Function and the patient with chronic low back pain. Level of Distress in a Recurrent Low Back Pain Population Referred for Physical Therapy Treatment of low back pain by acupressure and physical therapy: randomised controlled trial The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Assessing Activity Limitations and Symptoms in People With Pelvic Girdle Pain The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain Responsiveness of common outcome measures for patients with low back pain. Early Physician Notification of Patient Disability Risk and Clinical Guidelines After Low Back Injury: A Randomized, Controlled Trial A within-subjects trial to test the equivalence of online and paper outcome measures: the Roland Morris Disability Questionnaire Symptoms, signs, and functional disability in adult spondylolisthesis. Rasch Analysis of the Roland Disability Questionnaire Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain Functional Restoration for Chronic Low Back Pain: Two‐Year Follow‐Up of Two Randomized Clinical Trials Physical Therapy Treatment of Back Complaints on Children and Adolescents Health-related quality of life in patients with advanced prostate cancer: A multinational perspective Components of Initial and Residual Disability After Back Injury in Nurses Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble Is Work Status of Low Back Pain Patients Best Described by an Automated Device or by a Questionnaire? The Effects of Therapeutic Climbing in Patients with Chronic Low Back Pain: A Randomized Controlled Study French validation of the Foot Function Index (FFI). Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. The immediate and long-term effects of exercise and patient education on physical, functional, and quality-of-life outcome measures after single-level lumbar microdiscectomy: a randomized controlled trial protocol Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain Fear-avoidance Beliefs, Physical Activity, and Disability in Elderly Individuals With Chronic Low Back Pain and Healthy Controls Prospective, Multicenter Study of Spinal Cord Stimulation for Relief of Chronic Back and Extremity Pain Exercise and changes in health status in patients with ankylosing spondylitis. Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials Cervical Spine Outcomes Questionnaire: Its Development and Psychometric Properties Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study Randomized Controlled Trial of Specific Spinal Stabilization Exercises and Conventional Physiotherapy for Recurrent Low Back Pain Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability Development and Initial Validation of the Back Pain Functional Scale Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation Risk Factors Associated With the Transition From Acute to Chronic Occupational Back Pain Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized Controlled Trial of Biopsychosocial Education, Manual Therapy, and Exercise Socioeconomic status predicts functional disability in patients participating in a back pain trial Psychosocial Variables in Patients With (Sub)Acute Low Back Pain: An Inception Cohort in Primary Care Physical Therapy in the Netherlands Can Exercise Therapy Improve the Outcome of Microdiscectomy? Active Therapy for Chronic Low Back Pain: Part 3. Factors Influencing Self-Rated Disability and Its Change Following Therapy Yoga as a treatment for chronic low back pain: A systematic review of the literature
OBJECTIVE To undertake a comparative examination of the reliability and validity of two frequently used self-report measures of functional disability , the Pain Disability Index  ( PDI ) and the Oswestry Low Back Pain Disability Question naire  ( OLBPDQ ) . DESIGN A descriptive ex-post facto design was used in the study . SETTING Pain clinics and neurosurgical units at three metropolitan hospitals . SUBJECTS One hundred patients with chronic low back pain of noncancer origin were administered the two question naires as part of a larger question naire battery . RESULTS Acceptable internal consistency values of 0.76 for the PDI and 0.71 for the OLBPDQ were obtained . A correlation of r = 0.63 was found between the PDI and the OLBPDQ , supporting the concurrent validity of the two scales . Both the scales were found to be correlated to the Beck Depression Inventory scores ( PDI , r = 0.42 ; OLBPDQ , r = 0.39 ) , with higher disability associated with greater depression . Only the total PDI score was found to be sensitive to functional status differences within the patient sample . CONCLUSIONS These findings support other recent work in favor of the PDI . The PDI had a slightly higher internal consistency and was more sensitive than the OLBPDQ Study Design . Recruitment phase of a r and omized clinical trial . Objectives . To review the published literature on the use of the  distress risk assessment method in different back pain population s and healthcare setting s and compare results with those obtained from the current trial . Summary of Background . Psychological distress in low back pain is commonplace , and distress increases the relative risk of poor outcome with physical treatment alone . The  Distress and Risk Assessment Method  is a tool for use in the clinical setting to assist in the identification of distress and clinical decision-making . Methods . The  Distress Risk Assessment Method and Rol and Morris Disability Question naire were used to assess eligibility of patients with recurrent low back pain for recruitment into a r and omized clinical trial examining different physical therapy approaches . Results . In total , 221 patients were assessed , result ing in 212 correctly complete question naires . Of those 212 , 71 ( 33 % ) showed evidence of marked distress ( 41 depressed and 30 somatic ) . Functional disability , measured using the Rol and Morris Disability Question naire , was higher for the distressed group ( mean 14.1 , SD 4.8 , range 3–23 ) than the nondistressed group ( mean 8.0 , SD 5.1 , range 0–21 ) . Distress and anxiety measured using the distress risk assessment method were correlated to self-reported back-related functional disability . Conclusions . Distress associated with low back pain is common with one third of patients referred for physical therapy at the units studied exhibiting a level of distress that increased their relative risk of poor outcome by 3 to 4 times . Clinical ly , screening this group of patients may help indicate when liaison with other professionals is appropriate and possibly identify those patients who may be too distressed to respond to physical therapy intervention alone Abstract Objective To evaluate the effectiveness of acupressure in terms of disability , pain scores , and functional status . Design R and omised controlled trial . Setting Orthopaedic clinic in Kaohsiung , Taiwan . Participants 129 patients with chronic low back pain . Intervention Acupressure or physical therapy for one month . Main outcome measures Self administered Chinese versions of st and ard outcome measures for low back pain ( primary outcome : Rol and and Morris disability question naire ) at baseline , after treatment , and at six month follow-up . Results The mean total Rol and and Morris disability question naire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score ( - 3.8 , 95 % confidence interval - 5.7 to - 1.9 ) or mean change from the baseline ( - 4.64 , - 6.39 to - 2.89 ) . Acupressure conferred an 89 % ( 95 % confidence interval 61 % to 97 % ) reduction in significant disability compared with physical therapy . The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up . Statistically significant differences also occurred between the two groups for all six domains of the core outcome , pain visual scale , and modified Oswestry disability question naire after treatment and at six month follow-up . Conclusions Acupressure was effective in reducing low back pain in terms of disability , pain scores , and functional status . The benefit was sustained for six months Background No appropriate measures have been specifically developed for pelvic girdle pain ( PGP ) . There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice . Objective The objective of this study was to develop a condition-specific measure , the Pelvic Girdle Question naire ( PGQ ) , for use during pregnancy and postpartum . Design This was a methodology study . Methods Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP .  Face validity and content validity were assessed by classifying the items according to the World Health Organization 's International Classification of Functioning , Disability and Health . After a pilot study , the PGQ was administered to participants with clinical ly verified PGP by means of a postal question naire in 2 surveys . The first survey included 94 participants ( 52 pregnant ) , and the second survey included 87 participants ( 43 pregnant ) . Rasch analysis was used for item reduction , and the PGQ was assessed for unidimensionality , item fit , redundancy , and differential item functioning . Test-retest reliability was assessed with a r and om sample of 42 participants . Results The analysis result ed in a question naire consisting of 20 activity items and 5 symptom items on a 4-point response scale . The items in both subscales showed a good fit to the Rasch model , with acceptable internal consistency , satisfactory fit residuals , and no disordered threshold . Test-retest reliability showed high intraclass correlation coefficient estimates : .93 ( 95 % confidence interval=0.86–0.96 ) for the PGQ activity subscale and .91 ( 95 % confidence interval=0.84–0.95 ) for the PGQ symptom subscale . Limitations The PGQ should be compared with low back pain question naires as part of a concurrent evaluation of measurement properties , including validity and responsiveness to change . Conclusions The PGQ is the first condition-specific measure developed for people with PGP . The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum , it is simple to administer , and it is feasible for use in clinical practice Study Design . Cross-cultural translation and psychometric testing were performed . Objectives . To cross-culturally translate the Oswestry Disability Index ( ODI ) , Rol and -Morris Disability Question naire ( RDQ ) , and Quebec Back Pain Disability Scale ( QDS ) into Persian , and then investigate the psychometric properties of the Persian versions produced . Summary of Background Data . To the authors ’ knowledge , there is no vali date d instrument to measure functional status in Persian-speaking patients with low back pain ( LBP ) in Iran . To our knowledge , the widely used back-specific measures , the ODI , RDQ , and QDS , have not been translated and vali date d for Persian-speaking patients with LBP . Methods . The translation and cross-cultural adaptation of the original question naires were performed in accordance with published guidelines . A total of 100 patients with chronic LBP were asked to complete a question naire booklet ( the Persian versions of the ODI , RDQ , QDS , Short Form Health Survey ( SF-36 ) , and visual analog scale measure of pain ) . There were 31 r and omly select patients with chronic LBP asked to complete the second question naire booklet 24 hours later . Results . The Cronbach-α for the ODI , RDQ , and QDS was 0.75 , 0.83 , and 0.92 , respectively . The ODI , RDQ , and QDS showed excellent test-retest reliability ( intraclass correlation coefficient = 0.91 , 0.86 , and 0.86 , respectively ) ( P < 0.01 ) . The correlation among the ODI , RDQ , QDS and physical functioning scales of the SF-36 was −0.66 , −0.62 , and −0.69 , respectively ( P < 0.001 ) . The correlation among the ODI , RDQ , and QDS and visual analog scale was 0.54 , 0.36 , and 0.46 , respectively ( P < 0.001 ) . Conclusions . The Persian versions of the ODI , RDQ , and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales , and the use of them can be recommended in a clinical setting and future outcome studies in Iran Pain Management Programmes ( PMPs ) are a multi-disciplinary approach to the management of chronic low back pain ( CLBP ) . Notwithst and ing evidence of effectiveness , successful take-up of programmes requires acceptability to patients . We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care . Specifically , we estimated the probability of uptake of alternative configurations of PMPs . Potential attributes and associated levels influencing take-up were identified through a systematic literature review , survey of current PMPs , expert consultation , and focus groups . Five attributes were included : content ; provider ; schedule ; group size ; and travel time to clinic . Four hundred and fourteen question naires were mailed to patients attending clinics and 124 question naires were returned suitable for analysis . Method of delivery influenced probability of take-up , with small group sizes and low intensity programmes over a prolonged period increasing the probabilities . Travel time was also important . However , providers and contents of PMPs were not main drivers of preferences , though those with more severe pain did prefer PMPs provided by more specialists . Probability of take-up increases when PMPs better reflect patient preferences . Given preferences , re source constraints , and evidence on clinical outcomes of alternative configurations it is suggested more re source -intensive PMPs be reserved for those with the most severe and disabling pain and less intensive programmes delivered over a longer time period in smaller groups for those with less severe pain . These findings can inform future r and omised trials to evaluate acceptable PMPs in primary care OBJECTIVE To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain . DESIGN A r and omized controlled trial . PATIENTS A total of 146 patients with chronic low back pain were enrolled in the study . METHODS Subjects were divided into 2 groups : the back school group received exercise , physical treatment modalities and a back school programme ; and the control group received exercise and physical treatment modalities .  Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment , in terms of pain , measured with the Visual Analogue Scale , and functional status , measured with the Oswestry Low Back Pain Disability Question naire . RESULTS In both groups , Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire were significantly reduced after therapy ( p < 0.01 ) , but the difference between the scores at the end of treatment and 3 months post-treatment was not significant . There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire in the back school group compared with the control group at the end of therapy and 3 months post-treatment ( p < 0.05 ) . CONCLUSION The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) ,  Oswestry Disability Index ( ODI ) ,  Disability Rating Index ( DRI ) , and  Physical Functioning scale of the SF-36 ( PFSF-36 ) , and two  pain scales , a  Numerical Pain Rating Scale ( NRS ) and  Visual Analogue Scale ( VAS ) .  Summary of Background Data . Concurrent comparisons of different outcome measurements in back patients have been requested . Methods .  Norwegian versions of the scales and question naires  were completed by 54 patients with acute ( < 3weeks ) and 50 patients with chronic low back pain ( > 3 months ) . Clinical change was estimated on a global change index . An alternative external criterion was the expected clinical course in the two cohorts . Mean changes , st and ardized response mean ( SRM ) , and area under the receiver operating characteristic ( ROC ) curves with cutoff point for highest sensitivity and specificity were calculated . Results . At the follow-up , 63 % of the acute and 41 % of the chronic sample reported improvement on the global change index . Large SRMs ( 1.3–2.0 ) and areas under the ROC curves ( 0.84–0.93 ) were found for the measurements in the acute sample . In the chronic sample , the SRMs ( 0.4–1.1 ) and areas under the ROC curves ( 0.65–0.83 ) were lower , in particular for the PFSF-36 and the VAS . There was no statistically significant difference between the responsiveness in the measurements , except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change . Conclusion . The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain , whereas among chronic patients the RMDQ , ODI , DRI , and NRS were most appropriate STUDY DESIGN A prospect i ve cohort study assessing the responsiveness of two disease-specific question naires and a generic health question naire for patients with low back pain and sciatica . OBJECTIVES To compare the responsiveness of the eight scales and two summery scales of the SF-36 question naire with that of the Oswestry Disability Index and Low Back Outcome Score question naires . SUMMARY OF BACKGROUND DATA Evaluation of treatment outcome is being determined more frequently from a patient 's perspective , particularly the impact treatment has on current health status . METHODS Patients were recruited from two orthopedic back pain clinics in a tertiary hospital . Patients completed the pretreatment question naire 1 month before treatment and follow-up question naires a minimum of 2 - 6 months after treatment . Patients undergoing surgery were also observed for a minimum of 2 years . RESULTS Overall , the Oswestry Disability Index was most responsive ; however , individual scales from the SF-36 question naire showed equal or greater sensitivity to change than the Oswestry Disability Index in each of the patient subgroups . The SF-36 Role Physical scale was prone to floor effects ( a high percentage of respondents score zero ) , and the change scores from the SF-36 Role Emotional scale varied by 100 points in either direction in each of the patient subgroups . CONCLUSION Responsiveness varied according to which method was used in its calculation . The responsiveness of the SF-36 question naire shows that it can be a useful adjunct in the assessment of patients with low back pain when combined with disease-specific question naires Study Design . Back‐injured workers with high disability risk scores on a predictive question naire participated in a r and omized , controlled trial of physician notification , with outcomes follow‐up 3 months after injury . Objectives . To test whether physician intervention improves return to work and self‐ assessment outcomes for people at relatively high risk for disability . Summary of Background Data . Only a small number of back‐injured workers suffer significant disability . Ouick identification of these people would facilitate more efficient targeting and trials of interventions . Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability . Methods . Workers filing back injury reports responded to a disability prediction question naire . Those with high risk scores were r and omly assigned to control or intervention groups . Patient‐ design ated physicians in the intervention group received two letters identifying the patient 's risk and making recommendations for care , including the Agency for Health Care Policy and Research 's algorithms for acute low back pain . Predictive accuracy of the question naire and efficacy of physician intervention were evaluated on the basis of work status and self‐ assessment s 3 months after injury . Results . Of the 268 workers completing the question naire portion of the study , 32 ( 12 % ) were out of work because of back pain 3 months after injury . The question naire 's predictive accuracy included maximum κ of 0.277 and a receiver operating curve area of 0.78 . Fifty‐three people completed the physician intervention trial . The intervention had no significant impact on return to work , self‐assessed pain , or satisfaction with health care . Conclusions . Stratification of back‐injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not . The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future Background Augmenting vali date d paper versions of existing outcome measures with an equivalent online version may offer substantial research advantages ( cost , rapidity and reliability ) . However , equivalence of online and paper question naires can not be assumed , nor can acceptability to respondents . The aim was to test whether online and written versions of the Rol and Morris Disability Question naire  ( RMDQ ) , a st and ard measure of functional disability in back pain , are equivalent at both group and individual levels to establish whether they can be used interchangeably . Methods This is a within- participants equivalence study . 167 participants with back pain fully completed both the paper and online versions of the RMDQ  in r and om order . Participants were recruited from a chiropractic clinic and patient support groups in Southern Engl and . Limits of equivalence were pre-defined as 0.5 RMDQ points , the Bl and -Altman range was calculated , and participants ' comments were examined using content analysis . Results The mean score difference was 0.03 ( SD = 1.43 ) , with the 95 % Confidence Interval falling entirely within our limits of equivalence ( -0.19 to 0.25 ) . The Bl and -Altman range was -2.77 to 2.83 RMDQ points . Participants identified unique advantages and disadvantages associated with each version of the RMDQ . Conclusions The group and individual level data suggest that online and paper versions of the RMDQ are equivalent and can be used interchangeably . The Bl and -Altman range appears to reflect the known measurement properties of the RMDQ . Furthermore , participants ' comments confirmed the potential value to be had from offering them the choice of completing the RMDQ online or on paper STUDY DESIGN A cross-sectional clinical study . OBJECTIVES To determine whether there are specific symptoms , signs , and functional disability associated with adult spondylolisthesis . SUMMARY OF BACKGROUND DATA In spite of the common occurrence of adult spondylolisthesis , the symptoms , signs , and disability associated with it have not been analyzed in a large , well-defined group of patients . METHODS The symptoms , signs , and disability of 111 consecutive patients with adult spondylolisthesis , before r and omized treatment with fusion or physiotherapy  , were compared with those of 39 patients with nonspecific low back pain before lumbar fusion .  The patients completed a question naire covering clinical history and symptoms and su bmi tted a pain drawing . The signs were documented . Functional disability and pain were quantified by 12-function and 2-pain visual analog scales , respectively . RESULTS Sixty-two percent of the patients reported low back pain as well as sciatica , 7 % sciatica only , and 31 % low back pain only . Specific signs were infrequent . A positive straight leg raising test result in 12 % and an L5 sensory disturbance in 13 % were the most common . The symptoms were similar in patients with spondylolisthesis and chronic low back pain , but the chronic low back pain group reported more functional disability . Patients with a nonorganic pain drawing ( widespread , nonspecific pain ) were more often blue collar workers ; were more often and longer on sick leave ; and reported reduced mental condition , sexual function , functional ability , and more pain than patients with an organic pain drawing ( localized , specific pain ) . CONCLUSIONS The clinical pattern and functional disability in adult spondylolisthesis and in low back pain of nonspecific origin are similar . Sciatica in adult spondylolisthesis is typically not associated with a positive straight leg raising test result Study Design . A cross-sectional survey using  patient question naires  was conducted . Objective . To assess whether the Rol and Disability Question naire satisfies the Rasch model including unidimensionality and item separation . Summary of Background Data . The Rol and Disability Question naire , the most widely used patient-assessed measure of health outcome for back pain , has undergone several evaluations for its measurement properties including reliability , validity , and responsiveness . However , there is no published work relating to the underlying dimensionality of the instrument and the extent to which individual items contribute to the construct of physical disability result ing from low back pain . Methods . Patients entering a r and omized controlled trial of exercise , manipulation , and usual management for back pain completed a question naire that included the Rol and Disability Question naire . The Winsteps program was used to assess whether the Rol and Disability Question naire fits the Rasch model . Item fit was assessed using the Infit and Outfit statistics . Results . The  Rol and Disability Question  naire was completed by 1008 ( 90 % ) of the patients taking part in the trial . Most of the items in the Rol and Disability Question naire contribute to a single underlying construct . However , four items had poor Outfit statistics , suggesting that they do not contribute sufficiently to the scale hierarchy . Several items positioned around the middle of the hierarchy are not sufficiently distinct in terms of difficulty . There were very few items positioned at the extremes of the hierarchy . Conclusions . The Rol and Disability Question naire largely satisfies the Rasch model for unidimensionality . However , the instrument could be improved through the removal of poorly fitting items and the addition of items at the upper and lower points of the scale hierarchy . The distribution of Rol and Disability Question naire scores should be carefully considered before statistical testing is undertaken . Rasch transformed scores can be used to deal with deficiencies in the scale hierarchy Study Design . The effectiveness and efficacy of Iyengar yoga for chronic low back pain ( CLBP ) were assessed with intention-to-treat and per- protocol analysis . Ninety subjects were r and omized to a yoga ( n = 43 ) or control group ( n = 47 ) receiving st