Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Low back pain and physical activity – A 6.5 year follow-up among young adults in their transition from school to working life Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration The natural course of low back pain: a systematic critical literature review Low Back Pain in a General Population. Natural Course and Influence of Physical Exercise–A 5-Year Follow-up of the Musculoskeletal Intervention Center-Norrtälje Study A 2-year prospective longitudinal study on low back pain in primary school children Body Mass Index as a Risk Factor for Developing Chronic Low Back Pain: A Follow-up in the Nord-Trøndelag Health Study The Predictive Relationship of Physical Activity on the Incidence of Low Back Pain in an Occupational Cohort The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews Active Lifestyle Protects Against Incident Low Back Pain in Seniors: A Population-Based 2-Year Prospective Study of 1387 Danish Twins Aged 70–100 Years Physical and Mental Function and Incident Low Back Pain in Seniors: A Population-Based Two-Year Prospective Study of 1387 Danish Twins Aged 70 to 100 Years A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Quality of life improved by multidisciplinary back school program in patıents with chronic non-specific low back pain: a single blind randomized controlled trial. Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting Randomized Controlled Trial of Specific Spinal Stabilization Exercises and Conventional Physiotherapy for Recurrent Low Back Pain Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain. Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. Spinal mechanical load: a predictor of persistent low back pain? A prospective cohort study The effectiveness of two active interventions compared to self-care advice in employees with non-acute low back symptoms: a randomised, controlled trial with a 4-year follow-up in the occupational health setting Low back pain incident episodes: a community-based study. One-year prognosis in sick-listed low back pain patients with and without radiculopathy. Prognostic factors influencing pain and disability. Low Back Pain in the Young A Prospective Three‐Year Follow‐up Study of Subjects With and Without Low Back Pain
BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain Background The association between leisure time physical activity and  low back pain in young adults is unclear and is in the need of prospect ively obtained evidence . This study examined the course of low back pain and the association between low back pain and leisure time physical activity in a cohort of young adults in their transition from school to working life . Methods Both low back pain and leisure time physical activity was monitored over a 6.5 year period in 420 subjects starting out as students within hairdressing , electrical installation and media/ design . The association between physical activity and low back pain was investigated through the follow-up period by using linear mixed models analysis . Results Low back pain was significantly influenced by time and overall there was a decreasing trend of low back pain prevalence throughout the follow-up . Analysis showed a weak trend of decreasing low back pain with moderate/high physical activity levels , but this association was not significant . Conclusions Low back pain decreased during follow-up with baseline as reference . Findings in our study did show non-significant trends of reduced low back pain with increased leisure time physical activity . Still , we could not support the theory of moderate/high levels of physical activity acting protective against low back pain in young adults entering working life . Our results , in combination with previous relevant research , can not support a clear relationship between  physical activity and low back pain for young adults . Thus , recommendations regarding effect of physical activity on reducing low back pain for this group are not clear Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP Background Most patients in the secondary care sector consulting for low back pain ( LBP ) seem to have a more or less constant course of pain during the ensuing year . Fewer patients with LBP in the primary care sector report continual pain over a one-year period . However , not much is known about the long-term course of LBP in the general population . A systematic critical literature review was undertaken in order to study the natural course of LBP over time in the general population . Methods A search of articles was performed in Pubmed , Cinahl and Psychinfo using the search terms ‘ epidemiology ’ ; ‘ low back pain ’ or ‘ back pain ’ ; ‘ prospect i ve study ’ or ‘ longitudinal study ’ ; ‘ follow-up ’ , ‘ natural course ’ , ‘ course ’ or ‘ natural history ’ ; ‘ general population ’ or ‘ working population ’ . Inclusion criteria were that one of the objectives was to study the course of (L)BP in the adult population , that the period of follow-up was at least 3 months , and that there were three points of observation or more . The review was undertaken by two independent review ers using three checklists relating to description of studies , quality and outcomes . The course of LBP was established in relation to those who , at baseline , were reported not to have LBP