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1.
Artigo em Alemão | MEDLINE | ID: mdl-31529183

RESUMO

BACKGROUND: Pain not only causes suffering in children and adolescents, but also leads to school absenteeism, medication intake, medical treatment, and an increased risk of recurrent pain in adulthood. OBJECTIVES: Based on data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the 3­month prevalence of recurrent headache, abdominal and back pain in girls and boys is reported, and is compared with the prevalence from the KiGGS baseline survey (2003-2006). The consequences of recurrent headache were also explored. MATERIALS AND METHODS: Data from >11,000 participants (KiGGS Wave 2) and from >12,000 (KiGGS baseline) participants aged between 3 and 17 years were analyzed. For 3­ to 10-year-olds, parents/guardians answered the questions, while 11- to 17-year-olds provided information themselves. RESULTS: In 3­ to 10-year-olds, recurrent abdominal pain was most prevalent, affecting one third of girls and one quarter of boys. Headache was the most frequent type of pain in 11- to 17-year-olds, affecting almost every second girl and about every third boy. The 3­month prevalence of recurrent headache, abdominal and back pain has increased in girls and boys, especially in the age groups 7 to 10 years and 11 to 13 years. Among recurrent headache sufferers, adolescents take medication almost twice as often as children. CONCLUSIONS: Headache, abdominal, and back pain are still and with increasing prevalence very common symptoms in children and adolescents in Germany. Their prevention requires a holistic view of children's health in the psychosocial living environment, and healthcare context.


Assuntos
Dor/epidemiologia , Dor Abdominal/epidemiologia , Adolescente , Adulto , Dor nas Costas/epidemiologia , Criança , Saúde da Criança , Pré-Escolar , Estudos Transversais , Feminino , Alemanha/epidemiologia , Cefaleia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência
2.
NeuroRehabilitation ; 44(3): 419-424, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177242

RESUMO

BACKGROUND: Postural deformities, such as Pisa syndrome (PS), and camptocormia and antecollis (C&A) are common in patient with Parkinson's disease (PwPD). These deformities can lead to back disability and pain with different mechanisms, including abnormal loading or stress on soft tissues as muscles, lumbar discs and ligaments. OBJECTIVES: To evaluate the effect of different postural deformities including PS and C&A on back function and pain in PwPD. METHODS: The function, disability and pain were assessed by Oswestry disability index (ODI) and brief pain inventory (BPI). All participants completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). RESULTS: PS and C&A groups significantly showed worse disability ODI and pain BPI, and higher LEDD and mH&Y stage compared with PD groups. However, no differences were found in PD duration and UPDRS in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales. CONCLUSION: These results demonstrated that PS and C&A are associated with severe impairment of back functions and pain. Rehabilitation programs for PwPD and PS, and C&A should include spine alignment and postural training.


Assuntos
Dor nas Costas/fisiopatologia , Atrofia Muscular Espinal/fisiopatologia , Doença de Parkinson/fisiopatologia , Postura/fisiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/epidemiologia , Medição da Dor/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Curvaturas da Coluna Vertebral/diagnóstico , Curvaturas da Coluna Vertebral/epidemiologia
3.
Dtsch Med Wochenschr ; 144(10): 665-669, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31083735

RESUMO

In the case of acute back pain, the indication for inpatient diagnosis and therapy is rarely given. The indication is provided if a potentially dangerous disease situation is suspected and if the pain is immobilizing or cannot be controlled on an outpatient basis. The high treatment numbers in German hospitals indicate that there is overuse in the treatment of back pain. Back pain, especially acute low back pain, is a frequent consultative activity of general practitioners. Serious diseases of the spine occur in only about 1 % of cases in GP practices. Identifying potentially dangerous disease outcomes requires a detailed history and thorough physical examination of the unclothed patient. "Red flags", together with the overall clinical impression of the patient, provide decisive warnings for urgently needed back pain. Common non-specific low back pain can be treated on an outpatient basis by prescribing painkillers and instructions for exercise by GPs.


