Effect of exercise on sick leave due to low back pain. A randomized, comparative, long-term study.

STUDY DESIGN: The study was carried out as an open, randomized, multicenter, parallel-group study with an observation period of 12 months. Four norwegian physiotherapy institutes took part. Patients were subsequently followed for 12 months of home exercise on their own, without for 12 months of home exercise on their own, without the supervision of a physiotherapist. OBJECTIVES: 1) To investigate and compare the effects of two different exercise programs on low back problems in patients after a 1-year training program under the supervision of a physiotherapist. 2) To investigate the effect supervision by, and motivation from, physiotherapists has on training compliance and efficacy. SUMMARY OF BACKGROUND DATA: After ordinary physiotherapy treatment for low back problems, patients were randomly allocated either to a conventional training program designed by physiotherapists or to a training program using a new Norwegian-developed training apparatus called the TerapiMaster. The study included 153 patients with low back problems, all of whom had been referred to physiotherapy by their general practitioners. One hundred twenty-six patients were followed for an additional 12 months when performing home exercise programs on their own. METHODS: Monitoring patient satisfaction with the training program, compliance with the program, and absenteeism from work during the training period. RESULTS: Patient satisfaction with both training programs was high, with about 83% of participating patients completing the study in accordance with the protocol. Mean absenteeism (SD) during the preceding year totaled 82.5 days (19.8) in the conventional training group and 61.6 days (14.7) in the TerapiMaster group. Significant reductions to 17.2 days (6.0) and 16.4 days (5.3) in the two groups, respectively, were recorded during the training period, corresponding to a 75% to 80% reduction compared with the preceding 1-year period. Mean absenteeism showed a further significant decline during the 12-month period without supervised training. The average values were 9.9 days (3.2) for conventional training and 9.3 days (3.1) for the TerapiMaster, respectively. CONCLUSIONS: Both exercise programs reduced absenteeism significantly (75-80%). No difference in the effects of the two different programs was discernible. Regular follow-up through encouragement and variation in the training programs appear to be important factors for motivating patients to adhere to regular exercise programs for low back problems. This thesis was corroborated by the 12-month study of unsupervised exercise.

[Pain school. Therapeutic offers to patients with fibromyalgia and other non-malignant pain problems]. / Smerteskole. Behandlingstilbud for fibromyalgipasienter og andre med kroniske, ikke-ondartede smerter.

A prospective study of 71 patients with fibromyalgia (Yunus 1981 criteria) experience improved quality of life and management of pain after treatment at a pain school for one year. There was no significant improvement in total pain score (VAS) and sickness impact profile (SIP) for these patients compared with 71 paired controls with fibromyalgia matched by age and sex. The need for health care services was reduced and more patients from the pain school group returned to work. The main programme in the pain school classes consisted of information on chronic, non-malignant pain, psychomotoric physiotherapy and group therapy. The pupils evaluated all three items as important, with group dynamics as most beneficial. Good results have also been achieved in other chronic, non-malignant patients. Organized and structural pain management programmes in pain school classes have a favourable cost benefit profile and we recommend more use of such classes in the Norwegian health care system.

"Pelvic girdle relaxation"--suggested new nomenclature.

The term "pelvic girdle relaxation" is not uniformly used. For better understanding of pelvic joint pain during and after pregnancy it is crucial to have commonly accepted definitions for the different conditions. A committee appointed by the Norwegian Medical Association suggests the term "physiological pelvic girdle relaxation" for the ligament relaxation that occurs during any pregnancy. Ligament relaxation that causes considerable pain and/or pelvic instability during pregnancy and/or puerperium (so that daily function is impaired) is termed "symptom-giving pelvic girdle relaxation". A pain condition in one or more of the pelvic joints outside pregnancy and puerperium is called "pelvic joint syndrome".

[Pelvic girdle relaxation. Pathogenesis, etiology, definition, epidemiology]. / Bekkenløsning. Patogenese/etiologi/definisjon/epidemiologi.

