Relato de caso de lombalgia inflamatória com extenso comprometimento anatômico-funcional: a importância de uma adequada abordagem da dor lombar na Atenção Primária à Saúde / Case report of inflammatory low back pain with extensive anatomical-functional impairment: The importance of an adequate approach to low back pain in Primary Care / Presentación de un caso de lumbalgia inflamatoria con afectación anatómico-funcional extensa: La importancia de un abordaje adecuado de la lumbalgia en Atención Primaria de Salud

Introdução: A lombalgia é uma condição prevalente e que apresenta importante impacto na capacidade funcional e na qualidade de vida, sendo a sua correta abordagem na Atenção Primária à Saúde fundamental para a identificação e o estabelecimento de um diagnóstico etiológico precoce de possíveis patologias que possam estar relacionadas a desfechos mórbidos e a graves limitações funcionais. Apresentação do caso: Paciente de 56 anos, sexo masculino, hipertenso, foi encaminhado para serviço especializado de reumatologia com histórico de lombalgia havia mais de 20 anos. Ao exame físico foi constatada presença de deformidades da coluna vertebral e extensa limitação de movimentos. Exames radiográficos mostravam esclerose de articulações sacroilíacas, osteopenia difusa e coluna vertebral em aspecto de "bambu". Conclusões: Constata-se a importância de que na abordagem das lombalgias na atenção primária se busque o reconhecimento de possíveis etiologias graves e potencialmente incapacitantes que possam estar subjacentes à queixa de dor lombar. Com esse objetivo, é fundamental o reconhecimento das chamadas red flags relacionadas às lombalgias, além de sua caracterização como mecânica ou inflamatória. Perante a atuação da atenção primária no oferecimento de um cuidado pautado na integralidade e na prevenção de agravos, reafirma-se a importância de uma avaliação clínica pormenorizada das lombalgias nesse nível de atenção à saúde.

Introduction: Low back pain is a prevalent condition that has an important impact on functional capacity and quality of life, and its correct approach in Primary Care is fundamental to the identification and establishment of an early etiological diagnosis of possible pathologies that may be related to outcomes morbid conditions and serious functional limitations. Case presentation: 56-year-old male patient, hypertensive, referred to a specialized rheumatology service with a history of low back pain for over 20 years. Physical examination revealed the presence of spinal deformities and extensive movement limitations. Radiographic examinations showing sclerosis of the sacro-iliac joints, diffuse osteopenia and a "bamboo" appearance of the spine. Conclusions: It is important that in the approach of low back pain in Primary Care, we seek to recognize possible serious and potentially disabling etiologies that may underlie the complaint of low back pain. For that, it is essential to recognize the so-called "red flags" related to low back pain, in addition to its characterization as mechanical or inflammatory. Given the role of Primary Care in offering care based on integrality and in the prevention of injuries, the importance of a detailed clinical assessment of low back pain at this level of health care is reaffirmed.

Introducción: La lumbalgia es una patología prevalente que tiene un impacto importante en la capacidad funcional y la calidad de vida, y su correcto abordaje en Atención Primaria de Salud es fundamental para la identificación y establecimiento de un diagnóstico etiológico precoz de posibles patologías que puedan estar relacionadas con los resultados, condiciones morbosas y limitaciones funcionales graves. Presentación del caso: Paciente masculino de 56 años, hipertenso, remitido a servicio especializado de reumatología con antecedentes de dolor lumbar de más de 20 años. El examen físico reveló la presencia de deformidades de la columna y amplias limitaciones de movimiento. Los exámenes radiológicos muestran esclerosis de las articulaciones sacroilíacas, osteopenia difusa y una apariencia de "bambú" de la columna. Conclusiones: Es importante que al abordar la lumbalgia en Atención Primaria de Salud busquemos reconocer las posibles etiologías graves y potencialmente incapacitantes que pueden subyacer a la queja de lumbalgia. Con este objetivo, es fundamental reconocer las llamadas "banderas rojas" relacionadas con la lumbalgia, además de su caracterización como mecánica o inflamatoria. Dado el papel de Atención Primaria de Salud a la hora de ofrecer una atención basada en la integralidad y prevención de enfermedades, se reafirma la importancia de una evaluación clínica detallada de la lumbalgia en este nivel de atención sanitaria.

