A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain

Joint Association of Occupational and Leisure-Time Physical Activity With Low Back Pain in Korean Adults

OBJECTIVE

This study aimed to examine the effect of the interaction between gender-specific occupational physical activity (OPA) and leisure-time physical activity (LTPA) on low back pain (LBP) risk.

METHODS

Data were obtained from a large-scale cohort survey of Koreans, comprising a total of 2750 participants recruited during 2011-2012. OPA and LTPA were assessed using validated questionnaires and classified into two groups: "< 150 min/wk" and "≥ 150 min/wk." LBP was defined based on the Oswestry Disability Index (ODI) and visual analogue scale (VAS) criteria. Multiple logistic regression analyses were performed to calculate odds ratios (OR) with 95% confidence intervals (CI), and multiple linear regression analyses were used to estimate β coefficients with 95% CI to assess the associations between OPA, LTPA, and LBP.

RESULTS

The results showed that increased OPA was significantly associated with higher ODI scores (β = 0.02, p = 0.021), whereas increased LTPA was significantly associated with reductions in both ODI (β = -0.07, p = 0.012) and VAS scores (β = -0.01, p = 0.013). Furthermore, engaging in OPA for ≥ 150 min/week was associated with an elevated LBP risk (OR = 1.38, 95% CI = 1.12-1.69), with significant gender differences observed. In contrast, for participants with < 150 min/wk of leisure-related physical activity, LBP risk increased (OR = 1.22, 95% CI = 1.01-1.76), whereas for those with ≥ 150 min/wk, LBP risk decreased (OR = 0.84, 95% CI = 0.66-0.95), a significant effect observed only in females.

CONCLUSION

These findings suggest that ensuring adequate rest during OPA and promoting leisure-related physical activity may be critical strategies for reducing chronic LBP.

Preventing chronic low back pain: investigating the role of Pilates in subacute management-a randomized controlled trial

BACKGROUND

Subacute low back pain (LBP) is a critical phase that can determine long-term patient outcomes. Exercise therapy, including Pilates, is widely used to manage LBP, but its effectiveness in the subacute phase remains underexplored. This randomized controlled trial aims to compare the effects of an 8-week Pilates-based intervention versus a home exercise program on pain intensity, functional disability, and quality of life in patients with subacute LBP.

METHODS

Sixty-six participants with subacute LBP were randomized into two groups: a supervised Pilates group and a home exercise group. Pain intensity (Visual Analog Scale), functional disability (Roland-Morris Disability Questionnaire), and quality of life (Short Form-36) were assessed at baseline, post-intervention, and 3-month follow-up.

RESULTS

Both groups exhibited significant improvements in all outcome measures (p < 0.001). However, the Pilates group showed superior reductions in pain intensity (p = 0.010 post-treatment, p = 0.002 at follow-up) and functional disability (p = 0.009 and p = 0.002). Additionally, quality of life scores improved more significantly in the Pilates group, particularly in physical function (p = 0.031 and p = 0.025) and general health (p = 0.005 and p = 0.012).

CONCLUSIONS

Pilates-based rehabilitation was more effective than a home exercise program in improving pain, disability, and quality of life in patients with subacute LBP. These findings support the inclusion of Pilates in early-stage rehabilitation to prevent chronicity.

TRIAL REGISTRATION

Clinical Trials Number: NCT06699511.

Benefits and harms of exercise therapy and physical activity for low back pain: An umbrella review

PURPOSE

The purpose of this umbrella review is to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity (PA) for the secondary prevention and management of low back pain (LBP).

METHODS

An umbrella review was conducted to evaluate the effectiveness of exercise therapy and PA in the management and secondary prevention of LBP. A systematic search was performed in Medline via Ovid, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Physiotherapy Evidence Database (PEDro), including reference lists of relevant reviews, covering studies published between January 2010 and May 20, 2024. Eligible studies were systematic reviews of randomized controlled trials and observational studies, with or without meta-analyses. The primary outcome for secondary prevention was LBP recurrence, while for management, primary outcomes included pain intensity and disability, with adverse events as secondary outcomes. Data were extracted across immediate, short-term, intermediate, and long-term follow-up periods. The GRADE framework was used to assess the certainty of evidence, and the AMSTAR tool was applied by 2 independent reviewers (JC, QL, and/or DXMW) to evaluate the quality of the included reviews. The study was prospectively registered on the Open Science Framework (OSF) (registration DOI: https://doi.org/10.17605/OSF.IO/9P).

RESULTS

A total of 70 systematic reviews were included, 43 with meta-analyses, 7 with network meta-analyses, and 20 without meta-analyses. Six (out of 10) reviews with meta-analyses for secondary prevention indicated a small benefit from general exercises and leisure-time PA (low-to-moderate certainty). For LBP management, 35 (out of 36) reviews reported that exercise therapies such as Pilates, motor control, mixed exercise, Tai Chi, water-based exercises, and yoga showed small beneficial effects on pain and disability compared to minimal intervention mainly in the short-term (low-to-moderate certainty). Seven network meta-analyses favored motor control and Pilates over other forms of exercise to reduce pain (low certainty). Adverse events were reported in less than 31% of the reviews, predominantly involving post-exercise soreness and temporary increases in pain, mainly in yoga-related studies. Adverse events were considered minor, and no serious adverse events were reported.

CONCLUSION

There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.

Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool

OBJECTIVE

To assess the therapeutic quality of exercise interventions delivered in chronic low back pain (cLBP) trials using the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool and its inter-rater agreement.

METHODS

We performed a meta-research study, starting from the trials' arms included in the published Cochrane review (2021) 'Exercise therapy for chronic low back pain'. Two pairs of independent reviewers applied the i-CONTENT tool, a standardised tool designed to ensure the quality of exercise therapy intervention, in a random sample of 100 different exercise arms. We assessed the inter-rater agreement of each category calculating the specific agreement. A percentage of 70% was considered satisfactory.

RESULTS

We included 100 arms from 68 randomised controlled trials published between 1991 and 2019. The most assessed exercise types were core strengthening (n=27 arms) and motor control (n=13 arms). Among alternative approaches, yoga (n=11) and Pilates (n=7) were the most representative. Overall, most exercise interventions were rated as having a low risk of ineffectiveness for patient selection (100%), exercise type (92%), outcome type and timing (89%) and qualified supervisor (84%). Conversely, some items showed more uncertainty: the safety of exercise programmes was rated as 'probably low risk' in 58% of cases, exercise dosage in 34% and adherence to exercise in 44%. The items related to exercise dosage (31%) and adherence (29%) had heterogenous judgements, scoring as high risk of ineffectiveness or probably not done. Among all exercise types, Pilates scored best in all domains. A satisfactory specific agreement for 'low risk category' was achieved in all items, except dosage of exercise (60%) and adherence to exercise (54%).

CONCLUSION

Exercises delivered for patients with cLBP generally demonstrate favourable therapeutic quality, although some exercise modalities may present poor therapeutic quality related to dosage and adherence. While the i-CONTENT judgements generally showed satisfactory specific agreement between raters, disagreements arose in evaluating some crucial items.