Assuntos
Dor nas Costas , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Dor nas Costas/terapia , Alemanha , Humanos
4.
Medicine (Baltimore) ; 98(22): e15729, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145287

RESUMO

The study sought to characterize back pain (BP) (in the period of 12 months) in children and youth aged 10 to 19 from eastern Poland.The study included 11619 children and youth (6254 girls and 5365 boys) aged 10 to 19 from eastern Poland. An original questionnaire was applied as a research tool. Before the study, the reliability of the questionnaire had been assessed. The Kappa coefficient value for all the analyzed variables was equal to or higher than 0.91.Over 74.4% of the respondents admitted that within the last 12 months, they had experienced BP which was usually located in the lumbar spine (55.8%). The percentage of individuals reporting BP increased with age of participants. Girls reported BP more often than boys (82.8% vs 64.3%). The main circumstances in which BP occurred included lifting heavy objects, carrying school backpack and maintaining a sedentary position (70.7% vs 67.4% vs 67.8%). Over 67% of the respondents declared they did not know ergonomic principles.High prevalence of BP was noted. The declared BP was mainly located in the lumbar spine. Girls reported BP more often than boys. The students presented a very low level of knowledge about ergonomics. Therefore, the appropriate education should be included at school.


Assuntos
Dor nas Costas/epidemiologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Estudantes/psicologia , Adolescente , Dor nas Costas/prevenção & controle , Dor nas Costas/psicologia , Criança , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares , Masculino , Polônia , Prevalência , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-31003399

RESUMO

Objective: To explore the potential classroom furniture mismatch with students' anthropometric measurements and back pain related to sitting for extended periods. Methods: This cross-sectional study was carried out on all twelve male and female intermediate and secondary schools located in Abha city. Anthropometric and classroom furniture measurements were assessed, and the mismatch was determined using standardized methods. Students were also screened for back pain related to long sitting at school. Results: A total number of 879 students was selected. The study revealed seat height mismatch in both intermediate, and secondary school of 84.3%, and 75.6%, respectively. Seat depth mismatch was 74.0% in intermediate schools and reached 84.5% in secondary schools. The desk height was improper for 94.1%, and 82.3% of students in intermediate, and secondary schools, respectively. The levels of mismatch differ significantly by grade level and gender. A prevalence of 10.8% of back pain related to long sitting at school was found. In multivariable logistic regression, males, intermediate school children, and the presence of buttock-popliteal length/seat depth mismatch were significantly associated with pain. On the other hand, practicing exercise was a significant protective factor. Conclusions: There is a prevalent mismatch between students' dimensions and existing schools' furniture. School furniture providers should take in consideration the average Saudi students' dimensions, while designing school furniture especially for males, and at intermediate schools, or provide schools with adjustable seats and desks.


Assuntos
Dor nas Costas/epidemiologia , Decoração de Interiores e Mobiliário , Instituições Acadêmicas , Adolescente , Antropometria , Estudos Transversais , Exercício , Feminino , Humanos , Masculino , Fatores de Proteção , Arábia Saudita/epidemiologia , Estudantes
6.
BMC Musculoskelet Disord ; 20(1): 94, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819162

RESUMO

BACKGROUND: Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. A comprehensively studied stratification instrument is the STarT Back Tool (SBT). It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). Moreover, the potential to improve prognosis for disability by adding further predictor variables, an analysis for differences in pain intensity according to the STarT-Classification, and discriminative ability were investigated. METHODS: Data from the control group of a randomized controlled trial were analysed. Trial participants were members of a private medical insurance with a minimum age of 18 and indicated as having persistent back pain. Measurements were made for the risk of back pain chronification using the STarT-G, disability (as primary outcome) and back pain intensity with the Chronic Pain Grade Scale (CPGS), health-related quality of life with the SF-12, psychological distress with the Patient Health Questionnaire-4 (PHQ-4) and physical activity. Analysis of variance (ANOVA), multiple linear regression, and area under the curve (AUC) analysis were conducted. RESULTS: The mean age of the 294 participants was 53.5 (SD 8.7) years, and 38% were female. The ANOVA for disability and pain showed significant differences (p < 0.01) among the risk groups at 12 months. Post hoc Tukey tests revealed significant differences among all three risk groups for every comparison for both outcomes. AUC for STarT-G's ability to discriminate reference standard 'cases' for chronic pain status at 12 months was 0.79. A prognostic model including the STarT-Classification, the variables global health, and disability at baseline explained 45% of the variance in disability at 12 months. CONCLUSIONS: Disability differences in patients with back pain after a period of 12 months are in accordance with the subgroups determined using the STarT-G at baseline. Results should be confirmed in a study developed with the primary aim to investigate those differences.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Avaliação da Deficiência , Medição da Dor/normas , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prognóstico , Fatores de Risco , Fatores de Tempo
7.
J Altern Complement Med ; 25(S1): S138-S146, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30870015

