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This systematic review and meta-analysis aimed to examine the effects of physical exercise cum cognitive-behavioural therapy (CBT) on alleviating pain intensity, functional disabilities, and mood/mental symptoms in those suffering with chronic musculoskeletal pain. MEDLINE, EMBASE, PubMEd, PsycINFO and CINAHL were searched to identify relevant randomised controlled trials from inception to 31 December 2018. The inclusion criteria were: (a) adults ≥18 years old with chronic musculoskeletal pain ≥3 months, (b) randomised controlled design, (c) a treatment arm consisting of physical intervention and CBT combined, (d) the comparison arm being waitlist, usual care or other non-pharmacological interventions such as physical exercise or CBT alone, and (e) outcomes including pain intensity, pain-related functional disabilities (primary outcomes), or mood/mental symptoms (secondary outcome). The exclusion criteria were: (a) the presence of comorbid mental illnesses other than depression and anxiety and (b) non-English publication. The search resulted in 1696 records and 18 articles were selected for review. Results varied greatly across studies, with most studies reporting null or small effects but a few studies reporting very large effects up to 2-year follow-up. Pooled effect sizes (Hedges' g) were ~1.00 for pain intensity and functional disability, but no effect was found for mood/mental symptoms. The effects were mainly driven by several studies reporting unusually large differences between the exercise cum CBT intervention and exercise alone. When these outliers were removed, the effect on pain intensity disappeared at post-intervention while a weak effect (g = 0.21) favouring the combined intervention remained at follow-up assessment. More consistent effects were observed for functional disability, though the effects were small (g = 0.26 and 0.37 at post-intervention and follow-up respectively). More importantly, the value of adding CBT to exercise interventions is questionable, as consistent benefits were not seen. The clinical implications and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: The function of the pelvic bones is to transfer load generated by body weight. Proper function of the pelvic bones can be disturbed by alignment changes that occur during pregnancy. Further, misalignment of the pelvic bones can lead to pain, urinary incontinence, and other complications. An understanding of the timing and nature of pelvic alignment changes during pregnancy may aid in preventing and treating these complications. Objective: To investigate the changes in pelvic alignment during pregnancy and one month after childbirth. Methods: This is a prospective, longitudinal cohort study. Pelvic measurements were obtained for 201 women at 12, 24, 30, and 36 weeks of pregnancy, and 1 month after childbirth. The anterior and posterior width of the pelvis (the distance between the bilateral anterior superior iliac spines and the bilateral posterior superior iliac spines), the anterior pelvic tilt, and pelvic asymmetry (the mean left and right pelvic tilt degrees and the bilateral difference of the anterior pelvic tilt) were measured. For the change in pelvic alignment, a Friedman test was conducted to determine any significant difference in the measurements over time. Results: The anterior and posterior width of the pelvis became significantly wider with pregnancy progress and the anterior width of the pelvis at 1 month after childbirth remained wider than that at 12 weeks of pregnancy (p < 0.001). The anterior pelvic tilt increased during pregnancy and decreased after childbirth (p < 0.05). Conclusion: Some changes in pelvic alignment occur continuously during the perinatal period. Changes in the anterior width of the pelvis are not recovered at one month post-childbirth. Understanding these perinatal changes may help clinicians avert complications due to pelvic misalignment. [ABSTRACT FROM AUTHOR]

Background: Chiropractic maintenance care is effective as secondary/tertiary prevention of non-specific low back pain (LBP), but the potential effect moderation by psychological characteristics is unknown. The objective was to investigate whether patients in specific psychological sub-groups had different responses to MC with regard to the total number of days with bothersome pain and the number of treatments. Method: Data from a two-arm randomized pragmatic multicenter trial with a 12-month follow up, designed to investigate the effectiveness of maintenance care, was used. Consecutive patients, 18–65 years of age, with recurrent and persistent LBP seeking chiropractic care with a good effect of the initial treatment were included. Eligible subjects were randomized to either maintenance care (prescheduled care) or to the control intervention, symptom-guided care. The primary outcome of the trial was the total number of days with bothersome LBP collected weekly for 12 months using an automated SMS system. Data used to classify patients according to psychological subgroups defined by the West Haven-Yale Multidimensional Pain Inventory (adaptive copers, interpersonally distressed and dysfunctional) were collected at the screening visit. Results: A total of 252 subjects were analyzed using a generalized estimating equations linear regression framework. Patients in the dysfunctional subgroup who received maintenance care reported fewer days with pain (-30.0; 95% CI: -36.6, -23.4) and equal number of treatments compared to the control intervention. In the adaptive coper subgroup, patients who received maintenance care reported more days with pain (10.7; 95% CI: 4.0, 17.5) and more treatments (3.9; 95% CI: 3.5, 4.2). Patients in the interpersonally distressed subgroup reported equal number of days with pain (-0.3; 95% CI: -8.7, 8.1) and more treatments (1.5; 95% CI: 0.9, 2.1) on maintenance care. Conclusions: Psychological and behavioral characteristics modify the effect of MC and should be considered when recommending long-term preventive management of patients with recurrent and persistent LBP. [ABSTRACT FROM AUTHOR]

Background: There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. Objectives: 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. Methods: Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. Results: Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. Conclusions: Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended. [ABSTRACT FROM AUTHOR]

Background: Effective and cost-effective primary care treatments for low back pain (LBP) are required to reduce the burden of the world's most disabling condition. This study aimed to compare the clinical effectiveness and cost-effectiveness of the Fear Reduction Exercised Early (FREE) approach to LBP (intervention) with usual general practitioner (GP) care (control).Methods and Findings: This pragmatic, cluster-randomised controlled trial with process evaluation and parallel economic evaluation was conducted in the Hutt Valley, New Zealand. Eight general practices were randomly assigned (stratified by practice size) with a 1:1 ratio to intervention (4 practices; 34 GPs) or control group (4 practices; 29 GPs). Adults presenting to these GPs with LBP as their primary complaint were recruited. GPs in the intervention practices were trained in the FREE approach, and patients presenting to these practices received care based on the FREE approach. The FREE approach restructures LBP consultations to prioritise early identification and management of barriers to recovery. GPs in control practices did not receive specific training for this study, and patients presenting to these practices received usual care. Between 23 September 2016 and 31 July 2017, 140 eligible patients presented to intervention practices (126 enrolled) and 110 eligible patients presented to control practices (100 enrolled). Patient mean age was 46.1 years (SD 14.4), and 46% were female. The duration of LBP was less than 6 weeks in 88% of patients. Primary outcome was change from baseline in patient participant Roland Morris Disability Questionnaire (RMDQ) score at 6 months. Secondary patient outcomes included pain, satisfaction, and psychosocial indices. GP outcomes included attitudes, knowledge, confidence, and GP LBP management behaviour. There was active and passive surveillance of potential harms. Patients and outcome assessors were blind to group assignment. Analysis followed intention-to-treat principles. A total of 122 (97%) patients from 32 GPs in the intervention group and 99 (99%) patients from 25 GPs in the control group were included in the primary outcome analysis. At 6 months, the groups did not significantly differ on the primary outcome (adjusted mean RMDQ score difference 0.57, 95% CI -0.64 to 1.78; p = 0.354) or secondary patient outcomes. The RMDQ difference met the predefined criterion to indicate noninferiority. One control group participant experienced an activity-related gluteal tear, with no other adverse events recorded. Intervention group GPs had improvements in attitudes, knowledge, and confidence compared with control group GPs. Intervention group GP LBP management behaviour became more guideline concordant than the control group. In cost-effectiveness, the intervention dominated control with lower costs and higher Quality-Adjusted Life Year (QALY) gains. Limitations of this study were that although adequately powered for primary outcome assessment, the study was not powered for evaluating some employment, healthcare use, and economic outcomes. It was also not possible for research nurses (responsible for patient recruitment) to be masked on group allocation for practices.Conclusions: Findings from this study suggest that the FREE approach improves GP concordance with LBP guideline recommendations but does not improve patient recovery outcomes compared with usual care. The FREE approach may reduce unnecessary healthcare use and produce economic benefits. Work participation or health resource use should be considered for primary outcome assessment in future trials of undifferentiated LBP.Trial Registration: ACTRN12616000888460. [ABSTRACT FROM AUTHOR]

