There is concern that a sedentary lifestyle in childhood is harmful to spinal health. The literature stands divided, as there are reports also of an increased injury rate in children who are physically active. Children cannot be expected to remember correctly amount of physical activity in the past nor can they remember correctly past events of backpain. We therefore used a new method, SMS-Track, to collect weekly data over a long period of time. In a prospective Danish study, the effect of increased physical activity was tested vs. “business-as-usual” in 10 primary schools. We collected data on time spent on physical activities and any backpain in the preceding week. For this we sent the children weekly text-messages, to which the children/parents responded with a text-message as well. If the child reported having had any backpain during the preceding week, the parents were contacted, the child seen by a health professional, and treatment initiated if necessary.Background
Methods and material
Social context may be important in chronic pain. One focus is reactions to pain between persons with LBP and their partners. Researchers have investigated partner reactions and found influences on pain levels and psychological outcomes, but little is known about factors underpinning these reactions. To investigate the associations of relationship quality and perceived partner responses with LBP intensity and disability.Background
Aim
The clinical assessment of Chronic Low Back Pain (CLBP) is usually undertaken at a single time point at clinic rather than through continuous monitoring. To address this, a wearable prototype sensor to monitor motion of the lumbar spine and pelvis has been developed. The system devised was based on inertial sensor technology combined with wireless Body Sensor Network (BSN) platform. This was tested on 16 healthy volunteers for ten common movements (including sit to stand, lifting, walking, and stairs) with results validated by optical tracking. Preliminary findings suggest good agreement between the optical tracker and device with mean average orientation error (°) ranging from 0.1 ± 2.3 to 4.2 ± 2.6. The sensor repeatability errors range from 0 to 4° while subject movement variability ranged from 4% to 14%. Parameters of angular motion suggest greater movement of the lumbar spine compared to the pelvis with mean velocities (°/s) for lumbar spine ranging from 15.3 to 74.13 and pelvis ranging from 5.6 to 40.74. Further analysis revealed the extent to which the pelvis was engaged, as a proportion of the total movement. This demonstrated that the pelvis underwent smooth transitions from low (0.02), moderate (0.4) to high (0.99) use during different movement phases.Background
Sensor Development, Testing and Results
It is likely that the most common method for calculating a Roland Morris Disability Index (RMDQ) sum score is to simply ignore any unanswered questions. In contrast, the raw sum score on the Oswestry Disability Index (ODI) is converted to a 0-100 scale, with the advantage of allowing missing data to be accommodated by proportional recalculation. The aim of this study was to quantify the calculation error in RMDQ scores when one or more questions were unanswered and compare this with the error present when the ODI was scored in the same way. The prevalence of unanswered RMDQ questions was measured in a research and a routine care setting. The accuracy of the RMDQ proportional recalculation method was measured using 311 fully completed RMDQ and matching ODI questionnaire sets. Raw sum scores were calculated, and questions systematically dropped. At each stage, sum scores were converted to a score on a 0-100 scale and the error calculated. Wilcoxon Tests were used to compare the magnitude of the error scores. The prevalence of unanswered questions was 29.5% (RMDQ) in routine care, and 13.9% (ODI) and 20.3% (RMDQ) in a research project. Proportional recalculation was a more accurate method to calculate RMDQ sum scores than simply ignoring missing data.Background and purpose
Methods and results
By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP). MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies.Purpose
Materials and methods
Low back pain is a common condition amongst Armed Services personnel and can have significant impact upon their ability to undertake military duties, including being deployed into austere environments. This was a qualitative study of 16 military physiotherapists exploring their attitudes and beliefs towards management of low back pain. Semi-structured interviews were conducted and transcribed. The transcripts were analysed using a method of thematic content analysis. Six themes were identified; military culture, occupational issues, continuing professional development, clinical reasoning, need for a cure and labelling the patient. The highly challenging occupational demands placed on military patients appeared to prompt physiotherapists to request radiological investigations at an earlier stage than recommended in current guidelines. Justification for early investigation was considered to be both in the patients' and the Armed Services best interests, for the patient to initiate treatment with minimum delay whilst also decreasing the number of personnel unable to deploy for medical reasons.Background
Methods and results
Previous work( EMG data was recorded from 192 subjects across two years (initial contact, 12 months and 24 months). The data were analysed and SCMs produced. The 30 second test data was split into 30 one second epochs. Colour values were scaled to the individual data set maximum and divided into 12 bands according to frequency strength at a particular point. Median Frequency values were calculated for each epoch and a line of best fit added to the colour map to further aid the diagnosis process. Maps with faulty recordings were excluded and 20 data sets from each group (BP and no BP) selected at random. Four observers were given only 5 minutes instruction and then asked to indicate whether they thought each map belonged to the LBP or no LBP group.Introduction
Methods
Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. Post-hoc analysis. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p=0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made.
