Low handgrip strength is closely associated with chronic low back pain among women aged 50 years or older: A cross-sectional study using a national health survey

Association between Handgrip Strength, Skinfold Thickness, and Trunk Strength among University Students

OBJECTIVES

The main goal was to explore the relationship between hand grip strength (HGS), the thickness of the skinfold at multiple sites, and the trunk flexor (TF) and extensor (TE) muscle strength among healthy participants.

METHODS

We employed a cross-sectional design and randomly recruited 40 participants. Ultimately, only 39 participants were included. First, measurements for demographic and anthropometric variables were carried out. After that, the evaluation of hand grip strength and skinfold was performed.

DATA ANALYSIS

Descriptive statistics were used to explore the amount of interaction between the smoking and nonsmoking groups, and a repeated measures analysis of variance was employed. Furthermore, associations between dependent and independent variables were discovered through a multiple linear regression model.

RESULTS

The participants had a mean age of 21.59 ± 1.19 years. The results of the repeated measures analysis of variance validated an acceptable interaction between the trunk and hand grip strength at a significance level of p < 0.01, further emphasized by their moderate association (p < 0.05). Multiple regressions between TE, TF, the independent variables T score, height, and age were also significant (p < 0.05).

CONCLUSIONS

The trunk muscle strength can be used as a health indicator for comprehensive evaluation. The present study also found a moderate relationship between hand grip strength, trunk strength, and T score.

Prevalence and factors associated with low back pain in warehouse workers: A cross-sectional study

BACKGROUND

Low back pain is a highly prevalent musculoskeletal disorder that leads to functional incapacity and absence from work.

OBJECTIVE

To analyze warehouse workers' prevalence and factors associated with low back pain.

METHODS

Cross-sectional study design with 204 male warehouse workers (stocker, separator, checker, and packer) from motor parts companies. Age, body mass, marital status, education, the practice of physical exercise, presence of pain, low back pain intensity, comorbidities, time away from work, handgrip strength, flexibility, and trunk muscle strength were collected and analyzed. Data are presented as mean, standard deviation, absolute and relative frequency. A binary logistic regression was performed, with low back pain (yes or no) as the dependent variable.

RESULTS

24.0% of the workers reported low back pain with an average intensity of 4.7 (± 2.4) points. The participants were young, had completed high school education, were single and married, and had normal body weight. There was a more likely low back pain presence in separator tasks. Greater handgrip strength in the dominant (right) hand and trunk muscle is associated with no low back pain.

CONCLUSION

Low back pain prevalence was 24% among young warehouse workers, more likely in separation tasks. A greater handgrip and trunk strength can be a protective factor to no low back pain.

Development and Validation of a Risk-Prediction Nomogram for Chronic Low Back Pain Using a National Health Examination Survey: A Cross-Sectional Study

BACKGROUND

Several prognostic factors have been reported for chronic low back pain (CLBP). However, there are no studies on the prediction of CLBP development in the general population using a risk prediction model. This cross-sectional study aimed to develop and validate a risk prediction model for CLBP development in the general population, and to create a nomogram that can help a person at risk of developing CLBP to receive appropriate counseling on risk modification.

METHODS

Data on CLBP development, demographics, socioeconomic history, and comorbid health conditions of the participants were obtained through a nationally representative health examination and survey from 2007 to 2009. Prediction models for CLBP development were derived from a health survey on a random sample of 80% of the data and validated in the remaining 20%. After developing the risk prediction model for CLBP, the model was incorporated into a nomogram.

RESULTS

Data for 17,038 participants were analyzed, including 2693 with CLBP and 14,345 without CLBP. The selected risk factors included age, sex, occupation, education level, mid-intensity physical activity, depressive symptoms, and comorbidities. This model had good predictive performance in the validation dataset (concordance statistic = 0.7569, Hosmer-Lemeshow chi-square statistic = 12.10, p = 0.278). Based on our model, the findings indicated no significant differences between the observed and predicted probabilities.

CONCLUSIONS

The risk prediction model presented by a nomogram, which is a score-based prediction system, can be incorporated into the clinical setting. Thus, our prediction model can help individuals at risk of developing CLBP to receive appropriate counseling on risk modification from primary physicians.

The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort

METHODS

This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire.

RESULTS

A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (β = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (β = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item.

