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BACKGROUND: To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. METHODS: Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women's Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. RESULTS: Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters ('none or infrequent', 'frequent' and 'persistent') for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. CONCLUSION: Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.

BACKGROUND: To examine the associations between hip muscle cross-sectional area and hip pain and function in community-based individuals with mild-to-moderate hip osteoarthritis. METHODS: This study included 27 participants with mild-to-moderate hip osteoarthritis. Cross-sectional area of hip muscles, including psoas major, rectus femoris, gluteus maximus, gluteus medius and minimus, adductor longus and magnus, obturator internus, and obturator externus, were measured from magnetic resonance images. Hip pain and function were evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS) categorised into 5 subscales: pain, symptoms, activity of daily living, sport and recreation function, and hip-related quality of life (for each subscale 0 representing extreme problems and 100 representing no problems). RESULTS: Mean age of the 27 participants was 63.2 (SD 7.6) years and 66.7% (n = 18) were female. After adjusting for age and gender, greater cross-sectional area of adductor longus and magnus was associated with a higher HOOS score in quality of life (regression coefficient 1.4, 95% confidence interval (CI) 0.2-2.7, p = 0.02), activity of daily living (regression coefficient 1.3, 95% CI 0.1-2.6, p = 0.04) and sport and recreation function (regression coefficient 1.6, 95% CI 0.1-3.0, p = 0.04). There was a trend towards an association between greater cross-sectional area of psoas major and a higher quality of life score (regression coefficient 3.6, 95% CI - 0.5 to 7.7, p = 0.08). The cross-sectional area of hip muscles was not significantly associated with HOOS pain or symptom score. CONCLUSION: Greater cross-sectional area of hip adductors was associated with better function and quality of life in individuals with mild-to-moderate hip osteoarthritis. Greater cross-sectional area of hip flexors might be associated with better quality of life. These findings, while need to be confirmed in longitudinal studies, suggest that targeting the hip adductor and fl

Aims. Back pain is the leading cause of disability worldwide. With minimal effective therapies and rising financial burden, identifying modifiable risk factors remains a key priority. Our objective was to determine the course and contributors to back pain in middle-aged women over a nine-year period. Methods. The Australian Longitudinal Study on Women's Health is a cohort study of community-based, middle-aged women who completed questionnaires every three years between 2004 and 2013. 10,530 completed the survey in 2004 (mean age 55.5 years), 9,020 completed follow-up nine years later. 7,562 (72%) women provided back pain data in all four surveys. Self-reported data on back pain in the last 12 months and other socio-demographic factors were collected at all four surveys. 'Frequent back pain' was defined as back pain reported at >= 3 surveys. Results. Back pain was common and persistent, with 48% having back pain in >= 3 out of four surveys, and 29% having back pain at every survey. Baseline obesity (RR 1.21, 95% CI 1.14-1.27), lack of vigorous physical activity (RR 1.21, 95% CI 1.13-1.30) and self-reported depression (RR 1.28, 95% CI 1.20-1.36), were independently associated with an increased risk of frequent back pain (all p<0.001). Overall, 22% of the risk of frequent back pain could be attributed to these factors, equating to one extra case of frequent back pain for every seven women with depression, for every 11 women who do not do vigorous physical activity, and for every 10 obese women, at baseline. Conclusions. Obesity, depression and lack of vigorous physical activity are associated with higher risk of frequent back pain over the following nine years among women in their mid-50s. Targeting these risk factors may lessen the burden of back pain.

Aims. Back pain is the leading cause of disability worldwide. With minimal effective therapies and rising financial burden, identifying modifiable risk factors remains a key priority. Our objective was to determine the course and contributors to back pain in middle-aged women over a nine-year period. Methods. The Australian Longitudinal Study on Women's Health is a cohort study of community-based, middle-aged women who completed questionnaires every three years between 2004 and 2013. 10,530 completed the survey in 2004 (mean age 55.5 years), 9,020 completed follow-up nine years later. 7,562 (72%) women provided back pain data in all four surveys. Self-reported data on back pain in the last 12 months and other socio-demographic factors were collected at all four surveys. 'Frequent back pain' was defined as back pain reported at >= 3 surveys. Results. Back pain was common and persistent, with 48% having back pain in >= 3 out of four surveys, and 29% having back pain at every survey. Baseline obesity (RR 1.21, 95% CI 1.14-1.27), lack of vigorous physical activity (RR 1.21, 95% CI 1.13-1.30) and self-reported depression (RR 1.28, 95% CI 1.20-1.36), were independently associated with an increased risk of frequent back pain (all p<0.001). Overall, 22% of the risk of frequent back pain could be attributed to these factors, equating to one extra case of frequent back pain for every seven women with depression, for every 11 women who do not do vigorous physical activity, and for every 10 obese women, at baseline. Conclusions. Obesity, depression and lack of vigorous physical activity are associated with higher risk of frequent back pain over the following nine years among women in their mid-50s. Targeting these risk factors may lessen the burden of back pain.