Background: Leg length inequalities (LLIs) are a common finding in patients with a total hip arthroplasty (THA). Therefore, we compared the effects of simulated LLIs in patients with total hip arthroplasty (THA) with a matched control group. Research question: Do LLIs lead to different effects on the musculoskeletal apparatus of patients with a THA then in a control group? Methods: In 99 patients with a THA the effects of simulated LLIs were compared to a matched control group of 101 subjects without a hip arthroplasty. First, we compared methods for LLI quantification (tape measurements, pelvic x- ray and rasterstereography). Second, the effects of simulated LLIs on the spine and pelvis were evaluated in both groups using surface topography. LLIs of 5, 10, 15, 20 and 30 mm were simulated on both sides with a simulation platform. The changes of pelvic position (pelvic obliquity & pelvic torsion) and the effects on spinal posture (surface rotation & lateral deviation) were measured and analysed using a surface topography system. Results: Mean LLI measured with a tape was 0.9 mm (SD +/- 14.8). Mean pelvic obliquity measured on x-rays was 1.2 mm (SD +/- 11.6) and with surface topography 0.9 mm (SD +/- 7.9). Simulated LLIs resulted in significant changes of pelvic position and spinal posture in the patient and control group. Interestingly, our study showed that simulated LLIs lead to greater changes in pelvic position (p<0.05) in patients with a THA. Significance: This is the first study to demonstrate that LLIs might have a greater impact on the pelvic position of THA patients than in native hips, which could indicate that LLIs do need to be compensated differently in patients with THA than in patients without a THA. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) can provide objective continuous intervertebral disc (IVD) measures in low back pain (LBP) patients. However, there are limited studies comparing quantitative IVD measures of symptomatic and asymptomatic individuals. Purpose: This study aimed to investigate possible differences in IVD tissue composition in patients with chronic LBP and controls using quantitative MRI and correlate IVD measures with the phenotype High-Intensity Zone (HIZ). Methods: The lumbar spine of 25 LBP-patients (25-69y, mean 38y, 11 males) and 12 controls (25-59y, mean 38y, 7 males) was examined with T2-mapping on a 1.5T MRI scanner. The mean T2-map value and standard deviation were determined in three midsagittal IVD slices and five sub-regions dividing each IVD in the sagittal plane. The distribution of T2-map values over the IVD was also determined with histogram analysis (Δμ = distribution width). Results: When compared to controls, patient IVDs displayed lower values for all metrics, with significant differences for the T2-map value, standard deviation (p = 0.026) and Δμ (p = 0.048). Significantly different T2-map values were found between cohorts in the region representing nucleus pulposus and the border zone between nucleus pulposus and posterior annulus fibrosus (p = 0.047–0.050). Excluding all IVDs with HIZs resulted in no significant difference between the cohorts for any of the analyzed metrics (p = 0.053–0.995). Additionally, the T2-map values were lower in patients with HIZ in comparison without HIZ. Conclusions: Differences in IVD characteristics, measured with quantitative MRI, between LBP patients and controls were found. The T2-differences may reflect altered IVD function associated with HIZ. Future studies are recommended to explore IVD functionality in relation to HIZ and LBP. [ABSTRACT FROM AUTHOR]

Background: Occupational medicine seeks to reduce sick leave; however, evidence for an add-on effect to usual care is sparse. The objective of the GOBACK trial was to test whether people with low back pain (LBP) in physically demanding jobs and at risk of sick leave gain additional benefit from a 3-month complex intervention that involves occupational medicine consultations, a work-related evaluation and workplace intervention plan, an optional workplace visit, and a physical activity program, over a single hospital consultation and an MRI.Methods and Findings: We enrolled people from the capital region of Denmark to an open-label, parallel-group randomized controlled trial with a superiority design from March 2014 through December 2015. In a hospital setting 305 participants (99 women) with LBP and in physically demanding jobs were randomized to occupational intervention (n = 153) or no additional intervention (control group; n = 152) added to a single hospital consultation giving a thorough explanation of the pain (i.e., clinical examination and MRI) and instructions to stay active and continue working. Primary outcome was accumulated sick leave days due to LBP during 6 months. Secondary outcomes were changes in neuropathic pain (painDETECT questionnaire [PDQ]), pain 0-10 numerical rating scale (NRS), Fear-Avoidance Beliefs Questionnaire (FABQ), Roland-Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) for physical and mental health-related quality of life (HRQoL), and self-assessed ability to continue working (range 0-10). An intention-to-treat analysis of sick leave at 6 months showed no significant difference between groups (mean difference in days suggestively in favor of no additional intervention: 3.50 [95% CI -5.08 to 12.07], P = 0.42). Both groups showed significant improvements in average pain score (NRS), disability (RMDQ), fear-avoidance beliefs about physical activities and work (FABQ), and physical HRQoL (SF-36 physical component summary); there were no significant differences between the groups in any secondary outcome. There was no statistically significant improvement in neuropathic pain (PDQ score), mental HRQoL (SF-36 mental component summary), and self-assessed ability to stay in job. Four participants could not complete the MRI or the intervention due to a claustrophobic attack or accentuated back pain. Workplace visits may be an important element in the occupational intervention, although not always needed. A per-protocol analysis that included the 40 participants in the intervention arm who received a workplace visit as part of the additional occupational intervention did not show an add-on benefit in terms of sick leave (available cases after 6 months, mean difference: -0.43 days [95% CI -12.8 to 11.94], P = 0.945). The main limitations were the small number of sick leave days taken and that the comprehensive use of MRI may limit generalization of the findings to other settings, for example, general practice.Conclusions: When given a single hospital consultation and MRI, people in physically demanding jobs at risk of sick leave due to LBP did not benefit from a complex additional occupational intervention. Occupational interventions aimed at limiting biopsychological obstacles (e.g., fear-avoidance beliefs and behaviors), barriers in the workplace, and system barriers seem essential to reduce sick leave in patients with LBP. This study indicates that these obstacles and barriers may be addressed by thorough usual care.Trial Registration: Clinical Trials.gov: NCT02015572. [ABSTRACT FROM AUTHOR]

Objectives: Exercise can be used as a treatment for depressive symptoms in the general population. However, little is known as to whether exercise has mental health benefits for adults experiencing chronic low back pain (CLBP). The aim of this study was to examine the feasibility of two intervention protocols commonly used in clinical practice for treating chronic low back pain, but with differing exercise dose, on depressive symptoms. Methods: Forty men and women (mean age = 35) experiencing chronic persistent (>3 months), non-specific low back pain were recruited into a randomised clinical trial during 2015–2016. Participants were randomised to receive motor control (low-dose exercise) and manual therapy (n = 20), or general strength and conditioning training (moderate-dose exercise) (n = 20). Depressive symptoms were assessed fortnightly throughout a 6-month follow-up period using the Centre for Epidemiologic Studies Depression Scale (CES-D 10). Linear mixed models were used to examine within-group and between-group changes in depressive symptoms. Results: Mean CES-D 10 score at baseline was 9.17 (SD = 4.32). There was evidence of a small decrease in average depressive symptoms over time (β -0.19 per fortnight, 95% CI = -0.34, -0.02). However, there was no evidence that change over time was dependent on treatment group. Conclusions: Reduction in depressive symptoms amongst adults with CLBP occurred with both treatment methods (motor control [low-dose exercise] and manual therapy; or general strength and conditioning [moderate-dose exercise]). Further interventions including a true control group are needed to draw conclusions as to the effectiveness of each of these treatment methods on depressive symptoms amongst adults with CLBP. Trial registration: Australian New Zealand Clinical Trials Registry, . Registered on 20 November 2015. [ABSTRACT FROM AUTHOR]

