References: Low Back Pain; Volume 3 Issue 5

1.AUTHOR	Savage-R-A, Whitehouse-G-H, Roberts-N
INSTITUTION	Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, UK.
TITLE	The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males.
SOURCE	Eur-Spine-J 1997, VOL: 6 (2), P: 106-14, ISSN: 0940-6719.
ABSTRACT	The purpose of this study was to undertake a critical review of the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP) and to determine if there were differences in the MRI appearances between various occupational groups. The study group, 149 working men (78 aged 20-30 years and 71 aged 31-58 years) from five different occupations (car production workers, ambulance men, office staff, hospital porters and brewery draymen), underwent MRI of the lumbar spine. Thirty-four percent of the subjects had never experienced LBP. Twelve months later, the examination was repeated on 89 men. Age-related differences were seen in the MRI appearances of the lumbar spine. Disc degeneration was most common at L5/S1 and was significantly more prevalent (P < 0.01) in the older age group (52%) than in the younger age group (27%). Although LBP was more prevalent in the older subjects there was no relationship between LBP and disc degeneration. No differences in the MRI appearance of the lumbar spine were observed between the five occupational groups. Overall, 45% had 'abnormal' lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression). There was not a clear relationship between the MRI appearance of the lumbar spine and LBP. Thirty-two percent of asymptomatic subjects had 'abnormal' lumbar spines and 47% of all the subjects who had experienced LBP had 'normal' lumbar spines. During the 12-month follow-up period, 13 subjects experienced LBP for the first time. However, there was no change in the MRI appearances of their lumbar spines that could account for the onset of LBP. Although MRI is an excellent technique for evaluating the lumbar spine, this study shows that it does not provide a suitable pre-employment screening technique capable of identifying those at risk of LBP. Author.

2.AUTHOR	van-der-Weide-W-E, Verbeek-J-H, van-Tulder-M-W.
INSTITUTION	Coronel Institute for Occupational and Environmental Health, University of Amsterdam, The Netherlands.
TITLE	Vocational outcome of intervention for low-back pain.
SOURCE	Scand-J-Work-Environ-Health 1997 Jun, VOL: 23 (3), P: 165-78, ISSN: 0355-3140.
ABSTRACT	Practical management guidelines for occupational health physicians are needed for the individual support of employees with low-back pain. In this study the level of evidence regarding the efficacy of intervention with vocational outcome parameters was assessed. In a systematic literature search, 40 randomized clinical trials on different types of intervention were retrieved. Their internal validity and statistical power criteria were assessed. The randomization procedure, blinding of patients, and sample size were problematic in most studies. For patients with acute low-back pain limited or moderate evidence was found for the efficacy of no bed rest, a short period of bed rest, and spinal manipulation. For chronic patients limited evidence was found for the efficacy of antidepressants. For the other types of intervention, studies with sufficient statistical power were lacking. Such studies are needed before more-detailed evidence-based guidelines can be formulated for occupational health care. Author.

3.AUTHOR	van-den-Hoogen-H-J, Koes-B-W, Deville-W, van-Eijk-J-T, Bouter-L-M.
INSTITUTION	Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
TITLE	The prognosis of low back pain in general practice.
SOURCE	Spine 1997 Jul 1, VOL: 22 (13), P: 1515-21, ISSN: 0362-2436.
ABSTRACT	STUDY DESIGN: A prospective cohort study on low back pain in consecutive patients in general practice, in which potential prognostic indicators at baseline and at the 1-year follow-up examination were assessed by means of four weekly questionnaires. OBJECTIVES: To identify prognostic indicators of the duration of low back pain in general practice and the occurrence of a relapse. BACKGROUND: Little is known about the prognosis of low back pain in general practice. Different designs and different results of preceding studies make drawing conclusions about the prognostic indicators, in any, of the course of low back pain in general practice difficult. METHODS: For a period of 2 years, 15 general practitioners from Amsterdam and surrounding areas studied consecutive patients with chronic low back pain and those with a recent onset of low back pain. A large number of potential prognostic indicators were assessed at the initial visit. After the initial visit, each patient was monitored for a period of 12 months. The follow-up assessment was conducted with four weekly postal questionnaires. The associations among the potential prognostic indicators, the duration of the index episode, and the occurrence of a relapse were analyzed using multivariate Cox regression and logistic regression analysis, respectively. RESULTS: Of the 605 patients identified, 443 were included in the follow-up period of assessment; the questionnaires were completed by 269 patients. In general, patients with less severe low back pain participated less often or did not complete the follow-up study. Thirty-five percent of the population still experienced low back pain after 12 weeks, and 10% still experienced it after 1 year. Approximately three of every four patients whose index episode ended before the end of the follow- up period had one or more relapses within a year. The analysis resulted in a model with four variables predicting the duration of the low back pain, including "the duration of the low back pain preceding the initial visit, " "receiving physical therapy, " "pain intensity", and "history of back surgery." Daily functioning appeared to be the only variable that was significantly associated with the occurrence of a relapse. CONCLUSIONS: Only a few variables appear to be related to the clinical course of low back pain seen in general practice. In particular, the duration preceding the initial visit and, unexpectedly, receiving physical therapy were both associated with a longer duration of low back pain. Author.

4.AUTHOR	Rainville-J, Sobel-J-B, Hartigan-C, Wright-A.
INSTITUTION	New England Spine Care Center, Chestnut Hill, Massachusetts, USA.
TITLE	The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.
SOURCE	Spine 1997 Sep 1, VOL: 22 (17), P: 2016-24, ISSN: 0362-2436.
ABSTRACT	STUDY DESIGN: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND: Previous studies have produced conflicting results concerning this issue. METHODS: Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota- based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS: The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS: In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions. Author.

5.AUTHOR	Blake-C, Garrett-M.
INSTITUTION	Department of Physiotherapy, St. Vincent's Hospital, Dublin.
TITLE	Impact of litigation on quality of life outcomes in patients with chronic low back pain.
SOURCE	Ir-J-Med-Sci 1997 Jul-Sep, VOL: 166 (3), P: 124-6, ISSN: 0303-3910.
ABSTRACT	Low back pain progresses to chronic low back pain (CLBP) in 5-10 per cent of patients. A Multi-disciplinary Pain Management Programme was tested in 20 patients (m = 4, f = 16). This regime involved psychological and behaviour modification strategies, combined with intensive exercise. Treatment outcome in terms of impairment was assessed by lumbar flexibility, trunk muscle endurance and pain. The disability assessed was exercise fitness and handicap was assessed using the Sickness Impact Profile (SIP) to define the impact of the condition on the patient's life. Overall the patients showed significant improvement (p < 0.05) in all of the measured variables. Patients with on-going litigation however (n = 11) showed no significant improvement in the SIP quality of life score, although they shared the significant improvements attained by the whole group in the domains of impairment (lumbar flexibility, trunk muscle endurance and pain) and disability (exercise fitness). Author.