Background: An improved understanding of patients’ perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP. Methods: A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs for medical services for LBP were categorised. Results: 50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients’ preferences for medications. (3) Of the few studies which examined the patients’ perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms. Conclusions: Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developi

Objectives: Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. Methods: A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. Results: Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. Conclusions: Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.

© 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the comparative effectiveness of non-surgical and non-pharmacological interventions for the management of congenital muscular torticollis (CMT) in infants and children aged 0 to 5 years.

Background Context: Optimal management of low back pain (LBP) involves patients’ active participation in care, facilitated by positive interactions with their health care provider(s) (HCP). An understanding of patients’ perceived needs regarding their HCP is, therefore, necessary to achieve such outcomes. Therefore, the aim of the present study is to review the existing literature regarding patients’ perceived needs of HCP managing LBP. Methods: A systematic scoping review of publications in MEDLINE, EMBASE, CINAHL, and PsycINFO (1990–2016) was performed. Descriptive data regarding study design and methodology were extracted, and risk of bias was assessed. Aggregates of patients’ perceived needs of HCP for LBP were categorized. Results: Forty-three studies (30 qualitative, 12 quantitative, and 1 mixed methods) from 1,829 were relevant. Four areas of perceived need emerged: (1) there are several characteristics of HCP that patients desire, such as good communication and shared decision-making; (2) patients wanted HCP to provide information, including a cause of their LBP and legitimization of their symptoms; (3) patients’ valued holistic, individualized care, and continuity of care; and (4) patients perceived long waiting times, difficulties with access to treatment, cost, and personal effort to be obstacles to care. Conclusions: Patients with LBP want patient-centered care, to be actively involved, and they have identified characteristics of HCP that foster a good provider-patient relationship. They noted areas of dissatisfaction with HCP and perceived obstacles to care. Given limited health care resources, HCP and policy makers need to implement novel methods of health care delivery that address these issues to facilitate improved patient satisfaction and achieve better patient and health system outcomes.

Question: What needs of non-biomedical services are perceived by people with low back pain? Design: Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016). Participants: Adults with low back pain of any duration. Data extraction and analysis: Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. Results: Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. Conclusion: People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM

Background/Purpose: Low back pain (LBP) causes enormous financial and disability burden worldwide, and therapeutic options have limited efficacy. This burden could be potentially reduced by gaining an understanding of the predictors of LBP in order to optimize preventive strategies. As having previous episodes of LBP are predictive of future recurrences, understanding the risk factors associated with LBP in early adulthood are particularly important. There is evidence that women are more likely to suffer from LBP and utilise health care to a greater extent in comparison to men, and there is a paucity of data examining predictors of LBP, such as weight and physical activity, in young women. The aim of this study was to identify whether modifiable risk factors, weight and physical activity, were predictive of low back pain in young adult women. Method(s): Participants took part in a large population-based cohort study, the Australian Longitudinal Study of Women's Health. Community dwelling women born between 1973 and 1978 were randomly selected from the national health insurance scheme database, which includes most permanent residents of Australia. Women were recruited nationally with intentional oversampling from rural and remote areas. Women completed questionnaires three-yearly between 2000 and 2012. In year 2000, 9,688 women completed the questionnaire and 83% completed follow up questionnaires 12 years later. Self-reported data on back pain, weight, height, age, education status, physical activity, and depression were collected at each of the five surveys. Result(s): In this cohort of women at baseline, median age was 24.6 years and 41% had self-reported back pain in the last 12 months. Women reporting back pain were more likely to seek help (38.2% vs. 3.4%, p<0.001) and be unemployed (19.7% vs. 15.7%, p<0.001) compared with those without back pain. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (b

Background/Purpose: Low back pain (LBP) causes enormous financial and disability burden worldwide, and therapeutic options have limited efficacy. This burden could be potentially reduced by gaining an understanding of the predictors of LBP in order to optimize preventive strategies. As having previous episodes of LBP are predictive of future recurrences, understanding the risk factors associated with LBP in early adulthood are particularly important. There is evidence that women are more likely to suffer from LBP and utilise health care to a greater extent in comparison to men, and there is a paucity of data examining predictors of LBP, such as weight and physical activity, in young women. The aim of this study was to identify whether modifiable risk factors, weight and physical activity, were predictive of low back pain in young adult women. Method(s): Participants took part in a large population-based cohort study, the Australian Longitudinal Study of Women's Health. Community dwelling women born between 1973 and 1978 were randomly selected from the national health insurance scheme database, which includes most permanent residents of Australia. Women were recruited nationally with intentional oversampling from rural and remote areas. Women completed questionnaires three-yearly between 2000 and 2012. In year 2000, 9,688 women completed the questionnaire and 83% completed follow up questionnaires 12 years later. Self-reported data on back pain, weight, height, age, education status, physical activity, and depression were collected at each of the five surveys. Result(s): In this cohort of women at baseline, median age was 24.6 years and 41% had self-reported back pain in the last 12 months. Women reporting back pain were more likely to seek help (38.2% vs. 3.4%, p<0.001) and be unemployed (19.7% vs. 15.7%, p<0.001) compared with those without back pain. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (b

