Segmental stabilizing exercises and low back pain: What is the evidence?

Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions

Effects of a Health Promotion Program Based on a Train-the-Trainer Approach on Quality of Life and Mental Health of Long-Term Unemployed Persons

Background. Long-term unemployment is associated with poorer mental health. The aim of this study was to evaluate the effectiveness of a health promotion program using the train-the-trainer approach on health-related quality of life (HRQoL) and mental health of long-term unemployed persons. Methods. A prospective parallel-group study was conducted among 365 long-term unemployed persons. 287 participants (179 members of the intervention group IG and 108 members of the control group) were reassessed after three months. The intervention comprised both individual sessions based on Motivational Interviewing and participatory group sessions;no health promotion program was administered in the control group. The endpoints were HRQoL (SF-12),depression, and anxiety. The effect size of the change across time in the IG and CG was measured by Cohen's d. To assess the significance of group differences in the change across time, a random effects model was used. Results. Within three months HRQoL improved and anxiety and depression decreased significantly in the IG. A significant intervention effect was observed for anxiety (p = 0.012). Effect sizes in the IG were small to moderate in terms of Cohen's d (anxiety: d = -0.33; SF-12 mental: d = 0.31; depression: d = -0.25; SF-12 physical: d = 0.19). Conclusions. The health promotion program, based on a train-the-trainer approach, showed positive effects on HRQoL and mental health, especially anxiety, of long-term unemployed persons, a highly burdened target group where an improvement in mental health is a crucial prerequisite to social participation and successful reintegration into the job market

Effects of a Health Promotion Program Based on a Train-the-Trainer Approach on Quality of Life and Mental Health of Long-Term Unemployed Persons

Background. Long-term unemployment is associated with poorer mental health. The aim of this study was to evaluate the effectiveness of a health promotion program using the train-the-trainer approach on health-related quality of life (HRQoL) and mental health of long-term unemployed persons. Methods. A prospective parallel-group study was conducted among 365 longterm unemployed persons. 287 participants (179 members of the intervention group IG and 108 members of the control group) were reassessed after three months. The intervention comprised both individual sessions based on Motivational Interviewing and participatory group sessions; no health promotion program was administered in the control group. The endpoints were HRQoL (SF-12), depression, and anxiety. The effect size of the change across time in the IG and CG was measured by Cohen's d. To assess the significance of group differences in the change across time, a random effects model was used. Results. Within three months HRQoL improved and anxiety and depression decreased significantly in the IG. A significant intervention effect was observed for anxiety (p = 0.012). Effect sizes in the IG were small to moderate in terms of Cohen's d (anxiety: d = −0.33; SF-12 mental: d = 0.31; depression: d = −0.25; SF-12 physical: d = 0.19). Conclusions. The health promotion program, based on a train-the-trainer approach, showed positive effects on HRQoL and mental health, especially anxiety, of long-term unemployed persons, a highly burdened target group where an improvement in mental health is a crucial prerequisite to social participation and successful reintegration into the job market

Self-perceived stress reactivity is an indicator of psychosocial impairment at the workplace

BACKGROUND: Work related stress is associated with a range of debilitating health outcomes. However, no unanimously accepted assessment tool exists for the early identification of individuals suffering from chronic job stress. The psychological concept of self-perceived stress reactivity refers to the individual disposition of a person to answer stressors with immediate as well as long lasting stress reactions, and it could be a valid indicator of current as well as prospective adverse health outcomes. The aim of this study was to determine the extent to which perceived stress reactivity correlates with various parameters of psychosocial health, cardiovascular risk factors, and parameters of chronic stress and job stress in a sample of middle-aged industrial employees in a so-called "sandwich-position". METHODS: In this cross-sectional study, a total of 174 industrial employees were assessed for psychosocial and biological stress parameters. Differences between groups with high and low stress reactivity were analysed. Logistic regression models were applied to identify which parameters allow to predict perceived high versus low stress reactivity. RESULTS: In our sample various parameters of psychosocial stress like chronic stress and effort-reward imbalance were significantly increased in comparison to the normal population. Compared to employees with perceived low stress reactivity, those with perceived high stress reactivity showed poorer results in health-related complaints, depression, anxiety, sports behaviour, chronic stress, and effort-reward imbalance. The educational status of employees with perceived low stress reactivity is higher. Education, cardiovascular complaints, chronic stress, and effort-reward imbalance were moderate predictors for perceived stress reactivity. However, no relationship was found between stress reactivity and cardiovascular risk factors in our sample. CONCLUSIONS: Job stress is a major burden in a relevant subgroup of industrial employees in a middle management position. Self-perceived stress reactivity seems to be an appropriate concept to identify employees who experience psychosocial stress and associated psychological problems at the workplace

