Search Results (435)

In Uganda, in 2019, 6.8 million people experienced health conditions that are amenable to rehabilitation. This is largely due to musculoskeletal disorders such as low back pain (LBP). Measuring effective coverage of rehabilitation means assessing whether a population that needs rehabilitation services receives the interventions with sufficient quality to produce the desired health gain. This study reports on the first measurement of effective coverage of rehabilitation in Uganda and globally using chronic primary LBP as the tracer health condition. A population survey was conducted to administer the WHO global tracer indicator questions. The survey questions were used to identify respondents with chronic primary LBP experiencing limitations in functioning and to determine utilization of rehabilitation services. The WHO Disability Assessment Schedule (WHODAS) 2.0 12-item was used for the measurement of an improvement in functioning that is meaningful to service users. The questions were nested in the Iganga–Mayuge Health and Demographic Surveillance Site (IMHDSS) update round 22 in seven sub-counties in rural Eastern Uganda between June and September 2023. Data collection followed a training session on survey administration and data capture for enumerators, field supervisors, research managers and lead scientists from the Makerere University Centre for Health and Population Research and a pilot testing of the data collection tool. Survey administration resulted in data collection for 8645 respondents aged 18 years and above. Specifically, 15.2% of the respondents had experienced chronic LBP in the last 12 months, of which 88.5% had experienced pain that was severe enough to affect their usual household, recreational or work activities. A total of 46% of this population in need of rehabilitation had been utilizing rehabilitation services (crude coverage), with no difference between women and men. Only 7.05% of the respondents with chronic primary low back pain experiencing limitations in functioning had been managed with sufficient quality to produce the desired health gain, defined by a minimal but meaningful improvement in functioning (effective coverage). Full article

Background: Quantitative assessment of postural parameters in all anatomical planes may help clarify the potential role of posture in the pathomechanism of low back pain (LBP) in tennis players and support the development of preventive and rehabilitation strategies. This observational cross-sectional study aimed to compare selected pelvic and spinal posture parameters of amateur tennis players with LBP, amateur tennis players without LBP, and physically active controls without LBP who did not participate in asymmetric sports. Methods: The study included 116 participants (52 women and 64 men): amateur tennis players with self-reported tennis-limiting LBP within the previous 6 months, amateur tennis players without such a history, and physically active controls who did not participate in asymmetric sports and were free of LBP. Spinal and pelvic posture parameters were assessed using the DIERS Formetric 4D rasterstereography system. Group comparisons were performed using ANOVA or the Kruskal–Wallis test, as appropriate. Results: Across most analysed body posture parameters, no clear and consistent between-group differences were detected in this sample. Among men, significant between-group differences were observed in pelvic rotation and maximum right vertebral rotation. Men in the TBP (Tennis Back Pain) group showed a mean left-sided pelvic rotation compared with a mean right-sided rotation in those in the TNBP (Tennis No Back Pain) group, and lower maximum right vertebral rotation than men in the PAC (Physically Active Control) group. Among women, a significant between-group difference was observed for coronal imbalance, with higher left-sided values in the TBP group than in PACs. No consistent between-group differences were found across the remaining pelvic and spinal parameters. Conclusions: In this sample of amateur tennis players, static body posture parameters showed limited and non-uniform associations with LBP. The observed differences were selective and of uncertain clinical relevance, and the analyses did not reveal a single consistent postural pattern clearly associated with LBP in this sample. Full article

Background/Objectives: Few previous studies have evaluated both radiological changes and the clinical effectiveness of platelet-rich plasma (PRP) injections, a biomedical therapy, in patients with chronic discogenic and/or radicular low back pain. Methods: This retrospective comparative cohort study reviewed patients with chronic LBP (>3 months) refractory to first-line conservative therapy between July 2022 and August 2024. Patients who underwent lumbar transforaminal epidural or intradiscal PRP injections, according to clinical presentation and imaging findings, were assigned to the PRP group. (n = 312), while those continuing conservative treatment served as controls (n = 391). Patients receiving both treatments were excluded. Pain and functional outcomes were evaluated using the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Follow-up continued through February 2025. Results: Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). At three months, the PRP group demonstrated significantly greater reductions in pain (NRS: 4.51 ± 0.79 from a baseline of 7.20 ± 0.89) and disability (ODI: 23.73 ± 3.96 from 37.21 ± 3.14), when compared with the conservative group (both p < 0.001). These improvements were sustained at six months (NRS: 2.86 ± 0.80 vs. 6.54 ± 1.99; ODI: 15.37 ± 3.99 vs. 33.70 ± 9.95; both p < 0.001). MRI changes were more frequent in the PRP group (73.09% vs. 9.28%, p < 0.001); however, these findings should be considered exploratory due to potential selection bias in imaging follow-up. Conclusions: PRP injection was associated with greater improvements in pain and function than conservative treatment. MRI improvements were more frequent in the PRP group, but these findings remain exploratory. Full article

