Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Relationship Between Low Back Pain and Lumbar Multifidus Size at Different Postures Low back and lower-limb muscle performance in male and female recreational runners with chronic low back pain. A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Association between changes in abdominal and lumbar multifidus muscle thickness and clinical improvement after spinal manipulation. Which Prognostic Factors for Low Back Pain Are Generic Predictors of Outcome Across a Range of Recovery Domains? Lumbar multifidus muscle thickness does not predict patients with low back pain who improve with trunk stabilization exercises. New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain Effectiveness of a lumbopelvic monitor and feedback device to change postural behaviour: a protocol for the ELF cluster randomised controlled trial Muscle activation patterns in subjects with and without low back pain. Reliability and Validity of a New Objective Tool for Low Back Pain Functional Assessment Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain. The validity and reliability of the functional rating index for evaluating low back pain in athletes. Identification of Modifiable Personal Factors That Predict New-onset Low Back Pain: A Prospective Study of Female Nursing Students
BACKGROUND CONTEXT A range of morphologic and psychosocial variables has been suggested as risk factors for serious low back pain ( LBP ) illness . Although the relative contributions of structural and psychosocial variables are intensely debated , the validity of differing hypotheses has proven difficult to test because the incidence of serious disabling LBP illness is low in healthy subjects . These factors dictate the requirement for large sample sizes , extensive structural imaging and extended longitudinal study . Previous studies included either small cohorts with intensive imaging testing or large population studies that do not establish a detailed morphologic baseline . PURPOSE To establish , using a strict patient sample design , the relative contribution of structural and psychosocial determinants of serious LBP illness among subjects with no previous LBP disability or clinical LBP illness . STUDY DESIGN / SETTING A prospect i ve , longitudinal study of subjects with high risk factors for serious LBP as determined by structural and psychosocial characteristics . PATIENT SAMPLE One hundred subjects with known mild persistent low back pain and a 2:1 ratio of chronic ( non-lumbar ) pain syndrome were recruited from a study population with a predisposition to disc degenerative disease , to undergo baseline examination , testing and 5-year follow-up . OUTCOME MEASURES Observations were made at 6-month intervals over 4 to 6 years ( mean , 5.3 ) for the after primary outcomes measures : episodes of serious back pain ( visual analogue scale [ VAS ] > or = 6 ) , episodes of occupational disability less than 1 week , episodes of occupational disability for 1 week , remission episodes of all back pain symptoms at least 6 months and medical visits primarily for LBP evaluation and treatment . METHODS Lumbar magnetic resonance imaging ( MRI ) , lumbar provocative discography ( in psychometrically normal subjects ) , physical examinations , medical and work histories and psychometric testing were performed at baseline . Imaging and psychometric testing were grade d by blinded examiners . A scripted interview was conducted every 6 months during follow-up by independent research assistants who also were blinded to patient baseline data . The interview covered interval medical , occupational and accident or injury histories . RESULTS Psychosocial variables strongly predicted both long- and short-term disability events , duration and health-care visits for LBP problems ( p<0.0001 - 0.004 ) . The likelihood of a sustained remission from the baseline persistent ( sub clinical ) LBP appeared to be linked to occupation factors ( leaving a heavy labor occupation ; p=0.0001 ) , neurophysiologic variables ( chronic nonlumbar pain ; p=0.0002 ) and psychometric profiles at baseline ( DRAM and FABQ-PA ; p=0.003 - 0.002 ) . Of the structural findings measured only moderate or severe Modic changes of the vertebral end plate were weakly associated with an adverse outcome . A positive provocative discogram at baseline did not predict any future adverse event . CONCLUSION The development of serious LBP disability in a cohort of subjects with both structural and psychosocial risk factors was strongly predicted by baseline psychosocial variables . Structural variables on both MRI and discography testing at baseline had only weak association with back pain episodes and no association with disability or future medical care Study Design . A prospect i ve study of multifidus images . Objective . To compare the change of the cross-sectional area ( CSA ) of multifidus in subjects with and without chronic low back pain ( LBP ) at different postures . Summary of Background Data . Ultrasound imaging was shown to be useful in assessing acute LBP patients at rest only . Methods and Measures . Thirty-five male adults participated , including 19 normal and 16 chronic LBP patients . The CSAs of multifidus were assessed on ultrasound images acquired on both sides of the L4 and L5 levels with the subjects in prone lying , upright st and ing , and 25 ° and 45 ° forward stooping . Results . In the control group , the CSA of multifidus increased from prone lying to upright st and ing and then gradually decreased from 25 ° to 45 ° forward stooping . However , a reverse pattern of the CSA changes