Factors Related to Prevalence of Depression in Türkiye: A Population-Based Study. / Türkiye'de Depresyonun Yayginligi ile Iliskili Faktörler: Nüfusa Dayali Bir Çalisma.

OBJECTIVE: This study aims to determine the prevalence of depressive symptoms in the adult population in Türkiye and to examine the relationship of depression with socio-demographic and behavioral variables and chronic diseases. METHOD: This sturdy utilized data from the 2019 Turkey Health Survey. The Patient Health Questionnaire Depression Module (PHQ- 8) was employed to assess depressive symptoms in the survey. Based on the analysis using the diagnostic algorithm of the PHQ-8, from a total of 17084 people aged 15+ years old who were, we selected 6.4% individuals with depressive symptoms. Then, we randomly selected 1101 individuals without depressive symptoms, comprising of a total of 2202 individuals as the study sample. We assessed the factors associated with depressive symptoms using multivariate logistic regression analyses. RESULTS: The risk of developing depressive symptoms increased with age. Women were more likely to report depressive symptoms. Education, physical activity, and marital status were negatively correlated with reporting depressive symptoms. Further, social support was a protective factor to report depressive symptoms. The presence of chronic diseases was positively associated with depressive symptoms. CONCLUSION: The results showed that point and annual prevalence of depressive symptoms were high. The findings provide a basis for further studies to explore the factors associated with a higher prevalence of depressive symptoms in Türkiye. Our findings could serve as a reference to monitor depression in the country, as well as help in the planning of health resource and identify high risk segments of the population.

Age-dependent flexion relaxation phenomenon in chronic low back pain patients.

Background: The flexion relaxation phenomenon (FRP) is characterized by suddenly reduced paraspinal muscle activity during full flexion. Previous studies showed significant differences in FRP and flexion angles in chronic low back pain (cLBP) patients compared to individuals without back pain (no-BP). However, the relationship between FRP and flexion angles remains insufficiently understood in older populations. Thus, this study investigated the relationship between FRP and flexion angles concerning to the age and presence of cLBP. Methods: Forty no-BP subjects (20m/20f; mean age 41.5 years) and thirty-eight cLBP patients (19m/19f; mean age 43.52 years) performed maximum full upper body flexion task. Electromyographic (EMG) measurements were conducted to assess the activity of lumbar erector spinae (ESL), thoracic erector spinae (EST), and multifidus (MF). Lumbar, thoracic, and pelvic angles at the onset (OnsetL/T/P) and offset of the FRP (OffsetL/T/P) and maximum trunk inclination (MaxL/T/P) were calculated. The FRP was evaluated using a flexion relaxation ratio (FRR). Results: cLBP patients showed smaller FRR in MF and right ESL compared to no-BP individuals (p < 0.05), while no differences were found in flexion angles between two groups. Subjects over 40 showed smaller FRR in MF and ESL, and smaller flexion angles on OffsetL and MaxL (p < 0.05). Age-related analysis in the cLBP group revealed that patients over 40, compared to younger ones, had smaller FRR in MF and ESL, and smaller values in all thoracic and lumbar flexion angles (p < 0.05). While in no-BP group, significant larger flexion angles in OnsetL and OffsetT (p < 0.05) were observed in participants over 40. Pain-related analysis in the older group revealed that the cLBP patients, compared to no-BP individuals, had smaller FRR in right MF and right ESL, and smaller values in all lumbar and thoracic flexion angles (p < 0.05), while in younger group, there were no significant pain-related differences in FRR, with larger values in all lumbar flexion angles (p < 0.05). Conclusion: Our findings indicate a reduction or absence of FRP in cLBP patients compared to no-BP individuals, with age being a significant factor as those over 40 showed smaller FRP and flexion angles compared to younger individuals.

Prognostic Factors for Outcome of Fusion Surgery in Patients With Chronic Low Back Pain - A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVE: This systematic review aims to identify prognostic factors, encompassing biomedical and psychosocial variables, linked to outcome of fusion surgery for chronic low back pain (CLBP) in single or two-level lumbar degenerative spinal disorders. Identifying these factors is crucial for decision making and therefore long-term treatment outcome. METHODS: A systematic search (PROSPERO ID: CRD4202018927) from January 2010 to October 2022 was conducted, utilizing Medline, Embase, and the Cochrane Database of Systematic Reviews (CDSR, CENTRAL). Prognostic factors associated with various outcomes, including functional status, back and leg pain, health-related quality of life, complications, return to work, and analgesic use, were assessed. Risk of bias was determined using QUIPS, and the quality of evidence was evaluated using GRADE approach. RESULTS: Of the 9852 initially screened studies, eleven studies (n = 16,482) were included in the analysis. In total, 161 associations were identified, with 67 prognostic factors showing statistical significance (P < 0.05). Thirty associations were supported by two or more studies, and only eight associations were eligible for meta-analyses: female gender remained statistically significant associated with decreased postoperative back pain, but negatively associated with complication rates and functional status, and smoking with increased postoperative back pain. CONCLUSION: Only female gender and smoking were consistently associated with outcome of fusion for CLBP. Most of the included studies exhibited low to moderate methodological quality, which may explain the relatively weak associations identified for the assessed prognostic factors.

Magnitude of changes in muscle endurance in the Biering-Sorensen test and changes in balance in subjects with LBP treated with muscle energy techniques.

Purpose: Manual therapy is used as a conservative treatment for people with low back pain (LBP). The scale of the problem encourages the search for the most effective methods to assess of manual treatment. Therefore, the aim of the study was to investigate magnitude of changes in muscle endurance using the Biering-Sorensen test (BST) and to analyse balance in patients with LBP treated with ERS and FRS muscle energy techniques (MET). Methods: The study included fifteen men with LBP (mean age: 42 years) working as automotive assemblers. Endurance of the biceps femoris (BF), gluteus maximus (GM) and erector spinae (ES) muscles were analysed using sEMG during the BST. The level of experienced pain, degree of disability and postural stability were also examined. Results before and after a three-week treatment cycle using MET were compared. Results: The MET therapy resulted in a reduction in pain ( p = 0.001), an improvement in the degree of disability ( p < 0.001) and an increase in the duration of the BST ( p < 0.001). After therapy, the values of the NMFs parameter indicating the degree of fatigue increased, i.e., ES muscle endurance increased, both right ( p = 0.004) and left ( p < 0.001). There was also a statistically significant decrease in the centre of pressure (COP) movement velocity in balance tests. Conclusions: The use of MET in patients with LBP increases muscle endurance, improves postural balance, and reduces pain levels on the VAS and disability levels according to the ODI. MET appears to be a good tool for preventing LBP.

The link between childhood physical activity enjoyment and adult kinesiophobia in individuals with chronic low back pain.

BACKGROUND: This study aimed to investigate the relationship between childhood physical activity enjoyment and current kinesiophobia among individuals with chronic low back pain (CLBP), considering the mediating influence of adult physical activity. METHODS: We recruited 648 adults (474 males, 174 females) with CLBP through an online platform. Of these, 99.1% (n = 642) were aged 18-60 years, and 0.9% (n = 6) were older than 60 years. Childhood physical activity enjoyment was retrospectively assessed using a single-item question to gauge participants' enjoyment during primary school. Kinesiophobia was measured with the 11-item Tampa Scale for Kinesiophobia (TSK-11), and physical activity was assessed focusing on walking, moderate, and vigorous physical activities. Age, sex, education, and income served as control variables in the analysis. RESULTS: A significant negative association was found between childhood physical activity enjoyment and adult kinesiophobia. Additionally, childhood physical activity enjoyment was positively associated with adult physical activity across the three types of physical activities. In the adjusted mediation model, walking was identified as the only statistically significant partial mediator. CONCLUSION: The findings highlight the long-term protective role of childhood physical activity enjoyment against the development of kinesiophobia in adulthood. Walking, in particular, holds unique therapeutic potential, emphasizing the importance of fostering physical activity enjoyment early in life for sustained physical activity and reduced risk of kinesiophobia among CLBP patients.

