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Överskrift Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors
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Överskrift Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors
Beskrivning The aims of this investigation were: (1) To describe a population of patients who had to meet the following criteria; (a) lumbo-sacral pain, with or without radiation to the thigh, (b) duration of pain before entry to the trial not longer than 3 mth, (c) a pain-free year before the onset of the current episode, (2) To determine whether various clinical, vocational, psychological and social factors are of any prognostic value when assessing the course of acute and subacute low back pain, (3) To evaluate the effect of (a) the Back School, based on ergonomic advice, (b) combined physiotherapy, consisting of mainly manual therapy, (c) 'placebo', by means of low intensity short-wave diathermy, on acute and subacute low back pain. This prospective investigation was carried out at the Medical Department of the Automotive Division of AB Volvo, Goteborg, Sweden. Of all patients consulting the Medical Department because of low back pain from August, 1974 to May, 1975, 217 fulfilled the criteria for admission to the trial. These patients were all followed for one year. No dropouts were registered. The average age of the patients was 34.5 yr and 13% were women, as compared to 20% women among all Volvo's employees in Goteborg. Just over half the patients had previously suffered from back symptoms in the form of one or more attacks of lumbago or sciatica. The duration of the current episode of pain when the patients first attended the medical centre varied between 1 and 86 days, with a median duration of 9 days. Just over half of the patients had a gradual onset of symptoms while the remainder had a sudden onset, often in connection with lifting or bending. All patients had low back pain. 26% had radiation of the pain to the gluteal region or thigh. A majority of the patients considered their pain to be intense and half had continuous aching. Coughing and sneezing caused aggravation of the pain in 40%. Pain when leaning forward and sitting was the predominating functional limitation. Straight Leg Raising Test was positive in 62% of the patients, while only 14% had a positive test below 60degr.. Almost 90% of the patients had pain on lumbar flexion, and the mean value for flexion according to a modification of Schober's method was lower than normal. The history of back pain, the clinical manifestations and the vocational, psychological, social and demographic factors characterizing the group of patients studied were all related to the course of acute low back pain during 1 yr. The course of back pain has been characterized by (1) the duration of symptoms during the initial episode of pain; (2) the duration of sick-leave during the initial episode, (3) the total length of recurrences of pain in one year and (4) the total duration of absence from work due to recurrences in one year. Vocational factors in terms of working postures required, vocational fatigue, variation, satisfaction and need to concentrate at work, were related to the course of acute low back pain. Frequent bending and twisting, fixed postures, lifting and forceful movements, general fatigue, daily back fatigue, repetitive work, no needs of concentration and discontent at work, were all related to either a longer initial episode of pain or a longer absence from work or both when all the patients were analysed together. A comparison between manual workers and office staff revealed pronounced differences in the duration of symptoms and sick-leave in the two groups. The manual workers had both a longer initial episode of pain and a longer duration of sick-leave during both the initial episode and the relapses. The findings of this study support previous observations that psychological factors are of importance for the course of back pain. No firm conclusions about the importance of psychological factors or the mechanism of the causal association could be drawn from the results of this study. Copyright © 2008 Elsevier B. V., Amsterdam. All Rights Reserved.
Publicerad 1977
Författare Bergquist-Ullman M, DuPriest CM., Larsson U


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