Accumulation of health complaints is associated with persistent musculoskeletal pain two years later in adolescents: The Fit Futures Study

There is limited knowledge on the association between different health complaints and the development of persistent musculoskeletal pain in adolescents. The aims of this study were to assess whether specific health complaints, and an accumulation of health complaints, in the first year of upper-secondary school, were associated with persistent musculoskeletal pain 2 years later. We used data from a population-based cohort study (the Fit Futures Study in Norway), including 551 adolescents without persistent musculoskeletal pain at baseline. The outcome was persistent musculoskeletal pain (≥3 months) 2 years after inclusion. The following self-reported health complaints were investigated as individual exposures at baseline: asthma, allergic rhinitis, atopic eczema, headache, abdominal pain and psychological distress. We also investigated the association between the accumulated number of self-reported health complaints and persistent musculoskeletal pain 2 years later. Logistic regression analyses estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs). At the 2-year follow-up, 13.8% (95% CI [11.2–16.9]) reported persistent musculoskeletal pain. Baseline abdominal pain was associated with persistent musculoskeletal pain 2 years later (OR 2.33, 95% CI [1.29–4.19], p = 0.01). Our analyses showed no statistically significant associations between asthma, allergic rhinitis, atopic eczema, headache or psychological distress and persistent musculoskeletal pain at the 2-year follow-up. For the accumulated number of health complaints, a higher odds of persistent musculoskeletal pain at the 2-year follow-up was observed for each additional health complaint at baseline (OR 1.33, 95% CI [1.07–1.66], p = 0.01). Health care providers might need to take preventive actions in adolescents with abdominal pain and in adolescents with an accumulation of health complaints to prevent development of persistent musculoskeletal pain. The potential multimorbidity perspective of adolescent musculoskeletal pain is an important topic for future research to understand the underlying patterns of persistent pain conditions in adolescents

Risk factors for episodes of back pain in emerging adults. A systematic review

BACKGROUND AND OBJECTIVE: The transition from adolescence to adulthood is a sensitive period in life for health outcomes, including back pain. The objective was to synthesize evidence on risk factors for new episodes of back pain in emerging adults (18-29 years). METHODS: The protocol was registered in PROSPERO (CRD42016046635). We searched Medline; EMBASE; AMED and other databases up to September 2018 for prospective cohort studies that estimated the association between risk factor(s) and self-reported back pain. Risk factors could be measured before or during the age range 18-29 years, and back pain could be measured during or after this age range, with at least 12 months between assessments. Risk factors assessed in ≥3 studies were summarized. Risk of bias was assessed using a 6-item checklist. RESULTS: Forty-nine studies were included with more than 150 different risk factors studied. Nine studies had low risk of bias, 26 had moderate, and 14 had high risk of bias. Age, sex, height, body mass index (BMI), smoking, physical activity level, a history of back pain, job satisfaction and structural imaging findings were investigated in 3 or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (9 studies). CONCLUSION: There is moderate quality evidence that a history of back pain is a risk factor for back pain. There are inconsistent associations for age, sex, height, BMI, smoking, and activity level. No associations were found between job satisfaction and structural imaging findings and back pain. This article is protected by copyright. All rights reserved

Emotional distress was associated withpersistent shoulder pain afterphysiotherapy: a prospective cohort study

Background: There is a paucity of research on the association between psychological factors and persistent shoulder pain. The aim of this study was to investigate whether emotional distress was associated with pain intensity and self-reported disability after physiotherapy treatment in patients with shoulder pain. Methods: Data from 145 patients treated at physiotherapy outpatient clinics aged ≥18 years with self-reported pain in the shoulder or arm, and movement activity problems related to the upper-extremity, were included. Outcome measures were pain intensity measured by Numeric Pain Rating Scale and disability measured by Patient Specific Functional Scale. Demographic and clinical characteristics, including emotional distress measured by Hopkins Symptom Checklist – 25, were obtained at study onset. Association between characteristics at study onset and pain and disability after physiotherapy treatment were analysed using multiple linear regression and a backward manual elimination method. The final models were adjusted for age and sex. Results: Higher emotional distress at study onset (B 1.06, 95% CI 0.44 to 1.68) was associated with higher pain intensity after the physiotherapy treatment (P=0.001). Emotional distress was not associated with self-reported disability after the physiotherapy treatment. Conclusion: This study found that emotional distress at study onset was associated with shoulder pain intensity after physiotherapy treatment, but not with disability. The findings indicate that emotional distress should be included in the initial physiotherapy examination of shoulder pain

En single subject design studie: Ponseti-metoden – med eller uten intensivemanuelle tøyninger

Bakgrunn: Mange norske sykehus har integrert intensive manuelle tøyninger i tillegg til Ponseti-metoden i behandlingen av klumpfot, men det er lite dokumentasjon på om tøyningene har effekt. n Hensikt: Hensikten var å undersøke om en periode uten disse manuelle tøyningene reduserer ankel- og fotbevegelighet i klumpføtter som blir behandlet med Ponsetimetoden. n Metode: Single subject design (SSD). Tre babyer mellom tre og 12 måneder født med totalt fem klumpføtter ble inkludert i studien. Utfallsmålene var grader av dorsalfleksjon, plantarfleksjon, totalt bevegelsesutslag i ankelleddet og forfotsadduksjon. Intervensjonen varte i fire uker. Hyppige målinger med goniometer ble gjort før, under og etter intervensjonen. n Resultater: Resultatene viser en trend mot redusert dorsalfleksjon og totalt bevegelsesutslag i hele perioden uten noen tydelige forandringer i intervensjonsperioden. n Fortolkning: En periode på fire uker uten intensive manuelle tøyninger så ikke ut til å ha innvirkning på ankelbevegeligheten i klumpføtter som ble behandlet med Ponseti-metoden. Randomiserte kontrollerte studier er nødvendige for å evaluere effekten av manuelle tøyninger på klumpføtter

Styrketreningsprogram for kneartrosepasienter: Hva er adekvat dosering for å oppnå effekt av behandling?

Hensikt: Hensikten var å beskrive type øvelser, etterlevelse, dosering og endring i smerte- og funksjonsnivå for et styrketreningsprogram for pasienter med symptomatisk kneartrose. Design: Pre-post design. Materiale: Femtito pasienter mellom 35 og 70 år med symptomatisk og røntgenologisk mild til moderat kneartrose ble inkludert. Metode: Et 12 ukers styrketreningsprogram ble implementert med treningsdagbøker for å innhente data på type øvelser, dosering, og etterlevelse. Utfallsmål var isokinetisk quadriceps muskelstyrke, pasientrapporterte utfallsmål: Knee injury and Osteoarthritis Outcome Score (KOOS), smerteskala (NRS), global endring i funksjon (GRC) og fysisk aktivitet. Resultater: Gjennomsnittlig antall gjennomførte nevromuskulære- og styrkeøvelser per uke var henholdsvis 7,9 ±3,6 og 12,5±3,3. Det var 73% som hadde gjennomført ≥80% av antall treningsøkter. Pasientene hadde gjennomsnittlig 36±25% økning i motstand for kneekstensjonsøvelsen fra uke 1 til uke 12. Det var en høysignifikant økning i quadriceps muskelstyrke, men kun 18% hadde en økning utover minste observerbare endring (MDC). Det var henholdsvis 67%, 18% og 15% som rapporterte at de var bedre, uforandret eller verre i kneet sammenlignet med oppstart. Redusert smertenivå ble rapportert hos 22% av pasientene (NRS). Konklusjon: Majoriteten av pasientene (73%) gjennomførte ≥ 80% av treningsøktene, men dosen var antagelig for lav, da en liten andel pasienter (18%) oppnådde en klinisk relevant økning i quadriceps muskelstyrke og gjennomsnittlig ingen klinisk relevant bedring i pasientrapportert funksjon (KOOS)

Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up

Objectives: To examine the associations between return to pivoting sport following anterior cruciate ligament reconstruction (ACLR) and knee osteoarthritis (OA), self-reported knee symptoms, function, and quality of life after 15 years. Methods: Study sample included 258 participants with ACLR 15 years previously. Return to pivoting sport (handball, soccer, and basketball) data were collected by interviews, and symptomatic OA was defined as Kellgren-Lawrence grade ≥2 plus almost daily knee pain in the last month. Self-reported symptoms, function and quality-of-life were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Adjusted regression models were used to analyze the associations between return to pivoting sport and OA (present or not), and self-reported outcomes. P-values ≤ 0.05 were considered statistically significant. Results: Two hundred and ten (81%) participants (57% men) with mean age 39.1 (±8.7) years completed the 15-year follow-up, and 109 (52%) had returned to pivoting sport. Returning to pivoting sport was associated with less symptomatic OA (OR 0.28, 95% CI 0.09, 0.89) and radiographic OA (OR 0.40, 95% CI 0.17, 0.98), adjusted for age, sex, combined injury, self-reported knee function, and time between injury and surgery. Those who returned to pivoting sport had better function in activities of daily living (ADL). Conclusion: The participants with ACLR who returned to pivoting sport had lower odds of knee OA, and better self-reported ADL function. Further investigation is required to understand the clinical significance of these findings