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Aims: Caries and periodontal disease are associated with inadequate control of oral bacteria. Since conventional microbiological evaluations are impractical in dental clinics or public engagement activities, a rapid test for the quantification of oral bacteria represents a useful tool. We describe the development of a colour change test to rapidly estimate bacterial colonisation density in the mouth. Methods and Results: Volunteers rinsed with milk or milkshake. Viability indicators were added and colour changes quantified during incubation. Using milkshake and the resazurin‐based solution PrestoBlue (9% v/v), the method distinguished between samples before and after brushing within 5 min. Colour changes were quantified and viable counts were obtained using oral rinses. Measured colour changes strongly correlated with total counts of both anaerobes and streptococci (Spearman's correlation coefficient of 0·782 and 0·769, respectively, P ≤ 0·001) and with perceived changes, as determined by volunteers (n = 10) visually ranking images. Conclusions: The resazurin milkshake test can rapidly and visually quantify viable bacteria in oral samples. Significance and Impact of the Study: The resazurin milkshake test could serve as a sensitive semi‐quantitative method for measuring oral bacteria in human oral rinse samples. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate if lumbar disc pathology identified on MRI scans is more common in patients with acute, likely discogenic, low back pain than matched controls.Methods: We compared rates of MRI findings between 30 cases with low back pain and 30 pain-free controls. Cases were patients presenting for care with likely discogenic low back pain (demonstrated centralisation with repeated movement testing), of moderate intensity and with minimal past history of back pain. Controls were matched for age, gender and past history of back pain. Cases and controls underwent MRI scanning which was read for the presence of a range of MRI findings by two blinded assessors.Results: The presence of disc degeneration, modic changes and disc herniation significantly altered the odds of a participant being a case or control. For example subjects were 5.2 times more likely to be a case than a control when disc degeneration grade of ≥3 was present, and 6.0 times more likely with modic changes. The presence of a high-intensity zone or annular tear was found to significantly alter odds for one assessor but not the other assessor.Conclusion: MRI findings including disc degeneration, modic changes and herniation are more common in selected people with current acute (likely discogenic) low back pain than in controls without current low back pain. Further investigation of the value of MRI findings as prognostic factors and as treatment effect modifiers is required to assess the potential clinical importance of these findings. [ABSTRACT FROM AUTHOR]

Resting metabolic rate (RMR) is highly variable between individuals within a single species and the relationship between body mass and RMR does not wholly explain this variability. One factor that could account for a portion of the residual variation is animal personality or consistent individual differences (CIDs) in behaviour, but no study has examined this relationship in a free-living population of mammals. In this paper, we test for a relationship between RMR and CIDs in activity in live-trapped meadow voles Microtus pennsylvanicus after controlling for the effect of body mass. We quantified the activity levels of voles both in an unfamiliar environment and for the first 2 min in the metabolic apparatus, and then measured RMR using open-flow respirometry. As expected, there was a linear relationship between RMR and body mass, and we found strong evidence for repeatable differences in activity levels between individuals. However, contrary to the hypothesis, we did not identify a significant correlation between CIDs in behaviour and RMR after controlling for body mass. Our results suggest that, at least within species, higher activity levels may not require a greater investment in energetically demanding tissues or increased capacity for processing of energy. Alternatively, if a relationship exists, our inability to detect it may reflect a weak behavioural signal in noisy RMR data that are influenced by many factors. Our results could also reflect an artefact of individual responses to stress or a sampling bias towards more exploratory individuals in animals captured by live-trapping. [ABSTRACT FROM AUTHOR]

Lack of standardization of terminology in low back pain (LBP) research has significantly impeded progress in this area. The diversity in existing definitions for a 'recurrence of an episode of LBP' and 'recurrent LBP' is an important example. The variety of definitions used by researchers working in this area has prevented comparison of results between trials and made meta-analyses of this data unfeasible. The aim of this study was to use a modified Delphi approach to gain consensus on definitions for a 'recurrence of an episode of LBP' (e.g. outcome event) and for 'recurrent LBP' (e.g. patient population). Existing definitions for both constructs were classified into the main features comprising the definition (e.g. 'duration of pain') and the items that defined each feature (e.g. 'pain lasting at least 24 h'). In each round, participants were asked to rate the importance of each feature to a definition of a 'recurrence of an episode of LBP', and a definition of 'recurrent LBP' and rank the items (defining each feature) in order of decreasing importance. Forty-six experts in LBP research, from nine different countries, participated in this study. Four rounds were completed with responses rates of 94, 91, 83, and 97% in rounds 1, 2, 3, and 4, respectively. Consensus definitions were reached in both areas with 95% of panel members supporting the definition of a 'recurrence of an episode of LBP' and 92% of panel members supporting the definition of 'recurrent LBP'. Future research is necessary to evaluate these definitions. [ABSTRACT FROM AUTHOR]

Several versions of the 24-item Roland Morris Disability Questionnaire (RMDQ) have been proposed; however, their responsiveness has not been extensively explored. The objective of this study was to compare the responsiveness of four versions of the RMDQ. Perceived disability was measured using the 24-item, two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six randomised controlled trials. Responsiveness was calculated using effect size, Guyatt's responsiveness index (GRI) and receiver operating characteristics (ROC) curves. Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ. GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item. ROC curves revealed that the 11-item was less responsive than the other three versions, which had similar responsiveness. The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item. [ABSTRACT FROM AUTHOR]

