flexibilidade, amplamente utilizadas e referenciadas à saúde osteomuscular, associam-se, quando abaixo dos pontos de corte estabelecidos, à maior ocorrência de dor e alteração postural da coluna lombar.
The relationship between health related physical fitness and low back pain occurrence and posture assessment study during adolescence is important, because allows to establish health criteria. The aim of this study is to evaluate the association between low back pain and low back posture with health related physical fitness in adolescents aged 10 to 16 years old. This cross sectional study with correlation and predictive technique comprised a sample of 260 boys and 207 girls, which were selected by convenience criterion. Health related physical fitness components analyzed were flexibility (sit and reach test) and abdominal strength (sit up test). Low back pain was evaluated through a questionnaire and the low back posture assessed by photographs with reference marks. Hip extension and hamstrings flexibility was measured by goniometer and sagittal lumbar mobility was assessed by Schober´s modified technique. Body height and weight were measured, and BMI was calculated. Data description was made through frequency of occurrence and quisquare test was used to evaluate categorical variables association. Binary logistic regression was used to predict low back pain and increased lumbar lordosis occurrence. All statistic analyzes were made at SPSS 13.0 statistic program for Windows with the significance level of 5%. The results showed high lumbar hyperlordosis prevalence (78%) and high low back pain prevalence (54,2%). Those occurrences was associated with female gender. There was no association between low back pain and increased lumbar lordosis. The predictive variables for low back posture deviation were gender, sagittal lumbar mobility, abdominal strength, flexibility and height. Variables gender, age and flexibility have shown to be predictive to the occurrence of low back pain. In conclusion, abdominal strength and flexibility, widely used as health related physical fitness, were associated, when bellow cut off points recommended with low back pain and hyperlordosis occurrence.

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The low back pain is a condition that affect 70-80% of adult population, at least once for the life. Recently, it was observed that low back pain in children and adolescents is a complaint as common as that verified in adults. The aim of this study was to investigate the prevalence of acute low back pain (ALBP) and associated factors, in adolescents of urban high school of Southern Brazilian city. A high school-based cross-sectional study was realized including 1233 students aged 14-19 years. The acute low back pain (ALBP) was evaluated by means of two questions. The outcome was LBP in the last 30 days. The prevalence of ALBP was 13.7%. The non-white skin students, which moved walking to the school, showed a higher prevalence of ALBP. The prevalence of ALBP is relatively high. Further studies with followup until adult age are indispensable for investigate whether physical cumulative load upon lumbar spine (for example, duration/transport, schoolbags and improper school furniture) during adolescence, may concur for development of ALBP in the adult stage
A dor lombar (DL) é um transtorno que atinge 70-80% da população adulta, pelo menos uma vez na vida. Recentemente foi constatado que a DL nas crianças e adolescentes é uma queixa tão comum quanto aquela observada nos adultos. A finalidade deste estudo foi analisar a prevalência da DL aguda e fatores associados, nos adolescentes do ensino médio da zona urbana de Pelotas/RS, Brasil. Foi delineado um estudo transversal de base escolar no ensino médio, abrangendo 1233 escolares entre 14-19 anos de idade. A DL aguda (DL30) foi determinada por duas questões. O desfecho foi DL durante os últimos trinta dias. A prevalência da DL30 foi de 13,7%. Indivíduos de cor de pele não-branca e que se deslocavam para a escola caminhando foram os que demonstraram maior prevalência de DL30. A prevalência da DL aguda é relativamente alta. Estudos adicionais com a evolução até a idade adulta são indispensáveis para averiguar se a carga física cumulativa sobre a coluna lombar (por exemplo, transporte/tempo, mochilas e mobiliário escolar inadequado) durante a adolescência contribui para a DL adulta.

Tesis por compendio de publicaciones
El dolor lumbar en niños y adolescentes es un problema de salud que va en aumento. Desde la Fisioterapia se aborda este problema con medidas preventivas y de tratamiento. El objetivo de esta Tesis fue estimar la prevalencia del dolor lumbar en niños y adolescentes, así como, analizar la eficacia de las diferentes modalidades fisioterapéuticas para la prevención y el tratamiento del dolor lumbar en esta población, mediante tres estudios meta-analíticos. Para la búsqueda de los estudios se utilizaron fuentes formales e informales, lo que nos permitió identificar 86 artículos que cumplieron con los criterios de selección. Respecto de los resultados, las tasas de prevalencia de vida en el dolor lumbar de niños y adolescentes fueron más altas en los sujetos de mayor edad, y en los estudios más recientes y de mejor calidad metodológica. Los tratamientos preventivos de Fisioterapia para el cuidado de la espalda en niños y adolescentes fueron eficaces para la adquisición de conocimientos y mejora de las conductas saludables. Para adquirir conductas los tratamientos fueron más eficaces cuando se combinó la adquisición de conocimientos con el entrenamiento de hábitos posturales, cuando se combinó la enseñanza teórica y práctica y cuanto mayor fue el número de horas por semana y el número de horas total de tratamiento que recibió cada sujeto. Los tratamientos de Fisioterapia para el dolor lumbar en esta población fueron eficaces, siendo la combinación de acondicionamiento físico terapéutico y terapia manual el más eficaz.
Low back pain (LBP) in children and adolescents is a health problem that is increasing, and the physiotherapy addresses this problem with preventive and treatment interventions. The aim of this Dissertation was to estimate the prevalence of LBP in children and adolescents and to analyze the effectiveness of different physiotherapic modalities for preventing and treating LBP in this population, by means of three meta-analyses. Formal and informal sources were used to search for the studies, identifying a total of 86 articles for the three meta-analyses that met the selection criteria. Regarding the results, rates of lifetime prevalence for LBP in children and adolescents were higher in older subjects, as well as for more recent studies and with a better methodological quality. Physiotherapy preventive treatments for LBP in children and adolescents were effective in acquiring knowledge and improving healthy behaviors. To modify behaviors, preventive treatments were more effective when combined with knowledge acquisition training postural habits, when combined theoretical and practical teaching and the greater the number of hours per week and the total number of hours of treatment received by each subject. Physiotherapy treatments for LBP were effective in this population, with the combination of therapeutic physical conditioning and manual therapy as the most effective.

The cause of low back pain in populations of professional drivers is uncertain. A literature review revealed factors that seem to be associated with low back pain (e.g. physical factors: exposure to whole body-vibration, prolonged sitting posture, frequent lifting, pushing and pulling, lack of physical fitness; psychosocial factors: job satisfaction or stress; individual factors: age, gender, anthropometrics, tobacco, alcohol consumption, etc.). This thesis investigates the occurrence of back pain in professional car drivers – a group found to be not focussed upon in previous epidemiological studies. The thesis seeks to advance understanding of response relationships between risk factors and low back pain in populations of car drivers (209 taxi drivers and 365 police drivers) and 485 non-drivers. A longitudinal study with cross-sectional baseline combined with field measurement of driving in selected vehicles was performed to investigate the occurrence of musculoskeletal problems (mainly low back pain) and the relationship between risk factors and low back pain experienced for at least one day during the past 12 months in the two populations of professional drivers (taxi drivers and police drivers) and professional non-drivers. The cross-sectional baseline of the longitudinal study revealed that 45% (38.3-51.7%) of taxi drivers, 53% (48-58.6%)of police drivers and 46% (41-50.1%) of police non-drivers reported low back pain for at least one day during the past 12-months (p = 0.09). The prevalence of low back pain in the non-driving population of police employees fell within prevalence range reported by professional car drivers in this study and in previous epidemiological studies. The cross-sectional study revealed risk factors associated with the prevalence of low back pain (i.e., stature, previous physical demands, increased psychosomatic distress, daily and cumulative driving in taxi drivers; age, lifting, bending, increase psychosomatic distress in police drivers; stature, bending, increased psychosomatic distress in police non-drivers). Measurements of whole-body vibration in selected taxi and police vehicles revealed frequencyweighted accelerations in the dominant vibration direction (i.e., z-axis) to be 0.47 ms-2 r.m.s. in taxi vehicles and 0.58 ms-2 r.m.s. in police vehicles. A study of cumulative exposure to whole-body vibration in a group of taxi drivers pointed to a possible overestimation of their self-estimated duration of vibration exposure by 31% on average. The longitudinal study revealed a lower incidence of low back pain in taxi drivers than in both police drivers and police non-drivers (p = 0.02). The difference might be attributed to a different approach to low back pain in taxi drivers who lose income if unable to work. An alternative explanation for increased low back pain among police employees could be that taxi drivers with low back pain leave their profession and were excluded from the follow-up study – a healthy worker effect. The longitudinal study revealed that increased psychosomatic distress was a risk factor associated with the development of new episodes of low back pain in all three of the studied populations (i.e. taxi drivers and police drivers and non-drivers). In police drivers, increased daily duration of driving was a risk factor for the development of low back pain. Although the results point to increased incidence of low back pain with increasing duration of daily driving, non-drivers were at a similar risk of developing of low back pain. Plausible explanations for this finding include ergonomic factors that were present for both the drivers and the non-drivers (e.g., the duration of sitting or duration in a constrained posture) and the presence of other risk factors not investigated in the study but associated with increased incidence of low back pain in non-drivers.

Chronic low back pain (CLBP) causes ongoing pain, disability and psychological suffering, at a huge personal and socio-economic cost. CLBP is a heterogeneous condition and its mechanisms are poorly understood. Characterisation and classification of low back pain (LBP) is controversial, there is disagreement on the characterisation and diagnosis of neuropathic low back pain (NuLBP) in relation to mechanical LBP (MLBP). Diagnostic uncertainty is coupled with poor clinical outcomes for treatment. There is therefore an urgent need to develop more effective assessment strategies to identify and better differentiate NuLBP from MLBP in order to facilitate a better understanding of underlying mechanisms and more successful treatments. The primary aim of this study was to establish clinical profiles of CLBP, in particular, differences between MLBP and NuLBP using Questionnairebased behavioural evaluation and sensory testing, structural neuroimaging (voxel based morphometry) and functional neuroimaging (arterial spin labelling). Significant differences were identified between CLBP patients and healthy controls and between NuLBP and MLBP patients in multiple behavioural domains measuring pain, function and psychological well-being. Significant differences were demonstrated in CLBP patients compared to controls in both tactile threshold discrimination and two-point discrimination and between NuLBP and MLBP in tactile threshold discrimination. Functional and structural neuroimaging showed significant differences between all groups in widespread brain regions involved in the evaluation of decision making and planning, mood and emotion, modulation of pain and representation of body schema. This study has demonstrated the ability to characterise CLBP using a battery of behavioural, examination and functional and structural neuroimaging methodologies and has been able to differentiate between CLBP patients and controls and importantly, between NuLBP and MLBP patients. This work demonstrates the impact of CLBP across sensory-discriminative, affectivemotivational and cognitive-evaluative dimensions of the pain experience and shows the increased impact and burden on those who suffer with NuLBP compared to MLBP.

PhD
Abstract Low back pain is a significant public health problem in many countries of the world being one of the major causes of work absence and disability. Although the outlook for evidence-based management of low back pain has greatly improved over the past decades, many questions remain. Questions related to treatment options, underlying mechanisms of treatment effects and optimal assessment of low back pain have yet to be fully addressed by researchers. The broad aim of this thesis therefore was to contribute to a better understanding of the contemporary management of low back pain by performing studies in these key research areas. Most clinical practice guidelines recommend exercise as an effective treatment option for chronic low back pain. However the evidence for this recommendation comes from trials that are not placebo-controlled and so this may potentially provide biased estimates of the effects of exercise. Therefore a randomised controlled trial testing the effect of motor control exercise versus placebo in patients with chronic low back pain was conducted. Chapters 2 and 3 describe the trial protocol and the report of the trial respectively. A total of 154 patients with chronic low back pain were randomised to receive a motor control exercise program, or placebo (i.e. detuned short-wave therapy and detuned ultrasound therapy). Primary outcomes were pain, function, and the patient’s global impression of recovery measured at 2 months. The exercise intervention improved function and patient’s global impression of recovery, but not pain, at 2 months. The mean effect of exercise on function was 1.1 points (95%CI, 0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95%CI, 0.4 to 2.5) and the mean effect on pain was 0.9 points (95%CI, - 0.01 to 1.8), all measured on 11 point scales. Secondary outcomes also favoured motor control exercise. This is the first study ever to demonstrate that motor control exercise is better than placebo for patients with chronic low back pain. Most of the treatment effects were maintained at 6 and 12 months follow-up. These results suggest that this intervention should be considered for patients with chronic low back pain in order to improve disability, function, and global impression of recovery, and to improve pain intensity in the long term, but not in the short term. Rehabilitative ultrasound imaging (RUSI) has been increasingly used by physiotherapists in order to identify impairments in motor control as well as to monitor progress of patients with low back pain. As with any other clinical measure it is important to know how reproducible the RUSI measures are, and although there are some reproducibility studies in the literature, no systematic review on this topic has been conducted. Therefore a systematic review was performed with the objective of assessing the reproducibility studies of RUSI for abdominal wall muscles (Chapter 4). Eligible studies were indentified via searches in CINAHL, EMBASE and MEDLINE with citation tracking via the Web of Science Index. A total of 21 studies were included. Due to heterogeneity of the studies’ designs, pooling the data for a meta-analysis was not possible. RUSI measures of thickness of abdominal wall muscles were found to be reliable. Few studies analysed the reliability for the measurement of thickness changes (reflecting the muscle activity) finding good to poor results. Evidence for the reproducibility of the difference in thickness changes over time (necessary to evaluate improvements in muscle activity with treatment) was not available. A limitation of the existing literature is that studies typically had suboptimal designs and analysis. The current evidence for the reproducibility of RUSI for measuring abdominal muscle activity is mainly based upon studies with suboptimal designs that included mostly healthy subjects, making generalisability to clinical settings uncertain. Some questions about the reproducibility of RUSI measures of abdominal wall muscles are still unanswered; this is mainly due to design issues, such as inadequate statistics, inadequate sampling and lack of control of sources of bias (e.g. blinding and absence of controlling for ordering effects). In addition the clinically important questions about the reproducibility of thickness changes (reflecting the muscle activity) and differences in thickness changes over time (reflecting the improvement or deterioration of muscle activity) have not been adequately investigated. Therefore a reproducibility study that aimed to answer these questions was performed (Chapter 5). Thirty-five patients seeking care for chronic low back pain participated in this study. RUSI measures were taken at baseline and eight weeks post-baseline. Replicate measures of thickness, thickness changes and differences in thickness changes over time were analysed. The reproducibility of static images (thickness) was excellent (ICC2,1 = 0.97, 95%CI = 0.96-0.97, Standard Error of the Measurement (SEM) = 0.04cm, Smallest Detectable Change (SDC) = 0.11cm), the reproducibility of thickness changes was moderate (ICC2,1 = 0.72, 95%CI 0.65-0.76 SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes over time was poor. Improvements in the test protocol should be undertaken in order to enhance the reproducibility of RUSI measures, especially for differences in thickness chang over time. Self-report outcome measures (questionnaires) are widely used by health care providers for measuring