Comparison of Combined Motor Control Training and Isolated Extensor Strengthening Versus General Exercise on Lumbar Paraspinal Muscle Health and Associations With Patient-Reported Outcome Measures in Chronic Low Back Pain Patients: A Randomized Controlled Trial

Study DesignProspective Randomized Controlled Trial.ObjectivesTo investigate the effect of combined motor control and isolated lumbar strengthening exercise (MC + ILEX) vs general exercise (GE) on upper lumbar paraspinal muscle volume and composition, strength and patient outcomes in individuals with chronic low back pain (LBP).Methods50 participants with nonspecific chronic LBP were randomly allocated (1:1) to each group (MC + ILEX or GE) and underwent a 12-week supervised intervention program 2 times per week. Magnetic resonance imaging was performed at baseline, 6-weeks and 12-weeks to examine the impact of each intervention on multifidus (MF) and erector spinae (ES) muscle volume (cm3) and fatty infiltration (%FI) at L1-L2, L2-L3 and L3-L4.ResultsOur results revealed no significant between-groups findings for MF and ES %FI and volume, and patient-reported psychosocial measures. However, both groups had significant within-groups decreases in MF %FI at L1-L2, L2-L3 and L3-L4, with concomitant decreases in MF volume at L1-L2 and L2-L3, and at L3-L4 in the GE group. Each group displayed significant improvements in Kinesiophobia, while only MC + ILEX had significant improvements in pain catastrophizing, anxiety, depression and sleep. Lastly, significant correlations were found between change in Kinesiophobia and upper lumbar MF %FI, and between change in strength and lower lumbar MF and ES size.ConclusionsBoth exercise interventions may help reduce upper lumbar MF %FI in individuals with chronic LBP, while MC + ILEX could significantly improve important patient outcomes. Our results support the idea that improvements in paraspinal muscle health associate with better patient outcomes. Further high-quality imaging studies are needed to explore these relationships.

The effects of abdominal muscle contraction using real-time feedback on adults with chronic low back pain: A pilot study

BackgroundThis study aimed to examine the influence of real-time feedback on intentional abdominal muscle engagement in adults with chronic low back pain (CLBP) during daily activities. The research further sought to evaluate the outcomes of this training on neuromuscular control, pain perception, and functional capacity.ObjectiveWe compared a group of adults who received real-time feedback on changes in waist circumference with a group trained in abdominal contraction without real-time feedback.MethodsSurface electromyographic (sEMG) signals were measured in the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles. Pain intensity was assessed using the visual analog scale (VAS), and functional outcomes were assessed using the Oswestry Disability Index (ODI).ResultsAfter the intervention, sEMG signals of the RA, EO, and IO muscles were significantly higher in the experimental group. There were no significant differences in ES muscle activity between the groups. Both the experimental and control groups showed significant decreases in VAS and ODI scores after the intervention.ConclusionIntentional abdominal contraction aided by real-time feedback can improve functionality in patients with chronic low back pain.

Feasibility study of core training in knee injury recovery

Objectives

This study aims to investigate the effects of core and routine training on joint function, anterior tibia translation and balance in patients with knee joint injury.

Patients and methods

Between March 2021 and March 2022, a total of 70 patients (49 males, 21 females; mean age: 31.2±5.3 years; range, 17 to 44 years) with knee ligament injury or meniscus injury were included. The patients were divided into core training group (n=35) and conventional training group (n=35) by matching method. During the recovery process, the regular training group performed routine training, whereas the core training group engaged in core training. Both groups were trained for a total of eight weeks. After training, the Visual Analog Scale (VAS), knee Lysholm score, KT-2000 tibial anterior translation, and the star excursion balance test (SEBT) results were collected.

Results

The mean VAS scores in both groups were decreased from baseline values. The mean Lysholm score increased from baseline data; the degree of tibial anterior translation decreased compared with baseline data (p<0.05). The mean SEBT scores showed significant improvement over baseline data. In contrast with the routine training group, the mean VAS score of core training was lower and the total score of Lysholm was higher (p<0.05). When bending the knee at 90°, the mean tibial anterior translation was 3.87±1.23 mm in the core training group, significantly lower than in the regular training group (p<0.05). The SEBT results showed that, after eight weeks of training, healthy and injured legs in core training group exceeded those of the regular training group in the farthest distance (p<0.05).

Conclusion

Our study results indicate that core training is more successful than regular training in reducing pain, and it can ameliorate the dynamic balance stability of patients with knee injury.

Joint Pain and Leisure-Time Physical Activity: Cross-Sectional Findings From the Cardiovascular Health Study

Background

Joint pain is common and limits leisure-time physical activity (LTPA) in older adults. However, some older adults with pain are also physically active. Psychosocial factors that may indicate external engagement (such as social network) and internal drive (such as feeling able to "get going") are emerging as predictors of LTPA and may explain why some older adults with pain are physically active.

Methods

We investigated the cross-sectional association of psychosocial factors with LTPA (kcal/week) in adults over the age of 64 with pain in their back, hips, knees and/or feet from the Cardiovascular Health Study. Psychosocial factors included: social network score from the Lubben Social Network scale and three questions from the Center of Epidemiologic Studies Depression Scale (CES-D): perceived effort, difficulty getting going, and trouble concentrating. Separate multivariable ordinal regression models estimated the association between these indicators and LTPA, while controlling for demographics and other contributors of LTPA: number of medications, number of pain sites, body mass index, gait speed, digit substitution symbol test, brain white matter hyperintensities, and mood.

Results

Among 902 participants (65% female, 14% Non-White) with joint pain and complete data, higher social network score, and no self-reported "difficulty getting going" were associated with higher levels of LTPA, independent of covariates. Associations with perceived effort or trouble concentrating were not statistically significant.

Conclusions

Our research suggests that some older adults with pain are physically active and psychosocial factors related to external engagement and internal drive might be important targets to support LTPA. Studies should investigate the role of psychosocial states on LTPA among older adults with pain.

Impact Statement

We certify that this work is novel.The potential impact of this research on clinical care includes the following: Resiliency factors such as psychosocial factors may be more important targets to promote leisure-time physical activity in older adults with pain than specific pain reduction strategies.

The effect of dynamic neuromuscular stabilization technique combined with Kinesio Taping on neuromuscular function and pain self-efficacy in individuals with chronic nonspecific low back pain: A randomized trial

BACKGROUND

This study investigates the therapeutic efficacy of dynamic neuromuscular stabilization (DNS) technology paired with Kinesio Taping in patients with persistent nonspecific low back pain, as well as the effect on neuromuscular function and pain self-efficacy.

METHODS

A randomized controlled clinical study was conducted to collect clinical data on DNS combined with KT for the treatment of chronic nonspecific low back pain from November 2023 to April 2024. The inclusion criteria were patients with chronic nonspecific lower back pain, aged between 18 and 30 years old, and without serious underlying medical conditions, such as cardiac disease, hypertension, and diabetes. The control group received Kinesio Tape therapy, and the experimental group received a combination of Kinesio Tape therapy and DNS technology. The treatment lasted for 6 weeks, 3 times a week. Patients were examined before and after treatment using the Visual Analog Rating Scale, Oswestry Dysfunction Score, and Pain Self-Efficacy Questionnaire. Multifidus and transversus abdominis muscle strength was tested using surface electromyography signals, and the patient's joint mobility, maximal isometric muscle strength, and muscular endurance were tested using the Davy Spine Rehabilitation System. Internal lumbar and abdominal pressures were assessed using stabilizer pressure biofeedback.

