Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: Study protocol of a randomized clinical trial [NCT00257998]

BACKGROUND: Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR. METHODS/DESIGN: Consecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Following the baseline examination patients will be randomly assigned to receive the lumbopelvic manipulation used in the development of the CPR, an alternative lumbar manipulation technique, or non-thrust lumbar mobilization technique for the first 2 visits. Beginning on visit 3, all 3 groups will receive an identical standard exercise program for 3 visits (visits 3,4,5). Outcomes of interest will be captured by a therapist blind to group assignment at 1 week (3(rd )visit), 4 weeks (6(th )visit) and at a 6-month follow-up. The primary aim of the study will be tested with analysis of variance (ANOVA) using the change in OSW score from baseline to 4-weeks (OSW(Baseline )– OSW(4-weeks)) as the dependent variable. The independent variable will be treatment with three levels (lumbo-pelvic manipulation, alternative lumbar manipulation, lumbar mobilization). DISCUSSION: This trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR

Low back pain among female nurses in Yemen

Objectives: This study aimed to investigate the prevalence of Low Back Pain (LBP) among female nursing staff and explore the potential risk factors associated with LBP. Methods: An analytical cross-sectional study was conducted on randomly selected female nurses using payroll as a sampling frame in all public hospitals in Sana'a City, Yemen. Data was collected through face-to-face interview using a structured, pre-coded questionnaire that was available in Arabic and English. Weight and height of the nurses were measured using weight and height scales and body mass index was calculated. Multiple logistic regression was used to identify the factors associated with LBP. Results: Out of 696 female nurses selected, 687 (98.7%) responded. The life-time, the 12-month and one-week prevalence rates of LBP among female nurses were 512 (74.5%; 95% CI: 71.1-77.7%), 411 (59.8%; 95% CI: 56.0-63.5%) and 249 (36.2%; 95% CI: 32.6-39.9%), respectively. The prevalence was significantly lower in Indian nurses compared to other nurses. Three out of every 10 nurses with LBP had sick leave because of LBP in the last 12 months. Factors that showed significant association with LBP among nursing staff in the multivariate analysis were age, nationality, menstrual disorders and stress level at work. Conclusion: LBP is common among female nurses in Yemen. The role of menstrual disorders in developing LBP among female nurses seems to be important. Although sharing the same working conditions, Indian nurses were less likely to report LBP, which highlight the importance of cultural differences in willingness to report LBP

Outcome of non-invasive treatment modalities on back pain: an evidence-based review.

At present, there is an increasing international trend towards evidence-based health care. The field of low back pain (LBP) research in primary care is an excellent example of evidence-based health care because there is a huge body of evidence from randomized trials. These trials have been summarized in a large number of systematic reviews. This paper summarizes the best available evidence from systematic reviews conducted within the framework of the Cochrane Back Review Group on non-invasive treatments for non-specific LBP. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated with additional trials, if available. Traditional NSAIDs, muscle relaxants, and advice to stay active are effective for short-term pain relief in acute LBP. Advice to stay active is also effective for long-term improvement of function in acute LBP. In chronic LBP, various interventions are effective for short-term pain relief, i.e. antidepressants, COX2 inhibitors, back schools, progressive relaxation, cognitive–respondent treatment, exercise therapy, and intensive multidisciplinary treatment. Several treatments are also effective for short-term improvement of function in chronic LBP, namely COX2 inhibitors, back schools, progressive relaxation, exercise therapy, and multidisciplinary treatment. There is no evidence that any of these interventions provides long-term effects on pain and function. Also, many trials showed methodological weaknesses, effects are compared to placebo, no treatment or waiting list controls, and effect sizes are small. Future trials should meet current quality standards and have adequate sample size