title: Smoking, heavy physical work and low back pain: a four-year prospective study. Risk factors for restricting back pain in older persons. Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness. Does physical activity moderate the relationship between depression symptomatology and low back pain? Cohort and co-twin control analyses nested in the longitudinal study of aging Danish twins (LSADT) Are risk factors for atherothrombotic disease associated with back pain sickness absence? The Whitehall II Study. Influencing Factors on the Overestimation of Self-Reported Physical Activity: A Cross-Sectional Analysis of Low Back Pain Patients and Healthy Controls Active Lifestyle Protects Against Incident Low Back Pain in Seniors: A Population-Based 2-Year Prospective Study of 1387 Danish Twins Aged 70–100 Years Low back pain and physical activity – A 6.5 year follow-up among young adults in their transition from school to working life Low back pain incident episodes: a community-based study. Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. New low back pain in nurses: work activities, work stress and sedentary lifestyle. High-level physical activity in childhood seems to protect against low back pain in early adolescence. Predictors of low back pain onset in a prospective British study. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Predictive risk factors for chronic regional and multisite musculoskeletal pain: A 5-year prospective study in a working population Occupational loading, health behavior and sleep disturbance as predictors of low-back pain. Ten year course of low back pain in an adult population-based cohort--the Doetinchem cohort study. The Role of Physical Fitness as Risk Indicator of Increased Low Back Pain Intensity Among People Working With Physically and Mentally Disabled Persons: A 30-Month Prospective Study The Predictive Relationship of Physical Activity on the Incidence of Low Back Pain in an Occupational Cohort Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Identification of Modifiable Personal Factors That Predict New-onset Low Back Pain: A Prospective Study of Female Nursing Students Active Therapy for Chronic Low Back Pain: Part 3. Factors Influencing Self-Rated Disability and Its Change Following Therapy A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference. Predictors of low back pain in British schoolchildren: a population-based prospective cohort study.
abstract: Data from a community-based four-year prospect i ve study were used to test the hypothesis that heavy physical work is a stronger predictor of  low back pain in smokers than in non-smokers . Of 708 working responders without low back pain during the entire year prior to 1990 , 562 ( 79 % ) completed a question naire four years later in 1994 . A job involving heavy lifting and much st and ing in 1990 was a strong predictor of low back pain in smokers four years later [ odds ratio ( OR ) = 5.53 , 95 % confidence interval ( CI ) = 1.93 - 15.84 , p < 0.01 ) after having adjusted for other job characteristics , demographic factors , emotional symptoms , physical exercise and musculoskeletal pain elsewhere . In non-smokers , having a job with heavy lifting and much st and ing was not associated with low back pain . One explanation may be that smoking leads to reduced perfusion and malnutrition of tissues in or around the spine and causes these tissues to respond inefficiently to mechanical stress OBJECTIVES To identify risk factors for back pain leading to restricted activity ( restricting back pain ) in older persons . DESIGN Prospect i ve cohort study . SETTING Greater New Haven , Connecticut . PARTICIPANTS A total of 731 men and women aged 70 years or older , who were community living and nondisabled in essential activities of daily living at baseline . MEASUREMENTS C and i date risk factors were ascertained every 18 months for 108 months during comprehensive home-based assessment s.  Restricting back pain  was assessed during monthly telephone interviews for up to 126 months . Incident episodes of ( 1 ) short-term ( 1 episode lasting 1 month ) restricting back pain ; and ( 2 ) persistent ( 1 episode lasting 2 or more months ) or recurrent ( 2 or more episodes of any duration ) restricting back pain were determined during each 18-month interval . The associations between the c and i date risk factors and short-term and persistent/recurrent restricting back pain , respectively , were evaluated using a multivariable Cox model . RESULTS The cumulative incidence was 21.3 % ( 95 % confidence interval [ CI ] 19.6%-23.1 % ) for short-term restricting back pain and 20.6 % ( CI 18.6%-22.9 % ) for persistent/recurrent restricting back pain over a median follow-up of 109 months . In a recurrent event multivariable analysis , female sex ( hazard ratio [ HR ] 1.30 ; 1.07 - 1.58 ) , weak grip strength ( HR 1.24 ; 1.01 - 1.52 ) , and hip weakness ( HR 1.19 ; 1.07 - 1.32 ) were independently associated with an increased likelihood of having short-term restricting back pain , whereas female sex ( HR 1.48 ; CI 1.13 - 1.94 ) , depressive symptoms ( HR 1.57 ; 1.23 - 2.00 ) , 2 or more chronic conditions ( HR 1.38 ; 1.08 - 1.77 ) , and arthritis ( HR 1.66 ; 1.31 - 2.09 ) were independently associated with persistent/recurrent restricting back pain . CONCLUSION In this prospect i ve study , several factors were independently associated with restricting back pain , including some that may be modifiable and therefore potential targets for interventions to reduce this common and often recurrent condition in older persons OBJECTIVE All occupations expose workers to varied and unique conditions . The nature of work has been recognized as influencing the health of workers . Whether predictors for chronic neck and low back pain would be occupation-specific is unknown . This study aim ed to identify predictors for chronic neck and low back pain in a cohort of office workers . METHODS A prospect i ve study was carried out among 669 healthy office workers . At baseline , risk factors were assessed using a question naire and st and ardized physical examination . A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS , and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months . Two regression models were built to analyze the risk factors for developing chronic neck and low back pain . RESULTS Of the sample , 17 and 27 % of office workers who reported a new onset of neck or low back pain developed chronicity , respectively . Predictors for chronic neck pain were high body mass index , frequent neck extension during the work day , high initial pain intensity , and high psychological job dem and s. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity . CONCLUSIONS The findings suggest that predictors for chronic musculoskeletal pain in a sub population may be a subset of predictors identified in a general population or occupation specific . Successful management to prevent chronic musculoskeletal pain may also need to consider the patient 's occupation BACKGROUND CONTEXT Association between low physical fitness and  low back pain ( LBP ) is contradictory in previous studies . PURPOSE The objective of the present prospect i ve cohort study was to investigate the predictive associations of various intrinsic risk factors in young conscripts for LBP , with special attention to physical fitness . STUDY DESIGN A prospect i ve cohort study . PATIENT SAMPLE A representative sample of Finnish male conscripts . In Finl and , military service is compulsory for male citizens and 90 % of young men enter into the service . OUTCOME MEASURES Incidence of LBP and recurrent LBP prompting a visit at the garrison health clinic during 6-month military training . METHODS Four successive cohorts of 18- to 28-year-old male conscripts ( N=982 ) were followed for 6 months . Conscripts with incidence of LBP were identified and treated at the garrison clinic . Predictive associations between intrinsic risk factors and LBP were examined using multivariate Cox proportional hazard models . RESULTS The cumulative incidence of LBP was 16 % , the incidence rate being 1.2 ( 95 % confidence interval [ CI ] , 1.0 - 1.4 ) per 1,000 person-days . Conscripts with low educational level had increased risk for incidence of LBP ( hazard ratio [ HR ] , 1.6 ; 95 % CI , 1.1 - 2.3 ) . Conscripts with low dynamic trunk muscle endurance and low aerobic endurance simultaneously ( ie , having coimpairment ) at baseline also had an increased risk for incidence of LBP . The strongest risk factor was coimpairment of trunk muscular endurance in tests of back lift and push-up ( HR , 2.8 ; 95 % CI , 1.4 - 5.9 ) . CONCLUSIONS The increased risk for LBP was observed among young men who had a low educational level and poor fitness level in both muscular and aerobic performance Purpose To investigate whether depression symptomatology is associated with low back pain ( LBP ) in twins aged 70 + and whether this effect depends on a person ’s physical activity ( PA ) status . Methods This prospect i ve cohort and nested case – control study used a nationally representative sample of twins . Data on depression symptomatology ( modified Cambridge Mental Disorders Examination ) and  self-reported PA were obtained from the Longitudinal Study of Aging Danish Twins using twins without LBP at baseline . Associations between depression symptomatology ( highest quartile ) at baseline and LBP two years later were investigated using logistic regression analyses adjusted for sex . To examine the moderating effect of PA , we tested its interaction with depression . Associations were analysed using the complete sample of 2446 twins and a matched case – control analysis of 97 twin pairs discordant for LBP at follow-up . Odds ratios ( OR ) with 95 % confidence intervals ( CI ) were calculated . Results Using the whole sample , high depression scores were associated with an increased probability of LBP ( OR 1.56 , 95 % CI 1.22–1.99 , P ≤ 0.01 ) . There was no statistically significant interaction of light PA and depression symptomatology ( OR 0.78 , 95 % CI 0.46–1.35 , P = 0.39 ) and strenuous PA and depression symptomatology ( 0.84 , 95 % CI 0.50–1.41 , P = 0.51 ) . The case – control analysis showed similar ORs , although statistically insignificant . Conclusions High depression symptomatology predicted incident LBP . This effect is supposedly not attributable to genetic or shared environmental factors . Physical activity did not moderate the effect of depression symptomatology on LBP STUDY OBJECTIVE : To explore the previously stated hypothesis that risk factors for atherothrombotic disease are associated with back pain . DESIGN : Prospect i ve ( mean of four years of follow up ) and retrospective analyses using two main outcome measures : ( a ) short ( < or = 7 days ) and long ( > 7 days ) spells of sickness absence because of back pain reported separately in men and women ; ( b ) consistency of effect across the result ing four duration of spell and sex cells . SETTING : 14 civil service departments in London . PARTICIPANTS : 3506 male and 1380 female white office-based civil servants , aged 35 - 55 years at baseline . MAIN RESULTS : In age adjusted models , low apo AI was associated with back pain across all four duration -sex cells and smoking was associated across three cells . Six factors were associated with back pain in two cells : low exercise and high BMI , waist-hip ratio , triglycerides , insulin and Lp(a ) . On full adjustment ( for age , BMI , employment grade and back pain at baseline ) , each of these factors retained a statistically significant effect in at least one duration -sex cell . Triglycerides were associated