Prognosis of a new episode of low-back pain in a community inception cohort.

BACKGROUND: Most studies investigating the prognosis of low back pain (LBP) enrol people presenting for care, rather than all people who have an episode of LBP. We aimed to describe the prognosis of an acute episode of LBP in a community inception cohort. METHODS: We used data from two previous studies investigating recurrence of LBP. Participants without current LBP were contacted monthly to assess if they had experienced a new episode of LBP. 366 participants reporting a new episode of LBP were included in the current study. The primary outcome was duration of the new episode of LBP. Secondary outcomes were average and worst pain during the episode and the proportion of participants seeking care. RESULTS: The median duration of the episode was 5 days (95% CI 3.99 to 6.02). The cumulative probability of recovery was 70.0% (95% CI 65.3 to 74.7) before 1 week, 86.1% (95% CI 82.6 to 89.6) before 3 weeks, 90.9% (95% CI 88.0 to 93.8) before 6 weeks, and 93.5% (95% CI 90.8 to 96.0) before 12 weeks. The mean average pain intensity was 3.7 (SD ± 1.5), and the mean worst pain intensity was 5.6 (SD ± 1.9). The proportion of patients who sought care was 39.5% (95% CI 33.9 to 46.4). CONCLUSIONS: This study found most episodes of LBP recover rapidly and more quickly than typically reported for clinical populations. The worst pain during the episode was typically moderate despite the rapid recovery for most people. Approximately 40% of the participants who experienced an episode of LBP sought care. SIGNIFICANCE: This study describes the prognosis of an acute episode of LBP in a community inception cohort. This study found the majority of episodes of LBP, in community-dwelling adults, recover rapidly (median of 5 days) and more quickly than typically reported for clinical populations. The community should be reassured about the favourable prognosis of acute LBP.

An individualised self-management exercise and education program did not prevent recurrence of low back pain but may reduce care seeking: a randomised trial.

QUESTION: What is the effect of a McKenzie-based self-management exercise and education program on the risk of recurrence of low back pain (LBP) and on the impact of LBP? DESIGN: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: 262 adults recently recovered from an episode of LBP. INTERVENTION: The experimental group received a McKenzie-based self-management exercise and education program delivered over two individual sessions of 30 to 45 minutes with a physiotherapist, approximately 2 weeks apart. The control group received a single advice session over the phone. OUTCOME MEASURES: The primary outcome was time to first recurrence of an episode of activity-limiting LBP. Secondary outcomes included time to recurrence of any LBP, time to a recurrence causing care seeking and a composite measure of pain and function ('impact of LBP'). Participants were followed-up monthly for ≥ 12 months. RESULTS: The estimated effect of the experimental intervention on the risk of recurrence of an episode of: activity-limiting LBP was HR 1.11 (95% CI 0.80 to 1.54), any LBP was HR 0.95 (95% CI 0.72 to 1.26), and LBP for which care was sought was HR 0.69 (95% CI 0.46 to 1.04). The quarterly estimates of the experimental intervention's effect on impact of LBP and their 95% CIs were all within 4 points above or below 0 (no effect) on this scale from 8 to 50. CONCLUSION: This study's best estimate is that a McKenzie-based self-management exercise and education program does not produce a worthwhile reduction in the risk of an activity-limiting episode of LBP; however, modestly reduced or moderately increased risk cannot be ruled out. It may markedly reduce the risk of an episode of LBP resulting in care seeking, but does not have any worthwhile effect on the impact of LBP over 12 months. TRIAL REGISTRATION: ACTRN12616000926437.

Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis.

