ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00072.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Health care providers often prescribe exercises as treatment for nonspecific low back pain. However, the effectiveness of this treatment is poorly documented in the literature. While the evidence suggests that exercise in general is beneficial, there is a lack of knowledge about the types, frequency and duration of exercises that should be prescribed and at what stage of injury they are most helpful. In addition, few studies have dealt with exercise treatment alone rather than in combination with other treatments, making it hard to decipher the unique contribution of exercise. Inadequate study designs also make conclusions difficult. Conversely, the literature clearly shows that inactivity has detrimental effects (i.e. delayed return to normal activity, and negative physiological and psychological effects) for low back pain patients.

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00073.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Exercise has played a central role in rehabilitation of subjects with low back pain. The research in this field has intensified since the 1980s. Low back pain has been associated with both physically stressful and sedentary occupations. There is no clear association between low back pain and physical activity during leisure time. Many studies have shown that subjects with back pain have impairments in muscular and connective tissue, functional limitations in muscular strength, endurance, speed, and neuromuscular functions, and physical, social and psychological disabilities. The ultimate aims of the exercise‐based programs are to reduce and prevent these impairements, functional limitations and disabilities. The results of controlled studies with exercise programs have shown a positive effect on physical impairments and functional limitations for subjects with chronic low back pain. The outcome of exercise programs has not been so positive for disability, defined as an inability or a limitation in performance in social interactions including occupational activitie

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00074.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Over the years there has been an apparent contradiction between the widely utilized treatment of low back pain through exercise, and the often apparently disappointing results reported in the scientific literature. Recently published studies have shown that the most important factor regarding the training effects of chronic low back patients is the administration of a high training stimulus (number of repetitions of the exercise, exercise resistance, and the total number of sessions). This would explain why several of the previously published studies regarding training show insignificant results. Simply stated, in many low‐dosage or short‐time studies, the positive effects of training have not had adequate opportunity to take hold in the chronic low back pain patient. The patient group which has been operated on for disc prolapse often exhibits considerable functional deteriorations post‐operatively. Rehabilitation studies have shown that many of these patients also benefit from post‐operative rehabilitation including high dosage exercise programs. Exercise programs are generally free of side

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00075.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Conventional treatments have not slowed down the ever expanding low back pain (LBP) problem. Traditional treatment has most probably contributed to the growth of the problem. Therefore, in a search for new solutions, ‘functional restoration’ has been devised. In connection with chronic LBP the term has been associated with a full‐day program lasting from 3 to 5 weeks. it includes multidisciplinary treatment of patients in groups with intensive physical and ergonomic training, psychological pain management, back school, as well as teaching in social/work related issues. The key concepts are ‘acceptance of the pain’, ‘activity’, ‘self‐responsibility’, ‘multidisciplinary’ and ‘quantitative functional evaluation (QFE)’. The latter is aimed so that the participants can feel the physical improvement, encouraging them to be able to go back to work, or at least to lead a more active life style. Several controlled studies suggest a lasting effect in terms of regaining their ability to work and improving pain behavior for a good part of disabled chronic LBP patients. However, it is noteworthy that randomized studies seemingly show poorer results than studies not em

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00076.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In a prospective, randomized study, primarily designed to test the efficacy of activation on consecutive blue‐collar workers sick‐listed for 6 weeks due to subacute low back pain, 25% of the workers were excluded for medical reasons. In the intervention study (n=103), only a minority of cases (6%) had ‘true’ subacute complaints, i.e. no prior history of low back pain. Subjective reports on general well‐being, health status and work‐related ergonomic factors were significantly lower or worse in patients than in reference samples. The randomized intervention study could establish a significant effect of graded activation on work return, but the effect seemed to be restricted to patients moderately disabled, i.e. one‐third of the subacute low back pain patients included. A predictive four‐factor model on work return increased the possibility of identifing nonresponders (chronic low back pain) more than threefold with a specificity (91%) and sensitivity (74%) comparable to that of clinical disc herniation. The history of a prolonged disablement process, cognitive factors, pain behavior and mentally straining ergonomic factors seemed to be of importance. Psychological reactions, or ‘barriers to recovery’, were slightly different in treatment and control groups but the type of intervention did not significantly alter the predictive model, suggesting that subsets of the study sample may benefit from other optional functional approaches. Descriptive characteristics of the study sample emphasized that subacute low back pain patients cannot be conceptualized as a homogeneous group. Four subgroups could be identified: (a) specific medical disorders; (b) spontaneous recovery group; (c) moderately disabled back pain patients; and (d) nonresponders. The results support proposals that treatment should be tailored according to individual needs and that better case management should have priority for those belonging to the

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00077.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The purpose of this study was to assess, in subjects with low back pain, the changes and their permanence in muscular performance after a 3 month progressive physical exercise program. Ninety subjects with chronic low back pain participated in the study. The study design was controlled and it was carried out in three groups: intensive training, home exercise, and control group. Isometric and dynamic muscle strength of the trunk and lower limb were measured, at the beginning of the study and after the 3 months exercise program, and then during each of the follow‐up sessions. The Oswestry Index and back pain intensity were also determined. Both exercise groups received benefit from the progressive exercise program. Their muscular performance improved and their back pain intensity decreased significantly. Among the home exercise group, the Oswestry Index also changed positively. The results demonstrate that the home exercise program could be as effective as the intensive training program in increasing muscle strength, as well as decreasing back pain and functional disability among low back pain patients with mild functional limitation

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00078.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Musculoskeletal disorders are a major health problem, and nursing staff are often seen as a risk group. The purpose of this study was to evaluate the effect of a weekly exercise program among nursing staff on musculoskeletal symptoms and to study the relation to changes in physical capacity. A total of 106 nurses and nursing aides from four geriatric wards were invited to participate; 86 accepted. A cross‐over design was used. The staff from two wards were assigned to an exercise period and the staff from the other wards to a control period for the first intervention period. After a wash‐out period, the intervention changed. For the exercise periods the staff were invited to participate in an exercise program twice a week for 8 weeks. In total 50 subjects participated more than 8 times regularly during the exercise periods (participants≤8 times regular participation, nonparticipants≤8). During the control periods 78 subjects attended without intervention. Assessments were made with a standardized questionnaire for analysis of musculoskeletal and psychosomatic symptoms, testing of muscle strength in m. quadriceps with a Cybex dynamometer, and testing of cardiovascular capacity with a Dynavite computerized exercise bicycle before and after the exercise periods. The muscle strength in m. quadriceps increased more during the exercise periods compared with the control periods, explained primarily by the subgroup of nonregular exercisers and those ≥40 years of age. The number of musculoskeletal symptoms tended to decrease more in the subgroup of nonregular exercisers (those who exercised less than once a week in their spare time) during the exercise periods compared with the nonregular exercisers during the control periods. Comparisons within groups showed a decrease in the number of musculoskeletal symptoms within the exercise periods, explained primarily by a decrease among the participants rather than among the nonparticipants. The decrease within the participants was explained primarily by the subgroup of nonregular exercisers and those ≥40 years of age. An increase in cardiovascular capacity and a tendency to increase in muscle strength in m. quadriceps were seen among the participants, explained primarily by the effect in the subgroup of nonregular exercisers. The study suggests that a moderate weekly exercise program, performed in a group, among nursing staff affects physical capacity and the number of musculoskeletal symptoms for subjects who are nonregular exercisers and probably subjects ≥40

ISSN:0905-7188    

DOI:10.1111/j.1600-0838.1996.tb00079.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY