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Search Results for : Low Back Pain
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
The development and validation of a Low Back Pain Knowledge Questionnaire - LKQ.
Author(s): Maciel, SC; Jennings, F; Jones, A; Natour, J
Journal: Clinics (Sao Paulo) 2010 Jul 24; Vol. 64, Issue 12; Page(s) 1167-75
[Medline ID - 20037704]

OBJECTIVE: The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION: There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS: The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS: The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p < 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p < 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p < 0.001). CONCLUSION: The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.

Typical whole body vibration exposure magnitudes encountered in the open pit mining industry.
Author(s): Howard, B; Sesek, R; Bloswick, D
Journal: Work 2010 Mar 3; Vol. 34, Issue 3; Page(s) 297-303
[Medline ID - 20037244]

According to recent research, a causal link has been established between occupational exposure to whole body vibration and an increased occurrence of low back pain. To aid in the further development of an in-house health and safety program for a large open pit mining facility interested in reducing back pain among its operators, whole body vibration magnitudes were characterized for a range of jobs. Specifically, thirty-five individual jobs from five different areas across the facility were evaluated for tri-axial acceleration levels during normal operating conditions. Tri-axial acceleration magnitudes were categorized into thirteen job groups. Job groups were ranked according to exposure and compared to the ISO 2631-1 standard for health risk assessment. Three of the thirteen job groups produced tri-axial acceleration magnitudes below the ISO 2631-1 low/moderate health caution limit for a twelve hour exposure. Six of the thirteen job groups produced exposures within the moderate health risk range. Four job groups were found to subject operators to WBV acceleration magnitudes above the moderate/high health caution limit.

Effect of chair design on ratings of discomfort.
Author(s): Alnaser, MZ; Wughalter, EH
Journal: Work 2010 Mar 26; Vol. 34, Issue 2; Page(s) 223-34
[Medline ID - 20037234]

The purpose of this study was to determine if ratings of discomfort differ over time between two ergonomic chairs of the same approximate cost. Twenty participants from a metropolitan university sat on two types of ergonomic chairs for 90~minutes in each of two sessions while performing typing, reading, and writing tasks. Repeated measures three-way and two-way analyses of variance were used to examine the effect of the ergonomic chair design on rating of discomfort. Data were collected using the General Comfort Rating Scale (GCRS) and the Body Part Discomfort Rating Scale (BPDRS), which were administered at 0, 30, 60, and 90 minute marks of each session. The results revealed: 1) discomfort was not related to the type of chair, 2) discomfort increased over time, 3) discomfort was influenced by the task performed while sitting, 4) dis comfort level decreased when switching between different chairs, and 5) most discomfort was reported in the low back and lower arms.

Metastasis of malignant struma ovarii to the lumbar spine.
Author(s): Yamashita, M; Ishii, T; Ohtori, S; Oikawa, Y; Watanabe, T; Ito, T; Furuya, M; Takahashi, K
Journal: J Clin Neurosci 2010 Jun 9; Vol. 17, Issue 2; Page(s) 269-72
[Medline ID - 20036545]

A 32-year-old woman with a solitary metastasis to the lumbar spine from a struma ovarii was treated surgically with tumour extirpation and anterior spinal reconstruction. Metastasis may occur when a patient has had prior surgery to remove this rare tumour.

Factors defining care-seeking in low back pain--a meta-analysis of population based surveys.
Author(s): Ferreira, ML; Machado, G; Latimer, J; Maher, C; Ferreira, PH; Smeets, RJ
Journal: Eur J Pain 2009 Dec 29; Vol. 14, Issue 7; Page(s) 747.e1-7
[Medline ID - 20036168]

Little is known about factors determining health care-seeking behavior in low back pain. While a number of studies have described general characteristics of health care utilization, only a few have aimed at appropriately assessing determinants of care-seeking in back pain, by comparing seekers and non-seekers. The objective of this systematic review was to identify determinants of health care-seeking in studies with well-defined groups of care-seekers and non-seekers with non-specific low back pain. A search was conducted in Medline, AMED, Cinahl, Web of Science, PsycINFO, National Research Register, Cochrane Library and LILACS looking for population- based surveys of non-specific low back pain patients older than 18 years, published since 1966. To be included in the review, studies needed to report on characteristics of well-defined groups of care-seekers and non-seekers. Methodological quality was assessed using a criteria list based on sampling, response rate, data reproducibility, power calculation and external validity. Risk estimates were expressed as odd ratios (95% confidence intervals). When possible, meta-analyses were performed, using a random effects model. Eleven studies were included in the review. Pooled results show that women are slightly more likely to seek care for their back pain as are patients with a previous history of back pain. Pain intensity was only slightly associated with care-seeking, whereas patients with high levels of disability were nearly eight times more likely to seek care than patients with lower levels of disability.