Background: Low back pain (LBP) is a leading cause of disability, particularly in young adults. Decreased trunk endurance and altered movement patterns have been associated with lumbar symptoms and functional limitations; however, their concurrent relationships in active populations with minimal disability remain insufficiently characterized. This study was designed as an exploratory cross-sectional analytical study. Methods: The sample comprised 71 physically active university students (mean age, ~23 years; 79% men). Trunk endurance was assessed using the McGill isometric tests, and selected movement-pattern measures were obtained from four Functional Movement Screen (FMS) tasks focused on lumbopelvic control. The total FMS score was calculated, asymmetries were recorded in the Inline Lunge and Rotary Stability tasks, and lumbar-related disability was measured using the Oswestry Disability Index (ODI). Associations were analyzed using correlations and adjusted linear regression, and asymmetry-based comparisons were evaluated using non-parametric tests. Results: The average ODI was very low (approximately 4%), suggesting a floor effect. Greater trunk endurance was associated with lower ODI values, whereas the association between total FMS and ODI was weak and did not reach statistical significance in the adjusted model. Inline Lunge asymmetry was associated with higher ODI values, but this finding should be interpreted cautiously because of the very small subgroup size. Conclusions: In this physically active young adult sample, trunk endurance and selected movement-pattern measures provided complementary descriptive information on lumbar-related function; however, the observed associations were modest and should be interpreted cautiously. Full article

Background: Lumbar disc herniation (LDH) is the most common etiological cause of low back pain (LBP). Objective and precise pain evaluation is of significant clinical value. Functional near-infrared spectroscopy (fNIRS) as a noninvasive neuroimaging modality, has been increasingly validated to reflect subjective pain perception through hemodynamic correlates. This study aimed to analyze the fNIRS changes in patients with LDH about to receive Unilateral Biportal Endoscopy and to further explore the feasibility of fNIRS as an objective biomarkers for clinical assessment of LDH. Methods: Resting-state fNIRS data were acquired from 67 preoperative LDH patients and 20 healthy controls (HC). Brain functional maps—including z-standardized fractional amplitude of low-frequency fluctuations (zfALFF) and seed-based functional connectivity (FC)—were extracted and quantified. Group-level comparisons were performed between LDH and HC groups across four predefined regions of interest; additionally, correlation analyses were conducted between fNIRS metrics and clinical assessment scores within the LDH cohort. Results: Compared with HC, LDH patients exhibited significantly altered zfALFF in the medial prefrontal cortex (mPFC): decreased amplitude at channel CH12 (t = −2.031, p = 0.045) and increased amplitude at CH21 (t = 2.462, p = 0.016). Whole-brain FC analysis further revealed widespread changes—particularly between the parietal somatosensory cortex and prefrontal regions. Among all tested FC–clinical indicator associations, 56 reached statistical significance after FDR correction (q < 0.05). VAS_ lumbar and SF-36_SF exhibited the highest number of significant connections. Conclusions: LDH patients with LBP exhibit notable alterations in prefrontal resting-state ALFF and FC between the parietal somatosensory cortex and prefrontal cortex relative to HC. Importantly, these neural alterations exhibit significant associations with both pain severity (VAS) and long-term health-related quality of life (SF-36), thereby strengthening their candidacy as neural correlates meriting prospective validation as objective, mechanism-informed biomarkers for clinical evaluation of lumbar disc herniation (LDH). Moreover, these findings highlight candidate neural targets for future longitudinal studies investigating early prognostic prediction and treatment response monitoring in LDH. Full article

Introduction: Low back pain (LBP) is the leading cause of disability worldwide, with substantial variation in prevalence across regions. It is associated with a wide range of biophysical, psychological, social, and lifestyle factors, as well as comorbid conditions. Given its high impact, identifying population-level correlations of LBP is essential for informing prevention strategies. This study aimed to assess demographic, socioeconomic, lifestyle, and health-related factors associated with LBP in Hungary. Methods: A repeated cross-sectional analysis was conducted using secondary data from three waves of the European Health Interview Survey (EHIS) carried out in Hungary in 2009, 2014, and 2019. Results: The prevalence of LBP increased over the study period. Female sex, higher educational attainment, normal body mass index, non-smoking status, abstaining from alcohol, and good self-perceived health were associated with lower odds of LBP. In contrast, older age (≥65 years), unfavorable financial status, residence in socioeconomically disadvantaged regions, use of over-the-counter medications, and several chronic conditions were associated with higher odds. Conclusions: Reducing the impact of low back pain requires its integration into comprehensive public health frameworks that combine chronic disease management with consideration of socioeconomic inequalities at the population level. Full article

Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II–III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety. Full article

Background/Objectives: Low back pain (LBP) is one of the most common musculoskeletal conditions globally and a leading cause of disability. University populations may be particularly vulnerable due to prolonged sitting, academic stress, and frequently suboptimal ergonomics, especially in rapidly expanding higher education systems such as those in Saudi Arabia. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence of LBP among university attendants in Saudi Arabia and to quantify its associations with key demographic and environmental risk factors. Methods: We systematically reviewed observational studies reporting LBP prevalence and/or risk factors among university students and faculty in Saudi Arabia published in English, following Cochrane methodological guidance and PRISMA 2020 reporting recommendations. The protocol was prospectively registered in PROSPERO (CRD420250654048). We searched PubMed, Embase and CINAHL from inception to February 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Random effects meta-analyses were used to pool prevalence estimates across recall periods, regions, populations, and measurement tools, and to calculate pooled odds ratios (ORs) for age, sex, smoking, family history of LBP, and college seating conditions. Heterogeneity, subgroup, and sensitivity analyses were undertaken. Results: Thirteen cross-sectional studies were included. The overall pooled prevalence of LBP was 57% (95% confidence interval [CI] approximately 43–71), with substantial heterogeneity. Prevalence varied by recall period, region, population group, and measurement instrument; pooled prevalence was 58% among students and 50% among faculty. Increasing age (OR 1.17, 95% CI 1.01–1.34) and poor college seating conditions (OR 1.42, 95% CI 1.07–1.76) were significantly associated with LBP. Male gender, smoking, and family history showed non-significant pooled effects. These estimates are limited by substantial between-study heterogeneity, variable measurement tools, and exclusively cross-sectional designs, which restrict causal inference. Conclusions: LBP is prevalent among university attendants in Saudi Arabia, affecting both students and faculty. The consistent associations with age and seating ergonomics highlight the need for ergonomic classroom redesign and age-sensitive preventive strategies. Future work should adopt standardized LBP measures and longitudinal designs to clarify causal pathways and evaluate targeted interventions. Funding: This work was supported by the Deanship of Graduate Studies and Scientific Research at Jouf University (grant DGSSR-2026-NF-01-002). Full article

Despite the high prevalence of low back pain (LBP), evidence supporting the clinical effects of repetitive peripheral magnetic stimulation (rPMS) remains limited. A combined double-coil and handheld rPMS approach may enhance the therapeutic potential of this technology. This observational case series analyzed prospectively collected routine clinical data from 37 patients treated with a combined protocol of static double-coil lumbar rPMS and dynamic handheld lower-limb rPMS. Pain intensity, disability, and quality of life were assessed at baseline, post-treatment, and 1-month follow-up. Statistical analyses were complemented by an evaluation of clinical relevance using established minimal clinically important difference (MCID) thresholds. Significant improvements were observed across all outcomes. Pain decreased by 62.5% post-treatment and by 87.5% at follow-up, while disability was reduced by 86.8% and 92.1%, respectively. Quality of life scores approximately doubled. High MCID responder rates and consistent within-group changes were observed; however, given the single-arm design without a control group, these findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory evidence of treatment effectiveness. This combined rPMS approach was feasible and well tolerated in routine clinical practice and was associated with clinically meaningful within-group improvements in pain, function, and quality of life. Further controlled studies are warranted. Full article