CONCLUSIONS

In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

Prevalence of chronic low back pain and its associated factors in the general population of South Korea: a cross-sectional study using the National Health and Nutrition Examination Surveys

BACKGROUND

Many factors associated with chronic low back pain (CLBP) have been proposed, including individual, psychosocial, and physical factors. However, these associated factors are still controversial.

PURPOSE

(1) To determine the prevalence of CLBP and (2) to analyze factors associated with CLBP in the general population using a nationally representative sample of South Koreans.

STUDY DESIGN

Cross-sectional study.

PATIENT SAMPLE

Data from versions IV-1, -2, and -3 of the Korea National Health and Nutrition Examination Survey (KNHANES), which were performed in 2007, 2008, and 2009, respectively (n = 24,871).

OUTCOME MEASURES

Multiple logistic regression analysis was performed to determine the association between several factors (age, gender, alcohol consumption, household income, education level, mid-intensity physical activity, depressive symptoms, vitamin D level, and comorbidities [stroke, ischemic heart disease, knee osteoarthritis, asthma, COPD, cancer history]) and CLBP.

METHODS

CLBP status was surveyed using a self-reported questionnaire. Demographic, socioeconomic status, comorbidities, and other factors were evaluated from health questionnaires, health and physical examinations, and laboratory tests. To analyze the association between these factors and CLBP, we used multiple logistic regression analysis.

RESULTS

Data from 17,038 participants were included in the final analysis, including 2,693 with CLBP and 14,345 without. The prevalence of CLBP was 15.8% in South Korean subjects, with a prevalence of 11.8% in men and 24.5% in women. After regression analysis, we found advanced age, female gender, mid-intensity physical activity, depressive symptoms, stroke, ischemic heart disease, knee arthritis, asthma, COPD, and cancer history were positively associated with CLBP. In contrast, alcohol consumption ≥ 1 drink per month, increased household income, higher education level, and vitamin D insufficiency were negatively associated with CLBP.

CONCLUSIONS

Our study showed that CLBP was most common in the elderly and women in the general South Korean population. Several individual, socioeconomic, lifestyle, and health-related factors were associated with CLBP. These results demonstrate the influence of these factors on CLBP in the general population and suggest that consideration of these factors may improve the management of CLBP.

Associations between social integration, participation and productivity loss among persons with chronic pain: a registry based cross sectional study

Purpose

To examine associations between factors of social inclusion and participation and productivity loss in employed persons with chronic pain, assessed for an interprofessional pain rehabilitation programme. We hypothesized that factors of social inclusion and participation and work related social factors are significantly associated with productivity when experiencing chronic pain and we expected a moderate effect.

Methods

Cross-sectional study using data collected prospectively in an interprofessional patient registry for chronic pain. The primary end point was productivity loss, measured with the iMTA Productivity Costs Questionnaire. We included data from 161 individuals. To be included, persons had to be 18 years old or older, in paid work, and had to have a medical diagnosis of chronic pain syndrome with actual or potential tissue damage. In addition, participants had to have indicators of significant impairments in psychosocial functions.

Results

Linear regression analysis showed that a highly stressful professional situation, frequent problems regarding the compatibility of the family and job and not being Swiss were associated with a significantly higher total productivity loss. Similar results were found for productivity loss in paid work. However, problems concerning the compatibility of the family and job did not reach the significance level for productivity loss in paid work.

Conclusion

The results of this study underscore the importance of factors of social inclusion and participation for interprofessional rehabilitation programmes to manage chronic pain especially when focussing on productivity loss.

Potential Explanatory Factors for the Concurrent Experience of Dyspnea and Pain in Patients with COPD

Previous research has identified unexpectedly strong associations between dyspnea and pain, but the reasons remain unclear. Ascertaining the underlying biological and psychological mechanisms might enhance the understanding of the experience of both conditions, and suggest novel treatments. We sought to elucidate whether demographic factors, disease severity, psychological symptoms and biomarkers might account for the association between pain and dyspnea in individuals with COPD. We analyzed data from 301 patients with COPD who were followed in a prospective longitudinal observational study over 2 years. Measures included self-reported dyspnea and pain, pulmonary function tests, serum levels of inflammatory cytokines, measures of physical deconditioning, and scales for depression and anxiety. Analyses involved cross-sectional and longitudinal linear regression models. Pain and dyspnea were strongly correlated cross-sectionally (r = 0.77, 95% CI 0.72-0.82) and simultaneously across time (r = 0.42, 95% CI 0.28-0.56). Accounting for any of the other health factors only slightly mitigated the associations. Symptoms of pain and dyspnea thus may be fundamentally linked in COPD, rather than being mediated by common biological, psychological, or functional factors. From the patient's perspective, pain and dyspnea may be part of the same essential experience. It is possible that treatments for one condition would improve the other.