Interrelationship between depression and low back pain-related disability among patients seen at orthopedic clinics in Al Qassim region, Saudi Arabia: Prevalence, severity, and determinants.

OBJECTIVES: Low back pain (LBP) is a widespread health problem that poses a severe economic burden on both affected patients and their societies. The purpose of this study was to investigate the association between depression and low back pain among patients seen at an orthopedic clinic and examine the association with physical disability. METHODS: A cross-sectional study was carried out in the orthopedic clinics of AlBadaya General Hospital in the Qassim Region, Saudi Arabia. All patients with LBP seen in the clinic between April and June 2024 were included in the study. A questionnaire was administered that collected demographic information, asked about medical history and behaviors, and administered the Arabic-validated version of the Roland-Morris Disability Questionnaire (RMDQ) and the Patient Health Questionnaire (PHQ-9; depression). Multivariate logistic regression analysis was performed to identify correlates of depression. RESULTS: A total of 365 patients were included in the study. Age ranged between 18 and 85 years, with a mean of 47.9 years (55.6% female). The overall prevalence of depression was 56.2%, with 40.3% being mild, 13.2% being moderate, and 2.7% being moderately severe or severe. Patients with moderately severe/severe depression had the highest disability score, while those with no depression had the lowest disability score. Multivariate logistic regression analysis revealed that with each unit increase in disability score, there was a 20% increase in depression (adjusted odds ratio = 1.20, 95% CI = 1.14-1.26, P < 0.001). CONCLUSION: Depression, although mostly mild, was common in this clinic sample of orthopedic patients with chronic LBP and was frequently associated with disability. Disability can be a serious complication of chronic LBP and is often closely linked with depression. As a result, patients with chronic LBP seen at orthopedic clinics in Saudi Arabia (and likely other Middle Eastern countries) should be screened for depression and managed appropriately.

Umbrella Review of Primary Care Treatments for Adults With Chronic Low Back Pain.

OBJECTIVES: The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP). METHODS: We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria. RESULTS: Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment. CONCLUSIONS: Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.

Factors Predicting Nonadherence to Treatment Recommendations for Patients With Chronic Low Back Pain in India: A Cross-Sectional Survey.

OBJECTIVE: The purpose of this study was to examine patients' expectations and factors that influence adherence to physiotherapists' treatment recommendations on chronic low back pain (CLBP). METHOD: One hundred and forty seven patients with CLBP were included in this study. Predictive indicators including demographic information, views, expectations, and opinions regarding the health status and treatment expectations of patients were derived from questionnaires. The dependent outcome variables were the absence of trust in treatment recommendations provided by physiotherapists, the anticipation of treatment recommendations based on patient expectations, and the resistance to modifying expectations despite efforts by physiotherapists to persuade otherwise. The study was carried out between April 2022 and January 2023 in 2 regions located in India. RESULTS: Multivariate regression analyses show that age, expectations about diagnosis, preference for passive therapies and medical care, and information seeking behavior emerged as independent predictors of a lack of trust in physiotherapists' treatment recommendations. The information-seeking behavior of the patients' alone predicted the anticipation of treatment recommendations based on patient expectations and the reluctance to alter those expectations despite the physiotherapists' persuasion. CONCLUSION: Our results suggest that information seeking behavior is the most consistent independent predictor of treatment expectations that will align with physiotherapist recommendations. This indicates the importance of screening for such factors and the importance of patient education to optimize the management of CLBP. However, larger studies incorporating all variables associated with patient expectations in similar patient populations are needed to confirm these results.

Communicating safety-netting information in primary care physiotherapy consultations for people with low back pain.

