Prevalence of low back pain and its associated risk factors among professions and workers in health, medical, and welfare facilities in Japan.

BACKGROUND: The prevalence of low back pain (LBP) and its associated risk factors, including physical function, are not fully clarified among health, medical, and welfare facility professionals and workers. Furthermore, issues related to the prevention of LBP are not completely understood. OBJECTIVE: To investigate the prevalence of LBP and associated risk factors, including physical function, in professionals and workers in health, medical, and welfare facilities. DESIGN: Cross-sectional study. SETTING: Physical examinations for LBP were conducted, and data were collected at health, medical, and welfare facilities in Japan. PARTICIPANTS: A total of 1085 health, medical, and welfare facility professionals and workers participated in the study. MAIN OUTCOME MEASURES: Prevalence was calculated based on the presence or absence of symptoms of LBP at the time of survey. Then, bivariate analysis was conducted to examine the relationship between LBP and age, gender, occupation, history of treatment for LBP, passive straight leg raising (SLR) angle, and abdominal muscle strength. Furthermore, multivariate analysis was performed to examine the relationship between LBP and the six risk factors. RESULTS: The prevalence of LBP was high (74.8%). Bivariate analysis showed a significantly higher percentage of nursing professionals (46.2%) in the LBP group (p < .001). The association between LBP and the risk factors in multivariate analysis was as follows: history of treatment for LBP (odds ratio [OR] = 3.92, 95% confidence interval [CI] 2.63-5.84, p < .001), nursing professionals as occupation (OR = 2.12, 95% CI 1.55-2.90, p < .001), passive SLR angle (OR = 2.06, 95% CI 1.24-3.42, p = .005), abdominal muscle strength (OR = 1.61, 95% CI 1.07-2.41, p = .021), and gender (OR = 1.52, 95% CI 1.08-2.14, p = .015). CONCLUSION: In the future, it will be necessary to take preventive measures for risk factors and to follow up longitudinally on the prevalence of LBP and on workers with indicated risk factors.

Reliability of ultrasound to measure the distance between lumbar interspinous processes.

OBJECTIVES: This study aimed to determine the reliability of ultrasound to measure the distance between interspinous processes of the lumbar spine at the segmental level (i.e., L1-L2, L2-L3, L3-L4, and L4-L5). METHODS: Ten men with no history of orthopedic diseases or dysfunctions were included in this study. In total, 720 images of the lumbar spines of participants were analyzed (10 participants, 4 segments, 3 trials, 3 positions, 2 examiners). With participants in three different positions, images of each segment specifically focused on the distance between lumbar interspinous processes. Bland-Altman analysis (BAA) was used to determine intra- and inter-rater reliability. RESULTS: Intra-rater intraclass correlation coefficient (ICC) values (1, 1) were found to range from 0.840 to 0.988, whereas inter-rater ICC values (2, 1) ranged from 0.605 to 0.876. BAA results confirmed a fixed bias regarding the L4-L5 of the lumbar spine segment in the flexion position. CONCLUSIONS: Inter-rater reliability decreased throughout this study; however, results showed that using ultrasound to measure the distance between lumbar segmental interspinous processes could be applied in clinical settings to evaluate lumbar segmental mobility.

Absolute and relative reliability of lumbar interspinous process ultrasound imaging measurements.

[Purpose] The intra- and inter-examiner reliabilities of lumbar interspinous process distances measured by ultrasound imaging were examined. [Subjects and Methods] The subjects were 10 males who had no history of orthopedic diseases or dysfunctions. Ten lumbar interspinous images from 360 images captured from 10 subjects were selected. The 10 images were measured by nine examiners. The lumbar interspinous process distance measurements were performed five times by each examiner. In addition, four of the nine examiners measured the distances again after 4 days for test-retest analysis. In statistical analysis, the intraclass correlation coefficient was used to investigate relative reliability, and Bland-Altman analysis was used to investigate absolute reliability. [Results] The intraclass correlation coefficients (1, 1) for intra-examiner reliability ranged from 0.985 to 0.998. For inter-rater reliability, the intraclass correlation coefficient (2, 1) was 0.969. The intraclass correlation coefficients (1, 2) for test-retest reliability ranged from 0.991 to 0.999. The Bland-Altman analysis results indicated no systematic error. [Conclusion] The results indicate that ultrasound measurements of interspinous process distance are highly reliable even when measured only once by a single person.

Reliability and validity of an ultrasound-based imaging method for measuring interspinous process distance in the lumbar spine using two different index points.

