Margareta C Nordin

Managing nonspecific low back pain: do nonclinical patient characteristics matter?
Weiner, Shira S; Weiser, Sherri R; Carragee, Eugene J; Nordin, Margareta
2011 Nov 1;36(23):1987-1994, Spine
STUDY DESIGN.: A fully blocked experimental design using clinical vignettes to query primary care physicians on prescription for management of acute nonspecific low back pain. OBJECTIVE.: To identify how nonclinical patient factors, specifically sex, patient presentation, and socioeconomic status, influence physician treatment recommendations for assessing and treating acute nonspecific low back pain. SUMMARY OF BACKGROUND DATA.: Adherence to evidence-based practice guidelines for nonspecific low back pain remains inconsistent. Therefore, it is important to understand what factors guide physician management of these cases. METHODS.: One vignette and questionnaire was distributed to primary care and emergency department clinical physicians during meetings at five teaching hospitals. The questionnaire asked for diagnostic and treatment recommendations including specific tests, medications, therapeutic procedures, activity, referral to other services, and patient education for the case represented in the vignette. RESULTS.: Subjects included 284 physicians and approximately 75% had less than 5 years of clinical practice experience. Multivariate logistic regression showed seven significant associations of patient factors with treatment recommendations for acute nonspecific low back pain (one sex, two socioeconomic status, and four patient presentation; P < 0.05). CONCLUSION.: All three assessed nonclinical factors influenced physician decisions regarding diagnostic and treatment recommendations for acute nonspecific low back pain. Patient presentation, suggestive of a patient's emotional state, was shown to be the most influential
— id: 139467, year: 2011, vol: 36, page: 1987, stat: Journal Article,

Management recommendations for knee osteoarthritis: how usable are they?
Poitras, Stephane; Rossignol, Michel; Avouac, Jerome; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Eric; Hilliquin, Pascal
2010 Oct;77(5):458-465, Joint, bone, spine
OBJECTIVES: Despite the availability of practice guidelines for the management of knee osteoarthritis, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. Literature has shown that simply disseminating management recommendations does not lead to adherence. Research suggests that barriers to use should be identified and addressed to improve adherence. The objective of this study was to identify barriers to use of conservative management recommendations for knee osteoarthritis by patients, general practitioners and physiotherapists. METHODS: Following systematic reviews of evidence and guidelines, 12 key management recommendations were elaborated on four themes: medication, exercise, self-management and occupation. Focus groups were separately done with patients with knee osteoarthritis, general practitioners and physiotherapists to assess barriers to the use of recommendations. RESULTS: Patients and general practitioners appeared generally fatalistic with regards to knee osteoarthritis, with physiotherapists being more positive regarding long-term improvement of knee osteoarthritis. For medication, discrepancies were found between recommendations and views of clinicians. Both patients and general practitioners appeared ambivalent towards exercise and activity, recognizing its usefulness but identifying it at the same time as a cause of knee osteoarthritis. Patients and general practitioners appeared to consider weight loss particularly difficult. DISCUSSION/CONCLUSIONS: Barriers specific to each knee osteoarthritis management recommendation and stakeholder group were identified. Recommendations to address these barriers were elaborated. Results of this study can be used to develop implementation strategies to overcome identified barriers, with the goal of facilitating the use of guideline recommendations and improving outcomes
— id: 134398, year: 2010, vol: 77, page: 458, stat: Journal Article,

Prevention and management of chronic back pain
Weiner, Shira Schecter; Nordin, M
2010 Apr;24(2):267-279, Bailliere's best practice & research. Clinical rheumatology
Low back pain is prevalent, and both debilitating for the patient and costly for society if it becomes a chronic condition. The initial prognosis at the onset of low back pain is positive, however the rate of recurrence is high and about 20% of patients seeking care develop a chronic problem that may or may not lead to disability. The main message, based on the best evidence, is that keeping active despite low back pain is 'healthy'. A large portion of patients seeking care can manage their short term and even longer term incapacity. However, for those who cannot manage their pain, significant relief can be found in a variety of conservative treatments. Passive treatment should be kept to a minimum as evidence shows that active treatments are more effective for improving function and return to work. There is evidence that identifying psychosocial symptoms and barriers, and referral to appropriate interventions improves outcomes. There are currently no clear indications for surgery in nonspecific low back pain
— id: 108795, year: 2010, vol: 24, page: 267, stat: Journal Article,

Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carragee, Eugene J; Hurwitz, Eric L; Cheng, Ivan; Carroll, Linda J; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W; Cote, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J David; Haldeman, Scott
2009 Feb;32(2 Suppl):S176-S193, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. SUMMARY OF BACKGROUND DATA: There have been no comprehensive systematic literature or evidence-based reviews published on this topic. METHODS: We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. RESULTS: Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term outcomes are improved with the surgical treatment of cervical radiculopathy compared to nonoperative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%-20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. CONCLUSION: Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support
— id: 96414, year: 2009, vol: 32, page: S176, stat: Journal Article,

Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Cassidy, J David; Peloso, Paul M; Giles-Smith, Lori; Cheng, C Sam; Greenhalgh, Stephen W; Haldeman, Scott; van der Velde, Gabrielle; Hurwitz, Eric L; Cote, Pierre; Nordin, Margareta; Hogg-Johnson, Sheilah; Holm, Lena W; Guzman, Jaime; Carragee, Eugene J
2009 Feb;32(2 Suppl):S39-S45, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To provide a detailed description of the methods undertaken in a systematic search and perform a best evidence synthesis on the frequency, determinants, assessment, interventions, course and prognosis of neck pain, and its associated disorders. SUMMARY OF BACKGROUND DATA: Neck pain is an important cause of health burden; however, the published information is vast, and stakeholders would benefit from a summary of the best evidence. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders conducted a systematic search and critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain. Citations were screened for relevance to the Neck Pain Task Force mandate, using a priori criteria, and relevant studies were critically reviewed for their internal scientific validity. Findings from studies meeting criteria for scientific validity were synthesized into a best evidence synthesis. RESULTS: We found 31,878 citations, of which 1203 were relevant to the mandate of the Neck Pain Task Force. After critical review, 552 studies (46%) were judged scientifically admissible and were compiled into the best evidence synthesis. CONCLUSION: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders undertook a best evidence synthesis to establish a baseline of the current best evidence on the epidemiology, assessment and classification of neck pain, as well as interventions and prognosis for this symptom. This article reports the methods used and the outcomes from the review. We found that 46% of the research literature was of acceptable scientific quality to inform clinical practice, policy-making, and future research
— id: 96411, year: 2009, vol: 32, page: S39, stat: Journal Article,

Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hogg-Johnson, Sheilah; Cote, Pierre; van der Velde, Gabrielle; Holm, Lena W; Carragee, Eugene J; Hurwitz, Eric L; Peloso, Paul M; Cassidy, J David; Guzman, Jaime; Nordin, Margareta; Haldeman, Scott
2009 Feb;32(2 Suppl):S108-S116, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best-evidence synthesis. OBJECTIVE: To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in workers. SUMMARY OF BACKGROUND DATA: Knowledge of the course of neck pain in workers guides expectations for recovery. Identifying prognostic factors assists in planning effective workplace policies, formulating interventions and promoting lifestyle changes to decrease the frequency and burden of neck pain in the workplace. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis. CONCLUSION: The Neck Pain Task Force presents a report of current best evidence on course and prognosis for neck pain. Few modifiable prognostic factors were identified; however, having some influence over one's own job and being physically active seem to hold promise as prognostic factors
— id: 96418, year: 2009, vol: 32, page: S108, stat: Journal Article,

Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Haldeman, Scott; Holm, Lena W; Carragee, Eugene J; Hurwitz, Eric L; Cote, Pierre; Nordin, Margareta; Peloso, Paul M; Guzman, Jaime; Cassidy, J David
2009 Feb;32(2 Suppl):S87-S96, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis on course and prognosis of neck pain and its associated disorders in the general population. SUMMARY OF BACKGROUND DATA: Knowing the course of neck pain guides expectations for recovery. Identifying prognostic factors assists in planning public policies, formulating interventions, and promoting lifestyle changes to decrease the burden of neck pain. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Findings from studies meeting criteria for scientific validity were abstracted into evidence tables and included in a best evidence synthesis. RESULTS: We found 226 articles on the course and prognostic factors in neck pain and its associated disorders. After critical review, 70 (31%) of these were accepted on scientific merit. Six studies related to course and 7 to prognostic factors in the general population. Between half and three quarters of persons in these populations with current neck pain will report neck pain again 1 to 5 years later. Younger age predicted better outcome. General exercise was unassociated with outcome, although regular bicycling predicted poor outcome in 1 study. Psychosocial factors, including psychologic health, coping patterns, and need to socialize, were the strongest prognostic factors. Several potential prognostic factors have not been well studied, including degenerative changes, genetic factors, and compensation policies. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for this symptom. General exercise was not prognostic of better outcome; however, several psychosocial factors were prognostic of outcome
— id: 96407, year: 2009, vol: 32, page: S87, stat: Journal Article,

Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Holm, Lena W; Hogg-Johnson, Sheilah; Cote, Pierre; Cassidy, J David; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L; Carragee, Eugene J; van der Velde, Gabrielle; Peloso, Paul M; Guzman, Jaime
2009 Feb;32(2 Suppl):S97-S107, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I-III whiplash-associated disorders (WAD). SUMMARY OF BACKGROUND DATA: Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial
— id: 96406, year: 2009, vol: 32, page: S97, stat: Journal Article,

