Health-related quality of life after hip fracture: effects of a 12-month home-based exercise intervention-secondary analyses of an RCT.

PURPOSE: In this randomized controlled trial, we analyzed the effects of a 12-month home-based exercise intervention on the health-related quality of life (HRQoL) of patients with a hip fracture. METHODS: Participants (n = 121) aged ≥ 60 years, with a Mini-Mental State Examination (MMSE) score of ≥ 12 and an operated hip fracture, were placed into Exercise (n = 61) or Usual care (n = 60) groups. Physiotherapist-supervised, home-based training was given twice a week over 12 months. HRQoL was assessed using the 15D instrument at baseline and at 3, 6, and 12 months. The total 15D scores and dimension scores were analyzed and compared to national age- and sex-matched reference data. RESULTS: The participants' mean age was 81 years (SD 7), 75% were women, and 61% had a femoral neck fracture. The mean within-group change in total 15D score over 12 months was 0.023 (95% CI: -0.003 to 0.048) in the Usual care group, and 0.028 (CI: 0.003 to 0.054) in the Exercise group (between-group p = 0.76). We found a statistically significant change in total 15D score in the Exercise group, as well as in the dimension scores of mobility and usual activities in both groups. All 15D scores remained below the general population reference level. CONCLUSION: Exercise training for 12 months did not enhance the HRQoL of home-dwelling patients with hip fractures any more than usual care. In addition, HRQoL remained below the population level in both groups.

Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. DESIGN: A randomized controlled trial with a 1:1 allocation. SETTING: Home-based. PARTICIPANTS: Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria. INTERVENTIONS: A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149). MAIN OUTCOME MEASURES: FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months. RESULTS: FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity. CONCLUSIONS: One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.

Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. DESIGN: Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. SETTING: Home-based intervention. PARTICIPANTS: Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. INTERVENTIONS: Supervised physical exercise twice a week. MAIN OUTCOME MEASURES: The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. RESULTS: Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. CONCLUSIONS: Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.

Older persons with signs of frailty in a home-based physical exercise intervention: baseline characteristics of an RCT.

BACKGROUND: Increasing the level of physical activity among persons with signs of frailty improves physical functioning. There is a lack of long-term supervised physical exercise intervention studies including a validated definition of frailty. AIMS: To present baseline characteristics of persons with signs of frailty participating in a randomized long-term home-based physical exercise trial (HIPFRA), and to study associations between the severity of frailty, functional independence and health-related quality-of-life (HRQoL). METHODS: Three hundred persons, ≥ 65 years old and with signs of frailty (assessed by Fried´s phenotype criteria) were recruited from South Karelia, Finland and randomized to a 12-month physiotherapist-supervised home-based physical exercise program (n = 150), and usual care (n = 150). Assessments at the participants' homes at baseline, and after 3, 6 and 12 months included the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM), HRQoL (15D) and the Mini-Mental State Examination (MMSE). RESULTS: Eligibility was screened among 520 persons; 300 met the inclusion criteria and were randomized. One person withdrew consent after randomization. A majority (75%) were women, 182 were pre-frail and 117 frail. The mean age was 82.5 (SD 6.3) years, SPPB 6.2 (2.6), FIM 108.8 (10.6) and MMSE 24.4 (3.1) points, with no significant differences between the study groups. Inverse associations between the severity of frailty vs. FIM scores and HRQoL (p < 0.001 for both) were found. CONCLUSIONS: Our participants showed marked physical frailty without major disabilities. The severity of frailty seems to be associated with impaired functional independence and HRQoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT02305433.

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study).

BACKGROUND: Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. METHODS: This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. DISCUSSION: Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02305433 , Registered Nov 28, 2014.

Does strenuous leisure time physical activity prevent severe back disorders leading to hospitalization?

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study the associations between strenuous leisure time physical activity (LTPA) and subsequent hospitalization due to back disorders. Socioeconomic and lifestyle factors are associated with back-related hospitalization, but the significance of strenuous LTPA in the working population is unclear. METHODS: The cohort (n = 902) was drawn from among employees in the metal industry (n = 2,653). Data were collected by a questionnaire and a structured interview on LTPA. Activity regarding strenuous (>500 kcal/h) LTPA was categorized as none, some, and high. Information from national registers on hospitalizations and deaths during 28 years of follow-up was linked to the data. Cox proportional hazards regression was used. RESULTS: Subjects with a high level of strenuous LTPA had a decreased risk of hospitalization due to back disorders (hazard ratio 0.40; 95% CI 0.21-0.79) compared with persons with no strenuous activity, after adjustment for age and gender. The association persisted (0.48; 0.24-0.96) when further adjusted for occupational class, self-reported back diseases, smoking, and body mass index at baseline. CONCLUSION: Strenuous LTPA decreased the risk of inpatient hospital care for back disorders among industrial employees.

