Audy Paul Hodselmans

Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage

The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspecific CLBP who had entered a rehabilitation programme. Results were as follows: the mean (standard deviation) aerobic capacity (VO2max) of CLBP patients was significantly (P<0.001) lower 7.3 (5.6) ml/kg lean body mass/min as compared with the normative data. The mean (standard deviation) body fat percentage of the patients was significantly (P<0.001) higher 3.9 % (5.9) as compared with the normative data. These results provide evidence of a reduced level of aerobic capacity and an increased body fat percentage in nonspecific CLBP patients compared with healthy participants.

Exercise capacity in non-specific chronic low back pain patients: a lean body mass-based Astrand bicycle test; reliability, validity and feasibility.

Objective Measurement of exercise capacity is essential in patients with non-specific chronic low back pain (CLBP). However, the conventional Ǻstrand bicycle test is not feasible in patients with a very poor aerobic capacity. Therefore the Ǻstrand bicycles test for non-specific CLBP patients based on lean body mass (LBM) was developed as an alternative. The aim of this study was to evaluate reliability and validity of the LBM-based Ǻstrand test. Subjects Twenty patients with non-specific CLBP and 20 healthy subjects were included for the reliability evaluation, and 19 healthy subjects for the validity evaluation. Method Patients and healthy subjects were assessed twice. Intra class correlation (ICC), repeatability coefficient (RC) and the limits of agreement (LOA) were calculated as a measure of test re-tests reliability. An ICC ≥ 0.75 was considered acceptable. Validity was tested by calculating ICC between the LBM-based Ǻstrand test and a maximal bicycle test. Results The LBM-based Ǻstrand test shows good reliability, reflected by an ICC ≥ 0.91 and 95% of the 20 patients could perform the test. However, differences with the estimated true value reflected by the RC and natural variation reflected by the LOA were substantial in patients. Validity was good, reflected by ICC ≥ 0.88. Conclusion The present study shows that the LBM-based Ǻstrand test is a reliable, valid, and feasible method for patients with non-specific CLBP. However, a substantial amount of variation should be taken into account in patients when interpreting the test results clinically.

Test-retest reliability of psychophysical lift capacity in patients with non-specific chronic low back pain and healthy subjects.

OBJECTIVE Psychophysical lift capacity tests are lifting tests in which the performance, expressed in Newtons, is divided by the perceived exertion, expressed on a Borg scale. The aim of this study was to analyse test-retest reliability of psychophysical lift capacity tests. SUBJECTS Patients with non-specific chronic low back pain (n=20) and healthy subjects (n=20). METHODS Psychophysical lift capacity tests were assessed during a back school intake at the Centre for Rehabilitation of the University Medical Centre Groningen. Patients on the waiting list and healthy subjects were assessed twice, with a 2-week interval between assessments. Intra-class correlation (ICC) was calculated as a measure of reliability. An ICC > or = 0.75 was considered as an acceptable reliability. Limits of agreement as a measure for natural variation were calculated. RESULTS The psychophysical static and dynamic lift capacity tests showed good reliability (ICC > or = 0.75). The limits of agreement are substantial, indicating a considerable natural variation between test-sessions for all psychophysical tests. CONCLUSION The psychophysical static lift capacity and dynamic lifting capacity are reliable instruments for patients with non-specific chronic low back pain and healthy subjects. However, a substantial amount of natural variation should be taken into account between 2 test sessions when interpreting the test results clinically.

Determinants of change in perceived disability of patients with non-specific chronic low back pain

OBJECTIVE Change in psychophysical capacity, calculated as the ratio between physical capacity and perceived effort, may be a determinant of change in perceived disability. The aim of this study was to identify determinants for change in perceived disability, as measured with the Roland Morris Disability Questionnaire (RMDQ), in patients with non-specific chronic low back pain after rehabilitation. METHODS Data were gathered for 84 outpatients. Psychophysical capacity (psychophysical static leg lift, psychophysical static trunk lift, and psychophysical dynamic lifting capacity), physical lifting capacity, perceived lifting effort, aerobic capacity and RMDQ were assessed. Associations between change in RMDQ and potential determinants were calculated. Variables associated with change in RMDQ were entered in a multivariate linear regression analysis (backward). RESULTS Change in psychophysical static trunk lift (r = -0.51), psychophysical dynamic lifting capacity (r = -0.53) and psycho-physical static leg lift capacity (r = -0.23) were significantly associated with change in RMDQ. The RMDQ score at baseline (beta = -0.438), change in psychophysical dynamic lifting capacity (beta = -0.109), psychophysical static trunk lift capacity (beta = -0.038), psychophysical static leg lift capacity (beta = -0.012) and static leg lift capacity (beta = 0.007) all contributed significantly to the regression model (r2 = 52%). CONCLUSION Improvements in psychophysical lifting capacity are determinants for a reduction in perceived disability.

Physiotherapy students’ perceived stress, stressors, and reactions to stressors: A comparative study between Sweden and The Netherlands

ABSTRACT Background and Purpose: Studies of healthcare students report increased levels of stress, with academic pressures being the greatest source. The objective of this study was to examine the differences in the overall stress level, stressors, and reactions to stressors between physiotherapy students at the University of Gothenburg (GU) and those at the Hanze University of Applied Sciences (HUAS). Methods: The Student-life Stress Inventory was used. The participants (n = 116) included physiotherapy students at GU and HUAS. The distribution of the questionnaire occurred during a regular lecture or in a lecture that was scheduled particularly for its distribution. Results: At GU, 13.7% of the students rated their level of stress as mild, whereas 72.5% of them rated it as moderate. The corresponding values for HUAS students were 43.9% and 43.9%, respectively. This difference between two universities was significant (p = 0.006). The total score of the subcategories indicated that the students at GU reported significantly higher levels of stressors (p = 0.027) and reactions to stressors (p = 0.003). However, there were no significant differences in the male participants between the universities. Conclusion: Female students in their three-year educational program in Sweden experienced significantly more stress than Dutch female students in their four-year educational program.