Lumbar extension peak-torque, muscle endurance and motor imagery in junior-elite basketballers with and without a history of low back pain: a pilot study.

Objectives: Low back pain (LBP) is common in elite athletes. Several peripheral and central factors have been identified to be altered in non-athletic LBP populations, however whether these alterations also exist in elite athletes with LBP is unknown. The aim of this study was to determine whether elite basketballers with a history of persistent LBP perform worse than those without LBP at a lumbar muscle endurance task, a lumbar extension peak-torque task, and a lumbar motor imagery task. Method: An observational pilot study. Twenty junior elite-level male basketballers with (n = 11) and without (n = 9) a history of persistent LBP were recruited. Athletes completed a lumbar extensor muscle endurance (Biering-Sorensen) task, two lumbar extensor peak-torque (modified Biering-Sorensen) tasks and two motor imagery (left/right lumbar and hand judgement) tasks across two sessions (48 hours apart). Performance in these tasks were compared between the groups with and without a history of LBP. Results: Young athletes with a history of LBP had reduced lumbar extensor muscle endurance (p < 0.001), reduced lumbar extension peak-torque (p < 0.001), and were less accurate at the left/right lumbar judgement task (p = 0.02) but no less accurate at a left/right hand judgement task (p = 0.59), than athletes without a history of LBP. Response times for both left/right judgement tasks did not differ between groups (lumbar p = 0.24; hand p = 0.58). Conclusions: Junior elite male basketballers with a history of LBP demonstrate reduced lumbar extensor muscle endurance and lumbar extension peak-torque and are less accurate at a left/right lumbar rotation judgement task, than those without LBP.

Harnessing Children's Picture Books to Socialize Children About Pain and Injury: A Qualitative Study.

Pain experiences are common during childhood (eg, "everyday" pain, vaccine injections) and are powerful opportunities for children to learn about pain and injury. These experiences likely inform fundamental and life-long beliefs about pain. There is scant research investigating the sociocultural contexts in which children learn about pain and injury. One unexplored context is the shared reading of picture books (eg, between parents/caregivers and children). In this study, we investigated whether shared reading of picture books that included depictions of pain and/or injury prompted parent/caregiver-child interactions. If interactions were observed, we explored what those interactions entailed. Twenty parents/caregivers (8 men, 12 women) and their children (n = 27; 10 boys, 17 girls) were recruited from libraries in South Australia. Parent/caregiver-child families chose from 8 books (7 fiction, 1 nonfiction) with varying amounts of pain/injury-related content. Shared reading interactions were video recorded, transcribed, and analyzed alongside analysis of the picture books using reflexive thematic analysis. Pain/injury-related interactions were observed between parents/caregivers and children during shared reading of picture books. Qualitative analyses generated 1 main theme and 3 subthemes. Findings identified that shared reading presented an opportunity for children's understanding of pain and injury to be socialized through discussion of characters' experiences. This included teaching children about pain and injury, as well as promoting empathy and emotional attunement toward characters who were depicted as being in pain. Finally, parents/caregivers often responded with observable/expressed amusement if pain/injury was depicted in a light-hearted or unrealistic way. Overall, shared reading of picture books presents an untapped opportunity to socialize children about pain and injury. PERSPECTIVE: Shared reading of picture books that have depictions of pain and/or injury can prompt parent/caregiver-child interactions about pain and injury. These interactions present critical opportunities that can be harnessed to promote children's learning of adaptive pain-related concepts and behaviors during a critical developmental period.

The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis.

BACKGROUND: Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. METHODS: To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. RESULTS: We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. INTERPRETATION: Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. PROTOCOL REGISTRATION: PROSPERO - CRD42020207442.

We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain.

Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.

The effect of compression and combined compression-tactile stimulation on lower limb somatosensory acuity.

Background: Lower limb somatosensation and proprioception are important for maintaining balance. Research has shown that compression garments or exposure to textured surfaces, can enhance somatosensation however, little is known about the effect of combined compression and texture on somatosensory acuity in the lower limb. This study aimed to assess the effects of combined compression socks with a plantar textured sole, on lower limb somatosensory acuity. Methods: Thirty participants completed a somatosensory acuity task (active movement extent discrimination apparatus; AMEDA) under three conditions: barefoot (control condition), standard knee-high compression sock (compression sock), and knee-high compression sock with internal rubber nodules situated on the sole (textured-compression sock). Somatosensory acuity was assessed between the different sock conditions for the (i) entire group, (ii) high performers, and (iii) low performers. It was hypothesized that low performers would see gains wearing either sock, but the greatest improvement would be in the textured-compression sock condition. Results: AMEDA scores were not significantly different between conditions when the entire group was analyzed (p = 0.078). The low performers showed an improvement in somatosensory acuity when wearing the compression sock (p = 0.037) and the textured compression sock (p = 0.024), when compared to barefoot, but there was no difference between the two sock conditions (p > 0.05). The high performers did not show any improvement (p > 0.05 for all). Conclusion: These findings demonstrate that additional sensory feedback may be beneficial to individuals with lower baseline somatosensory acuity but is unlikely to provide benefit for those with higher somatosensory acuity.