RESULTS

A total of 32 subjects (17 males and 15 females) were enrolled, of which 16 were in the experimental group and 16 in the control group. After the treatment, the patients in both groups showed significant improvements in the visual analogue scale, Oswestry disability index, Chinese version of Pain Self-Efficacy Questionnaire (PSEQ), joint mobility, maximum isometric strength, muscle endurance, abdominal pressure, transverse abdominal muscle and multifidus muscle scales compared with the pretreatment results. (Chinese version of Pain Self-Efficacy Questionnaire) scales were significantly improved compared with the pretreatment; joint mobility, maximal isometric muscle strength, muscular endurance, intra-abdominal pressure, transversus abdominis and multifidus AEMG (average electromyography) were more significantly improved, and the differences were statistically significant (P < .05). The experimental group showed more significant improvement than the control group (P < .05).

CONCLUSION

DNS technology paired with Kinesio Taping can considerably improve neuromuscular function and enhance pain self-efficacy in chronic nonspecific low back pain patients, reducing discomfort and improving dysfunction.

Multimodal intervention based on physical exercise, mindfulness, behaviour change and education to improve pain and health in patients with chronic primary low back pain: a study protocol of the HEALTHYBACK randomised controlled trial

The HEALTHYBACK trial is based on a multimodal intervention to determine the effectiveness of a supervised physical exercise, mindfulness, behaviour change and pain neuroscience education programme on several health variables in individuals with chronic primary low back pain (CPLBP). The study will be a randomised controlled trial among 70 individuals diagnosed with CPLBP (aged 18-65 years). The intervention will be conducted in person within a hospital setting for 16 weeks and comprises a first phase (16 sessions supervised physical exercise (2 days/week, 45 min/session), mindfulness (1 day/week, 2.5 hours/session), behaviour change (daily/24 hours via a wrist-worn activity prompting device) and pain neuroscience education (1 day/biweekly, 2 hours/session)) and a second phase (16 sessions functional full-body muscle strengthening exercise, 3 days/week, 50 min/session). The primary outcomes will include perceived acute pain, pain pressure threshold, conditioned pain modulation, temporal summation of pain and disability due to pain. Secondary measures will include physical fitness, body composition, gait parameters, device-measured physical activity and sedentary behaviour, haematological profile, self-reported sedentary behaviour, quality of life, pain catastrophising, mental health, sleep duration and quality, and symptoms related to central sensitisation. The groups will undergo pretest (before the intervention), post-test (after each phase of the intervention) and retest (at a 6-week detraining period after the intervention) measurements. The results will determine the effectiveness of multidimensional interventions on several health parameters in individuals with CPLBP. They will provide knowledge for pain management and functioning in affected individuals, which might diminish the need for primary healthcare services. Trial registration number: NCT06114264.

Frequency of physical activity during leisure time and variables related to pain and pain medication use in Spanish adults: A cross-sectional study

BACKGROUND

Physical inactivity has been identified as a risk factor for pain.

OBJECTIVE

The main objective was to analyze the relationships between leisure time physical activity frequency (PAF) and pain prevalence, pain level, pain impairment, daily life pain impairment, and analgesic use in Spanish adults. In addition, risk factors such as sex, body mass index, marital status and social class were assessed for these pain variables in addition to PAF.

METHOD

Cross-sectional study based on data from the 2014 and 2020 European Health Surveys in Spain residents. The Chi-square test was used to analyze the relationship of dependence between the variables of interest. A correlation study calculating Spearman's rho and a multiple logistic regression were performed to assess risk factors for pain variables.

RESULTS

20,113 and 19,196 subjects with a median age of 49 and 52 years old in 2014 and 2020 European Health Surveys, respectively, were analyzed. Dependence relationships were found between PAF and pain variables (p<0.001). The prevalence of: pain, high levels of pain, pain impairment, high level of pain impairment and use analgesic were higher in the inactive population than in the rest of the PAF levels (36.7-53%) vs (18.6-44.3%), p<0.05. Weak correlations were found between PAF and pain variables (-0.177 ≤ Rho ≤ -0.107) (p<0.001). Logistics regression show that being active or very active reduces the odds of pain, the intensity of pain and being affected in daily activities due to pain by 0.524 to 0.776 times. Likewise, being active or very active reduces the odds of taking pain medication by 0.661 to 0.755 times. Also age, low social class, being a woman, and being obese increase of odds of pain, pain affectation and use of analgesics in both surveys by 1.008 to 2.202 times.

CONCLUSIONS

Physical inactivity was related to a higher prevalence of: pain, higher levels of pain, higher pain involvement and higher analgesic use. In addition, lower social class, being female, older age, and obesity were factors for higher odds of pain, pain involvement, and analgesic use in both surveys.

Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study

OBJECTIVE

This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).

METHODS

Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.

RESULTS

The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.

CONCLUSION

This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.

Analysis of Physical Activity on Mental Hyperactivity, Sleep Quality, and Bodily Pain in Higher Education Students-A Structural Equation Model

The university population is at a vital stage of human development for acquiring an active lifestyle. Following this lifestyle will bring benefits in adulthood. This study seeks to analyse the relationship between physical activity and bodily pain, mental hyperactivity, and sleep quality as a function of the intensity of physical activity. A comparative, descriptive, and exploratory study is presented in a sample of 506 university students. The International Physical Activity Questionnaire, the Chronic Pain Grade Questionnaire, the Mental Hyperactivity Questionnaire, and the Pittsburgh Sleep Quality Index were used. The proposed model analyses the relationships of physical activity to bodily pain, mental hyperactivity, sleep disturbances, and time to fall asleep. The fit of the different adjustment indices is satisfactory (X2 = 0.47, df = 1, pl = 0.48, IFI = 0.99, CFI = 0.97; NFI = 0.91; RMSEA = 0.01). The relational analysis shows a positive relationship of physical activity to bodily pain (r = 0.02; p < 0.01), mental hyperactivity (r = 0.054; p < 0.01), sleep disturbances (r = 0.029; p < 0.01), and time to fall asleep (r = 0.047; p < 0.01). Multi-group structural equation analysis indicates that there are differences in the causal relationships of physical activity to sleep quality, mental hyperactivity, and bodily pain as a function of exercise intensity. The conclusion is that the intensity at which physical activity is performed plays a key role in mental and physical health.

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain

Introduction

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness.

Methods

A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA.

Results

Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio.

Conclusion

This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

Algorithm Validation for Quantifying ActiGraph™ Physical Activity Metrics in Individuals with Chronic Low Back Pain and Healthy Controls

Assessing physical activity is important in the treatment of chronic conditions, including chronic low back pain (cLBP). ActiGraph™, a widely used physical activity monitor, collects raw acceleration data, and processes these data through proprietary algorithms to produce physical activity measures. The purpose of this study was to replicate ActiGraph™ algorithms in MATLAB and test the validity of this method with both healthy controls and participants with cLBP. MATLAB code was developed to replicate ActiGraph™'s activity counts and step counts algorithms, to sum the activity counts into counts per minute (CPM), and categorize each minute into activity intensity cut points. A free-living validation was performed where 24 individuals, 12 cLBP and 12 healthy, wore an ActiGraph™ GT9X on their non-dominant hip for up to seven days. The raw acceleration data were processed in both ActiLife™ (v6), ActiGraph™'s data analysis software platform, and through MATLAB (2022a). Percent errors between methods for all 24 participants, as well as separated by cLBP and healthy, were all less than 2%. ActiGraph™ algorithms were replicated and validated for both populations, based on minimal error differences between ActiLife™ and MATLAB, allowing researchers to analyze data from any accelerometer in a manner comparable to ActiLife™.

Changes in isokinetic trunk muscle strength and endurance after two different restoration programs in people with chronic low back pain: A longitudinal retrospective study

Background

Multidisciplinary functional restoration programs (FRPs) aim to improve pain and function in people with chronic low back pain (CLBP). The intensity and content of FRPs varies; the benefits of one program over another are unclear.

Objective

To assess changes in trunk muscle strength and endurance after an intensive (IFRP) (for people on sick leave for >6 months with high levels of fear-avoidance beliefs about physical activity and work) or semi-intensive (SIFRP) (for people working) FRP in people with CLBP.

Methods

Longitudinal retrospective study from March 2016 to December 2019. Setting: rehabilitation department of a tertiary care center. Trunk flexor and extensor muscle strength (60°.s-1) and endurance (120°.s-1) were measured with the Humac NORM isokinetic dynamometer at pre and post FRP. Change in isokinetic variables (peak torque, total work and flexor/extensor ratio) after each program was assessed with a paired t-test (p < 0.05). Pearson's rho and multiple linear regression assessed associations between changes in isokinetic and clinical variables and demographic characteristics.

Results

125 individuals, 63.2 % female, age 43.5 (10.3) years, were included. Mean low back pain intensity was 49.8 (24.9) and 37.2 (25.8)/100 and mean activity limitation (QBPDS) was 38.8 (16.4) and 32.0 (14.6)/100 in the IFRP and SFRP groups, respectively. Trunk extensor peak torque, flexor total work, extensor total work and flexor/extensor peak ratio improved significantly in both FRPs, p < 0.001. The flexor/extensor total work ratio improved in the IFRP group only, p = 0.003. Trunk extensor endurance increased more in the IFRP than the SIFRP group, the absolute pre-post differences for extensor total work [95%CI] N.m were 611.7 [495.2; 728.3] in the IFRP group and 380.0 [300.8; 459.3] in the SIFRP group. No variables were correlated and none predicted improvement in extensor total work in either group.

Conclusion

This study highlights the short-term independence of clinical and trunk muscle strength and endurance changes.

Exercise and Dietary Recommendations for Women with Chronic Pain: What's Weight and Race Got To Do with It?

Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N = 90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75, 244.72) = 6.19, P < .01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89) = 17.20, P < .01), strength (F(1,89) = 6.08, P = .02), and dietary recommendations (F(1,89) = 37.56, P < .01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89) = 4.92, P = .03) than Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning.

Physical Fitness as a Predictor of Disability Retirement: A 9-Year Register Linked Follow-Up Study

BACKGROUND

To prospectively examine the association between physical fitness and risk of disability retirement in a large population-based cohort.

METHODS

This study utilized data from Health 2011 survey Physical Activity subsample (n = 4898), combined with information on disability retirement derived from 2 national registers. In total, 2455 individuals aged 18-74 years underwent the physical fitness test protocol concerning measures of cardiorespiratory fitness, muscle strength, and balance. The outcome variable was disability retirement, during the follow-up period of 9 years. After excluding those not at risk of disability retirement (ie, age ≥63 y) or who had already been granted disability pension, and those who had not completed the fitness protocol, the analytical sample included 1381 participants. Data were analyzed using Cox regression model with SPSS (version 29).

RESULTS

During the 9-year follow-up period, 61 individuals (4.4%) transitioned to a disability retirement. Cox regression analysis showed an association between the various physical fitness subdomains and the risk of disability retirement. In model 1, all fitness tests were associated with the risk of disability retirement, except the one-leg stand test with hazard ratios ranging from 1.69 (95% CI, 0.86-3.34) to 5.75 (95% CI, 1.84-17.90). Further adjustment for sociodemographic, health behavior, and health-related covariates attenuated the associations and statistical significance was lost, except for the vertical jump test (hazard ratio = 4.33; 95% CI, 1.32-14.10) and 6-minute walk test (hazard ratio = 3.81; 95% CI, 1.35-10.70).

CONCLUSION

These findings highlight the importance of physical fitness for preventing work disability.

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study

Purpose

Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care.

Patients and Methods

In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian's quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively.

Results

Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients' motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (±4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (±6.0), FABQ-w M = 24.0 (±12.1), SES6G M = 6.4 (±2.3), and OEE-2 M = 2.7 (±0.5).

Conclusion

In this sample, patients' understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.

Influence and Relationship of Pain on Lumbar Biomechanics in a Young Adult Population with Non-Specific Low Back Pain

The therapeutic actions indicated for low back pain, in addition to physiotherapy, include mobilization of the affected segment, as it is assumed that a loss of mobility may contribute to a patient's pain. The aim of this study was to investigate the influence of back pain on the degrees of spinal mobility in young adults. Eighty-six volunteers participated in the study. Fingertip-to-floor distance, Schöber's test, the fingertip-to-floor lateral flexion test, GHQ-12, the Fear-Avoidance Beliefs Questionnaire and the STarT Back Screening Tool were used. There were statistically significant differences between the two groups (pain and no pain) in degrees of spinal flexion (Schöber's test and side flexion) showing greater mobility in the group with pain. However, the group with low back pain showed less rotational mobility. The presence or absence of back pain had an impact on the individual's sporting practice and perception of pain, and they were able to carry out their sporting activities normally. Young adults with idiopathic low back pain showed some statistically significant differences in relation to the mobility of the spine in the different planes of movement (flexion and side flexion), conditioning their quality of life and sports practice.

Efficacy of specific exercises in general population with non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP).

METHODS

We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach.

RESULTS

Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low.

CONCLUSION

These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.

Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain

ABSTRACT

People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.

Beyond the Back: The Science of Lumbar Epidural Steroid Injections

Chronic low back pain causes significant morbidity and increases the global burden of disability. It has been shown to increase psychological, physical, and monetary load on the world population, In the USA alone, it causes an economic burden of 100 billion dollars/year [1]. Low back pain has been referred to as sciatica pain, lumbar radiculopathy, lumbar nerve entrapment, and neurogenic claudication. It is basically pain arising from the lower back region and radiating like a current to the lower limbs. The two prime causes of this low back pain with radiculopathy are intervertebral disc disease and facet joint arthritis [2]. The pathological aging changes happening in intervertebral disk cause disk herniation and other degenerative diseases such as lumbar canal stenosis and chronic instability. Lumbar radiculopathy or sciatica is mainly caused by compression of the nerve by protruded nucleus pulposus, which is the jelly like material of intervertebral disk [3,4]. Most of the patients with intervertebral disk disease and sciatica can be managed with conservative measures. These include anti-inflammatory analgesics, neuropathic medications such as pregabalin and gabapentin, regular exercises, and epidural steroid injections [5-7]. These measures help to prevent surgery. Significant compression of nerves with no relief from conservative measures qualifies to surgical intervention [2]. ESI, which has been used since 1952, is mainly used for lumbar and neck pain with radicular pain. It has shown excellent and quick results with minimal adverse effects. The ESI consists of injecting the steroids with or without local anesthetic medication in the epidural space to decrease the discogenic source of pain [8-11]. LSEI can be divided according to the needle route (interlaminar, transforaminal, or caudal). In this article, we will go over the various approaches for intralaminar (between the 2 adjacent laminae of lumbar vertebrae), transforaminal (through the intervertebral foramen), and caudal (through the sacral hiatus) epidural steroid injections [12-14].