and ard medical care . Participants were followed 6 months after completion of the intervention . Objective . This study aim ed to evaluate Iyengar yoga therapy on chronic low back pain . Yoga subjects were hypothesized to report greater reductions in functional disability , pain intensity , depression , and pain medication usage than controls . Summary of Background Data . CLBP is a musculoskeletal disorder with public health and economic impact . Pilot studies of yoga and back pain have reported significant changes in clinical ly important outcomes . Methods . Subjects were recruited through self-referral and health professional referrals according to explicit inclusion /exclusion criteria . Yoga subjects participated in 24 weeks of biweekly yoga classes design ed for CLBP . Outcomes were assessed at 12 ( midway ) , 24 ( immediately after ) , and 48 weeks ( 6-month follow-up ) after the start of the intervention using the Oswestry Disability Question naire , a Visual Analog Scale , the Beck Depression Inventory , and a pain medication-usage question naire . Results . Using intention-to-treat analysis with repeated measures ANOVA ( group × time ) , significantly greater reductions in functional disability and pain intensity were observed in the yoga group when compared to the control group at 24 weeks . A significantly greater proportion of yoga subjects also reported clinical improvements at both 12 and 24 weeks . In addition , depression was significantly lower in yoga subjects . Furthermore , while a reduction in pain medication occurred , this was comparable in both groups . When results were analyzed using per- protocol analysis , improvements were observed for all outcomes in the yoga group , including agreater trend for reduced pain medication usage . Although slightly less than at 24 weeks , the yoga group had statistically significant reductions in functional disability , pain intensity , and depression compared to st and ard medical care 6-months postintervention . Conclusion . Yoga  improves functional disability , pain intensity , and depression in adults with CLBP . There was also a clinical ly important trend for the yoga group to reduce their pain medication usage compared to the control group Study Design . Two r and omized , prospect i ve clinical trials involving 238 chronic low back disability patients were carried out . Results at 2‐year follow‐up are presented . Objectives . To compare the clinical outcomes of a multidisciplinary functional restoration program with a nontreated control group ( Project A ) and with two less intensive but different training programs ( Project B ) . Summary of Background Data . The effectiveness of functional restoration programs has not been firmly established . Results from trials carried out in the United States differ from those in trials conducted in other countries . Only a few of these studies have been carried out as prospect i ve and r and omized clinical studies . Methods . Two hundred thirty‐eight patients with chronic low back disability of at least 6 months ' duration were included . There were 106 patients in project A and 132 patients in project B. Two years after completion of treatment , patients were mailed a question naire that included questions regarding their work status , pain and disability levels , number of sick leave days , number of medical care contacts , medication use , physical activity levels , and subjective overall assessment of their " back life situation . " Results . Patients in both studies were comparable at inclusion , except that patients in Project A were recruited from all of Denmark , whereas those in Project B were from the greater Copenhagen area . Thirteen patients did not report for treatment after r and omization . Of the remaining 225 patients , 20 ( 9 % ) did not complete treatment . The question naire response rate was 94 % . In Project A , those patients receiving treatment ( functional restoration ) reported significantly less contact with the health care system , fewer sick leave days , and a less disabled life style during the follow‐up period , compared with reports of patients in the control group . Other effect parameters did not demonstrate a significant difference between the two groups . In Project B , all effect parameters reported , except leg pain and medication usage , were significantly in favor of functional restoration , compared with reports from the less intensively treated groups . Conclusions . The functional restoration program seems effective in various parameters compared with the less intensive programs , but the differences in outcome in the two parallel studies indicate the necessity of testing a treatment program in different setting s , in that the statistical variation may be a major factor in results of different studies Study Design . A r and omized controlled trial was performed . Objectives . To evaluate how 2 different treatment options affect perception of health , pain , and physical functioning over time among children and adolescents with low back pain ( LBP ) . Summary of Background Data . LBP among children and adolescents has increased . The literature shows that children with LBP also suffer from this condition as adults . Thus , it is important to prevent and treat LBP in children and adolescents . Methods . Forty-five children and adolescents were consecutively r and omized into one of 2 treatment groups and were studied for 12 weeks . Group 1 was given individualized physical therapy and exercise and a st and ardized self-training program and back education . Group 2 was given self-training program and back education but no individualized therapy . The children and adolescents were tested before and after the treatment period .  Child Health Question naire Child Form 87 , Rol and & Morris Disability Question naire , Painometer , Back Saver Sit and Reach , and test of trunk muscle endurance  were used to evaluate the interventions . Results . Both groups improved statistically significant in most parameters over time . On comparison between the groups the physical function measured by Rol and & Morris Disability Question naire and the duration of pain measured by Painometer improved statistically significant in Group 1 . Conclusion . An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function , pain , strength , and mobility , regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist To explore the value of anti and rogen therapy for advanced prostate cancer , two clinical trials of similar design were recently conducted in six countries throughout Europe . A total of 550 patients with previously untreated metastatic prostate cancer were r and omized either to treatment with an anti and rogen or castration .  While time to treatment failure , objective tumour response and survival were expected to be similar between study treatments , their effects on health-related quality of life ( HRQOL ) were expected to differ and were therefore a focus of concern in this trial . To assess these effects , we developed a brief self-administered patient question naire covering 10 domains of HRQOL ( general health perceptions , pain , emotional well-being , vitality , social functioning , physical capacity , sexual interest , sexual functioning , activity limitation and bed disability ) , which we translated from English into several other language s. In this paper , we describe the development , content and translation of this survey instrument and report on its reliability and validity in six countries based on data collected for the first 487 patients to complete question naires at study entry Study Design . A pre‐ versus postintervention with concurrent control group design was used to investigate the effect of a workplace‐based early intervention program on perception of disability in nurses with low back injury . Objectives . This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Question naire in two groups of back‐injured nurses‐those who received the early intervention program ( study ) and those who were not offered the program ( control ) . Summary of Background Data . Early intervention programs can decrease morbidity , time lost from work , and compensation costs . Although perception of disability decreases , some residual disability remains , the nature of which is not clear . Methods . The Oswestry Low Back Pain and Disability Question naire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined . Analysis of variance was used to compare changes in mean overall scores over time . The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Question naire at each time period was compared with the results of a chi‐square test . Results . Overall Oswestry Low Back Pain and Disability Question naire scores were similar between study and control nurses at time of injury , but were significantly lower in study nurses at 6 months after injury . However , scores of individual Oswestry Low Back Pain and Disability Question naire components that related to job dem and s increased over time ; this was most apparent in lifting , particularly in study nurses . Conclusions . Although overall perception of disability decreased 6 months after injury , particularly in study nurses , disability in job‐related activities persisted . Residual disability after back injury should be addressed in workplace‐based prevention programs OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Study Design A prospect i ve survey of patients seeking primary care for low back pain . Clinical and psychosocial data , available at presentation , were explored for predictors of outcome at 1 year . Objectives To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis . Summary of Background Data Current treatment strategies for low back pain have failed to stem the rising levels of disability . Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients , but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated . Methods Two hundred fifty-two patients with low back pain , presenting to primary care , underwent a structured clinical interview and completed a battery of psychosocial instruments . Follow-up was done by mail at 1 year ; outcome was measured using a back pain disability question naire . Predictive relationships were sought between the data at presentation and disability at follow-up . Results Most patients showed improved disability and pain scores , although more than half had persisting symptoms . Eighteen percent showed significant psychological distress at presentation . Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain ; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble . Discriminant models successfully allocated typically 76 % of cases to recovered/not-recovered groups , largely on the basis of psychosocial factors evident at presentation . Conclusions Early identification of psychosocial problems is important in underst and ing , and hopefully preventing , the progression to chronicity in low back trouble Study Design . A prospect i ve cohort study of patients with subacute occupational back pain . Objectives . To study the relation between a marketed opto‐electric device measuring trunk kinematics , a widely used specific functional capacity question naire , and work status in back pain patients , and to assess the responsiveness to change in work status of the opto‐electric device and the question naire . Summary of Background Data . Several instruments have been developed to evaluate the functional capacities of patients with back pain , but the relation between these instruments and work status has rarely been studied . Methods . The relation between the opto‐electric device , the question naire , and work status in patients with back pain was evaluated . The study population was a prospect i ve cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks . All data were compiled blindly on the same day , at study entry ( 4 weeks after work accident ) , and at 12 , 24 , and 52 weeks after the work accident . The validity of the question naire and opto‐electric device scores was assessed with partial correlation analyses , st and ardized response mean , logistic regression analyses , and receiver operating characteristics curves . Results . The correlation between the question naire and opto‐electric device scores was low . The question naire scores were significantly related to work status , but the opto‐electric device scores were not . The question naire was responsive to change in work status , whereas the opto‐electric device was not . Conclusions . The opto‐electric device scores were not related to either functional capacity scores ( question naire ) or work status in patients with low back pain , and the opto‐electric device was not responsive to change in work status . Conversely , the question naire was related to work status and was responsive to change in work status Study Design . A r and omized controlled study investigated the effects of therapeutic climbing in patients with chronic low back pain . Before and after 4 weeks of training , physical and mental well-being were measured by two question naires ( 36-Item Short Form Health Survey [ SF-36 ] ; Hannover Functional Ability Question naire for measuring back pain – related disability [ FFbH-R ] ) . Objective . Therapeutic climbing has been suggested to increase muscular strength and perceived physical and mental well-being . This study focused on the psychological effects of therapeutic climbing and compared it with st and ard exercise therapy . Summary of Background Data . Therapeutic climbing has become increasingly popular in rehabilitation and its effects on muscular strengthening have been shown . Therapeutic climbing has also been suggested to yield psychological effects such as changes in attentional focus from pain to physical capabilities . To date , no controlled clinical trial has investigated these psychological effects and it is unclear whether therapeutic climbing is comparable or superior to other forms of exercise . Methods . Twenty-eight patients with chronic low back pain conducted either a therapeutic climbing or a st and ard exercise regime . Each program took 4 weeks , including four guided training sessions per week . Before and after the program , patients answered two question naires assessing their physical and mental well-being . Results . For the Hannover Functional Ability Question naire for measuring back pain – related disability , there was no difference before versus after or between the treatments . For the SF-36 , both treatments showed significant improvements in 3/8 subscales of the SF-36 . In 2/8 subscales , only the participants of the therapeutic climbing improved and in 1/8 subscales the converse was true . Comparing both groups , significantly larger improvements were found after therapeutic climbing in two subscales of the SF-36 : physical functioning and general health perception . Conclusion . The benefits of therapeutic climbing were comparable with those of a st and ard exercise regime . In two subscales of the SF-36 , the benefits of therapeutic climbing exceeded those of st and ard exercise therapy , primarily in perceived health and physical functioning of the patients . This finding demonstrates that therapeutic climbing is equivalent and partly superior to st and ard exercise therapy for patients with chronic low back pain OBJECTIVE French validation of the Foot Function Index ( FFI ) , self- question naire design ed to evaluate rheumatoid foot according to 3 domains : pain , disability and activity restriction . METHODS The first step consisted of translation/back translation and cultural adaptation according to the vali date d methodology . The second stage was a prospect i ve validation on 53 patients with rheumatoid arthritis who filled out the FFI . The following data were collected :  pain ( Visual Analog Scale ) , disability ( Health Assessment Question naire ) and activity restrictions ( McMaster Toronto Arthritis question naire ) . A test/retest procedure was performed 15 days later . The statistical analyses focused on acceptability , internal consistency ( Cronbach 's alpha and Principal Component Analysis ) , test-retest reproducibility ( concordance coefficients ) , external validity ( correlation coefficients ) and responsiveness to change . RESULTS The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis . The Cronbach 's alpha ranged from 0.85 to 0.97 . Reproducibility was correct ( correlation coefficients>0.56 ) . External validity and responsiveness to change were good . CONCLUSION The use of a rigorous methodology allowed the validation of the FFI in the French language ( FFI-F ) . This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot . The FFI-F could be used in other pathologies with foot-related functional impairments Context Lumbar supports are commonly used to prevent low back pain , but evidence on their effectiveness is lacking . Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits , with or without worker-directed use of a lumbar support . Over 12 months , participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only . Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence , but not absenteeism , among workers with previous low back pain . The Editors Low back pain is a common problem that results in high medical expenses , work absenteeism , and disability ( 1 ) . The reported 1-year prevalence ranges from 15 % to 40 % in a general population ( 2 ) and from 44 % to 72 % among home care workers ( 3 , 4 ) . Various ergonomic aids are marketed for the prevention of low back pain . Workers frequently use lumbar supports to prevent back pain ( 5 ) , but the effectiveness of such supports remains unclear . Recent systematic review s of the sparse evidence on lumbar supports ( 6 , 7 ) concluded that no evidence exists for the effectiveness of  lumbar supports  in the primary prevention of low back pain in the workplace , but 2 of the 4 included r and omized , controlled trials ( 8 , 9 ) reported that lumbar supports might be effective in workers with a history of low back pain ( secondary prevention ) . However , these findings were derived from subgroup analyses , and evidence from direct research on secondary prevention was not available . In cohort studies , a history of low back pain proved to be a strong predictor for the incidence of new episodes of low back pain ( 1012 ) . Home care workers with a history of low back pain may therefore be well suited to secondary preventive measures . In a previous uncontrolled feasibility study , we found that home care workers who had frequent episodes of low back pain reported adherence rates of 61 % to 81 % with lumbar supports and a 45 % decrease in pain intensity when using lumbar supports ( 13 ) . We design ed the current trial to evaluate the effectiveness of adding worker-directed use of lumbar supports to a short course on healthy working methods to reduce low back pain and work absenteeism among home care workers with a history of low back pain . Methods Design Our r and omized , controlled trial included 2 groups . The control group received a short refresher course on healthy working methods provided by their employer at the start of their employment ( Appendix ) ; primary and secondary care for the management of low back pain was available as usual ( 14 ) . The intervention group received a lumbar support in addition to usual care . The intervention and data collection continued for 12 months after enrollment . The Medical Ethical Committee of the Erasmus University Medical Center , Rotterdam , the Netherl and s , approved the study . Participants All participants were recruited from employees of a large home care organization in Rotterdam . During staff meetings , all present team members completed a brief survey about study inclusion criteria that was distributed and collected by the team managers . We included persons who performed medical care or domestic tasks as a home care worker , were experiencing low back pain symptoms at the time of inquiry or had experienced 2 or more episodes ( on 2 consecutive days ) of low back pain symptoms in the 12 months before the inquiry , did not have specific low back pain ( for example , due to rheumatoid arthritis or vertebral fractures ) , and were not pregnant at the start of the study . Because of a possible association between lumbar supports and increased blood pressure and heart rate , we excluded workers receiving medical treatment for high blood pressure ( 15 ) . Employees who met the inclusion criteria received detailed information about the trial , and those who agreed to participate provided written consent . R and omization In the Netherl and s , home care workers provide 1 of 8 functions , each of which requires different skills and tasks . To ensure a balance in workload and working conditions between the 2 study groups , we stratified r and omization by these 8 functions . We also stratified r and omization by low back pain experience at baseline ( current pain vs. past pain ) . The r and omization process used a computer-generated r and om-number table with 16 strata ( 2 low back pain by 8 workplace functions ) , arranged in blocks of 8 within each stratum . After baseline measurements were completed , colleagues who were not otherwise involved in the study and who were blinded to participants ' baseline characteristics used the r and om-number table to allocate each participant to 1 of the study groups . Intervention All participants in the intervention group were instructed to wear the lumbar supports on working days on which they had or expected they might develop low back pain . Participants could select 1 of 4 types of lumbar supports , supplied by Bauerfeind B.V. , Haarlem , the Netherl and s. LumboTrain and LumboTrain Lady are individually adjustable , hook- and -loop fastening , fully elastic supports that are available in 5 sizes for men or women . LumboLoc and LordoLoc are more structured supports , with integrated stays in the back , that have individually adjustable hook- and -loop fastenings and are available in 6 sizes . Participants chose the lumbar support on the basis of fit and wearing comfort , and they were not given advice to direct their choice from among the 4 available supports . When measured by the research er for the lumbar support , the participants were advised to wear the support for a few days in a row , regardless of low back pain , in order to become accustomed to it . The expected duration of wearability of the lumbar supports was 1 year . The costs of the lumbar supports were 75 for LumboTrain and LumboTrain Lady , 56 for LumboLoc , and 50 for LordoLoc . Outcome Measures Our primary outcome measures were the number of days that participants reported low back pain per month and the number of calendar days of sick leave that participants took during the 12-month intervention . Secondary outcome measures were the average severity of low back pain in the previous week , rated on a scale of 0 to 10 ( 16 ) , and functional status in the previous week , measured by using a Dutch translation of the Quebec Back Pain Disability Scale ( on which 0 corresponds to no disablement and 100 corresponds to fully disabled ) ( 17 , 18 ) . Participants used a calendar to record the days per month on which they experienced low back pain . The intervention group was also asked to record on the calendar whether they had worn the lumbar support ;  thus , the calendars also served as a monitor for adherence to therapy . The calendars were collected for review after 1 , 3 , 6 , 9 , and 12 months . The number of calendar days of sick leave was derived from the staff register and was provided by the home care organization at the end of the study ; this information covered 15 months , from 3 months before the start of the study until the end of the intervention . We could gather only general data on sick leave because employees are not obliged to specify their illness for the employer when they report themselves ill , and registration by a company doctor starts from 6 consecutive weeks of sick leave . We collected information on self-reported , low back painrelated sick leave ; however , this was not a predetermined outcome , and the results should be interpreted cautiously . We administered a question naire at baseline to obtain information on the secondary outcome measures and demographic characteristics ; history of low back pain ; job characteristics ( among others , the Job Content Question naire , Dutch translation [ 19 ] ) ; and other possible confounders , such as additional work ( hours per week and type ) , preference for study group assignment , confidence in pain reduction with use of the lumbar support ( scale of 0 to 10 ) , and confidence in improved functioning ( scale of 0 to 10 ) . Follow-up question naires were administered at 3 , 6 , 9 , and 12 months to measure the secondary outcomes . In the intervention group , these question naires also measured the general satisfaction with the lumbar support ( scale of 0 to 10 ) , several items on comfort of wearing ( 5-point Likert scale ) , and adherence to use of the lumbar support ( 7-point Likert scale ) . We recorded spontaneously reported side events and asked participants about side effects in the question naires . Statistical Analysis We estimated that with a power of 80 % , a significance level of 0.05 , and an SD of 20 days , we would need 140 participants in each study group to demonstrate a difference of 7 days of low back pain per year or sick leave per year between the 2 groups . To prevent inadequate power because of participant withdrawal or low adherence to therapy , we sought to enroll 400 home health care workers . We used a longitudinal marginal model with generalized estimating equation estimates to analyze the data , according to intention-to-treat principles . For the primary outcomes ( number of days of low back pain and number of days of sick leave ) , we used a negative-binomial count data model with a log-link and an exchangeable correlation structure . Covariates ( history of low back pain , body mass index , additional work , and pregnancy during follow-up ) were added to the model separately and were used in the final model if they statistically significantly contributed to the model ( P < 0.05 ) . The scale scores of the secondary outcomes were analyzed by using a normal distributed model and an exchangeable correlation structure . To investigate model misspecification and the effect of missing data , we performed sensitivity analyses in which we used various structures for the working correlation to estimate the models and used multiple imputation techniques to analyze 5 imputed data sets for missing data ( 20 ) . For all analyses , we used SAS , BACKGROUND AND OBJECTIVES The aim of this study was to determine whether low power laser therapy ( Gallium-Arsenide ) is useful or not for the therapy of chronic low back pain ( LBP ) . STUDY DESIGN / MATERIAL S AND METHODS This study included 75 patients ( laser + exercise-25 , laser alone-25 , and exercise alone-25 ) with LBP .  