Background: Work-related back and lower extremity disorders often present remarkable health and economic burdens on societies. Occupational barbers are usually neglected in research and policy actions, mainly in developing countries, and are hence more vulnerable to the conditions. So far, information about the factors influencing back and lower extremity disorders among barbers in Ethiopia is unknown. Therefore, the aim of this study was to determine the prevalence and factors affecting back and lower extremity disorders among barbers in Gondar town, Ethiopia. Methods: A cross-sectional study was conducted from April to May 2017. A sample of 434 barbers recruited using the systematic random sampling technique. A pre-tested standardized Nordic Musculoskeletal questionnaire was interviewer-administered for data collection. Data were analyzed using statistical package for social sciences (SPSS) version 20. The significance of associations was evaluated at ≤0.05 p-value with a 95% confidence intervals (CI) and adjusted odds ratios (AOR). Results: The response rate was 98.8% (N = 429). The mean age and mean length of employment were 26.38 (standard deviations (SD) ± 4.78) and 4.91 years, respectively. The prevalence of work-related low back pain in the previous 12 months and in the last 7 days was 55.7% (N = 239) [95% CI (51.0, 60.4)] and 32.6% (N = 140), respectively. About 40.6% (n = 97) of the participants with back pains indicated their activities were limited. The prevalence of knee/leg and ankle pain was 39.4% (N = 169) and 25.6% (N = 110), respectively. Out of the participants, 17% (n = 41) sought treatment services. Less than half, 40.6% (n = 97) said they perceived high disability, while 38.1% (n = 91) explained their pain was intense (severe). Age [AOR: 2.001; 95% CI (1.174, 4.346)], alcohol use [AOR: 2.283; 95% CI (1.376, 3.789)], lack of safety training [AOR: 0.110; 95% CI (0.032, 0.271], working posture [AOR: 0.142; 95% CI (0.045, 0.215)], and length of employment [AOR: 1.650.132; 95% CI (1.107, 2.140] were significantly associated factors. Conclusions: Back and lower extremity musculoskeletal pain and disability were found to be prevalent among Ethiopian barbers and to be associated with age, alcohol use, safety training, work postures, and length of employment. We believe that programs for management of musculoskeletal disorders need to address these factors. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity participation is known to promote better mobility and coordination. Although previous research has established that lack of physical activity participation may increase the risk of developing low back pain, the role of physical activity as a predictor of recovery among symptomatic individuals remains unclear. Objective: To evaluate whether: (i) the level of physical activity participation before an acute episode of low back pain predicts recovery within 12 months following the acute pain episode (i.e. index episode); and (ii) participants return to their pre-pain level of physical activity participation 12 months from the index episode. Design: This study used longitudinal data from the TRIGGERS case-crossover study. Setting: This study was conducted through over-the-phone interviews to participants that presented to 300 primary care clinics with a new episode of acute low back pain. Participants: This study included 999 consecutive patients, aged 18 years or older. Follow-up assessment was completed at 12 months following the index episode. Methods: This is a cohort study where consecutive patients, aged 18 years or older, that presented with a new episode of acute low back pain were recruited between October 2011 and November 2012. Main outcome measurements: Self-reported level of physical activity participation. Results: A total of 830 participants completed the study. When comparing participants who reported pain at 12 months follow-up with those without pain, all participants reported similar levels of physical activity participation one week before (p = 0.449), one week after (p = 0.812) and 12 months after the index episode (p = 0.233). The level of physical activity participation before the index episode was not a reliable predictor of presence of pain at either 3 or 12 months follow-up (OR 0.99; 95% CI 0.993 to 1.003; p = 0.523 and OR 1; 95% CI 0.992 to 1.008; p = 0.923, respectively). Conclusion: Physical activity participation did not predict recovery from the pain episode. Also all participants returned to their pre-pain level of physical activity participation after 12 months. [ABSTRACT FROM AUTHOR]

Background: The quality of life for millions of people worldwide is affected by chronic pain. In addition to the effect of chronic pain on well-being, chronic pain has also been associated with poor health conditions and increased mortality. Due to its multifactorial origin, the classification of pain types remains challenging. MicroRNAs (miRNA) are small molecules that regulate gene expression. They are released into the bloodstream in a stable manner under normal and pathological conditions and have been described as potential biomarkers. In the present study, we aimed to investigate whether pain may induce an aberrant, specific dysregulation of miRNA expression, depending on the origin of the pain. Methods and findings: To do so, we measured the expression changes of 184 circulating miRNAs (c-miRNAs) in the plasma samples of patients with different origins of chronic musculoskeletal pain. After statistical analyses, we identified seven c-miRNA candidates that were differentially expressed depending on the nociceptive or neuropathic origin of the pain. We then developed a two c-miRNA signature (hsa-miR-320a and hsa-miR-98-5p) that was able to correctly classify the pain type of 70% of the patients from the validation set. Conclusions: In conclusion, circulating miRNAs are promising biomarkers to identify and characterize the chronic pain type and to further improve its clinical management. [ABSTRACT FROM AUTHOR]

Background: Despite evidence of physical (illness) and mental (stress) health problems, there appears to be a lack of studies or concern regarding occupational safety and health among educators in Malaysia. Objective: To review the prevalence of illness, stress, and corresponding risk factors among educators in Malaysia. Method: Scopus, ProQuest, PubMed, ScienceDirect, CAB, and other computerized databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between January 2013 and April 2019 on the prevalence and associated risk factors of illness and stress among educators (). The keywords used included educator, teacher, lecturer, academic staff, teaching profession, university staff, academician, faculty, illness, injury, disease, pain, WMSD, dysphonia, hoarseness, stress, mental health, strain, health problem, disorder, and/or Malaysia. Selected studies were evaluated by quality assessment. Results: Twenty-two articles fulfilled the eligibility criteria. The prevalence of illness and stress was determined for low back pain (33.3–72.9%); upper back pain (33.33–56.4%); neck/shoulder pain (40.4–80.1%); upper arm discomfort (91.3%); forearm pain (89.6%); wrist pain (16.7–93.2%); hip pain (13.2–40.9%); thigh discomfort (91.8%); lower leg discomfort (90.5%); knee pain (23.7–88.0%); ankle/feet pain (19.3–87.7%); elbow pain (3.5–13.0%); voice disorder (10.4–13.0%) and stress (5.5–25.9%). Sex, education level, teaching experience, quality of life, anxiety, depression, coping styles, and others were reported as associated risk factors across the studies. Conclusions: There appears to be a cause for concern regarding musculoskeletal disorders, voice disorder, and stress reported among educators in Malaysia. While most risk factors matched those reported in studies elsewhere, others such as school characteristics (school level, government or private school, and location [rural/urban]) have not been investigated. [ABSTRACT FROM AUTHOR]

Objectives: Chronic pain, such as low-back pain, can be a highly disabling condition degrading people’s quality of life (QoL). Not every patient responds to pharmacological therapies, thus alternative treatments have to be developed. The chronicity of pain can lead to a somatic dysperception, meaning a mismatch between patients’ own body perception and its actual physical state. Since clinical evaluation of pain relies on patients’ subjective reports, a body image disruption can be associated with an incorrect pain rating inducing incorrect treatment and a possible risk of drug abuse. Our aim was to reduce chronic low-back pain through a multimodal neurorehabilitative strategy using innovative technologies to help patients regain a correct body image. Methods: Twenty patients with chronic low-back pain were included. Before and after treatment, patients underwent: a neurological exam; a neuro-psychological evaluation testing cognitive functions (memory, attention, executive functions) and personality traits, QoL and mood; pain ratings; sensorimotor functional abilities’ testing. Patients underwent a 6 week-neurorehabilitative treatment (total 12 sessions) using virtual reality (VRRS system, Khymeia, Italy). Treatment consisted on teaching patients to execute correct movements with the painful body parts to regain a correct body image, based on the augmented multisensory feedback (auditory, visual) provided by the VRRS. Results: Our data showed significant reductions in all pain rating scale scores (p<0.05); significant improvements of QoL in the domains of physical functioning, physical role functioning, bodily pain, vitality, and social role functioning; improvements in cognitive functions (p<0.05); improvements in functional scales (p<0.05) and mood (p = 0.04). Conclusion: This non-pharmacological approach was able to act on the multi-dimensional aspects of pain and improved patients’ QoL, pain intensity, mood and patient’s functional abilities. [ABSTRACT FROM AUTHOR]

Chronic pain affects 50% of adults with sickle cell disease (SCD). Although central sensitization is thought to contribute to the pathogenesis of this chronic pain, no studies have examined differences in functional connectivity of the brain between patients with SCD with and without chronic pain. We performed an observational cohort study using resting-state functional MRI (rsfMRI) of the brain on adults with SCD with and without chronic pain. We tested the hypothesis that, compared to those without chronic pain, those with chronic pain would have differences in functional connectivity between the periaqueductal grey (PAG) and other regions of the brain. Twenty-two adults with SCD, 15 with chronic pain and 7 without chronic pain, as well as 10 African-American controls, underwent rsfMRI of the brain. When SCD patients with chronic pain were compared to those without chronic pain, significant differences in connectivity were noted between the PAG and 9 regions of the brain, including several in the default mode network, a network involved in introspection that has been implicated in other chronic pain syndromes. Changes in functional connectivity between patients with SCD with and without chronic pain suggest a mechanism for chronic pain that involves neuro-plastic changes to the brain. [ABSTRACT FROM AUTHOR]