patient’s health status or treatment outcomes. Most of the questionnaires related to low back pain were developed in English and therefore their usefulness in non-English speaking countries is considerably limited. Cross-cultural adaptation and clinimetric testing are possibly the most efficient methods for solving this problem. Although there are many publications on the topic, a simple guide on how to perform a cross-cultural adaptation and clinimetric testing was not available. Therefore a “clinician-friendly” narrative review for Brazilian physical therapists (Chapter 6) was written. This review aimed firstly to explain the concepts and the relevance of cross-cultural adaptation and clinimetrics testing, secondly to summarise the current guidelines on the topic, thirdly to provide advice on how to choose a relevant questionnaire and finally how to evaluate the quality of an adapted questionnaire. Some examples of cross-cultural adaptations and clinimetrics testing of relevant low back pain questionnaires in the Brazilian-Portuguese language were also provided. Although the number of international versions of low back questionnaires is growing, to date it is unclear which questionnaires have been cross-culturally adapted and into which specific language. To answer these questions a systematic review was conducted in order to describe the available cross-cultural adaptations of low back pain self-report outcome measures and the clinimetric testing that has occurred for each adaptation (Chapter 7). Searches were performed in MEDLINE, EMBASE, CINALH and LILACS; these searches were supplemented with information from experts in the field of low back pain from 27 different countries to ensure that the results were comprehensive. Sixty-one adaptations were identified. While there are a large number of low back pain questionnaires available, very few have been adapted into other languages, particularly commonly spoken languages such as Mandarin, Hindi and Portuguese. The quality and comprehensiveness of clinimetric testing varied considerably, with the evaluation of reliability and construct validity most common. Further cross-cultural adaptation and clinimetric studies are clearly needed and special consideration must be given to study designs for clinimetric testing. The final aim of this thesis was to cross-culturally adapt self-report instruments relevant to the management of low back pain in Brazil. This was achieved by two independent studies. The first study (Chapter 8) aimed to cross-culturally adapt the Functional Rating Index (FRI) into Brazilian-Portuguese and to test the clinimetric properties of the FRI and also of an existing Brazilian-Portuguese version of the Roland Morris Disability Questionnaire (RMDQ) which was not fully evaluated in the original study. Both instruments were tested for internal consistency, reliability, construct validity, ceiling and floor effects and internal responsiveness in 140 chronic low back patients presenting for physiotherapy treatment in Brazil. Both instruments were considered reliable and valid for the measurement of disability in Brazilian-Portuguese speakers with low back pain, no ceiling or floor effects were detected, but the internal responsiveness of both instruments was considered small. The second study (Chapter 9) aimed to cross-culturally adapt the Patient-Specific Functional Scale (PSFS) and to perform a head-to-head comparison of the clinimetric properties of the PSFS, RMDQ and FRI. All instruments were tested for internal consistency, reliability, construct validity, ceiling and floor effects, internal and external responsiveness in 99 acute low back patients presenting for physiotherapy treatment in Brazil. In order to fully test the construct validity and external responsiveness, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale. The results of this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, FRI and PSFS have similar clinimetric properties to each other and to the original English versions; however the PSFS was the most responsive instrument. The results from the studies in Chapters 8 and 9 will benefit the understanding of low back pain by enabling international comparisons between studies conducted in Brazil and English speaking countries. In addition it will encourage researchers to include Brazilian- Portuguese speakers in their future clinical trials. Overall, the studies included in this thesis have provided an important contribution to the contemporary management of low back pain. Firstly the use of motor control exercise could be considered for patients with chronic low back pain as it produces improvements in global impression of recovery, function, disability and pain. Secondly RUSI measures of abdominal wall muscles in patients with low back pain were considered reproducible for the measurement of muscle activity, but not as an outcome measure to detect improvement/deterioration of muscle activity over the course of treatment. Thirdly just a few high-quality cross-cultural adaptations and clinimetrics testing for self-report outcome measures relevant to the management of low back pain are available, and clearly more studies in this area are needed. Finally the Brazilian-Portuguese versions of the Functional Rating Index, the Roland Morris Disability Questionnaire and the Patient-Specific Functional Scale have acceptable clinimetric properties and could be used in clinical practice as well as in research studies in Brazil.

