It is worthy of note that stiffness after seated rest may also have a mechanical cause as it has also been attribu- ted to intervertebral disc herniation of the lumbar spine. The discs at the L4-5 and L5-S1 levels bear high loads [21,22] and in the seated position intradiscal pressure has shown increases to 100 kilograms of force (kgf), from 70 kgf in the standing position . Therefore in a patient with a suspected lumbar spine disc lesion such as herniation, stiffness after resting (particularly in the seated position) may be a poor discriminating symptom of “ mechanical ” or “ inflammatory ” backpain in the absence of further clinical information.
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]).
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 chronic lowbackpainpatients and to examine the effect of clinical and activity Our study consisted of 400 patients who had a diagnosis of chronic lowbackpain 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 chronic lowbackpain, the increase in pain severity resulted in a
In the study duration of lowbackpain showed that more than half 62 (55.3%) of the LPB patients had 1-5 years of backpain and few of them 6 (5.4%) had their lowbackpain for 11-15 years. Mean duration of LBP patients were found 3.59 (SD 3.52) years Lankhorst studied patients with persistent LBP and he found that mean duration of backpain for the group was 5.4 years (SD 3.6). 17 This study showed that majority 43.8% of the LBP patients felt pain at the center of the back and 16.1% patients suffering from backpain in both right and left side of the back. Present study found that nearly two-third 62 (55.4%) lowbackpainpatients had severe pain on the back. And one third patients felt moderate pain 36 (32.1%) and few of them 14 (12.5%) felt mild pain on the back. But another study conducted by Nujhat found dissimilar result that among the participants, the severity of pain in VAS scale was in between no pain in 29.6%, medium pain in 58.3% and severe pain in 12.20%. 18 The study also revealed that 18 (16.1%) cases long standing and weight lifting aggravated backpain. Montakarn found that there was 62.9% of them reported that LBP was aggravated by sitting during a 6-hour working shift. 19 It also found that 91 (81.3%) patients given their opinion that backpain worsening day by day. The study found that that patients feel comfortable to lying on bed during the pain started which were about 27(24.1%). And they 26 (23.2%) also said that hot compress also relief backpain. French found that Application of heat for 15 to 20 minutes at a time relieve backpain. And patients felt comfortable than harsh pain perceptions. 20
Lowbackpain is a very common complaint with major social and economical consequences. In a recent cross-sec- tional study the annual prevalence of lowbackpain in the general Dutch population was estimated at 44% . The course of lowbackpain is usually relatively short: about 80–90% of people with lowbackpain spontaneously recover within four to six weeks. However, approximately 1–7% develop chronic lowbackpain. Although this is a relatively small group, the economic consequences are enormous . The total costs of lowbackpain in the Netherlands in 1991 have been estimated at 1.7% of the Gross National Product . About 93% of the total costs were due to absenteeism and disablement. Because of the enormous costs related to lowbackpain, effective inter- ventions aimed at prevention and treatment of chronic complaints are necessary. The Cochrane Collaboration has published several systematic reviews on the effective- ness of different treatments for lowbackpain. Exercise therapy, back schools and behavioural therapy seem to be the most promising interventions for treatment of chronic lowbackpain . Authors recommended future trials with sufficiently large sample sizes and sufficiently long follow-up periods. Cost-effectiveness and cost-utility analyses of treatments were also recommended, because the observed differences in effectiveness were only small. Evidence-based physiotherapy for sub-acute and chronic lowbackpainpatients consists of adequate information and an active approach, including behavioural principles. As physiotherapists have not yet put these principles into practice [5-7] two important barriers have to be dealt with. First, changing behaviour of health care providers is always very difficult, even when guidelines are actively implemented . Second, physiotherapists usually do not have specific knowledge of behavioural principles and are usually not specifically trained to provide behavioural therapy. To solve these issues, physiotherapists in Amster- dam have developed a new intervention program. This program not only makes optimal use of the combination of the principles of exercise therapy, behavioural therapy and back schools, but has structured it into a protocol that facilitates physiotherapists to perform this intervention in clinical practice. This trial will evaluate the cost-effective- ness and cost-utility of the intensive group training proto- col compared with physiotherapy guideline care.