RESUMO

OBJECTIVES: To report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP). DESIGN: Observational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months. SETTINGS/LOCATION: Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH. SUBJECTS: CLBP patients seeking care at OCC or non-OCC BWH clinics. INTERVENTIONS: Integrative or conventional care for CLBP as prescribed by the treating clinician(s). OUTCOME MEASURES: Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes. RESULTS: Total adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale. CONCLUSIONS: When adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.


Assuntos
Dor nas Costas/economia , Dor nas Costas/terapia , Dor Crônica/economia , Dor Crônica/terapia , Terapias Complementares/economia , Medicina Integrativa , Adulto , Idoso , Dor nas Costas/epidemiologia , Dor Crônica/epidemiologia , Terapias Complementares/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
8.
BMC Musculoskelet Disord ; 20(1): 85, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777049

RESUMO

BACKGROUND: Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel. METHODS: The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave. DISCUSSION: This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.


Assuntos
Dor nas Costas/terapia , Terapia por Exercício/métodos , Educação de Pacientes como Assunto/métodos , Desenvolvimento de Programas/métodos , Autogestão/métodos , Dor nas Costas/epidemiologia , Dinamarca/epidemiologia , Terapia por Exercício/psicologia , Humanos , Manipulação Quiroprática/métodos , Fisioterapeutas , Autogestão/psicologia , Resultado do Tratamento
9.
Eur J Pediatr ; 178(5): 695-706, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30788593

RESUMO

This study aims to describe the prevalence of spinal pain among Danish children, explore the differential nature of spinal pain, and investigate socio-demographic factors predisposing spinal pain. A descriptive study of 46,726 11-14-year-olds participating in the Danish National Birth Cohort was conducted. Self-reported spinal pain (neck, middle back, and low back pain) was registered and classified according to severity. Socioeconomic data on children and their parents were identified in Statistics Denmark registers. Associations between socio-demographic factors and aspects of spinal pain were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting (IPW) was applied. Almost 10% boys and 14% girls reported severe spinal pain, whereas around 30% of all children reported moderate pain. Effect estimates indicated the risk to increase with increasing age. Further, children without biological full siblings, not living with both of their parents, or children living in less-educated or lower-income families were more likely to experience spinal pain. The study conclusions were essentially unaffected by IPW.Conclusion: A considerable number of children suffer from spinal pain, and it is more common among children in more disadvantaged families. Etiology of spinal pain needs to be explored further with the aim of informing efficient and targeted prevention. What is Known: • Childhood spinal pain may cause marked discomfort and impairment in children's everyday life, and is suggested as important predictor of later-in-life spinal pain. • Methodological heterogeneity in previous studies and complexity of measuring pain make inferences at a broader level inadequate. What is New: • Prevalence of severe spinal pain in 11-14-year-olds was estimated to almost 10% for boys and 14% for girls, and children in more disadvantaged families were more likely to experience spinal pain. • The results seemed unaffected by sample selection.


Assuntos
Dor nas Costas/epidemiologia , Adolescente , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Criança , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Medição da Dor , Prevalência , Fatores de Risco , Fatores Socioeconômicos
10.
Turk Neurosurg ; 29(3): 400-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30649816

RESUMO

AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor. MATERIAL AND METHODS: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. The results were compared to spinopelvic parameters of healthy population. RESULTS: The mean PI of the coccydynia patients did not differ from the healthy population, and there were no differences between treatment subgroups. The Postacchini classification showed that patients with type-3 and type-4 configurations had higher PI. When treatment groups were evaluated according to Postacchini classification, 80% of the surgery group had type-3 and type-4 configurations (50%, 30% respectively). CONCLUSION: This is the first study to evaluate the PI of coccydynia patients. Patients with higher PI were prone to having type-3 of type-4 coccyx configurations and undergoing surgical treatment.