Developing a multivariate prediction model of falls among older community-dwelling adults using measures of neuromuscular control and proprioceptive acuity: A pilot study.

OBJECTIVE: To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community-dwelling population and to develop a multivariate prediction model. METHODS: Fifty-eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall. RESULTS: For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception. CONCLUSIONS: This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least-challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.

The Foundations for Chronic Low Back Pain Management may Start in Early Life. Exploring the Role of Caregiver Parental Leave on Future Low Back Pain in the Offspring.

Chronic low back pain is difficult to treat and despite increased spending on health services, clinical outcomes for people with low back pain have not improved. Innovative, large scale initiatives seem necessary to stem the cost of low back pain. Psychological health contributes to the development and persistence of chronic low back pain and psychological interventions are important in the management of low back pain. Given the contribution of psychological health to low back pain development and management, it raises the question; can we support psychological health in later life by bolstering emotional development in early life, and reduce the burden of this common condition? Positive early life experiences, including those induced by extended paid parental leave, could bolster emotional development and support the psychological health necessary to manage low back pain in later life. We present the current state of evidence demonstrating the potential value of increasing support for parent-child relationships in early life to reduce the burden of low back pain in future generations. The current evidence is limited to cross-sectional associations, but strong preclinical data clearly shows the potential negative impacts of maternal separation on rodent pup health that compels consideration in human populations. PERSPECTIVE: The benefits stemming from enhanced child development include stable emotional foundations, possibly improving psychological health and low back pain management in the future. This perspective raises questions for future studies - within the context of low back pain, what ingredients bolster stable psychological health? And are these ingredients influenced by parental leave?

Communicating with children about 'everyday' pain and injury: A Delphi study.

BACKGROUND: 'Everyday' pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown. METHODS: In this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2-7 years) about 'everyday' pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development and psychology; educators and parents. The survey included three rounds. RESULTS: Response rate was over 88%. Two hundred fifty-three items were raised; 187 reached 'consensus' (≥80% agreement amongst experts). Key messages that the experts agreed to be 'very important' were aligned with current evidence-based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role modelling, responses to child pain and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies and resilience building. CONCLUSIONS: This diverse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children. SIGNIFICANCE: Parents and caregivers likely play a critical role in the development of children's fundamental beliefs and behaviours surrounding pain and injury that are carried into adulthood. Everyday pain experiences provide key opportunities to promote positive pain-related beliefs and behaviours. This Delphi survey identified key messages and strategies that caregivers can consider to optimize learning, encourage the development of adaptive pain behaviours and build resilience for future pain experiences.

Daily surveillance of falls is feasible and reveals a high incidence of falls among older adults.

OBJECTIVE: To ensure accurate data capture for a fall study through a system of daily contact with participants. METHODS: Fifty-eight adults older than 60 years of age and living independently in the community in Canberra, Australia, were recruited for a prospective fall study. We adopted a system of daily contact with study participants for at least 12 months, either by email or by text, asking whether they had suffered a fall in the previous 24 h. At the final testing session, we asked participants whether they had experienced a fall during the previous twelve months. RESULTS: We found no evidence that the daily reporting regime led to excess participant attrition. Only three participants withdrew over the course of the study, and the burden of responding was not cited as a factor in any of these cases. Of the 55 participants who completed the full twelve-month study period, 38 (69%) experienced at least one fall. We also identified inconsistencies between recall of falls occurring during the last twelve months of the study and the contemporaneously recorded data. CONCLUSIONS: Previous studies have found that increasing the reporting demands on fall study participants will lead to higher attrition. This study demonstrates that it is possible to maintain participant engagement and minimise attrition with appropriate design of reporting procedures. We confirm existing evidence regarding the unreliability of retrospective recall of falls. The study highlights the importance of comprehensive and accurate data capture and points to the possibility of under-reporting of fall incidence.