BackgroundSome studies suggest that leg length discrepancy (LLD) is associated with low back pain (LBP) but many have not found such an association leading to conflicting evidence on the role of LLD in LBP.MethodsThe study population consisted of meat cutters with a standing job and customer service workers with a sedentary job from Atria Suomi Ltd (Nurmo, Finland) who were at least 35 years old and had been working in their jobs for at least 10 years. Leg length of each participant was measured with a laser range meter fixed in a rod, which was holding the scanning head of the ultrasound apparatus. Association of the intensity of LBP (10-cm Visual Analog Scale) with LLD was analysed by linear regression model, while the hurdle model was used in analysing the association of number of days with LBP and days on sick leave during the past year. Associations were adjusted by gender, age, BMI, smoking, depressive feelings and type of work (standing or sedentary job).ResultsThe final study population consisted of 114 meat cutters (26 females and 88 males) and 34 customer service workers (30 females and four males). Forty-nine percent of the meat cutters and 44% of the customer service workers had LLD of at least 6 mm, while 16% and 15%, respectively, had LLD of at least 11 mm. In the whole study population, LLD of 6 mm or more was associated with higher intensity of LBP and number of days with LBP. In the stratified analysis, both intensity of LBP and number of days of LBP were associated with LLD among meat cutters but not among customer service workers. The sick leaves during past year were slightly longer among those with LLD 10 mm or more, but the differences were not statistically significant.ConclusionsLLD, measured with a laser range meter, was associated with intensity of LBP and self-reported days with LBP during the past year among meat cutters engaged in standing work.Trial registrationISRCTN11898558 - The role of leg length discrepancy in low back pain.

Mixing of roles between professionals, volunteers and service users creates a new, complex environment in which to produce and deliver public services. In this kind of environment, the issues of accountability become ever more important. This article presents a qualitative case study of co-production between volunteers and professionals in the legally regulated restorative justice services in Finland. Theoretically, we draw together the concept of citizen co-production with the literature on street-level bureaucracy and accountability. As a result of the study, we can say that co-production between volunteers and professionals increases accountability ties. In particular, the meaning of process-centred accountability is salient in horizontal accountability relations. Thus, co-production as a governance arrangement changes the working culture of public service professionals. In the new partnerships, although not entirely horizontal, we can recognize a seed for cultural change for professionalized public service organizations. Points for practitionersIn this article we have researched co-production between professionals and volunteers in a legally regulated public service, the conciliation service, examining the perceptions of accountability in the frontline practices. The results show that the process-centred nature of the co-produced services leaves less room for discretion and the application of rules by individual street-level workers. Furthermore, as the service users do not consider volunteers to be part of the authority, co-production might be smoother. This is significant especially in the social services, where the clients per se are not necessarily motivated to co-produce, but where co-production would be essential for achieving effective service outcomes.

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The ultrasound-laser technique is quick and easy to perform. Both reliability and agreement with the radiographic method are excellent. The ultrasound measurement is non-invasive and therefore a potential alternative to radiographic methods in the evaluation of LLD.

BackgroundThe etiology of non-specific low back pain (LBP) is complex and not well understood. LBP is common and causes a remarkable health burden worldwide. Leg-length discrepancy (LLD) is potentially a risk factor for development of LBP, although this relationship has been questioned. Yet only one randomized controlled study (RCT) has been performed. The objective of our study was to evaluate the effect of insoles with leg-length discrepancy (LLD) correction compared to insoles without LLD correction among meat cutters in a RCT-design.MethodsThe study population consisted 387 meat cutters who were over 35 years old and had been working 10 years or more. The LLD measurement was done by a laser ultrasound technique. All workers with an LLD of at least 5 mm and an LBP intensity of at least 2 on a 10-cm Visual Analog Scale were eligible. The LLD of all the participants in the intervention group was corrected 70%, which means that if the LLD was for example 10 mm the correction was 7 mm. The insoles were used at work for eight hours per day. The control group had insoles without LLD correction. The primary outcome was between-group difference in LBP intensity. Secondary outcomes included sciatic pain intensity, disability (Roland Morris), RAND-36, the Oswestry Disability Index, physician visits and days on sick leave over the first year. We used a repeated measures regression analysis with adjustments for age, gender and BMI. The hurdle model was used for days on sick leave.ResultsIn all, 169 workers were invited and 114 (67%) responded. Of them, 42 were eligible and were randomized to the intervention (n = 20) or control group (n = 22). The workers in the intervention group had a higher improvement in LBP intensity (− 2.6; 95% confidence intervals − 3.7 – − 1.4), intensity of sciatic pain (− 2.3; − 3.4 – − 1.07) and RAND-36 physical functioning (9.6; 1.6–17.6) and a lesser likelihood of sick leaves (OR -3.7; − 7.2 - -0.2).ConclusionsCorrection of LLD with insoles was an effective intervention among workers with LBP and a standing job.Trial registrationISRCTN11898558. Registration date 11. Feb 2011. BioMed Central Ltd.