A Health- and Resource-Oriented Perspective on NSLBP

Nonspecific low back pain (NSLBP) is an important health issue of our time. Personal as well as economic factors, like suffering pain and experiencing disability on the one hand and enormous and still increasing costs to the economy and society on the other hand, display the importance of the matter. Tremendous research has been conducted in the last few decades on NSLBP. A PubMed search (June 17, 2013) on “low back pain” provided 22,980 hits, and when specifying for “low back pain, systematic review,” 3,134 hits were still generated. Most research has been done examining the development, risk factors, or therapeutic measures of NSLBP, but hardly any literature exists on resources related to NSLBP. The aims of this review are twofold. In order to shade light on the salutogenetic approach of NSLBP, and thus to focus on health instead of illness, the first aim is to facilitate the understanding of which therapeutic measures enhance the ability to cope with chronic NSLBP and enable (more) normal functioning in life. The second aim is to stimulate the understanding of resources protecting against the onset of NSLBP or against the development of chronic NSLBP and its resulting work absence

Musculoskeletal and cognitive effects of stochastic resonance whole body vibration: a randomized controlled trial

Introduction: We investigated the acute musculoskeletal and cognitive effects of stochastic resonance whole-body vibration (SR-WBV). To our knowledge, no study looked at the effects of SR-WBV on inhibitory control so far. Materials and Methods: In this randomized controlled trial, participants were randomly allocated into a verum (6 Hz, SR-WBV) or sham (2 Hz, SR-WBV) condition. Inhibitory control was measured with the Stroop Test before and after the exercise. Also, muscle stiffness, muscle relaxation, sense of balance and surefootedness were assessed in a questionnaire before and after the exercise. Results: Inhibitory control increased significantly after verum SR-WBV (t = 2.949, P = 0.018), but not after sham SR-WBV (t = 1.165, P = 0.252). Muscle stiffness decreased significantly after verum (t = 5.273, P < 0.000), but not after sham SR-WBV (t = 1.533, P = 0.135). Also, muscle relaxation increased significantly after verum (t = -2.879, P = 0.007), but not after sham SR-WBV (t = -1.650, P = 0.108). Sense of balance increased significantly after verum (t = -2.061, P = 0.047), but not after sham SR-WBV (t = 0.347, P = 0.730). No significant effect was found in surefootedness, whether after verum (t = -0.966, P = 0.341) nor after sham SR-WBV (t = 0.849, P = 0.402). Conclusions: SR-WBV seems to be an appropriate method to improve not only physiological measurements but newly also cognition, i.e. inhibitory control. In this study we could show that SR-WBV exercise reduces interference and increases inhibitory control in a young and healthy sample. Keywords: Stochastic resonance whole body vibration (SRWBV); Musculoskeletal effects; Cognitive effects; Inhibitory control; Randomized controlled trial

Transition from Acute to Persistent Low Back Pain: Do Fear-Avoidance Beliefs, Magnification, and Helplessness Cognitions Screen Best at First Medical Consultation or Afterwards at 3-, 6-, or 12-Week Follow-Up?

