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    Traction for low back pain, the evidence is flawed : a thesis presented in partial fulfilment of the requirements for the Masters of Health Science (MHlthSci) in Environmental Health at Massey University Campus, Wellington, New Zealand
    (Massey University, 2017) Plumbley, Grant David
    Research suggests the burden of low back pain is growing despite recent advances in investigative technology and the explosion in research. Evidence based practice is necessary within physiotherapy. However, the best evidence component must be clinically appropriate, accurate, and grounded within pertinent research. The selection of participants and the methodological designs of the studies must be appropriate to provide results valid to everyday clinical practice. Systematic reviews and meta-analyses consider primary research to critically analyse research questions, and formulate scientific conclusions on the efficacy of interventions. These research derived conclusions then inform clinical practice guidelines which are envisioned to improve clinical practice. These guidelines are also utilised by educational facilities to flavour their curriculum, and by insurance and governmental policy writers in accrediting specific interventions. Information from today will dictate the beliefs, attitudes, and practices of future graduates, and determine approved treatment options. The reported negative conclusions on the efficacy of traction as an intervention for low back pain have resulted in traction no longer being recommended within clinical practice guidelines, any remaining sporadic use questioned by professional colleagues and policy writers, and it no longer taught at undergraduate level. This is despite its long history, popularity amongst some practitioners, anecdotal evidence supporting its use in the clinical setting, and its demonstrable effects in scientific studies. This masters project argues that the cause of the disparity lies within incongruous study designs, which are not valid to clinical practice. Specifically, caused by the misappropriation of historical definitions and classifications vis-à-vis low back pain cohorts. This has resulted in substantial heterogeneity within study populations themselves, both between groups and between studies, which along with other methodological flaws and inappropriate reporting, has given rise to unwarranted conclusions. These fundamental errors have made the conclusions of scientific trials, systematic reviews, and clinical practice guidelines erroneous, and inapplicable to everyday clinical practice. The ‘evidence based’ recommendations of the
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    Evaluation of back education programme at the Medical Rehabilitation Unit, Palmerston North Hospital : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1994) Williams, Mei Wah
    Chronic low back pain is a significant health care problem and is frequently one of the most difficult conditions to treat. For the individual, chronic low back pain evolves into a constellation of problems involving psychological and behavioural symptoms as a result of the recurrent pain. Numerous pain clinics have been established providing a multidisciplinary approach to the treatment of chronic pain. A considerable amount of evidence has attested to the efficacy of a comprehensive treatment approach for the management of chronic pain. Despite the support for pain clinics, many outcome studies have been plagued by methodological difficulties. The present study was designed to improve on previous methodological shortcomings and evaluate the efficacy of a multidisciplinary treatment for chronic back pain. The programme, carried out over four mornings per week for three weeks, was conducted in an outpatient clinic of a public hospital. Twenty-four patients consecutively referred to the pain clinic were randomly assigned to treatment and waitlist control conditions. The treatment group was assessed four times and the waitlist control group assessed six times throughout the study. The two groups were compared for differences on a variety of outcome measures on three separate occasions; at pretreatment, immediately after treatment and at follow-up. Outcome measures included self-reported pain intensity, mood, coping skills and physical disability; and objective measures of physical impairments. Multivariate analyses of variance (MANOVA) for outcome measures were carried out. Results suggested significant improvements were achieved after treatment in depression levels and muscle strength. No significant gains were reported in physical functioning such as everyday activities, flexibility, spinal functioning, or pain intensity. When assessed at follow-up six months later, the original gains in mood were maintained but a significant decline in muscle strength was reported. The goals of the programme to improve physical functioning and return to work were not achieved, thus predictions for the efficacy of the chronic back pain programme were not supported. Implications of these findings are discussed together with recommendations for improving outcomes, especially the importance of physical reactivation.
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    Interaction between physical and psychosocial work risk factors for low back symptoms : a study of prevalence, risk factors, and interaction between physical and psychosocial work risk factors for low back symptoms and its consequences (reduced activities and absenteeism) in a random sample of workers in New Zealand and in Indonesian coal mining workers : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Ergonomics at Massey University, Manawatu, New Zealand
    (Massey University, 2013) Widanarko, Baiduri
    The prevalence of low back symptoms (LBS) in developed and industrially developing countries (IDCs) is high, and there have only been a few studies in New Zealand and IDCs. It is well known that the risk factors for LBS include physical and psychosocial exposures, but the interaction between these is not well understood. Even less is known about prevalence of, and risk factors for, twopossible consequences of LBS (reduced activities and absenteeism). Hence, this thesis examines the prevalence, risk factors, and the interaction between physical and psychosocial work risk factors for LBS and its consequences in a developed country and an IDC. This was done in two cross-sectional studies of: A) a large random sample of workers in New Zealand, and; B) Indonesian coal mining workers. In telephone interviews of 3,003 participants (1,431 males and 1,572 females) aged 20-64 randomly selected from the New Zealand Electoral Roll, the 12-month period prevalence of LBS, reduced activities, and absenteeism due to LBS were 54%, 18%, and 9%, respectively. Risk factors of LBS for the whole population (males and females) increased with work in awkward or tiring positions and stressful jobs. Awkward or tiring positions at work, dissatisfaction with contact and cooperation with management, and stressful jobs were risk factors for women but not for men. The only risk factor for reduced activities was lifting. Risk factors for absenteeism were working in awkward or tiring positions and in a cold or damp environment. In a self-administered questionnaire among 1,294 Indonesian coal mining workers (1,252 males and 42 females), the 12-month period prevalence of LBS, reduced activities, and absenteeism due to LBS were 75%, 16%, and 13%, respectively. This study afforded an opportunity to examine selection bias due to a healthy worker effect. It showed that blue-collar work (as opposed to white-collar work) was a risk factor for LBS, after adjustment for a healthy worker effect and other potential confounders. The presence of LBS and smoking increased the risk of reduced activities and absenteeism. This study also indicated that those who were exposed to both high physical (awkward posture, whole-body vibration, using vibrating hand tools, and lifting) and high psychosocial (high effort, low reward, job dissatisfaction, and work stress) factors were most likely to report LBS and both consequences. High psychosocial exposure increased the likelihood of reporting LBS, but high physical exposure did so for reduced activities and absenteeism. Current smokers were more likely to report LBS consequences than nonsmokers. Permanent employment and night shift work increased the risk of LBS and its consequences. There was an interaction between physical and psychosocial exposures for LBS. The overall risk for LBS was greater than the sum of the individual risks due to physical and psychosocial factors (as indicated by departure from an additive model of risk). Thirty-nine percent of LBS cases among those who were exposed to high physical and high psychosocial risk factors were due to exposure to both factors. There were also interactions between the risk factors for reduced activities due to LBS, although not significant, whereas for absenteeism due to LBS it was not present. The implications of these findings for New Zealand workers are that LBS and its consequences could be reduced by using interventions designed to avoid or minimise exposure to physical and psychosocial work factors. In addition, environmental factors should also be improved in order to reduce the consequences of LBS. For Indonesian coal mining workers, addressing both physical and psychosocial factors in the workplace is likely to reduce up to 39% of LBS cases among workers exposed to both factors. This will in turn, reduce the risk of LBS consequences. The intervention strategy should also focus on permanent employment, night shift work, and smokers.