BACKGROUND: Safety-netting involves communicating information to patients about diagnostic uncertainty, the likely time-course of their condition and how to appropriately seek help from a healthcare professional if their condition persists or worsens. Little is known about how physiotherapists communicate safety-netting information to people with low back pain (LBP). OBJECTIVES: This research aimed to use a Safety-Netting Coding Tool (SaNCoT) to explore how physiotherapists communicate safety-netting information to people with LBP. METHODS: The SaNCoT was used to conduct a secondary analysis of audio-recordings and transcripts from 79 primary care physiotherapy consultations (41 initial and 38 follow-up) involving 12 physiotherapists and 41 patients with LBP in Southern England. Quantitative data from the SaNCoT were analysed descriptively. FINDINGS: The study found evidence of diagnostic uncertainty in 53 (67%) appointments and no examples of physiotherapists providing patients with specific information about their condition time-course. Eight patients were given safety-netting advice, but most (57.9%, n = 11) episodes of safety-netting advice did not include specific signs and symptoms for patients to monitor. Potential missed opportunities for safety-netting advice were identified in 19 appointments (24.1%) which tended to relate to the patient's associated leg symptoms but also included possible serious pathology. CONCLUSION: The SaNCoT was successfully used to measure safety-netting communication within physiotherapy consultations and found missed opportunities for providing clear safety-netting advice. Physiotherapists can use the findings to reflect on how they can provide clear safety-netting information to patients with LBP to effectively support patients to self-manage and help them seek appropriate care if their condition deteriorates.

The Correlation between Unilateral Hip Bridge Endurance and Lumbar Multifidi Sonologic Characteristics in Physically Active Allied Healthcare Professionals at St. Luke's Medical Center - Quezon City: A Cross-sectional Study.

Background and Objective: Low back pain is one of the most common work-related musculoskeletal disorders. Healthcare workers are prone to low back pain because of the nature of their profession. Low back pain may be related to lumbar multifidi atrophy or instability and poor core stability. Core stability can be assessed using the unilateral hip bridge endurance test. This cross-sectional study aims to determine the correlation between unilateral hip bridge endurance (UHBE) and sonologic characteristics of the bilateral L4-L5 lumbar multifidus muscles of physically active allied healthcare professionals. Methods: Forty (40) physically active healthcare professionals (mean age = 31.3 ± 6.39 years, mean height = 161.17 ± 8.45 cm, mean weight = 61.88 ± 13.58 kg, mean BMI = 23.61 ± 3.68 kg/m2) were recruited via purposive sampling. The participants answered online versions of the Global Physical Activity Questionnaire (GPAQ) and Oswestry Disability Index. They subsequently underwent the UHBE test and ultrasound assessment of the L4-L5 multifidi. Multiplied anteroposterior (AP) and lateral linear (L) measurements were used to estimate L4-L5 multifidi size. The Pearson test was used to test for correlation between the primary outcomes of the study. Results: There was no statistically significant correlation between Lumbar Multifidi CSA and UHBE Scores (r = -0.172, p > 0.05), and between Lumbar Multifidi CSA% Difference and UHBE Scores (r = -0.140, p > 0.05). However, results showed a very weak negative correlation between the Lumbar Multifidi CSA% Difference and UHBE Scores. Conclusion: There is no definite evidence showing a correlation between core stability tests such as the unilateral hip bridge test scores and sonologic characteristics of the lumbar multifidi. However, lumbar multifidi symmetry may have a role with core stability. The correlation between core stability tests and lumbar multifidus morphology should be further investigated.

Botulinum toxin type A for treating chronic low back pain: A double blinded randomized control study.

BACKGROUND: Low back pain (LBP) is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting. LBP can arise from various causes, with stiffness in the paraspinal muscles being a notable contributor. The administration of Botulinum toxin type A (BoNT-A) has been found to alleviate back pain by relaxing these stiff muscles. While BoNT-A is approved for use in numerous conditions, a limited number of randomized clinical trials (RCTs) validate its efficacy specifically for treating LBP. AIM: To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP (CLBP). METHODS: In this RCT, adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled. Participants were allocated to either the Drug group, receiving 200 Ipsen Units (2 mL) of BoNT-A, or the Control group, which received a 2 mL placebo. Over a 2-month follow-up period, both groups were assessed using the Visual Analog Scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for disability at the start and conclusion of the study. A decrease in pain by 50% was deemed clinically significant. RESULTS: The study followed 40 patients for two months, with 20 in each group. A clinically significant reduction in pain was observed in 36 participants. There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months. Nonetheless, when comparing the mean score changes, only the reduction in ODI scores (15 in the placebo group vs 16.5 in the drug group, clinically insignificant) was statistically significant (P = 0.012), whereas the change in mean VAS scores was not significant (P = 0.45). CONCLUSION: The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home).