Introduction There is a gap in the knowledge regarding the ideal time point to screen patients at risk of developing persistent LBP. Therefore, our research question was, “what is the best time point to identify patients with acute/subacute LBP at risk of developing persistent LBP at 6 months”? The aim of our study was to identify, in a group of patients presenting to a health practitioner with a new episode of LBP, the key time point at which those at risk of developing persistent LBP can be best detected. Materials and Methods Prospective cohort study of patients presenting to a health practitioner with a new episode of acute/subacute LBP. Patients were assessed at baseline and at 3, 6, 12 weeks and 6 months looking at factors of “maladaptive cognition” (fear-avoidance beliefs, magnification, helplessness) as potential predictors. Multivariate logistic regression analysis was performed for all time points. Results The best time point to predict the development of persistent LBP at 6 months was the 12-week follow-up (sensitivity 52%; overall predictive value 75%). The odds ratio of predicting persistent LBP was 1.77 for the index “maladaptive cognition” (95% CI, 1.04–3.03). The 6-week follow-up assessment was the next best time point (sensitivity 43%; overall predictive value 73%). The odds of predicting persistent LBP were 1.63 for the index “maladaptive cognition” (95% CI, 1.02–2.62). Even after 3 weeks, maladaptive cognitions were predictive whereas cognitions assessed at first visit to a health practitioner were not. Conclusion Our study revealed that maladaptive cognitions at 12 and at 6 weeks are suitable predictors for a transition from acute to persistent LBP in primary care. After 3 weeks, patients were present to a health care practitioner with an episode of acute/subacute, LBP cognitions influence the development of persistent LBP. Consequently, according to our results, patients at risk of developing persistent LBP should not be screened at baseline but rather at a later time point such as the 12- or 6-week follow-up for a better overall predictive value. Furthermore, cognitive behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared </jats:sec

Who is likely to develop persistent low back pain? A longitudinal analysis of prognostic occupational factors

Introduction Socioeconomic costs of persistent low back pain (LBP) exceed the costs of acute and subacute LBP by far. This makes the early identification of patients at risk of developing persistent LBP essential. By differentiating risk from protective factors, these factors could be addressed proactively to limit the associated socioeconomic burden. Aim of our study was to identify factors influencing the progression of acute/subacute LBP to the persistent state. Materials and Methods This is a prospective cohort study of patients attending a health practitioner for their first episode of acute/subacute LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical, and demographic/lifestyle factors and followed up over 6 months according to the recommendations from the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender, and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model. Results The final four-predictor model predicted 51% of variance of persistent LBP and included “resigned attitude towards the job” (OR 1.73; 95% CI, 1.16–2.59), “social support at work” (OR 0.54; 95% CI, 0.32–0.90), “functional limitation” (OR 1.05; 95% CI, 1.01–1.10), and “duration of LBP” (OR 1.04; 95% CI, 1.02–1.06). The accuracy of the model was 83%, with 92% of nonpersistent and 67% of persistent LBP patients correctly identified. Conclusion In this study of patients with acute/subacute LBP, “resigned attitude towards the job” increased the likelihood of persistent LBP at 6 months. Addressing this factor with workplace interventions has the potential to modify the outcome. “Social support at work” was a protective factor meaning that development of persistent LBP was less likely. It can therefore be considered as a resource for prevention of persistent LBP. Findings from this study confirm the requirement for measurement of occupational factors in screening tools for patients at risk of developing persistent LBP. Further research is required to investigate different types of social support at work regarding their prognostic influence on the development of persistent LBP. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared </jats:sec

Predictors of sickness absence in patients with a new episode of low back pain in primary care

Introduction Although there is a call for early risk prediction of sickness absence, specific prognostic factors of low back pain (LBP) related sickness absence have not yet been established in either clinical or research settings. This study examines predictors of sickness absence in patients presenting to a health practitioner with acute/subacute LBP. The aims of our study were twofold: (1) To identify baseline variables that detect patients with a new LBP episode at risk of sickness absence; and (2) To identify prognostic models for sickness absence at different time points after initial presentation. Materials and Methods Prospective cohort study investigating 310 patients presenting to a health practitioner with a new episode of LBP at baseline, 3-, 6-, 12-week, 6-month follow-up, addressing work-related, psychological, and biomedical factors. Multivariate logistic regression analysis was performed to identify baseline predictors of sickness absence at different time points. Results The best prognostic model comprised “job control”, “depression,” and “functional limitation” as predictive baseline factors of sickness absence at 6-week follow-up (sensitivity 43.5; specificity 96.5; overall predictive value 89.0) with “job control” being the best single predictor (OR 0.49; 95% CI, 0.27–0.89). This model explained 46% of variance of sickness absence at 6-week follow-up ( p &lt; 0.001). The second best model included “job control” (OR 0.64; 95% CI, 0.42–0.96) as the only significant predictive baseline factor for sickness absence at 3-week follow-up (sensitivity 45.2; specificity 94.7; overall predictive value 83.9). This model explained 39% of variance of sickness absence ( p &lt; 0.001). Sickness absence at a time point beyond 6 weeks could not be predicted. Conclusion For patients with acute/subacute LBP, the model has the greatest predictive ability for sickness absence at 6 weeks after initial presentation to a health practitioner. The prediction of sickness absence beyond 6 weeks is limited, and health practitioners should re-assess patients at 6 weeks, especially if they have previously been identified as at risk of sickness absence. This would allow timely intervention with measures designed to reduce the likelihood of prolonged sickness absence. Further research is warranted investigating assessment at different time points, to identify the optimal time at which to reassess at risk acute/subacute LBP patients to accurately predict sickness absence. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared </jats:sec