was identified in patients with chronic LBP . Conclusion . Multifidus contracts maximally at upright st and ing in the normal group , while maximum contraction of the muscle occurs at 25 ° forward stooping in the patient group . The role of multifidus may be altered in the stabilization of the lumbar spine of chronic LBP patients . Assessment of the change in muscle size reacting to different postures is found to be helpful STUDY DESIGN Controlled laboratory study , cross-sectional . OBJECTIVE To compare lumbar extensor muscle fatigability , lumbar stabilizing muscle activation , and lower-limb strength between male and female runners with chronic low back pain ( LBP ) and healthy runners . BACKGROUND Little is known about muscle performance in runners with chronic LBP . METHODS Eighteen recreational runners with chronic LBP ( 9 men , 9 women ; mean age , 27.8 years ) and 18 healthy recreational runners ( 9 men , 9 women ; mean age , 24.6 years ) were recruited . The median frequency slopes for bilateral iliocostalis and longissimus were calculated from electromyographic signals captured during a 2-minute Sorensen test . The thickness changes of the transversus abdominis and lumbar multifidus between resting and contraction were measured using an ultrasound scanner .  Peak concentric torques  of the bilateral hip extensors , hip abductors , and knee extensors were measured using an isokinetic dynamometer at 60 ° /s . The average values for both sides were used for statistical analysis . RESULTS When averaged across sexes , peak knee extensor torque was 12.2 % lower in the LBP group compared to the healthy group ( mean difference , 0.29 Nm/kg ; 95 % confidence interval : 0.06 , 0.53 ; P = .016 ) . Male runners with chronic LBP exhibited smaller lumbar multifidus thickness changes compared to healthy male runners ( mean difference , 0.13 cm ; 95 % confidence interval : 0.01 , 0.25 ; P = .033 ) . No other group differences were observed . CONCLUSION Runners with chronic LBP exhibited diminished knee extensor strength compared to healthy runners . Male runners with chronic LBP demonstrated additional deficits in lumbar multifidus activation Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing OBJECTIVE To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain ( LBP ) . DESIGN A prospect i ve , cohort study of patients with nonradicular LBP referred to physical therapy ( PT ) . SETTING Outpatient PT clinics . PARTICIPANTS Fifty-four patients with nonradicular LBP . INTERVENTION A st and ardized stabilization exercise program . MAIN OUTCOME MEASURE Treatment response ( success or failure ) was categorized based on changes in the Oswestry Disability Question naire scores after 8 weeks . RESULTS Eighteen subjects were categorized as treatment successes , 15 as treatment failures , and 21 as somewhat improved . After using regression analyses to determine the association between st and ardized examination variables and treatment response status , preliminary clinical prediction rules were developed for predicting success ( positive likelihood ratio [ LR ] , 4.0 ) and failure ( negative LR , .18 ) . The most important variables were age , straight-leg raise , prone instability test , aberrant motions , lumbar hypermobility , and fear-avoidance beliefs . CONCLUSIONS It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination . The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises STUDY DESIGN Prospect i ve case series . OBJECTIVE To examine the relation between improved disability and changes in abdominal and lumbar multifidus ( LM ) thickness using ultrasound imaging following spinal manipulative therapy ( SMT ) in patients with low back pain ( LBP ) . BACKGROUND Although there is a growing body of literature demonstrating physiologic effects following the application of SMT , few studies have attempted to correlate these changes with clinical ly relevant outcomes . METHODS Eighty-one participants with LBP underwent 2 thrust SMT treatments and 3 assessment sessions within 1 week .  Transversus abdominis  ( TrA ) , internal oblique ( IO ) , and LM muscle thickness  was assessed during each session , using ultrasound imaging of the muscles at rest and during submaximal contractions . The Modified Oswestry Disability Index was used to quantify participants ' improvement in LBP-related disability . Stepwise hierarchical multiple linear regression and repeated- measures analysis of variance were performed to examine the multivariate relationship between change in muscle thickness and clinical improvement over time . RESULTS After controlling for the effects of age , sex , and body mass index , change in contracted LM muscle thickness was predictive of improved disability at 1 week ( P = .02 ) . As expected , larger increases in contracted LM muscle thickness at 1 week were associated with larger improvements in LBP-related disability . Contrary to our hypothesis , significant decreases in both contracted TrA and IO muscle thickness were observed immediately following SMT ; but these changes were transient and unrelated to whether participants experienced clinical improvements . CONCLUSION These findings provide evidence that clinical improvement following SMT is associated with increased thickening of the LM muscle during a submaximal task . LEVEL OF EVIDENCE Prognosis , level 4 Background Recovery from low back pain ( LBP ) is multidimensional and requires the use of multiple-response ( outcome ) measures to fully reflect these many dimensions . Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered “ universal ” prognostic variables . Objective The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP . Design Predictive modeling was performed using data extracted from a r and omized controlled trial . Four prognostic models were created using backward stepwise deletion logistic , Poisson , and linear regression . Methods Data were collected from 16 outpatient physical therapy facilities in 10 states . All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge . Four different measures of response were used : Oswestry Disability Index and Numeric Pain Rating Scale change scores , total visits , and report of rate of recovery . Results The set of statistically significant predictors was dependent on the definition of response . All regression models were significant . Within both forms of the 4 models , meeting the clinical prediction rule for manipulation at baseline was present in all 4 models , whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models . Limitations The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP . Conclusions Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor . Other predictive variables were dependent on the outcomes measure used in the predictive model OBJECTIVE To underst and lumbar multifidus ( LM ) muscle activation as a clinical feature to predict patients with low back pain ( LBP ) who are likely to benefit from stabilization ( STB ) exercises .  DESIGN Prospect i ve , cohort study . SETTING Outpatient physical therapy clinics . PARTICIPANTS Persons with LBP were recruited for this study . Subjects ( N=25 ) were classified as either eligible to receive STB exercises or ineligible on the basis of current clinical prediction rules . INTERVENTIONS Six weeks of STB treatment . MAIN OUTCOME MEASURES Before and after treatment , subjects underwent rehabilitative ultrasound imaging to quantify LM-muscle activation and completed disability and pain question naires . Analyses were performed to examine the ( 1 ) relation between LM-muscle activation and current clinical features used to predict patients with LBP likely to benefit from STB exercises , ( 2 ) LM-muscle activation between the STB-eligible and STB-ineligible groups before and after STB treatment , and ( 3 ) relation between LM-muscle activation before STB treatment and ( a ) disability and ( b ) pain outcomes after treatment for both groups . RESULTS No relation was found between LM-muscle activation and the number of clinical features . Before STB treatment , LM-muscle activation between the STB-eligible and STB-ineligible groups did not differ . After STB treatment , LM-muscle activation differed between the groups ; however , this interaction was because the LM-muscle activation for the STB-eligible group decreased after treatment while that for the STB-ineligible group increased after treatment . Finally , only the STB-eligible group had a significant reduction in disability following treatment ; however , no relation was found between LM-muscle activation before treatment and ( a ) disability or ( b ) pain outcomes after treatment in the STB-eligible group . CONCLUSIONS LM-muscle activation does not appear to be a clinical feature that predicts patients with LBP likely to benefit from STB exercises Objectives The purpose of the international multicenter prospect i ve single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain ( CMLBP ) in patients who have failed conventional therapy and are not c and i date s for surgery or spinal cord stimulation ( SCS ) .  Material s and Methods Fifty‐three subjects were implanted with a neurostimulator ( ReActiv8 , Mainstay Medical Limited , Dublin , Irel and ) . Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve . The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale ( NRS ) . Responders were defined as subjects with an improvement of at least the Minimal Clinical ly Important Difference ( MCID ) of ≥2‐point in low back pain NRS without a clinical ly meaningful increase in LBP medications at 90 days . Secondary outcome measures included Oswestry Disability Index ( ODI ) and Quality of Life ( QoL ; EQ‐5D ) . Results For 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided  satisfactory pain relief  , the responder rate was 58 % . The percentage of subjects at 90 days , six months , and one year with ≥MCID improvement in single day NRS was 63 % , 61 % , and 57 % , respectively . Percentage of subjects with ≥MCID improvement in ODI was 52 % , 57 % , and 60 % while those with ≥MCID improvement in EQ‐5D was 88 % , 82 % , and 81 % . There were no unanticipated adverse events ( AEs ) or serious AEs related to the device , procedure , or therapy . The initial surgical approach led to a risk of lead fracture , which was mitigated by a modification to the surgical approach . Conclusions Electrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP . Results demonstrate clinical ly important , statistically significant , and lasting improvement in pain , disability , and Objectives Although motor control exercises have been shown to be effective in the management of  low back pain ( LBP ) the mechanism of action is unclear . The current study investigated the relationship between the ability to recruit transversus abdominis and clinical outcomes of participants in a clinical trial . Methods Ultrasonography was used to assess the ability to recruit transversus abdominis in a nested design : a sample of 34 participants with chronic LBP was recruited from participants in a r and omised controlled trial comparing the efficacy of motor control exercise , general exercise and spinal manipulative therapy .  