Aerobic exercise therapy for chronic low back pain

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of aerobic exercise on pain, function, quality of life, psychological functioning, and adverse events, compared with placebo, sham treatment, attention control, or no treatment.

Demographic and clinical characteristics associated with failure of physical therapy in chronic low back pain: a secondary analysis from a randomized controlled trial

BACKGROUND

The effect of physical therapy on pain and disability alleviation in patients with chronic low back pain (cLBP) has been demonstrated, but the risk factors for treatment failure remain unknown.

AIM

To explore the associations of baseline demographic and clinical characteristics with treatment failure after physical therapy intervention for cLBP.

DESIGN

A secondary analysis of a single-blind randomized clinical trial.

SETTING

A rehabilitation hospital.

POPULATION

A total of 98 patients with cLBP completed the 12-month measurement.

METHODS

Patients were randomly grouped into 3-month therapeutic aquatic exercise or physical therapy modalities. The primary outcome was treatment failure, which was defined as a decrease in the numeric rating scale to less than 2.0 points at 12-month follow-up. Associations between baseline demographic and clinical characteristics with risk of treatment failure were assessed by logistic regressions.

RESULTS

The pain intensity in the failure cases was alleviated after 3-month intervention but continuously increased at 6- and 12-month follow-up (P<0.05). Old age was significantly associated with an increased risk of treatment failure (adjusted OR 3.26, 95% CI 1.11-9.60). Compared with those receiving physical therapy modalities, the patients receiving therapeutic aquatic exercise had less risk of treatment failure (adjusted OR 0.19, 95% CI 0.08-0.47), and age (P=0.022) was a modifier for this association.

CONCLUSIONS

Compared with younger ones, older patients with cLBP had a higher risk of treatment failure after physical therapy and gained a stronger benefit of long-term pain alleviation from therapeutic aquatic exercise.

CLINICAL REHABILITATION IMPACT

Therapeutic aquatic exercise is an effective therapy for cLBP and more helpful for preventing treatment failure than physical therapy modalities, especially for older patients.

Finite Element Analysis of Stress Distribution and Range of Motion in Discogenic Back Pain

OBJECTIVE

Precise knowledge regarding the mechanical stress applied to the intervertebral disc following each individual spine motion enables physicians and patients to understand how people with discogenic back pain should be guided in their exercises and which spine motions to specifically avoid. We created an intervertebral disc degeneration model and conducted a finite element (FE) analysis of loaded stresses following each spinal posture or motion.

METHODS

A 3-dimensional FE model of intervertebral disc degeneration at L4-5 was constructed. The intervertebral disc degeneration model was created according to the modified Dallas discogram scale. The von Mises stress and range of motion (ROM) regarding the intervertebral discs and the endplates were analyzed.

RESULTS

We observed that mechanical stresses loaded onto the intervertebral discs were similar during flexion, extension, and lateral bending, which were greater than those occurring during torsion. Based on the comparison among the grades divided by the modified Dallas discogram scale, the mechanical stress during extension was greater in grades 3-5 than it was during the others. During extension, the mechanical stress loaded onto the intervertebral disc and endplate was greatest in the posterior portion. Mechanical stresses loaded onto the intervertebral disc were greater in grades 3-5 compared to those in grades 0-2.

CONCLUSION

Our findings suggest that it might be beneficial for patients experiencing discogenic back pain to maintain a neutral posture in their lumbar spine when engaging in daily activities and exercises, especially those suffering from significant intravertebral disc degeneration.

Precision Rehabilitation After Neurostimulation Implantation for Multifidus Dysfunction in Nociceptive Mechanical Chronic Low Back Pain

Chronic low back pain (CLBP) is a debilitating, painful, and costly condition. Implantable neuromuscular electrical stimulation targeting the multifidus musculature is growing as a non-pharmacologic option for patients with recalcitrant nociceptive mechanical CLBP who have failed conservative treatments (including medications and physical therapy) and for whom surgery is not indicated. Properly selecting patients who meet specific criteria (based on historical results from randomized controlled trials), who diligently adhere to implant usage and precisely implement neuromuscular rehabilitation, improve success of significant functional recovery, as well as pain medication reductions. Patients with nociceptive mechanical CLBP who underwent implanted multifidus neurostimulation have been treated by physicians and rehabilitation specialists who have honed their experience working with multifidus neurostimulation. They have collaborated on consensus and evidence-driven guidelines to improve quality outcomes and to assist providers when encountering patients with this device. Physicians and physical therapists together provide precision patient-centric medical management with quality neuromuscular rehabilitation to encourage patients to be experts of both their implants and quality spine motion to help override long-standing multifidus dysfunction related to their CLBP.

Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial

Background

Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves.

Purpose

This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms.

Methods

A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception.

Results

Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size).

Conclusions

In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.

Comprehensive Physiotherapy Rehabilitation in a 25-Year-Old Female With Nonspecific Low Back Pain: A Case Report

A prevalent musculoskeletal disorder known as nonspecific low back pain (NSLBP) is characterized by lumbar discomfort or pain that lacks a distinct, identifiable etiology. It is the main root of disability in all corners of the globe, affecting individuals across diverse age groups and occupations. NSLBP is often categorized as a multifactorial condition, encompassing a range of potential contributing factors such as poor posture, sedentary lifestyle, muscle imbalances, and psychosocial elements. According to current standards, there is a good prognosis for acute nonspecific back pain, although this prognosis is mostly reliant on return to function. Various treatment strategies are available, totally reliant upon the underlying cause of the discomfort. This case report presents the combination of traditional therapy and William's flexion exercises in a 25-year-old female nursing student who presented with complaints of low back pain (LBP) for the last three months. This study investigates the effect of William's flexion exercises in nonspecific low back pain to manage pain and range of motion (ROM), and improve the overall quality of life, which was evaluated using the visual analog scale (VAS), modified Schober's test, pressure biofeedback unit, and modified Oswestry disability questionnaire. The patient received an enhanced physiotherapy program that increased the flexibility and range of motion in the lumbar extensor, hip flexor, and hamstring muscles. The outcome measure shows notable gains after the therapeutic interventions.