BACKGROUND: There is uncertainty about the role of preoperative physical activity (PA) level and its influence on postoperative outcomes, especially for patients undergoing cancer surgery. AIM: To investigate if the level of preoperative PA in patients undergoing cancer surgery is associated with postoperative complication rates, length of hospital stay (LOS) and quality of life (QOL). METHODS: An electronic search was performed from inception to 26th November 2017 in MEDLINE, Embase, AMED and CINAHL. Studies investigating the association between objective or subjective level of PA and postoperative complication rates, LOS and QOL were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When possible, summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effect models. RESULTS: 13 studies (5523 unique patients) were included. Overall, most studies were rated as having low or moderate risk of bias. Higher preoperative level of PA was not significantly associated with absence of postoperative complications (OR = 2.60; 95%CI = 0.59 to 11.37) but was significantly associated with shorter LOS (OR = 3.66; 95%CI = 1.38 to 9.6) and postoperative QOL (OR = 1.29; 95%CI = 1.11 to 1.49). CONCLUSIONS: The available literature suggests higher levels of preoperative PA in patients undergoing cancer surgery may be associated with better postoperative outcomes, particularly shorter LOS and better QOL. There is a need for high-quality studies investigating the association between preoperative PA and postoperative outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2017 CRD42017082334. Available from:http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017082334.

Effectiveness of McKenzie Method-Based Self-Management Approach for the Secondary Prevention of a Recurrence of Low Back Pain (SAFE Trial): Protocol for a Pragmatic Randomized Controlled Trial.

BACKGROUND: Although many people recover quickly from an episode of low back pain (LBP), recurrence is very common. There is limited evidence on effective prevention strategies for recurrences of LBP. OBJECTIVE: The purpose of this study was to determine the effectiveness of a McKenzie method-based self-management approach in the secondary prevention of LBP. DESIGN: This will be a pragmatic randomized controlled trial. SETTING: Participants will be recruited from the community and primary care, with the intervention delivered in a number of physical therapist practices in Sydney, Australia. PARTICIPANTS: The study will have 396 participants, all of whom are at least 18 years old. INTERVENTION: Participants will be randomly assigned to either the McKenzie method-based self-management approach group or a minimal intervention control group. MEASUREMENTS: The primary outcome will be days to first self-reported recurrence of an episode of activity-limiting LBP. The secondary outcomes will include: days to first self-reported recurrence of an episode of LBP, days to first self-reported recurrence of an episode of LBP leading to care seeking, and the impact of LBP over a 12-month period. All participants will be followed up monthly for a minimum of 12 months or until they have a recurrence of activity-limiting LBP. All participants will also be followed-up at 3, 6, 9, and 12 months to assess the impact of back pain, physical activity levels, study program adherence, credibility, and adverse events. LIMITATIONS: Participants and therapists will not be masked to the interventions. CONCLUSIONS: To our knowledge, this will be the first large, high-quality randomized controlled trial investigating the effectiveness of a McKenzie method-based self-management approach for preventing recurrences of LBP. If this approach is found to be effective, it will offer a low-cost, simple method for reducing the personal and societal burdens of LBP.

Methionine and methionine sulfoxide treatment induces M1/classical macrophage polarization and modulates oxidative stress and purinergic signaling parameters.

Methionine is an essential amino acid involved in critical metabolic process, and regulation of methionine flux through metabolism is important to supply this amino acid for cell needs. Elevation in plasma methionine commonly occurs due to mutations in methionine-metabolizing enzymes, such as methionine adenosyltransferase. Hypermethioninemic patients exhibit clinical manifestations, including neuronal and liver disorders involving inflammation and tissue injury, which pathophysiology is not completely established. Here, we hypothesize that alterations in macrophage inflammatory response may contribute to deleterious effects of hypermethioninemia. To this end, macrophage primary cultures were exposed to methionine (1 mM) and/or its metabolite methionine sulfoxide (0.5 mM), and M1/proinflammatory or M2/anti-inflammatory macrophage polarization was evaluated. In addition, inflammation-related pathways including oxidative stress parameters, as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) activities; reactive oxygen species (ROS) production, and purinergic signaling, as ATP/ADP/AMPase activities, were investigated. Methionine and/or methionine sulfoxide induced M1/classical macrophage activation, which is related to proinflammatory responses characterized by increased iNOS activity and TNF-α release. Further experiments showed that treatments promoted alterations on redox state of macrophages by differentially modulated SOD and CAT activities and ROS levels. Finally, methionine and/or methionine sulfoxide treatment also altered the extracellular nucleotide metabolism, promoting an increase of ATPase/ADPase activities in macrophages. In conclusion, these findings contribute to better understand the participation of proinflammatory responses in cell injury observed in hypermethioninemic patients.