Background and Objectives: Low back pain (LBP) represents a major cause of disability worldwide, with a significant impact on quality of life and functional capacity. Standard physiotherapy is widely used for LBP, whereas comparative short-term evidence on balneotherapy and prolotherapy remains limited. This study aimed to compare clinical outcomes across therapeutic approaches in patients with LBP. Materials and Methods: This non-randomized, three-group interventional cohort study included adult patients diagnosed with LBP lasting more than three months and presenting a baseline Visual Analog Scale (VAS) score ≥ 4. 84 patients were allocated to one of three treatment groups: standard physiotherapy (CG) (25 patients), balneotherapy plus physiotherapy (BG) (28 patients), or prolotherapy (PG) (31 patients). Outcome measures included pain intensity, functional disability, lumbar mobility, quality of life, and psychological status. This clinical study has been officially registered on ClinicalTrials.gov under the identifier NCT07399145. Results: Statistical analyses were performed to assess within- and between-group differences over time. At the 4-week follow-up, all three treatment groups showed significant improvements compared to baseline in pain intensity (VAS; p < 0.001 for PG, BG, and CG) and lumbar mobility (Schober test; p < 0.001 for PG, BG, and CG), and functional disability (RMDQ; p < 0.001 for PG, p = 0.027 for BG, and p = 0.016 for CG). Between-group analyses at T1 revealed significant differences for RMDQ, ODI, Schober, and EQ-5D-5L. In contrast, no significant intergroup differences were observed for VAS, PPT-RS, PPT-LS, total PPT, HADS-A, HADS-D, BDI-II, or PHQ-9. Conclusions: All evaluated interventions improved clinical, functional, and psychological outcomes in patients with LBP. Prolotherapy showed a pattern of more consistent improvements, particularly in disability, spinal mobility, and health-related quality of life. These findings should be interpreted cautiously, given the non-randomized design and baseline differences between groups. Further randomized studies with larger samples and longer follow-up are warranted to confirm these results. Full article

Low back pain (LBP) represents an immense economic burden, with a lifetime prevalence of up to 84%. However, conventional diagnostic methods such as Magnetic Resonance Imaging (MRI) or X-rays provide only limited information about the pathogenesis and specific pain-related functional limitations. Wearable inertial sensors (IMU) and electromyography sensors (EMG) offer an expanded spectrum for the targeted identification and diagnosis of LBP. The aim of the study is to develop and evaluate a standardized multi-sensor functional assessment protocol for the subcategorization of functional deficits in LBP. Based on a systematic literature review, a standardized and objectively measurable functional LBP assessment protocol was defined that tests fatigue resistance, neuromuscular control, lumbopelvic stability, and global trunk musculature. Subsequently, 38 individuals were recruited in a prospective cross-sectional study and divided into three groups: “healthy,” “mild pain,” and “severe pain.” These individuals underwent an assessment. The two pain groups differed significantly from the symptom-free individuals in all previously defined functional levels. In addition, the two pain groups also differed significantly from each other. The functional assessment, which incorporates IMUs and EMG sensors as central diagnostic elements, enables the identification of functional deficits and associated neuromuscular characteristics, thus enabling individualized therapy. Full article

Objectives: This study aimed to evaluate the effectiveness and safety of paracetamol 1000 mg/ibuprofen 300 mg administered three times daily (TID) in comparison with ibuprofen 600 mg TID in the management of patients with acute moderate/severe non-specific low back pain (LBP). Methods: This was a phase IV, randomized, open-label, parallel-group study conducted in adults with moderate/severe LBP (Visual Analogue Scale [VAS] score ≥ 40 mm). Results: A total of 171 patients were included in the modified intention-to-treat (m-ITT) population (paracetamol 1000 mg/ibuprofen 300 mg: 83 patients; ibuprofen 600 mg: 88 patients). No significant between-group difference on the primary endpoint (SPID 0–3 days) was found. Patients were mainly women (60.2% and 55.7%), with a mean age of 42.8 and 43.3 years, respectively. In the m-ITT population, the effectiveness, safety and tolerability were similar between groups. In the per-protocol population, clinical pain reduction was observed with paracetamol 1000 mg/ibuprofen 300 mg. At visit 1, significant differences in the Clinical Global Impression–Improvement scale (paracetamol 1000 mg/ibuprofen 300 mg: 63.9%; ibuprofen 600 mg: 45.5%; p = 0.0137) and a trend favouring paracetamol 1000 mg/ibuprofen 300 mg in Patients’ Global Impression of Change (63.9% vs 44.4%; p = 0.0539) score were observed. Conclusions: Given the open-label design and the exploratory nature of study’s secondary endpoints, no claims of superiority can be drawn; but our findings confirm that good management of acute moderate/severe LBP can be achieved with multimodal therapy with paracetamol 1000 mg/ibuprofen 300 mg. EudraCT Number: 2020-005278-86 (EudraCT Number 2020-005278-86—Clinical trial results—EU Clinical Trials Register; date of registration: 14 June 2021). Full article