Predisposition and Working Conditions for the Occurrence of Lumbar Syndrome in Medical Workers of the Clinical Center of Montenegro during the COVID-19 Pandemic

Background: Lumbar pain is a condition of discomfort in the lower back caused by numerous factors, lasting for short or longer periods of time. Healthcare professionals, regardless of the type of care they are engaged in, are at risk of lumbar pain. This is the first study that deals with the problem of lumbar syndrome in health workers in Montenegro. Methods: This cross-sectional study included full-time health workers employed in the Clinical Center of Montenegro who were involved in the treatment of COVID-19 patients during 2020 and 2021. The survey consisted of general questions for collecting socio-demographic and COVID-19 engagement data; the Modified Nordic questionnaire was used for the analysis of musculoskeletal symptoms, and the EQ-5D-questionnaire was used to measure the quality of life associated with health. Results: The one-year prevalence of lumbar pain was 68.1%. Factors associated with lumbar pain were as follows: a higher degree of physical inactivity (each subject with a higher degree of physical inactivity had a 24% higher chance of occurrence of lumbar pain); a higher degree of load and over-engagement during the COVID-19 pandemic (each subject with a higher degree of workload had a nearly 50% higher chance of occurrence of lumbar pain); duration of engagement during the COVID-19 pandemic (subjects engaged up to a month were 4 times more likely to develop lumbar pain, and subjects engaged for 1-3 months were 3.5 times more likely to develop lumbar pain compared to those who were not engaged in COVID-19 treatment). This study also confirms that lumbar syndrome affects the quality of life of health workers. Conclusions: Lumbar syndrome is highly prevalent among healthcare professionals in the Clinical Center of Montenegro, especially in the population of nurses, where evidence-based preventive measures are needed.

Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.

Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF)

BACKGROUND

Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines.

AIM

To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists.

DESIGN

Clinical practice guideline.

SETTING

Inpatient and outpatient.

POPULATION

Adults with LBP and/or LRS.

METHODS

Clinically relevant questions were identified based on perceived barriers in current practice of physical therapy. All clinical questions were answered using published guidelines, systematic reviews, narrative reviews or systematic reviews performed by the project group. Recommendations were formulated based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. Patients participated in every phase.

RESULTS

The guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health (ICF) Core Set for LBP and LRS, including the identification of alarm symptoms and red flags. Patients are assigned to three treatment profiles (low, moderate and high risk of persistent symptoms) based on prognostic factors for persistent LBP. The guideline recommends offering simple and less intensive support to people who are likely to recover quickly (low-risk profile) and more complex and intensive support to people with a moderate or high risk of persistent complaints. Criteria for initiating and discontinuing physical therapy, and referral to a general practitioner are specified. Recommendations are formulated for information and advice, measurement instruments, active and passive interventions and behavior-oriented treatment.

CONCLUSIONS

An evidence based physical therapy guideline for the management of patients with LBP and LRS without red flags for physical therapists and Cesar and Mensendieck therapists was developed. Cornerstones of physical therapy assessment and treatment are risk stratification, shared decision-making, information and advice, and exercises.

CLINICAL REHABILITATION IMPACT

This guideline provides guidance for clinicians and patients to optimize treatment outcomes in patients with LBP and LRS and offers transparency for other healthcare providers and stakeholders.

Prevalence of Lower Cross Syndrome in Housemaids

Introduction  Lower cross syndrome, also known as pelvic crossed syndrome, occurs if there is inadequate muscle strength, leading to an imbalance in the lower extremities. This condition is characterized by the weakening and tightening of muscle groups on the anterior and posterior aspects of the body. Mostly, there is weakness in the abdominal muscles, gluteus maximus, and gluteus medius, while there is tightness in the hip flexor muscle groups. There are various studies investigating musculoskeletal disorders across different professions, but there is no research on the prevalence of lower cross syndrome among housemaids. Housemaids frequently report complaints of joint pain and exhibit specific postural changes such as anterior pelvic tilt, increased lumbar lordosis, and lower back pain. Therefore, this research aims to fill this gap by determining the prevalence of lower cross syndrome within the housemaid profession. The study aims to find out the prevalence of lower cross syndrome among housemaids. Methodology A total of 75 housemaids between the ages of 35 and 50 years complaining of pain in the lower back were included in the study, and the housemaids with recent surgical histories and cognitive impairments were excluded. The evaluation was done by measuring the strength and range of motion (ROM) of the affected muscles. Outcome measures include the length of the iliopsoas muscle, measurement of the spinal extensor muscle, and strength of the gluteus maximus muscle to identify which structures are tight or weak.  Result Statistical changes were observed in the housemaids' population to check tight and weak structures using all outcome measures. According to the visual analogue scale (VAS), the pain was found to have a standard deviation of 5.39 ± 1.26 (3-8). The length of the iliopsoas muscle on the right and left sides had a t-value of 1.51 (p = 0.13), and the length of lumbar extensors had a standard deviation of 5.39 ± 1.26 (3-8). Conclusion In our study, the conclusion was found that housemaids who are working continuously for long periods without maintaining good ergonomics are prone to lower cross syndrome. It indicates a strong need for further research on the management of symptoms in such a population (housemaids) to prevent chronic musculoskeletal illness.

Physical activity, suicidal ideation, suicide attempt and death among individuals with mental or other medical disorders: A systematic review of observational studies

A growing body of research has demonstrated the potential role for physical activity as an intervention across mental and other medical disorders. However, the association between physical activity and suicidal ideation, attempts, and deaths has not been systematically appraised in clinical samples. We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, and PsycINFO for observational studies investigating the influence of physical activity on suicidal behavior up to December 6, 2023. Of 116 eligible full-text studies, seven (n = 141691) were included. Depression was the most frequently studied mental condition (43%, k = 3), followed by chronic pain as the most common other medical condition (29%, k = 2). Two case-control studies examined suicide attempts and found an association between physical activity and a reduced frequency of such attempts. However, in studies examining suicidal ideation (k = 3) or suicide deaths (k = 2), no consistent associations with physical activity were observed. Overall, our systematic review found that physical activity may be linked to a lower frequency of suicide attempts in non-prospective studies involving individuals with mental disorders.

A Phase 1 randomized, open-label clinical trial to evaluate the effect of a far-infrared emitting patch on local skin perfusion, microcirculation and oxygenation

Far-infrared radiation (FIR) has been investigated for reduction of pain and improvement of dermal blood flow. The FIRTECH patch is a medical device designed to re-emit FIR radiated by the body. This phase 1 study was conducted to evaluate the local effects of the FIRTECH patch on local skin perfusion, microcirculation and oxygenation. This prospective, randomized, open-label, parallel designed study admitted 20 healthy participants to a medical research facility for treatment for 31 h on three anatomical locations. During treatment, imaging assessments consisting of laser speckle contrast imaging, near-infrared spectroscopy, side-stream dark-field microscopy, multispectral imaging and thermography were conducted regularly on patch-treated skin and contralateral non-treated skin. The primary endpoint was baseline perfusion increase during treatment on the upper back. Secondary endpoints included change in baseline perfusion, oxygen consumption and temperature of treated versus untreated areas. The primary endpoint was not statistically significantly different between treated and non-treated areas. The secondary endpoints baseline perfusion on the forearm (least square means [LSMs] difference 2.63 PU, 95% CI: 0.97, 4.28), oxygen consumption (LSMs difference: 0.42 arbitrary units [AUs], 95% CI: 0.04, 0.81) and skin temperature (LSMs difference 0.35°C, 95% CI: 0.16, 0.6) were statistically significantly higher in treated areas. Adverse events observed during the study were mild and transient. The vascular response to the FIRTECH patch was short-lived suggesting a non-thermal vasodilatory effect of the patch. The FIRTECH patch was well tolerated, with mild and transient adverse events observed during the study. These results support the therapeutic potential of FIR in future investigations.

