Suchergebnisse

Back pain and neck pain are very common and among the most frequent causes of sick-leave and disability pension, thereby greatly affecting the individual and the community. This stresses the need for prognostic research regarding these conditions. Aim: The main aim of the present work was to study prognostic factors, including manual therapy, for back and neck pain. The specific aims were, to investigate the influence of regular leisure physical activity and the body mass index (BMI) on the recovery from persistent low back pain (Study I), to study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain (Study II), to explore the long-term effects (up to one year) of naprapathic manual therapy for patients with non-specific back and/or neck pain (Study III), and to develop a prediction model for the recovery from whiplash-associated disorders (WAD) in patients who consulted physiotherapy (Study IV). Methods: Studies I and II were based on the Stockholm Public Health Cohort, and comprised data from four questionnaire-based public-health surveys conducted between 2002 and 2010. Study I included 1836 individuals reporting persistent low back pain at baseline in 2002 and answering the follow-up in 2007, while Study II involved 8994 individuals with occasional low back pain at baseline in 2006 responding to the 2010 survey. Information on exposures and potential confounders was collected at baseline. The exposures were, regular leisure physical activity and BMI (Study I), and "healthy lifestyle behaviour", a combination of four lifestyle factors (smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables) (Study II). Both Studies I and II assessed men and women separately. Study III was based on a Swedish randomized controlled trial of 409 patients with non-specific back and/or neck pain. It compared naprapathic manual therapy with evidence based support on staying active and on pain coping strategies. Questionnaires at 26 and 52 weeks provided the follow-up data. Study IV included 680 patients with WAD consulting physiotherapy, using data retrieved from the Saskatchewan Government Insurance study, Canada (1997-1999). A prediction model for recovery from WAD was developed and internally validated by assessing twenty-five possible prognostic factors, using survival analyses. Results and Conclusions: Regular leisure physical activity improved recovery from persistent low back pain among women. No such association was found among men, or between BMI and recovery regardless of sex (Study I). Healthy lifestyle behaviour decreased the risk of long duration troublesome low back pain among women with occasional low back pain. No clear association was found among men (Study II). Compared to evidence-based care, naprapathic manual therapy implied greater long-term improvement in pain and disability for patients with non-specific back and/or neck pain (Study III). The prediction model developed includes seven clinically important prognostic factors, and has acceptable predictive ability (Study IV). The conclusions in this thesis are, that lifestyle factors are of importance for the prognosis of low back pain among women, that combined manual therapy, such as naprapathy, has a long-term effect on non-specific back and/or neck pain, and that the present prediction model for recovery from WAD has acceptable predictive ability but has to be further validated to be used in clinical practice.

BACKGROUND: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. METHODS: Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping. RESULTS: Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit. CONCLUSIONS: We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.