OBJECTIVES: Low back pain was the sixth most common reason for an ED visit in 2022-2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes. METHODS: Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care. RESULTS: This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724-AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function. CONCLUSIONS: Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

Prevalence of and risk factors for low back pain among professional drivers: a systematic review and meta-analysis.

PURPOSE: A growing body of research indicates a correlation between occupational exposure, particularly among individuals in driving-related occupations, and the incidence of low back pain (LBP). METHODS: Databases were systematically searched, including PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, from their inception through December 2023 for relevant studies of the prevalence and risk factors of LBP among professional drivers. Subsequent meta-analyses were performed utilizing Stata 17.0 and RevMan 5.4 software, while risk factor indicators were assessed using the Grading of Recommendations, Assessment, Development and Evaluation evidence quality grading system. RESULTS: A systematic review and meta-analysis comprising 19 studies involving 7,723 patients indicated that the incidence of LBP among drivers was 39% (95% confidence interval [CI] 0.20-0.57) in the past 7 days and 53% (95% CI 0.43-0.63) in the past 12 months. A subgroup analysis revealed a prevalence of 48% (95% CI 0.33-0.64) in 2005-2015 and 56% (95% CI 0.42-0.70) in 2016-2023. Among the identified factors, robust evidence highlighted age ≥ 41 years (odds ratio [OR] = 2.10; 95% CI 1.36-3.24; P = 0.0008), alcohol consumption (OR = 1.75; 95% CI 1.31-2.34; P = 0.0001), sleeping < 6 h/night (OR = 1.60; 95% CI 1.13-2.24; P = 0.007), uncomfortable seating (OR = 1.71; 95% CI 1.23-2.36; P = 0.001), improper driving posture (OR = 2.37; 95% CI 1.91-2.94; P < 0.00001), and manual handling (OR = 2.23; 95% CI 1.72-2.88; P < 0.00001) as significant risk factors for LBP. There was moderate evidence of a lack of exercise (OR = 1.78; 95% CI 1.37-2.31; P < 0.0001), working > 10 h/day (OR = 2.49; 95% CI 1.89-3.28; P < 0.00001), > 5 years' driving experience (OR = 2.12; 95% CI 1.66-2.69; P < 0.00001), a lack of back support (OR = 1.81; 95% CI 1.25-2.62; P = 0.002), high work-related pressure (OR = 2.04; 95% CI 1.59-2.61; P < 0.00001), and job dissatisfaction (OR = 1.57; 95% CI 1.23-2.01; P = 0.0003) as moderate risk factors. There was no evidence of body mass index or smoking as risk factors for LBP among professional drivers. CONCLUSION: The current evidence indicates an increasing annual trend in the prevalence of LBP among professional drivers. Factors including age ≥ 41 years, alcohol consumption, and sleeping < 6 h/night were among the 12 influential factors contributing to LBP in professional drivers. Enhancing awareness of these factors and formulating targeted preventive strategies may be beneficial.

The DECISION project: DiscrEte Choice experIment Spinal manipulative therapy for lOw back paiN: A study protocol.

The smallest worthwhile effect (SWE) is the smallest beneficial effect of an intervention that justifies the costs, risks, and inconveniences. The objective is to establish the SWE of spinal manipulative therapy (SMT) for the treatment of low back pain (LBP), and to gain insight into how different attributes of the treatment are traded among each other when choosing SMT. Part 1. A mixed-methods study will be conducted to establish and prioritize a list of attributes influencing choices for those who consider SMT for the treatment of LBP. Individual interviews and consensus groups with chiropractors, manual therapists, and osteopaths and their patients will be conducted. Interviews and consensus groups will be voice-recorded and transcribed verbatim. Part 2. A Discrete Choice Experiment (DCE) will be conducted among people with LBP who have limited to no experience with SMT. Participants will be recruited through an online independent panel company. The survey will consist of several choice sets with attributes and their levels established from Part 1. The DCE will be preceded by a short survey to understand the clinical aspects (i.e. presentation, history and previous treatment for LBP) as well as socio-demographic characteristics of the participants.

