Louisa Chou

The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men

AbstractLow back pain (LBP) and obesity are major public health problems; however, the relationship between body composition and low back pain in men is unknown. This study aims to examine the association between body composition and LBP and disability in a population-based sample of men, as well as the factors that may affect this relationship.Nine hundred seventy-eight male participants from the Geelong Osteoporosis Study were invited to participate in a follow-up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of an emotional disorder was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry.Of the 820 respondents (84% response rate), 124 (15%) had high-intensity low back pain and/or disability (back pain). Low back pain was associated with higher body mass index (28.7 ± 0.4 vs 27.3 ± 0.2 kg/m2, P = 0.02) and waist–hip ratio (0.97 ± 0.006 vs 0.96 ± 0.006, P = 0.04), with increased tendency toward having a higher fat mass index (8.0 vs 7.6 kg/m2, P = 0.08), but not fat-free mass index (P = 0.68). The associations between back pain and measures of obesity were stronger in those with an emotional disorder, particularly for waist–hip ratio (P = 0.05 for interaction) and fat mass index (P = 0.06 for interaction).In a population-based sample of men, high-intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with an emotional disorder. This provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain.

Patient-centred management of inflammatory arthritis: more than just disease control

heumatoid arthritis and seronegative spondyloarthropathies are the most common R types of inflammatory arthritis. They cause pain, joint damage and progressive functional loss, which limit participation in life and constitute a significant disease burden. Over the past decades, great advances in management, with the availability of corticosteroids, synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs, have significantly improved the disease control and outcomes. The guidelines, whose algorithms focus on drug prescription to achieve remission of disease, support everyday treatment. However, while they provide direction for the use of DMARDs, they do not consider the patients’ broader health needs.

How are obesity and body composition related to patellar cartilage? A systematic review

Objective. The aim of this review was to systematically examine the evidence for an association between measures of obesity [weight and body mass index (BMI)] and body composition (fat mass and fat-free mass) and patellar cartilage, assessed using magnetic resonance imaging. Methods. Three electronic databases (MEDLINE, EMBASE, and CINAHL) were searched up to April 2016 using full text and MeSH terms to identify studies examining the associations between obesity and body composition, and patellar cartilage. Two independent reviewers extracted the data and assessed the methodological quality of included studies. Results. Seventeen studies were included: 5 cross-sectional, 10 cohort studies measuring outcomes at 2 timepoints, and 2 longitudinal studies assessing outcome only at the timepoint. Eleven studies were of high or moderate quality. In asymptomatic middle-aged adults, elevated body weight and BMI were systematically associated with worse patellofemoral cartilage scores. There was more consistent evidence for patellar cartilage defects than patellar cartilage volume, particularly in women. Increased BMI was also consistently associated with increased cartilage loss in longitudinal studies, although not all attained statistical significance. Conclusion. There is a need for more high-quality research to confirm these findings and to better explain the relative contributions of metabolic and biomechanical factors to the initiation of patellofemoral osteoarthritis, to devise effective strategies to manage this common and disabling condition.

Patients’ perceived needs of osteoarthritis health information: A systematic scoping review

Background Optimal management of osteoarthritis requires active patient participation. Understanding patients’ perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients’ perceived health information needs for OA. Methods A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs of osteoarthritis health information were categorized. Results 30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention. Conclusions Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes.

People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review

QUESTION What needs of non-biomedical services are perceived by people with low back pain? DESIGN Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016). PARTICIPANTS Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. RESULTS Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. CONCLUSION People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE (2018) People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review. Journal of Physiotherapy 64: 74-83].

SAT0519 The Association between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders – A Population-Based, Cross-Sectional Study of Men

Background Low back pain (LBP) and obesity are both major public health problems. Obesity has been linked with LBP, with recent studies reporting that increased fat but not lean tissue mass is associated with LBP, however previous studies predominantly examined women. The relationship between body composition and LBP in men is unknown. Objectives The aim of this study was to examine the relationship between body composition and LBP and disability in a population-based sample of men. Methods 978 male participants from the Geelong Osteoporosis Study (GOS), a population-based Australian study designed to investigate the epidemiology of osteoporosis among adults, were invited to participate in a follow up study in 2006. Participants completed questionnaires on sociodemographics and health status. LBP was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of mood disorders was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Independent samples t-tests and chi-square tests were used to compare the baseline characteristics of men with and without LBP and/or disability. Estimated marginal means were used to examine the relationships between obesity measures and body composition in participants with high intensity pain and disability compared to those with no or low pain and disability. Multivariate analyses included adjustments for age, mood disorder, education, mobility and body mass index (BMI). To examine the multivariate associations between body composition and back pain, adjustment was also made for the alternate body composition measure. Interactions between risk factors for LBP and measures of obesity, including measures of body composition were examined. Results Of the 820 respondents (84% response rate), 124 (15%) had high intensity LBP and/or disability. Participants with high intensity pain and/or disability were older, more likely to have a mood disorder, less likely to have completed secondary school and more likely to have poor mobility than those with no or LBP and disability (p<0.002 for all). LBP was associated with higher BMI (28.7±0.4 vs 27.3±0.2 kg/m2, p=0.02) and waist-hip ratio (0.97±0.006 vs 0.96±0.006, p=0.04), with increased tendency towards having a higher fat mass index (8.0 vs 7.6 kg/m2, p=0.08), but not fat-free mass index (p=0.68). The associations between LBP and measures of obesity were stronger in those with a mood disorder, particularly for waist-hip ratio (p=0.05 for interaction) and fat mass index (p=0.06 for interaction). Conclusions In a population-based sample of men, high intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with mood disorders. This provides evidence to support a biopsychosocial interaction between mood disorders and obesity with LBP. Acknowledgement S.B: NHMRC Postgraduate Scholarship, S.BO: Alfred Deakin Postdoctoral Fellowship, D.M.U & A.E.W: NHMRC Career Development Fellowships, A.T: NHMRC Early Career Fellowship, JP: NHMRC grants, GOS: NHMRC grants. Disclosure of Interest None declared