Course of Recovery in Patients with Acute Low Back Pain: Does Depression Matter?

Introduction While there is extensive knowledge on the course of acute low back pain (LBP), little is known about the course of recovery of acute LBP patients as a function of depression. The aims of our study were to determine if the course of recovery in patients with acute LBP differs in relation to the presence/absence of depression and to identify the best time point for an intervention against LBP-associated depression. Materials and Methods This is a prospective cohort study of 286 patients with acute LBP. Patients were assessed at baseline and followed up over 6 months addressing psychological, occupational, biomedical, and demographic/lifestyle factors. Recovery was defined as improvement in functional limitation measured by the Oswestry disability index (ODI); depression was defined by the Zung depression scale. Repeated-measures analysis of covariance (ANCOVA) was employed with ODI as repeated factor, age, gender, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. A second ANCOVA was performed with depression as dependent variable and functional limitation, pain intensity, and job stressors as potential predictor variables. Results A total of 18% of study participants were classified as depressive. In these patients, the course of recovery was slower than in nondepressive patients. ODI scores in the nondepression-LBP group decreased over time, whereas scores in the depression-LBP group remained at the same level (F(3.295, 431.607) = 4.63; p &lt; 0.01, partial η2 = 0.034; Fig. 1). High functional limitation (F(1.261) = 15.79; p &lt; 0.001, partial η2 = 0.057), high pain intensity (F(1.260) = 6.84; p &lt; 0.01, partial η2 = 0.026), and a high job stressor index (F(1.252) = 8.95; p &lt; 0.01, partial η2 = 0.034) were predictors of depression at baseline. Further, the presence of depression caused maintenance of LBP especially after 6 weeks. Conclusion The presence of depression has a negative influence on the course of recovery in patients presenting with a new episode of LBP. Therefore, depression should be included in screening instruments for patients with acute LBP to identify those at risk of delayed recovery at an early stage. Further research is required investigating interventions at different time points, to identify the optimal time at which to treat acute LBP patients with concomitant depression to reduce the socioeconomic costs of delayed recovery. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared </jats:sec

Assessing Psycho-social Barriers to Rehabilitation in Injured Workers with Chronic Musculoskeletal Pain: Development and Item Properties of the Yellow Flag Questionnaire (YFQ)