Background and Aim: Low back pain (LBP) represents an important public health issue, with approximately 20% of acute cases progressing to chronic low back pain (CLBP). In addition to pain, patients with CLBP also suffer from reduced cognitive performance, depressive symptoms and catastrophic thoughts. Central sensitization (CS) is considered a key point in pain persistence. This study examines CS and its impact on cognitive, emotional, and behavioral functioning in patients with CLBP. Methods: In this cross-sectional study, 67 patients with CLBP were classified using the Central Sensitization Inventory (CSI) into groups with (WCS, n = 32) and without central sensitization (WoCS, n = 35). Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA), emotional functioning using the Center for Epidemiologic Studies Depression Scale (CES-D), and behavioral functioning using the Pain Catastrophizing Scale (PCS), including helplessness, rumination, and magnification domains. Normality was assessed using the Shapiro–Wilk test. Between-group comparisons were performed using Mann–Whitney U, chi-square, or Welch’s t-tests. Multivariable linear regression analyses adjusted for age and gender were conducted. Results: Compared with the WoCS group, patients with central sensitization were older (median 58 vs. 50 years, p = 0.001) and more frequently female (71.9% vs. 40.0%, p = 0.018). The WCS group showed higher PCS total scores (31.8 ± 14.2 vs. 16.0 ± 11.9), higher helplessness (14.3 ± 6.1 vs. 6.9 ± 5.5), rumination (12.7 ± 6.2 vs. 7.0 ± 4.8), and magnification scores (4.8 ± 2.4 vs. 2.1 ± 2.1), higher CES-D scores (26.3 ± 10.4 vs. 11.7 ± 7.2), and lower MoCA scores (23.6 ± 3.0 vs. 26.1 ± 2.1) (all p < 0.001). All associations remained significant after adjustment for age and gender. Conclusions: Central sensitization in CLBP is independently associated with greater pain catastrophizing across all domains, increased depressive symptoms, and reduced cognitive performance, supporting its role as a multidimensional clinical phenotype. Full article

Work-related musculoskeletal disorders (MSDs) are leading causes of disability and productivity loss globally, yet registry-based evidence from low- and middle-income countries remains limited. The study analyzed compensated work-related MSDs claims reported to the Workers’ Compensation Fund (WCF) in Tanzania between 2016 and 2022 to identify patterns and associated risk factors. A registry-based cross-sectional design was conducted using de-identified WCF data on demographics, occupation, industry, diagnosis, and recorded workplace exposures. Modified Poisson regression was used to estimate associations between work-related MSDs and risk factors. Among the 243 workers with work-related MSDs whose claims were accepted and compensated, 84% had low back pain (LBP), predominantly males (90%) and middle-aged workers (mean age 41.6 years). Mining and quarrying accounted for 50% of the cases, with drivers and mobile plant operators being the most affected. Whole-body vibration (WBV) exposure and work in mining and quarrying were significant predictors of LBP (adjusted PR = 1.25; 95% CI: 1.061.49 and PR = 1.21; 95% CI: 1.01–1.44, respectively). These findings highlight WBV and mining work as significant risk factors of work-related MSDs and underscore the need for targeted interventions alongside enhanced health surveillance systems for exposure documentation. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability and work absenteeism worldwide. Lumbar facet joint degeneration is a common source of chronic LBP, and when conservative treatment fails, interventional procedures may be indicated. Cryodenervation is a minimally invasive option that remains less extensively studied. This study aims to evaluate clinical outcomes, cost–utility, and return-to-work rates following lumbar facet joint cryodenervation. Methods: A retrospective study included 42 professionally active patients treated with lumbar facet joint cryoablation between 2020 and 2022 at a tertiary neurosurgical center. All patients had facet-mediated LBP confirmed by a positive diagnostic medial branch block. Pain (VAS), disability (ODI), and work status were assessed before and after treatment. ODI scores were converted to SF-6D utilities to estimate quality-adjusted life years (QALYs). Cost data were obtained from institutional records. Results: Mean ODI improved from 48.5 ± 12.8 to 36.6 ± 17.8, and mean VAS from 7.0 ± 1.7 to 3.8 ± 2.0. Mean SF-6D increased from 0.53 to 0.59, corresponding to a gain of 0.0103 QALYs over four months (annualized 0.0309). The mean procedure cost was 1905 PLN, resulting in approximately 185,000 PLN per QALY, which is within the national cost-effectiveness threshold. Overall, 58.5% of patients returned to work, with the highest rate in those aged 30–39 years (83.3%). Conclusions: Lumbar facet cryoablation provides meaningful pain relief and functional improvement at a favorable cost-effectiveness profile. Younger patients show higher return-to-work rates. Larger prospective studies are required to confirm these findings. Full article