or to have LBP . Would this course be stable , fluctuating , worsening , or improving over time ? A synthesis of results in relation to common patterns was presented in a table and interpreted in a narrative form . Results Eight articles were included . Articles were different on time span , the number of surveys , and the definition of LBP . In six of the seven relevant studies , for those with no LBP at baseline , relatively substantial stable subgroups of people who continued to be LBP free were identified . In six of the seven relevant studies , definite stable subgroups of continued LBP were noted and improvement ( becoming pain free ) was never reported to be a common finding . Conclusion The status of LBP in individuals of the general population appears to be relatively stable over time , perhaps particularly so for those without LBP at baseline Study Design . A 5-year prospect i ve cohort study was conducted of men and women seeking care for a new period of low back pain ( LBP ) . Objectives . To study the natural course of pain and disability due to LBP during a 5-year follow-up period , and to investigate the possible influence of regular physical exercise on recovery . Summary of Background Data . LBP is major health problem , but its natural course is not very well studied . Several studies have investigated the role of physical exercise on LBP disorders , with inconsistent results . Methods . At baseline , a total of 790 subjects seeking care for LBP were interviewed about physical exercise during leisure time . Over 5 years , 3 follow-up assessment s were made by postal question naire . At all measuring points , pain intensity ratings and disability scores were compared between men and women , and among 3 exercise categories . Results . The pain intensity and disability scores were improved after 5 years for both men and women . The most prominent improvements occurred after 6 months , but less so thereafter . There were no significant differences between men and women with regard to individual changes at the 5-year follow-up concerning the pain intensity or disability scores . There were no significant differences , either for women or men , between low , median , or high intensity exercise groups regarding pain intensity or disability values for the individual change at the 5-year follow-up . Conclusions . Over a 5-year period , both men and women who had sought care for LBP reported a decrease in pain and disability ; however , only a few were fully restored . In this study , we found no effect of nonspecific physical exercise on recovery from LBP in men and women Abstract . There is increasing evidence that non-specific low back pain ( LBP ) is common among children and adolescents , but there are few longitudinal studies on this subject . This is a longitudinal prospect i ve study aim ed at finding factors associated with the prediction of low back pain in schoolchildren aged 9–12 years , which is a younger age group than has previously been studied . This study was performed on school children in the city of Antwerp , Belgium . A total of 287 children filled out a question naire  and were examined at the beginning of the study ( T1 ) and 2 years later ( T2 ) . The question naire asked about back pain , general health , health perceptions , quality of life perceptions , sports , leisure , daily life , school life ( weight of satchel ... ) and some issues related to parents ( smoking , LBP ) . The question naire reliability was tested . Logistic regression was used to analyse the data . No predictors for LBP in children could be identified . Using logistic regression techniques , we analysed the children who reported no lifetime episode of LBP at both T1 and T2 , the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only ( New LBP ) . At T2 there were 51 children ( 17.8 % ) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1 . Only one parameter showed a statistical difference : New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001 ) . An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2 . It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away . It is extremely interesting to note that among the few significant variables , those related to general well-being and self-perception of health , are prominent . It appears , therefore , that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults . Poor self-perception of health ( health belief ) could be a factor behind the reporting of LBP . Some variables linked to consequences of LBP ( absence from school or from gym and visit to a doctor ) play a significant role in reporting LBP , which suggests that those " health care " factors may reinforce a feeling of disease severity Study Design . A population -based , prospect i ve cohort study . Objective . To determine whether overweight , obesity , or more generally an elevated body mass index ( BMI ) increase the probability of experiencing  chronic low back pain ( LBP ) after an 11-year period , both among participants with and without LBP at baseline . Summary of Background Data . Chronic LBP is a common disabling disorder in modern society . Cross-sectional studies suggest an association between an elevated BMI and LBP , but it is not clear whether this is a causal relationship . Methods . Data were obtained from the community-based HUNT 