Thesis (Ph. D.)--University of Sydney, 2009.
Title from title screen (viewed Aug. 11, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliographical references. Also available in print form.

Acute low back pain is a commonly occurring symptom that can impact considerably upon a person's life. It is poorly defined, difficult to classify and challenging to measure. However, due to the high prevalence rates of the symptom, cited in the epidemiological literature, and the costs incurred by individuals, health services and society in general, it is vital that clients are encouraged to take more responsibility for their health. This thesis is concerned with perceptions of control in people with acute low back pain. It is about how they respond to this symptom and the way it impacts upon their lives. The underpinning literature is drawn from both medical and social science research, as the work crosses faculty boundaries. Problems are addressed from a physiotherapeutic and social science perspective, as links are formed between the different disciplines. From this literature, a significant theoretical development was the creation of a framework, which enabled the systematic review of existing outcome measures. A number of instruments, relevant to clients with acute low back pain, were reviewed using this framework, for the dimensions of control, function, pain and anxiety. The findings were used to inform the selection of outcome measures in this research. Four studies were then undertaken, all linked to studying clients with acute low back pain. The first study was a survey of general practitioners in Southampton and the New Forest, which identified their strategies for managing clients with acute low back pain. The second study focused on clients' experiences and was a randomized controlled trial, which tested the effectiveness of an information leaflet, designed to encourage clients to take more responsibility for their own health. The third study primarily focused on clients' perceptions of control over time, addressing the question of how these perceptions change during a one-year period. Finally, since recruitment of clients by their doctors was problematic throughout this research, a follow-up survey was undertaken with these health professionals to establish the reasons for this. The results of these studies are used to discuss the importance of clients' perceptions of control and the implications for clinical practice.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Prior studies have reported differences in lower back biomechanics during activities of daily living between individuals with and without chronic low back pain (LBP). Nevertheless, the literature on lower back biomechanics of patients with non-chronic LBP is scant. Therefore, the objective of this study, as the first step towards future prospective studies, was to investigate the lower back biomechanics in patients with non-chronic LBP. Case-control studies were conducted wherein measures of lumbo-pelvic coordination during bending and return tasks as well as measures of mechanical demand on the lower back during lifting tasks in the sagittal plane were investigated between patients with non-chronic LBP and matched asymptomatic individuals. Patients were enrolled into the study at the non-chronic stage of their LBP. We found distinct difference in measures of lumbo-pelvic coordination as well as mechanical demands on the lower back between patients with non-chronic LBP and controls. Reduced lumbar range of flexion and slower task pace as well as the more in-phase and less variable lumbo-pelvic coordination observed in patients with non-chronic low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Such a neuromuscular adaptation, however, resulted in a larger shearing demand on the lower back. Persistent abnormal lumbo-pelvic coordination might play a role in transition to chronic stage or recurrence of LBP. However, such inferences need to be further investigated using prospective studies as well as clinical trials involving a combination of physical and psychological treatments aimed at correction of lumbo-pelvic coordination.

This study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic. In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure.

The thesis aimed to investigate the effectiveness of AT for LBP. A systematic review was conducted to determine the effectiveness of acupuncture. There is strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy for non-specific LBP although the effectiveness of acupuncture compared with other forms of control intervention still requires further investigation.

Introduction: Lifetime prevalence of low back pain in the adult population has been estimated to be over 60% and the costs to society are huge. It has been calculated that the direct health care costs of the condition approach £2billion per annum in the UK alone, and further costs are associated with informal care and with lost productivity in the workplace. Prevalence of the condition increases with age from approximately 30% at age 25yrs and studies have shown that, in adults, the greatest predictor of low back pain is a previous history of similar symptoms. It is important, therefore, to examine the aetiology of low back pain in youth. In childhood low back pain is also reasonably common and some authors have published prevalence estimates approaching those in adults. A number of factors have been associated with the occurrence of low back pain in childhood and/or adolescence: physical factors, such as height and weight; mechanical factors, such as the carriage of heavy schoolbags; lifestyle factors, such as sports participation; psychosocial and psychological factors, such as behavioural conditions and a negative affect score; and familial factors, such as the presence of parental pain. However, the majority of published research in this field has been cross-sectional in nature and, therefore, cannot distinguish between cause and effect. To investigate the aetiology of low back pain it is clear that longitudinal studies that examine the onset of the condition are required. Aims: To identify the risk factors for the onset of low back pain in adolescents. Study Design: Population-based prospective cohort study. Methodology: Two cross-sectional surveys were carried out twelve months apart. At baseline, 1040 children aged 11-14yrs, from thirty-nine schools in the Northwest of England, were identified as being free of low back pain. In these children, average daily mechanical load was assessed using schoolbag weight, recorded over a five day period. Using a self-completion questionnaire, exposure to a number of other potential risk factors was assessed: lifestyle factors, psychosocial factors, and the occurrence of other common childhood (somatic) pain complaints. These children were then followed up twelve months subsequently to establish episodes of new onset low back pain. In addition, using a postal questionnaire, information was obtained from parents of the subjects regarding the occurrence of parental pain, and also, in girls, menstrual status. Results: 935 children (89.4%) participated at follow-up, of whom 168 (18.6%) reported low back pain - by definition, new onset low back pain. The occurrence of new onset low back pain increased with age and was more common in girls than boys but was unrelated to menstruation. The onset of low back pain was associated with neither average daily mechanical load, nor mechanical load relative to body weight. In general, lifestyle factors were not predictive of future pain, although sporting activity was significantly, but non-linearly, associated with an increased risk of pain. In contrast, adverse psychosocial factors were consistently and strongly associated with an increased risk of future pain; this was true for conduct problems in particular. Furthermore, the baseline occurrence of headache, abdominal pain and sore throats was associated with an increased risk of low back pain at follow-up. Children whose parents reported pain were no more likely to report low back pain (or indeed, any pain) than other children. Conclusions: This study has provided no evidence that mechanical factors are associated with an increased risk of future low back pain. Adverse psychosocial behaviour, and conduct problems in particular, are associated with an increased risk of new onset low back pain. In addition, the prior occurrence of other common pain conditions was strongly associated with an increased risk of future pain. Thus, this study concludes that low back pain in childhood may be a manifestation of somatisation.