Research priorities and methodological implications: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hurwitz, Eric L; Cote, Pierre; Hogg-Johnson, Sheilah; Carragee, Eugene J; Nordin, Margareta; Holm, Lena W; van der Velde, Gabrielle; Cassidy, J David; Guzman, Jaime; Peloso, Paul M; Haldeman, Scott
2009 Feb;32(2 Suppl):S244-S251, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors, assessment, intervention, and course and prognostic factors for neck pain and its associated disorders. SUMMARY OF BACKGROUND DATA: The scientific literature on neck pain is large and of variable quality. We reviewed 1203 studies and judged 46% to be of sufficient scientific validity to be included in the best evidence synthesis. Scientific quality varied across study topics, and fundamental questions remain about important issues. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We outline a large number of gaps in the current literature. For example, we found important gaps in our knowledge about neck pain in children (risk factors, screening criteria to rule out serious injury, management, course and prognosis); and in the prevention of neck pain-related activity limitations. Few studies addressed the impact of culture or social policies (such as governmental health policies or insurance compensation policies) on neck pain. A number of important questions remain about the effectiveness of commonly used interventions for neck pain. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for whiplash-associated disorders. We identify a number of gaps in the current knowledge, and provide recommendations for the conduct of future studies
— id: 96412, year: 2009, vol: 32, page: S244, stat: Journal Article,

The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Cote, Pierre; van der Velde, Gabrielle; Cassidy, J David; Carroll, Linda J; Hogg-Johnson, Sheilah; Holm, Lena W; Carragee, Eugene J; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L; Guzman, Jaime; Peloso, Paul M
2009 Feb;32(2 Suppl):S70-S86, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Systematic review and best evidence synthesis. OBJECTIVES: To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. SUMMARY OF BACKGROUND DATA: Previous reviews of the etiology of neck pain in workers relied on cross-sectional evidence. Recently published cohorts and randomized trials warrant a re-analysis of this body of research. METHODS: We systematically searched Medline for literature published from 1980-2006. Retrieved articles were reviewed for relevance. Relevant articles were critically appraised. Articles judged to have adequate internal validity were included in our best evidence synthesis. RESULTS: One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Quebec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. CONCLUSION: Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers
— id: 96408, year: 2009, vol: 32, page: S70, stat: Journal Article,

Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations
Guzman, Jaime; Haldeman, Scott; Carroll, Linda J; Carragee, Eugene J; Hurwitz, Eric L; Peloso, Paul; Nordin, Margareta; Cassidy, J David; Holm, Lena W; Cote, Pierre; van der Velde, Gabrielle; Hogg-Johnson, Sheilah
2009 Feb;32(2 Suppl):S227-S243, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To provide evidence-based guidance to primary care clinicians about how to best assess and treat patients with neck pain. SUMMARY OF BACKGROUND DATA: There is a need to translate the results of clinical and epidemiologic studies into meaningful and practical information for clinicians. METHODS: Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians. RESULTS: The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology. CONCLUSION: The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired
— id: 96413, year: 2009, vol: 32, page: S227, stat: Journal Article,

A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Guzman, Jaime; Hurwitz, Eric L; Carroll, Linda J; Haldeman, Scott; Cote, Pierre; Carragee, Eugene J; Peloso, Paul M; van der Velde, Gabrielle; Holm, Lena W; Hogg-Johnson, Sheilah; Nordin, Margareta; Cassidy, J David
2009 Feb;32(2 Suppl):S17-S28, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Iterative discussion and consensus by a multidisciplinary task force scientific secretariat reviewing scientific evidence on neck pain and its associated disorders. OBJECTIVE: To provide an integrated model for linking the epidemiology of neck pain with its management and consequences, and to help organize and interpret existing knowledge, and to highlight gaps in the current literature. SUMMARY OF BACKGROUND DATA: The wide variability of scientific and clinical approaches to neck pain described in the literature requires a unified conceptual model for appropriate interpretation of the research evidence. METHODS: The 12-member Scientific Secretariat of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders critically reviewed and eventually accepted as scientifically admissible a total of 552 scientific papers. The group met face-to-face on 18 occasions and had frequent additional telephone conference meetings over a 6-year period to discuss and interpret this literature and to agree on a conceptual model, which would accommodate findings. Models and definitions published in the scientific literature were discussed and repeatedly modified until the model and case definitions presented here were finally approved by the group. RESULTS: Our new conceptual model is centered on the person with neck pain or who is at risk for neck pain. Neck pain is viewed as an episodic occurrence over a lifetime with variable recovery between episodes. The model outlines the options available to individuals who are dealing with neck pain, along with factors that determine options, choices, and consequences. The short- and long-term impacts of neck pain are also considered. Finally, the model includes a 5-axis classification of neck pain studies based on how subjects were recruited into each study. CONCLUSION: The Scientific Secretariat found the conceptual model helpful in interpreting the available scientific evidence. We believe it can assist people with neck pain, researchers, clinicians, and policy makers in framing their questions and decisions
— id: 96415, year: 2009, vol: 32, page: S17, stat: Journal Article,