Perceived recovery , function , disability and pain were also assessed . Results Participants with chronic LBP receiving motor control exercise had a greater improvement in recruitment of transversus abdominis ( 7.8 % ) than participants receiving general exercise ( 4.9 % reduction ) or spinal manipulative therapy ( 3.7 % reduction ) . The effect of motor control exercise on pain reduction was greater in participants who had a poor ability to recruit transversus abdominis at baseline . There was a significant , moderate correlation between improved recruitment of transversus abdominis and a reduction in disability ( r = −0.35 ; 95 % CI 0.02 to 0.62 ) . Conclusion These data provide some support for the hypothesised mechanism of action of motor control exercise and suggest that the treatment may be more effective in those with a poor ability to recruit transversus abdominis Introduction Low back pain ( LBP ) is the most common , costly and disabling musculoskeletal disorder worldwide , and is prevalent in healthcare workers . Posture is a modifiable risk factor for LBP shown to reduce the prevalence of LBP . Our feasibility research suggests that postural feedback might help healthcare workers avoid hazardous postures . The Effectiveness of Lumbopelvic Feedback ( ELF ) trial will investigate the extent to which postural monitor and feedback ( PMF ) can reduce exposure to hazardous posture associated with LBP . Methods This is a participant-blinded , r and omised controlled trial with blocked cluster r and om allocation . Participants will include volunteer healthcare workers recruited from aged care institutions and hospitals . A postural monitoring and feedback device will monitor and record lumbopelvic forward bending posture , and provide audio feedback whenever the user sustains a lumbopelvic forward bending posture that exceeds predefined thresholds . The primary outcome measure will be postural behaviour ( exceeding thresholds ) . Secondary outcome measures will be incidence of LBP , participant-reported disability and adherence . Following baseline assessment , we will r and omly assign participants to 1 of 2 intervention arms : a feedback group and a no-feedback control group . We will compare between-group differences of changes in postural behaviour by using a repeated measures mixed-effect model analysis of covariance ( ANCOVA ) at 6 weeks . Postural behaviour baseline scores , work-related psychosocial factors and disability scores will be input as covariates into the statistical models . We will use logistic mixed model analysis and Cox 's proportional hazards for assessing the effect of a PMF on LBP incidence between groups . Discussion Posture is a modifiable risk factor for low back disorders . Findings from the ELF trial will inform the design of future clinical trials assessing the effectiveness of wearable technology on minimising hazardous posture during daily living activities in patients with low back disorders . Trial registration number ACTRN12616000449437 OBJECTIVE To analyze muscle activation patterns during various footplate perturbations , used as proprioceptive challenges in patients with low back pain ( LBP ) and in controls . DESIGN A prospect i ve and controlled comparative study . SETTING Outpatient clinic . PARTICIPANTS Twenty subjects with chronic LBP and 20 age- and sex-matched controls . INTERVENTIONS The subjects underwent 5 sets of footplate perturbations in 3 directions with 16 perturbations for each set . MAIN OUTCOME MEASURES Latency , frequency , and asymmetry of muscle activation of the erector spinae , rectus abdominus , anterior tibialis , and gastrocnemius muscles were measured bilaterally with  surface electromyography .  RESULTS In the toes-up movements , subjects with LBP were significantly less likely to activate their rectus abdominus muscles ( P=.02 ) , and they were more likely to exhibit asymmetric muscle activation in the smaller forward movements ( odds ratio=4.1 , P=.03 ) . The latter result appears to be driven by asymmetric contraction of the erector spinae and rectus abdominus . CONCLUSIONS Significantly more subjects with LBP than control subjects exhibited absent firing of trunk muscles during 2 of the 5 footplate perturbations . These results suggest an abnormality of the neuromuscular loop and may represent altered proprioception Study Design . Classification and functional assessment model for nonspecific low back pain ( LBP ) patients and controls on the basis of kinematic analysis parameters . Objective . Develop a logistic regression model using kinematic analysis variables to ( 1 ) discriminate between LBP patients and controls and ( 2 ) obtain objective parameters for LBP functional assessment . Summary of Background Data . Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales . Objective functional techniques have been developed , which usually involve the application of external loads or the analysis of highly st and ardized trunk flexion-extension maneuvers . Few studies have used everyday activities such as sit-to-st and or lifting an object from the ground . They have shown that the motion patterns of LBP patients differ from those of healthy subjects . Nevertheless , very few studies have tried to correlate objective findings to the results of subjective scales , and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities . Methods . Sixteen controls and 39 LBP patients performed a sit-to-st and task , and lifted three different weights from a st and ing position . The vertical forces exerted and the relative positions of the lower limb and the cervical , thoracic , lumbar , and sacroiliac regions were recorded . Reliability was