Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time.

OBJECTIVE: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the immediate increase in low back pain (LBP) (determined by pain scale rating) in people >18 years of age. METHODS: Four databases (PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to September 1, 2018. Randomized controlled trials and cohort and cross-sectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full-text review, data extraction, and risk of bias assessment (Quality In Prognosis Studies) of included papers were performed independently by 2 reviewers, with a third available to resolve disagreements. RESULTS: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility, and 10 met the inclusion criteria. All but 1 reported sitting time to be associated with an immediate increase in LBP. Six of these reported clinically relevant pain levels (n = 330). Half of the included studies were rated as having a low risk of bias and the remaining were rated as having a moderate risk of bias. CONCLUSION: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Based upon these findings, we recommend that future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP.

Effectiveness of Training Clinicians' Communication Skills on Patients' Clinical Outcomes: A Systematic Review.

OBJECTIVE: The aim of this systematic review was to investigate the literature on the effectiveness of communication skills training for clinicians on patients' clinical outcomes in primary care and rehabilitation settings. METHODS: We systematically reviewed the literature for randomized controlled trials investigating the effectiveness of communication skills training for clinicians on patients' satisfaction with care and on pain and disability in primary care and rehabilitation settings. The search strategy was conducted using AMED, PsycINFO, MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Central Register of Controlled Trials through June 2015. Methodological quality of included trials was assessed by 2 independent investigators using the PEDro scale, and consensus was used to resolve disagreements. Data were extracted, and meta-analyses were performed. RESULTS: Nineteen randomized controlled trials were included. Of these, 16 investigated communication training for clinicians that emphasized patient participation (eg, shared decision-making approaches). Communication training had small effects on patients' satisfaction with care when compared to control (4.1 points on a 100-point scale, 95% confidence interval [CI], 1.1-7.0). Communication training also had small effects on pain and disability with pooled results showing weighted mean differences of -3.8 points (95% CI, -6.5 to -1.1) and -3.6 (95% CI, -5.4 to -1.7), respectively. CONCLUSIONS: Studies show that communication training for clinicians produces small effects in improving patients' satisfaction with care or reducing pain and disability in primary care and rehabilitation settings.

Influence of clinician characteristics and operational factors on recruitment of participants with low back pain: an observational study.

OBJECTIVE: The purpose of this study was to identify factors that influence recruitment of patients to an observational study of low back pain (LBP). METHODS: From 1147 primary care (first health contact) clinicians initially contacted, 138 (physiotherapists and chiropractors) agreed to participate in a large observational study of LBP and were the focus of the current study. Data were collected pertaining to clinicians' characteristics, operational factors, and the number of patients recruited. The association of a variety of clinician characteristics and operational factors with recruitment rate was determined using a multivariate negative binomial regression analysis. RESULTS: From October 2011 to November 2012, 1585 patients were screened by 138 study clinicians with 951 eligible patients entering the observational study. Clinicians who were members of their professional association had a recruitment rate less than half that of those who were nonmembers (P < .0001). Clinicians who were trained by telephone had a recruitment rate 4.01 times higher than those trained face to face (P < .0001). Similarly, clinicians who referred a larger number of ineligible participants had a slightly higher recruitment rate with an incident rate ratio of 1.04 per ineligible patient (P < .0001). Other clinicians' characteristics and operational factors were not associated with recruitment. CONCLUSION: This study provides evidence that it is feasible to recruit participants from primary care practices to a simple observational study of LBP. Factors identified as influencing recruitment were professional association (negative association), training by telephone, and referring a higher number of ineligible participants.

Gross motor deficits in children prenatally exposed to alcohol: a meta-analysis.

BACKGROUND AND OBJECTIVES: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or "moderate" to "heavy" maternal alcohol intake. METHODS: A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to ≤18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS: The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence. CONCLUSIONS: The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.

Ultrasonographic analysis of the neck flexor muscles in patients with chronic neck pain and changes after cervical spine mobilization.