Recurrent low back pain (recurrent LBP) is a common condition, however, it is unclear if uniform definitions are used in studies investigating the prevalence and management of this condition. The aim of this systematic review was to identify how recurrent LBP is defined in the literature. A literature search was performed on MEDLINE, EMBASE, CINAHL, AMED, and PEDro. Studies were considered eligible if they investigated a cohort of subjects with recurrent LBP or if they were measuring the prevalence of recurrent LBP. Two independent reviewers assessed inclusion of studies and extracted definitions of recurrent LBP. Forty-three studies met the inclusion criteria. The majority of studies (63%) gave an explicit definition of recurrent LBP; however, the definitions varied greatly and only three definitions for recurrent LBP were used by more than one study. The most common feature given as part of the definition was the frequency of previous episodes of low back pain. Only 8% (3/36) of studies used previously recommended definitions for recurrent LBP. Large variation exists in definitions of recurrent LBP used in the literature, making interpretation of prevalence rates and treatment outcomes very difficult. Achieving consensus among experts in this area is required. [ABSTRACT FROM AUTHOR]

Ultrasound (US) measures are used by clinicians and researchers to evaluate improvements in activity of the abdominal muscles in patients with low back pain. Studies evaluating the reproducibility of these US measures provide some information; however, little is known about the reproducibility of these US measures over time in patients with low back pain. The objectives of this study were to estimate the reproducibility of ultrasound measurements of automatic activation of the lateral abdominal wall muscles using a leg force task in patients with chronic low back pain. Thirty-five participants from an existing randomised, blinded, placebo-controlled trial participated in the study. A reproducibility analysis was undertaken from all patients using data collected at baseline and after treatment. The reproducibility of measurements of thickness, muscle activation (thickness changes) and muscle improvement/deterioration after intervention (differences in thickness changes from single images made before and after treatment) was analysed. The reproducibility of static images (thickness) was excellent (ICC(2,1) = 0.97, 95% CI = 0.96-0.97, standard error of the measurement (SEM) = 0.04 cm, smallest detectable change (SDC) = 0.11 cm), the reproducibility of thickness changes was moderate (ICC(2,1) = 0.72, 95% CI 0.65-0.76, SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes from single images with statistical adjustment for duplicate measures was poor (ICC(2,1) = 0.44, 95% CI 0.33-0.58, SEM = 21%, SDC = 66.5%). Improvements in the testing protocol must be performed in order to enhance reproducibility of US as an outcome measure for abdominal muscle activation. [ABSTRACT FROM AUTHOR]

Questions: How much of an effect do five common physiotherapy interventions need to have for patients with low back pain to perceive they are worth their cost, discomfort, risk, and incovenience? Are there any differences between the interventions? Do specific characteristics of people with low back pain predict the smallest important difference? Design: Cross-sectional, observational study. Participants: 77 patients with non-specific low back pain who had not yet commenced physiotherapy intervention. Outcome measures: The smallest worthwhile effect was measured in terms of global perceived change (0 to 4) and percentage perceived change. Results: Participants perceived that intervention would have to make them 'much better', which corresponded to 1.7 (SD 0.7) on the 4-point scale, or improve their symptoms by 42% (SD 23), to make it worthwhile. There was little distinction made between interventions, regardless of whether smallest worthwhile effects were quantified as global perceived change (p = 0.09) or percentage perceived change (p = 1.00). Severity of symptoms independently (p = 0.01) predicted percentage perceived change explaining 9% of the variance, so that for each increase in severity of symptoms of 1 point out of 10 there was an increase of 4% in the percentage perceived change that participants considered would make intervention worthwhile. Conclusions: Typically people with low back pain feel that physiotherapy intervention must reduce their symptoms by 42%, or make them feel 'much better' for intervention to be worthwhile. [ABSTRACT FROM AUTHOR]

QUESTIONS: Can clinical prediction rules be derived for injured Australian workers with persistent musculoskeletal pain? Are they valid? DESIGN: Longitudinal observational study. PARTICIPANTS: 847 injured workers with persistent musculoskeletal pain undergoing rehabilitation. OUTCOME MEASURES: At baseline, 12 putative predictors were measured. At 9 weeks, short-term outcomes such as pain (visual analogue scale), activity limitation (Functional Rating Index) and work upgrade (increase in work hours or duties) were measured. At 6 months, long-term work status (working or not working) was measured. RESULTS: Data were obtained from 85% of the participants who were followed up at both 9 weeks (720 of 847) and 6 months (247 of 290). Predictors of outcome included high baseline pain and activity limitation, long duration of previous intervention, not working, non-English speaking background, and the area of pain. Accuracy was highest for clinical prediction rules predicting pain and level of activity limitation at 9 weeks (R2 = 0.67 and 0.69 respectively) and work status at 6 months (LR- = 0.24). CONCLUSION: Accurate clinical prediction rules have been derived and validated for injured workers with persistent musculoskeletal pain, predicting activity limitation, pain, and work outcomes following exercise-based rehabilitation. Further research to validate these prediction rules in other populations and to assess the effectiveness of tailoring intervention based on the estimated prognosis would be valuable. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4–5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: −LR = 0.21 (95%CI 0.12–0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3–4.4) and −LR of 0.29 (95%CI 0.12–0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. [ABSTRACT FROM AUTHOR]

The article presents relevant issues in the process of cross-cultural adaptations and clinimetric testing for self-report outcome measurements used by physiotherapists for measuring patient's health status or treatment outcomes. It provides advice on performing a cross-cultural adaptation, how to properly check the clinimetric properties, how to select a relevant questionnaire and how to evaluate the quality of an adapted questionnaire. It also presents all Brazilian-Portuguese cross-cultural adaptations of low back pain measurements.