Idiopathic spinal epidural lipomatosis - two cases report and review of literature.
Author(s): Chan, JY; Chang, CJ; Jeng, CM; Huang, SH; Liu, YK; Huang, JS
Journal: Chang Gung Med J 2010 Mar 11; Vol. 32, Issue 6; Page(s) 662-7
[Medline ID - 20035646]

Spinal epidural lipomatosis (SEL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. During the period of 1990 to 2006, we have two cases of medically heath SEL patients without history of steroid administration. Their initial clinical manifestations were low back pain, pr ogressive lower extremities weakness, numbness, followed by rapid deterioration of neurogenic intermittent claudication. They were misdiagnosed and treated as degenerative spinal disease for a long time. Due to prominent neurological deficit, lumbar magnetic resonance image (MRI) was obtained and showed SEL. These 2 patients all underwent laminectomy and removal of epidural fat. Postoperatively, they both showed improvement. We reviewed the literature and discussed the current concept in the management of SEL.

Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials.
Author(s): Helmhout, PH; Staal, JB; Heymans, MW; Harts, CC; Hendriks, EJ; de Bie, RA
Journal: Eur Spine J 2010 Jun 15; Vol. 19, Issue 4; Page(s) 650-9
[Medline ID - 20035358]

The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 +/- 10.5 years, range 20-56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland-Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment.

Pain and clinical findings in the low back: a study of industrial employees with 5-, 10-, and 28-year follow-ups.
Author(s): K; ääriä, SM; M; älkiä, EA; Luukkonen, RA; Leino-Arjas, PI
Journal: Eur J Pain 2009 Dec 26; Vol. 14, Issue 7; Page(s) 759-63
[Medline ID - 20034826]

Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist's findings in the low back were associated with local and radiating LBP among a cohort (n=902) of employees in the engineering industry. A systematic non-proportional sample was drawn in strata by age, gender, and occupational class. The non-proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight-leg raising test (SRL), and made assessments of the fingertip-to-floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow-ups of the occurrence of local and radiating LBP at 5, 10, and 28 years from baseline were made. At the 5-year follow-up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4-5.1) and 3.8 (2.0-6.9), respectively, adjusted for age, gender, and occupational class. At the 10-year follow-up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0-3.1) and of local LBP (4.1; 1.9-9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling.

Frequency of screening magnetic resonance imaging to detect occult spinal cord compromise and to prevent neurological deficit in metastatic castration-resistant prostate cancer.
Author(s): Venkitaraman, R; Sohaib, SA; Barbachano, Y; Parker, CC; Huddart, RA; Horwich, A; Dearnaley, D
Journal: Clin Oncol (R Coll Radiol) 2010 May 12; Vol. 22, Issue 2; Page(s) 147-52
[Medline ID - 20034772]

AIMS: Neurological deficit from malignant spinal cord compression (SCC) is a major complication of metastatic castration-resistant prostate cancer (CRPC). The aims of the present study were to determine the incidence of neurological deficit in metastatic prostate cancer patients and to determine the optimal frequency of screening magnetic resonance imaging (MRI) spine required to detect clinically occult radiological SCC (rSCC). MATERIALS AND METHODS: A retrospective analysis of the clinical data of 130 consecutive patients with CRPC, with no functional neurological deficit, who had screening MRI spine from January 2001 to May 2005, was undertaken. Patients found to have rSCC received radiotherapy. All patients were followed-up to document the incidence of neurological deficit. RESULTS: Thirty-seven (28.4%) patients had rSCC on MRI. The proportion of patients free from neurological deficit at 3, 6, 12, 18 and 24 months was 94, 80, 59 and 43%, respectively, in patients who had rSCC on initial MRI and 97.5, 89, 75 and 63%, respectively, in patients who had no rSCC. A high prostate-specific antigen (PSA) level at initial MRI (P = 0.035) and a short PSA doubling time < 3 months (P = 0.009) significantly predicted for neurological deficit on univariate analysis, whereas back pain (P = 0.059), although an important predictive factor, did not attain statistical significance. On multivariate analysis, only rapid PSA doubling time ( < 3 months) independently predicted for future neurological deficit (P = 0.042). CONCLUSION: MRI spine can be used to detect asymptomatic rSCC in patients with CRPC and serial estimations are required to maintain a low incidence of clinical SCC. If serial screening MRI spine is used to detect rSCC in 90% of patients before the development of neurological signs, the optimum frequency depends on the subset of patients studied. The results of our study suggest that the optimum frequency would be every 4-6 months for patients with previous SCC, rapid or high PSA or back pain and annually for asymptomatic patients.

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study.
Author(s): Kalichman, L; Hodges, P; Li, L; Guermazi, A; Hunter, DJ
Journal: Eur Spine J 2009 Dec 25; Vol. 19, Issue 7; Page(s) 1136-44
[Medline ID - 20033739]

The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis a t L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.
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