Association between Dietary Protein Intake, Regular Exercise, and Low Back Pain among Middle-Aged and Older Korean Adults without Osteoarthritis of the Lumbar Spine

This study aimed to evaluate the effect of dietary protein intake and regular exercise on low back pain (LBP) using data from the Korea National Health and Nutrition Examination Survey. A total of 2367 middle-aged and older adults (≥50 years) who underwent dual-energy X-ray absorptiometry and plain radiography of the lumbar spine were included. LBP was defined using a questionnaire to determine the presence of LBP lasting more than 30 days in the preceding three months. Twenty-four-hour dietary recall data were used to estimate protein intake, and regular exercise was assessed using the International Physical Activity Questionnaire. Multivariable logistic regression analysis revealed that men who did not perform regular exercise had a high probability of LBP (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.24−4.44). Low protein intake (<0.8 g/kg/day) was associated with high odds for LBP in women (OR 1.83; 95% CI 1.12−2.99). Low protein intake and lack of regular exercise were also associated with a higher probability of LBP in women (OR 2.91; 95% CI 1.48−5.72). We recommend that women over 50 years of age consume the recommended daily amount of protein to prevent LBP and engage in regular exercise.

Association between Relative Handgrip Strength and Chronic Lower Back Pain: A Nationwide Cross-Sectional Analysis of the Korea National Health and Nutrition Examination Survey

Lower back pain (LBP) is the most common musculoskeletal complaint and significantly reduces the quality of life. Muscle weakness is a major cause of LBP. Handgrip strength (HGS) is widely used to determine general muscle strength. Relative HGS (RHGS) incorporates body mass and provides a more accurate estimation of muscle strength and health status. We analyzed the data from Korea National Health and Nutrition Examination Survey to investigate the association between RHGS and chronic LBP. We identified 14,930 participants and excluded a total of 9553 participants with age < 50 years, with incomplete LBP information, and with incomplete HGS information. We analyzed the data of 5377 participants: 1086 (20.19%) with chronic LBP and 4291 (79.8%) without chronic LBP. Multivariate regression analysis with adjustment for covariates identified an association between weak RHGS and chronic LBP (odds ratio 1.31; CI 1.07-1.61; p = 0.01). This article demonstrated a significant association between RHGS and chronic LBP. Therefore, RHGS should be measured for patients with chronic LBP.

Precarious Employment and Increased Incidence of Musculoskeletal Pain among Wage Workers in Korea: A Cross-Sectional Study

The number of precarious workers is increasing globally, and precarious employment is becoming a public concern in terms of workers' health. However, sufficient research on precarious employment and its impact on musculoskeletal pain (MSP) is lacking. This study aimed to investigate the relationship between precarious employment and the risk of MSP among Korean wage workers. After merging the data from the 4th and 5th Korean Working Conditions Surveys, 59,644 wage workers were analyzed. The control group comprised full-time permanent workers, and precarious employment was defined as workers involved in temporary or daily employment, or part-time workers. The outcome variable was the summed number of MSP in three anatomical sites (back, neck and upper limb, lower limb). Zero-inflated negative binomial analyses were selected to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) between precarious employment and MSP. In adjusted models with age, sex, educational level, income level, weekly working hours, and occupation, precarious employment was significantly associated with an increased risk of both MSP (OR 1.66 95% CI 1.56-1.77) and work-related MSP (OR 1.18 95% CI 1.11-1.25). Given the job insecurity and health inequity associated with precarious employment, special attention on precarious workers' health is needed.