Visual analogue scale ( VAS ) , Schober test , flexion and lateral flexion measures , Rol and Disability Question naire ( RDQ ) and Modified Oswestry Disability Question naire ( MODQ ) were used in the clinical and functional evaluations pre and post therapeutically . A physician , who was not aware of the therapy undertaken , evaluated the patients . RESULTS Significant improvements were noted in all groups with respect to all outcome parameters , except lateral flexion ( P < 0.05 ) . CONCLUSIONS Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP Background Low back pain remains a costly quality -of-life-related health problem . Microdiscectomy is often the surgical procedure of choice for a symptomatic , single-level , lumbar disc herniation in younger and middle-aged adults . The question of whether a post-microdiscectomy exercise program enhances function , quality of life , and disability status has not been systematic ally explored . Thus , the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program , developed at University of Southern California ( USC ) , targeting the trunk and lower extremities ( USC Spine Exercise Program ) for persons who have undergone a single-level microdiscectomy for the first time . Methods / design One hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study . Subjects will be r and omly assigned to one of two groups : 1 ) one session of back care education , or 2 ) a back care education session followed by the 12-week USC Spine Exercise Program . The outcome examiners ( evaluators ) , as well as the data managers , will be blinded to group allocation . Education will consist of a one-hour " one-on-one " session with the intervention therapist , guided by an educational booklet specifically design ed for post-microdiscectomy care . This session will occur four to six weeks after surgery . The USC Spine Exercise Program consists of two parts : back extensor strength and endurance , and mat and upright therapeutic exercises . This exercise program is goal -oriented , performance-based , and periodized . It will begin two to three days after the education session , and will occur three times a week for 12 weeks . Primary outcome measures include the Oswestry Disability Question naire , Rol and -Morris Disability Question naire , SF-36 ® quality of life assessment , Subjective Quality of Life Scale , 50-foot Walk , Repeated Sit-to-St and , and a modified Sorensen test . The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program . Long-term follow up assessment s will occur every six months beginning one year after surgery and ending five years after surgery . Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance ( MANOVA ) . If significant interactions are found , one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons . Discussion We have presented the rationale and design for a r and omized controlled trial evaluating the effectiveness of a treatment regimen  for people who have undergone a single-level lumbar microdiscectomy Study objective Low back pain causes more than 2.5 million visits to US emergency departments ( EDs ) annually . Low back pain patients are often treated with nonsteroidal anti‐inflammatory drugs and benzodiazepines . The former is an evidence ‐based intervention , whereas the efficacy of the latter has not been established . We compare pain and functional outcomes 1 week and 3 months after ED discharge among patients r and omized to a 1‐week course of  naproxen+diazepam versus naproxen+placebo . Methods This was a r and omized , double‐blind , comparative efficacy clinical trial conducted in an urban health care system . Patients presenting with acute , nontraumatic , nonradicular low back pain of no more than a duration of 2 weeks were eligible for enrollment immediately before discharge from an ED if they had a score greater than 5 on the Rol and ‐Morris Disability Question naire , a vali date d 24‐item inventory of functional impairment caused by low back pain . Higher scores on the question naire indicate greater functional disability . The primary outcome in the trial was improvement in the score between ED discharge and 1 week later . Secondary outcomes included pain intensity 1 week and 3 months after ED discharge , as measured on a 4‐point descriptive scale ( severe , moderate , mild , and none ) . All patients were given 20 tablets of naproxen 500 mg , to be taken twice a day as needed for low back pain . Additionally , patients were r and omized to receive either 28 tablets of diazepam 5 mg or identical placebo , to be received as 1 or 2 tablets every 12 hours as needed for low back pain . All patients received a st and ardized 10‐minute low back pain educational session before discharge . Using a between‐group mean difference of 5 Rol and ‐Morris Disability Question naire points , a previously vali date d threshold for clinical significance , we calculated the need for at least 100 patients with primary outcome data . Results Enrollment began in June 2015 and continued for 9 months . Five hundred forty‐five patients were screened for eligibility . One hundred fourteen patients met selection criteria and were r and omized . Baseline demographic characteristics were not substantially different between the 2 groups . One hundred twelve patients ( 98 % ) provided 1‐week outcome data . The mean Rol and ‐Morris Disability Question naire score of patients r and omized to naproxen+diazepam improved by 11 ( 95 % confidence interval [ CI ] 9 to 13 ) , as did the mean score of patients r and omized to naproxen+placebo ( 11 ; 95 % CI 8 to 13 ) . At 1‐week follow‐up , 18 of 57 diazepam patients ( 32 % ; 95 % CI 21 % to 45 % ) reported moderate or severe low back pain versus 12 of 55 placebo patients ( 22 % ; 95 % CI 13 % to 35 % ) . At 3‐month follow‐up , 6 of 50 diazepam patients ( 12 % ; 95 % CI 5 % to 24 % ) reported moderate or severe low back pain versus 5 of 53 placebo patients ( 9 % ; 95 % CI 4 % to 21 % ) . Adverse events were reported by 12 of 57 diazepam patients ( 21 % ; 95 % CI 12 % to 33 % ) and 8 of 55 placebo patients ( 15 % ; 95 % CI 7 % to 26 % ) . Conclusion Among ED patients with acute , nontraumatic , nonradicular low back pain  , naproxen+diazepam did not improve functional outcomes or pain compared with naproxen+placebo 1 week and 3 months after ED discharge Objective Research studies focussing on the fear-avoidance beliefs model ( FABM ) have exp and ed considerably during the last years , however , there has been very little research directed at the elderly . The objective of the present study was to investigate the validity of the FABM in older patients with chronic low back pain ( CLBP ) . Method In a cross-sectional study , a group of elderly patients with CLBP ( N=103 ) was compared with an age-matched group of pain-free individuals ( N=59 ) to test the constructs inherent in the FABM . Constructs include  fear avoidance beliefs ( FABs ) , disability , disuse , and physical activity . In addition , the relationship of these constructs was also investigated in the patient group . CLBP- patients had an average age of 71.41 years ( SD=5.2 ) and pain-free individuals of 71.19 years ( SD=4.73 ) . Individuals participated in a photographed series of physical activities adapted to the age group ( Photograph Series of Daily Activities-German version for the elderly ) for the assessment of FAB , in the Hannover Disability Question naire , in the Freiburg Physical Activity Question naire , and in an ultrasound measurement to evaluate lumbar flexion . In addition , they completed an activity diary for 1 week . Before computation , the physical activity measurements were converted into metabolic units that characterize energy expenditure . Results In the patient group , FAB , pain intensity , and age predicted functional capacity , but not physical activity . Lumbar flexion was predicted by FAB and age . Patients were more fear-avoidant , reported more disability , and displayed less lumbar flexion than the pain-free individuals . No differences between the groups could be detected in regard to energy expenditure measured either by the question naire or by diary data . Conclusions The findings are consistent with results reported in the literature for younger age groups and confirm the assumption that the FABM is also valid for the elderly Study Design This prospect i ve , multicenter study was design ed to investigate the efficacy and outcome of spinal cord stimulation using a variety of clinical and psychosocial outcome measures . Data were collected before implantation and at regular intervals after implantation . This report focuses on 70 patients who had undergone 1 year of follow‐up treatment at the time of data analysis . Objectives To provide a more generalizable assessment of long‐term spinal cord stimulation outcome by comparing a variety of pain and functional/ quality ‐of‐life measures before and after management . This report details results after 1 year of stimulation . Summary of Background Data The historically diverse methods , patient selection criteria , and outcome measures reported in the spinal cord stimulation literature have made interpretation and comparison of results difficult . Although short‐term outcomes are generally consistent , long‐term outcomes of spinal cord stimulation , as determined by prospect i ve studies that assess multidimensional aspects of the pain complaint among a relatively homogeneous population , are not well established . Methods Two hundred nineteen patients were entered at six centers throughout the United States . All patients underwent a trial of stimulation before implant of the permanent system .  Most were psychologically screened . One hundred eighty‐two patients were implanted with a permanent stimulating system .  At the time of this report , complete 1‐year follow‐up data were available on 70 patients , 86 % of whom reported pain in the back or lower extremities . Patient evaluation of pain and functional levels was completed before implantation and 3 , 6 , 12 , and 24 months after implantation . Complications , medication usage , and work status also were monitored . Results All pain and quality ‐of‐life measures showed statistically significant improvement during the treatment year . These included the average pain visual analogue scale , the McGill Pain Question naire , the Oswestry Disability Question naire , the Sickness Impact Profile , and the Beck Depression Inventory . Overall success of the therapy was defined as at least 50 % pain relief and patient assessment of the procedure as fully or partially beneficial and worthwhile . Using this definition , spinal cord stimulation successfully managed pain in 55 % of patients on whom 1‐year follow‐up is available . Complications requiring surgical intervention were reported by 17 % ( 12 of 70 ) of patients . Medication usage and work status were not changed significantly . Conclusions This prospect i ve , multicenter study confirms that spinal cord stimulation can be an effective therapy for management of chronic low back and extremity pain . Significant improvements in many aspects of the pain condition were measured , and complications were minimal BACKGROUND Although exercise is a commonly recommended treatment for ankylosing spondylitis ( AS ) , little is known about the effectiveness of unsupervised recreational and back exercises . We examined the effects of recreational exercise and back exercises on  patient-reported pain severity , stiffness severity , and functional disability  in a prospect i ve longitudinal study of 220 patients with AS . METHODS Participants provided information on exercise habits and health status every 6 months using mailed question naires ( median follow-up , 4.5 years ) . Pain severity and stiffness severity were measured using visual analog scales , and functional disability was measured using the Health Assessment Question naire ( HAQ ) Disability Index . RESULTS Among all patients , there were no associations between either the number of exercise minutes per week or the number of days of back exercise per week and short-term ( 6-month ) changes in pain , stiffness , or HAQ Disability Index . However , among those who had AS for 15 years or less , pain scores were 0.18 points lower ( on a scale of 0 - 3 ; P = .04 ) , and stiffness scores were 6.4 points lower ( on a scale of 0 - 100 ; P = .005 ) during periods with more than 200 minutes per week of exercise compared with periods with 0 to 30 minutes of exercise per week . Among those who had AS for more than 15 years , pain scores were 0.11 points lower ( on a scale of 0 - 3 ; P = . 