Assuntos
Dor nas Costas/diagnóstico por imagem , Dor nas Costas/terapia , Cóccix/diagnóstico por imagem , Tratamento Conservador/métodos , Procedimentos Neurocirúrgicos/métodos , Ossos Pélvicos/diagnóstico por imagem , Corticosteroides/administração & dosagem , Adulto , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Dor nas Costas/epidemiologia , Cóccix/cirurgia , Tratamento Conservador/tendências , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Prognóstico , Estudos Retrospectivos , Fatores de Risco
11.
PLoS One ; 14(1): e0210429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677044

RESUMO

BACKGROUND: The prevalence of back pain in athletes has been investigated in several studies, but there are still under- or uninvestigated sports discipline like sports exposed to repetitive overhead activity. Elite athletes spend much time in training and competition and, because of the nature of their disciplines, subject their bodies to a great deal of mechanical strain, which puts a high level of stress on their musculoskeletal systems. From this it is hypothesized that elite athletes who engage in repetitive overhead motions experience a higher strain on their spine and thus possibly a higher prevalence of back pain compared with an active control group. OBJECTIVES: To examine the prevalence of back pain and the exact location of pain in a cohort of elite athletes with repetitive overhead activity and in a control group of physically active sport students. Additionally, to examine different characteristics of pain, and to evaluate the influence of confounders on back pain. METHODS: A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to German national and international elite athletes, and a control group of physically active but non-elite sports students. RESULTS: The final sample comprised 181 elite athletes of the sports disciplines badminton, beach volleyball, handball, tennis and volleyball and 166 physically active controls. In elite athletes, lifetime prevalence of back pain was 85%, 12-month prevalence was 75%, 3-month prevalence was 58% and point prevalence was 38%; for the physically active control group, these prevalences were 81%, 70%, 59% and 43%, respectively. There was no significant group difference in prevalence over all time periods. The lower back was the main location of back pain in elite athletes across all disciplines and in controls; additionally a distinct problem of upper back pain was found among volleyball players. CONCLUSION: Despite the high mechanical load inherent in the sport disciplines included in this study, the elite athletes who engaged in repetitive overhead activities did not suffer more from back pain than the physically active controls. This suggests that other mechanisms may be influencing back pain prevalences in a positive way in these athletes. Furthermore, these disciplines may practice preventive factors for back pain that outweigh their detrimental factors. Therefore, we posit that extensive prevention work is already being implemented in these sports and that there are additional individual protection factors in play. More research is required to explore these suppositions, and should include investigations into which preventive training programs are being used. Nevertheless, in volleyball particularly, a focus on stabilization/preventive training should be applied to the upper back and neck.


Assuntos
Atletas , Dor nas Costas/epidemiologia , Esportes , Adolescente , Adulto , Fatores de Confusão (Epidemiologia) , Avaliação da Deficiência , Alemanha/epidemiologia , Humanos , Modelos Logísticos , Prevalência , Índice de Gravidade de Doença , Adulto Jovem
12.
BMC Musculoskelet Disord ; 20(1): 38, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674298

RESUMO

BACKGROUND: Recent research has suggested that wide international variation in the prevalence of disabling regional pain among working populations is driven largely by factors predisposing to musculoskeletal pain in general and not specific to individual anatomical sites. We sought to confirm this finding, using data from an independent source. METHODS: Using data from the fifth (2010) and sixth (2015) European Working Conditions Surveys, we explored correlations between the one-year prevalence of pain in the back and neck/upper limb among people of working age across 33 European countries, and between changes in pain prevalence at the two anatomical sites from 2010 to 2015. RESULTS: Each survey recruited ≥1000 participants per country, response rates ranging from 11 to 78%. In 2010, the estimated one-year population prevalence of back pain ranged from 23% in Ireland to 66% in Portugal, and that of pain in the neck/upper limb from 25% in Ireland to 69% in Finland, the prevalence of pain at the two anatomical sites being correlated across the 33 countries (r = 0.42). A similar pattern was apparent in 2015. For back pain, the percentage change in prevalence from 2010 to 2015 varied from - 41.4% (Hungary) to + 29.6% (Ireland), with a mean across countries of - 3.0%. For neck/upper limb pain, the variation was from - 41.0% (Hungary) to + 44.1% (Romania), with an average of - 0.1%. There was a strong correlation across countries in the change in pain prevalence at the two anatomical sites (r = 0.85). CONCLUSIONS: Our findings accord with the hypothesis that international variation in common pain complaints is importantly driven by factors that predispose to musculoskeletal pain in general.