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Carroll, Linda J; Holm, Lena W; Cassidy, J David; Guzman, Jamie; Cote, Pierre; Haldeman, Scott; Ammendolia, Carlo; Carragee, Eugene; Hurwitz, Eric; Nordin, Margareta; Peloso, Paul
2009 Feb;32(2 Suppl):S46-S60, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population. SUMMARY OF BACKGROUND DATA: The evidence on burden and determinants of neck has not previously been summarized. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing. CONCLUSION: Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain
— id: 96410, year: 2009, vol: 32, page: S46, stat: Journal Article,

The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Holm, Lena W; Carroll, Linda J; Cassidy, J David; Hogg-Johnson, Sheilah; Cote, Pierre; Guzman, Jamie; Peloso, Paul; Nordin, Margareta; Hurwitz, Eric; van der Velde, Gabrielle; Carragee, Eugene; Haldeman, Scott
2009 Feb;32(2 Suppl):S61-S69, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions. SUMMARY OF BACKGROUND DATA: Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. METHODS: A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980-2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis. RESULTS: The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females. CONCLUSION: WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed
— id: 96409, year: 2009, vol: 32, page: S61, stat: Journal Article,

Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Hurwitz, Eric L; Carragee, Eugene J; van der Velde, Gabrielle; Carroll, Linda J; Nordin, Margareta; Guzman, Jaime; Peloso, Paul M; Holm, Lena W; Cote, Pierre; Hogg-Johnson, Sheilah; Cassidy, J David; Haldeman, Scott
2009 Feb;32(2 Suppl):S141-S175, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. SUMMARY OF BACKGROUND DATA: No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. METHODS: We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. RESULTS: Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. CONCLUSION: Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies
— id: 96416, year: 2009, vol: 32, page: S141, stat: Journal Article,

Erratum: Assessment of neck pain and its associated disorders: Rthe bone and joint decade 2000-2010 task force on neck pain and its associated disorders (European Spine Journal (2008) 17:1 (S101-S122) (10.1007/s00586-008-0630-0))
Nordin M.; Carragee E.J.; Hogg-Johnson S.; Weiner S.S.; Hurwitz E.L.; Peloso P.M.; Guzman J.; Van Der Velde G.; Carroll L.J.; Holm L.W.; Cote P.; David Cassidy J.; Haldeman S.
2009 ;18(3):435-436, European spine journal
— id: 97997, year: 2009, vol: 18, page: 435, stat: Journal Article,

Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Nordin, Margareta; Carragee, Eugene J; Hogg-Johnson, Sheilah; Weiner, Shira Schecter; Hurwitz, Eric L; Peloso, Paul M; Guzman, Jaime; van der Velde, Gabrielle; Carroll, Linda J; Holm, Lena W; Cote, Pierre; Cassidy, J David; Haldeman, Scott
2009 Feb;32(2 Suppl):S117-S140, Journal of manipulative & physiological therapeutics
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To critically appraise and synthesize the literature on assessment of neck pain. SUMMARY OF BACKGROUND DATA: The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain. RESULTS: We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. CONCLUSION: The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research
— id: 96417, year: 2009, vol: 32, page: S117, stat: Journal Article,

Perioperating nurses and technicians' perceptions of ergonomic risk factors in the surgical environment
Sheikhzadeh, Ali; Gore, Chaitrali; Zuckerman, Joseph D; Nordin, Margareta
2009 Sep;40(5):833-839, Applied ergonomics
The aim of this study was to identify the magnitude and characteristics of work-related musculoskeletal complaints among perioperative nurses and technicians (PNT) and determine the associated ergonomic risk factors in the operating room (OR) environment based on self-report and focus group discussion. The 50 PNTs who participated in the study completed a self-report survey for musculoskeletal symptoms, Job Description Questionnaire, and Psychometric Evaluation Questionnaire, and participated in focus groups to discuss potential OR ergonomic risk factors. The results of the study demonstrated a high prevalence of work-related musculoskeletal disorders (WMSD) among PNTs, with lower back pain the most prevalent (84%) complaint, followed by ankle/foot (74%) and shoulder (74%) pain. In addition, lower back pain (31%), followed by ankle/knee (24%) pain were found to be the main causes of absenteeism from work. Participants suggested simple ergonomic and engineering solutions can be adopted to improve the work environment of PNTs
— id: 93939, year: 2009, vol: 40, page: 833, stat: Journal Article,