Our study has also found that generalized anxiety disorder is a significant comorbidity among cases (14% in organic, 20% in functional group). 40 % cases and 15% controls had generalized anxiety disorder in a study conducted by Manchikanti et al. (Manchikanti, 2002). Whereas, other studies reported 15% and 20% of chronic painpatients had thesimilar psychiatric disorder (Waddell, 2004 and Kostova, 2001). Our study results are consistent with another study that presented the comorbidity of anxiety disorder and musculoskeletal pain in 18% of patients (Dempsey, 1997). The analysis of other studies indicated that depression has significantly and highly reported/scored in patients with LBP compared to people with no pain (Bener, 2004 and Bener, 2006). Somatization was more prevalent in patients with LBP, followed by depression and then anxiety, regarding thetypes of psychological distress (Kostova, 2001). However the ranking is not consistent, where anxiety was highly prevalent, followed by somatization (second rank) and then depression in another study (Manchikanti, 2002). The study findings describe the association between psychological factors and LBP. In Iran, the coexistence of psychological disorder with LBP among patients has been an increased (Mirzamani-Bafghi, 2003). Another study in Australia also showed that depression and LBP are highly associated (Henschke, 2008). In general, psychological factors aggravate LBP (Burton, 2004). In contrast, a study that evaluated the impact of anxiety or somatization on the Lower backpain occurrence, found no association; however, it found that somatization can predict disability (Burton, 2004). The more predominant somatic symptom was headache and almost half of the patients with lower backpain were anxious and nervous. Psychological factors remain a challenge for LBP patients and or the health care providers. Depression and somatization are concurrent with LBP. The present study delivers epidemiological evidence about psychiatric illness in LBP patients who have anxiety, higher depression prevalence and highly severe depression, compared to patients with no LBP. This evidence urges health care providers to start considering and identifying the psychologicalchallengesin order to understand the mechanism of interference, to design effective preventive measures and to involve them in the treatment and recovery of LBP.
This is the first study evaluation the effectiveness of NW in backpainpatients and we have therefore learned important lessons in relation to this intervention. First and foremost, it was not easy to recruit participants and consequently the inclusion period was extended several times. Since NW is a novel and experimental treatment for backpain, patients may not have considered it to be a “ real ” or “ serious ” treatment for their chronic problem and highly motivated recruitment personnel is essential if future trials involving this intervention are underta- ken. Second, there may have been a certain stigmatism around NW which in the public is often associated with elderly frail persons. Our target population was in their middle to late forties and may therefore have been reluctant to engage in such an activity. Interestingly and quite contrary to popular beliefs in Denmark, NW is also performed by young, highly trained and skilled indi- viduals who compete at an international level and thus this intervention may be perceived differently in other countries . Third, it is obvious based on the acceler- ometer data that the trained instructors were not able to motivate the participants in the supervised NW group to elevate their general physical activity level. In fact, some of the participants were not even able to comply with the very reasonable predetermined intensity
Deviations from the expected answer were noted in cases where the predetermined recommended strategy was “Try again” or “External help – keep in touch”. In- stead, the French chiropractors would opt for a “Second opinion”, i.e. a more defensive strategy. Another notable difference was that instead of “Quick fix” or possibly “Symptom-guided maintenance care”, about half the French chiropractors would choose “Clinical findings- guided maintenance care”, meaning that patients with benign, short-term and quickly subsiding symptoms might be subjected to long-term treatment, an approach that does not seem reasonable.
The psychologic variables, which were not included until the last step, led to the greatest increase in variance, which was between 3.9% and 16.0%. More pronounced fear avoidance beliefs and an external locus of control were associated with more pronounced communication needs on many scales. As can be expected, all areas of communica- tion (except patient-centered communication) were more important for patients who had higher values for warmth as a personality characteristic. Unexpectedly, gregariousness was negatively associated with the preference for emotionally supportive communication. However, this relationship was just barely significant. Perceived efficacy in patient-physician interaction was the one predictor that was most consistently related to all areas of communication. As expected, persons with greater communication self-efficacy also had higher expectations of patient-physician communication. Overall, between 8.2% and 18.6% of the variance in communication
The only difference in the selection criteria between the groups was whether subjects had lowbackpain or not . This study demonstrated that there is a difference between subjects with and without backpain which is a first step in the validation process of developing diagnos- tic tests. In clinical practice identifiable subgroups of patients with LBP have been proposed [3,13,14], e.g. flex- ion, extension, rotational pattern or combinations of them, that are distinguishable from one another based on MC problems. Future studies should investigate whether the six tests evaluated in this study are able to distinguish these subgroups. The correlation between MC ability and other findings, such as disability and pain, should be eval- uated in future studies. Furthermore, research is needed to look into whether or not improvement of MC ability is causally related to symptom reduction.