with short and long spells of sickness absence because of back pain in men in fully adjusted models with rate ratios ( 95 % confidence intervals ) of 1.53 ( 1.1 , 2.1 ) and 1.75 ( 1.0 , 3.2 ) respectively . There was little or no evidence of association in age adjusted models with : fibrinogen , glucose tolerance , total cholesterol , apoB , hypertension , factor VII , von Willebr and factor , electrocardiographic evidence of coronary heart disease and reported angina . CONCLUSIONS : In this population of office workers , only modest support was found for an atherothrombotic component to back pain sickness absence . However , the young age of participants at baseline and the lack of distinction between different types of back pain are likely to bias the findings toward null . Further research is required to ascertain whether a population sub-group of atherothrombotic back pain can be identified Introduction . The aim of the present study was to determine the closeness of agreement between a self-reported and an objective measure of physical activity in low back pain patients and healthy controls . Beyond , influencing factors on overestimation were identified . Methods . 27 low back pain patients and 53 healthy controls wore an accelerometer ( objective measure ) for seven consecutive days and answered a question naire on physical activity ( self-report ) over the same period of time . Differences between self-reported and objective data were tested by Wilcoxon test . Bl and -Altman analysis was conducted for describing the closeness of agreement . Linear regression models were calculated to identify the influence of age , sex , and body mass index on the overestimation by self-report . Results . Participants overestimated self-reported moderate activity in average by 42 min/day ( p = 0.003 ) and vigorous activity by 39 min/day ( p < 0.001 ) . Self-reported sedentary time was underestimated by 122 min/day ( p < 0.001 ) . No individual-related variables influenced the overestimation of physical activity .  Low back pain patients were more likely to underestimate sedentary time compared to healthy controls . Discussion . In rehabilitation and health promotion , the application-oriented measurement of physical activity remains a challenge . The present results contradict other studies that had identified an influence of age , sex , and body mass index on the overestimation of physical activity Study Design . Prospect i ve cohort study of twins . Objectives . To investigate associations between physical activity , physical function , and incident low back pain ( LBP ) in an elderly population . Summary of Background Data . The relationship between an active lifestyle and LBP in seniors is unknown . Methods . Participants in the population -based Longitudinal Study of Aging Danish Twins free from LBP at baseline ( no LBP during the past month ) were included , and interview data on physical activity , overall physical function , and LBP at baseline and follow-up were obtained . Associations between levels of  physical activity and LBP were estimated using logistic regression for the entire cohort , and using a matched case-control design for twin pairs discordant for physical activity . Absolute risk and relative risks for incident LBP in relation to physical activity were calculated for participants with higher or lower than average physical function at baseline . Absolute risk for LBP was also calculated for participants based on whether they remained active or inactive between baseline and follow-up or changed activity level . Results . A total of 1387 persons aged 70–100 at baseline were included in the analyses , including 86 twin pairs discordant for physical activity at baseline . In the total sample , 83 % were engaged in light physical activity  , and 42 % of men and 35 % of women were engaged in strenuous  physical activity  at least weekly . Being engaged in strenuous physical activity at baseline was strongly protective in relation to both having had any LBP ( odds ratio 0.21 , 95 % confidence interval 0.12–0.37 for intra-pair analysis ) and having had LBP lasting more than 30 days altogether during the past year at follow-up ( odds ratio 0.08 , 95 % confidence interval 0.03–0.18 for intra-pair analysis ) . Statistically significant dose-response associations between increasing frequency of strenuous physical activity and magnitude of this protective effect were found . Participants with poor initial physical function experienced the strongest protective effect of strenuous physical activity . Finally , LBP does not appear to be an important factor affecting whether participants remained engaged in strenuous physical activity at baseline and follow-up or vice versa . Conclusions . Strenuous physical activity at least once a week is protective for incident LBP in seniors Background The association between leisure time physical activity and  low back pain in young adults is unclear and is in the need of prospect ively obtained evidence . This study examined the course of low back pain and the association between low back pain and leisure time physical activity in a cohort of young adults in their transition from school to working life . Methods Both low back pain and leisure time physical activity was monitored over a 6.5 year period in 420 subjects starting out as students within hairdressing , electrical installation and media/ design . The association between physical activity and low back pain was investigated through the follow-up period by using linear mixed models analysis . Results Low back pain was significantly influenced by time and overall there was a decreasing trend of low back pain prevalence throughout the follow-up . Analysis showed a weak trend of decreasing low back pain with moderate/high physical activity levels , but this association was not