Variables Associated With Level of Disability in Working Individuals With Nonacute Low Back Pain: A Cross-sectional Investigation

Abstract

Considerable research over the last decade has focused on classification-based treatments for acute low back pain (LBP). 3,4,9,[17][18][19][20]23,24,56 Much of this research has been influenced by the treatment-based-classification (TBC) model proposed by Delitto et al. 9 A major tenet of the TBC model is to stage patients based on the severity of LBP-related disability and functional status rather than the traditional time-based method. Delitto et al 9 identified 3 stages of LBP: stage 1 (acute), stage 2 (subacute), and stage 3 (chronic). They reported that individuals in stage 1 often have an inability to perform basic mechanical activities, such as sitting, walking, and standing, and typically score greater than 40 on an LBP disability questionnaire similar to the Oswestry Low Back Pain Disability Questionnaire (mOSW). Those in stage 2 are characterized as having limitation in instrumental activities of daily living (eg, mowing grass, vacuuming) and commonly have an mOSW score between 20 and 40. Those in stage 3 are described as having deficits in performing high-level, physical-demand activities (eg, work) and frequently have an mOSW score of less than 20.Compared to the stage 1 category in the TBC model, which has been significantly updated and revised, 4,14,17,18,23,56 few studies have examined the variables associated with level of LBP-related disability in subjects with stage 2 and stage 3 LBP. The Delitto et al 9 TBC model identified impairment-based interventions for individuals with stage 2 LBP that address deficits in flexibility, strength, cardiovascular function, coordination, and body T T METHODS:Data analyzed were from working individuals with nonacute LBP (n = 235). The response variable was dichotomized by mOSW score (less than 20 or 20 or greater), and the regressor variables included 27 self-report, sociodemographic, impairment-based, and kinematic measures used to assess individuals with LBP. Logistic regression was used to identify variables associated with mOSW. T T RESULTS:One hundred eleven subjects had a mOSW score of 20 or greater, and 124 subjects had a mOSW score of less than 20. Logistic regression analysis identified 4 variables associated with LBP-related disability (mOSW): duration of LBP (P = .006), numeric pain rating (P<.0001), Fear-Avoidance Beliefs Questionnaire physical activity subscale (P = .0007), and limits of stability movement velocity in the forward direction (P = .02). The best model had an R 2 (u) of 0.25. T T CONCLUSION:The odds of LBP-related disability (mOSW) in this sample of nonacute working individuals were found to increase with longer duration of LBP, higher numeric pain rating scores, higher Fear-Avoidance Beliefs Questionnaire physical activity subscale scores, and slower limits of stability movement velocity in the forward direction. The identification of limits of stability movement velocity is a novel finding that may support a link between sensorimotor balance deficits and disability in working individuals with nonacute LBP.

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists’ Adherence, Beliefs, and Perspectives

“…A number of physical, psychological, and social characteristics have been associated with higher risk of NSLBP-related disability and are common for men and women of different ages (Hartvigsen et al, 2018;Lardon, Dubois, Cantin, Piché, & Descarreaux, 2018;Lin et al, 2011;Rundell et al, 2017;Salvetti, Pimenta, Braga, & Corrêa, 2012;Scott Davis et al, 2013). Physical and lifestyle characteristics include being overweight, smoking, reporting higher pain intensity and longer pain duration, and practicing less physical activity (Hartvigsen et al, 2018;Lardon et al, 2018;Lin et al, 2011;Rundell et al, 2017;Salvetti et al, 2012;Scott Davis et al, 2013).…”

“…Psychological characteristics encompass a history of depression, fatigue, anxiety, fear-avoidant beliefs (i.e., avoidance of specific activities for fear of increasing the pain), kinesiophobia (i.e., fear of movement), and low pain-related self-efficacy (Hartvigsen et al, 2018;Rundell et al, 2017;Salvetti et al, 2012;Scott Davis et al, 2013). Social characteristics, such as fewer years of formal education, lower family income, absence of a paid job, compensated work leave, and work dissatisfaction, have also been shown to predict disability among patients with NSLBP (Hartvigsen et al, 2018;Lardon et al, 2018;Salvetti et al, 2012).…”

Estatinas en la prevención del tromboembolismo venoso

“…Dos estudios adicionales también valoraron el rol de las estatinas en la prevención primaria del TEV, pero además se comparó con otros agentes hipolipemiantes. Los resultados fueron favorables para las estatinas (disminuciones del riesgo de 47% y 58%), no observándose este beneficio con otros agentes hipolipemiantes 18,21 . Estos primeros estudios, eran de tipo observacional.…”

Is postural stability compromised in women with urinary incontinence?

“…Similarly, it was hypothesized that in response to computerized posturography limit of stability measures, sway velocity would be greater in subjects with chronic low back pain (67). However, contrary to this hypothesis, the subjects with chronic low back pain actually had less sway velocity in the forward direction compared to the control group (67).…”

“…Davis et. al discussed that this may be a compensatory response resulting from fear of movement and reflecting a tactic to avoid pain (67).…”