This thesis presents a set of studies which investigated chronic low back pain. The specific aim of this thesis was to develop reliable methods for the assessment and rehabilitation of chronic low back pain. The two assessment methods tested were a broad based clinical evaluation and an isokinetic assessment of trunk muscle strength. The first part of the thesis describes the reliability and validity studies of the clinical methods for measuring trunk mobility, trunk muscle strength, spinal shape and palpation. A total of 27 physical tests were studied using 70 patients and 10 normal subjects. Twenty-three of these tests were found to be reliable and were incorporated into the isokinetic assessment study. The second part of the study reports the standardisation and reliability studies for the isokinetic assessment of trunk muscle strength in 70 normal subjects and 120 patients with chronic low back pain. The results showed that the main isokinetic measures were reliable for both normal subjects and patients. There was a significant learning effect from test 1 to test 2 in both normal subjects and patients. The magnitude of this learning effect was greater in patients than normal subjects. The normal subjects were followed up by a postal questionnaire in a two year prospective study to predict future back pain using the isokinetic measures. None of the measures used showed any significant differences between those subjects who developed back pain and those who did not. The third part of the thesis describes studies to develop a rehabilitation programme for patients with chronic low back pain using the isokinetic machines, both as a means of monitoring progress and as an exercise regime. The first study of 26 patients indicated that the programme was safe and effective, but also revealed a major problem with adherence to a six week exercise programme. The second study investigated the problem of adherence and examined the time course of response to isokinetic exercise by repeating the tests at three weeks and six weeks.

Low back pain is a debilitating condition that afflicts millions of people each year. It is characterized by complex biochemical, morphological, and biomechanical changes. However, most believe low back pain arises due to abnormal mechanical loading, inflammation, and disc degeneration. Several studies have investigated radial back pain, but to date, there is only one in vivo animal model for low back pain. Despite advances in science, the causes of low back pain remain unclear and treatments fail to relieve the pain. To better understand the causative factors of low back pain, a reliable animal model is needed. This study was designed to advance the knowledge of the previous in vivo animal model for low back pain by investigating the effects of shear loading on disc degeneration (for a longer duration of time) and discogenic low back pain (in terms of immunohistochemistry) in hopes developing better treatment strategies for low back pain sufferers and to help elucidate the etiology of low back pain. Adult male Sprague Dawley rats (n=31) were shear loaded for 4- and 8- weeks. Pain behavioral testing was done prior to and after surgery. After sacrifice, immunohistochemistry was used to detect the presence of pain in the intervertebral discs and the spinal cord. Results of this study indicate that the application of an abnormal shear load gives rise to disc degeneration. Histology revealed that all loaded levels as well as the adjacent levels degenerated due to the shear load. Pain behavior testing revealed that the rats did experience pain, however, when combined with the immunohistochemical results, we were able to exclude the pain as pain stemming from the degenerated discs. Surprisingly, we observed that shear loading caused scoliosis of the thoracolumbar spine.

Low back pain is a common but severe health problem. Chronic low back pain accounts for the bulk of the burden of low back pain. Exercise interventions are effective in the management of chronic low back pain. Current clinical thinking in physical therapy treats low back pain as a heterogeneous entity seeking to match specific interventions to subpopulations. None of these subgroups assess the role of gluteus medius dysfunction in chronic low back pain. These projects seek to describe the prevalence of gluteus medius weakness in people with chronic low back pain and test the effectiveness of a gluteus medius strengthening exercise intervention in people with chronic low back pain. Gluteus medius strength was assessed in 150 people seeking care for chronic low back pain and 75 healthy people without low back pain. Gluteus medius was found to be weaker on affected sides compared to unaffected sides within people with chronic low back pain and weaker than people without low back pain. Gluteus medius weakness was a strong predictor of the presence of low back pain. A gluteus medius strengthening program was compared with lumbar stabilization exercises in 56 people with chronic low back pain. Although there was a clinically significant improvement in pain in people who performed the gluteus medius strengthening exercise program, this was not significantly different from the stabilization exercise intervention. Adherence to exercise was significantly correlated with reduction in pain and perceived improvement of low back pain. Although gluteus medius weakness is common in people with low back pain and treating this weakness with a targeted exercise intervention is effective, it is not better than a standard stabilization exercise intervention. Doing exercise is likely more important than what exercise is done.

This thesis investigates position awareness of the low back, measured using an electrogoniometer, in participants with and without recurrent non-specific low back pain (NSLBP). The ability to appreciate body position and movement makes an essential contribution to control of posture and functional movement. Pain may impair this awareness and initiate or exacerbate joint damage. Impairment of position awareness in the low back has been reported in patients with chronic low back pain. In addition, work-related activities may impair positional awareness, particularly in people experiencing LBP. The accuracy, stability and through range test-retest reliability of the electrogoniometer was assessed. It was found to be a reliable measure of degrees during movement in the sagittal plane between 0 to +/- 60 degrees, when compared to measurements using a calibrated, highly accurate, bevel protractor (mean error differences below 0.5 degrees for all tests). Low back position awareness was measured before and after a shift of work, in sitting and standing, in 61 people with recurrent NSLBP and 40 without a history of LBP. In addition, secondary analysis investigated the effect of occupation (manual workers, sedentary workers, drivers) on position sense. Low back position awareness was also measured in 50 people with recurrent NSLBP and 50 without a history of LBP during mid-range of sagittal plane movement of the low back in sitting; and when trying to return to a "good" sitting posture. There were no differences between participants with and without recurrent NSLBP in repositioning accuracy of the low back during any of the studies. When investigating the effect of occupation however, only sedentary workers achieved the power required for analysis. People with LBP positioned their "good" sitting posture significantly closer to end-range of low back extension, than people without LBP (12.47 SD8.46, v’s 16.51 SD9.41 degrees respectively; P=0.026). Recurrent NSLBP and sedentary work-related activities did not affect accuracy of position awareness in the low back. In people with recurrent NSLBP however, the position of their "good" sitting posture closer to end-range low back extension could lead to greater compressive loading of pain-sensitive spinal tissue, as well as increases in facet joint forces and shear forces on discs. These mechanisms may be aetiologic in the recurrence and maintenance of LBP. This finding may have implications for clinical practice, with consideration perhaps given to assessing the position of "good" sitting posture and its relationship to end-range in patients with LBP. Future research should investigate this further in larger populations of people with and without LBP, including specific sub-groups of LBP.