significant . Conclusions Low back pain decreased during follow-up with baseline as reference . Findings in our study did show non-significant trends of reduced low back pain with increased leisure time physical activity . Still , we could not support the theory of moderate/high levels of physical activity acting protective against low back pain in young adults entering working life . Our results , in combination with previous relevant research , can not support a clear relationship between  physical activity and low back pain for young adults . Thus , recommendations regarding effect of physical activity on reducing low back pain for this group are not clear BACKGROUND CONTEXT The available evidence regarding low back pain ( LBP ) incident episodes is not consistent . Such knowledge can add information for the potential contribution of preventive programs . PURPOSE a ) To evaluate annual incident episodes of LBP among the general population . b ) To evaluate the contribution of demographic , lifestyle , and back pain history to LBP incident episodes . STUDY DESIGN A community-based longitudinal study . PATIENT SAMPLE A r and omized sample of individuals , free of LBP at a previous cross-sectional survey . OUTCOME MEASURES Low back pain during the past year . METHODS Subjects were followed up after 1 year . Baseline data included back pain history , perception of general health , physical activity , smoking , work satisfaction , and demographic characteristics . RESULTS Annual incident episodes of LBP were 18.4 % . Those who experienced LBP during the past year had a lower baseline perception of general health and were less involved in sporting activities than those free of pain . Those without history of LBP were more likely to be free of back pain after 1 year . CONCLUSIONS The annual incident episodes of LBP are relatively high and relate indirectly to baseline perception of general health and to level of sporting activities . Those without history of LBP are more likely to be free of back pain after 1 year . These results raise the potential of LBP preventive programs for adult population STUDY DESIGN A prospect i ve population -based cohort study performed in South Manchester , United Kingdom . OBJECTIVES To determine whether nonoccupational physical activity and indicators of physical stress on the spine predict low back pain in the short term . SUMMARY OF BACKGROUND DATA There is evidence that physical activity outside the workplace helps to protect against low back pain in the long term . However , such activity may injure or stress the spine in the short term . METHODS A baseline survey question naire identified 2715 adults , aged 18 - 75 years , with no low back pain at the time of the survey . Information on potential predictors of low back pain also was obtained . New episodes of back pain were identified during the subsequent year . RESULTS A new low back pain episode occurred in 34 % of men and 37 % of women . Poor general health at baseline was the strongest predictor of a new episode of pain ( men : relative risk ( RR ) 1.5 , 95 % confidence intervals ( CI ) 0.8 , 2.7 ; women : RR 2.2 , 95 % CI 1.2 , 4.0 ) . High weight was associated with subsequent low back pain in women ( RR 1.4 ; 95 % CI 1.0 , 2.0 ) , but neither height nor weight predicted low back pain in men . A self-rated low level of physical activity  was not consistently linked with subsequent low back pain , nor were specific nonoccupational physical activities , apart from home-improvement work in men and regular sports in women . CONCLUSION Although some specific activities may be hazardous to the back , physical activity outside the workplace does not increase the short-term risk of low back pain overall . Leisure-time physical activity is not a hazard to the back , whereas poor physical health in both genders and heavier weight in women do increase the risk of new low back pain episodes in the short term BACKGROUND Low back pain is common among nurses . Previous studies have shown that the risk of low back pain increases rapidly with greater amounts of physical work and psychological stress , but is inversely related to leisure activities . However , these previous studies were predominantly retrospective in design and not many took account of three factors simultaneously . AIMS This 12-month prospect i ve study examined the relationships between work activities , work stress , sedentary lifestyle and new low back pain . METHODS A total of 144 nurses from six Hong Kong district hospitals completed a face-to-face baseline interview , which was followed-up by a telephone interview . The main study measures were demographic characteristics , work activities , work stress , physical leisure activities and the nature of new low back pain during the 12-month follow-up period . Level of work stress , quality of relationships at work , level of enjoyment experienced at work , and work satisfaction were self-reported . RESULTS Fifty-six ( 38.9 % ) nurses reported experiencing new low back pain . Sedentary leisure time activity was not associated with new low back pain . Being comparatively new on a ward ( adjusted relative risk 2.90 ) , working in bending postures ( adjusted relative risk 2.76 ) and poor work relationships with colleagues ( adjusted relative risk 2.52 ) were independent predictors of new low back pain . CONCLUSION The findings of this study suggest that low back pain is a common problem in the population of nurses in Hong Kong . Being comparatively new on a ward , bending frequently during work and having poor work relationships with colleagues are independent predictors of new low back pain . Training for high-risk work activities and ergonomic assessment of awkward work postures are essential . Moreover , relaxation and team-building workshops for nurses , especially those who are less experienced in the type of work on their current ward , are recommended BACKGROUND The evidence on the impact of physical activity on  back pain in children and adolescents has been contradicting . It has also been shown that the physical activity can not accurately be estimated in children using question naires . PURPOSE The aim of this study was to establish if physical activity in childhood had any impact on back pain reporting in early adolescence ( 3 years later ) , using an objective instrumental measurement of physical activity . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Representative r and om sample of Danish children from the city of Odense sample d at age 9 years and followed-up at age 12 years . OUTCOME MEASURES The 1-month period prevalence of back pain ( neck pain , mid back pain , and low back pain ) was established using a structured interview . METHODS  Physical activity  was assessed with the MTI-accelerometer . The accelerometer provides a minute-by-minute measure of the physical activity performed . An overall measure of physical activity and time spent in high activity were studied in relation to back pain using logistic regression . The analyses were performed on the total sample and then stratified on back pain ( yes/no ) at baseline . RESULTS High physical activity ( HPA ) levels seem to protect against future low back pain and appear to actually " treat " and reduce the odds of future mid back pain . When comparing the least active children to the most active children , the least active had a multivariate odds ratio of 3.3 of getting low back pain and 2.7 of getting mid back pain 3 years later . When stratified on back pain at baseline , this effect on mid back pain was especially noticeable in children who had had mid back pain already at baseline , with an odds ratio of 7.2 . CONCLUSIONS HPA in childhood seems to protect against low back pain and mid back pain in early adolescence . Larger prospect i ve studies with repetitive follow-ups and preferably intervention studies should be performed , to see if these findings can be reproduced OBJECTIVES This study examined predictors of low back pain onset in a British birth cohort . METHODS Univariate and multivariate analyses focused on individuals who experienced onset of low back pain at 32 to 33 years of age ( n= 571 ) and individuals who were pain free ( n = 5210 ) . Participants were members of the 1958 British birth cohort . RESULTS Incident pain was elevated among those with psychological distress at 23 years of age ( adjusted odds ratio [ OR ] = 2.52 , 95 % confidence interval [ CI ] = 1.65 , 3.86 ) and among persistent moderate or heavy smokers ( adjusted OR = 1.63 , 95 % CI = 1.23 , 2.17 ) . Significant univariate associations involving other factors ( e.g. , social class , childhood emotional status , body mass index , job satisfaction ) did not persist in multivariate analyses . CONCLUSIONS This prospect ively studied cohort provides evidence that psychological distress more than doubles later risk of low back pain , with smoking having a modest independent effect . Other prospect i ve studies are needed to confirm these findings before implication s for low back pain prevention can be assessed UNLABELLED The aim of this study was to examine whether treatments based on different theories change pain catastrophizing and internal control of pain , and whether changes in these factors mediate treatment outcome . Participants were 211 patients with nonspecific chronic low back pain ( CLBP ) participating in a r and omized controlled trial , attending active physical treatment ( APT , n = 52 )  , cognitive-behavioral treatment ( CBT , n = 55 ) , treatment combining the APT and CBT ( CT , n = 55 ) , or waiting list ( WL , n = 49 ) . Pain catastrophizing decreased in all 3 active treatment groups and not in the WL . There was no difference in the change in internal control across all 4 groups . In all the active treatment groups , patients improved regarding perceived disability , main complaints , and current pain at post-treatment , and no changes were observed in the WL group . Depression only changed significantly in the APT group . Change in pain catastrophizing mediated the reduction of disability , main complaints , and pain intensity . In the APT condition , pain catastrophizing also mediated the reduction of depression . Not only cognitive-behavioral treatments but also a physical treatment produced changes in pain catastrophizing that seemed to mediate the outcome of the treatment significantly . The implication s and limitations of these results are discussed . PERSPECTIVE This article shows that treatment elements that do not deliberately target cognitive factors can reduce pain catastrophizing . Reduction in pain catastrophizing seemed to mediate the improvement of functioning in patients with chronic low back pain . The results might contribute to the development of more effective interventions Summary Physical and psychological work‐related factors pertaining to the 5‐year incidence of multiple body sites musculoskeletal pain ( MSP ) may be gender specific . In particular , psychological factors seem to be predictive of onset of MSP , but only in women . Only the physical work factor ( ie , forceful effort constraints ) was an important robust predictor of multisite MSP , but only in men . ABSTRACT The role of psychosocial and physical factors in the development of musculoskeletal pain ( MSP ) has now been clearly demonstrated . However , it is unclear whether these factors contribute to specific regional MSP or to multisite pain . The main goal of this study was to assess the impact of work‐related factors  according to gender on the development of regional and multisite MSP . A total of 12,591 subjects ( 65 % men and 35 % women ) who were born in 1938 , 1943 , 1948 , and 1953 and were participating in a French longitudinal prospect i ve epidemiological survey ( ESTEV ) in 1990 to 1995 were eligible . Personal factors and work exposure were assessed by self‐administered question naires . Statistical associations between chronic MSP ( regional body site or multisite ) , personal factors , and occupational factors were analyzed using logistic regression modeling . The incidence of regional MSP and multisite pain in 1995 were , respectively , 17 % and 25.6 % . For women , highly repetitive movements predicted neck/shoulder pain ; posture and vibrations predicted arm and low back pain ; and effort with tools predicted arm pain . For men , forceful effort and vibrations predicted neck/shoulder pain ; posture and forceful effort predicted lower limb and low back pain ; and forceful effort and effort with tools predicted arm pain . Physical constraints ( ie , forceful effort or vibrations ) were associated with multisite pain in both genders . Only for women , psychological factors were risk factors predictive of upper limb pain and in 3 or 4 painful anatomical sites . These results support the hypothesis that some physical and psychological work‐related factors are predictive of regional or multisite MSP but differ according to gender . Gender differences and risk factors for work‐related musculoskeletal pain should be also taken into account to more effectively target preventive measures OBJECTIVES Risk factors for low-back pain are known to co-occur , but their joint effect has not often been studied . Little is also known about the variation of the risk factors or their effects with age . METHODS This prospect i ve study assessed the 1-year incidence of low-back pain by age group in a Finnish industrial population . The effects of the baseline variables on the risk of low-back pain in the follow-up were estimated with a log-binomial regression . RESULTS Among 2256 blue- and white-collar workers free of low-back pain 12 months preceding the baseline , 21 % reported low-back pain after 1-year of follow-up . Physical work load ( sum of heavy lifting , awkward postures , and whole-body vibration ) predicted low-back pain among those younger than 50 years [ highest relative risk ( RR ) 2.4 , 95 % confidence interval ( 95 % CI ) 1.4 - 4.2 ] , whereas health behavior ( sum of smoking , overweight , and lack of physical exercise ) increased the risk only among those 50 years or older ( RR up to 2.8 , 95 % CI 1.4 - 5.4 ) . Mental stress , dissatisfaction with life , and sleep problems were significant predictors in the group of 40- to 49-year-old workers . Work-related psychosocial factors were not associated with the outcome . CONCLUSIONS In this study , workers of different ages were affected by slightly different risk factors . The results support the provision of health promotion and stress management as part of programs to prevent work-related low-back pain . In particular , aging workers may benefit from such an integrated approach . More prospect i ve studies on the joint effects of age-specific risk factors of low-back pain are warranted BACKGROUND The long-term course of long-st and ing low back pain is largely unknown since long-term data are scarce . OBJECTIVE We examined the course of  self-reported low back pain  in the prospect i ve population -based Doetinchem cohort over a period of 10years . METHODS Between 1993 and 2007 , around 5700 r and omly selected men and women in four age groups of originally 20 - 29 , 30 - 39 , 40 - 49 , 50 - 59years were measured three times .  Logistic regression analysis was used to study the association of  sociodemographic ( gender , age , education , work status ) and  lifestyle characteristics ( BMI , smoking , physical activity )  with persistent and new episodes of long-st and ing low back pain . RESULTS The prevalence of long-st and ing low back pain is quite stable over a 10year period , approximately 20 % on population level . On individual level , around 30 % of the population was completely free of low back pain during the entire period , 6 % can be characterized as persistent back pain sufferers . Individuals with persistent and a varying pattern have a more unhealthy lifestyle ( BMI and smoking ) than those without low back pain . Age , smoking , obesity and not having a paid job are associated with 10-year persistent back pain in the general population , whereas age and not having a paid job are associated in those with long-lasting back pain at baseline . New episodes of long-st and ing back pain are relatively frequent among women and smokers . CONCLUSIONS Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly . Long-term information on the course of back pain is needed to define severe subgroups Study Design . A prospect i ve cohort study . Objective . To study if low level of physical fitness was associated with increased  low back pain ( LBP ) intensity at 30-month follow-up . Summary of Background Data . The evidence of low physical fitness as a risk factor for LBP is inconclusive due to contradictory results . Methods . Study participants were 327 employees ( women = 271 , men = 56 ) at institutions for physically and mentally disabled persons . Physical fitness was measured by tests of : back extension and flexion endurance , flexibility and balance ; and by self-assessed aerobic fitness , muscle strength , endurance , flexibility and balance , using visual analogue scales .  