03 ) , and HAQ Disability Indexes were 0.08 points lower ( on a scale of 0 - 3 ; P<.001 ) during periods with 5 to 7 days per week of back exercise compared with periods when back exercises were not performed . Less intense levels of exercise were not associated with improvements in health status . CONCLUSIONS Unsupervised recreational exercise improves pain and stiffness , and back exercise improves pain and function in patients with AS , but these effects differ with the duration of AS . Health status is improved when patients perform recreational exercise at least 30 minutes per day and back exercises at least 5 days per week . Arch Intern Med . 2000;160:2969 - Background Low back pain ( LBP ) and neck pain ( NP ) are common conditions in old age , leading to impaired functional ability and decreased independence . Manual and exercise therapies are common and effective therapies for the general LBP and NP population s. However , these treatments have not been adequately research ed in older LBP and NP sufferers . The primary aim of these studies is to assess the relative clinical effectiveness of 1 ) manual treatment plus home exercise , 2 ) supervised rehabilitative exercise plus home exercise , and 3 ) home exercise alone , in terms of patient-rated pain , for senior LBP and NP patients . Secondary aims are to compare the three treatment approaches in regards to patient-rated disability , general health status , satisfaction , improvement and medication use , as well as objective outcomes of spinal motion , trunk strength and endurance , and functional ability . Cost-effectiveness and cost-utility will also be assessed . Finally , using qualitative methods , older LBP and NP patient 's perceptions of treatment will be explored and described . Methods / Design This paper describes the design of two multi- methods clinical studies focusing on elderly patients with non-acute LBP and NP . Each study includes a r and omized clinical trial ( RCT ) , a cost-effectiveness study alongside the RCT , and a qualitative study . Four hundred and eighty participants ( 240 per study ) , ages 65 and older , will be recruited and r and omized to one of three , 12-week treatment programs .  Patient-rated outcome measures are collected via self-report question naires at baseline and at 4 , 12 , 26 , and 52 weeks post-r and omization . Objective outcomes are assessed by examiners masked to treatment assignment at baseline and 12 weeks . Health care cost data is collected through st and ardized clinician forms , monthly phone interviews , and self-report question naires throughout the study . Qualitative interviews using a semi-structured format are conducted at the end of the 12 week treatment period . Discussion To our knowledge , these are the first r and omized clinical trials to comprehensively address clinical effectiveness , cost-effectiveness , and patients ' perceptions of commonly used treatments for elderly LBP and NP sufferers . Trial Registration NCT00269321 and Study Design . A cross-sectional study was conducted to analyze a convenience sample of patients seeking treatment for cervical spine conditions . Objective . To develop and evaluate the psychometric properties of a comprehensive , disease-specific question naire for characterizing complaints of neck pain and evaluating the outcomes of treatments for these complaints . Summary of Background Data . There currently are a number of generic and disease-specific instruments for assessing complaints of neck pain . None comprehensively cover the wide range of factors considered essential in evaluating treatment outcomes . Methods . The authors developed a comprehensive , disease-specific question naire for characterizing complaints of neck pain and evaluating the outcomes of treatments for these complaints . In this study , 216 patients who underwent surgery for cervical spine disorders completed the Cervical Spine Outcomes Question naire before treatment , then at 3 and 6 months after treatment . The data were used to evaluate the reliability , validity , and responsiveness of the question naire . Results . The authors have shown that the Cervical Spine Outcomes Question naire has high test – retest reliability , good construct validity , and responsiveness to change after treatment . Conclusions . The Cervical Spine Outcomes Question naire is a comprehensive , disease-specific instrument for assessing complaints of neck pain and evaluating the outcomes of treatments for these complaints . It provides information on demographics , pain severity , functional disability , psychological distress , physical symptoms , health care utilization , and satisfaction . It appears to be acceptable to patients , easy to administer , highly reliable , valid , and responsive . It should be considered for use in monitoring patients with cervical spine conditions and in studies of cervical spine disorders and their treatments Background There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders . For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery . We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain . Methods / Design All participating patients were recruited ( Jan 2003-Dec 2008 ) from the same rehabilitation centre and were evaluated by means of ( postal ) question naires and physical examinations at baseline , during the 2-month therapy program , and at 5 and 12 months after start of therapy . The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate ( movement ) behaviour aim ed at physical and functional recovery . The program is part of regular care and consists of 16 sessions of 3 hours each , over an 8-week period ( in total 48 hours ) , followed by a 3-month self-management program . The primary outcomes are low back pain intensity , disability , quality of life , patient 's global perceived effect of recovery , and participation in work . Baseline characteristics include information on socio-demographics , low back pain , employment status , and additional clinical items status such as fatigue , duration of activities , and fear of kinesiophobia . Prognostic variables are determined for recovery at short-term ( 5 months ) and long-term ( 12 months ) follow-up after start of therapy . Discussion In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint Study Design . Pragmatic , multicentered r and omized controlled trial , with 12-month follow-up . Objective . To evaluate the effect of adding specific spinal stabilization exercises to conventional physiotherapy for patients with recurrent low back pain ( LBP ) in the United Kingdom . Summary of Background Data . Spinal stabilization exercises are a popular form of physiotherapy management for LBP , and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result . Methods . A total of 97 patients ( 18–60 years old ) with recurrent LBP were recruited . Stratified r and omization was undertaken into 2 groups : “ conventional , ” physiotherapy consisting of general active exercise and manual therapy ; and conventional physiotherapy plus specific spinal stabilization exercises . Stratifying variables used were laterality of symptoms , duration of symptoms , and Rol and Morris Disability Question naire score at baseline . Both groups received The Back Book , by Rol and et al. Back-specific functional disability ( Rol and Morris Disability Question naire ) at 12 months was the primary outcome . Pain , quality of life , and psychologic measures were also collected at 6 and 12 months . Analysis was by intention to treat . Results . A total of 68 patients ( 70 % ) provided 12-month follow-up data . Both groups showed improved physical functioning , reduced pain intensity , and an improvement in the physical component of quality of life . Mean change in physical functioning , measured by the Rol and Morris Disability Question naire , was −5.1 ( 95 % confidence interval −6.3 to −3.9 ) for the specific spinal stabilization exercises group and −5.4 ( 95 % confidence interval −6.5 to −4.2 ) for the conventional physiotherapy group . No statistically significant differences between the 2 groups were shown for any of the outcomes measured , at any time . Conclusions . Patients with LBP had improvement with both treatment packages to a similar degree . There was no additional benefit of adding specific spinal stabilization exercises to a conventional physiotherapy package for patients with recurrent LBP There is growing evidence for the idea that in back pain patients , pain-related fear ( fear of pain/physical activity/(re)injury ) may be more disabling than pain itself . A number of question naires have been developed to quantify pain-related fears , including the Fear-Avoidance Beliefs Question naire ( FABQ ) , the Tampa Scale for Kinesiophobia ( TSK ) , and the Pain Anxiety Symptoms Scale ( PASS ) . A total of 104 patients , presenting to a rehabilitation center or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aim ed at ( 1 ) replicating that pain-related fear is more disabling than pain itself ( 2 ) investigating the association between pain-related fear and poor behavioral performance and ( 3 ) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs ( e.g. pain catastrophizing ) . All three studies showed similar results . Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance . Even when controlling for sociodemographics , multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance . The PASS appeared more strongly associated with pain catastrophizing and negative affect , and was less predictive of pain disability and behavioral performance . Implication s for chronic back pain assessment , prevention and treatment are discussed Study Design . A prospect i ve repeated- measures design was applied . Objectives . To examine the measurement properties of the Back Pain Functional Scale ( BPFS ) and the Rol and –Morris Question naire ( RMQ )  and to formulate hypotheses and sample size estimates for a subsequent comparison study . Summary of Background Data . Although there are numerous functional status measures for patients with low back pain , most have been conceived of and vali date d with a group rather than an individual patient as the unit of interest . Also , little has been done to formally compare — this includes the generation of a priori hypotheses , followed by statistical hypotheses testing — the many competing measures . Methods . Subjects were 77 patients with low back pain who were referred by physicians to 10 outpatient physical therapy clinics located in Canada and the United States . The question naires were administered at patients ’ initial visits , within 48 hours of the initial visit , and at 1- , 2- , and 3-week follow-up visits . Reliability , cross-sectional validity , and longitudinal validity ( sensitivity to change ) coefficients were calculated . Results . Test – retest reliability estimates of 0.81 and 0.88 were obtained for the RMQ and BPFS , respectively . The measures demonstrated similar levels of cross-sectional validity . Correlations of 0.56 and 0.65 were noted between a prognostic rating of change and the RMQ and BPFS , respectively . The RMQ demonstrated a ceiling effect .  