The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2006.
Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology, School of Public Health." Discipline: Epidemiology; Department/School: Public Health.

Context: Hundreds of thousands of Quebec residents suffer from chronic pain, for which treatment is far from optimal. Despite low back pain being the second most common reason to visit a primary care physician, management remains challenging. Additionally, chronic low back pain (CLBP) has been found to be the most common reason for patients to be referred to tertiary pain centers. Recently, there has been an increasing acceptance that bio-psycho-social factors play a crucial role the clinical course of CLBP. Objectives: The purpose of this study was to identify subgroups of CLBP patients treated in tertiary care, as defined by their changes in pain and disability over time, and to explore possible characteristics associated with these changes. Specific objectives were: 1) to establish whether there are distinct subgroups of patients with CLBP with different characteristics associated with change in pain and disability at 6, 12, and 24 months following an initial visit in a tertiary pain clinic; and 2) to identify potential social, psychological, biological, and environmental factors that may predict their responses in pain intensity and disability in accordance with the Revised Wilson and Cleary Model for Health-Related Quality of Life. Design: Observational prospective design to follow a cohort of patients who were enrolled in the web-based Quebec Pain Registry. Setting: The Quebec Pain Registry, a research database comprised of close to 5000 chronic pain patients. Eligible participants included all patients who 1) have been diagnosed with lumber without radicular pain, LBP (diagnostic code 3.1), lumbar & radicular pain, LRP (diagnostic code 3.2), or diffuse lumbar pain, DLP (diagnostic code 3.4), 2) who provided written consent for their data to be used for research purposes, and 3) have completed their initial visit to the pain clinic by May 31, 2011. Intervention: The data required for this project had previously been collected and entered in the Quebec Pain Registry. Basic descriptive results were produced using SAS® software 9.2. This analysis described the characteristics of the 917 patients included in the study at baseline. Additional data were explored to examine patterns of changes over two years for certain characteristics. A generalized estimating equations model (GEE) was used to analyze data at 6, 12, and 24 months after the initial visit. Results: 299 (32.6%) patients were diagnosed LBP, 522 (56.9%) with LRP, and 96 (10.4%) with DLP. In general, all patients were relatively comparable in terms of their characteristics with the exception of DLP, where proportions were noticeably different. Patients diagnosed with DLP had a higher pain duration median (6.0 years) and the most frequently current employment status was permanent disability (both in regards to proportions). The most common ethnicity was Caucasian among all diagnoses. Income was similarly distributed among all groups and secondary school was the highest level of education completed for all. The top three medical conditions reported other than CLBP were rheumatoid arthritis/osteoarthritis, hypertension, and depressive disorders. DLP patients reported "accident at work" as the most common circumstance surrounding their onset of pain. DLP also had noticeably different mean scores for average pain, worst pain, depression, catastrophizing, disability, mental and physical summary scores on the health-related quality of life questionnaire at baseline, 6, 12, and 24 months (in regards to proportions). Patients with higher worst pain scores, longer pain duration, and lower physical summary scores at the initial visit were significantly less likely to show improvements in pain intensity and disability at six and 12 months. Conclusions: Although modifying the analysis prohibited conclusions for a two-year follow to be made, characteristics, such as worst pain, pain duration, and lower physical summary scores at both six and 12 months were discovered.
Contexte: Des centaines de milliers de résidents du Québec souffrent de douleurs chroniques. En dépit de la douleur au bas du dos étant la deuxième cause la plus fréquente de consulter un médecin de soins primaires. . Récemment, il y a eu une acceptation croissante que les facteurs bio- psychosociale (biologiques, psychologiques et sociaux ) jouent un rôle crucial de l'évolution clinique de la lombalgie chronique , mais peu de recherches concernant la lombalgie chronique ont étés achevé plus d'un an . Objectif: Les objectifs spécifiques sont : 1) d'établir s'il existe des groupes distincts de patients atteints de lombalgie chronique avec des caractéristiques de réponse à 6, 12 et 24 mois après la visite initiale, et 2) pour identifier le potentiel social, psychologique, biologique et environnemental caractéristiques, conformément à la modèle révisée Wilson et Cleary pour la qualité liée à la santé de la vie. Conception: analyse prospective d'une cohorte historique. Cadre: Le Registre québécois de la douleur, une base de données de recherche unique composée de près de 5000 patients souffrant de douleurs chroniques de centres de la douleur tertiaires. Participants: adultes diagnostiqués avec la douleur chronique au bas du dos qui sont inscrits dans le registre de la douleur Québec. Les participants admissibles inclus tous les patients qui ont été diagnostiqués avec le bois sans douleur radiculaire , LBP (code de diagnostic 3.1), lombaire et douleur radiculaire , LRP (code de diagnostic 3.2) , ou une douleur lombaire diffuse , DLP (code de diagnostic 3.4) et ont terminé leur formation initiale visite à la clinique de la douleur avant le 31 mai 2011. Intervention: Les données nécessaires à ce projet avaient déjà été recueillies et consignées sur le registre de la douleur Québec. Résultats descriptives de base ont été produites en utilisant SAS ® 9.2 logiciel. L'analyse descriptive a décrit les 917 patients inclus dans l'échantillon de l'étude au départ, générant des scores moyens. Des données supplémentaires ont été explorées pour observer des modèles sur deux ans pour certaines caractéristiques. Un modèle des équations d'estimation généralisées (GEE) a été utilisé pour analyser des données corrélées à six, 12 et 24 mois. Résultats: 299 (32.6%) patients ont été diagnostiqués LBP, 522 (56.9%) avec LRP, et 96 (10.4%) avec DLP. En général, tous les diagnostics étaient comparables à l'exception de DLP. Les patients diagnostiqués avec DLP avaient une durée médiane de la douleur plus élevé (6,0) et l'invalidité permanente le plus fréquemment rapporté pour le statut actuel de l'emploi. L' ethnie la plus fréquente était de race blanche parmi tous les diagnostics . Le revenu a été distribué similaire dans tous les groupes, et à l'école secondaire était le plus haut niveau de scolarité atteint pour tous. Les trois conditions médicales rapportées étaient la polyarthrite rhumatoïde / arthrose, l'hypertension et les troubles dépressifs. DLP patients ont signalé « accident du travail » comme circonstance la plus courante qui entoure leur apparition de la douleur. DLP a également indiqué sensiblement différents scores moyens pour la douleur moyenne, pire douleur, la dépression, catastrophisme, le handicap, le score résumé mental, et le score résumé physique au départ, 6, 12 et 24 mois. Les patients ayant les plus mauvais scores de la douleur, la durée de la douleur plus élevé, et des scores plus bas sommaires physiques étaient significativement moins susceptibles de montrer des améliorations dans la douleur et le handicap à six et 12 mois. Conclusions: Bien que la modification des conclusions interdites d'analyse pour un suivi de deux ans à faire, des caractéristiques importantes telles que la pire douleur, la durée de la douleur, et les scores sommaires physiques inférieurs aux deux six et 12 mois ont été découverts.