Trials Investigating Exercise for Low Back Pain Lack Pragmatic Application: A Systematic Review

OBJECTIVE

To systematically review the orientation of trials analyzing exercise for low back pain (LBP) on the efficacy-effectiveness spectrum.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE were searched for trials published between January 1, 2010, and August 13, 2022.

STUDY SELECTION

Randomized controlled trials investigating exercise for adults with LBP.

DATA EXTRACTION

Two reviewers independently used the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool to determine the efficacy-effectiveness orientation. The same 2 reviewers assessed the risk of bias for all studies using the Cochrane Collaboration risk of bias 2.0 tool.

DATA SYNTHESIS

The search identified 2975 records. Full-text review was conducted on 674 studies, and 159 studies were included. The proportion of trials with a strong or rather strong efficacy orientation (RITES rating=1 or 2), balanced emphasis (RITES rating=3), or strong or rather strong effectiveness (RITES rating=4 or 5) orientation on the efficacy-effectiveness spectrum within each RITES domain were reported. A greater proportion of trials had an efficacy orientation when compared with effectiveness or a balanced emphasis within 4 domains: participant characteristics: efficacy 43.9%, 41.9% effectiveness, balanced 14.5%; trial setting: 69.0% efficacy, effectiveness 15.8% balanced 15.2%; flexibility of interventions: 74.2% efficacy, effectiveness 8.8%, balanced 17.0%; clinical relevance of experimental and comparison interventions: 50.3% efficacy, 33.3% effectiveness 33.3%, balanced 16.4%. A high risk of bias was found in 42.1% (n=67) of trials.

CONCLUSION

Trials investigating the effect of exercise for LBP have a greater orientation toward efficacy across multiple trial design domains. Researchers should consider pragmatic designs in future trials to improve generalizability. Clinicians should consider the efficacy-effectiveness orientation when translating evidence into clinical practice.

Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial

BACKGROUND

'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability.

OBJECTIVE

This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP).

METHODS

Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks.

RESULTS

WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR.

CONCLUSION

Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Perceived social support impacts on exercise adherence in patients with chronic low back pain

BACKGROUND

Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP).

OBJECTIVE

This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise).

METHODS

This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis.

RESULTS

A positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01).

CONCLUSION

Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol

BACKGROUND

Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.

METHODS

This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.

DISCUSSION

This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.

TRIAL REGISTRATION

NCT05823857, registered prospectively on April 27th, 2023.

Baduanjin exercise for chronic non-specific low back pain: protocol for a series of N-of-1 trials

INTRODUCTION

Chronic non-specific low back pain (CNLBP) is one of the most common health problems worldwide. According to the clinical guideline released by the American College of Physicians, exercise has been recommended for the treatment of chronic LBP. In recent years, traditional Chinese medicine (TCM) is becoming increasingly popular for the management of chronic LBP. Baduanjin exercise is one of the exercise therapies in TCM. N-of-1 trial is a randomised cross-over self-controlled trial suitable for patients with this chronic disease. A series of similar N-of-1 trials can be pooled to estimate the overall and individual therapeutic effects synchronously by hierarchical Bayesian analysis. And N-of-1 trials are considered as a good tool for evaluating the therapeutic effect of TCM. Therefore, this study aims to conduct a series of N-of-1 trials with hierarchical Bayesian analysis for assessing whether Baduanjin exercise is effective and safe for CNLBP.

METHODS AND ANALYSIS

This study conducts a series of N-of-1 trials on Baduanjin exercise for the management of CNLBP. Fifty participants will receive 1-3 treatment cycles. They will be randomised into a Baduanjin exercise or waiting list group for a week during the two periods of each treatment cycle. The primary outcome is the 10-point Visual Analogue Scale. The secondary outcomes include the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Short Form Health Survey 12. Statistical analysis will be conducted with WinBUGS V.1.4.3 software. Overall and individual therapeutic effects will be estimated synchronously by hierarchical Bayesian analysis.

ETHICS AND DISSEMINATION

This study is approved by the Medical Ethics Committee of Tianjin University of TCM (reference number TJUTCM-EC20220005). Our findings will be published in a peer-reviewed journal or international conference.

TRIAL REGISTRATION NUMBER

ChiCTR2200063307.

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

BACKGROUND

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting.

METHODS

A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol.

RESULTS

Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large.

CONCLUSIONS

A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.

Therapeutic effects of combining curcumin and swimming in osteoarthritis using a rat model

Osteoarthritis (OA) is a common debilitating degenerative disease of the elderly. We aimed to study the therapeutic effects of combining curcumin and swimming in monosodium iodoacetate (MIA)-induced OA in a rat model. The rats were divided into 5 groups (n = 9). Group 1 received saline and served as a control group. Groups 2-5 were injected intra-articularly in the right knee with 100 μL MIA. One week later, groups 3 and 5 were started on daily swimming sessions that gradually increased to 20-mins per session, and for groups 4 and 5, oral curcumin was administered at a dose of 200 mg/kg for 4 weeks. The combination therapy (curcumin + swimming) showed the most effective results in alleviating pain and joint stiffness as well as improving histological and radiological osteoarthritis manifestations in the knee joints. The combination modality also reduced serum C-reactive protein and tissue cartilage oligomeric matrix protein levels. Mechanistically, rats received dual treatment exhibited restoration of miR-130a and HDAC3 expression. The dual treatment also upregulated PPAR-γ alongside downregulation of NF-κB and its inflammatory cytokine targets TNF-α and IL-1β. Additionally, there was downregulation of MMP1 and MMP13 in the treated rats. In conclusion, our data showed that there is a therapeutic potential for combining curcumin with swimming in OA, which is attributed, at least in part, to the modulation of miR-130a/HDAC3/PPAR-γ signaling axis.

The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.

Association of age-related hearing loss, tinnitus, and chronic low back pain in middle-aged and older Korean adults

This was a cross-sectional study conducted to evaluate the association between hearing impairment and low back pain (LBP) using data from the Korean National Health and Nutrition Examination Survey. A total of 5,504 middle-aged and older Korean adults (aged ≥50 years old) who underwent plain radiography of the lumbar spine and pure tone audiometry were included. The presence of LBP was evaluated using a questionnaire, which included a question on whether the patient had experienced LBP that lasted for more than 30 days during the past three months. Patients with age-related hearing loss (ARHL) were defined as those with bilateral hearing impairment who met the following criteria: 1) normal otologic examination results, 2) average pure-tone hearing thresholds of ≤15 dB in both ears, and 3) no occupational noise exposure. Multivariable logistic regression analysis showed that ARHL was not associated with LBP (odds ratio, 1.33; 95% CI, 0.94-1.89) after adjusting for potential confounders in the final model. However, when participants without both ARHL and tinnitus were defined as the reference group, the results showed that the participants with both ARHL and tinnitus were more likely to have LBP (OR, 1.86; 95% CI, 1.11-3.11). These results indicate that ARHL with tinnitus is significantly associated with LBP. We recommend that elderly patients with ARHL and tinnitus increase their daily physical activities and engage in more muscle-strengthening exercises to prevent LBP.