Approximately 180 patients are needed for a subsequent head-to-head comparison study of the measures . Conclusions . The BPFS appears to have sound measurement properties , and a formal head-to-head comparison study with the RMQ is warranted Context Exercise and advice are common treatments for patients with subacute low back pain  , but their effectiveness is unclear . Contribution In this trial , 259 adults with subacute low back pain received 12 real or sham physiotherapist-directed exercise sessions and 3 real or sham advice sessions over 6 weeks . Compared with sham exercise and sham advice , patients who received real exercise and real advice had the most benefit at 6 weeks . However , only a small benefit on patient-reported function persisted at 12 months . Implication Compared with no exercise or advice , a combination of physiotherapist-directed exercise and advice seems to improve pain and function in the short term for patients with subacute low back pain . The Editors Back pain is 1 of the most frequent reasons for consultation with a general practitioner ( 1 , 2 ) . Most treatment guidelines provide advice for patients on managing acute or recent-onset low back pain but not chronic pain ( 3 ) . This reflects the view that acute low back pain is typically self-limited and that only a small proportion of persons develop chronic pain . However , a recent systematic review of the prognosis of acute low back pain ( 4 ) showed that this view is inaccurate : Pain and disability are typically ongoing , and recurrences are common . Thus , effective treatments for patients whose pain and disability persist beyond the acute phase are needed . We are interested in the subacute phase , which is the transition period from acute ( duration < 6 weeks ) to chronic ( duration > 3 months ) low back pain . All treatment guidelines ( 3 ) endorse advice as a treatment for subacute low back pain , and advice is the most frequently administered treatment in general practice ( 1 ) . Exercise is the most common treatment for low back pain ( 2 , 5 , 6 ) , and some guidelines recommend it for subacute low back pain ( 3 ) . However , a systematic review of treatment for subacute low back pain ( 7 ) concluded that no high- quality evidence exists for the efficacy of any intervention . To address this knowledge gap , we conducted a factorial r and omized , placebo-controlled trial of the effect of exercise , advice , or both on pain , function , and global perceived effect . Methods Setting The trial was conducted at 7 physiotherapy clinics in Australia and New Zeal and , of which 6 were in university teaching hospitals and 1 was in a primary care clinic . There were 16 physiotherapists . Each clinic had 1 to 5 therapists providing treatment . We enrolled participants from January 2001 to June 2003 . The study protocol was approved by the institutional review boards of the University of Sydney , Sydney , Australia , and of each clinic . Participants We sought persons between 18 and 80 years of age with nonspecific low back pain lasting for at least 6 weeks but no longer than 12 weeks . Participants were recruited by direct referral to the trial by a health care professional ( n= 1 ) , invitations to patients on hospital waiting lists for physiotherapy treatment of low back pain ( n= 73 ) , and advertisements in newspapers ( n= 185 ) . Exclusion criteria were spinal surgery in the past 12 months , pregnancy , nerve root compromise , confirmed or suspected serious spinal abnormality ( for example , infection , fracture , or the cauda equina syndrome ) , contraindications to exercise , and poor comprehension of the English language . We did not exclude participants who were receiving low back pain treatment other than spinal surgery . Potential participants who reported osteoarthritis ; spondylitis ; spondylolysis ; spondylolisthesis ; disc protrusion , herniation , or prolapse ; or spinal stenosis were eligible . We asked participants not to take other treatments for low back pain during the 6-week treatment phase . Written informed consent was obtained from all participants before they enrolled in the trial . R and omization and Interventions After completing the baseline assessment , we r and omly allocated participants to 1 of 4 intervention groups : exercise and advice , exercise and sham advice , sham exercise and advice , or sham exercise and sham advice . The allocation schedule was generated by using the r and om-number function in Microsoft Excel ( Microsoft , Inc. , Redmond , Washington ) , and the allocation codes were placed in sequentially numbered , sealed , opaque envelopes . At each site , the trial coordinator or the physiotherapist allocated participants to groups by opening the next numbered envelope . This process ensured that allocation was concealed from participants , referring medical practitioners , trial staff who determined eligibility , and the assessor of outcomes . The 12 exercise or sham exercise sessions were delivered over 6 weeks : 3 sessions per week in weeks 1 and 2 , 2 sessions per week in weeks 3 and 4 , and 1 session per week in weeks 5 and 6 . In weeks 1 , 2 , and 4 , participants also received advice or sham advice . Sham treatments were design ed to provide similar contact time with the treating clinician . The clinicians who provided the sham treatments were the same ones who provided the real treatments . Registered physiotherapists who received training from an experienced clinical psychologist delivered treatment . Treatment consistency was promoted at the initial staff meeting and at regular trial treatment meetings , and by providing a treatment manual to all treatment providers . To assess treatment validity , an investigator recorded and assessed sample treatment sessions . In addition , 1 investigator regularly visited each treatment site to monitor delivery of treatment . The comprehensive treatment manual is in the Appendix . Appendix . Treatment Manual Exercise The exercise program was based on the program described by Lindstrm and colleagues ( 8) . It included an individualized , progressive , submaximal program design ed to improve the abilities of participants to complete functional activities that they specified as being difficult to perform because of low back pain . Each participant undertook aerobic exercise ( for example , a walking or cycling program ) ; stretches ; functional activities ; activities to build speed , endurance , and coordination ; and trunk- and limb-strengthening exercises . Physiotherapists used principles of cognitive-behavioral therapy , including setting goals of progressively increasing difficulty , encouraging self-monitoring of progress , and promoting self-reinforcement ( 9 ) . Physiotherapists provided individualized home exercise programs , which they regularly review ed , and they encouraged continuation of the home program after the intervention finished . Sham Exercise The control for the exercise intervention consisted of sham pulsed ultrasonography ( 5 minutes ) and sham pulsed short-wave diathermy ( 20 minutes ) . The sham units were identical to active units ( for example , the on and off lights illuminated and the output dial moved ) except that they did not provide output . To optimize treatment credibility , physiotherapists followed the usual clinical routine for delivering these treatments . The active forms of these treatments delivered in pulsed mode do not produce heat ; thus , previous experience with the treatments would not unblind participants . Participants allocated to exercise did not receive the active forms of these treatments . Advice Advice sessions were based on the program by Indahl and colleagues ( 10 ) and aim ed to encourage a grade d return to normal activities . The physiotherapist explained the benign nature of low back pain , addressed any unhelpful beliefs about back pain , and emphasized that being overly careful and avoiding light activity would delay recovery . Sham Advice During sham advice sessions , participants were given the opportunity to talk about their low back pain and any other problems . The physiotherapist responded in a warm and empathic manner , displaying genuine interest in the participant , but did not give advice about the low back pain ( 11 ) . Participants were told that the trial included active and placebo physiotherapy treatments and that they would receive 2 treatments , but they were not told whether the interventions they received were active or sham . Outcomes and Measurements We determined participants ' perceptions of the effectiveness of treatment at the beginning of the trial and at 12 months . We assessed treatment adherence by the number of  appointments attended  ,  session  duration , and amount of time the physiotherapist spent with each participant . Participants were asked not to seek other treatments during the 6-week treatment period . Participants who discontinued treatment were encouraged to return for follow-up . Immediately before r and omization , we obtained baseline measurements . We collected additional data on work status , medication use , side effects , adverse events , and number and type of co- interventions  at 6 weeks , 3 months , and 12 months after r and omization . We chose primary and secondary outcomes a priori . The primary outcomes were pain , global perceived effect , and functional ability at 6 weeks and 12 months . Secondary outcomes were pain , global perceived effect , and functional ability at 3 months ; number of health care contacts during the past 6 weeks ( determined at 12 months ) ; and disability and depression at 6 weeks , 3 months , and 12 months . We rated pain as average pain over the past week on a scale of 0 ( no pain ) to 10 ( worst pain possible ) ( 12 ) . We measured functional ability by using the Patient-Specific Functional Scale ( score range , 0 [ can not perform activity ] to 10 [ can perform activity at preinjury level ] ) ( 13 ) . We measured global perceived effect of treatment on an 11-point scale , ranging from 5 ( vastly worse ) to 5 ( completely recovered ) , with 0 being no change . We measured disability with the Rol and Morris Disability Question naire ( score range , 0 to 24 ) ( 14 ) . We measured depression , anxiety , and stress by using the 21-item Depression Anxiety Stress Scales ( DASS-21 ) ( score range for each subscale , 0 to 42 ) ( 15 ) . These measures have acceptable psychometric properties and are widely used in Study Design . Pragmatic , r and omized , assessor blinded , clinical trial with economic analysis . Objective . To compare the effectiveness and cost-effectiveness of three kinds of physiotherapy commonly used to reduce disability in chronic low back pain . Summary of Background Data . Physiotherapy reduces disability in chronic back pain , but there are several forms of physiotherapy and it is unclear which is most effective or cost effective . Methods . A total of 212 patients referred to physiotherapy with chronic low back pain were r and omized to  receive usual outpatient physiotherapy , spinal stabilization classes , or physiotherapist-led pain management classes . Primary outcome was Rol and Disability Question naire score 18 months from baseline ; secondary measures were pain , health-related quality of life , and time off work . Healthcare costs associated with low back pain and quality -adjusted life years ( QALYs ) were also measured . Results . A total of 71 participants were assigned to usual outpatient physiotherapy , 72 to spinal stabilization , and 69 to physiotherapist-led pain management . A total of 160 ( 75 % ) provided follow-up data at 18 months , showing similar improvements with all interventions : mean ( 95 % confidence intervals ) Rol and Disability Question naire score improved from 11.1 ( 9.6–12.6 ) to 6.9 ( 5.3–8.4 ) with usual outpatient physiotherapy , 12.8 ( 11.4−14.2 ) to 6.8 ( 4.9–8.6 ) with spinal stabilization , and 11.5 ( 9.8–13.1 ) to 6.5 ( 4.5–8.6 ) following pain management classes . Pain , quality of life , and time off work also improved within all groups with no between-group differences . Mean ( SD ) healthcare costs and QALY gain were £ 474 ( 840 ) and 0.99 ( 0.27 ) for individual physiotherapy , £ 379 ( 1040 ) and 0.90 ( 0.37 ) for spinal stabilization , and £ 165 ( 202 ) and 1.00 ( 0.28 ) for pain management . Conclusions . For chronic low back pain , all three physiotherapy regimens improved disability and other relevant health outcomes , regardless of their content . Physiotherapist-led pain management classes offer a cost-effective alternative to usual outpatient physiotherapy and are associated with less healthcare use . A more widespread adoption of physiotherapist-led pain management could result in considerable cost savings for healthcare providers Study Design . A prospect i ve cohort study was conducted on workers cl aim ing earnings-related compensation for low back pain . Information obtained at the time of the initial cl aim was linked to compensation status ( still cl aim ing or not cl aim ing ) 3 months later . Objective . To identify individual , psychosocial , and workplace risk factors associated with the transition from acute to chronic occupational back pain . Summary of Background Data . Despite the magnitude of the economic and social costs associated with chronic occupational back pain , few prospect i ve studies have investigated risk factors identifiable in the acute stage . Methods . At the time of the initial compensation cl aim , a self-administered question naire was used to gather information on a wide range of risk factors . Then 3 months later , chronicity was determined from cl aim ants ’ computerized records . Results . The findings showed that 3 months after the initial assessment , 204 of the recruited 854 cl aim ants ( 23.9 % ) still were receiving compensation payments . A combined multiple regression model of individual , psychosocial , and workplace risk factors demonstrated that severe leg pain ( odds ratio [ OR ] , 1.9 ) , obesity ( OR , 1.7 ) , all three Oswestry Disability Index categories above minimal disability ( OR , 3.1–4 ) , a General Health Question naire score of at least 6 ( OR , 