determined from repetitions of the tests performed by the control group . Binary logistic regression analyses were computed . The results of the selected regression equation were correlated to the Oswestry Disability Index scale results , to check the validity of the procedure for the measurement of functional disability . Results . Reliability of the parameters was good . The selected regression model used two variables , and correctly classified 97.3 % of the patients . High correlations were found between the results of this regression equation and the Oswestry Disability Index scale . Conclusion . It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks . This kind of analysis can produce objective and reliable indexes about the patients ' degree of functional impairment Background Many studies on low back pain ( LBP ) have identified prognostic factors , but prediction models for use in secondary health care are not available . The purpose of this cohort study , based on a r and omised clinical study , was to identify risk factors for unsuccessful return to work ( U-RTW ) in sick-listed LBP patients with or without radiculopathy and to vali date a prediction model for U-RTW . Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year . Afterwards , 117 other LBP patients were recruited similarly , included in a validation study and also followed for one year . All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist . Half of them received case manager guidance within a multidisciplinary setting . At baseline , they completed a question naire and went through a clinical low-back examination . Sciatica was investigated by magnetic resonance imaging ( MRI ) . U-RTW was registered in a national data base both initially and at 1-year . Results Neither initial U-RTW ( 24.0 % ) nor one-year U-RTW ( 38.2 % ) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy . Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW ( primary outcome ) . The clinical predictors included pain score ( back+leg pain ) and side-flexion . The five psychosocial predictors included ‘ bodily distress ’ ‘ low expectations of RTW ’ , ‘ blaming the work for pain ’ , ‘ no home ownership ’ and ‘ drinking alcohol less than once/month ’ . These predictors were not statistically significantly different in patients with and without radiculopathy , and they also predicted initial U-RTW ( secondary outcome ) . Obesity and older age were only supplementary predictors in patients with radiculopathy . A prediction model was established and tested in the validation study group . The model predicted one-year U-RWT in patients with intermediate and high risk , but only partially in patients with low risk . The model predicted all three risk categories in initial U-RTW . Conclusions A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low , intermediate and high risk for unsuccessful return to work , both initially and at 1-year Observation-based assessment s of movement are a st and ard component in clinical assessment of patients with non-specific low back pain . While aberrant motion patterns can be detected visually , clinicians are unable to assess underlying neuromuscular strategies during these tests . The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessment s for lumbopelvic control in people with low back pain ( LBP ) and matched control subjects .  Electromyography was recorded from hip and trunk muscles of 34 participants ( 17 with LBP ) during performance of the Active Hip Abduction ( AHAbd ) and Active Straight Leg Raise ( ASLR ) tests .  Relative muscle timing was calculated using cross-correlation . Participants with LBP demonstrated a variable strategy , while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements . Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches The purpose of the present study was to determine the reliability and validity of the Functional Rating Index ( FRI ) for athletes with low back pain ( LBP ) . In this cross-sectional and prospect i ve cohort study , the vali date d Persian FRI ( PFRI ) was tested in 100 athletes with LBP and 50 healthy athletes . From the athletes with LBP , data were recollected among 50 athletes with a 7-day interval to examine test-retest reliability . The content validity was excellent , and the athletes with LBP responded to all items with no floor or ceiling effects . The discriminative validity was supported by a statistically significant difference in PFRI total scores between the athletes with LBP and healthy athletes . The concurrent criterion validity was good ( rho = 0.72 ) . The construct , convergent validity was good ( r = 0.83 ) . The internal consistency reliability estimate was high ( Cronbach 's α = 0.90 ) . Factor analysis demonstrated a single-factor structure with an explained variance of 52.22 % . The test-retest reliability was excellent , indicated by an ICC(agreement ) of 0.97 , and the agreement observed in the Bl and and Altman plot demonstrated no systematic bias . It is concluded that the PFRI has excellent psychometric properties for assessing athletes with LBP 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
Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise .
Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up .
However , there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions .
There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments .
Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain ( LBP ) , a related systematic review is unavailable .
Therefore , this review summarized evidence regarding the predictive value of these muscular characteristics .