Assuntos
Dor nas Costas/epidemiologia , Comparação Transcultural , Cervicalgia/epidemiologia , Extremidade Superior , Adolescente , Adulto , Avaliação da Deficiência , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Adulto Jovem
13.
Chiropr Man Therap ; 27: 2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30675336

RESUMO

Background: The Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care. Methods: The SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores). Results: Of 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]). Conclusion: The sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.


Assuntos
Dor nas Costas/diagnóstico , Quiroprática/métodos , Avaliação da Deficiência , Programas de Rastreamento/métodos , Inquéritos e Questionários/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dor nas Costas/epidemiologia , Estudos Transversais , Feminino , Humanos , Illinois/epidemiologia , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prevalência , Medição de Risco/métodos
14.
Spine (Phila Pa 1976) ; 44(12): 887-895, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30601356

RESUMO

STUDY DESIGN: Longitudinal Cohort Study. OBJECTIVE: Determine 1-year patient-reported outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosages in patients undergoing elective spine surgery. SUMMARY OF BACKGROUND DATA: Back pain is the most disabling condition worldwide and over half of patients presenting for spine surgery report using opioids. Preoperative dosage has been correlated with poor outcomes, but published studies have not assessed the relationship of both preoperative chronic opioids and opioid dosage with patient-reported outcomes. METHODS: For patients undergoing elective spine surgery between 2010 and 2017, our prospective institutional spine registry data was linked to opioid prescription data collected from our state's Prescription Drug Monitoring Program to analyze outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosage, while adjusting for confounders through multivariable regression analyses. Outcomes included 1-year meaningful improvements in pain, function, and quality of life. Additional outcomes included 1-year satisfaction, return to work, 90-day complications, and postoperative chronic opioid use. RESULTS: Of 2128 patients included, preoperative chronic opioid therapy was identified in 21% and was associated with significantly higher odds (adjusted odds ratio [95% confidence interval]) of not achieving meaningful improvements at 1-year in extremity pain (aOR:1.5 [1.2-2]), axial pain (aOR:1.7 [1.4-2.2]), function (aOR:1.7 [1.4-2.2]), and quality of life (aOR:1.4 [1.2-1.9]); dissatisfaction (aOR:1.7 [1.3-2.2]); 90-day complications (aOR:2.9 [1.7-4.9]); and postoperative chronic opioid use (aOR:15 [11.4-19.7]). High-preoperative opioid dosage was only associated with postoperative chronic opioid use (aOR:4.9 [3-7.9]). CONCLUSION: Patients treated with chronic opioids prior to spine surgery are significantly less likely to achieve meaningful improvements at 1-year in pain, function, and quality of life; and less likely to be satisfied at 1-year with higher odds of 90-day complications, regardless of dosage. Both preoperative chronic opioid therapy and high-preoperative dosage are independently associated with postoperative chronic opioid use. LEVEL OF EVIDENCE: 2.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor nas Costas/cirurgia , Procedimentos Cirúrgicos Eletivos/tendências , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pré-Operatórios/tendências , Idoso , Analgésicos Opioides/efeitos adversos , Dor nas Costas/tratamento farmacológico , Dor nas Costas/epidemiologia , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Cuidados Pré-Operatórios/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Fatores de Tempo
15.
Clin Rheumatol ; 38(3): 625-634, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30588555

RESUMO

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine. Delayed or inadequate treatment may decrease quality of life and lead to poor long-term outcomes, including irreversible loss of spinal function. In this review, we discuss clinical practice related to axSpA within the USA, including prevalence, diagnosis, reasons for delayed/missed diagnosis, and suggestions for making early diagnosis. The US population prevalence of axSpA (0.9-1.4%) is higher than the diagnostic prevalence (0.2-0.7%). Although the estimated diagnostic delay for axSpA is 14 years in the USA, the disease can be identified earlier if appropriately preselected patients are quickly referred to rheumatologists. Only 37% of patients with ankylosing spondylitis in the USA are diagnosed by rheumatologists; the remaining 63% are diagnosed by primary care (26%), chiropractic/physical therapy (7%), orthopedic surgery (4%), pain clinics (4%), acute care (3%), and other settings (19%). To help reduce diagnostic delay, non-rheumatologist-healthcare professionals are urged to refer patients with back pain and ≥ 1 of 3 SpA features (HLA-B27 positivity, current inflammatory back pain, or x-ray/MRI evidence of sacroiliitis) to a rheumatologist. Prevalence and diagnosis rates of axSpA are disparate in the USA due to the lack of awareness and knowledge among non-rheumatologists. Progress has been made in identifying hurdles causing diagnostic delays. Public health initiatives are needed to guide primary care physicians, physical therapists, chiropractors, and other specialists seeing patients with chronic back pain on methods for suspecting or identifying axSpA and early referral to rheumatologists.