Effects of a Health Promotion Program Based on a Train-the-Trainer Approach on Quality of Life and Mental Health of Long-Term Unemployed Persons

Background. Long-term unemployment is associated with poorer mental health. The aim of this study was to evaluate the effectiveness of a health promotion program using the train-the-trainer approach on health-related quality of life (HRQoL) and mental health of long-term unemployed persons. Methods. A prospective parallel-group study was conducted among 365 long-term unemployed persons. 287 participants (179 members of the intervention group IG and 108 members of the control group) were reassessed after three months. The intervention comprised both individual sessions based on Motivational Interviewing and participatory group sessions; no health promotion program was administered in the control group. The endpoints were HRQoL (SF-12), depression, and anxiety. The effect size of the change across time in the IG and CG was measured by Cohen’s d. To assess the significance of group differences in the change across time, a random effects model was used. Results. Within three months HRQoL improved and anxiety and depression decreased significantly in the IG. A significant intervention effect was observed for anxiety (p = 0.012). Effect sizes in the IG were small to moderate in terms of Cohen’s d (anxiety: d=-0.33; SF-12 mental: d=0.31; depression: d=-0.25; SF-12 physical: d=0.19). Conclusions. The health promotion program, based on a train-the-trainer approach, showed positive effects on HRQoL and mental health, especially anxiety, of long-term unemployed persons, a highly burdened target group where an improvement in mental health is a crucial prerequisite to social participation and successful reintegration into the job market

Long-term stability of diurnal salivary cortisol and alpha-amylase secretion patterns

This study aimed to investigate long-term stability and variability of diurnal cortisol and alpha-amylase patterns. Diurnal cortisol and alpha-amylase secretion patterns were assessed on a single workday with three waves of measurement across a total time period of 24months in 189 participants. Separate hierarchical linear models were analyzed, with and without a number of potential predictor variables (age, BMI, smoking, chronic stress, stress reactivity). While low long-term stability was found in diurnal cortisol, the stability of diurnal alpha-amylase was moderate across the time period of 24months. Several predictor variables had a positive impact on diurnal cortisol and alpha-amylase secretion patterns averaged across waves. Our findings underpin the notion that long-term stability is not necessarily warranted in longitudinal studies. It is important to choose an appropriate study design when attempting to disentangle clinically and biologically relevant changes from naturally occurring variations in diurnal cortisol and alpha-amylase

Factors associated with differences in perceived health among German long-term unemployed

<p>Abstract</p> <p>Background</p> <p>Unemployment is associated with reduced physical and psychological well-being. Perceived health is an important factor influencing health outcomes as well as successful returns to work. This study aims to determine the extent to which perceived health correlates with mental health, various health risk characteristics and socio-demographic characteristics in a setting-selected sample of long-term unemployed persons.</p> <p>Methods</p> <p>Using SF-12, 365 long-term unemployed persons were assessed for self-perceived health and various socio-demographic and health characteristics. Perceived health data of the sample was compared to the German SF-12 reference population. Bivariate analyses and multiple linear regression models were applied to identify those variables significantly associated with perceived health.</p> <p>Results</p> <p>The study population reported poorer perceived health compared with the general population. Analyses showed that perceived mental health was significantly worse in women, among persons with heightened depression and anxiety scores, and in participants reporting reduced levels of physical activity. Perceived physical health was significantly lower among older persons, participants with a higher BMI, and participants with heightened depression and anxiety scores. Both mental and physical health were worse among the unemployed assigned to an employment center as compared to those engaged in the secondary labor market. In total, 36% of the variance in the SF-12 mental score and 20% of the variance in the SF-12 physical score were explained by the factors included in the final multiple linear regression models.</p> <p>Conclusions</p> <p>Perceived health among a select group of long-term unemployed is reduced to a clinically relevant extent compared to the general population. The preliminary findings underline an association between mental health and perceived health. Negative self-perceptions of health were also associated with the labor market setting and some of the socio-demographic and health behavior variables. Further research is needed to determine risk factors leading to reduced perceived health in the unemployed. The strong association between mental health and perceived health suggests interventions targeting mental health are urgently needed to positively influence perceived health, a key determinant of individuals’ chances to successfully return to work.</p