For non-specific lowbackpain (LBP), research has shown that a model of stratified care that does not over- treat those with a good chance of improvement but identifies those likely to need more intensive treatment, has led to superior clinical and cost effectiveness com- pared to non-stratified care [7, 8]. This approach in LBP utilises a brief self-completed screening tool (the Keele STarT Back tool)  which captures eight modifiable physical and psychological prognostic indicators. The STarT Back tool has 9 items, 4 are physical constructs, with 2 questions capturing backpain/leg pain related disability, and 5 are psychological constructs. A score of 3 or less indicates the patient is at low risk of future persistent backpain-related disability, a score of 4 or more of the 5 psychological items indicates the patient is at high risk, any other score identifies patients as at medium risk of persistent disability . By estimating future risk of persistent backpain-related disability, the STarT Back tool supports early clinical decision-making about conservative treatments (such as GP care and physiotherapy management) [7, 9]. Although neither the STarT Back trial  nor the subsequent implementation study (IMPaCT Back)  excluded patients with sciatica, the STarT Back tool and matched treatments were not specifically developed for sciatica. Sciatica patients have more severe pain and take longer to recover . Cur- rently there is no screening tool or algorithm available to support clinical decision-making in directing patients with sciatica to matched care pathways, when they first consult with sciatica symptoms which are not suspicious
Abstract: Depression caused by physical dysfunction and associated symptoms as the aftermath of the lowback (spinal) injury is commonly undiagnosed and untreated. In this paper, based on our clinical experience, we have described a relation between depression and lumbosacral injury. In our research, we selected 54 (26 female and 28 male) patients in two different groups: (1) those whose lowback injury occurred less than 12 months before research commenced; and (2) those whose injuries occurred more than 12 months before the research (their condition has been considered as a chronic). All of the patients (n=54) were assessed by using the Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS), and General Health Questionnaire-28 (GHQ-28) in order to evaluate their level of depression. The results show that lowback (spinal) injured patients suffered depression due to their body discomfort and changed day-to-day capacities. Those who sustained injury more than one year developed an upper level of a moderate depression. However, if not taking any treatment following their psychological disturbances, the patients had suffered a severe depression. Their level of depression increases with a chronicity of the physical pain making also depression as a chronic disorder.
Appropriate treatment for low-risk patients can pro- vide important clinical benefits. It could be a fast and low-cost treatment option for the health system since it would help in identifying patients who do not require unnecessary or extensive assessment and treatment . To date, there are no studies that have investigated the therapeutic alliance combined with minimal intervention in the treatment of patients with chronic, nonspecific lowbackpain and low risk of psychosocial-factor in- volvement. Therefore, the objective of this study is to evaluate the effectiveness of the addition of the thera- peutic alliance with minimal intervention in the treat- ment of patients with chronic, nonspecific lowbackpain with a low risk of having psychosocial-factor in- volvement in their pain, specific and general disability, global perceived effect, empathy, credibility and expect- ation. The hypothesis of this study is that there will be a clinical benefit in pain, and especially in specific disability, 1 month after randomization into the group receiving treatment with the addition of the therapeutic alliance.
