Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review

Background: Causative factors may be different for the very first onset of symptoms of the 'disease' of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP. Methods: A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms 'low back pain' or 'back pain' and 'risk factor' or 'caus*' or 'predict*' or 'onset' or 'first-time' or 'inception' or 'incidence'. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods. Results: Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the 'disease' or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction. Conclusion: Recent literature concerning the causality of LBP does not differentiate between the 'disease' of LBP and its recurring episodes mainly due to a lack of a clear definition of absence of LBP at baseline. Therefore, current research is not capable of providing a valid answer on this topic

Exploring 1st- and 2nd-year chiropractic students' willingness and attitudes toward peer physical examination

Objective This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it. Methods A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation. Results A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex. Conclusion Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination

The prognostic merit of self-reported triggers of recurrent low back pain: Study protocol

Background Most cases of low back pain (LBP) are regarded as non-specific and current studies indicate that for many this is a chronic recurrent condition, in which people experience episodes of pain with symptom-free periods in between. It is likely that acute exposure to some factors triggers the reappearance of new episodes in recurrent LBP regardless of the causality of the underlying condition (i.e. risk factors). Additionally, it has been shown that LBP patients present with different trajectories and different trajectories possibly have different triggers. Hence, dividing patients into some clinically meaningful subgroups may offer new insights into triggers, effective preventive strategies and, therefore, prognosis. This study aims to identify self-reported triggers and trajectories of episodes of recurrent LBP and to examine the prognostic association between different triggers and LBP trajectories. Methods This is a longitudinal, multicentre, Australia-wide observational study of patients with recurrent non-specific LBP. Two hundred adults with at least a one-year history of LBP will be recruited from primary care clinics or private practices and followed for a year. Each will receive an SMS every fortnight (26 time-points in total) enquiring the occurrence of a new episode of pain in the past 2 weeks and its intensity. Upon report of a new episode, a telephone interview will be performed to appraise exposure to self-nominated triggers in a period of 24 h preceding the pain. Trajectories will be identified by latent class analysis at the end of the follow-up based on the pain intensity, frequency, and length of episodes. Triggers will be categorised into physical and psychosocial groups. Generalised linear mixed models with logit links will be used to explore pain triggers associated with pain trajectories. Discussion The completion of this study will provide insight into the patients’ self-reported triggers of LBP and also their possible prognostic association with different trajectories. Some newly-identified and pre-identified triggers are likely to be found and reported

Supplementing a neuroanatomical module with YouTube videos does not improve student learning outcomes

Curriculum changes resulting in reduced contact time, and the implementation of the “Learning & Teaching Strategy”¹ at Murdoch University, have prompted the adoption of “Blended Learning” in many units. Blended learning has been reported to improve student outcomes in a gross anatomy course for second-year physiotherapy students at La Trobe University². The effect of blended learning on the academic performance of second-year health profession students, who have been taught anatomy at an undergraduate medical level3,4, has not been investigated

Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis

Background Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology. Methods Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained. Results Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: −0.40 (95% CI = −0.70, −0.09) and type II fibers [SMD: −0.38 (95% CI = −0.69, −0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis. Conclusions Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies

Fine-tuning of prediction of isolated impaired glucose tolerance: A quantitative clinical prediction model

In this cross-sectional study, we evaluated results of oral glucose tolerance test (OGTT) from 4742 women and 3470 men, participated in the Tehran Lipid and Glucose Study, aged ≥20 years and without diabetes, to determine the diagnostic value of subjects’ clinical traits with isolated impaired glucose tolerance (isolated-IGT) defined as fasting plasma glucose (FPG) <5.6 mmol/L and 2-h plasma glucose between 7.8 and 11.1 mmol/L. The overall prevalence of IGT was 13.6% (n = 1120); of these subjects, 59.6% (n = 668) had isolated-IGT. The adjusted odds ratios for having isolated-IGT among 7012 subjects with FPG <5.6 mmol/L were significant for age ≥40 years (2.5), hypertension (1.9), abnormal waist circumference (1.9), obesity (1.5), and family history of diabetes (1.3). Adding the lipid profiles to the clinical model increased the area under the ROC curve only slightly (73.2% vs. 72.1%, respectively; P = 0.002). In summary, this study showed that in adults with FPG <5.6 mmol/L, older age, family history of diabetes, abnormal waist circumference and obesity, and hypertension were significantly associated with a higher likelihood of isolated-IGT; OGTT could hence be recommended in subjects who have most of these characteristics to find Isolated-IGT, especially if the findings are supported by appropriately designed clinical trials

Effects of different doses of oral cholecalciferol on serum 25(OH)D, PTH, calcium and bone markers during fall and winter in schoolchildren

Background/objectives: Controversies surround the actual requirements of vitamin D in adolescents. We aimed to assess the efficacy and safety of different doses of vitamin D in high schoolchildren of Taleghan (latitude 36.5°N) near Tehran. Subjects/methods: In a randomized double-blind, placebo-controlled trial, 210 subjects, aged 14-20 years, 105 boys and 105 girls were assigned to three groups; group A (n=70) received 50 000 U oral cholecalciferol monthly (equal to 1600 U per day), group B (n=70), 50 000 U bimonthly (equal to 800 U/day) and group C (n=70), placebo. The study began in November 2007 and continued until April 2008. Serum 25(OH)D, parathyroid hormone (PTH), calcium (Ca) and bone markers were measured. Results: At baseline, girls had significantly lower concentrations of 25(OH)D than boys (19.25±16 vs 40.5±14 nmol/l). Mean 25(OH)D increased from 32±22 to 60±27.5 and 28.25±14.5 to 45.75±24 in groups A and B, respectively (P<0.001); however, it did not change over time in group C (29±18 vs 29±17.5). Increment of mean 25(OH)D was higher in group A than in group B (P<0.01). In all groups, girls had lower concentrations of 25(OH)D than boys (P<0.001). Serum Ca increased and PTH decreased in groups A and B (P<0.001). In group A, osteocalcin (OC) and bone-specific alkaline phosphatase increased (P<0.001), but in group B only OC increased (P<0.001). Urine C telopeptide and Ca did not change in all three groups; no case of hypercalcemia was observed. Conclusions: Although monthly administration of 50 000 U vitamin D(3) increased serum 25(OH)D significantly, it was apparently not enough to correct vitamin D deficiency, especially in girls

Reliability and validity of the Iranian version of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales in adolescents

Objective The objective of this study was to investigate the reliability and validity of the Iranian version of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0) Generic Core Scales in adolescents Methods After linguistic validation, the Iranian version of the PedsQL™ 4.0 was completed by 848 healthy and 26 chronically ill adolescents aged 13–18 years and their parents. Results The internal consistency as measured by Cronbach’s alpha coefficients exceeded the minimum reliability standard of .70. No floor effects were observed. Ceiling effects detected ranged from 1.5% for adolescent self-report total scale score to 42.2% for self-report social functioning. All monotrait-multimethod correlations were higher than multitrait-multimethod correlations. The intraclass correlation coefficients (ICC) between adolescent self-report and parent proxy-report showed good to excellent agreement. Exploratory factor analysis supported mainly comparable results with the original US English dialect version. The results of the confirmatory factor analysis for 5-factor models for both self-report and proxy-report indicated acceptable fit for the proposed models. Regarding gender and health status, as hypothesized from previous studies, girls reported lower health-related quality of life than boys on the total score, physical and emotional functioning, and healthy adolescents reported significantly higher health-related quality of life than those with chronic illnesses. Conclusion The findings support the initial reliability and validity of the Iranian version of the PedsQL™ 4.0 as a generic instrument to measure HRQOL of adolescents in Iran