Musculoskeletal physiotherapy is the most common intervention for chronic low back disorder. Any observation on clinical practice or investigation into the clinical and scientific literature indicates that musculoskeletal physiotherapy encompasses a plethora of treatment modalities and approaches. The aim of the present investigation was to determine the most common intervention(s) that comprise musculoskeletal physiotherapy and to critically explore their empirical therapeutic basis. Two components were highlighted as the most frequently employed interventions; namely manually applied therapy (manual therapy) and exercise(s) to rehabilitate the lumbar spine's stabilising system. In the course of an extensive literature search, work was uncovered that suggested that the mechanisms required for spinal stability could be better facilitated using methods other than those in current clinical use. These discoveries culminated in the creation of a ten-week rehabilitation programme which was primarily developed to facilitate rehabilitation of spinal stabilisation but also permitted an empirical analysis of this component of musculoskeletal physiotherapy. The efficacy of the regime was then assessed in comparison to manual therapy and to a control (an education booklet) in a randomised controlled trial. Following a series of pilot studies, 300 patients with chronic low back disorder were randomly assigned to groups and completed their respective management programmes. Data were collected on pain, disability, handicap, impairment and quality of life prior to entry and at three, six, twelve and twenty-four months post intervention. The results indicated a consistent trend for greater improvement in the spinal stabilisation group in the pain, handicap, impairment, disability, dysfunction and medication variables. These trends reached statistical significance at the three-month follow-up stage as evidenced by quality of life (P = 0.025), at the six-month follow-up stage in pain (P = 0.009) and dysfunction (P = 0.042) and at the one-year follow-up stage in medication (P = 0.007), dysfunction (P = 0.048), disability (P = 0.0098) and quality of life (P = 0.003). It was therefore concluded that the spinal stabilisation programme was a more effective component of musculoskeletal physiotherapy (when analysed in isolation) than manually applied therapy or an education booklet in the management of chronic low back disorder. Various sub-analyses of the data were conducted. Subjects who entered the study with high levels of low back pain (greater than 50 numerical rating scale) demonstrated a statistically Significant reduction in pain levels (P = 0.04) in both the manual therapy group and the spinal stabilisation group in comparison to the education control group at the three-month follow-up stage. These data provide empirical evidence towards the efficacy of these two musculoskeletal physiotherapy management regimes as being effective in pain reduction in comparison to an active control intervention. This has not hitherto been demonstrated on patients with chronic low back disorder.