Articles: low-back-pain.
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This study evaluated the incidence of lumbar isthmic spondylolisthesis among subjects permanently disabled because of low back pain syndromes. ⋯ The finding that the incidence corresponds well with the incidence in the normal population may suggest that lumbar isthmic spondylolisthesis does not invariably lead to severe impairment or disability, although location of the defect at the level proximal to L5 may be connected to an increased risk for permanent low back disability.
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To determine the relationship between pain provocation and the analgesic response in lumbar zygapophyseal joint blocks. ⋯ This study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar zygapophyseal joint blocks.
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The aim of this study was to assess the ability of specific and clinically relevant Minnesota Multiphasic Personality Inventory (MMPI) profile types to predict outcomes in a structured interdisciplinary pain-management program for patients with low back pain. ⋯ Even when subjects with chronic pain are divided into cluster groups associated with highly similar clinical interpretations, the MMPI for the most part fails to predict self-reported outcomes in an interdisciplinary pain-management program.
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J Orthop Sports Phys Ther · Dec 1994
Randomized Controlled Trial Clinical TrialA randomized-control study of active and passive treatments for chronic low back pain following L5 laminectomy.
The professional literature contains relatively few randomized-control studies that have assessed the efficacy of physical therapy approaches to the management of patients with chronic low back pain (CLBP). The purposes of this study were: 1) to investigate the effects of physical agents, joint manipulation, low-tech exercise, and high-tech exercise on objective measures of CLBP; 2) to track the length of CLBP relief; and 3) to determine treatment cost-effectiveness. Two-hundred-fifty subjects (68 females, 182 males; ages 34-51 years) with CLBP following an L5 laminectomy were randomly assigned into five separate groups for a treatment period of 8 weeks. ⋯ Results revealed that: 1) only low-tech and high-tech exercise produced significant improvements (p < .05) in CLBP, 2) the mean period of CLBP relief ranged from 1.6 weeks (control) to 91.4 weeks (low-tech exercise), and 3) low-tech exercise was most cost-effective. It was concluded that: 1) low-tech and high-tech exercise were the only effective treatments for CLBP, 2) low-tech exercise produced the longest period of CLBP relief, and 3) low-tech exercise was the most cost-effective form of treatment. Clinically, low-tech exercise may be the treatment method of choice for the effective management of chronic low back pain.
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Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach. ⋯ Research on predictors of return to work outcome following MDR were identified and included variables in five categories: demographics, medical history, physical findings, pain and psychological characteristics. The literature provides support for the use of integrated approaches that target the medical, physical, ergonomic and psychosocial factors that can exacerbate and/or maintain work disability. Future research should address current methodological limitations in the literature and focus on: 1) identifying critical treatment components of such approaches, 2) developing innovative screening methods to identify high risk cases to facilitate earlier more targeted efforts to assist such individuals, and 3) consider variations in the staging of various combinations of interventions in an effort to develop more cost-effective variations in the multidisciplinary approach.