change because of the CLBP). To explore the change of the frequency of intercourse, we proceed by calculating the mean difference between the monthly intercourse fre- quency before and after lowbackpain onset. Question 8 of ODI was also used to assess sex life difficulties in our patients. In addition, we studied the sexual quality of life using the French version of the sexual quality of life ques- tionnaire (SQOL - F  for women and the SQOL - M  for men). The SQOL-F has 18 items and the SQOL-M contains 11 items, each with a 6 point ranging from “com- pletely agree” to “completely disagree”. Except for item 4 which corresponds to the only gender specific question, the male and female versions of the SQOL are very similar. The SQOL-M has seven fewer items than the original SQOL-F instrument: two on relationship; one related to emotional well-being; three related to frequency and avoid- ance of sexual activity; and one on the overall enjoyment. The items that have been removed in the SQOL-M are the ones that worked well for women, but did not work so well in a male population . For example, questions on the sexuality-related emotional connection with the part- ner (e.g. “when I think about my sexual life I feel close to my partner”) may not resonate with men in the same way they do for women. Similarly, questions re- lating to avoidance and low frequency of the sexual ac- tivity because of sexual problems may be more relevant to the female sexual dysfunction than to the male sexual dysfunction . The SQOL-F and SQOL- M are valid instruments for assessing the impact of the sexual dysfunction on the quality of life [7,8]. They showed good psychometric properties (convergent val- idity, discriminate validity and test-retest reliability) [7,8]. Total score of SQOL ranges from 0 to 100 [7,8]. Increasing scores employ better sexual quality of life. According to the data of the original validation study, men and women without a sexual dysfunction had high mean scores on the SQOL (87.13 and 90.1, re- spectively [7,8]).
Of the participants surveyed, 425 were identified as hav- ing CLBP. The average age of a respondent with CLBP was 54 years old, and 44 % were female (Table 1). When assessed according to depression status, CLBP patients with depression (PHQ-9 ≥ 10; N = 70) were younger than CLBP patients without depression (PHQ-9 < 10; N = 355) by approximately 9 years on average, but did not differ in terms of average CCI score, gender, or employment status. Patients with depression were less likely to be married or live with a partner (Table 1). Patients indi- cated their LBP was either mild (47 %) or moderate (44 %) rather than severe (9 %). Both overall severity of pain and current level of pain were near the midpoint of the NRS, and almost half reported daily problems with pain. Depression was significantly associated with more severe pain and higher levels of pain, current and in the prior week (Table 1).
Nine studies [41 – 49] examining the effect of PNI on physical performance, pain cognition and disability in CLBP reported positive effects. However, there was a lack of standardization of the type of information pro- vided. Seven studies provided detailed information con- cerning the PNI [41, 43, 45 – 49], whereas only five studies specifically addressed the description of the dif- ferent components of the PNI [43, 45 – 47, 49]. Although promising, there is no strong evidence for the use of PNI for CLBP patients because this evidence has been rated as very low quality by some authors due to the lack of good randomized controlled trials [19, 50]. Moreover, the authors in all of the studies developed the PNI with- out exploring the needs of CLBP patients. Therefore, the rationale of this protocol is to develop an educational tool focused on of beliefs and knowledge of patients to- wards their CLBP. This rationale justifies the use of a mixed methodology wherein the authors explore the pa- tients ’ beliefs and knowledge about their pain for the subsequent development of an educational patient- centered tool. The authors understand that an educative tool must take into account the patients ’ thoughts and beliefs.
In population based samples the prevalence for CLBP is higher in older patients [1, 71 – 73] and younger patients seem to recover slightly better under multidis- ciplinary therapy . In samples composed only of chroniclowbackpainpatients however, there is usually no cross-sectional relationship between age and disability . In our study, higher age also did not correlate with disability at baseline but it predicted higher disability after one year. There are several possible explanations for this finding. First, older patients might have less favourable courses of pain. For example they might develop pain in more regions and therefore also experience more dis- ability. However, when we examined the transition into CWP in another analysis of the same sample, pain generalization was not predicted by age . We can therefore rule out that the age-disability relationship is confounded by pain generalization. Second, multimor- bidity increases with age which leads to additional dis- ability [76, 77]. Even though patients were asked to rate the disability caused by the pain, it might not have been possible for them to distinguish disability caused by pain or by other comorbidities, especially when their condition has been chronic for years. We can neither Table 4 Associations of predictors with follow-up disability, using multiple regression analysis
Lowbackpain (LBP) is a major medical, social, and economic problem in both developed and developing countries. It often affects all life domains from fairly basic self-care activities to advance and complex social interactions, work, and leisure activities and eventually has a profound impact on quality of life. The aim of the study was planned to investigate the health-related quality of life with chroniclowbackpainpatients and to examine the effect of clinical and activity Our study consisted of 400 patients who had a diagnosis of chroniclowbackpain in Orthopedics and Traumatology Department of DEU Medical Faculty Hospital. A total of 400 patients (200 male) and (200 female) were included, ranging in age from 18 to 62 years (mean ± SD 27.25 ± 10.68). Demographic data, occupational status, education status, body mass index (BMI). study. Visual analogue scale (VAS), functional status and quality of life were used in the Nottingham health profile questionnaire (NHP). Also the functional independence rding to demographic characteristics; There was no statistically significant difference between the groups in terms of the sex ratios of the cases and the BMI values (p> 0.05). There was a statistically significant difference between groups in terms of , occupation and educational status of the cases (p <0.05). The VAS, NHP scores of the patient age and VAS pain scores (p <0.05). The total ly higher than the total FIM scores of the control group (p <0.05). With the VAS values of the cases; There was a statistically significant correlation between NHP scores in the positive direction and total FIM score values in the negative 05). There was a statistically significant correlation between total FIM scores and all In patients with chroniclowbackpain, the increase in pain severity resulted in a
Two questionnaires were filled in during the initial examination: Short Form McGill Pain Questionnaire (SF-MPQ) and Oswestry Disability Index (ODI). The SF-MPQ is often used in clinical practice, capturing not only the intensity but also the character of the pain (Rokyta, Kršiak, & Kozák, 2012). It also includes Present Pain Intensity Scale and Visual Analog Scale (VAS). The ODI is a questionnaire used in individuals with chroniclowbackpain focusing on pain and limita- tion of activities of daily living. It quantifies subjective disability of the individual and expresses the rate of disability (Savre, 2011). Furthermore, detailed anam- nesis was taken, and an initial kinesiology examination focused on the area of a pelvis and lower extremities were performed. Information and data from anamnesis and kinesiology examination were used only for the control of physiotherapist during rehabilitation. Two tests on the functional state of deep spinal stabiliza- tion system (diaphragmatic test and the flexion of the hip, ankle and knee joint test – Kolář & Lewit, 2005) were also conducted. Then measurement using a pres- sure algometer (Wagner Instruments, Greenwich, CT, USA) was performed. In the lowback area, 5 places in the paravertebral muscle areas at the level of L1, L2, L3, L4, and L5 were defined 2–3 cm from the verte- brae spinous processes, which are the same for each subject. These places were defined only for use in this study after the consultation with the neurologist. Both sides of the spine were measured, the research con- sidered only the data corresponding to the side with greater pain.
The first step was to find the painless range of motion of the spine for a particular patient. Patients were en- couraged to start the exercise regimen within this zone. We do not propose any new exercises that are not an already established core strengthening exercise. But we have picked few exercises that are easily doable for the Asian population and proposed a protocol which is ef- fective in achieving improvement. As patients became accustomed to the exercise regimen, their pain-free range increased. Foundation set of exercises include ab- dominal tights, pelvic tilts, partial curls, and back exten- sion. The intermediate set of exercises includes supine bridge, side bridge, prone bridge, and quadruped exer- cises. The advanced set includes doing the above exer- cises in an unstable platform like exercise ball and advanced quadruped exercises. When doing pelvic tilt exercises, patients were asked to concentrate on their deep core—transverse abdominis. They were asked to lie down in a supine position and asked to bring their hips together. This movement will contract their transverse abdominis. Patients were asked to do 20 repetitions of each exercise twice daily. Core stabilization exercises done over a physio ball has shown early and better achievement of core stability . Neural adaptation with respect to body proprioception is found to occur as early as 4 weeks. The neural adaptations are the physio- logic mechanisms by which torso strength and balance adaptations occur in the early phases of a conditioning training program. Hence, we have included performing on physio ball the exercises which patients have trained themselves in the initial phases of the TRICCS protocol. These constitute the advanced set of exercises. The ob- jective of the advanced exercises on the physio ball should not be to achieve strength but to gain body con- trol and proprioception. Neural adaptation systems will help in more efficient neural recruitment patterns result- ing in coordinated motor activity and lowering of neural inhibitory reflexes .
Aim:Low backpain is a common disease, and it is observed at least once in 70-85% of the population during their lifetime.Chronic lowbackpain (CLBP)interferes with the physical ability and mobility of high number of people. This study will determine if there is a relationship between mental disorders including depression, hypochondriasis and anxiety, and the functional status of patients suffering from chroniclowback pain.Subjects and methods: The study was performed on a sample of 200 agreed to participate in this cross-sectional study. The patients were divided equally into two separate groups: first group consisted patients with chroniclowbackpain with clear organic lesion and validated radiologically.The second group consisted of patients with chroniclowbackpain in which no clinical and radiological confirmation for an organic lesion, or called functional group. Every patient has undergone to the following procedures: A) Medical evaluation including (Neurological evaluation, systemic examination mainly gynecological examination in all female patients and radiological examination mainly Plain x-ray of lumbosacral spine and Magnetic Resonence Imaging(MRI) lumbosacral spine. B) The psychological evaluation used to measure anxiety, depression and hypochondriasis by adopting the MMPI Questionnaire Results: This study sample has included 53% males and 47% females in organic group while 30% males and 70% females in functional group. In Organic group, age and LBPwere found to be significantly associated. Radiation was absent in 9% of patients in organic group and in 60% of patients in functional group. Parathesia present in 85% of organic group, while functional group 20%. 70% of those in organic group and 25% of those in functional group reported severe pain.Depressionwas observed in 15% oforganic group
In the present study we did not quantify changes in muscle activity following SM, but rather assessed the effects of SM on the evoked short-latency stretch reflex amplitude. Although our observation of no pre- versus post-manipulation difference in patients with chronic LBP or asymptomatic controls suggested that SM did not systematically alter the short-latency stretch reflex, we did observe a significant decrease in the short- latency stretch reflex when data were analyzed based on whether SM resulted in an audible joint sound. Many clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible response. While some evidence suggests that an audible response is not associated with improved clinical outcomes [35,36], there are differences in joint laxity and motion when an audible pop is asso- ciated with the manipulation . This may reflect the successful and rapid separation of the joint surfaces resulting in cavitation and an audible response. It has been hypothesized that the rapid stretch of the periarti- cular muscles and connective tissue associated with SM causes the reduction in spinal reflexes [17,18]; however, to our knowledge no previous studies have reported dif- ferential physiologic effects dependent upon whether SM results in an audible response. Thus, our finding that SM alters the short-latency stretch reflex–a critical component of the pain-spasm-pain model of LBP (Fig- ure 6)–only when an audible response occurs is novel. As stated before, the short-latency stretch reflex occurs in response to a muscle being rapidly stretched, which excites the Ia afferent fibers within the muscle spindles . This observation suggests that when SM results in an audible response it mechanistically acts by down-reg- ulating the sensitivity of the muscle spindles and/or the
For health economic evaluations of (primarily) preventable disorders like chronic LBP a reflection of the disease expression in the general population is of particular importance. In the chronic LBP description used in this study, we did not give explicit indications of pain intensity. However, the description seems to reflect moderate pain intensity since the mean VAS as rated by all LBP patients for the standardized chronic LBP scenario was 40.91 which is comparable to the mean VAS of 39.75 that LBP patients with a moderate degree of disability attributed to their own complaints. The ad- vantage of not giving explicit indications of pain inten- sity is that it reflects how the intensity of chronic LBP varies in the population. The disadvantage of this approach is that it impedes the concrete description of an illness that is primarily pain based. This problem becomes clear when comparing the patient and the population group in our sample: On average, healthy participants rated chronic LBP as more severe than pa- tients with chronic LBP did (note that most chronic LBP patients in our sample reported only light pain inten- sities). Furthermore, patients with more severe LBP rated the standardized chronic LBP scenario as more se- vere than patients with less severe LBP (Fig. 2). Conse- quently, future studies should incorporate explicit descriptions of a range of different pain intensities in their chronic LBP scenarios and derive HU for different
Methods: Ethical approval was taken before study. Forty patients with chroniclowbackpain (28 male, 12 female) were included in the study and divided into two groups each containing 20 subjects. All the participants were signed written consent after being informed in detail about the study. Group A has been given the proprioceptive neuromuscular facilitation exercises including Rhythmic Stabilization (RST) and Combination of Isotonics (COI) and Conventional back exercises. Group B was given conventional back exercises only. Outcome measures were taken at the end of one month i.e. after the treatment protocol. VAS, SF-36Questionnaire and Core stability gradation were taken in both groups. Results: There is significant improvement in VAS score in both groups but Group A was having more significant improvement than Group B. Also there is significant improvement in core stability grading and SF 36 score in Group A.
[27,28]. The strategy to prevent bias from the interven- tion is the individual monitoring of the participant by a trained physical therapist and the control of the level of exercise difficulty presented by the participant, since the treatment of chroniclowbackpain with the modi- fied Pilates exercise has proven to be a safe intervention [29-31]. Moreover, the exercise program ends after the 6-week intervention, without any additional treatment, since both groups will receive the treatment according to the guidelines [1,8] and the allocated interventions will not be modified. Participants that may need add- itional interventions will be referred to the outpatient Physical Therapy Clinic from the Universidade Cidade de São Paulo. During the study, the participants will be allowed to use their usual medication and this informa- tion will be monitored during the reassessments at six weeks and six months.
This study showed that the patients who were positive beliefs and evaluation regarding outcomes of PA behavior were more like to perform this behavior. Therefore, Cognitive, behavioral, and psychological factors can contribute to the experience of pain among patients with cLBP. One of the psychotherapy interventions is cognitive-behavioral therapy (CBT), which is an effective treatment for chronic general pain, especially lowbackpain 27 . Cognitive-behavioral interventions are very useful in modifying health
GRADE (Grades of Recommendation, Assessment, Development and Evaluation) profiles were used to evaluate the overall quality of the evidence and the strength of the recommendations (Atkins 2004). Using this approach, as recommended in the recent update of The Cochrane Handbook (Higgins 2009), and the Cochrane Back Review Group method guidelines (Furlan 2009), the overall quality of evidence for a particular outcome is considered to be high when multiple RCTs with a low risk of bias provide consis- tent, generalisable, and precise data. The quality of the evidence was downgraded by one level for each of the five factors that was encountered: 1) limitations in design (i.e. >25% of participants from studies with high risk of bias), 2) inconsistency of results (i.e. opposite direction of effects and/or significant statistical het- erogeneity), 3) indirectness (e.g. patients selected based on MRI results, surgical candidates), 4) imprecision (i.e. total number of participants <300 for each outcome), and 5) other considerations (e.g. reporting bias). The judgment of whether these factors were present for each outcome was made by two review authors (NH and RO) using the descriptions shown in brackets above. Sin- gle studies were considered inconsistent and imprecise (i.e. sparse data) and provided “low quality evidence”. This could be further downgraded to “very low quality evidence” if there were also limi- tations in design or indirectness. The following definitions of qual- ity of the evidence were applied (Guyatt 2008):
We evaluated LBP before treatment, one month after treat- ment, and at final follow-up. Pain scores in patients with spe- cific LBP awaiting surgery was evaluated at seven days be- fore their surgery, which was considered as their final follow- up. If a patient stopped the medication (e.g., non-responder), the pain evaluation from seven days before the last dose was administered was recorded. For the evaluation of pain in all patients, scores from the VAS score (0, no pain; 10, worst pain) and the Oswestry Disability Index (ODI) score (0, no pain; 100, worst pain) were recorded and compared.
The consequences of the patients holding negative attitudes and beliefs regarding their LBP have been widely reported [13, 31, 33]. In this study for instance, (nearly 93%) of the participants believed that, because of their LBP, any movement or physical activity, that will involve their back should be avoided as this may cause more harm to their already existing LBP. These findings are congruent with the findings of Keen et al  which found that, the majority of the participants with LBP in their study tended to avoid movements and physical activity; although some believed that keeping active could be the best way to easy their LBP. This is clear indications that, majority of patients with LBP tend to develop fear, leading to avoidance behavior , which increases the risk of developing chronic LBP and may be a significant indicator for development of disability and abstinence of physical activities .Moreover, persistent pain has been associated strongly with higher levels of chronicity and disability, psychosocial distress and enormous cost to the society .
Our hypothesis is practically relevant because understand- ing significant patient-related predictors of communication preferences would enable us to predict patients’ expectations. If predictors were readily observable (ie, age, sex) or easy to assess (ie, pain intensity, chronification), providers could make an initial judgment as to a patient’s probable commu- nication preferences without much difficulty, and adapt their communicative behavior accordingly. This would, however, require that the predictors explain a substantial amount of variance. Our hypothesis is also relevant to research on patient-centeredness, because hypotheses regarding how pref- erences are constructed can be derived from knowledge about the predictors of patient communication preferences. The development of patient preferences is an important research field that may well attract more attention in the future. 37
Lowbackpain remains a global public health problem . It is considered to be the sixth leading cause of disability- adjusted life years among more than 200 health conditions [1, 2]. Despite the increase in quantity and quality of re- search in recent decades, the available treatments for lowbackpain tend to produce minor or moderate effects. These effects are positive in the short term and only some of them maintain long-term improvements . The high prevalence of lowbackpain makes impossible the use of treatment strategies that demand high resources for all pa- tients . Studies have shown that a small group of pa- tients who develop chronicpain are responsible for most of the treatment-related costs [5, 6]. Thus, it is important to identify patients who would benefit from a specific treatment from those who would show little benefit or even worsening of symptoms .
most important occupational injury in nurses with a prevalence of 56-90%, which is slightly higher than in other populations (8). The prevalence of LBP has been reported as 62% (9) and 49.4% in (10) some parts of Iran. In a study conducted on the nursing staff of Namazi and Shahid Faghihi Hospitals, Shiraz, Iran, in 1999, a 78.3% prevalence of occupational LBP was reported (11). About 98% of nurses move patients in such a way that applies a great amount of pressure on the lumbar vertebrae (12). Moreover, bending on the patient’s bed during work and stretching the back increases the risk of backpain. In addition, inappropriate body postures, squatting, bending, prolonged standing, and a low nurse to patient ratio are other risk factors of backpain in nurses (12). Nurses who work in intensive care units are particularly prone to backpain due to their distinct work conditions (13, 14). Nurses are an efficient and effective part of any health system and are prone to the risk factors of backpain more than other occupational groups. They lose many work days due to backpain every year which lowers their productivity. However, backpain can be decreased using appropriate preventive measures, which requires the knowledgability of nurses on the