The Effects of Curl-Up and Straight Leg Raising Exercises in Different Hip Joint Positions on Abdominal Muscle Thickness

Objective

The purpose of this study was to investigate the effect of combining 2 exercises at different angles of the hip joint on the thickness of the transverse abdominis and internal oblique muscles.

Methods

Twenty-eight healthy adults (22.7 ± 2.5 years of age; 64.93 ± 8.8 kg; body mass index: 22.2 ± 2 kg/m2) performed the curl-up exercise and straight leg raise with external rotation of the hip and dorsiflexion of the ankle simultaneously. The thicknesses of transverse abdominis and internal oblique muscles were measured from right and left sides while resting, in curl up, curl up with 10º flexion of hip, curl up with 15º flexion of hip, and curl up with 10º flexion and 15º abduction of the hip. The means of muscle thicknesses were compared using repeated-measures analysis of variance and post hoc Bonferroni tests in the 5 positions.

Results

The thicknesses of transverse abdominis (P < .001) and internal oblique (P < .001) muscles were significantly greater in curl up with 10º flexion and 15º abduction of hip compared with the other positions. There was no significant difference between abdominal muscle thicknesses in measuring from either side.

Conclusion

Doing the curl-up exercise with 10º flexion and 15º abduction of the hip may be beneficial in strengthening deep abdominal muscles.

The effectiveness of different aerobic exercises to improve pain intensity and disability in chronic low back pain patients: a systematic review

Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised Controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and duration of different aerobic exercises.

A systematic review and meta-analysis of low back pain and its associated factors among school teachers in Africa

INTRODUCTION

Low back pain (LBP) is a key social, economic, and public health problem in the world. The impact of LBP is given less priority and is empirically unrepresented in low- and middle-income countries as a result of the focus on more pressing and life-threatening health issues, including infectious diseases. In Africa, the prevalence of LBP is irregular and increasing among schoolteachers on account of teaching activities performed under suboptimal working conditions. Therefore, the objective of this review was to estimate the pooled prevalence and associated factors of LBP among school teachers in Africa.

METHODS

This systematic review and meta-analysis was designed based on the PRISMA guidelines. A comprehensive systematic literature search focused on LBP in African school teachers was conducted using the PubMed/MEDLINE, CINAHL, and CABI databases, regardless of publication timelines, from October 20 to December 3, 2022. In addition, gray literature was searched using Google Scholar and Google Search. Data were extracted in Microsoft Excel by using the JBI data extraction checklist. The overall effect of LBP was estimated using a random effect model via DerSimonian-Laird weights. The pooled prevalence and odds ratio of associated factors with 95% CI were computed using STATA 14/SE software. The I² test and Egger's regression test were used to assess heterogeneity and publication bias, respectively.

RESULTS

A total of 585 articles were retrieved, and 11 eligible studies involving a total of 5,805 school teachers were included in this systematic review and meta-analysis. The overall estimated pooled prevalence of LBP in African school teachers was found to be 59.0% (95% CI: 52.0%-65.0%). Being female [POR: 1.53; 95% CI (1.19, 1.98)], being older [POR: 1.58; 95% CI (1.04, 2.40)], being physically inactive [POR: 1.92; 95% CI (1.04, 3.52)], having sleep problems [POR: 2.03; 95% CI (1.19, 3.44)] and having a history of injury [POR: 1.92; 95% CI (1.67, 2.21)] were factors significantly associated with LBP.

CONCLUSIONS

The pooled prevalence of LBP was high among school teachers in Africa compared to developed nations. Sex (female), older age, physical inactivity, sleep problems, and a history of previous injury were predictors of LBP. It is suggested that policymakers and administrators ought to gain awareness of LBP and its risk factors to put existing LBP preventive and control measures into action. Prophylactic management and therapeutic strategies for people with LBP should also be endorsed.

Physical functioning following spinal cord stimulation: a systematic review and meta-analysis

BACKGROUND

Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking.

OBJECTIVE

The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain.

EVIDENCE REVIEW

PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence.

FINDINGS

A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type.

CONCLUSION

This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.

Objective Evaluation of Chronic Low-Back Pain Using Serum Lipids: The Role of the Doctor-Patient Relationship

Statistical data show that pain intensity in patients with low back pain is associated with a higher BMI, total serum cholesterol, and triacylglycerol levels. The objective of our study was to evaluate how these associations are dependent on the nature of the patient-doctor relationship. Eighty-nine patients hospitalized with chronic low-back pain (50 women, 39 men; average age: 64.5 ± 12.7 years) were assessed over a 3-year period. A serum lipid analysis was conducted (LDL-C, HDL-C, and total cholesterols) at admission in parallel with a subjective evaluation of pain intensity, which was assessed using a numeric rating scale. The participating physician assigned, based on their personal interaction with the patient, an attribute of affinity (positive, neutral, and negative) towards them. Current serum lipid levels and pain intensity were correlated relative to these attributes. Pain intensity did not differ between the groups assigned positive or negative attributes of affinity. In patients belonging to the “positive” group, pain intensity correlated positively with total cholesterol ( $p=0.01$ ) and LDL cholesterol ( $p=0.007$ ). No correlations were found in the “negative” group or when the patient-doctor relationship was ignored. We found a significant association between subjectively assessed low back pain intensity and serum levels of total and LDL cholesterol in patients with whom the physician had a positive affinity. A positive affinity with the patients having chronic pain and the patient’s trust in their physicians may ultimately mean that the patient’s statement about pain is more credible, which may retroactively affect the outcome of therapy.

Evaluation of the impact of a smartphone application on adherence to home exercise program for people with chronic low back pain: research protocol for a pilot randomised controlled trial

INTRODUCTION

Multidisciplinary rehabilitation programmes are highly recommended for individuals with the most disabling low back pain (LBP). However, the long-term adherence to regular home exercise is often poor. We aim to perform a prospective, controlled, pilot, randomised study that will evaluate the impact of a smartphone application on adherence to exercise programme for people with chronic LBP (CLBP).

METHODS AND ANALYSIS

120 participants with non-specific CLBP aged 18-65 years will be recruited and randomised in two groups: an experimental group benefitting from education in the application's use in addition to a conventional multidisciplinary rehabilitation programme (exercises and self-management education) and a control group who will only participate in the multidisciplinary rehabilitation programme. Both groups will undergo the programme 5 days a week for 3 weeks. The primary outcome will be a change in patient's adherence to physical exercise (Exercise Adherence Rating Scale) at 6 months. Secondary outcomes will be function (Oswestry Disability Index), beliefs concerning physical activity (Evaluation of Physical Activity Perception), pain (Numeric Rating Scale), and physical capacity and qualitative adherence (video).Statistical analyses will be performed according to intention to treat. A linear mixed model will be used to compare the primary endpoint between groups at 6 months post-randomisation.The study could demonstrate the impact of using a smartphone application on adherence to exercise programme in people with CLBP. We hypothesise that the application's use will improve outcomes through improved exercise adherence.

ETHICS AND DISSEMINATION

The study was approved by the medical ethics committee of Ile de France 3. The results of this study will be disseminated in peer-reviewed publications and presentations at international scientific meetings and will also be disseminated to the participants.

TRIAL REGISTRATION NUMBER

NCT04264949.