Low back pain in a general population. Natural course and influence of physical exercise--a 5-year follow-up of the Musculoskeletal Intervention Center-Norrtälje Study.

STUDY DESIGN: A 5-year prospective cohort study was conducted of men and women seeking care for a new period of low back pain (LBP). OBJECTIVES: To study the natural course of pain and disability due to LBP during a 5-year follow-up period, and to investigate the possible influence of regular physical exercise on recovery. SUMMARY OF BACKGROUND DATA: LBP is major health problem, but its natural course is not very well studied. Several studies have investigated the role of physical exercise on LBP disorders, with inconsistent results. METHODS: At baseline, a total of 790 subjects seeking care for LBP were interviewed about physical exercise during leisure time. Over 5 years, 3 follow-up assessments were made by postal questionnaire. At all measuring points, pain intensity ratings and disability scores were compared between men and women, and among 3 exercise categories. RESULTS: The pain intensity and disability scores were improved after 5 years for both men and women. The most prominent improvements occurred after 6 months, but less so thereafter. There were no significant differences between men and women with regard to individual changes at the 5-year follow-up concerning the pain intensity or disability scores. There were no significant differences, either for women or men, between low, median, or high intensity exercise groups regarding pain intensity or disability values for the individual change at the 5-year follow-up. CONCLUSIONS: Over a 5-year period, both men and women who had sought care for LBP reported a decrease in pain and disability; however, only a few were fully restored. In this study, we found no effect of nonspecific physical exercise on recovery from LBP in men and women.

The introduction of sit-stand worktables; aspects of attitudes, compliance and satisfaction.

The introduction of sit-stand worktables was examined in this study. Purchasers at four companies were interviewed regarding preparations prior to purchase, follow-up after installation, and if expectations had been fulfilled. Personnel at the four companies answered a questionnaire examining use of the worktables' sit-stand function, and the influence of some variables on this. Utilisation of the sit-stand function was less than what could be expected to relieve static musculoskeletal loading during VDU work. Pain experienced during the past year, and education on the use of the worktable gave rise to modest increases in utilisation. Investment in sit-stand worktables was satisfactory to purchasers, in terms of providing flexible furniture to suit modern organisational dynamics. Users were, in general, positive to the worktables, but showed poor compliance in using them. User and purchaser satisfaction with regard to improving individual health ergonomics was questionable in respect of the low level of usage.

Neck/shoulder disorders in a general population. Natural course and influence of physical exercise: a 5-year follow-up.

STUDY DESIGN: A 5-year follow-up study was conducted of men and women seeking care for new incidents of neck/shoulder disorders (NSD). OBJECTIVES: To study the natural course of pain and disability caused by NSD during a 5-year follow-up and to investigate the possible influence of regular physical exercise on recovery. SUMMARY OF BACKGROUND DATA: NSD are a major health problem, but their natural course is not very well studied. Several studies have investigated the role of physical exercise on NSD, with inconsistent results. METHODS: At baseline, a total of 439 subjects seeking care for NSD completed a questionnaire, and were interviewed about personal, medical, and occupational history, as well as physical exercise during leisure time. Over 5 years, 4 follow-up assessments were made by postal questionnaire. At all measuring points, pain intensity ratings and disability scores were compared between men and women, and between 3 exercise categories. RESULTS: The highest improvements in pain and disability, both in men and in women, were seen after 3 months. After that, only minor improvements were seen. In some cases, there was deterioration. However, after 5 years, both men and women had significant improvements, men more than women. Only the women were analyzed concerning physical exercise and were pooled into 3 categories according to intensity of exercise. There were no differences in changes in pain intensity and disability scores from baseline between the groups. CONCLUSIONS: A gender difference was seen in the change of pain and disability, with men having higher improvement than women over 5 years. Self-reported physical exercise of any intensity was not associated with higher recovery in women.

To seek or not to seek? Care-seeking behaviour among people with low-back pain.