Relationship between handgrip strength and lung function in adults: a systematic review

Handgrip strength (HGS) is a functional test that has been directly associated with lung function in some healthy populations; however, inconsistent findings have been reported for populations with chronic diseases. The aim of this study was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. A systematic search was conducted using six databases from their earliest inception to February 29, 2020. Two authors reviewed and assessed methodological quality of eligible studies using the Crowe Critical Appraisal Tool (CCAT). Twenty-five studies met the inclusion criteria with 8 and 17 studies examining healthy and unhealthy populations, respectively. Reported average methodological quality of all included studies using the CCAT was 38-85% with most rated as Good to Excellent. Despite the use of heterogeneous equipment and protocols during HGS and lung function assessments, significant positive and moderate correlations and/or regression coefficients were reported for healthy populations consistently. Conversely, the reported relationships between HGS and lung function for unhealthy counterparts were variable. Handgrip strength was significantly associated with lung function in most healthy adults. Future robust studies are needed to confirm the suitability of HGS to assess lung function for healthy and unhealthy adults.

A Novel Magnetic Resonance Imaging-based Lumbar Muscle Grade to Predict Health-related Quality of Life Scores Among Patients Requiring Surgery

STUDY DESIGN

Retrospective cross-sectional cohort.

OBJECTIVE

The aim of this sudy was to determine whether muscle health measurements are associated with health-related quality of life scores (HRQOLs) for patients with lumbar spine pathology.

SUMMARY OF BACKGROUND DATA

Poor muscle health has been implicated as a source of pain/dysfunction for patients with lumbar spine pathology. Our aim was to quantify the relationship using muscle health measurements and HRQOLs.

METHODS

Three hundred and eight patients were included (mean age 57.7 ± standard deviation 18.2 years' old). We randomly selected patients into a derivation cohort (200) and validation cohort (108) to create our muscle health grade. We measured muscle health by the lumbar indentation value (LIV), goutallier classification (GC), and ratio of paralumbar muscle cross-sectional area over body mass index (PL-CSA/BMI). A muscle health grade was derived based on whether a measurement showed a statistically significant impact on visual analog scale back and leg pain (VAS-leg and VAS-leg), Oswestry Disability Index (ODI), short-form 12 physical health score (SF-12 PHS), short-form 12 mental health score (SF-12 MHS) and Patient-reported Outcomes Measurement Information System (PROMIS). A variety of statistical tools were used to determine whether there was a relationship between a measurement and HRQOLs.

RESULTS

In the derivation cohort, a muscle health grade was created based on the GC and PL-CSA/BMI ratio. For patients with a GC ≤2, one point was given. For patients with a PL-CSA/BMI ≥130, one point was given. Patients with 2 points were graded as "A" and 0 or 1 point were graded "B." Within the validation cohort of patients, there was a statistically significant higher PROMIS (mean 34.5 ± standard deviation 12.6 vs. 27.6 ± 14.0, P = 0.002), ODI (38.8 ± 18.3 vs. 45.8 ± 18.1, P = 0.05) and SF-12 PHS (34.7 ± 11.3 vs. 29.1 ± 6.3, P = 0.002) for patients with a good muscle health grade of "A."

CONCLUSION

This study offers an objective measurement of muscle health that correlates with HRQOLs for patients with lumbar spine pathology.Level of Evidence: 3.

Better muscle strength can decrease the risk of arthralgia and back &joint stiffness in Kurdish men; a cross-sectional study using data from RaNCD cohort study

Background

Musculoskeletal disorders can reduce the quality of life and work capacity. The study assessed handgrip strength (HGS) in relation to low back pain and arthralgia in Kurdish men.

Methods

This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 2164 men aged 35–65 years. HGS was measured using a hand-held hydraulic handgrip dynamometer. Low back pain, arthralgia, and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire.

Results

The results showed that 21.39 and 24.58% of studied participants had low back pain and arthralgia, respectively. Among the participants with low back pain, 14.5% had back stiffness, and among those with arthralgia, 12.8% had joint stiffness. The mean of HGS in participants with arthralgia and back & joint stiffness was significantly less than those without these disorders (P < 0.001, P = 0.05, and P = 0.005, respectively). Multiple-adjusted OR and 95% confidence intervals (CI) for arthralgia and back and joint stiffness across muscle strength showed the HGS increase to be associated with a lower risk of arthralgia and back &joint stiffness, but not low back pain.

Conclusions

Higher HGS was associated with a lower risk of arthralgia and back & joint stiffness. However, there was no association between HGS and low back pain. Exercise and adherence to proper nutrition are suggested to enhance muscle strength in order to reduce musculoskeletal pain.