To assess the effectiveness of dynamic stabilisation as a treatment for discogenic pain compared to standard treatment of interbody fusion. Study Design & Subjects All patients were referred for a 2 year back-pain management programme. Patients with continued pain following conservative treatment underwent discography & MRI. Patients with painful degenerate discs on the above investigations were selected. Patients underwent interbody fusion (PLIF/TLIF) or dynamic stabilisation. Mean follow-up was 24 months with a minimum follow-up of 12 months. All patients had pre-operative ODI and VAS scores. Patients were then sent further questionnaires at 6 month intervals.Objective
Outcome Measures
Some studies report greater repositioning error in LBP patients compared to healthy subjects with other studies showing no differences. This conflicting evidence may be due to different methodologies. A new tool, the Flexchair¯Back Balance Trainer measures consistency of lumbo-pelvic movement during visual tracking tasks which challenge the lumbo-pelvic region. This study aimed to establish the within day (WD) and between day (BD) reliability of a lumbo-pelvic tracking task using the Flexchair in healthy subjects, 22 subjects gave informed consent (10 females, 12 males (age 38.40(±9.29) Height 171.35cms (±8.07) weight 76.21kg (±18.55) Subjects completed six different tracking tasks on the Flexchair, 3 times in the first day with 2 hour of intervals between each test and once on a second and third visit with 2 days in between. Tests 1-6 are of increasing difficulty.Background
Method
To develop disease-specific quality indicators for patients with low-back-pain presenting to Danish chiropractic clinics. A cross-disciplinary group of healthcare providers (the indicatorgroup) prioritized nine evidensbased indicators and standards in a systematic consensus process. A pilot test including 206 low-back-pain patients was carried out in eight chiropractic clinics. An audit meeting with the test-clinics was conducted after the test-period, and the indicatorgroup designed the final set of indicators. The indicator domains were: Anamnesis, test for discogenic back pain, neurology, radiology, classification, exercise therapy, outcome assessment (process and result) and re-evaluation. Two indicators: outcome assessment as a process-indicator (standard ≥ 95 %, standard reached (95% CI): 95.8 % (91.6 – 98.3)) and outcome assessment as a result-indicator (standard ≥ 50 %, standard reached: 67.7 % (59.9 – 74.8)) met the standards set by the indicatorgroup. After evaluating the test-results the indicatorgroup decided to maintain all nine indicators, however, lowering the standards on anamnesis, discogenic back pain and classification.Purposes
Methods and results
To assess health care professional's knowledge with regards to the urinary symptoms of CES and when treatment should be offered. Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment.Objectives
Background
The musculoskeletal system is recognized as a possible source of pain in patients with chest pain. The objectives of the present study were (1) to investigate the interobserver reliability of an overall diagnosis of musculoskeletal chest pain using a standardized examination protocol in a cohort of patients with chest pain suspected to be of non-cardiac origin, (2) to investigate the interobserver reliability of the single components of the protocol, and finally, (3) to investigate the importance of clinical experience on the level of interobserver reliability. Eighty patients with acute chest pain were recruited from a cardiology department. Four observers (two chiropractors and two chiropractic students) performed a physical examination and an extended manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs and overall. Musculoskeletal chest pain was diagnosed in 44.0 % of patients. Interobserver kappa values were substantial for the chiropractors and overall, and moderate for the students. For single items of the protocol, both pairs showed fair to substantial agreement regarding pain provocation tests and poor to fair agreement regarding spinal segmental dysfunction tests.Background and purpose
Methods and results
Clinical trials for common health conditions are constantly being designed and implemented in our institution, often with some urgency to meet funding deadlines. The scope and complexity of these trials has resulted in the need for databased computer management systems typically tailored to each project. Even with current advanced software resources, development, testing and implementation can take months for each new project. This presentation describes a new approach to this problem involving an adaptive table-driven software system using project-specific recruitment and screening data which we have developed using visual basic. The chief design criterion was that the software be reconfigurable by the user based on data tables that contain the parameters of the project design. Essentially, each new project would be implemented by generating new input to the tables, but without the need for reprogramming. The first system implemented was a branching phone screen application that presents questions in an interview format and records participant responses in a data table which can be judged against inclusion/exclusion criteria contained in another table as well as for status reports.Purpose
Methods
“Spine Class” was organised at Southport Hospitals NHS Trust. The course was awarded 6 CPD (Continuing Professional Development) points. We propose a new method for assessing the effectiveness of educational courses by pre and post testing and participant satisfaction. The course was attended by 64 delegates (49 Allied Health Professionals e.g. Physiotherapists and 15 Physicians). 21 lectures were planned for the day. The lecturers were asked to submit 2 True/False questions (TFQs), a total of 42 questions. Questions were answered prior to the course and immediately after. The lectures were evaluated on a scale of 1 to 5.Introduction:
Materials and Methods
The prevalence of back pain has remained relatively constant in the population in spite of previous interventions. Persons with sub-acute back pain are assumed to benefit from extended multidisciplinary, interdisciplinary or transdiciplinary and multisectorial, intersectorial or trans-sectorial interventions as an alternative to traditional mono-professional interventions. The purpose of this health technology assessment (HTA) was to document the possible effect of such interventions in patients suffering from back pain of 4-12 weeks duration. A systematic literature review is the overall basis for this HTA and the analysis of the interventions in relation to technology, patients, organization, and economics. HTA reports, systematic reviews, and recent primary studies were included. Further, primary data from Danish institutions (public and private) with experience in working with this technology were collected. There is moderate evidence that early multidiciplnary, interdisciplinary and transdiciplinary interventions are more effective than monodiciplinary interventions or no interventions in primary care. The effects are mainly seen in relation to reduced sick leave at or beyond 12-months follow-up and not in relation to reduced pain or improved function. The interventions appear to be cost-effective. Danish back centers mainly use sequential and/or parallel collaborative models.Background and purpose
Methods and results
Changes in the central nervous system (CNS) pathways controlling trunk and leg muscles in patients with low back pain and radiculopathy have been observed and this study investigated whether surgery impacts upon these changes. Parameters of corticospinal control were examined on 3 occasions in 22 patients prior to, at 6 and 26 weeks following lumbar decompression surgery and in 14 control subjects at the same intervals. Electromyographic activity was recorded from tibialis anterior (TA), soleus (SOL), rectus abdominis (RA), external oblique (EO) and erector spinae (ES) muscles at the T12 & L4 levels in response to transcranial magnetic stimulation of the motor cortex.Introduction
Methods
The importance of interpreting clinical trial results in terms of the benefits a treatment may offer to individuals with chronic pain is becoming more widely recognized. The clinical meaningfulness of group differences can better be described by looking at the percentages of responders in each treatment group, rather than between group mean differences. We have reassessed the outcomes of a clinical trial for chronic low back pain (LBP) from this new perspective. The randomized clinical trial examined short- (12 weeks) and long-term (52 weeks) efficacy of high-dose, supervised trunk exercise (SET), spinal manipulative therapy (SMT), and a course of home exercise and self-care advice (HEA) for the treatment of LBP ≥ 6 weeks duration. We calculated response to care at 2 levels for 2 variables: numeric back pain scores (NRS) and Roland-Morris Disability (RMD), and at 3 timepoints (Weeks 12, 26 and 52). The 2 levels were calculated as percent improvement from baseline ≥ 30% and ≥75%. Finally, we calculated the relative proportion (± 95% confidence intervals) of the sample (∼100 per treatment group) that achieved each level of improvement.Purpose