While there is a plethora of new and emerging technologies that enable citizens to better monitor their health and manage chronic conditions, there is very little scientific evidence on the impact these technologies have on medical costs. A single study has come up by Bloss et al., (2016) investigating the link between mobile health devices and health care utilization. The study sought to ascertain whether mobile monitoring of chronic health conditions (diabetes, hypertension and cardiac arrhythmia) might lead to short-term changes in health care resource utilization, which was being measured by looking at the health insurance claim submissions. In this prospective randomized control trial one group used smartphone-enabled biosensors to monitor their health condition(s), while a control group did not. Even if there is an expectation that proper health-monitoring will yield better health outcomes, which in term will lower the burden on health services long-term, the short-term concern is that the new health technologies will lead to over-utilization of already stretched services due to patient inability to interpret data correctly. The study found no basis for this concern, and concluded that “any apprehension directed at consumer mobile health monitoring with respect to over-utilization of health care resources should be tempered, and focus should be placed on the potential merits of empowering patients through active health monitoring.” (Anderson 2016; Bloss et al., 2016)
A 26-year-old male massage therapist presented with symptoms of acute lowbackpain isolated to the lumbo- sacral region. Interview revealed a long standing history of lowbackpain which began at 14 years of age. Twelve years prior to presentation, while playing rugby, the pa- tient received a tackle from behind causing hyper-exten- sion of his back. He felt severe and immediate pain that disabled him for a few moments. After several days of continued backpain he consulted his family physician. X-rays were taken and the patient was told he sustained a hairline fracture of his spine. He was also informed that he had mechanical lowbackpain and that the fracture would heal with time. Although the patient’s recollection was vague, he was told by a medical specialist that he had spondylolysis of the spine and that he would experience more problems later in life. He was advised to avoid playing sports and to consider choosing a career in a non-
In the precision medicine models (ie, wherein opioid pre- scribing is assessed to determine if, in theory, it is concordant or discordant with pharmacogenetically informed care based on either the single-gene model or the multigene model), patients exclusively using opioids will be similarly matched with comparator patients as illustrated in Figure 3. The sample sizes and statistical power estimates for comparisons under the precision medicine models were based on the assumptions described earlier for opioid prescribing risk and the use of opioids, NSAIDs, and other pharmacologic treatments for lowbackpain. A summary of sample sizes, effect size detection limits, and statistical power estimates for each model is provided in Table 2. An estimated 600 registry
degenerative disc even without any mechanical compression [8,9]. To this hypothesis, sciatica pain may have 2 causes: neuropathic ectopia in injured dorsal ramus afferents or sensitized nociceptor endings in deep back tissues. In most patients, both mechanisms probably contribute, yielding qualitatively different pain sensations with different secondary consequences. Diagnosis of NP typically consists of a thorough history together with an extensive neurosensory examination. In fact, NP pain is generally identified by its spontaneous pain and evoked pain. Spontaneous pain could occur so continuous or intermittent and paroxysmal and may include: burning, prickling, tingling, itching, electric shock–like and stabbing sensations. Evoked pain was described as an exaggerated pain provoked by tactile or thermal stimuli: ‘allodynia’ is a pain induced by light touch or moderate thermal stimuli and ‘hyperalgesia’ refer to particularly severe pain elicited by normally mild nociceptive stimuli. An individual with NP may exhibit all or only a few of these components of NP. Patients describe being especially sensitive in the area of pain.
A physiotherapy outcome measure is a test or scale administered and interpreted by physiotherapists that has been shown to accurately measure a particular attribute of interest to patients and therapists, and is expected to be influenced by intervention(Cole ,1994; Rene man et al, 2002).Important properties of an outcome measure include the validity, practicality, precision, reliability, responsiveness and the ability to detect change in a specific condition (Lurie, 2000). There has been an increase in the recognition of the importance of outcome measures amongst physiotherapists over the last decade(Bayar et al, 2003). The lowbackpain rating scale (LBPRS) is a rating questionnair designed to evaluate the clinical outcome of LBP patients. This tool includes three different components: pain, disability and physical impairment (Manniche et al,1994). The three different components are weighted: 60 points for pain scoring, 30 points for disability and 40 points for physical impairment. Therefore, combining them, the final LBPRS score ranges from 0 (in patient without back problems) to 130 (in disabled patient). The questionnaire can be filled out in about 15 min and scored in about 3–5 min. The scale is available in Danish and English (Manniche et al., 1994). Turkish (Filiz et al., 2005), German (Nuhr et al, 2004) and Polish (Radziszewski, 2008). The scale has been validated in Danish (Manniche et al,1994)and culturally adapted into German (Nuhr et al, 2004). Any questionnaire was translated needs to be valid and reliable with the translated language even if it was valid and reliable with its original language.
Pain felt in your lower back may come from the spine, muscles, r structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the ovaries, uterus and other neighboring , 2017) You may feel a variety of urt your back. You may have a tingling or burning sensation, a dull ache or sharp pain. You also may experience weakness in your legs or feet. It won’t necessarily be one event that actually causes your pain. You may have been doing many things improperly, like standing, sitting, or lifting for a long time. Then suddenly, one simple movement, like reaching for something in the shelf or bending from your waist, leads to the feeling of pain. (Mayoclinic, 2015) If you are like most people, you will have at least once backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your lowback. This is because the lowback supports most of your body’s . Most back problems will get better on their own. The key is to know when you need to seek medical help and when care measures alone will allow you to get better. Web, Lowbackpain may be acute (short-