The mechanisms underlying the transition from acute to chronic pain remain unclear. Here, we sought to characterize the transcriptome associated with chronic low back pain as well as the transcriptome of the transition from acute to chronic low back pain. For the analysis, we compared the whole blood transcriptome of: (a) patients at the onset of low back pain who no longer had pain within 6 weeks after onset (acute) with patients who developed chronic low back pain at 6 months (chronic T5); and, (b) patients at the onset of low back pain (chronic T1) who developed chronic pain at 6 months with healthy pain-free (normal) controls. The majority of differentially expressed genes were protein coding. We illustrate a unique chronic low back pain transcriptome characterized by significant enrichment for known pain genes, extracellular matrix genes, and genes from the extended major histocompatibility complex (MHC) genomic locus. The transcriptome of the transition from acute to chronic low back pain was characterized by significant upregulation of antigen presentation pathway (MHC class I and II) genes and downregulation of mitochondrial genes associated with oxidative phosphorylation, suggesting a unique genomic signature of vulnerability to low back pain chronicity. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain (LBP) is highly prevalent in Nigeria and is more devastating in rural Nigeria due to adverse living and working conditions, reinforced by maladaptive illness beliefs. There is a need to develop measures for assessing such beliefs in this population. This study aimed to cross-culturally adapt the Fear Avoidance Beliefs Questionnaire (FABQ) and test its psychometric properties in mixed rural and urban Nigerian populations with chronic LBP. Methods: Translation, cultural adaptation, test–retest, and cross-sectional psychometric testing. FABQ was forward and back translated by clinical/non-clinical translators. A review committee evaluated the translations. Twelve people with chronic LBP in a rural Nigerian community pre-tested the questionnaire. Cronbach’s alpha assessing internal consistency; intra-class correlation coefficient and Bland–Altman plots assessing test–retest reliability; and minimal detectable change were investigated in a convenient sample of 50 chronic low back pain sufferers in rural and urban Nigeria. Construct validity was examined using Pearson’s correlation analyses with the eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ), and exploratory factor analysis in a random sample of 200 adults with chronic low back pain in rural Nigeria. Ceiling and floor effects were investigated in all samples. Results: Amendments allowed interviewer-administration. Item 8 was modified to ‘I have a compensation or gains I get from having my pain’ as there is no benefit system in Nigeria. Igbo phrase for ‘physical activity’ could also mean ‘being active’, ‘moving the body’ or ‘moving about’ and was used in the items with ‘physical activity’. The Igbo-FABQ had good internal consistency (α = 0.80–0.86); intra class correlation coefficients (ICC = 0.71–0.72); standard error of measurements (3.21–7.40) and minimal detectable change (8.90–20.51). It correlated moderately with pain intensity and disability, with a two-factor structure and no floor and ceiling effects. Conclusions: Igbo-FABQ is valid, reliable, and can be used clinically and for research. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate whether changes in psychosocial factors and pain severity were associated with reduction in disability due to pain among patients with chronic pain. We hypothesized that increased self-efficacy would reduce disability. Patients and methods: This longitudinal observational study included 72 patients. Patients’ psychological and physical variables were assessed before and after 3 months of treatment. Demographic and clinical information were collected, including the Pain Disability Assessment Scale (PDAS), the Pain Self-Efficacy Questionnaire (PSEQ), the Hospital Depression and Anxiety Scale, and the Numeric Rating Scale (NRS) to assess pain intensity. First, univariate regression analyses were conducted to clarify associations between change in PDAS and sex, age, pain duration, changes in psychosocial factors (self-efficacy, anxiety, and depression) and change in pain intensity. Second, multivariate regression was conducted using the variables identified in the univariate analyses (PSEQ and NRS) to detect the most relevant factor for reducing disability. Results: Univariate regression analyses clarified that changes in PSEQ (β = −0.31; 95% CI: −0.54–−0.08, p = 0.008) and NRS (β = 0.24; 95% confidence interval [CI]: 0.01–0.47, p = 0.04) were associated with reduction in PDAS. Multivariate regression analysis demonstrated that change in PSEQ (β = 0.26; 95% CI: −0.50–−0.02; p = 0.01) was associated with a reduction in disability, independent of change in NRS. Conclusion: These findings suggest improved self-efficacy is associated with reduced disability in patients with chronic pain, independent of reduction in pain intensity. Focusing on improvement in self-efficacy may be an effective strategy in chronic pain treatment in addition to pain relief. [ABSTRACT FROM AUTHOR]

The natural history of asymptomatic retroperitoneal schwannomas is poorly understood. This study aimed at investigating the natural history of incidental retroperitoneal schwannomas. The medical charts and imaging studies of 22 asymptomatic patients under observation for at least 12 months for retroperitoneal schwannomas were reviewed. The duration of follow-up ranged between 13 and 176 months (mean 48 months). In the 22 patients managed by the “wait and see” approach, the average tumor size at initial presentation was 51 mm, which increased to 57 mm at final follow-up. During the final follow-up, 2 patients required surgical treatment for tumor enlargement, while the remaining patients remained asymptomatic without surgery. The average growth rate of the tumors was 1.9 mm/year (range: -1.9 to 8.7 mm/year). The majority of asymptomatic retroperitoneal schwannomas demonstrate minimal growth and may be suitable for management with the “wait and see” approach. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain. Methods: A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in € for year 2016. Results: Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance. Conclusion: This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area. [ABSTRACT FROM AUTHOR]

Still little is known about how spinopelvic alignment affects spinal load distribution. Musculoskeletal modeling can potentially help to discover associations between spine alignment and risk factors of spinal disorders (e.g. disc herniation, vertebral fracture, spondylolisthesis, low back pain). The present study exploited the AnyBody full-body musculoskeletal model to assess the relation between lumbar loads and spinopelvic alignment in the sagittal plane. The model was evaluated in the standing position. The simulated postures were set using spinopelvic parameters gleaned from the literature and characterizing the healthy adult population. The parameters were: sagittal vertical axis, Roussouly lumbar type, sacral slope, and pelvic incidence. A total of 2772 configurations were simulated based on the following measurements: compression force and anterior shear at levels L4L5 and L5S1; multifidus, longissimus spinae, and rectus abdominis muscle forces. Changes in global sagittal alignment, lumbar typology, and sacral inclination, but not in pelvic incidence, were found to affect intervertebral loads in the lumbar spine and spinal muscle activation. Considering these changes would be advantageous for clinical evaluation, due to the recognized relation between altered loads and risk of disc herniation, vertebral fracture, spondylolisthesis, and low back pain. Musculoskeletal modeling proved to be a valuable biomechanical tool to non-invasively investigate the relation between internal loads and anatomical parameters. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate muscle activity variability within and between the right and left side of lumbar muscles in patients with chronic low back pain (cLBP) compared to healthy controls (HCs) during sustained quiet sitting. Surface electromyographic (EMG) signals were collected bilaterally from the lumbar muscles with 2 high density surface EMG grids of 9x14 electrodes. Root mean square values (RMS) over 1-sec epochs of all bipolar EMG leadings were obtained. Between-sides alternating activation was computed, as well as temporal- and spatial variability within the electrode grids through the coefficient of variation and correlations between RMS distributions. The subjective influence of sitting was evaluated by the rating of perceived exertion and the amount of LBP on a numeric pain rating scale. Compared to HCs, the patients with cLBP had lower temporal (p = 0.03) and similar spatial muscle activity variability during sitting, despite a more variable sitting position. This did not result in increased muscle fatigue indicated by EMG, but the patients with cLBP reported higher levels of RPE during- and more LBP after the sitting and as a consequence ended the sitting earlier than HCs (p < 0.01). Present findings lend support to the presence of less tolerance for low-level static muscle load in patients with cLBP. [ABSTRACT FROM AUTHOR]

Background: Burden of disease (BoD) estimations are increasingly used to prioritize public health interventions. Previous Cryptosporidium BoD models accounted only for acute episodes, while there is increasing evidence of long-term manifestations. Our objective was to update Cryptosporidium BoD and cost-of-illness (COI) models and to estimate BoD and COI for the Netherlands in years 2013–2017. Methods: We performed a scoping literature review and drew an outcome tree including long-term manifestations for which sufficient evidence was found, such as recurrent diarrhea and joint pain. We chose the Disability-Adjusted Life Year (DALY) metric to synthesize years of life lost due mortality (YLLs) and years lived with disability due to non-fatal outcomes (YLDs). For the costs, we adopted a societal perspective accounting for direct healthcare costs, patient costs and productivity losses. Uncertainty was managed using Latin Hypercube sampling (30,000 iterations). Results: In the Netherlands in 2017, we estimated 50,000 Cryptosporidium cases (95% uncertainty interval (UI): 15,000–102,000), 7,000 GP visits, 300 hospitalizations and 3 deaths, resulting in 137 DALYs (95%UI: 54–255) and €19.2 million COI (95%UI: €7.2 million– €36.2 million). Estimates were highest for 2016 (218 DALYs and €31.1 million in COI), and lowest in 2013 (100 DALYs and €13.8 million in COI). Most of the BoD was attributable to YLD (≈80% of DALYs). The most important cost was productivity losses (≈90% of total COI). Long-term manifestations, including recurring diarrhea and joint pain, accounted for 9% of the total DALYs and 7% of the total COI. Conclusion: Current evidence supports the inclusion of long-term manifestations in Cryptosporidium models, which contribute close to 10% of the total DALYs and costs. This may be an underestimation, as we were conservative in our assumptions. Cryptosporidium should be considered a priority organism with respect to public health surveillance, even in industrialized countries with high hygiene standards. [ABSTRACT FROM AUTHOR]