Pelvic girdle relaxation is physiologic during pregnancy and is caused by hormonal and biomechanical factors. When a pregnant women presents herself as a patient with low back- and pelvic pain, walking dysfunction, and when the pain is reproduced by sacroiliac provocation tests, the diagnosis "symptom-giving pelvic girdle relaxation" may be justified. If the same symptoms and signs continue after delivery, we suggest the term "pelvic joint syndrome". Studies of selected patients indicate an incidence of 1.5 to 16%. In a random Norwegian population comprising 1,045 women, 25% claimed to have had pelvic girdle relaxation pre- and/or post partum. Four months post partum a point prevalence of 26.5% was found to have pelvic and low back pain. One of three was diagnosed as pelvic joint syndrome on the basis of special criteria after having excluded other diagnoses by clinical examination, X-ray and laboratory controls. Symptomatic lowback pain may be a difficult differential diagnosis. Risk factors for pelvic joint syndrome seem to be previous pelvic girdle relaxation or pelvic girdle relaxation in mother and sisters.

[Symptomatic pelvic girdle relaxation. Clinical aspects]. / Symptomgivende bekkenløsning. Klinikk.

In pregnancy a relaxation of the sacroiliac joints and the symphysis is a physiologic phenomenon which usually occurs without symptoms. In some cases, however, these changes cause characteristic symptoms, with pain and difficulty in walking: the symptomatic pelvic girdle relaxation. The condition may be confirmed by tenderness of the joints and provocation of pain by the sacroiliac joints tests. Usually the symptoms disappear shortly after giving birth, but some women suffer for several months, and a few suffer persistent symptoms, the pelvic joint syndrome.

[Retropharyngeal tendinitis after chiropractor therapy]. / Retrofaryngeal tendinitt etter kiropraktorbehandling.

We describe a patient diagnosed as having retropharyngeal tendinitis with severe neck pain, difficulties in swallowing and muscular spasm in the neck. Roentgenograms and CT showed the characteristic picture of soft tissue swelling and calcification in a prevertebral position in front of C1 and C2 corresponding to the longus colli muscle. The syndrome is not often diagnosed but in patients with neck pain the differential diagnosis should be kept in mind.

Low-back pain: pain description as a diagnostic aid.

Chronic low-back pain sufferers often present a mixture of somatic and psychologic symptoms, complicating the determination of diagnoses. Two hundred consecutively referred patients with chronic low-back pain had clinical, radiological and laboratory tests performed. The patients were classified into one of the three different categories: a somatic (I) and a somatoform group (III), and an intermediate variety (II). All patients completed a pain questionnaire, giving information about distribution, intensity, variation and somato-sensory qualities of pain in various parts of the body. Patients in group I compared to group III showed differences in pain localization, dispersion and intensity, as well as pain variation and relief. Somatoform patients were mostly females in their forties, their symptoms had started earlier and lasted longer as compared to patients of the intermediate and somatic variety. In diagnosing and dealing with low-back pain patients general practitioners and specialists are recommended to use a simplified pain questionnaire as an aid in sorting the complainers.

Malignant synovioma.

Malignant synoviomas may clinically resemble localized arthritis and it is the rheumatologist who may be in a position to make the important early diagnosis. The course of the disease may be rapid or prolonged as illustrated by two case reports. The clinical, histological and roentgenological features are described and a review of the treatment and prognosis is given.

Physical activity in the treatment of inflammatory rheumatic disorders.

A search of the literature in this area shows that there is little national or international documentation available on the effect of physical activity on the development of disease in inflammatory rheumatic disorders. Low capacity for physical work has been demonstrated and is based on poor circulation and reduced muscle strength in rheumatism: several studies from Norway and elsewhere have documented the value of physical training, especially in improving the rheumatic patient's physical condition (1--2, 8). No investigations have been able to document any arrest of progress of the disease, but physical training seems to be able to maintain existing joint function and also to some extent prevent progressive deterioration in condition. There is therefore no disagreement about the significance of physiotherapy, but the intensity and duration of training are more controversial.