2 ( 1995–1997 ) and HUNT 3 ( 2006–2008 ) studies of an entire Norwegian county . Participants were 8733 men and 10,149 women , aged 30 to 69 years , who did not have chronic LBP at baseline , and 2669 men and 3899 women with LBP at baseline . After 11 years , both groups indicated whether they currently had chronic LBP , defined as pain persisting for at least 3 months continuously during the last year . Results . A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline . The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 ( 95 % confidence interval [ CI ] , 1.08–1.67 ) for men and 1.22 ( 95 % CI , 1.03–1.46 ) for women , in analyses adjusted for age , education , work status , physical activity at work and in leisure time , smoking , blood pressure , and serum lipid levels . A significant positive association was also established between BMI and recurrence of LBP among women . LBP status at baseline had negligible influence on subsequent change in BMI . Conclusion . High values of BMI may predispose to chronic LBP 11 years later , both in individuals with and without LBP . The association between BMI and LBP is not explained by an effect of LBP on later change in BMI Objective : Quantify the relationship between physical activity and development of  incident low back pain ( LBP ) .  Methods : This nested prospect i ve cohort study utilized an objective measure of physical activity in 68 participants with 30 incident cases of LBP .  Physical activity was divided into tertiles and quartiles . Univariate and multivariate relative risks and hazard ratios were calculated . Results : Comparing highest to middle tertile of light activity demonstrated a statistically significant relative risk of 3.68 for developing incident LBP . Lowest and highest tertile of minutes of moderate/vigorous activity yielded statistically significant relative risks of 4.60 and 6.14 , respectively . Multivariate analyses demonstrated similar associations . Conclusions : Moderate amounts of physical activity were protective for the development of LBP  in this cohort , after adjustment for risk factors . This nonlinear relationship suggests higher levels of activity do not confer increased LBP prevention Abstract Objective : to review and up date the evidence for different forms of manual therapy ( MT ) for patients with different stages of non-specific low back pain ( LBP ) . Data sources : MEDLINE , Cochrane-Register-of-Controlled-Trials , PEDro , EMBASE . Method : A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent review ers according to Cochrane and PRISMA guidelines . A total of 360 studies were evaluated using qualitative criteria . Two stages of LBP were categorized ; combined acute – subacute and chronic . Further sub-classification was made according to MT intervention : MT1 ( manipulation ) ; MT2 ( mobilization and soft-tissue-techniques ) ; and MT3 ( MT1 combined with MT2 ) . In each sub-category , MT could be combined or not with exercise or usual medical care ( UMC ) . Consequently , quantitative evaluation criteria were applied to 56 eligible r and omized controlled trials ( RCTs ) , and hence 23 low-risk of bias RCTs were identified for review . Only studies providing new up date d information ( 11/23 RCTs ) are presented here . Results : Acute – subacute LBP : STRONG- evidence in favour of MT1 when compared to sham for pain , function and health improvements in the short-term ( 1–3 months ) . MODERATE- evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain , function and health improvements in the short-term . Chronic LBP : MODERATE to STRONG- evidence in favour of MT1 in comparison to sham for pain , function and overall-health in the short-term . MODERATE- evidence in favour of MT3 combined with exercise or UMC in comparison to  exercise  and back-school was established for pain , function and quality -of-life in the short and long-term . LIMITED- evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term . LIMITED- evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term . Conclusion : This systematic review up date s the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies Study Design . Prospect i ve cohort study of twins . Objectives . To investigate associations between physical activity , physical function , and incident low back pain ( LBP ) in an elderly population . Summary of Background Data . The relationship between an active lifestyle and LBP in seniors is unknown . Methods . Participants in the population -based Longitudinal Study of Aging Danish Twins free from LBP at baseline ( no LBP during the past month ) were included , and interview data on physical activity , overall physical function , and LBP at baseline and follow-up were obtained . Associations between levels of  physical activity and LBP were estimated using logistic regression for the entire cohort , and using a matched case-control design for twin pairs discordant for physical activity . Absolute risk and relative risks for incident LBP in relation to physical activity were calculated for participants with higher or lower than average physical function at baseline . Absolute risk for LBP was also calculated for participants based on whether they remained active or inactive between baseline and follow-up or changed activity level . Results . A total of 1387 persons aged 70–100 at baseline were included in the analyses , including 86 twin pairs discordant for physical activity at baseline . In the total sample , 83 % were engaged in light physical activity  , and 42 % of men and 35 % of women were engaged in strenuous  physical activity  at least weekly . Being engaged in strenuous physical activity at baseline was strongly protective in relation to both having had any LBP ( odds ratio 0.21 , 95 % confidence interval 0.12–0.37 for intra-pair analysis ) and having had LBP lasting more than 30 days altogether during the past year at follow-up ( odds ratio 0.08 , 95 % confidence interval 0.03–0.18 for intra-pair analysis ) . Statistically significant dose-response associations between increasing frequency of strenuous physical activity and magnitude of this protective effect were found . Participants with poor initial physical function experienced the strongest protective effect of strenuous physical activity . Finally , LBP does not appear to be an important factor affecting whether participants remained engaged in strenuous physical activity at baseline and follow-up or vice versa . Conclusions . Strenuous physical activity at least once a week is protective for incident LBP in seniors Study Design . Prospect i ve cohort study . Objectives . To investigate whether physical performance , grip strength , cognitive function , and depression symptomatology are risk factors for incident low back pain ( LBP ) over a 2-year period in seniors . Summary of Background Data . LBP is common in the older age groups , but little is known about predictors of LBP in this age group . Methods . Data from the 2001 and 2003 data collection from the population -based Longitudinal Study of Aging Danish Twins formed the basis of this analysis . Participants free from LBP at baseline ( no LBP during the past month , N = 1387 ) were included and interview data on overall physical function , and assessment of grip strength , overall cognitive function , and depression at baseline were obtained . LBP status at follow-up was assessed using a modified version of the St and ardized Nordic Question naire . Logistic regression was used to assess the associations between the baseline risk factors and LBP at follow-up . Results . A total of 1387 persons 70 to 100 years of age at baseline were included in the analyses . Of the initially LBP-free individuals , 7 % had experienced LBP more than 30 days out of the past year , 7 % had altered or decreased their physical activities due to LBP , and 11 % had received treatment for LBP at follow-up . Good overall physical function ( being among the top 50 % ) at baseline was protective for LBP of more than 30 days duration and for diminishing physical activities due to LBP and for care seeking due to LBP . High depression scores ( being among the top 25 % ) were strongly associated with altering or decreasing daily activities because of LBP . Grip strength and overall cognitive performance at baseline were associated with lower incidence of LBP and decreasing activities due to LBP at follow-up ; however , these associations were not statistically significant . Conclusion . Poor overall physical function and depression symptomatology are associated with LBP and consequences of LBP in persons 70 years of age and older Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing STUDY DESIGN A three and six months follow-up in a r and omized controlled trial . BACKGROUND Back School has become a widespread exercise program for low back pain ( LBP ) , since its introduction in 1969 . Back School could improve quality of life ( QoL ) , but there are controversial data regarding its effectiveness . AIM To evaluate the effects of the Back School program on quality of life ( primary outcome ) , disability and pain perceptions ( secondary outcomes ) in patients with chronic and non-specific low back pain . SETTING Rehabilitative specialized centre . POPULATION Seventy four patients with chronic non-specific LBP . METHODS Patients were r and omly placed in a 3:2 form and were allocated into 2 groups ( treated-control ) . Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises ( BSG , N.=41 ) , while the control group received medical assistance ( CG , N.=29 ) . Medication was the same in both groups . The Short Form 36 Health Status Survey , Waddel Index , Oswestry Disability Index and Visual Analogue Scale were collected at baseline , at the end of treatment , and at the three and six month follow-up . RESULTS Quality of life significantly improved along time more in BSG , both in Physical and Mental Composite Score ( repeated measure Anova : interaction time per group : P<0.001 and P=0.002 , respectively ) . We also observed a significant improvement in disability scores along time ( P<0.001 ) in BSG with significant differences between groups at three and at six months for Waddell Index ( P=0.006 and P=0.009 respectively ) and for Oswestry Disability Index ( P=0.018 and 0.011 respectively ) . Moreover , pain perception score VAS showed a reduction in both groups , but it was significantly lower in BSG at end of treatment and both follow-ups ( P<0.001 ) . CONCLUSION Our Back School program can be considered an effective treatment in people with chronıc non-specıfıc LBP Purpose Much research has been performed on physical exposures during work ( e.g. lifting , trunk flexion or body vibrations ) as risk factors for  low back pain ( LBP ) , however results are inconsistent . Information on the effect of doses ( e.g. spinal force or low back moments ) on LBP may be more reliable but is lacking yet . The aim of the present study was to investigate the prospect i ve relationship of cumulative low back loads ( CLBL ) with LBP and to compare the association of this mechanical load measure to exposure measures used previously . Methods The current study was part of the Study on Musculoskeletal disorders , Absenteeism and Health ( SMASH ) study in which 1,745 workers completed question naires .  Physical load at the workplace was assessed by video-observations and force measurements . These measures were used to calculate CLBL . Furthermore , a 3-year follow-up was conducted to assess the occurrence of LBP . Logistic regressions were performed to assess associations of CLBL and physical risk factors established earlier ( i.e. lifting and working in a flexed posture ) with LBP . Furthermore , CLBL and the risk factors combined were assessed as predictors in logistic regression analyses to assess the association with LBP . Results Results showed that CLBL is a significant risk factor for LBP ( OR : 2.06 ( 1.32–3.20 ) ) . Furthermore , CLBL had a more consistent association with LBP than two of the three risk factors reported earlier . Conclusions From these results it can be concluded that CLBL is a risk factor for the occurrence of LBP , having a more consistent association with LBP compared to most risk factors reported earlier Background In the treatment of  chronic back pain  , cognitive methods are attracting increased attention due to evidence of effectiveness similar to that of traditional therapies . The purpose of this study was to compare the effectiveness of performing a cognitive intervention based on a non-injury model with that of a symptom-based physical training method on the outcomes of  low back pain ( LBP ) , activity limitation , LBP attitudes ( fear-avoidance beliefs and back beliefs ) , physical activity levels , sick leave , and quality of life , in chronic LBP patients . Methods The study was a pragmatic , single-blind , r and omised , parallel-group trial . Patients with chronic/recurrent LBP were r and omised to one of the following treatments : 1 . Educational programme : the emphasis was on creating confidence that the back is strong , that loads normally do not cause any damage despite occasional temporary pain , that reducing the focus on the pain might facilitate more natural and less painful movements , and that it is beneficial to stay physically active . 2 . Individual symptom-based physical training programme : directional-preference exercises for those central ising their pain with repetitive movements ; ' stabilising exercises ' for those deemed ' unstable ' based on specific tests ; or intensive dynamic exercises for the remaining patients . Follow-up question naires ( examiner-blinded ) were completed at 2 , 6 and 12 months . The main statistical test was an ANCOVA adjusted for baseline values . Results A total of 207 patients participated with the median age of 39 years ( IQR 33 - 47 ) ; 52 % were female , 105 were r and omised to the educational programme and 102 to the physical training programme .  The two groups were comparable at baseline . For the primary outcome measures , there was a non-significant trend towards activity limitation being reduced mostly in the educational programme group , although of doubtful clinical relevance . Regarding secondary outcomes , improvement in fear-avoidance beliefs was also better in the educational programme group . All other variables were about equally influenced by the two treatments . The median number of treatment sessions was 3 for the educational programme group and 6 for the physical training programme group . Conclusions An educational approach to treatment for chronic LBP result ed in at least as good outcomes as a symptom-based physical training method , despite fewer treatment sessions . Trial registration Clinical trials.gov : # Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care . A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines . Further , the review recommended the use of theory in the development of implementation interventions . A clinical practice guideline for the management of acute low-back pain has been developed in Australia ( 2003 ) . Acute low-back pain is a common condition , has a high burden , and there is some indication of an evidence - practice gap in the allied health setting . This provides an opportunity to develop and test a theory-based implementation intervention which , if effective , may provide benefits for patients with this condition . Aims This study aims to estimate the effectiveness of a theory-based intervention  to increase allied health practitioners ' ( physiotherapists and chiropractors in Victoria , Australia ) compliance with a clinical practice guideline for acute non-specific low back pain ( LBP ) , compared with providing practitioners with a printed copy of the guideline . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray  , and improving mean level of disability for patients three months post-onset of acute LBP . Methods The design of the study is a cluster r and omised trial . Restricted r and omisation was used to r and omise 210 practice s ( clusters ) to an intervention or control group . Practitioners in the control group received a printed copy of the guideline . Practitioners in the intervention group received a theory-based intervention developed to address prospect ively identified barriers to practitioner compliance with the guideline . The intervention primarily consisted of an educational symposium .  Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period , three months post the intervention symposia , are eligible for inclusion . Sample size calculations are based on recruiting between 15 to 40 patients per practice . Outcome assessors will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12609001022257 ( date registered 25th November 2009 Background Evidence shows that low back specific patient information is effective in sub-acute low back pain ( LBP ) , but effectiveness and cost-effectiveness ( CE ) of information in early phase symptoms is not clear . We assessed effectiveness and CE of patient information in mild LBP in the occupational health ( OH ) setting in a quasi-experimental study . Methods A cohort of employees ( N = 312 , aged < 57 ) with non-specific , mild LBP ( Visual Analogue Scale between 10–34 mm ) was selected from the respondents of an employee survey ( N = 2480 ; response rate 71 % ) . A r and om sample , representing the natural course of LBP ( NC , N = 83 ; no intervention ) , was extracted as a control group . Remaining employees were invited ( 181 included , 47 declined , one excluded ) into a r and omised controlled study with two 1:1 allocated parallel intervention arms ( “ Booklet ” , N = 92 ; “ Combined ” , N = 89 ) . All participants received the “ Back Book ” patient information booklet and the Combined also an individual verbal review of the booklet  . Physical impairment ( PHI ) , LBP , health care ( HC ) utilisation , and all-cause sickness absence ( SA ) were assessed at two years . CE of the interventions on SA days was analysed by using direct HC costs in one year , two years from baseline . Multiple imputation was used for missing values . Results Compared to NC , the Booklet reduced HC costs by 196 € and SA by 3.5 days per year . In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA . Compared to NC , in the Combined arm , the figures were 107 € , 0.4 days , and 54 % , respectively . PHI decreased in both interventions . Conclusions Booklet information alone was cost-effective in comparison to natural course of mild LBP . Combined information reduced HC costs . Both interventions reduced physical impairment . Mere booklet information is beneficial for employees who report mild LBP in the OH setting , and is also cost saving for the health care system . Trial registration Clinical Trials.gov 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 Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain ( LBP ) . However , no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain . Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population . This prospect i ve cohort study recruited 101 consenting patients with sub-acute LBP ( < 6 weeks ) who completed the Rol and Morris Disability Question naire ( RMDQ ) , the Visual Analogue Scale , and resumption of full ‘ normal ’ activity question ( Y/N ) , at baseline and 3 months .  Physical activity  was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall question naire . Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ ( p > 0.05 ) or RMDQ change ( p > 0.05 ) over 3 months . A self-report of a return to full ‘ normal ’ activities was significantly associated with greater RMDQ change score at 3 months ( p < 0.001 ) . Paired t-tests found no significant change in activity levels measured with the RT3 ( p = 0.57 ) or the recall question naire ( p = 0.38 ) from baseline to 3 months . Conclusions These results question the predictive role of physical activity in LBP recovery , and the assumption that activity levels change as LBP symptoms resolve . The importance of a patient ’s perception of activity limitation in recovery from acute LBP was also highlighted . Trial registration Clinical Trial Registration Number , Observation-based assessment s of movement are a st and ard component in clinical assessment of patients with non-specific low back pain . While aberrant motion patterns can be detected visually , clinicians are unable to assess underlying neuromuscular strategies during these tests . The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessment s for lumbopelvic control in people with low back pain ( LBP ) and matched control subjects .  Electromyography was recorded from hip and trunk muscles of 34 participants ( 17 with LBP ) during performance of the Active Hip Abduction ( AHAbd ) and Active Straight Leg Raise ( ASLR ) tests .  Relative muscle timing was calculated using cross-correlation . Participants with LBP demonstrated a variable strategy , while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements . Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches STUDY DESIGN A prospect i ve population -based cohort study performed in South Manchester , United Kingdom . OBJECTIVES To determine whether nonoccupational physical activity and indicators of physical stress on the spine predict low back pain in the short term . SUMMARY OF BACKGROUND DATA There is evidence that physical activity outside the workplace helps to protect against low back pain in the long term . However , such activity may injure or stress the spine in the short term . METHODS A baseline survey question naire identified 2715 adults , aged 18 - 75 years , with no low back pain at the time of the survey . Information on potential predictors of low back pain also was obtained . New episodes of back pain were identified during the subsequent year . RESULTS A new low back pain episode occurred in 34 % of men and 37 % of women . Poor general health at baseline was the strongest predictor of a new episode of pain ( men : relative risk ( RR ) 1.5 , 95 % confidence intervals ( CI ) 0.8 , 2.7 ; women : RR 2.2 , 95 % CI 1.2 , 4.0 ) . High weight was associated with subsequent low back pain in women ( RR 1.4 ; 95 % CI 1.0 , 2.0 ) , but neither height nor weight predicted low back pain in men . A self-rated low level of physical activity  was not consistently linked with subsequent low back pain , nor were specific nonoccupational physical activities , apart from home-improvement work in men and regular sports in women . CONCLUSION Although some specific activities may be hazardous to the back , physical activity outside the workplace does not increase the short-term risk of low back pain overall . Leisure-time physical activity is not a hazard to the back , whereas poor physical health in both genders and heavier weight in women do increase the risk of new low back pain episodes in the short term Prospect i ve inception cohort . To assess the prognostic value of spinal mechanical load , assessed with the 24-hour schedule ( 24HS ) , in subjects with acute non-specific low back pain ( ALBP ) and to examine the influence of spinal mechanical load on the course of ALBP . In view of the characteristics of the natural course of ALBP , this should be viewed as a persistent condition in many patients rather that a benign self-limiting disease . Therefore , secondary prevention could be beneficial . Spinal mechanical load is a risk factor for ALBP and possibly a ( modifiable ) prognostic factor for persistent ( i.e. recurrent and /or chronic ) LBP . One hundred patients from primary care with ALBP were eligible for inclusion . At 6 months , 88 subjects completed the follow-up . For the follow-up assessment a research assistant , unaware of our interest in the prognostic factors , contacted the subjects by telephone . Question naires were completed focusing on changes in demographic data and on the course and current status of ALBP . Persistent LBP occurred in 60 % subjects . After multivariate regression analysis smoking ( harmful ) and advanced age ( protective ) were associated with persistent LBP . Differences in 24HS scores at baseline and follow-up were univariate-related to persistent LBP . Spinal mechanical load , quantified with the 24HS , is not a prognostic factor for persistent LBP . Modification of spinal mechanical load in terms of 24HS scores could be beneficial for secondary prevention in patients with acute LBP Objective Evaluate the effectiveness of two active interventions , aim ed at secondary prevention of low back pain ( LBP ) , in occupational health . Methods We performed a survey of LBP ( n=2480 ; response rate 71 % ) and r and omized 143 employees ( 66 % males , 45 years ) with LBP over 34 mm on VAS into Rehabilitation ( n=43 ) , Exercise  ( n=43 ) or self-care ( n=40 ) groups . Primary outcomes were LBP , physical impairment ( PI ) and health-related quality of life ( HRQoL ) for two years and sickness absence ( SA ) days during four years ( LBP specific , total ) . Results Compared to self-care , exercise  reduced LBP at 12 months ( mean difference ( MD ) −12 mm ; 95 % CI −21 to −2 ) and improved HRQoL at 12 and 24 months ( 0.03 ; 0.00 to 0.05 ) , but did not reduce PI . The MDs of SA days in four years were −17 ( −70 to 35 , total ) and −15 ( −47 to 13 , LBP specific ) . Exercise reduced the probability of LBP specific SA during the third and fourth year . Compared to self-care , Rehabilitation  reduced LBP at 3 months ( −10 mm ; −19 to −1 ) and 6 months ( −10 mm ; −20 to − 1 ) , but was not effective in HRQoL or PI . The MDs of SA days in four years were −41 ( −93 to 8 ; total ) and 5 ( −30 to 47 ; LBP specific ) . Rehabilitation reduced the probability of total SA during first and second year and amount of total SA days in the fourth year . Conclusions Among employees with relatively mild LBP , both interventions reduced pain , but the effects on SA and PI were minor . Exercise improved HRQoL. The effect sizes were rather small . Trial registration Number Clinical Trials.gov NCT00908102 BACKGROUND CONTEXT The available evidence regarding low back pain ( LBP ) incident episodes is not consistent . Such knowledge can add information for the potential contribution of preventive programs . PURPOSE a ) To evaluate annual incident episodes of LBP among the general population . b ) To evaluate the contribution of demographic , lifestyle , and back pain history to LBP incident episodes . STUDY DESIGN A community-based longitudinal study . PATIENT SAMPLE A r and omized sample of individuals , free of LBP at a previous cross-sectional survey . OUTCOME MEASURES Low back pain during the past year . METHODS Subjects were followed up after 1 year . Baseline data included back pain history , perception of general health , physical activity , smoking , work satisfaction , and demographic characteristics . RESULTS Annual incident episodes of LBP were 18.4 % . Those who experienced LBP during the past year had a lower baseline perception of general health and were less involved in sporting activities than those free of pain . Those without history of LBP were more likely to be free of back pain after 1 year . CONCLUSIONS The annual incident episodes of LBP are relatively high and relate indirectly to baseline perception of general health and to level of sporting activities . Those without history of LBP are more likely to be free of back pain after 1 year . These results raise the potential of LBP preventive programs for adult population BACKGROUND CONTEXT Previous research has documented various psychosocial risk factors with influence on outcome in low back pain ( LBP ) patients , but the value of clinical predictors has been less well documented . PURPOSE To identify clinical and psychosocial risk factors at baseline influencing disability and pain at 1 year in LBP patients sick-listed 3 to 16 weeks , and to look for differences between nonspecific LBP and radiculopathy . STUDY DESIGN Cohort study with 1-year follow-up based on a r and omized clinical trial . OUTCOME MEASURES Disability and change of disability , pain and change in pain at 1 year . METHODS In a r and omized clinical study evaluating multidisciplinary versus brief intervention , 325 patients were followed for 1 year . At baseline , they completed a question naire and went through a clinical low back examination , including measure of forward flexion and side flexion as well as tender point examination , a method to estimate diffuse tenderness . Furthermore , degenerative changes on plain X-rays of the lumbar spine were quantified , and sciatica was investigated by magnetic resonance imaging . RESULTS Radiculopathy was verified by magnetic resonance imaging in 111 ( 34 % ) patients . At 1 year , questions of disability in daily life activities and pain were answered by 60 % and 67 % , respectively . The intensity of back+leg pain and disability was closely correlated . Statistically significant predictors for both disability and back+leg pain at 1 year were intensity of back+leg pain , worrying and health anxiety , many tender points , and little or moderate exercise in leisure time . Two additional risk factors were identified in patients with radiculopathy : older age and " drinking alcohol less than once per month . " Furthermore , disability at 1 year was associated with initial disability and compensation cl aim , and back+leg pain at 1 year was associated with fear avoidance about physical activity and the duration of pain . Change in disability was more closely associated with return to work than change in pain . Disc degeneration was not associated with disability or pain at 1 year . General health was not statistically significantly associated with outcome when adjusted for back+leg pain , disability , and worrying and health anxiety . CONCLUSIONS Disability and pain at 1 year were associated with baseline disability and pain , diffuse tenderness , worrying and health anxiety , compensation cl aim , fear avoidance , and baseline exercise habits . Only in patients with verified nerve root affection , older age , and restrained alcohol seemed to play a role . The multivariate models were insufficient in predicting disability and pain , partly because disability and pain were also strongly associated with return to work Study Design . This was a prospect i ve 3-year follow-up study of r and omized matched subgroups of 15-year-old school children with or without low back pain initially . Objective . In addition to low back pain and leisure time physical activity , spinal mobility , trunk muscle strength , and early degenerative findings of the lumbar spine were evaluated . Summary of Background Data . Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse . Along with several other characteristics , the relationship of these changes to frequent low back pain in young persons is not known . Methods . After a question naire-based survey was administered , subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity , anthropometry , spinal mobility , trunk muscle strength , and magnetic resonance imaging findings of the lumbar spine . Results . At baseline and at follow-up , those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function . During follow-up , the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects . Furthermore , disc degeneration at baseline significantly predicted future frequent low back pain . Initial disc protrusion also predicted future frequent low back pain . Conclusion . After the rapid physical growth period , there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects
Conclusions Leisure time physical activity may reduce the risk of chronic LBP by 11%–16 % .
Background There are plausible mechanisms whereby leisure time physical activity may protect against  low back pain ( LBP )  but there have been no quality systematic review s and meta-analyses of the subject .
Objective This review aims to assess the effect of leisure time physical activity on non-specific LBP .