OBJECTIVE: The purpose of this study was to analyze changes in the recruitment of the muscles longus colli (Lco) and sternocledomastoid (SCM) as measured by ultrasonography in patients with chronic neck pain before and immediately after a single cervical Maitland's posterior-anterior central mobilization technique. METHODS: This was a cross-sectional, case-control research design study. Ultrasonographic images of Lco and SCM were taken in 31 patients with chronic neck pain and matched controls during the 5 phases of the craniocervical flexion test before and after a Maitland's posterior-anterior central mobilization session at the cervical spine. Changes in muscle thickness during the test were calculated to infer muscle recruitment. Separate analysis of variance models for each muscle was built. RESULTS: Both groups showed increases in Lco and SCM recruitment between phases (F = 7.95, P < .001; F = 21.29, P < .001), with patients with chronic neck pain demonstrating lesser increases for Lco changes in thickness compared with controls, mainly at phase 5 (-0.09, P = .004; 95% confidence interval [CI], 0.03-0.15). After the mobilization, Lco recruitment increased more significantly in patients with chronic neck pain, and previous difference between groups in phase 5 was no longer significant (-0.07, P = .07; 95% CI, -0.14 to 0.01). The SCM recruitment decreased in phase 1 for patients with chronic neck pain (P = .01; 95% CI, -0.06 to -0.01). CONCLUSION: Cervical mobilization appeared to modulate neck muscles function by increasing deep muscle and reducing superficial muscles recruitment.

Reliability and discriminatory capacity of a clinical scale for assessing abdominal muscle coordination.

OBJECTIVE: This study evaluated the reliability and discriminatory capacity of a novel clinical scale for assessing abdominal muscle coordination. We investigated the interrater reliability of this tool in patients with chronic low back pain (LBP) (reliability section); the ability of this tool to discriminate healthy and LBP subjects (discriminatory section); and the association between the score and measures of pain, disability, and kinesiophobia (correlation section). METHODS: For the reliability section of this study, 14 patients with chronic LBP were included. For the discriminatory section, 10 patients with chronic LBP and 10 pain-free controls were recruited. In the correlation study, data from the 10 chronic LBP patients in the discriminatory section were used. The clinical test was conducted by a blinded examiner while the subjects attempted to independently activate transversus abdominis separate from the rest of the abdominal muscles (hollowing or draw-in maneuver). The intraclass correlation coefficients, receiver operating characteristic curve, and Pearson r correlation coefficients were calculated to assess reliability and validity. RESULTS: An intraclass correlation coefficient((2,1)) of 0.72 (95% confidence interval, 0.33-0.90) was recorded for interrater reliability. The tool correctly identified the subject condition in 97% of the cases. The score did not correlate substantially with any clinical measures, with Pearson r ranging from 0.122 (P = .737) to 0.493 (P = .148). CONCLUSIONS: This study showed that the proposed scale is a reliable tool and may be useful in discriminating patients with chronic LBP from pain-free controls. The poor correlation between the score and clinical measures may be due to the multidimensional nature of chronic LBP.

Effect of 2 lumbar spine postures on transversus abdominis muscle thickness during a voluntary contraction in people with and without low back pain.

OBJECTIVE: The present study investigated the effect of 2 different lumbar spine postures, neutral and flexed lumbar postures, on transversus abdominis (TrA) muscle function during a voluntary contraction (hollowing and draw-in maneuver) in people with and without low back pain (LBP). METHODS: Thirty participants with LBP and 30 healthy participants were recruited for this cross-sectional study. Transversus abdominis muscle function was measured as a change in thickness with ultrasound imaging. Participants performed voluntary TrA contraction in a supine lying position with the lumbar spine in neutral and flexed postures. Data were analyzed using a 2-way (groups, postures) analysis of variance. RESULTS: Lumbar posture influenced TrA function during a voluntary contraction in people with and without LBP. There was a significant main effect of posture (F(1,58) = 16.140, P < .001). Neutral lumbar posture improved participants' ability to recruit TrA in both group (mean difference, 7.5%; 95% confidence interval, 3.8%-11.3%). No significant differences were found between healthy subjects and those with LBP. CONCLUSIONS: The results of the present study showed that, in subjects performing a voluntary TrA contraction, the neutral lumbar posture improves the ability to increase change in TrA thickness. This study found no significant difference in TrA thickness change between healthy subjects and those with nonspecific LBP.

A randomized controlled trial of tai chi for long-term low back pain (TAI CHI): study rationale, design, and methods.

BACKGROUND: Low back pain persisting for longer than 3 months is a common and costly condition for which many current treatments have low-moderate success rates at best. Exercise is among the more successful treatments for this condition, however, the type and dosage of exercise that elicits the best results is not clearly defined. Tai chi is a gentle form of low intensity exercise that uses controlled movements in combination with relaxation techniques and is currently used as a safe form of exercise for people suffering from other chronic pain conditions such as arthritis. To date, there has been no scientific evaluation of tai chi as an intervention for people with back pain. Thus the aim of this study will be to examine the effects of a tai chi exercise program on pain and disability in people with long-term low back pain. METHODS AND DESIGN: The study will recruit 160 healthy individuals from the community setting to be randomised to either a tai chi intervention group or a wait-list control group. Individuals in the tai chi group will attend 2 tai chi sessions (40 minutes)/week for 8 weeks followed by 1 tai chi session/week for 2 weeks. The wait-list control will continue their usual health care practices and have the opportunity to participate in the tai chi program once they have completed the follow-up assessments. The primary outcome will be bothersomeness of back symptoms measured with a 0-10 numerical rating scale. Secondary outcomes include, self-reports of pain-related disability, health-related quality of life and global perceived effect of treatment. Statistical analysis of primary and secondary outcomes will be based on the intention to treat principle. Linear mixed models will be used to test for the effect of treatment on outcome at 10 weeks follow up. This trial has received ethics approval from The University of Sydney Human Research Ethics Committee. HREC Approval No.10452 DISCUSSION: This study will be the first trial in this area and the information on its effectiveness will allow patients, clinicians and treatment funders to make informed choices regarding this treatment. TRIAL REGISTRATION: This trial has been registered with Australian New Zealand Clinical Trials Registry. ACTRN12608000270314.

Efficacy of spinal manipulative therapy for low back pain of less than three months' duration.

OBJECTIVES: To review the efficacy of spinal manipulation for low back pain of less than 3 months duration. Data sources Randomized clinical trials on spinal manipulative therapy for low back pain were identified by searching EMBASE, CINAHL, MEDLINE, and the Physiotherapy Evidence Database (PEDro). Study selection Outcome measures of interest were pain, return to work, adverse events, disability, quality of life, and patient satisfaction with therapy. Data extraction Methodological assessment of the trials was performed using the PEDro scale. Trials were grouped according to the type of intervention, outcome measures, and follow-up time. Where there were multiple studies with sufficient homogeneity of interventions, subjects, and outcomes, the results were analyzed in a meta-analysis using a random effects model. Data synthesis Thirty-four papers (27 trials) met the inclusion criteria. Three small studies showed spinal manipulative therapy produces better outcomes than placebo therapy or no treatment for nonspecific low back pain of less than 3 months duration. The effects are, however, small. The findings of individual studies suggest that spinal manipulative therapy also seems to be more effective than massage and short wave therapy. It is not clear if spinal manipulative therapy is more effective than exercise, usual physiotherapy, or medical care in the first 4 weeks of treatment. CONCLUSIONS: Spinal manipulative therapy produces slightly better outcomes than placebo therapy, no treatment, massage, and short wave therapy for nonspecific low back pain of less than 3 months duration. Spinal manipulative therapy, exercise, usual physiotherapy, and medical care appear to produce similar outcomes in the first 4 weeks of treatment.