Methods
Patient preferences have been shown to be associated with treatment effects ( To determine the treatment preferences of LBP patients and whether these affect clinical outcome.Background
Aim
The ‘Subgroups for Targeted Treatment back tool’ (STarT) is supposed to divide patients with low back pain (LBP) into three groups with different risks of non-recovery. The objectives of this study were 1) to investigate whether these groups exist among Danish chiropractor patients, and if so 2) to test if the groups differ on psychological profile as measured by the Major Depression Inventory (MDI), the Coping Strategies Questionnaire (CSQ), and the Fear-Avoidance-Beliefs Questionnaire (FABQ). Questionnaires were handed out to LBP patients aged 18 – 65 years in 19 chiropractor clinics during a 4 weeks period. Patients were anonymous and returned the completed forms in a sealed envelope. Associations between the risk groups and MDI, CSQ, and FABQ were tested by means of linear regression.Background
Methods
This systematic review sought to determine the efficacy of such targeted treatment in adults with non-specific low back pain (NSLBP). Many clinicians and researchers believe that tailoring treatment to subgroups of NSLBP positively impacts on patient outcomes. MEDLINE, EMBASE, Current Contents, AMED, the Cochrane Central Register of Controlled Trials, reference list searching and citation tracking. Inclusion criteria were randomised controlled trials of targeted manual therapy and/or exercise for NSLPB that used trial designs capable of providing robust information on targeted treatment (treatment effect modification) for the outcomes of activity limitation and pain. Included trials needed to be hypothesis-testing studies published in English, Danish or Norwegian. Method quality was assessed using the Cochrane Back Review Group criteria. Four high-quality trials of targeted manual therapy and/or exercise for NSLBP met the inclusion criteria. One study showed statistically significant effects for short-term outcomes using McKenzie directional preference-based exercise. Other included studies showed effects that might be clinically important in size but were not statistically significant with their samples sizes, as research into subgroups requires much larger sample sizes than traditional two-group trials.Purpose of study and background
Method and results
The prevalence estimates of LBP are so far well documented. However, only few longitudinal studies have described the variability of LBP in the same population over time. Therefore, little is known about the course of LBP at the individual level. The aim of this study was to describe changes in low back pain (LBP) reporting over an eight-year period in a cohort of adult Danes.Background
Purpose
The aim of this study was to describe, by means of weekly measures, the course of low back pain (LBP) in chiropractic patients. The primary outcome was number of days with bothersome pain, which was analyzed for association with known predictor variables (gender, leg pain, occupation and self rated health). Patients were followed for six months. A novel approach is used: short message services, SMS, sent to the respondents' mobile phones. Using specifically designed software, respondents received an SMS every week, which they responded to also using SMS. The question was: “How many days this previous week has your low back pain been bothersome (i.e. affected your daily activities or routines)? Please answer by a number from 0 to 7.” Baseline variables were collected during the chiropractic consultation. Patients were further assessed at the 4th visit. A follow-up questionnaire was sent to the respondents at the end of the six months. The associations of the primary outcome with baseline variables were investigated using mixed linear models.Aim
Method