Impact of Transforaminal Epidural Neuroplasty and Cooled Radiofrequency Ablation of Medial Branch on Pain Relief and Quality of Life in a Patient with Chronic Low Back Pain and Steppage Gait: A Case Report.

Introduction: Low back pain is one of the most common reasons for loss of productivity. Herniated lumbar discs can often cause muscle weakness, reduced motor function, and change in walking capacity including foot drop and gait abnormalities like steppage gait. Case Report: Here, we present the case report of a 52-year-old shopkeeper who had been suffering from low back pain for 5 years along with a steppage gait since childhood, which had grossly affected his business as well as his quality of life. The patient did not want a surgical procedure. Conclusion: Given these conditions, we opined that minimally invasive pain and spine intervention procedures like transforaminal epidural neuroplasty along with cooled radiofrequency ablation of medial branches can be effective in managing back pain as well as improving the quality of life.

Can assessment of human assumed central sensitisation improve the predictive accuracy of the STarT Back screening tool in acute low back pain?

BACKGROUND: The STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. OBJECTIVES: To examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. DESIGN: A prospective longitudinal study. METHOD: Data were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale ≥1 and Roland Morris Disability Questionnaire score ≥3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. RESULTS/FINDINGS: SBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). CONCLUSIONS: This study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.

Efficacy and Safety of Transforaminal Percutaneous Endoscopic Discectomy in Treatment of Patients Suffering From Discogenic Low Back Pain in Kenya.

BACKGROUND: Low back pain (LBP) is a globally prevalent condition, often attributed to lumbar disc herniation (LDH). Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive surgical approach for LDH, offering distinct advantages. This study aimed to assess the progression of pain in patients who underwent TPED in Kenya, with a focus on the impact of pre-existing factors. METHODS: This retrospective study included 610 patients from the Mediheal Group of Hospitals who underwent TPED between January 2018 and December 2022. Data were collected from medical records, direct patient interactions, and telephone interviews. Statistical analyses, including repeated measures analysis of variance, correlation coefficients, and t tests, were used to examine pain progression and factors influencing outcomes. RESULTS: Among the 610 included patients, all reported LBP and 87.9% reported leg pain. TPED resulted in significant pain reduction (P < 0.001) for both LBP and leg pain, with sustained improvement over 1 year. Factors such as age, body mass index, and duration of pain correlated with pain outcomes. No significant impact of comorbidities on pre- or postoperative pain was observed. Its retrospective design and the absence of a control group limit the strength of causal inferences. CONCLUSIONS: TPED is an effective treatment for LBP and leg pain in Kenyan patients with LDH. Pain improvement was sustained over 1 year after performing TPED, and pre-existing factors influenced outcomes. This study provides valuable insights into TPED outcomes, contributing to the understanding of LDH management in diverse populations.

Smart working during the COVID-19 pandemic: the prevalence of musculoskeletal and visual disorders in administrative staff of a large international company.

Introduction: During the COVID-19 Pandemic, the use of digital devices during work activities has increased with important re-percussions on the psychological and physical well-being of the employees. The aim of this study was to investigate the prevalence of musculoskeletal and visual disorders related to the use of computers and home workstation. Methods: The study is a cross-sectional study. A checklist, from the National Institute of Health, was administered to white collar workers of a large international pharmaceutical company based in Italy. Results: Our study showed that postural breaks have a protective effect on neck/shoulder pain (OR 0.32, CI 0.16-0.62), back and lower extremity pain (OR 0.35, CI 0.18-0.69), and eye burning (OR 0.50, CI 0.27-0.94) of study participants. Conclusions: The research recommends that remote employees who often change their workstations should establish a suitable work environment and obtaining enough risk training from an occupational physician. This is essential for maintaining their mental and physical well-being.