INTRODUCTION: The mechanism by which obesity increases the risk of hip osteoarthritis is unclear. One possibility may be by mediating abnormalities in bony geometry, which may in turn be associated with early structural abnormalities, such as cartilage defects and bone marrow lesions. METHODS: One hundred and forty one older adults with no diagnosed hip osteoarthritis had weight and body mass index measured between 1990 and 1994 and again in 2009 to 2010. Acetabular depth and lateral centre edge angle, both measures of acetabular over-coverage, as well as femoral head cartilage volume, cartilage defects and bone marrow lesions were assessed with 3.0 T magnetic resonance imaging performed in 2009 to 2010. RESULTS: Current body mass index, weight and weight gain were associated with increased acetabular depth and lateral centre edge angle (all P ≤ 0.01). For every 1 mm increase in acetabular depth, femoral head cartilage volume reduced by 59 mm(3) (95% confidence interval (CI) 20 mm(3) to 98 mm(3), P < 0.01). Greater acetabular depth was associated with an increased risk of cartilage defects (odds ratio (OR) 1.22, 95% CI 1.03 to 1.44, P = 0.02) and bone marrow lesions (OR 1.29, 95% CI 1.01 to 1.64, P = 0.04) in the central region of the femoral head. Lateral centre edge angle was not associated with hip structure. CONCLUSIONS: Obesity is associated with acetabular over-coverage. Increased acetabular depth, but not the lateral centre edge angle, is associated with reduced femoral head cartilage volume and an increased risk of cartilage defects and bone marrow lesions. Minimising any deepening of the acetabulum (for example, through weight management) might help to reduce the incidence of hip osteoarthritis.

Background: The relationship between obesity and low back pain and disability is unclear. No study has examined the role of body composition in low back pain and disability. The aim of the study was to determine whether body composition is associated with low back pain intensity and/or disability in a cross sectional study. Method(s): 135 participants (25 to 62 years), with a range of body mass indicies (BMI) (18 to 55 kg/m2), were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed the Chronic Back Pain Grade Questionnaire, which examines individuals' levels of low back pain intensity and disability. Body composition was assessed using dual x-ray absorptiometry. Result(s): BMI was associated with higher levels of back pain intensity (Odds ratio (OR) 1.35, 95% CI 1.09, 1.67) and disability (OR 1.66, 95% CI 1.31, 2.09). Higher levels of pain intensity were positively associated with total (1.19, 95% CI 1.04, 1.38) and lower limb fat mass (OR 1.51, 95% CI 1.04, 2.20), independent of lean tissue mass. There were also positive associations between higher levels of low back disability and total (OR 1.41, 95% CI 1.20, 1.67), upper (OR 1.67, 95% CI 1.27 2.19) and lower limb (OR 2.29, 95% CI 1.51, 3.49) fat mass. Similar relationships were observed with trunk, android and gynoid fat mass. After adjusting for confounders, no measures of lean tissue mass were associated with higher pain intensity or disability (p>0.10). Conclusion(s): Greater fat, but not lean tissue mass, was associated with high levels of low back pain intensity and disability. While this needs to be confirmed in longitudinal studies, it suggests that weight loss strategies aimed at reducing fat mass may be important in the prevention of low back pain and disability. Understanding the mechanism for these relationships may provide novel approaches to managing low back pain.

Background: The relationship between obesity and low back pain and disability is unclear. No study has examined the role of body composition in low back pain and disability. The aim of the study was to determine whether body composition is associated with low back pain intensity and/or disability in a cross sectional study. Method(s): 135 participants (25 to 62 years), with a range of body mass indicies (BMI) (18 to 55 kg/m2), were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed the Chronic Back Pain Grade Questionnaire, which examines individuals' levels of low back pain intensity and disability. Body composition was assessed using dual x-ray absorptiometry. Result(s): BMI was associated with higher levels of back pain intensity (Odds ratio (OR) 1.35, 95% CI 1.09, 1.67) and disability (OR 1.66, 95% CI 1.31, 2.09). Higher levels of pain intensity were positively associated with total (1.19, 95% CI 1.04, 1.38) and lower limb fat mass (OR 1.51, 95% CI 1.04, 2.20), independent of lean tissue mass. There were also positive associations between higher levels of low back disability and total (OR 1.41, 95% CI 1.20, 1.67), upper (OR 1.67, 95% CI 1.27 2.19) and lower limb (OR 2.29, 95% CI 1.51, 3.49) fat mass. Similar relationships were observed with trunk, android and gynoid fat mass. After adjusting for confounders, no measures of lean tissue mass were associated with higher pain intensity or disability (p>0.10). Conclusion(s): Greater fat, but not lean tissue mass, was associated with high levels of low back pain intensity and disability. While this needs to be confirmed in longitudinal studies, it suggests that weight loss strategies aimed at reducing fat mass may be important in the prevention of low back pain and disability. Understanding the mechanism for these relationships may provide novel approaches to managing low back pain.