1.9 ) , unavailability of light duties on return to work ( OR , 1.7 ) , and a job requirement of lifting for three fourths of the day or more all were significant , independent determinants of chronicity ( P < 0.05 ) . Conclusions . Simple self-report measures of individual , psychosocial , and workplace factors administered when earnings-related compensation for back pain is cl aim ed initially can identify individuals with increased odds for development of chronic occupational disability Study Design . A single blind r and omized controlled trial comparing two models of care for patients with acute simple low back pain . Objectives . To compare two research -based models of care for acute low back pain and investigate the effect of the timing of physical intervention . Summary of Background Data . National guidelines offer conflicting information on the delivery of physical treatment in the management of acute low back pain . The guidelines suggest two different models of care . Direct comparisons between these models are lacking in the literature . The present study aims to compare these approaches to the management of acute low back pain . Methods . Among 804 referred patients , 102 subjects met the specific admission criteria and were r and omly assigned to an “ assess/advise/treat ” group or an “ assess/advise/wait ” group . The intervention consisted of biopsychosocial education , manual therapy , and exercise . Assessment of short-term outcome enables comparison to be made between intervention and advice to stay active . Assessment of long-term outcome enables comparison to be made between early and late intervention . Study outcomes of reported pain ( Visual Analogue Scale ) , functional disability ( the Rol and and Morris Disability Question naire ) , mood ( Modified Zung Self Rated Depression Score , Modified Somatic Perception Question naire , State-Trait Anxiety Inventory ) , general health ( Euroqol ) , and quality of life ( Short Form 36 ) were assessed at baseline , 6 weeks , 3 months , and 6 months . Results . At 6 weeks , the assess/advise/treat group demonstrated greater improvements in disability , mood , general health , and quality of life than patients in the assess/advise/wait group ( P < 0.05 ) . Disability and pain were not significantly different between the groups at long-term follow up ( P > 0.05 ) . However , mood , general health , and quality of life remained significantly better in the assess/advise/treat group ( P < 0.05 ) . Conclusions . At short-term , intervention is more effective than advice on staying active , leading to more rapid improvement in function , mood , quality of life , and general health . The timing of intervention affects the development of psychosocial features . If treatment is provided later , the same psychosocial benefits are not achieved . Therefore , an assess/advise/treat model of care seems to offer better outcomes than an assess/advise/wait model of care Purpose . To investigate whether socioeconomic status in patients with back pain participating in a r and omised controlled trial was predictive of functional disability ( Rol and Disability Question naire , RDQ ) . Method . Secondary analysis of data ( n = 949 ) from a national primary care trial of physical treatments for back pain ( UKBEAM trial ) using multilevel modelling . The three indicators were Townsend scores , educational levels and work status . Results . All indicators were significant predictors of outcome after adjusting for baseline variables . As Townsend scores increased ( indicating greater deprivation ) RDQ scores ( functional disability related to back pain ) increased . Lower levels of educational attainment were associated with higher RDQ scores . Those ‘ Not in Work ’ reported markedly higher levels of RDQ scores which increased over time . There was no evidence that one particular treatment was more suitable for participants of different socioeconomic status . Conclusions . The findings from this study add to the body of literature which suggests the importance of socioeconomic factors as an influence on health , including result ant disability related to chronic musculoskeletal conditions such as back pain . Work status was particularly dominant in our findings and may suggest that helping patients with back pain back to work where appropriate , is an especially important part of the management process Study Design . A prospect i ve cohort study of patients with episodes of acute or subacute low back pain , seeking physical therapy in primary care , with follow-up at weeks 2 , 4 , 8 , and 12 . Objectives . To evaluate the association between psychosocial factors and the transition from acute or subacute low back pain to chronicity . Summary of Background Data . Psychosocial factors have long been thought to be associated with chronic pain only . Recent prospect i ve studies , however , suggest that these factors may also be important in acute or subacute low back pain . Methods . Demographic , psychosocial , and psychological baseline data were collected and analyzed from a sample of 66 acute or subacute patients with low back pain in order to predict the 3-month outcome . Results . After 3 months , response rate was 85 % ( 56 patients ) . Forty-five percent rated their current status as “ not recovered . ” Twelve percent reported work absenteeism . Using multiple regression analyses , baseline scores on the  Acute Low Back Pain Screening Question naire , Pain Coping Inventory , Fear-Avoidance Beliefs Question naire , and Tampa Scale for Kinesiophobia were not significantly associated with nonrecovery at 3 months . The only significant predictor at baseline was the subscale pain of the ALBPSQ , correctly classifying 80 % of the patients . The relative risk for not being recovered was 3.72 ( 95 % confidence interval , 1.63–8.52 ) for the subjects with high scores on the subscale for pain . Pain scores and scores on psychosocial variables at 12 weeks were not associated . Conclusions . The study strongly revealed pain-related items to be essential factors in the development of chronicity and long-term disability in primary care physical therapy . Health status at 8 weeks seems crucial in developing chronicity Study Design . A prospect i ve r and omized controlled trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbar intervertebral disc . Results of a pilot study are presented . Objective . To determine the effects of a postoperative exercise program on pain , disability , psychological status , and spinal function . Summary of Background Data . Microdiscectomy is often used successfully to treat prolapsed lumbar intervertebral disc . However , some patients do not have a good outcome and many continue to have low back pain . The reasons for this are unclear but impairment of back muscle function due to months of inactivity before surgery may be a contributing factor . A postoperative exercise program may improve outcome in such patients . Methods . Twenty patients who underwent lumbar microdiscectomy  were r and omized into EXERCISE and CONTROL groups . After surgery , all patients received normal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities . Six weeks after surgery , patients in the EXERCISE group undertook a 4-week exercise program that concentrated on improving strength and endurance of the back and abdominal muscles and mobility of the spine and hips . Assessment s of spinal function were performed in all patients during the week before surgery and at 6 , 10 , 26 , and 52 weeks after . The assessment included measures of posture , hip and lumbar mobility , back muscle endurance capacity and electromyographic measures of back muscle fatigue . On each occasion , patients completed question naires inquiring about pain , disability and psychological status . Results . Surgery improved pain , disability , back muscle endurance capacity and hip and lumbar mobility in both groups of patients . After the exercise program , the EXERCISE group showed further improvements in these measures and also in electromyographic measures of back muscle fatigability . All these improvements were maintained 12 months after surgery . The only further improvement showed by the CONTROL group between 6 and 52 weeks was an increase in back muscle endurance capacity . Conclusion . A 4-week postoperative exercise program can improve pain , disability , and spinal function in patients who undergo microdiscectomy Design . Cross-sectional analysis of the factors influencing  self-rated disability associated with chronic low back pain and prospect i ve study of the relationship between changes in each of these factors and in disability following active therapy . Objectives . To examine the relative influences of pain , psychological factors , and physiological factors on self-rated disability . Summary of Background Data . In chronic LBP , the interrelationship between physical impairment , pain , and disability is particularly complicated , due to the influence of various psychological factors and the lack of unequivocal methods for assessing impairment . Investigations using new “ belief ” question naires and “ sophisticated ” performance tests , which have shown promise as discriminating measures of impairment , may assist in clarifying the situation . Previous studies have rarely investigated all these factors simultaneously . Methods . One hundred forty-eight patients with cLBP completed question naires and underwent tests of mobility , strength , muscle activation , and fatigability , and ( in a subgroup ) erector spinae size and fiber size/type distribution . All measures were repeated after 3 months active therapy . Relationships between each factor and self-rated disability ( Rol and and Morris question naire ) at baseline , and between the changes in each factor and changes in disability following therapy , were examined . Results . Stepwise linear regression showed that the most significant predictors of disability at baseline were , in decreasing order of importance : pain ; psychological distress ; fear-avoidance beliefs ; muscle activation levels ; lumbar range of motion ; gender . Only changes in pain , psychological distress , and fear-avoidance beliefs significantly accounted for the changes in disability following therapy . Conclusion . A combination of pain , psychological and physiological factors was best able to predict baseline disability , although its decrease following therapy was determined only by reductions in pain and psychological variables . The active therapy programm — in addition to improving physical function — appeared capable of modifying important psychological factors , possibly as a result of the positive experience of completing the prescribed exercises without undue harm Objectives Chronic low back pain ( CLBP ) affects millions of people worldwide , and appears to be increasing in prevalence . It is associated not only with pain , but also with increased disability , psychological symptoms , and reduced quality of life . There are various treatment options for CLBP , but no single therapy st and s out as being the most effective . In the past 10 years , yoga interventions have been studied as a CLBP treatment approach . The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP . Methods A literature search through the beginning of 2015 was conducted in Pub Med for r and omized control trials addressing treatment of CLBP with yoga . Results In this review we evaluate the use of yoga as a treatment for CLBP . Specifically we evaluate how yoga impacts physical functioning and disability , pain , and associated psychological symptoms . We also evaluate possible mediators of the effect of yoga and the safety of yoga . Discussion With few exceptions , previous studies and the recent r and omized control trials ( RCTs ) indicate that yoga can reduce pain and disability , can be practice d safely , and is well received by participants . Some studies also indicate that yoga may improve psychological symptoms , but these effects are currently not as well established
Most of the outcome question naires had a mixed content reflecting various constructs such as pain and symptoms , sleep disturbances , psychological dysfunctions , physical impairments , and social functions .
STUDY DESIGN A systematic literature review of outcome question naires design ed for assessing functional status or disability in patients with low back pain .
OBJECTIVES To provide a comprehensive overview of all functioning/disability question naires used in recent years and to explore how the main concept(s ) was described or defined in the original paper , the content or the domains of disability , and the measurement properties of the question naires .
SUMMARY OF BACKGROUND DATA A number of clinical tools design ed for evaluating the functional status of patients with low back pain have been developed .
Only a few have been review ed earlier , and there has been little focus on the content reflected in the question naires .