Low back pain and neck pain as predictors of sickness absence among municipal employees.

OBJECTIVE: To study whether having ever had local low back pain (LBP), sciatica, neck pain (NP), or some combination of LBP and NP, predicts sickness absence among municipal employees. METHODS: The study sample (n=6911, 80% women, response rate 67%) included employees of the City of Helsinki who reached the age of 40, 45, 50, 55, or 60 years between 2000-02. Survey data on pain, working conditions, and health behaviours were linked to register data on sickness absence for three subsequent years. Sickness absence was categorised as self-certified (lasting for 1-3 days) and medically certified (lasting for 4 days or more) and the number of spells during the follow up was analysed using Poisson regression analysis. RESULTS: In women, medically certified sickness absence was predicted by sciatica (rate ratio, RR, 1.3, 95% CI 1.1-1.6), NP (RR 1.3, 95% CI 1.2-1.5) and the combination of sciatica and NP (RR 1.8, 95% CI 1.6-2.1), allowing for working conditions, body mass index, and smoking. In men, the corresponding RRs were 1.5 (95% CI 1.0-2.1), 1.7 (95% CI 1.2-2.4), and 2.2 (95% CI 1.6-2.9). Local LBP did not predict medically certified sickness absence. Self-certified sickness absence was modestly predicted by all pain categories in women (RRs between 1.2 and 1.5) and by NP alone and with local LBP or sciatica in men (RRs between 1.4 and 1.6). CONCLUSIONS: Medically certified sickness absence was predicted by sciatica and NP, but not by local LBP. The association was accentuated in those with both sciatica and NP. Pain combinations may have a stronger effect on work ability than pain in one location.

Changes in the Severity of Frailty Among Older Adults After 12 Months of Supervised Home-Based Physical Exercise: A Randomized Clinical Trial.

OBJECTIVE: To investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses. DESIGN: Randomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes. SETTING AND PARTICIPANTS: Home-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria. METHODS: The severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months. RESULTS: Two hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (-0.27, 95% CI -0.47, -0.08) and remained unchanged in the usual care group (0.01, 95% CI -0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P < .001) criteria were lower at 12 months in the exercise group than in the usual care group. CONCLUSIONS AND IMPLICATIONS: The severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.

Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT.

BACKGROUND: Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. METHODS: Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged ≥60 years, Mini-Mental State Examination (MMSE) score of ≥12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. RESULTS: Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. CONCLUSION: A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial.

OBJECTIVES: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. DESIGN: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. SETTING AND PARTICIPANTS: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17. METHODS: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. RESULTS: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004). CONCLUSIONS AND IMPLICATIONS: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.

Persistence of low back pain reporting among a cohort of employees in a metal corporation: a study with 5-, 10-, and 28-year follow-ups.

Low back pain (LBP) is a common symptom among adults but little is known about its persistence over time in defined populations. The aim of this study was to examine the persistence of LBP among a cohort of industrial employees studied in four successive surveys during a total of 28 years. Cross-tabulations and logistic regression was used to estimate the interdependence of LBP occurrence at the surveys. At baseline, 54% of the subjects reported local LBP and 25% LBP radiating to the lower limb(s). Persistent or recurrent LBP was common. Of those with LBP at baseline, 75, 73, and 88% reported it also at the 5-, 10- or 28-year follow-up, respectively. Of those with radiating pain, 66, 65, and 69% were symptomatic 5, 10, or 28 years later. The onset of reporting LBP increased during follow-up. Of those without local LBP at baseline, 33, 37 and 64% had pain at the 5-, 10-, or 28-year follow-up, respectively. Of those without radiating LBP, 17, 22, and 46% had pain at the 5-, 10-, or 28-year follow-up. The odds ratio of local LBP at the 5-, 10-, or 28-year follow-up for those with such pain at baseline vs. not were 6.0 (95% CI 4.3-8.3), 4.7 (3.3-6.6) and 4.0 (2.6-6.3), adjusted for age, gender and occupational class. The respective figures for radiating LBP were 8.5 (5.7-12.5), 6.7 (4.4-10.1) and 2.3 (1.5-3.6). We conclude that LBP is commonly recurrent.

Common mental and musculoskeletal disorders as predictors of disability retirement among Finns.

BACKGROUND: The contribution of common mental disorders (CMD) co-occurring with chronic musculoskeletal disorders (MSD) to disability retirement is not known. METHODS: A nationally representative sample (the Health 2000 survey) comprised 3943 occupationally active Finns aged 30-63. MSD and other chronic disorders were assessed by a physician in a standardized clinical examination, and CMD using the Composite International Diagnostic Interview. Disability pension data for 2000-2011 was retrieved from national pension records. Cox regression was used with censoring for death and pension other than that for disability. Covariate information was based on an interview. RESULTS: The baseline prevalence of CMD was 9.4% and of MSD 31.1%. CMD co-occurred with MSD in 3.3% of participants. The risks inflicted by CMD and MSD were additive. Thirty-eight per cent of the co-morbid subjects, 18% of those with CMD and 19% of those with MSD retired prematurely during the average follow-up of 8.6 years. Compared with those with neither type of disorder, the hazard ratio (HR) for disability pension was 2.4 (95% CI 1.7-2.7) for CMD only, 2.2 (1.8-2.7) for MSD only, and 4.1 (2.9-5.7) for the occurrence of both, allowing for age, gender, other chronic disorders, working conditions, and socio-economic and lifestyle factors. No synergistic or antagonistic interactive effects were observed. LIMITATIONS: The determinants were measured only once and we had no information on incident disorders during the follow-up. CONCLUSIONS: It is important to identify subjects with both mental and musculoskeletal complaints in order to efficiently support their work ability.

Pain and disability retirement: a prospective cohort study.

This study examined the association of pain with subsequent disability retirement due to all causes as well as musculoskeletal diseases, mental disorders, and a heterogeneous group of other diseases and to study whether pain has an effect of its own after taking into account long-standing illness, physician-diagnosed diseases, working conditions, and occupational class, which are the key factors affecting disability retirement. The data consisted of the Helsinki Health Study baseline survey linked to national pension register data (n=6258). Mean follow-up time was 8.1 years. The data included 594 disability retirement events. Pain (acute or chronic) was stratified by long-standing illness (yes/no). Cox regression analysis was performed. Chronic pain without and with co-occurring long-standing illness was strongly associated with all types of disability retirement outcomes, but the associations were particularly strong for disability retirement due to musculoskeletal diseases. The associations remained even when further adjusted for physician diagnosed chronic conditions and diseases, psychosocial and physical working conditions, and occupational class. Associations for acute pain were also found, but they were clearly weaker than those of chronic pain. Chronic pain contributes to disability retirement. Prevention and effective treatment of chronic pain may help prevent early retirement due to disability.

Different domains of health functioning as predictors of sickness absence--a prospective cohort study.

OBJECTIVES: The aim of this study was to examine different domains of health functioning as predictors of sickness absence. METHODS: The Short Form 36 (SF-36) is one of the best known instruments measuring various domains of physical and mental health functioning. A questionnaire including the SF-36 was mailed to 40-60-year-old employees of the City of Helsinki in 2000-2002. For the subsequent three years, sickness absence episodes >2 weeks were derived from the employer's register. The predictive ability of the eight subscales and two component summaries of the SF-36 were compared using regression methods and receiver operating characteristic (ROC) curve analysis. RESULTS: All eight SF-36 subscales and the two component summaries predicted the occurrence of sickness absence over the follow-up period. Among women, bodily pain was the strongest predictor, with 1 standard deviation increase in bodily pain increasing the occurrence of sickness absence by 77% [95% confidence interval (95% CI) 68-86%]. Role limitations due to emotional problems were the weakest predictor of sickness absence (29%, 95% CI 23-36%). Among men, the results were similar to those of women. In both genders, the area under the ROC curve was largest for bodily pain, general health, and physical functioning and lowest for mental health and role limitation due to emotional problems. CONCLUSIONS: The subscales measuring physical domains of functioning were more strongly associated with sickness absence than the mental subscales. In particular, ability to perform daily activities, pain, and general health were important predictors of sickness absence >2 weeks.

Risk factors of sciatic pain: a prospective study among middle-aged employees.

OBJECTIVE: To study the effects of occupational class, physical and psychosocial working conditions, health behaviours, and pain in the low back and the neck on sciatic pain among middle-aged employees. METHODS: The participants were municipal employees without previous sciatica, aged 40, 45, 50, 55, and 60 years at baseline (n=5261, 80% women). Sciatica was defined as low back pain radiating to the calf or the foot. Data on occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure-time physical activity, neck pain, local low back pain, and sciatica were obtained from baseline questionnaire surveys in 2000-2002. The question on sciatica was repeated in a follow-up survey in 2007. Logistic regression analysis was used. RESULTS: In women, manual occupational class (OR 1.3; 95% CI 1.0-1.6 compared with managers/professionals), overweight (1.3; 1.1-1.5), obesity (1.4; 1.1-1.7), smoking (1.5; 1.2-1.7), low leisure-time physical activity (1.3; 1.0-1.7), previous acute (1.5; 1.3-1.7) and chronic (1.5; 1.1-2.0) local low back pain, and acute (1.20; 1.0-1.4) and chronic (1.5;1.2-1.9) neck pain predicted the onset of sciatica in a multivariable model. In men, semi-professionals (1.5; 1.1-2.1) and manual workers (2.0; 1.4-2.8) had an increased risk compared with managers/professionals; also acute (1.5; 1.2-2.0) and chronic (2.1; 1.2-3.9) local low back pain predicted sciatica. CONCLUSIONS: Manual occupational class in both genders and semi-professional occupations in men, unhealthy behaviours and previous pain both in the neck and the lower back predicted sciatica, while physical and psychosocial working conditions had no independent effect.