Assuntos
Diagnóstico Tardio , Erros de Diagnóstico , Espondilite Anquilosante/diagnóstico , Dor nas Costas/epidemiologia , Diagnóstico Precoce , Intervenção Médica Precoce , Humanos , Imagem por Ressonância Magnética , Prevalência , Prognóstico , Radiografia , Encaminhamento e Consulta , Medição de Risco , Espondiloartropatias/diagnóstico , Espondiloartropatias/epidemiologia , Espondilite Anquilosante/epidemiologia , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia
16.
BMC Health Serv Res ; 18(1): 970, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558605

RESUMO

BACKGROUND: Chronic back disorders (CBD) are prevalent, costly, and among the most common reasons for seeking primary care; however, little is known regarding the comparative use of family physician, chiropractic, and physiotherapy services among people with CBD in Canada. Elucidating these differences may identify potential gaps in access to care and inform the development of strategies to improve access. The research objectives were to investigate patterns of health care use and to profile factors associated with self-reported use of family physicians, chiropractors, and physiotherapists among adult Canadians with CBD. METHODS: The combined 2009 and 2010 Canadian Community Health Surveys conducted by Statistics Canada were used to investigate self-reported health care use among adults with CBD. This complex survey employs population weights and bootstrapping to be representative of the Canadian population. Following descriptive analyses, we used multiple logistic regression to profile self-reported health care use while statistically controlling for possible confounding effects. RESULTS: The majority of adult respondents with CBD sought care only with a family physician (53.8%), with 20.9% and 16.2% seeking care with combined family physician/chiropractor or family physician/physiotherapist, respectively. Few respondents sought care only with a chiropractor (2.5%) or physiotherapist (1.0%). After adjustment, differential patterns of utilization (p < 0.05) were evident between provider groups with respect to age, gender, socioeconomic status, rural/urban residence, functional limitations, and presence of co-morbidities. CONCLUSIONS: This research highlights potential inequities in access to physiotherapists and chiropractors in relation to family physicians among adult Canadians with CBD, particularly among lower socioeconomic status and rural/remote populations.


Assuntos
Dor nas Costas/terapia , Quiroprática/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Dor nas Costas/epidemiologia , Canadá/epidemiologia , Dor Crônica/epidemiologia , Serviços de Saúde Comunitária/estatística & dados numéricos , Comorbidade , Utilização de Instalações e Serviços , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fisioterapeutas/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Prevalência , Saúde da População Rural/estatística & dados numéricos , Autorrelato , Inquéritos e Questionários , Adulto Jovem
17.
Nihon Eiseigaku Zasshi ; 73(3): 388-394, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30270307

RESUMO

OBJECTIVES: To clarify the association between job stress and the number of physical symptoms among newly certified female nurses. METHODS: In this cross-sectional self-administered survey, we investigated 313 female nurses working at three medical-university-affiliated hospitals in February 2016. We investigated working conditions including numbers of working and on-call hours, work-life balance, Job Content Questionnaire (JCQ) scores, and 16 physical symptoms perceived more often than once a week. RESULTS: Among the 313 participants (mean age, 31.9), 57% were aged 21-29 years and 70% were single. Of the 16 physical symptoms investigated, fatigability was the most frequent complaint (66.1%), followed by lower back pain (44.7%). Univariate analysis showed that significant factors related to physical symptoms are job demands (p<0.001) and social support (p<0.001) in JCQ, binary index of supports (p<0.001), and total working hours per day (p =0.025). Multivariable-adjusted logistic regression analyses demonstrated that the likelihood of reporting a greater number (n≥3) of physical symptoms increased by 7% [95% confidence interval (CI), 2-13%] with a one-unit increase in job demand degree, and decreased by 16% (95% CI, 10-22%) in social support degree. When binary JCQ indexes were assessed, the high-support group [odds ratio (OR) 0.36; 95% CI, 0.23-0.59] was protectively associated with a greater number of physical symptoms while long working hours was significantly associated with a higher risk (OR 18%, 95% CI, 1-38%). CONCLUSIONS: Reporting a greater number of physical symptoms may be a good indicator of job stress perceived by a nurse in a university hospital setting.


