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

Effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders: the MI-NAV randomised controlled trial.

OBJECTIVES: To evaluate if adding motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) to usual case management (UC), reduced sickness absence over 6 months for workers on sick leave due to musculoskeletal disorders. METHODS: We conducted a three-arm parallel pragmatic randomised controlled trial including 514 employed workers (57% women, median age 49 (range 24-66)), on sick leave for at least 50% of their contracted work hours for ≥7 weeks. All participants received UC. In addition, those randomised to UC+MI were offered two MI sessions from social insurance caseworkers and those randomised to UC+SVAI were offered vocational advice from physiotherapists (participants with low/medium-risk for long-term sickness absence were offered one to two sessions, and those with high-risk were offered three to four sessions). RESULTS: Median sickness absence was 62 days, (95% CI 52 to 71) in the UC arm (n=171), 56 days (95% CI 43 to 70) in the UC+MI arm (n=169) and 49 days (95% CI 38 to 60) in the UC+SVAI arm (n=169). After adjusting for predefined potential confounding factors, the results showed seven fewer days in the UC+MI arm (95% CI -15 to 2) and the UC+SVAI arm (95% CI -16 to 1), compared with the UC arm. The adjusted differences were not statistically significant. CONCLUSIONS: The MI-NAV trial did not show effect on return to work of adding MI or SVAI to UC. The reduction in sickness absence over 6 months was smaller than anticipated, and uncertain due to wide CIs. TRIAL REGISTRATION NUMBER: NCT03871712

Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: An updated systematic review and meta-analysis including 46 819 men and women.

Objective To update a systematic review on the association between knee extensor muscle weakness and the risk of incident knee osteoarthritis in women and men. Design Systematic review and meta-analysis. Data sources Systematic searches in PubMed, EMBASE, SPORTDiscus, CINAHL, AMED and CENTRAL in May 2021. Eligible criteria for selecting studies Longitudinal studies with at least 2 years follow-up including baseline measure of knee extensor muscle strength, and follow-up measure of symptomatic or radiographic knee osteoarthritis. Studies including participants with known knee osteoarthritis at baseline were excluded. Risk of bias assessment was conducted using six criteria for study validity and bias. Grading of Recommendations Assessments, Development and Evaluation assessed overall quality of evidence. Meta-analysis estimated the OR for the association between knee extensor muscle weakness and incident knee osteoarthritis. Results We included 11 studies with 46 819 participants. Low quality evidence indicated that knee extensor muscle weakness increased the odds of symptomatic knee osteoarthritis in women (OR 1.85, 95% CI 1.29 to 2.64) and in adult men (OR 1.43, 95% CI 1.14 to 1.78), and for radiographic knee osteoarthritis in women: OR 1.43 (95% CI 1.19 to 1.71) and in men: OR 1.39 (95% CI 1.07 to 1.82). No associations were identified for knee injured populations except for radiographic osteoarthritis in men. Discussion There is low quality evidence that knee extensor muscle weakness is associated with incident symptomatic and radiographic knee osteoarthritis in women and men. Optimising knee extensor muscle strength may help to prevent knee osteoarthritis

Defining the presence of radiographic knee osteoarthritis: a comparison between the Kellgren and Lawrence system and OARSI atlas criteria

The Kellgren and Lawrence (K/L) system and Osteoarthritis Research Society International (OARSI) atlas are frequently used to define radiographic knee osteoarthritis (OA). The purpose of the current study was to determine the extent to which tibiofemoral OA rates differ between the K/L system and OARSI atlas criteria and to compare qualitative (K/L and OARSI) and quantitative (millimetres) measures of joint space narrowing (JSN).Posteroanterior radiographs of 1,178 knees, from 621 individuals with varying severity of OA, were graded by a trained physician with the K/L system (grade 0-4) and the OARSI atlas (osteophytes/JSN graded 0-3). Using the K/L system, the presence of OA was defined with the traditional cut-off of ≥grade 2 (definite osteophyte and possible JSN) and an alternative cut-off of at least a definite osteophyte alone (≥grade 2/osteophyte). For the OARSI atlas, OA was considered present if the sum of osteophytes or JSN ≥grade 2, or grade 1 JSN occurred in combination with grade 1 osteophyte. Minimum joint space width (mJSW) was measured manually in millimetres.According to the K/L system (≥grade 2), 167 knees (14.2 %) had tibiofemoral OA and 203 (17.3 %) had ≥grade 2/osteophyte. In contrast, 309 knees (26.2 %) had tibiofemoral OA according to OARSI atlas criteria. K/L and OARSI JSN descriptions were significantly associated with mJSW (p < 0.022).Radiographic tibiofemoral OA was almost twice as common using OARSI atlas criteria compared with the K/L system. This discrepancy is likely to contribute to the large variability of OA prevalence observed in the literature and is important for clinicians to consider when diagnosing radiographic OA. The cut-off for defining radiographic knee OA using the two systems should not be considered comparable.III

Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation

Purpose: To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists’ experiences from delivering the SVAI. Methods: We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results: Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: ‘symptom burden’, ‘managing symptoms’, ‘relations with the workplace’ and ‘fear of not being able to manage work’. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion: Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave

Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: A systematic review and meta-analysis

Background: Knee magnetic resonance imaging (MRI) is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees. Methods: We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (i.e., cartilage defects, meniscal tears, bone marrow lesions, osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs. ≥40 years). Meta-regression explored heterogeneity. Results: We included 63 studies (5,397 knees of 4,751 adults). The overall pooled prevalence of cartilage defects was 24% (95%CI 15-34%) and meniscal tears was 10% (7-13%), With significantly higher prevalence with age: cartilage defect <40 years 11% (6-17%) and ≥40 years 43% (29-57%); meniscal tear <40 years 4% (2-7%) and ≥40 years 19% (13-26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12-24%) and 25% (14-38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis, and risk of bias. Conclusions: Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4-14% in adults aged <40 years to 19-43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision making

Anterior knee pain following anterior cruciate ligament reconstruction does not increase the risk of patellofemoral osteoarthritis at 15- and 20-year follow-ups.

Objective To prospectively evaluate the relationship between the presence or persistence of anterior knee pain (AKP) during the first 2-years following anterior cruciate ligament reconstruction (ACLR) and patellofemoral osteoarthritis (PFOA) at 15- and 20-years. Design This study was ancillary to a long-term prospective cohort study of 221 participants following bone-patellar-tendon-bone ACLR. AKP was assessed at 1- and 2-years post-ACLR using part of the Cincinnati knee score with an additional pain location question (persistence defined as presence at both follow-ups). Radiographic PFOA (definite patellofemoral osteophyte) and symptomatic PFOA (patellofemoral osteophyte, with knee pain during past 4 weeks) was assessed at 15- and 20-years follow-up. We used generalized linear models with Poisson regression to assess the relationship between AKP and PFOA. Results Of the 181 participants (82%) who were assessed at 15-years post-ACLR (age 39 ± 9 years; 42% female), 36 (24%) and 33 (22%) had AKP at 1- and 2-years, respectively, while 14 (8%) reported persistent AKP. Radiographic and symptomatic PFOA was observed at 15-years in 130 (72%) and 70 (39%) participants, respectively, and at 20-years in 115 (80%) and 60 (42%) participants, respectively. Neither the presence nor persistence of AKP at 1- and/or 2-years post-ACLR was associated with significantly higher risk of radiographic or symptomatic PFOA at 15- or 20-years (risk ratios <2.1). Conclusions Although AKP and PFOA were prevalent, AKP does not appear to be associated with long-term PFOA following ACLR

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 three or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (nine 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. Significance: Emerging adulthood is a transitional period of life with changes in life style, potentially influencing future musculoskeletal health. This systematic review included 49 articles evaluating more than 150 potential risk factors for back pain, one of the most prevalent musculoskeletal disorders. No consistent results were found for life style factors such as physical activity level or BMI, both highlighted as important risk factors in previous literature. Importantly, a previous episode of back pain was a consistent risk factor for a new episode of back pain across several studies, and further investigation of risk factors for the first back pain episode is needed