Lower back pain is a major public health problem. Despite claims that lumbar belts change spinal posture due to applied pressure on the trunk, no mechanical model has yet been published to prove this treatment. This paper describes a first model for belt design, based on the one hand on the mechanical properties of the fabrics and the belt geometry, and on the other hand on the trunk geometrical and mechanical description. The model provides the estimation of the pressure applied to the trunk, and a unique indicator of the belt mechanical efficiency is proposed: pressure is integrated into a bending moment characterizing the belt delordosing action on the spine. A first in-silico clinical study of belt efficiency for 15 patients with 2 different belts was conducted. Results are very dependent on the body shape: in the case of high BMI patients, the belt effect is significantly decreased, and can be even inverted, increasing the lordosis. The belt stiffness proportionally increases the pressure applied to the trunk, but the influence of the design itself on the bending moment is clearly outlined. Moreover, the belt/trunk interaction, modeled as sticking contact and the specific way patients lock their belts, dramatically modifies the belt action. Finally, even if further developments and tests are still necessary, the model presented in this paper seems suitable for in-silico pre-clinical trials on real body shapes at a design stage. [ABSTRACT FROM AUTHOR]

Integrated exercises that mimic daily tasks are generally preferred for improving performance and the later stages of rehabilitation, but it is unknown whether integrated core exercises are better than isolated core exercises at improving muscle activation for hypertrophy. The aim of the study was to compare the electromyographic (EMG) activity in rectus abdominis, oblique externus, and erector spinae while performing three conditions of integrated core exercises (lunges) with three isolated core exercises (prone bridge, side bridge and back extension). The three conditions of lunges were: on a stable surface, unstable surface and with external resistance to the trunk using an elastic band. The external resistance was measured with a force cell and peaked at 75N. After one familiarization session, all exercises were performed in one experimental session in randomized order. The isolated core exercises were performed in 20 seconds and the time performing the five repetitions with lunges was matched (20 seconds). Significantly greater peak normalized EMG activity were observed in the isolated core exercises compared to the three integrated core exercises (P<0.001) with two exceptions. For the oblique externus, the isolated core exercise was only greater than the stable lunge. Lunges with elastic bands only demonstrated greater peak erector spinae activation compared the other lunge conditions. Comparing the mean EMG activity between the isolated and three integrated exercises, greater muscle activations were observed performing the isolated exercises (P<0.001). Unstable lunges did not increase the peak or mean core muscle activations. In conclusion, mean and peak EMG activity performing the isolated exercises were in general greater than the three condition of lunges. Based on these results, we recommend using isolated core exercises when the primary goal is to improve muscle activation and elicit hypertrophy, but integrated exercises once adequate initial hypertrophy is achieved. [ABSTRACT FROM AUTHOR]

Discrepancies in patients’ responses to various outcome measures challenge clinicians’ evaluation of treatment outcomes. Therefore, we aimed to 1) evaluate the concordance of outcome measures after spine injection, 2) determine the patient variables that lead to discordant responses, and 3) suggest practical outcome measure for spine injections with good responsiveness. From October 2014 to November 2014, 164 patients with neck or low back pain who visited our outpatient clinics and had spine injections on the previous visit were enrolled. We asked patients to report changes in their symptom in the form of outcome measures: numeric rating scale, Oswestry disability index, neck disability index, residual symptom percentage and global perceived effect. The responses were categorized into three groups according to the degree of change; not improved, minimally improved, and significantly improved. The concordances of these categorized answers were evaluated. When “significantly improved” was considered as true improvement, 46 (28%) of the 164 patients had discordant responses to the four measures. There was no significant patients’ variable that affects discordance in the outcome measures. Good agreement was shown between the global perceived effect and residual symptom percentage, while the Oswestry disability index had poor agreement with the other measurements. The calculated numeric rating scale and residual symptom percentage also had low levels of agreement. However, patients with severe pre-treatment pain tended to have better agreement. In conclusion, this result suggest that the residual symptom percentage may be a more practical for clinicians and better represent patients’ improvements after spine injection. [ABSTRACT FROM AUTHOR]

Background and objective: Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain. Databases and data treatment: A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations. Results: Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain. Conclusions: Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established. Systematic review registration: PROSPERO registration . [ABSTRACT FROM AUTHOR]

Although cycling has been associated with overuse/fatigue and acute injuries, there is lack of information regarding associated risk factors and prevention factors. The objective of the study was to determine the factors associated with injury, and perceptions of discomfort and pain in cyclists. A total of 739 cyclists completed an online questionnaire between February and October 2016. The questionnaire acquired information on participant demographics, characteristics related to cycling profile and fitness training, bike components and cycling posture, self-reported perceptions of comfort and pain, and injuries sustained in the last 12 months. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (95%CI) that examined factors associated with reporting overuse/fatigue injury, acute injury, body discomfort, saddle discomfort, and pain while cycling. Odds of reporting an overuse/fatigue injury increased when the cyclists complemented training with running (OR = 1.74; 95%CI = 1.03–2.91) or swimming (OR = 2.17; 95%CI = 1.19–3.88), and with reported pain while cycling (OR = 1.17; 95%CI = 1.05–3.69) and not cycling (OR = 1.76; 95%CI = 1.07–2.90). Odds of reporting an acute injury increased when biking to work (OR = 1.79; 95%CI = 1.07–2.86), and decreased with increased average cycling speed (1-km/h decrease OR = 0.93; 95%CI = 0.88–0.97), and compared to low-end bike, with the use of mid-range (OR = 0.25; 95%CI = 0.09–0.72) and high-end bike (OR = 0.34; 95%CI = 0.13–0.96). Although body discomfort was only associated with saddle discomfort and the presence of pain during cycling, saddle discomfort was also associated with biking to work (OR = 0.46; 95%CI = 0.22–0.88). Finally, pain perception was associated with a number of factors such as ride to work, core training, cycling experience, saddle discomfort, pain while not cycling. Numerous factors are associated with injury, and perceptions of discomfort and pain in cyclists. Such factors should be considered when developing training routines, bicycle maintenance best practices, and injury prevention programs. [ABSTRACT FROM AUTHOR]

Background: A well-known supportive treatment for acute nonspecific back pain, elastic back support belts, are valued for their ability to accelerate natural self-healing, but there are concerns of a deconditioning effect due to their reliance on passive stabilization. Methods: To evaluate the systematic effects of elastic abdominal belts on the trunk musculature, a total of 36 persons with acute lumbar back pain (no longer than one week) were divided into two groups: an abdominal belt wearing group (B) and a non-abdominal belt wearing control group (C). All were examined over a period of three weeks at three time points: T1 just after assignment, T2 one week later, and T3 further two weeks later. Surface EMG (sEMG) was used to record trunk muscle activation when walking on a treadmill at walking speeds of 2, 3, 4, 5, and 6 km/h. Similarly, pain intensity (VAS) and functional impairment (ODI) over time were recorded in both groups. Results: Over the observation period, a slight advantage for decreased pain intensity (C: p<0.05 T2 vs. T1; B: p<0.01 T2 vs. T1, p<0.05 T3 vs. T1) and decreased functional impairment (Cohen's d vs. T1, C: T2 0.45, T3 0.86; B: T2 1.1, T3 1.0) was observed for the belt group. For the belt group both oblique abdominal muscles exhibited significantly lower sEMG throughout the observation period (external abdominal oblique muscle: (T1), T2, (T3), internal abdominal oblique muscle: T1, (T2), (T3)) and the sEMG for the back muscles ranged from unchanged to slightly elevated for this group, but never reached statistical significance. Discussion: The reduced abdominal amplitude levels in the belt group likely result from the permanent elastic stabilization provided by the belt: the required elevated intra-abdominal pressure to enhance spinal stability is then provided by lessened abdominal muscle activity complemented by the belt’s elastic support. With regard to the back muscles, the belt, due to its movement-restricting effect, tends to activate the paravertebral musculature. In this respect, the effect of elastic abdominal belts on the trunk muscles is not uniform. Therefore, the present results suggest that the effect of elastic abdominal belts appears to be more of a temporary neutral alteration of trunk muscle coordination, with some trunk muscles becoming more active and others less, and not a case of uniform deconditioning as is suspected. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that patients with chronic non-specific low back pain (CNSLBP) perform poorly in postural tasks when compared to healthy individuals. Despite its importance in posture and alignment of the trunk in relation to the head, neck proprioception has not been examined in patients with low back pain. The purpose of this study was to compare neck proprioception in patients with CNSLBP with healthy individuals. Methods: Cervical joint reposition error was measured five times consecutively in the neutral head position, 30° and 60° left and right head rotation. The main outcome measure was the mean cervical joint repositioning error of the head. Results: Forty-six participants with (n = 24, 54 ± 16yrs SD, 14 females) and without (n = 22, 36 ± 13yrs SD, 13 females) CNSLBP were included in the study. Comparison of mean cervical joint repositioning error between patients and healthy controls showed no statistically significant group difference in any of the applied positions. The range of deviation in CNSLBP patients was between 1.57° and 3.27° compared to 1.46° to 2.26° in healthy controls. An overshooting tendency for both groups was found in the neutral head position. Conclusion: The ability to accurately position the head does not seem to be impaired in patients with CNSLBP. This may suggest that sensorimotor control is affected on other levels of the movement system and future research should focus on methods to identify the source of these aberrations. [ABSTRACT FROM AUTHOR]