Non-specific low back pain
Brunner F; Weiser S; Schmid A; Nordin M
Spinal disorders : fundamentals of diagnosis and treatment Berlin ; New York : Springer, 2008,
— id: 5098, year: 2008, vol: , page: 585, stat: Chapter,

Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up
Campo, Marc; Weiser, Sherri; Koenig, Karen L; Nordin, Margareta
2008 May;88(5):608-619, Physical therapy
BACKGROUND: Work-related musculoskeletal disorders (WMSDs) have a significant impact on physical therapists, but few studies have addressed the issue. Research is needed to determine the scope of the problem and the effects of specific risk factors. OBJECTIVES: The objectives of this study were: (1) to determine the 1-year incidence rate of WMSDs in physical therapists and (2) to determine the effects of specific risk factors. DESIGN: This was a prospective cohort study with 1-year follow-up. METHODS: Subjects were randomly selected American Physical Therapy Association members (N=882). Exposure assessment included demographic data, physical risk factors, job strain, and specific physical therapy tasks. The primary outcome was WMSDs, with a severity rating of at least 4/10 and present at least once a month or lasting longer than a week. RESULTS: The response rate to the baseline questionnaire was 67%. Ninety-three percent of the subjects who responded to the baseline questionnaire responded to the follow-up questionnaire. The 1-year incidence rate of WMSDs was 20.7%. Factors that increased the risk for WMSDs included patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work, and job strain. LIMITATIONS: The primary limitation of this study was the number of therapists who had a change in their job situation during the follow-up year. CONCLUSIONS: Work-related musculoskeletal disorders are prevalent in physical therapists. Physical therapy exposures, patient handling, and manual therapy, in particular, increase the risk for WMSDs
— id: 78454, year: 2008, vol: 88, page: 608, stat: Journal Article,

The authors' reply to the letter to the editor by Paul Dreyfuss et al
Carragee, EJ; Hurwitz, EL; Cheng, I; Carroll, LJ; Nordin, M; Guzman, J; Peloso, P; Holm, LW; Cote, P; Hogg-Johnson, S; van der Velde, G; Cassidy, JD; Haldeman, S
2008 SEP ;17(9):1273-1275, European spine journal
— id: 86801, year: 2008, vol: 17, page: 1273, stat: Journal Article,

Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carragee, Eugene J; Hurwitz, Eric L; Cheng, Ivan; Carroll, Linda J; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W; Cote, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J David; Haldeman, Scott
2008 Feb 15;33(4 Suppl):S153-S169, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. SUMMARY OF BACKGROUND DATA: There have been no comprehensive systematic literature or evidence-based reviews published on this topic. METHODS: We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. RESULTS: Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term outcomes are improved with the surgical treatment of cervical radiculopathy compared to nonoperative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%-20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. CONCLUSION: Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support
— id: 78464, year: 2008, vol: 33, page: S153, stat: Journal Article,

Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Cassidy, J David; Peloso, Paul M; Giles-Smith, Lori; Cheng, C Sam; Greenhalgh, Stephen W; Haldeman, Scott; van der Velde, Gabrielle; Hurwitz, Eric L; Cote, Pierre; Nordin, Margareta; Hogg-Johnson, Sheilah; Holm, Lena W; Guzman, Jaime; Carragee, Eugene J
2008 Feb 15;33(4 Suppl):S33-S38, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To provide a detailed description of the methods undertaken in a systematic search and perform a best evidence synthesis on the frequency, determinants, assessment, interventions, course and prognosis of neck pain, and its associated disorders. SUMMARY OF BACKGROUND DATA: Neck pain is an important cause of health burden; however, the published information is vast, and stakeholders would benefit from a summary of the best evidence. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders conducted a systematic search and critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain. Citations were screened for relevance to the Neck Pain Task Force mandate, using a priori criteria, and relevant studies were critically reviewed for their internal scientific validity. Findings from studies meeting criteria for scientific validity were synthesized into a best evidence synthesis. RESULTS: We found 31,878 citations, of which 1203 were relevant to the mandate of the Neck Pain Task Force. After critical review, 552 studies (46%) were judged scientifically admissible and were compiled into the best evidence synthesis. CONCLUSION: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders undertook a best evidence synthesis to establish a baseline of the current best evidence on the epidemiology, assessment and classification of neck pain, as well as interventions and prognosis for this symptom. This article reports the methods used and the outcomes from the review. We found that 46% of the research literature was of acceptable scientific quality to inform clinical practice, policy-making, and future research
— id: 78461, year: 2008, vol: 33, page: S33, stat: Journal Article,

Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hogg-Johnson, Sheilah; Cote, Pierre; van der Velde, Gabrielle; Holm, Lena W; Carragee, Eugene J; Hurwitz, Eric L; Peloso, Paul M; Cassidy, J David; Guzman, Jaime; Nordin, Margareta; Haldeman, Scott
2008 Feb 15;33(4 Suppl):S93-100, Spine
STUDY DESIGN: Best-evidence synthesis. OBJECTIVE: To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in workers. SUMMARY OF BACKGROUND DATA: Knowledge of the course of neck pain in workers guides expectations for recovery. Identifying prognostic factors assists in planning effective workplace policies, formulating interventions and promoting lifestyle changes to decrease the frequency and burden of neck pain in the workplace. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis. CONCLUSION: The Neck Pain Task Force presents a report of current best evidence on course and prognosis for neck pain. Few modifiable prognostic factors were identified; however, having some influence over one's own job and being physically active seem to hold promise as prognostic factors
— id: 78455, year: 2008, vol: 33, page: S93, stat: Journal Article,

Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Haldeman, Scott; Holm, Lena W; Carragee, Eugene J; Hurwitz, Eric L; Cote, Pierre; Nordin, Margareta; Peloso, Paul M; Guzman, Jaime; Cassidy, J David
2008 Feb 15;33(4 Suppl):S75-S82, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis on course and prognosis of neck pain and its associated disorders in the general population. SUMMARY OF BACKGROUND DATA: Knowing the course of neck pain guides expectations for recovery. Identifying prognostic factors assists in planning public policies, formulating interventions, and promoting lifestyle changes to decrease the burden of neck pain. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Findings from studies meeting criteria for scientific validity were abstracted into evidence tables and included in a best evidence synthesis. RESULTS: We found 226 articles on the course and prognostic factors in neck pain and its associated disorders. After critical review, 70 (31%) of these were accepted on scientific merit. Six studies related to course and 7 to prognostic factors in the general population. Between half and three quarters of persons in these populations with current neck pain will report neck pain again 1 to 5 years later. Younger age predicted better outcome. General exercise was unassociated with outcome, although regular bicycling predicted poor outcome in 1 study. Psychosocial factors, including psychologic health, coping patterns, and need to socialize, were the strongest prognostic factors. Several potential prognostic factors have not been well studied, including degenerative changes, genetic factors, and compensation policies. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for this symptom. General exercise was not prognostic of better outcome; however, several psychosocial factors were prognostic of outcome
— id: 78457, year: 2008, vol: 33, page: S75, stat: Journal Article,

Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Holm, Lena W; Hogg-Johnson, Sheilah; Cote, Pierre; Cassidy, J David; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L; Carragee, Eugene J; van der Velde, Gabrielle; Peloso, Paul M; Guzman, Jaime
2008 Feb 15;33(4 Suppl):S83-S92, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I-III whiplash-associated disorders (WAD). SUMMARY OF BACKGROUND DATA: Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial
— id: 78456, year: 2008, vol: 33, page: S83, stat: Journal Article,

Research priorities and methodological implications: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Carroll, Linda J; Hurwitz, Eric L; Cote, Pierre; Hogg-Johnson, Sheilah; Carragee, Eugene J; Nordin, Margareta; Holm, Lena W; van der Velde, Gabrielle; Cassidy, J David; Guzman, Jaime; Peloso, Paul M; Haldeman, Scott
2008 Feb 15;33(4 Suppl):S214-S220, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors, assessment, intervention, and course and prognostic factors for neck pain and its associated disorders. SUMMARY OF BACKGROUND DATA: The scientific literature on neck pain is large and of variable quality. We reviewed 1203 studies and judged 46% to be of sufficient scientific validity to be included in the best evidence synthesis. Scientific quality varied across study topics, and fundamental questions remain about important issues. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We outline a large number of gaps in the current literature. For example, we found important gaps in our knowledge about neck pain in children (risk factors, screening criteria to rule out serious injury, management, course and prognosis); and in the prevention of neck pain-related activity limitations. Few studies addressed the impact of culture or social policies (such as governmental health policies or insurance compensation policies) on neck pain. A number of important questions remain about the effectiveness of commonly used interventions for neck pain. CONCLUSION: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for whiplash-associated disorders. We identify a number of gaps in the current knowledge, and provide recommendations for the conduct of future studies
— id: 78462, year: 2008, vol: 33, page: S214, stat: Journal Article,

Course and prognostic factors for neck pain in workers - Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Carroll, LJ; Hogg-Johnson, S; Cote, P; van der Velde, G; Holm, LW; Carragee, EJ; Hurwitz, EL; Peloso, PM; Cassidy, JD; Guzman, J; Nordin, M; Haldeman, S
2008 APR ;17(3):S93-S100, European spine journal
Study Design. Best-evidence synthesis. Objective. To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in workers. Summary of Background Data. Knowledge of the course of neck pain in workers guides expectations for recovery. Identifying prognostic factors assists in planning effective workplace policies, formulating interventions and promoting lifestyle changes to decrease the frequency and burden of neck pain in the workplace. Methods. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results. We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis. Conclusion. The Neck Pain Task Force presents a report of current best evidence on course and prognosis for neck pain. Few modifiable prognostic factors were identified; however, having some influence over one's own job and being physically active seem to hold promise as prognostic factors
— id: 78658, year: 2008, vol: 17, page: S93, stat: Journal Article,

Course and prognostic factors for neck pain in the general population - Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Carroll, LJ; Hogg-Johnson, S; van der Velde, G; Haldeman, S; Holm, LW; Carragee, EJ; Hurwitz, EL; Cote, P; Nordin, M; Peloso, PM; Guzman, J; Cassidy, JD
2008 APR ;17(3):S75-S82, European spine journal
Study Design. Best evidence synthesis. Objective. To undertake a best evidence synthesis on course and prognosis of neck pain and its associated disorders in the general population. Summary of Background Data. Knowing the course of neck pain guides expectations for recovery. Identifying prognostic factors assists in planning public policies, formulating interventions, and promoting lifestyle changes to decrease the burden of neck pain. Methods. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Findings from studies meeting criteria for scientific validity were abstracted into evidence tables and included in a best evidence synthesis. Results. We found 226 articles on the course and prognostic factors in neck pain and its associated disorders. After critical review, 70 (31%) of these were accepted on scientific merit. Six studies related to course and 7 to prognostic factors in the general population. Between half and three quarters of persons in these populations with current neck pain will report neck pain again 1 to 5 years later. Younger age predicted better outcome. General exercise was unassociated with outcome, although regular bicycling predicted poor outcome in 1 study. Psychosocial factors, including psychologic health, coping patterns, and need to socialize, were the strongest prognostic factors. Several potential prognostic factors have not been well studied, including degenerative changes, genetic factors, and compensation policies. Conclusion. The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for this symptom. General exercise was not prognostic of better outcome; however, several psychosocial factors were prognostic of outcome
— id: 78656, year: 2008, vol: 17, page: S75, stat: Journal Article,

Course and prognostic factors for neck pain in whiplash-associated disorders (WAD) - Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Carroll, LJ; Holm, LW; Hogg-Johnson, S; Cote, P; Cassidy, JD; Haldeman, S; Nordin, M; Hurwitz, EL; Carragee, EJ; van der Velde, G; Peloso, PM; Guzman, J
2008 APR ;17(3):S83-S92, European spine journal
Study Design. Best evidence synthesis. Objective. To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I-III whiplash-associated disorders (WAD). Summary of Background Data. Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. Methods. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results. We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. Conclusion. The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial
— id: 78657, year: 2008, vol: 17, page: S83, stat: Journal Article,

Research priorities and methodological implications - The bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Carroll, LJ; Hurwitz, EL; Cote, P; Hogg-Johnson, S; Carragee, EJ; Nordin, M; Holm, LW; van der Velde, G; Cassidy, JD; Guzman, J; Peloso, PM; Haldeman, S
2008 APR ;17(3):S214-S220, European spine journal
Study Design. Best evidence synthesis. Objective. To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors, assessment, intervention, and course and prognostic factors for neck pain and its associated disorders. Summary of Background Data. The scientific literature on neck pain is large and of variable quality. We reviewed 1203 studies and judged 46% to be of sufficient scientific validity to be included in the best evidence synthesis. Scientific quality varied across study topics, and fundamental questions remain about important issues. Methods. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results. We outline a large number of gaps in the current literature. For example, we found important gaps in our knowledge about neck pain in children (risk factors, screening criteria to rule out serious injury, management, course and prognosis); and in the prevention of neck pain-related activity limitations. Few studies addressed the impact of culture or social policies (such as governmental health policies or insurance compensation policies) on neck pain. A number of important questions remain about the effectiveness of commonly used interventions for neck pain. Conclusion. The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for whiplash-associated disorders. We identify a number of gaps in the current knowledge, and provide recommendations for the conduct of future studies
— id: 78661, year: 2008, vol: 17, page: S214, stat: Journal Article,

The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Cote, Pierre; van der Velde, Gabrielle; Cassidy, J David; Carroll, Linda J; Hogg-Johnson, Sheilah; Holm, Lena W; Carragee, Eugene J; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L; Guzman, Jaime; Peloso, Paul M
2008 Feb 15;33(4 Suppl):S60-S74, Spine
STUDY DESIGN: Systematic review and best evidence synthesis. OBJECTIVES: To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. SUMMARY OF BACKGROUND DATA: Previous reviews of the etiology of neck pain in workers relied on cross-sectional evidence. Recently published cohorts and randomized trials warrant a re-analysis of this body of research. METHODS: We systematically searched Medline for literature published from 1980-2006. Retrieved articles were reviewed for relevance. Relevant articles were critically appraised. Articles judged to have adequate internal validity were included in our best evidence synthesis. RESULTS: One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Quebec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. CONCLUSION: Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers
— id: 78458, year: 2008, vol: 33, page: S60, stat: Journal Article,

Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations
Guzman, Jaime; Haldeman, Scott; Carroll, Linda J; Carragee, Eugene J; Hurwitz, Eric L; Peloso, Paul; Nordin, Margareta; Cassidy, J David; Holm, Lena W; Cote, Pierre; van der Velde, Gabrielle; Hogg-Johnson, Sheilah
2008 Feb 15;33(4 Suppl):S199-S213, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To provide evidence-based guidance to primary care clinicians about how to best assess and treat patients with neck pain. SUMMARY OF BACKGROUND DATA: There is a need to translate the results of clinical and epidemiologic studies into meaningful and practical information for clinicians. METHODS: Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians. RESULTS: The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology. CONCLUSION: The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired
— id: 78463, year: 2008, vol: 33, page: S199, stat: Journal Article,

A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Guzman, Jaime; Hurwitz, Eric L; Carroll, Linda J; Haldeman, Scott; Cote, Pierre; Carragee, Eugene J; Peloso, Paul M; van der Velde, Gabrielle; Holm, Lena W; Hogg-Johnson, Sheilah; Nordin, Margareta; Cassidy, J David
2008 Feb 15;33(4 Suppl):S14-S23, Spine
STUDY DESIGN: Iterative discussion and consensus by a multidisciplinary task force scientific secretariat reviewing scientific evidence on neck pain and its associated disorders. OBJECTIVE: To provide an integrated model for linking the epidemiology of neck pain with its management and consequences, and to help organize and interpret existing knowledge, and to highlight gaps in the current literature. SUMMARY OF BACKGROUND DATA: The wide variability of scientific and clinical approaches to neck pain described in the literature requires a unified conceptual model for appropriate interpretation of the research evidence. METHODS: The 12-member Scientific Secretariat of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders critically reviewed and eventually accepted as scientifically admissible a total of 552 scientific papers. The group met face-to-face on 18 occasions and had frequent additional telephone conference meetings over a 6-year period to discuss and interpret this literature and to agree on a conceptual model, which would accommodate findings. Models and definitions published in the scientific literature were discussed and repeatedly modified until the model and case definitions presented here were finally approved by the group. RESULTS: Our new conceptual model is centered on the person with neck pain or who is at risk for neck pain. Neck pain is viewed as an episodic occurrence over a lifetime with variable recovery between episodes. The model outlines the options available to individuals who are dealing with neck pain, along with factors that determine options, choices, and consequences. The short- and long-term impacts of neck pain are also considered. Finally, the model includes a 5-axis classification of neck pain studies based on how subjects were recruited into each study. CONCLUSION: The Scientific Secretariat found the conceptual model helpful in interpreting the available scientific evidence. We believe it can assist people with neck pain, researchers, clinicians, and policy makers in framing their questions and decisions
— id: 78465, year: 2008, vol: 33, page: S14, stat: Journal Article,

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Carroll, Linda J; Holm, Lena W; Cassidy, J David; Guzman, Jamie; Cote, Pierre; Haldeman, Scott; Ammendolia, Carlo; Carragee, Eugene; Hurwitz, Eric; Nordin, Margareta; Peloso, Paul
2008 Feb 15;33(4 Suppl):S39-S51, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population. SUMMARY OF BACKGROUND DATA: The evidence on burden and determinants of neck has not previously been summarized. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis. RESULTS: We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing. CONCLUSION: Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain
— id: 78460, year: 2008, vol: 33, page: S39, stat: Journal Article,

The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Holm, Lena W; Carroll, Linda J; Cassidy, J David; Hogg-Johnson, Sheilah; Cote, Pierre; Guzman, Jamie; Peloso, Paul; Nordin, Margareta; Hurwitz, Eric; van der Velde, Gabrielle; Carragee, Eugene; Haldeman, Scott
2008 Feb 15;33(4 Suppl):S52-S59, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions. SUMMARY OF BACKGROUND DATA: Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. METHODS: A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980-2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis. RESULTS: The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females. CONCLUSION: WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed
— id: 78459, year: 2008, vol: 33, page: S52, stat: Journal Article,

Treatment of neck pain: Noninvasive interventions - Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Hurwitz, EL; Carragee, EJ; van Der Velde, G; Carroll, LJ; Nordin, M; Guzman, J; Peloso, PM; Holm, LW; Cote, P; Hogg-Johnson, S; Cassidy, JD; Haldeman, S
2008 APR ;17(3):S123-S152, European spine journal
Study Design. Best evidence synthesis. Objective. To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. Summary of Background Data. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. Methods. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. Results. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. Conclusion. