Psychological interventions in preventing chronicity of sub-acute back pain : a systematic review

Objectives: There is scarce information on preventive psychological and behavioural methods applicable to sub-acute (4-12 weeks) back pain, a precursor to chronic back pain. We conducted a systematic literature review of the efficacy of psychological interventions in preventing chronicity of sub-acute back pain. Methods: A systematic literature search in CINAHL, CENTRAL, MEDLINE, PubMed(R), PsychINFO, Scopus and Web of Science databases. Results: From a total of 271 records, only three studies met the eligibility criteria. In two of the reviewed studies, the interventions had an insignificant preventive impact on the chronification of back pain. In one study the CBT intervention proved promising in preventing back pain related disability. None of the studies reported a significant impact on pain intensity at follow-up. Conclusions: The psychological interventions did not impact pain outcomes. There is a disproportion between novel knowledge on psychological factors involved in the transition to chronic pain and corresponding preventive treatments. Additional studies on psychological interventions on sub-acute back pain prevention are highly warranted due to the enormous burden that back pain creates when it becomes chronic. The research project has the ethical approval of the Research Ethical Committee at Helsinki University Hospital, HUS/2435/2017.Peer reviewe

Functional Tests Predicting Return to Work of Workers with Non-Specific Low Back Pain: Are There Any Validated and Usable Functional Tests for Occupational Health Services in Everyday Practice? A Systematic Review

The literature predominantly advocates subjective perception of disability and pain as an outcome measure for the functional evaluation of patients with low back pain (LBP). Physical outcome measurements are almost completely ignored. In this systematic review, we focused on physical functional measurements that can contribute to the prediction of patients’ return to work (RTW) readiness after sick leave or rehabilitation. Searches were conducted in July 2022 without any time limit in the Cochrane Library, PEDro, PubMed and Scopus databases for functional and clinical tests reliable and applicable in clinical practice without demanding equipment. Two independent researchers extracted the data from the included articles in a standardised data collection form, and a third researcher validated the data extraction. No date restriction was applied. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in conducting the review. We found seven original articles, including six with an impact on predicting RTW. We found four fair and three poor original studies fulfilling our criteria. We found the Back Performance Scale (BPS) and back endurance test to be the most promising tests for occupational health service and the clinical practitioner. Radiation of back pain, with or without neurological deficiencies, had some predictive value in terms of RTW, too. The working conditions vary a lot, which causes inconsistency in the studies and in their interpretation. Functional tests could complete the widely used working ability evaluations methods such as the Work Ability Index (WAI) and are worth considering for future research. Overall, more research is needed in this field. The question of when LBP patients can resume everyday activities and work is not possible to determine with functional tests alone. Psychosocial aspects and work demands must be considered. PROSPERO: CRD42022353955. The study was funded by the University of Helsinki

Study protocol of a mixed method pragmatic quasi-experimental trial to evaluate the day activity services targeted at older home care clients in Finland

Background: In Finland, the ‘day activity service’ is targeted at older home care clients who are unable to participate in other available activities due to poor health or functional disabilities. The aim of the day activity service is to support home care client’s ability to live at home and to enhance their wellbeing and social inclusion. This mixed method study examines the effectiveness, cost-effectiveness and process of the day activity service. Methods: The target sample size is 200 participants. The intervention group (n = 100) is composed of home care clients who begin to participate in the day activity service. The comparison group (n = 100) are home care clients who do not participate in the day activity service, and whose functioning and care needs are similar to the participants of the intervention group. The primary outcome is social inclusion (ESIS-scale). Secondary outcomes are loneliness (single item and De Jong Gierveld Loneliness Scale) and social care related quality of life (ASCOT). Baseline, three-month and six-month follow-up surveys are gathered from intervention and comparison group participants in order to compare outcomes between groups pre- and post-intervention. Costs of health and social services, based on administrative data, and the costs of the intervention are utilized in examining the cost-effectiveness of the intervention with the above-described measurements. Qualitative data are collected by interviewing the intervention participants (n = 10) and professionals working at the day activity centres and older people’s services (4 focus groups) to explore the perceived outcomes and process of the intervention to find out how and why the intervention is effective or ineffective. Discussion: The study seeks to produce a comprehensive understanding of the effectiveness, cost-effectiveness and implementation process of the day activity service. Trial registration: ISRCTN13146087, Registration date 03/04/2022

ISSLS prize in clinical science 2022 : accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers

Purpose In this prospective observational cohort study, the development of lumbar intervertebral discs (LIVD) on magnetic resonance imaging (MRI) was investigated from childhood to adulthood with emphasis on the possible association of disc degeneration (DD) to low back pain (LBP). Methods In 2021, 89 subjects who were enrolled in 1994 in a longitudinal study with lumbar spine MRI at ages 8, 11 and 18 were invited to participate in a long-term follow-up comprising a clinical examination, selected patient-reported outcome measures and a lumbar spine MRI. We assessed all MRIs (three lowest LIVDs) with the Pfirrmann summary score, and the ratio of signal intensity of nucleus pulposus to signal intensity of cerebrospinal fluid (SINDL). We further analyzed whether disc changes at any age were associated with self-reported LBP at age 34. Results Of the 48 subjects in the follow-up, 35 reported LBP at age 34. The Pfirrmann summary score significantly increased with age (p < 0.001). Subjects reporting LBP at age 34 demonstrated statistically significantly higher summary scores at age 18 and 34 compared to asymptomatic subjects (p = 0.004 at age 18, and p = 0.039 at age 34). SINDL significantly decreased with age (p < 0.001 for all levels separately), but no significant differences between subjects with or without LBP at age 34 were noticed. Conclusion Subjects with LBP at age 34 had more widespread or severe DD already at age 18 compared to those without LBP.Peer reviewe

The intervertebral disc during growth : Signal intensity changes on magnetic resonance imaging and their relevance to low back pain

Funding Information: This research (official recipient: DS) was supported by The Research Institute of the Invalid Foundation (later Research Institute Orton) through grants by the Ministry of Social Affairs and Health in Finland (Project Identification Number A2500/ 465), and by the Siviä Kosti Foundation of the Invalid Foundation in Helsinki, Finland. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 Lund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Life-time prevalence of low back pain (LBP) in children and adolescents varies from 7% to 72%. Disc changes on magnetic resonance imaging (MRI) have been reported in up to 44% of children with earliest observations around pre-puberty. In this longitudinal cohort study, our objective was to determine the natural history of disc changes from childhood to early adulthood, and the possible association of these changes to LBP. Healthy 8-year-old schoolchildren were recruited for this longitudinal study consisting of a semi-structured interview, a clinical examination, and an MRI investigation at the age of 8–9 (Y8), 11–12 (Y12) and 18–19 (Y19) years. The interview inquired about LBP without trauma. T2-weighted sagittal MRI of the lumbar spine was acquired. Life-long prevalence of LBP was determined, and the disc signal intensity (SI) at the three lowest lumbar levels was assessed both visually using the Schneiderman classification (Bright-Speckled-Dark), and digitally using the disc to cerebrospinal fluid -SI ratio. Possible associations between SI changes and LBP were analyzed. Ninety-four of 208 eligible children were included at Y8 in 1994, 13 and 23 participants were lost to follow-up at Y12 and Y19, respectively. Prevalence of LBP increased after the pubertal growth spurt reaching 54% at Y19. On MRI, 18%, 10% and 38% of participants had disc SI changes at Y8, Y12 and Y19, respectively. No significant associations between self-reported LBP and either qualitative or quantitative disc SI changes were observed at any age. Life-time prevalence of LBP reached 54% by early adulthood. Disc SI changes on MRI traditionally labeled as degenerative were seen earlier than previously reported. Changes in disc SI were not associated with the presence of LBP in childhood, adolescence or early adulthood.Peer reviewe

Violists and Violinists Report More Intense Hand Pain on NRS Than Other Orchestra Musicians

Aims: Among musicians, string players have the highest prevalence for musculoskeletal overuse. Playing a violin or viola requires rapid, repetitive, and complicated movements of the hands and fingers. This cross-sectional study aimed to examine whether violin/viola, violin/cello, and violin/French horn players experience more intense musculoskeletal pain than other instrumentalists.Methods: The study sample consisted of 590 orchestra musicians (354 male, 236 female, mean age 36 yrs). Self-administered questionnaires were used to assess pain of the back, neck, shoulder, face, jaw, and upper extremity. Pain intensity during the last 7 days was measured by an 11-point numeric rating scale (NRS) with a score from 0 to 10, as well as was disadvantage at work and leisure.Results: Of the interviewed musicians, 20% presented playing-related musculoskeletal disorders at the time of the interview. Compared to other professional orchestra musicians, violin and viola players reported significantly more intense pain in the hand during the last week. Also, they had experienced more frequent neck pain ever and in 5 years than the others. During the past 30 days, violin and viola players had also perceived more harm in their upper limb joints. Violin/cello and violin/French horn players did not differ from the others.Conclusions: Our study showed that musicians playing the violin or viola have more intense hand pain and more frequent neck pain than other musicians, but these seem to disturb their daily tasks only a little.</p

Convergent Validity of Thoracic Outlet Syndrome Index (TOSI)

No disease-specific evaluation score for thoracic outlet syndrome (TOS) patients was available prior to the presentation of the Thoracic Outlet Syndrome Index (TOSI) score. Our aim was to assess the convergent validity of the TOSI when compared with the short form of Disabilities of the Arm, Shoulder and Hand (QDASH), the Cervical Brachial Symptom Questionnaire (CBSQ), and pain numeric rating scale (painNRS) after supraclavicular rib-sparing decompression for neurogenic TOS. The TOSI takes into account five domains important to TOS patients with 15 questions, whereas QDASH considers only four domains, and CBSQ and painNRS each has only one domain. Our 67 TOS patients, mean age 36.5 years at surgery, were evaluated clinically for a mean 13.2 years after rib-sparing surgery. They completed the QDASH, the CBSQ, the pain NRS, and the TOSI questionnaires. Correlations between TOSI total score and QDASH, CBSQ total scores, and the painNRS were strong: 0.67 for TOSI vs. QDASH; 0.75 for TOSI vs. CBSQ; and 0.65 for TOSI vs. painNRS. The TOSI demonstrated good convergent validity. It may thus become a valuable addition among tools for assessing the quality of life and functioning of those with neurogenic thoracic outlet syndrome as well as for improving comparability of results across varying settings in this field.</p

Rintakehän yläaukeaman oireyhtymä - toiminnallinen yläraajavaiva

English summary: Thoracic outlet syndromePeer reviewe

Sports injuries in Finnish elite cross-country skiers, swimmers, long-distance runners and soccer players

In sports with different exercise-loading characteristics, acute and overuse injury profiles and gender differences in injuries were investigated. In addition, trainingrelated risk factors for overuse injuries in endurance athletes were studied. This twelve-month retrospective questionnaire study comprised Finnish elite crosscountry skiers (n=149), swimmers (n=154), long-distance runners (n=143) and soccer players (n=128) aged 15–35 years. Questionnaires were sent to the athletes in each sports at the end of the 2006 competition season. Athletes who ended their sports career because of injury were studied in more detail by means of a telephone interview (n=20) 7-11 months after the questionnaire. Over 70% of soccer players and one-third of endurance athletes had sustained at least one acute injury during the past twelve months. In soccer players and cross-country skiers the most common acute injury site was the ankle. In skiers, acute and overuse injuries occurred mainly in sports other than their own sports and the same was true for acute injuries in swimmers. However, overuse injuries in swimmers mainly originated from swimming, with the shoulder region as the most common anatomical site. Nearly every second athlete reported at least one overuse injury, with the highest injury frequency, most commonly in the foot, occurring among long-distance runners. Soccer players and runners reported absences of nearly two months on average from training and competitions owing to acute or overuse injury. Male athletes had higher prevalence of at least one acute injury, and among runners males had more commonly at least one overuse injury than females. Among endurance athletes, vigorous training, defined as more than 700 hours/year, and rest and recovery time of less than two days a week in the training season predisposed to overuse injury. Older athletes had higher risk for overuse injury, and especially tendon overuse injury. Female athletes (13%) ended their career more often because of injury than male athletes (5%). The most prevalent injury was in the knee, shoulder or ankle. Most sports career terminators (70%) reported injury-related mild or moderate permanent disability. In conclusion, type of loading was strongly associated with the anatomical location of an overuse injury. In cross-country skiing and swimming a significant proportion of acute injuries occurred in other than the athlete’s main sports. Vigorous athletic training without sufficient rest and recovery time may be a risk factor for an injury, especially an overuse injury. Severe injuries may terminate an athlete´s sports career and cause permanent disability