Objective: Increasing evidence purports exercise as a first-line therapeutic for the treatment of nearly all forms of chronic pain. However, knowledge of efficacious dosing respective to treatment modality and pain condition is virtually absent in the literature. The purpose of this analysis was to calculate the extent to which exercise treatment shows dose-dependent effects similar to what is seen with pharmacological treatments. Methods: A recently published comprehensive review of exercise and physical activity for chronic pain in adults was identified in May 2017. This report reviewed different physical activity and exercise interventions and their effectiveness in reducing pain severity and found overall modest effects of exercise in the treatment of pain. We analyzed this existing data set, focusing specifically on the dose of exercise intervention in these studies. We re-analyzed data from 75 studies looking at benefits of time of exercising per week, frequency of exercise per week, duration of intervention (in weeks), and estimated intensity of exercise. Results: Analysis revealed a significant positive correlation with exercise duration and analgesic effect on neck pain. Multiple linear regression modeling of these data predicted that increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients. Discussion: Modest effects were observed with one significant correlation between duration and pain effect for neck pain. Overall, these results provide insufficient evidence to conclude the presence of a strong dose effect of exercise in pain, but our modeling data provide tes predictions that can be used to design future studies to explicitly test the question of dose in specific patient populations. [ABSTRACT FROM AUTHOR]

Background: Although poor standing posture is a known cause of low back pain, the mechanisms involved are unclear. The aim of this study was to clarify the kinetic and posture angle features of standing posture that might influence low back pain. Methods: Sixty-seven young men were enrolled in this cross-sectional case-control study and were categorized according to whether they did or did not have low back pain. Habitual standing posture was assessed in each group, using a three-dimensional motion analysis system, force plates, and a spinal mouse. Kinetic and posture angle factors were compared between participants with and without low back pain. The relationship between specific features of standing posture and low back pain was analyzed using logistic regression. Results: The intervertebral disc compressive force and the low back moment were significantly greater in the group with low back pain than in the group without low back pain. The intervertebral disc compressive force was the factor most strongly associated with low back pain during static standing. Conclusions: Logistic regression analysis identified intervertebral disc compressive force as an independent variable associated with low back pain. This finding suggests that increased intervertebral disc compressive force may promote development of low back pain in standing posture. [ABSTRACT FROM AUTHOR]

Background: This review aimed at examining the prevalence of musculoskeletal diseases and pain among dental professionals in Western countries. Furthermore, possible occupational risk factors were analyzed. Methods: The literature search was conducted from June to July 2016, with an update in December 2017 using the databases MEDLINE, CINAHL, LIVIVO, Science Direct, PubMed, and Web of Science. The quality assessment was performed with a standardized instrument consisting of 10 items. A meta-analysis was carried out to compute pooled prevalence rates for musculoskeletal diseases and pain. Results: A total of 41 studies were included in this review; 30 studies met the criteria for the meta-analysis. Prevalence rates of musculoskeletal diseases and pain among dental professionals ranged from 10.8% to 97.9%. The neck was the body region affected most often (58.5%, 95% CI = 46.0–71.0) followed by the lower back (56.4%, 95% CI = 46.1–66.8), the shoulder (43.1%, 95% CI = 30.7–55.5) and the upper back (41.1%, 95% CI = 32.3–49.9). Potential occupational risk factors included an awkward working posture, high number of treated patients, administrative work, vibration, and repetition. Conclusions: Musculoskeletal diseases and pain are a significant health burden for dental professionals. This study showed high prevalence rates for several body regions. Therefore, suitable interventions for preventing musculoskeletal diseases and pain among dental professionals are needed. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to verify whether the saddle seat provides lower ergonomic risk than conventional seats in dentistry. Methods: This review followed the PRISMA statement and a protocol was created and registered in PROSPERO (CRD42017074918). Six electronic databases were searched as primary study sources. The "grey literature" was included to prevent selection and publication biases. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Meta-analysis was performed to estimate the effect of seat type on the ergonomic risk score in dentistry. The heterogeneity among studies was assessed using I2 statistics. Results: The search resulted in 3147 records, from which two were considered eligible for this review. Both studies were conducted with a total of 150 second-year dental students who were starting their laboratory activities using phantom heads. Saddle seats were associated with a significantly lower ergonomic risk than conventional seats [right side (mean difference = -3.18; 95% CI = -4.96, -1.40; p < 0.001) and left side (mean difference = -3.12; 95% CI = -4.56, -1.68; p < 0.001)], indicating posture improvement. Conclusion: The two eligible studies for this review provide moderate evidence that saddle seats provided lower ergonomic risk than conventional seats in the examined population of dental students. [ABSTRACT FROM AUTHOR]

Most patients with chronic lower back pain (CLBP) exhibit degenerative disc disease. Disc specimens obtained during initial therapeutic discectomies are often infected/colonized with Propionibacterium acnes, a Gram-positive commensal of the human skin. Although pain associated with infection is typically ascribed to the body’s inflammatory response, the Gram-positive bacterium Staphylococcus aureus was recently observed to directly activate nociceptors by secreting pore-forming α-hemolysins that disrupt neuronal cell membranes. The hemolytic activity of P. acnes in cultured disc specimens obtained during routine therapeutic discectomies was assessed through incubation on sheep-blood agar. The β-hemolysis pattern displayed by P. acnes on sheep-blood agar was variable and phylogroup-dependent. Their molecular phylogroups were correlated with their hemolytic patterns. Our findings raise the possibility that pore-forming proteins contribute to the pathogenesis and/or symptomology of chronic P. acnes disc infections and CLBP, at least in a subset of cases. [ABSTRACT FROM AUTHOR]

Object: This study aimed to analyze the association between low handgrip strength (HGS) and low back pain (LBP) according to physical activity (PA) in the general population aged over 50 years. Methods: Nationwide health surveys and examinations were performed in a cross-sectional representative of the Korean general population (n = 7,550 in 2014, n = 7,380 in 2015). Chronic LBP status was determined by self-reported survey responses with respect to the occurrence of LBP for more than 30 days during the previous 3 months. Maximal HGS was determined as the maximal strength of the dominant hand, and low HGS was defined as measurement in the lower 20th percentile of HGS measurements for the general population. High PA was defined as muscle-strengthening exercise for at least 3 days within 1 week. Demographics, medical history, and other variables were used to analyze adjusted weighted logistic regression models with propensity score matching. After propensity score matching, 429 participants were included in each group. Results: Analysis was confined to those aged 50–89 years who responded to the chronic LBP survey and had no missing data on HGS. Low HGS and LBP showed significant association in the crude logistic regression model. In the multiple logistic regression model, after adjusting for confounding factors, low HGS was significantly associated with LBP in women with low PA (adjusted odds ratio [aOR]: 1.75, p = 0.047). In the logistic regression model after propensity score matching, low HGS was also significantly related to LBP in women with low PA (aOR: 3.12, p = 0.004). Conclusions: Our study showed the relationship between low HGS and LBP using a cross-sectional Korean population-based health survey. Low HGS in women aged over 50 years with low PA was significantly associated with the presence of LBP. [ABSTRACT FROM AUTHOR]

Objective: The theory of interpersonal problem behaviour (IPB) provides a more fundamental framework for understanding the psychosocial aspects of pain. The present study focused on the IPB, based on the Interpersonal Problem Circumplex (IPC), in persons with low back pain and its association with pain, psychological characteristics, and health care utilisation. Methods: In a cross-sectional design, individuals with back pain (N = 88) and healthy control persons who matched by age, gender, and educational level (N = 88) were compared with regard to IPB. Furthermore, back pain patients classified by their IPB (N = 24 low, N = 48 moderate, N = 16 high) were compared regarding pain, depression, catastrophising, and health care utilisation. Results: In comparison to the healthy reference sample, a significant difference in the interpersonal problems of the low back pain group, with a tendency towards being overly ‘introverted’, ‘exploitable’, and ‘subassertive’, was revealed. In the back pain group, participants with elevated IPB showed significantly higher levels of pain intensity, functional disability, depression, catastrophising, and health care utilisation than participants with IPB in the normal range. Conclusion: Application of the Interpersonal Circumplex Model can help to characterize a subgroup of persons with low back pain. Increased general interpersonal problems are associated with elevated burden in pain-related, psychological, and health care-related variables. Future research should focus on the treatment opportunities for this subgroup, as well as on the influence of interpersonal problems during the course of back pain. [ABSTRACT FROM AUTHOR]