Low back pain , lifestyle parameters , and physical and psychosocial work factors were assessed by question naires at baseline and at follow-up . Outcome was defined as an increase above 2 steps in average LBP intensity during the previous year ( 0–10 ) . Results . Persons with low level back endurance showed an insignificantly higher risk of increased LBP intensity ( OR = 2.4 , P = 0.076 ) , whereas persons with medium level back endurance were at significantly higher risk ( OR = 2.7 , P = 0.034 ) compared with those with high level back endurance . The general association between isometric back extension endurance and increased LBP intensity was insignificant ( P = 0.067 ) . Persons with medium level self-assessed aerobic fitness were at lower risk of increased LBP intensity compared with those with high level ( OR = 0.37 , P = 0.02 ) , although the general association of aerobic fitness was insignificant ( 0.066 ) . Performance-based back flexion endurance , flexibility , and balance ; and self-assessed muscle strength , endurance , flexibility , and balance were not associated with increased LBP intensity . Conclusion . The significant association between medium level back extension endurance and increased LBP intensity supports the finding of other studies that particularly back extension endurance is an important physicalfitness component in preventing LBP and that the subcomponents of physical fitness are related in different ways to LBP Objective : Quantify the relationship between physical activity and development of  incident low back pain ( LBP ) .  Methods : This nested prospect i ve cohort study utilized an objective measure of physical activity in 68 participants with 30 incident cases of LBP .  Physical activity was divided into tertiles and quartiles . Univariate and multivariate relative risks and hazard ratios were calculated . Results : Comparing highest to middle tertile of light activity demonstrated a statistically significant relative risk of 3.68 for developing incident LBP . Lowest and highest tertile of minutes of moderate/vigorous activity yielded statistically significant relative risks of 4.60 and 6.14 , respectively . Multivariate analyses demonstrated similar associations . Conclusions : Moderate amounts of physical activity were protective for the development of LBP  in this cohort , after adjustment for risk factors . This nonlinear relationship suggests higher levels of activity do not confer increased LBP prevention Chronic musculoskeletal pain constitutes a large socioeconomic challenge , and preventive measures with documented effects are warranted . The authors ' aim in this study was to prospect ively investigate the association between physical exercise , body mass index ( BMI ) , and risk of chronic pain in the low back and neck/shoulders . The study comprised data on approximately 30,000 women and men in the Nord-Trøndelag Health Study ( Norway ) who reported no pain or physical impairment at baseline in 1984 - 1986 . Occurrence of  chronic musculoskeletal pain  was assessed at follow-up in 1995 - 1997 . A generalized linear model was used to calculate adjusted risk ratios . For both females and males , hours of physical exercise per week were linearly and inversely associated with risk of chronic pain in the low back ( women : P-trend = 0.02 ; men : P-trend < 0.001 ) and neck/shoulders ( women : P-trend = 0.002 ; men : P-trend < 0.001 ) . Obese women and men had an approximately 20 % increased risk of chronic pain in both the low back and the neck/shoulders . Exercising for 1 or more hours per week compensated , to some extent , for the adverse effect of high BMI on risk of chronic pain . The authors conclude that physical inactivity and high BMI are associated with an increased risk of chronic pain in the low back and neck/shoulders in the general adult population BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application Objectives Prevention of occupational low back pain ( LBP ) in nurses is a research priority . Recent research suggests intervening before commencing nursing employment is ideal ; however , identification of modifiable risk factors is required . The objective of this study was to investigate modifiable personal characteristics that predicted new-onset LBP in nursing students . Methods This prospect i ve study was conducted on female nursing students ( n=117 ) without LBP at baseline to predict new-onset LBP ( an episode of significant LBP during the follow-up period ) . At the 12-month follow-up , participants with ( n=31 ) and without new-onset LBP ( n=76 ) were compared across baseline social or lifestyle , psychologic ( distress , back pain beliefs , coping strategies , and catastrophising ) , and physical ( spinal postures and spinal kinematics in functional tasks , leg and back muscle endurance , spinal repositioning error , and cardiovascular fitness ) characteristics . Results Participants response rate at follow-up was excellent ( 91 % ) . After controlling for earlier LBP , age , and BMI , regression analysis showed that modifiable social or lifestyle , psychologic and physical characteristics ( namely , smoking , increased physical activity , higher stress , reduced back muscle endurance , greater posterior pelvic rotation in slump sitting , and more accurate spinal repositioning in sitting ) were significant and independent predictors of new-onset LBP at follow-up . Inclusion of these factors in multivariate logistic regression analysis , with significant new-onset LBP as the outcome , result ed in a substantial model R2 of 0.45 . Discussion Modifiable personal characteristics across multiple domains are associated with new-onset LBP in female nursing students . These findings may have implication s for the development of prevention and management interventions for LBP in nurses Design . Cross-sectional analysis of the factors influencing  self-rated disability associated with chronic low back pain and prospect i ve study of the relationship between changes in each of these factors and in disability following active therapy . Objectives . To examine the relative influences of pain , psychological factors , and physiological factors on self-rated disability . Summary of Background Data . In chronic LBP , the interrelationship between physical impairment , pain , and disability is particularly complicated , due to the influence of various psychological factors and the lack of unequivocal methods for assessing impairment . Investigations using new “ belief ” question naires and “ sophisticated ” performance tests , which have shown promise as discriminating measures of impairment , may assist in clarifying the situation . Previous studies have rarely investigated all these factors simultaneously . Methods . One hundred forty-eight patients with cLBP completed question naires and underwent tests of mobility , strength , muscle activation , and fatigability , and ( in a subgroup ) erector spinae size and fiber size/type distribution . All measures were repeated after 3 months active therapy . Relationships between each factor and self-rated disability ( Rol and and Morris question naire ) at baseline , and between the changes in each factor and changes in disability following therapy , were examined . Results . Stepwise linear regression showed that the most significant predictors of disability at baseline were , in decreasing order of importance : pain ; psychological distress ; fear-avoidance beliefs ; muscle activation levels ; lumbar range of motion ; gender . Only changes in pain , psychological distress , and fear-avoidance beliefs significantly accounted for the changes in disability following therapy . Conclusion . A combination of pain , psychological and physiological factors was best able to predict baseline disability , although its decrease following therapy was determined only by reductions in pain and psychological variables . The active therapy programm — in addition to improving physical function — appeared capable of modifying important psychological factors , possibly as a result of the positive experience of completing the prescribed exercises without undue harm Study Design R and omized clinical trial . Background Motor control exercises are believed to improve coordination of the trunk muscles . It is unclear whether increases in trunk muscle thickness can be facilitated by approaches such as the McKenzie method . Furthermore , it is unclear which approach may have superior clinical outcomes . Objectives The primary aim was to compare the effects of the McKenzie method and motor control exercises on trunk muscle recruitment in people with chronic low back pain classified with a directional preference . The secondary aim was to conduct a between-group comparison of outcomes for pain , function , and global perceived effect . Methods Seventy people with chronic low back pain who demonstrated a directional preference using the McKenzie assessment were r and omized to receive 12 treatments over 8 weeks with the McKenzie method or with motor control approaches . All outcomes were collected at baseline and at 8-week follow-up by blinded assessors . Results No significant between-group difference was found for trunk muscle thickness of the transversus abdominis ( -5.8 % ; 95 % confidence interval [ CI ] : -15.2 % , 3.7 % ) , obliquus internus ( -0.7 % ; 95 % CI : -6.6 % , 5.2 % ) , and obliquus externus ( 1.2 % ; 95 % CI : -4.3 % , 6.8 % ) . Perceived recovery was slightly superior in the McKenzie group ( -0.8 ; 95 % CI : -1.5 , -0.1 ) on a -5 to + 5 scale . No significant between-group differences were found for pain or function ( P = .99 and P = .26 , respectively ) . Conclusion We found no significant effect of treatment group for trunk muscle thickness . Participants reported a slightly greater sense of perceived recovery with the McKenzie method than with the motor control approach . Level of Evidence Therapy , level 1b- . Registered September 7 , 2011 at www.anzctr.org.au ( ACTRN12611000971932 ) . J Orthop Sports Phys Ther 2016;46(7):514 - 522 . Epub 12 May 2016 . doi:10.2519/jospt.2016.6379 OBJECTIVE To determine the onset of low back pain ( LBP ) in schoolchildren and to investigate the role of mechanical and psychosocial factors as risk factors for its onset . METHODS A prospect i ve population -based cohort study was conducted of 1046 schoolchildren , aged 11 to 14 years at baseline , identified as being free of LBP , from 39 secondary schools in Northwest Engl and .  New onset of LBP at 1-year follow-up was measured . RESULTS Children who reported high levels of psychosocial difficulties were more likely to develop LBP than their peers ( relative risk : 1.6 ; 95 % confidence interval : 1.1 - 2.3 ) . An excess risk was , in particular , associated with conduct problems ( 2.5 ; 1.7 - 3.7 ) . Similarly , children who reported high numbers of somatic symptoms at baseline were at greater risk of developing LBP : abdominal pain ( 1.8 ; 1.1 - 3.0 ) , headaches ( 1.6 ; 0.97 - 2.8 ) , and sore throats ( 1.5 ; 0.8 - 2.6 ) . In contrast , we have been unable to demonstrate a strong association between daily mechanical load ( schoolbag weight ) and the short-term risk of new-onset LBP ( highest versus lowest quintile : 1.2 ; 0.7 - 2.1 ) . CONCLUSIONS In children who were initially free of LBP , adverse psychosocial factors and the presence of other preexisting somatic pain symptoms were predictive of future LBP , reflecting findings in adults . In contrast , there was little evidence of an increase in short-term risk associated with mechanical load across the range of weights commonly carried by children to school
target: Conclusions Leisure time physical activity may reduce the risk of chronic LBP by 11%–16 % .
background: Background There are plausible mechanisms whereby leisure time physical activity may protect against  low back pain ( LBP )  but there have been no quality systematic review s and meta-analyses of the subject .
  Objective This review aims to assess the effect of leisure time physical activity on non-specific LBP .