Pain and clinical findings in the low back: a study of industrial employees with 5-, 10-, and 28-year follow-ups.

Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist's findings in the low back were associated with local and radiating LBP among a cohort (n=902) of employees in the engineering industry. A systematic non-proportional sample was drawn in strata by age, gender, and occupational class. The non-proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight-leg raising test (SRL), and made assessments of the fingertip-to-floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow-ups of the occurrence of local and radiating LBP at 5, 10, and 28 years from baseline were made. At the 5-year follow-up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4-5.1) and 3.8 (2.0-6.9), respectively, adjusted for age, gender, and occupational class. At the 10-year follow-up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0-3.1) and of local LBP (4.1; 1.9-9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling.

Associations of low back pain with neck pain: a study of industrial employees with 5-, 10-, and 28-year follow-ups.

Low back pain (LBP) and neck pain (NP) are common among the adult population but relatively few reports exist on the associations between these. We examined cross-sectional and prospective relationships of LBP with NP in an employee cohort studied repeatedly over 28 years. Locally perceived pain was studied separately from pain with a radiating component. At baseline, adjusted for age, gender, and occupational class, the prevalence ratio (PR) of local NP for those with local LBP was 1.93 (95% CI 1.47-2.54), and for those with radiating LBP 2.16 (1.59-2.94), while the PR of radiating NP for those with local LBP was 1.51 (0.97-2.35) and for those with radiating LBP 3.24 (2.25-4.65). These associations remained stable at the 5-, 10-, and 28-year follow-ups. Both local and radiating LBP at baseline predicted new cases of radiating NP at the 5- and 10-year follow-ups, but not at the 28-year follow-up. In analyses stratified by gender, both the cross-sectional and prospective associations were more pronounced in men. In conclusion, the study showed a clear association of LBP with NP that persisted on a similar level irrespective of the aging of the cohort. Particularly, radiating LBP was associated with radiating NP. The prospective associations of LBP at baseline with new reports of radiating NP decreased as the length of follow-up increased.

Low back pain, work absenteeism, chronic back disorders, and clinical findings in the low back as predictors of hospitalization due to low back disorders: a 28-year follow-up of industrial employees.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study symptoms, chronic disorders, and clinical findings in the low back, and work absenteeism, as predictors of hospitalization. SUMMARY OF BACKGROUND DATA: Socioeconomic and lifestyle factors are associated with back-related hospitalization, but the significance in the working normal population of low back symptoms and clinical findings are not known. METHODS: The cohort (n = 902) was drawn in 1973 from among employees in the metal industry (n = 2,653). The data were collected by questionnaire and a structured clinical assessment by a physiotherapist. Weight was measured. A sum score of local and radiating low back symptoms (frequency during the past year on a 4-point Likert scale) was categorized as no/yes and no/infrequent/frequent. Local and radiating symptoms were considered also separately. The data were linked with those from the Finnish Hospital Discharge Register during 1973 to 2000. Logistic regression and the Cox proportional hazard models were used. RESULTS: As compared with persons without low back pain, those with frequent or radiating low back pain had an increased risk of hospitalization due to low back disorders (hazard rate ratio (HRR), 3.0; 95% confidence interval (CI), 1.4-6.5, and 3.7; 1.8-7.7, respectively) after adjustment for age, gender, and occupational class. Similarly, clinical findings (HRR, 2.4; 95% CI, 1.3-4.7), back-related absenteeism (HRR, 3.3; 95% CI, 1.6-6.7), and chronic low back disorders (HRR, 2.8; 95% CI, 1.5-5.4) predicted hospitalization. The associations persisted when further adjusted for smoking, body mass index, and distress symptoms at baseline. CONCLUSION: Frequent or radiating low back symptoms, chronic low back disorders, back-related work absenteeism, and having clinical findings in the low back predicted inpatient hospital care for low back disorders.