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 developing approaches for the management of LBP in order to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Placebo effects can be very effective in certain pain conditions, but their use is still highly controversial. Several studies show that patients would accept a placebo treatment under certain circumstances, particularly when they are informed prior to the treatment or when there are no effective treatment alternatives. This study examines the question, which factors influence the degree of acceptability of a hypothetical placebo application. Methods: Patients filled in a questionnaire dealing with placebo applications. Moreover general data, diagnosis, duration of pain, pain ratings and anxiety/depression/stress scores, sleep disorders and opioid intake were collected from the patients` charts. 129 patients (44 men / 85 women, mean age 51.5 years, 18.0–80.9 years) entered the study. All patients had chronic pain syndromes and were treated in an universitary academic interdisciplinary pain center. Mean duration of pain was 14.7 years. Results: The study did not show significant differences in placebo acceptability among patients with different pain diagnoses or accompanying psychological diagnoses or disorders. Hidden placebo application was considered much more unacceptable for the patients than the enhanced placebo or the open placebo application. An improved condition was associated with less feeling of deception, more trust and less negative mood than an unchanged or worsened condition. Conclusion: Acceptance of placebo as pain therapy is much more dependent on the way of application (hidden or open) or on the resulting condition (improved, unchanged or worsened) than on factors inherent in the individual patients. [ABSTRACT FROM AUTHOR]

Background: Approximately two thirds of patients with lumbar spinal stenosis (LSS) who undergo surgical treatment benefit from the surgery. The objective of this study was to derive a prognostic probability function (PPF) to identify patients with a high probability of post-surgical improvement because there is currently no method available. Methods: In this multicenter, prospective, observational study, we collected data from eight medical centers in Switzerland in which patients underwent surgery for LSS. The endpoints were meaningful clinically important differences (MCID) in pain and disability one year after baseline. We developed a PPF named PROCESS (PostopeRative OutComE Spinal Stenosis), based on a large set of prognostic indicators extracted from the literature. The PPF was derived using data from a random subset of two thirds of the patients and validated in the remaining third. We addressed overfitting by shrinking the regression coefficients. The area under the ROC curve (AUC) and calibration determined the accuracy of the PPF. Results: In this study, 452 LSS patients received surgery. 73% of the 300 patients in the derivation subset reached an MCID in pain and 68% reached an MCID in disability. The corresponding values were 70% and 63% in the validation subset, respectively. In the derivation subsample, the AUC was 0.64 (95% CI 0.57 to 0.71) for of the PPF predicting MCID in pain and 0.71 (0.64 to 0.77) for MCID in disability, after shrinkage. The corresponding numbers were 0.62 (0.52 to 0.72) and 0.70 (0.60 to 0.79) in the validation subsample, and the PPF showed good calibration. Conclusions: Surgical treatment for patients with lumbar spinal stenosis is being performed with increasing frequency. PROCESS is conditional on the individual pattern of preoperatively available prognostic indicators, and may be helpful for clinicians in counselling patients and in guiding the discussion on individual treatment decision in the era of personalized medicine. [ABSTRACT FROM AUTHOR]

The aim of the current study was to evaluate the literature examining the impact of osteopathic care for spinal complaints. The bibliographic databases Medline (Pubmed), Web of Science, Embase, and PEDro were searched. In addition, a number of grey literature sources were searched. Only randomized controlled trials conducted in high-income Western countries were considered. Two authors independently screened the titles and abstracts. Primary outcomes included ‘pain’ and ‘functional status’, while secondary outcomes included ‘medication use’ and ‘health status’. It was examined if differences existed related to the treatment protocol and geography (European vs. US studies). Study quality was assessed using the risk of bias tool of the Cochrane Back Review Group. Nineteen studies were included and qualitatively synthesized. Nine studies were from the US, followed by Germany with seven studies. The majority of studies (n = 13) focused on low back pain. In general, mixed findings related to the impact of osteopathic care on primary and secondary outcomes were observed. For the primary outcomes, a clear distinction between US and European studies was found, in favor of the latter ones. Studies were characterized by substantial methodological differences in sample sizes, number of treatments, control groups, and follow-up. In conclusion, there is some evidence suggesting that osteopathic care may be effective for people suffering from spinal complaints. Further studies with larger study samples and assessment of long-term impact are required to further increase the evidence-based knowledge of the potential of osteopathic care for individuals suffering from spinal complaints. [ABSTRACT FROM AUTHOR]

Introduction: The aging of workers generally implies an increased number of workers with health problems or psychological diseases because of the growing distance between personal resources and job demands; the first may decrease, while the second are stable. In the preschool setting, the demands remain constant because children are always aged 0–3 years, while the preschool teacher’s personal resources decrease with age. It is, therefore, necessary to propose multilevel interventions aimed at supporting work sustainability and workers’ resources. Method: This study involved twenty-seven preschools (324 teachers with an average age of 48.7 years): the control group included seventeen schools (190 teachers with an average age of 48.5 years), five schools were assigned to experimental group one (69 teachers with an average age of 48.8), and five schools were assigned to experimental group two (65 teachers with an average age of 49.1). In this context, we proposed two protocols of multilevel intervention comprising three solutions; two of these were common to both experimental groups: psychological counseling and psychosocial intervention. The third solution differed between groups: environmental redefinition (for group one); gymnastic and vocal hygiene (for group two). We hypothesized that the interventions improve teachers’ work abilities, increase well-being, and decrease stress and burnout. Furthermore we hypothesized that there would be an improvement in the organizational climate of trust and in social job resources. Results: Data analysis showed that the interventions were effective. In particular, the experimental groups reported significant decreases in psychological exhaustion (EG2: ß = -1.48; p = .00), indolence (EG1: ß = -1.36; p = .00), and stress (EG2: ß = -0.94; p = .00). Furthermore, the experimental groups significantly increased their enthusiasm towards work (EG2: ß = 1.21; p = .01), vertical trust (EG1: ß = 0.54; p = .01), and the perception of coworker social support (EG2: ß = 0.54; p = .01). The protocol that involved the GC2 was particularly effective. Conclusions: These results demonstrate the effectiveness of the intervention in a particular job setting (preschool classroom), emphasizing the need for implementing solutions aimed at supporting workers’ well-being, especially in light of an aging workforce. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this three-year cohort study was to assess the incidence rates and characteristics of abnormal lumbar findings and low back pain (LBP) in child and adolescent weightlifting athletes using magnetic resonance imaging (MRI) and medical questionnaires. This study evaluated subclinical sports injuries, which in turn may help prevent competition-specific injuries and improve performance levels. Materials and methods: Between 2014 and 2016, twelve participants who had been competing in weightlifting events for at least 2 years were enrolled in this study. The mean age of the participants at the start of this study was 11.4 ± 2.0 years, and there were 6 boys and 6 girls. Annual medical questionnaire surveys and lumbar examinations using MRI were performed during the 3-year follow-up. The incidence rates and variations of LBP and abnormal MRI findings were evaluated. Results: At the start of this study, there were no positive findings of LBP, and abnormal lumbar findings on MRI were observed in only 2 participants. At the 2-year follow-up, 1 participant had LBP, and 8 of 12 participants had abnormal lumbar findings. In the final year, only 3 participants had LBP; however, abnormal lumbar findings were observed on MRI in 11 participants. Among these, lumbar spondylolysis was observed in 4 participants, lumbar disc protrusion or extrusion in 2 participants, and lumbar disc degeneration in 9 participants. Conclusion: This prospective 3-year cohort study of 12 child and adolescent weightlifters revealed abnormal lumbar findings in 11 participants at a high rate on MRI examination. Children and adolescents undergoing resistance training at the competition level could potentially have irreversible changes in the lumbar vertebra without symptoms. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to describe the incidence proportion of different types of running-related injuries (RRI) among recreational runners and to determine their time to recovery. Methods: A sub-analysis of the injured runners included in the 839-person, 24-week randomized trial named Run Clever. During follow-up, the participants reported levels of pain in different anatomical areas on a weekly basis. In case injured, runners attended a clinical examination at a physiotherapist, who provided a diagnosis, e.g., medial tibial stress syndrome (MTSS), Achilles tendinopathy (AT), patellofemoral pain (PFP), iliotibial band syndrome (ITBS) and plantar fasciopathy (PF). The diagnose-specific injury proportions (IP) and 95% confidence intervals (CI) were calculated using descriptive statistics. The time to recovery was defined as the time from the first registration of pain until total pain relief in the same anatomical area. It was reported as medians and interquartile range (IQR) if possible. Results: A total of 140 runners were injured at least once leading to a 24-week cumulative injury proportion of 32% [95% CI: 26%; 37%]. The diagnoses with the highest incidence proportion were MTSS (IP = 16% [95% CI: 9.3%; 22.9%], AT (IP = 8.9% [95% CI: 3.6%; 14.2%], PFP (IP = 8% [95% CI: 3.0%; 13.1%]. The median time to recovery for all types of injuries was 56 days (IQR = 70 days). Diagnose-specific time-to-recoveries included 70 days (IQR = 89 days) for MTSS, 56 days (IQR = 165 days) for AT, 49 days (IQR = 63 days) for PFP. Conclusion: The most common running injuries among recreational runners were MTSS followed by AT, PFP, ITBS and PF. In total, 77 injured participants recovered their RRI and the median time to recovery for all types of injuries was 56 days and MTSS was the diagnosis with the longest median time to recovery, 70 days. [ABSTRACT FROM AUTHOR]