Purpose: To develop a multidimensional scale to asses psychosocial beliefs-the Yellow Flag Questionnaire (YFQ)-aimed at guiding interventions for workers with chronic musculoskeletal (MSK) pain. Methods: Phase 1 consisted of item selection based on literature search, item development and expert consensus rounds. In phase 2, items were reduced with calculating a quality-score per item, using structure equation modeling and confirmatory factor analysis on data from 666 workers. In phase 3, Cronbach's α, and Pearson correlations coefficients were computed to compare YFQ with disability, anxiety, depression and self-efficacy and the YFQ score based on data from 253 injured workers. Regressions of YFQ total score on disability, anxiety, depression and self-efficacy were calculated. Results: After phase 1, the YFQ included 116 items and 15 domains. Further reductions of items in phase 2 by applying the item quality criteria reduced the total to 48 items. Phase factor analysis with structural equation modeling confirmed 32 items in seven domains: activity, work, emotions, harm & blame, diagnosis beliefs, co-morbidity and control. Cronbach α was 0.91 for the total score, between 0.49 and 0.81 for the 7 distinct scores of each domain, respectively. Correlations between YFQ total score ranged with disability, anxiety, depression and self-efficacy was .58, .66, .73, -.51, respectively. After controlling for age and gender the YFQ total score explained between R2 27% and R2 53% variance of disability, anxiety, depression and self-efficacy. Conclusions: The YFQ, a multidimensional screening scale is recommended for use to assess psychosocial beliefs of workers with chronic MSK pain. Further evaluation of the measurement properties such as the test-retest reliability, responsiveness and prognostic validity is warranted

Emotion work and musculoskeletal pain in supermarket cashiers: a test of a sleep-mediation model

Repetitive movement and a lack of postural change are known risk factors for musculoskeletal pain in cashiers. This study tests emotional dissonance – the demand to keep being polite to impolite customers – as an additional risk factor. Furthermore, sleep problems are expected to mediate the link between emotion work and musculoskeletal pain. Data contains 103 female supermarket cashiers from three supermarkets of a large retailer responded to a questionnaire (participation rate 60.6%). An open question asked for the most negative job facets in daily work. Standardized questionnaire were used to assess emotional dissonance, sleep problems and musculoskeletal pain. Responses to the open question showed experience of unkind customers as the most prevalent negative experience at work reported by 47.6% of cashiers, followed by prolonged sitting (8.7%). Emotional dissonance was a significant predictor of neck and back pain when BMI, age, part-time work, and change of hand function during their shift (work rotation) were controlled (β = .30, p < .01). Moreover, sleep problems were confirmed as a mediator with respect to neck and back pain (B = .21, SE = .10, CI = 02–.22). No mediation was found in prediction of pain in arms and shoulders or hips, legs, and feet. Emotional dissonance in work of cashiers appeared as a unique risk factor of neck and back pain. Work design should pay more attention to the social demands of cashier work

Beyond physiology: Acute effects of side-alternating whole-body vibration on well-being, flexibility, balance, and cognition using a light and portable platform A randomized controlled trial.

A good body-balance helps to prevent slips, trips and falls. New body-balance interventions must be explored, because effective methods to implement daily training are sparse. The purpose of the current study was to investigate acute effects of side-alternating whole-body vibration (SS-WBV) training on musculoskeletal well-being, flexibility, body balance, and cognition. In this randomized controlled trial, participants were randomly allocated into a verum (8.5 Hz, SS-WBV, N = 28) or sham (6 Hz, SS-WBV, N = 27) condition. The training consisted of three SS-WBV series that lasted one-minute each with two one-minute breaks in between. During the SS-WBV series, participants stood in the middle of the platform with slightly bent knees. During the breaks in between, participants could loosen up. Flexibility (modified fingertip-to-floor method), balance (modified Star Excursion Balance Test), and cognitive interference (Stroop Color Word Test) were tested before and after the exercise. Also, musculoskeletal well-being, muscle relaxation, sense of flexibility, sense of balance, and surefootedness were assessed in a questionnaire before and after the exercise. Musculoskeletal well-being was significantly increased only after verum. Also, muscle relaxation was significantly higher only after verum. The Flexibility-Test showed significant improvement after both conditions. Accordingly, sense of flexibility was significantly increased after both conditions. The Balance-Test showed significant improvement after verum, and after sham. Accordingly, increased sense of balance was significant after both conditions. However, surefootedness was significantly higher only after verum. The Stroop-Test showed significant improvement only after verum. The current study shows that one SS-WBV training session increases musculoskeletal well-being, flexibility, body balance and cognition. The abundance of improvements on a light and portable platform has great influence on the practicability of training in daily life, aiming to prevent slip trips and falls at work