Green juice as a protector against reactive species in rats.

INTRODUCTION: Green juice is popularly known for introducing antioxidants, improving intestinal function and reducing weight gain. OBJECTIVES: In the present study we determine the antioxidant effect of green juice comparing it with orange juice. METHODS: Rats were divided into three experimental groups and submitted to supplementation for 15 days: the (GJ) group received green juice, the (OJ) group received orange juice and the control group received water. We evaluated the antioxidant activity and total phenolic content of green and orange juices, as well as rat weight gain. We also investigated some oxidative stress parameters, namely thiobarbituric acid-reactive substances (TBARS), superoxide dismutase and catalase in rat cerebral cortex. RESULTS AND DISCUSSION: Results showed that GJ had significantly less weight gain than the control group. With respect to antioxidant activity screening, the remaining percentage of DPPH at dilutions 1:10, 1:100 and 1:1000 of green juice was 22.8%, 58% and 78%, and orange juice, at the same dilutions, was 5.6%, 5.6% and 77.2%, respectively. The ability of juices to reduce the ABTS radical was 3.5 mmol trolox/L for green juice and 5.2 mmol trolox/L for orange juice. Additionally, the green juice did not present any difference in total phenolic acid content when compared to orange juice. TBARS were reduced in GJ and OJ. Besides, GJ supplementation decreased catalase activity. In conclusion, our data showed that green juice reduced weight gain, lipoperoxidation and catalase activity, suggesting that this supplementation may have a protective effect against reactive species.

Introducción: El zumo verde es conocido popularmente como fuente de antioxidantes, mejorando la función intestinal y reduciendo la ganancia de peso. Objetivos: En este estudio determinamos el efecto antioxidante del zumo verde en comparación con el zumo de naranja. Métodos: Se dividió a las ratas en tres grupos experimentales y se las sometió a un suplemento durante 15 días: el grupo ZV recibió zumo verde, el grupo ZN recibió zumo de naranja y el grupo control recibió agua. Evaluamos la actividad antioxidante y el contenido total en fenoles de los zumos verde y de naranja, así como la ganancia de peso en las ratas. También investigamos algunos parámetros del estrés oxidativo, en concreto las sustancias reactivas del ácido tiobarbitúrico (SRATB), la superóxido dismutasa y la catalasa en la corteza cerebral de las ratas. Resultados y discusión: Los resultados mostraron que el ZV producía una ganancia de peso significativamente menor que en el grupo control. Con respecto al estudio de la actividad antioxidante, el porcentaje restante de DPPH en diluciones al 1:10, 1:100 y 1:1000 de zumo verde fue del 22,8%, 58% y 78%, y para el zumo de naranja, a las mismas diluciones, fue del 5,6%, 5,6% y 77,2%, respectivamente. La capacidad de los zumos para reducir el radical de ATB fue de 3,5 mmol trolox/l para el zumo verde y de 5,2 mmol trolox/l para el zumo de naranja. Adicionalmente, el zumo verde no mostró ninguna diferencia en el contenido total de ácido fenólico en comparación con el zumo de naranja. Las SRATB se redujeron con el ZV y el ZN. Además, el suplemento con ZV disminuyó la actividad catalasa. En conclusión, nuestros datos mostraron que el zumo verde redujo la ganancia de peso, la lipoperoxidación y la actividad catalasa, lo que sugiere que este suplemento podría tener un efecto protector frente a las especies reactivas.