Articles: low-back-pain.
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Due to the lack of international consensus regarding the efficiency of various methods for prevention of low back pain (LBP), this article describes the Israeli guidelines for prevention of L.B.P., based on the recommendations of the European Commission, COST Action B13. ⋯ The recommendations of the European committee, COST B13, served as the main source of information. The European group based its conclusions on systematic reviews mainly from the Cochrane, Embase, and Medline databases, and other smaller databases for more specific topics. The search covered the years 1966-2003. Information was also gathered through personal contacts with experts in the field. Additional searches were conducted for recent RCT's, published following the most recent systematic reviews. The final recommendations were sent to be reviewed by international experts in LBP. Summary of recommendations for the general population: Physical exercise is recommended for prevention of sick leave due to LBP and for the occurrence or duration of further episodes (Level A). There is insufficient consistent evidence to recommend for or against any specific type or intensity of exercise (Level C). Information and education on back problems, if based on bio-psychosocial principles, should be considered (Level C), but information and education focused principally on a biomedical or biomechanical model cannot be recommended (Level C). Back schools based on traditional biomedical/biomechanical information, advice and instruction are not recommended for prevention in LBP (Level A). High intensity programs, which comprise both an educational/skills program and exercises, can be recommended for patients with recurrent and persistent back pain (Level B). Lumbar supports or back belts are not recommended (Level A). There is no robust evidence for or against recommending any specific chair or mattress for prevention in LBP (Level C), though persisting symptoms may be reduced with a medium-firm rather than a hard mattress (Level C). There is no evidence to support recommending manipulative treatment for prevention in LBP (Level D). Shoe insoles are not recommended for the prevention of back problems (Level A). There is insufficient evidence to recommend for or against correction of leg length (Level D). Despite the intuitive appeal of the idea, there is no evidence, at this time, that attempts to prevent LBP in schoolchildren will have any impact on LBP in adults (Level D).
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We present the positional magnetic resonance imaging findings of a prospective case series of patients undergoing surgery with the Dynesys spinal stabilization device (Zimmer, Inc., Warsaw, IN). ⋯ In vivo, the Dynesys Stabilization System allows movement at the instrumented level, albeit reduced, with no significant increased mobility at the adjacent segments. There was reduction of the anterior disc height without a significant increase of the posterior disc height.
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Reanalysis of data derived from longitudinal cohort studies. ⋯ We recommend the 5-item CWOM as a brief clinical measure for whiplash because it is quick to administer and score, and has excellent measurement properties. The CWOM may need to be supplemented with other questionnaires (e.g., when assessment of psychological or emotional health is required).
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A prospective, cohort clinical and magnetic resonance imaging (MRI) study of patients with low back pain. ⋯ Early DD in adolescent patients with low back pain predicted the evolution of enhanced DD and herniation in adulthood, but it was not associated with severe low back pain or increased frequency of spinal surgery.
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Fear-avoidance beliefs are important determinants for disability in patients with non-specific low-back pain (LBP). The association with self-reported level of physical activity is less known. The aim of the present study was to describe the level of physical activity in patients with chronic non-specific LBP and its relation to fear-avoidance beliefs and pain catastrophizing. ⋯ This study indicates that it seems important for physiotherapists in primary care to measure levels of fear-avoidance beliefs or pain catastrophizing. In particular, the two subscales of the TSK could be of real value for clinicians when making treatment decisions concerning physical exercise therapy for patients with chronic LBP.