Assuntos
Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Enfermeiras e Enfermeiros/psicologia , Saúde do Trabalhador , Estresse Ocupacional/complicações , Jornada de Trabalho em Turnos/efeitos adversos , Adulto , Estudos Transversais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Modelos Logísticos , Risco , Apoio Social , Inquéritos e Questionários , Local de Trabalho , Adulto Jovem
18.
Pan Afr Med J ; 30: 98, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30344882

RESUMO

Introduction: The prevalence of Sjögren's syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS. Methods: 85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria. Results: 83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (±11) years. Mean disease duration was 7.3 (±4) years. The patient and control groups were comparable in terms of age and gender (p > 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p < 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group. Conclusion: inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.


Assuntos
Dor nas Costas/epidemiologia , Sacroileíte/epidemiologia , Síndrome de Sjogren/epidemiologia , Espondiloartropatias/epidemiologia , Adulto , Dor nas Costas/etiologia , Feminino , Humanos , Inflamação/epidemiologia , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sacroileíte/diagnóstico por imagem , Espondiloartropatias/patologia
19.
BMC Res Notes ; 11(1): 304, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769111

RESUMO

OBJECTIVES: To guide the development of targeted interventions for the prevention of work-related back pain, this manuscript estimates the prevalence of back pain and its association with a variety of risk factors among Almeda textile factory production works from March to April 2015. An institutional-based cross-sectional study was carried out in Almeda textile factory, North Ethiopia. Randomly selected workers were administered a structured questionnaire about their socio-economic status, lifestyle, working conditions, back pain and selected risk factors. The data was entered to Epi Info 3.5.4 version and analyzed using SPSS version 16. Descriptive statistics were done to characterize the study participants. Bivariate and multiple logistic regressions were fitted to control confounding variables. Adjusted odds ratio with 95% confidence intervals was computed. RESULTS: The prevalence of work-related musculoskeletal disorders was 53.1%. Gender, age, years of service, lack of physical activity, unavailability of adjustable chair, work-load and poor light were significantly associated with increased risk of back pain. The high prevalence of work-related back pain disorder implies that; habit of doing physical exercise, availing adjustable chair and light at the working place, are key issues which require specific interventions.


Assuntos
Dor nas Costas/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Indústria Têxtil/estatística & dados numéricos , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
J Opioid Manag ; 14(2): 83-87, 2018 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29733094

RESUMO

OBJECTIVE: To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery. DESIGN: Retrospective review of perioperative records from March 2011 and February 2016. SETTING: University of Virginia Healthsystem. PATIENTS: Adult patients undergoing elective spinal fusion of two or more levels. MAIN OUTCOME MEASURES: Incidence of respiratory depression, time to extubation, hypotension, hypoxemia, reintubation, cardiac complications, and death. RESULTS: Reviewed 1,478 patient records. Mean intraoperative methadone dose was 0.14 ± 0.07 mg/kg. A total of 1,142 patients (77.4 percent) were extubated in the operating room, 543 (36.8 percent) experienced respiratory depression, 1,180 (79.8 percent) hypoxemia, and 22 (1.5 percent) required reintubation. Cardiac complications included arrhythmias (289 patients, 29.9 percent), QTc prolongation (568 patients, 58.8 percent), and myocardial infarction (16 patients, 1.1 percent). Two in hospital deaths occurred (0.14 percent). CONCLUSIONS: Mild-moderate respiratory depression is observed following a one-time dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor nas Costas/prevenção & controle , Metadona/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Fusão Vertebral/efeitos adversos , Idoso , Analgésicos Opioides/efeitos adversos , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Esquema de Medicação , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/epidemiologia , Humanos , Incidência , Cuidados Intraoperatórios , Masculino , Metadona/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Virginia/epidemiologia
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