[Purpose] This study assessed the reliability and validity of an ultrasound-based imaging method for measuring the interspinous process distance in the lumbar spine using two different index points. [Subjects and Methods] Ten healthy males were recruited. Five physical therapy students participated in this study as examiners. The L2-L3 interspinous distance was measured from the caudal end of the L2 spinous process to the cranial end of the L3 spinous process (E-E measurement) and from the top of the L2 spinous process to the top of the L3 spinous process (T-T measurement). Intraclass correlation coefficients were calculated to estimate the relative reliability. Validity was assessed using a model resembling the living human body. [Results] The reliability study showed no difference in intra-rater reliability between the two measurements. However, the E-E measurement showed higher inter-rater reliability than the T-T measurement (Intraclass correlation coefficients: 0.914 vs. 0.725). Moreover, the E-E measurement method had good validity (Intraclass correlation coefficients: 0.999 and 95% confidence interval for minimal detectable change: 0.29 mm). [Conclusion] These results demonstrate the high reliability and validity of ultrasound-based imaging in the quantitative assessment of lumbar interspinous process distance. Of the two methods, the E-E measurement method is recommended.

Validation of the Japanese Osteoporosis Quality of Life Questionnaire.

The Japanese Society for Bone and Mineral Research developed the Japanese Osteoporosis Quality of Life Questionnaire (JOQOL) to evaluate the disease-specific Health-Related QOL, which is specific for osteoporosis of Japanese patients. JOQOL was revised in 2000; it consisted of 38 items with the scale graded from 0 to 4 and a total full score of 152. To elucidate the reliability and validity of the revised JOQOL, we enrolled 193 postmenopausal women as subjects and diagnosed them as having osteoporosis or osteopenia. The mean age of the subjects was 68.2 +/- 8 years; 58 subjects (30.1%) had at least one vertebral fracture. Among them, 83 patients were retested for reliability. The mean lapse from the time of test to that of retest was 23.7(+/- 9.5) days. The subjects were questioned using the JOQOL, Medical Outcomes Study Short Form 36 (SF-36), along with questions on subjects' characteristics and their ADL. The JOQOL scores at the test and the retest were significantly correlated (r = 0.973) without significant difference between their mean scores. All the JOQOL items showed significant correlations at the test and the retest (Kendall's tau = 0.599-0.947). Cronbach's alpha coefficient of JOQOL was 0.918. These results proved the high reliability of JOQOL. The JOQOL score showed negative correlation with age (r = -0.183). The subjects with vertebral fractures had significantly lower JOQOL scores than the subjects without fractures. The JOQOL showed a significant correlation with all the scores in each domain of eight of SF-36 (r = 0.350-0.839). These results were consistent with that of the preceding study. It is concluded that the reliability and the validity of JOQOL were demonstrated in this study.

Intertester reliability and diagnostic validity of the cervical flexion-rotation test.

OBJECTIVE: This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test (FRT) to discriminate subjects with headache because of C1/2 dysfunction. In addition, this study evaluates agreement between experienced and inexperienced examiners. METHODS: These were 2 single blind comparative measurement study designs. In study 1, 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where C1/2 was the primary dysfunctional level, and 10 subjects with CeH but without C1/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2,1), and Bland-Altman plot were used to analyze FRT range of rotation between the examiners. Sensitivity, specificity, and examiner agreement for test interpretation were analyzed using cross tabulation and kappa. RESULTS: In study 1, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% (P < .001) and kappa = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and kappa values were all within clinically acceptable levels. CONCLUSIONS: The FRT can be used accurately and reliably by inexperienced examiners and may be a useful aid in CeH evaluation.

Relationship between the oxygen uptake during cardiopulmonary exercise testing and left ventricular function in patients with acute myocardial infarction.

The relationship between exercise capacity and left ventricular function has been evaluated in 35 patients with acute myocardial infarction (34 males and 1 female; mean age 55.5 ± 7.1 years). Single photon emission computed tomography (SPECT) was used to measure left ventricular function in the acute phase (4.9 ± 2.2 days after onset) and the chronic phase (188.5 ± 22.9 days after onset). More than 10% left ventricular dilatation from the acute phase to the chronic phase was defined as remodeling (RM) and the subjects were divided into 2 groups: RM and non-RM. Cardiopulmonary exercise testing was performed at 1 month (1M), 3 months (3M) and 6 months (6M) after onset. In the RM group, anaerobic threshold (AT) and peak oxygen uptake (Peak ) did not change significantly. In the non-RM group, AT was 15 ± 1 (ml/min/Kg) at 1M, 16 ± 2 at 3M and 18 ± 4 at 6M. Peak was 26 ± 3 (ml/min/Kg) at 1M, 30 ± 2 at 3M and 32 ± 3 at 6M. Both parameters in the chronic phase increased significantly compared with those at 1M (p<0.002 and p<0.0001). Thus, change in exercise capacity would correlate with change in left ventricular function.