AIM: The present study sought to identify potential differences between subjects who seek care for their low-back pain problems and those who do not with respect to pain intensity, grade of disability, physical or psychosocial working conditions, individual physical and physiological factors, and lifestyle factors. MATERIAL AND METHODS: The study population was obtained from a population-based, case-referent study, the MUSIC-Norrtälje study. All persons with low-back pain among cases as well as "referents" were compared according to care-seeking behaviour. In all 727 cases with low-back pain who had sought care by any of 75 caregivers in the region, including all physicians and physiotherapists as well as chiropractors, osteopaths, and homeopaths, 721 referents with low-back pain who did not seek care participated. All participants underwent a clinical examination, and filled in a questionnaire about personal and occupational data, pain and disability, pain history, psychosomatic complaints, and present psychosocial situation. RESULTS: High disability and high pain intensity were strongly related to care seeking among men and women with low-back pain. The odds ratios for high disability were 7.4 (CI 5.0 - 11.0) for women and 4.9 (CI 3.3 - 7.1) for men respectively. The odds ratios for high pain intensity were 3.7 (CI 2.2 - 6.0) for women and 1.7 (CI 1.1 - 2.8) for men. A more strained economic situation and use of passive coping strategies significantly increased the probability of women not seeking care. Neither previous pain history, high physical workload, nor jobstrain, poor job satisfaction, or life style factors (high body weight, smoking, and exercise) or psychosomatic complaints affected care-seeking behaviour. CONCLUSIONS: The most decisive factors for seeking care were disability and pain. However, numerous individuals with low disability and low pain intensity also seek care for their pain problems. Better information and advice on the common course of low-back pain may make those individuals less frightened of their pain and, as a result, reduce the consumption of care and social costs for society. The majority of people seek care for pain without wanting a medical prescription. The fact that economic factors seemed to be of importance indicates that costs for healthcare must be kept low if the goal is to give healthcare on equal terms for all.

Seeking care for low back pain in the general population: a two-year follow-up study: results from the MUSIC-Norrtälje Study.

STUDY DESIGN: A 2-year follow-up study was conducted to investigate new patients who sought care for low back pain from all the caregivers in a specific region with a population of approximately 17,000 men and women ages 20 to 59 years. OBJECTIVES: To describe care-seeking behavior for low back pain in a general population; to characterize pain, disability, and sick leave among the patients; and to study predictors of recovery. An additional aim was to find a simple way of classifying low back pain in epidemiologic studies. SUMMARY OF BACKGROUND DATA: Low back pain is very common, but its natural history in a general population and predictors of recovery are not fully known. METHODS: All the patients went through a clinical examination, and data on personal, medical, and occupational history were collected. Follow-up assessments were made during a 2-year period. RESULTS: Whereas 50% of the patients went to physicians and physiotherapists for treatment, 50% went to other caregivers. Some improvements in pain and disability were reported after 3 months, but not many after that. Approximately 70% of the care seekers had not been on sick leave during the follow-up period. Care seeking during the follow-up period was not associated with reduced pain and disability. No predictive factors for recovery were found. A simple pain drawing made by the patient gave information about pain distribution similar to that found by clinical examination. CONCLUSIONS: In a general working population in Sweden ages 20-59 years, approximately 5% sought care because of a new low back pain episode during a 3-year period. Few of the care seekers became pain-free during the follow-up period. This study strengthens the hypothesis that low back pain often becomes chronic even when sick leave is rare.

Validity of occupational energy expenditure assessed by interview.

Measuring physical activity at work has been a field of growing interest in recent decades, and there is a need for reliable, standardized assessment instruments for application in large population studies. The present study examined the validity of a task-oriented interview for assessing energy expenditure in occupational work. The interview was developed for use in the MUSIC-Norrtälje study, a population study with the overall aim of identifying risk and preventive factors for musculoskeletal disorders. Twenty-seven persons were included in the study. Each respondent defined all tasks performed during a typical workday and estimated their durations. For each task the interviewer then assessed the level of energy expenditure in multiples of the resting metabolic rate (MET) and calculated a time-weighted average MET (TWA-MET) for a typical workday. Measurements of oxygen consumption and observations of duration of each work task were performed during 2 workdays in all the interviewed subjects. The validity was tested by comparing TWA-MET derived from the interviews with those derived from measurements; the product moment correlation coefficient was 0.70. The interview may offer sufficient validity for assessment of energy expenditure in large population studies.