Background: The Fremantle Back Awareness Questionnaire (FreBAQ) claims to assess disrupted self-perception of the back. The aim of this study was to develop a German version of the FreBAQ (FreBAQ-G) and assess its test-retest reliability, its known-groups validity and its convergent validity with another purported measure of back perception. Methods: The FreBaQ-G was translated following international guidelines for the transcultural adaptation of questionnaires. Thirty-five patients with non-specific CLBP and 48 healthy participants were recruited. Assessor one administered the FreBAQ-G to each patient with CLBP on two separate days to quantify intra-observer reliability. Assessor two administered the FreBaQ-G to each patient on day 1. The scores were compared to those obtained by assessor one on day 1 to assess inter-observer reliability. Known-groups validity was quantified by comparing the FreBAQ-G score between patients and healthy controls. To assess convergent validity, patient’s FreBAQ-G scores were correlated to their two-point discrimination (TPD) scores. Results: Intra- and Inter-observer reliability were both moderate with ICC3.1 = 0.88 (95%CI: 0.77 to 0.94) and 0.89 (95%CI: 0.79 to 0.94), respectively. Intra- and inter-observer limits of agreement (LoA) were 6.2 (95%CI: 5.0–8.1) and 6.0 (4.8–7.8), respectively. The adjusted mean difference between patients and controls was 5.4 (95%CI: 3.0 to 7.8, p<0.01). Patient’s FreBAQ-G scores were not associated with TPD thresholds (Pearson’s r = -0.05, p = 0.79). Conclusions: The FreBAQ-G demonstrated a degree of reliability and known-groups validity. Interpretation of patient level data should be performed with caution because the LoA were substantial. It did not demonstrate convergent validity against TPD. Floor effects of some items of the FreBAQ-G may have influenced the validity and reliability results. The clinimetric properties of the FreBAQ-G require further investigation as a simple measure of disrupted self-perception of the back before firm recommendations on its use can be made. [ABSTRACT FROM AUTHOR]

Objective: Recent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior. Design: An exploratory cross-sectional study. Setting and participants: Primary care physicians of the French-speaking part of Switzerland. Main outcome measures: Primary care physicians’ perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths. Results: 533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general. Conclusion: Our results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented. [ABSTRACT FROM AUTHOR]

Objective: The Fear Avoidance Components Scale (FACS) is a new patient-reported outcome (PRO) questionnaire designed to comprehensively evaluate fear avoidance (FA) beliefs and attitudes in persons with painful medical conditions. The original English version has demonstrated acceptable psychometric properties, including concurrent and predictive validity. Two factors have been identified: 1. general fear avoidance; and 2. types of activities that are avoided. Methods: The FACS was first translated into Serbian, and then psychometrically validated. A cohort of 322 chronic musculoskeletal pain subjects completed the FACS-Serb and additional FA-related patient-reported outcome (PRO) measures. Their FACS-Serb scores were then compared to a cohort of 68 acute pain subjects. Results: Test-retest reliability (ICC2,1 = 0.928) and internal consistency for both Factors (Cronbach α 0.904 and 0,880 respectively) were very good. An acceptable fit was found with a confirmatory factor analysis of the 2-factor model found with the original English version of the FACS. Strong associations were found among FACS-Serb scores and other PRO measures of pain catastrophizing, depressive/anxiety symptoms, perceived disability, and pain intensity (p<0.001 for all analyses). FACS-Serb total scores, separate Factor scores, and subjective pain ratings were significantly higher in the chronic vs. acute pain cohorts (p<0.001 for all analyses). Conclusions: The FACS-Serb demonstrated strong psychometric properties, including strong reliability and internal consistency, criterion validity (through associations with other FA-related PRO measures), and discriminant validity (through comparisons with a separate acute pain cohort). The FACS-Serb appears to be a potentially useful pain-related assessment tool. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Low Back Pain (CLBP) is a heterogeneous condition with lack of diagnostic clarity. Therapeutic interventions show small effects. To improve outcomes by targeting interventions it is recommended to develop a triage system to surgical and non-surgical treatments based on treatment outcomes. The objective of the current study was to develop and internally validate prognostic models based on pre-treatment patient-reported profiles that identify patients who either respond or do not respond to two frequently performed treatments (lumbar spine surgery and multidisciplinary pain management program). Methods: A consecutive cohort study in a secondary referral spine center was performed. The study followed the recommendations of the PROGRESS framework and was registered in the Dutch Trial Register (NTR5946). Data of forty-seven potential pre-consultation (baseline) indicators predicting ‘response’ or ‘non-response’ at one-year follow-up for the two treatments were obtained to develop and validate four multivariable logistic regression models. The source population consisted of 3,410 referred CLBP-patients. Two treatment cohorts were defined: elective ‘spine surgery’ (n = 217 [6.4%]) and multidisciplinary bio-psychosocial ‘pain management program’ (n = 171 [5.0%]). Main inclusion criteria were age ≥18, CLBP (≥6 months), and not responding to primary care treatment. The primary outcome was functional ability: ‘response’ (Oswestry Disability Index [ODI] ≤22) and ‘non-response’ (ODI ≥41). Results: Baseline indicators predictive of treatment outcome were: degree of disability (all models), ≥2 previous spine surgeries, psychosocial complaints, age (onset <20 or >50), and patient expectations of treatment outcomes. The explained variances were low for the models predicting response and non-response to pain management program (R2 respectively 23% and 26%) and modest for surgery (R2 30% and 39%). The overall performance was acceptable (c-index; 0.72–0.83), the model predicting non-response to surgery performed best (R2 = 39%; c-index = 0.83). Conclusion: This study was the first to identify different patient-reported profiles that predict response to different treatments for CLBP. The model predicting ‘non-response’ to elective lumbar spine surgery performed remarkably well, suggesting that referrals of these patients to a spine surgeon could be avoided. After external validation, the patient-reported profiles could potentially enhance timely patient triage to the right secondary care specialist and improve decision-making between clinican and patient. This could lead to improved treatment outcomes, which results in a more efficient use of healthcare resources. [ABSTRACT FROM AUTHOR]

Purpose: Multiple clinical and epidemiological studies have provided estimates of fibromyalgia prevalence and sex ratio, but different criteria sets and methodology, as well as bias, have led to widely varying (0.4%->11%) estimates of prevalence and female predominance (>90% to <61%). In general, studies have failed to distinguish Criteria based fibromyalgia (CritFM) from Clinical fibromyalgia (ClinFM). In the current study we compare CritFM with ClinFM to investigate gender and other biases in the diagnosis of fibromyalgia. Methods: We used a rheumatic disease databank and 2016 fibromyalgia criteria to study prevalence and sex ratios in a selection biased sample of 1761 referred and diagnosed fibromyalgia patients and in an unbiased sample of 4342 patients with no diagnosis with respect to fibromyalgia. We compared diagnostic and clinical variables according to gender, and we reanalyzed a German population study (GPS) (n = 2435) using revised 2016 criteria for fibromyalgia. Results: In the selection-biased sample of referred patients with fibromyalgia, more than 90% were women. However, when an unselected sample of rheumatoid arthritis (RA) patients was studied for the presence of fibromyalgia, women represented 58.7% of fibromyalgia cases. Women had slightly more symptoms than men, including generalized pain (36.8% vs. 32.4%), count of 37 symptoms (4.7 vs. 3.7) and mean polysymptomatic distress scores (10.2 vs. 8.2). We also found a linear relation between the probability of being females and fibromyalgia and fibromyalgia severity. Women in the GPS represented 59.2% of cases. Discussion: The perception of fibromyalgia as almost exclusively (≥90%) a women’s disorder is not supported by data in unbiased studies. Using validated self-report criteria and unbiased selection, the female proportion of fibromyalgia cases was ≤60% in the unbiased studies, and the observed CritFM prevalence of fibromyalgia in the GPS was ~2%. ClinFM is the public face of fibromyalgia, but is severely affected by selection and confirmation bias in the clinic and publications, underestimating men with fibromyalgia and overestimating women. We recommend the use of 2016 fibromyalgia criteria for clinical diagnosis and epidemiology because of its updated scoring and generalized pain requirement. Fibromyalgia and generalized pain positivity, widespread pain (WPI), symptom severity scale (SSS) and polysymptomatic distress (PSD) scale should always be reported. [ABSTRACT FROM AUTHOR]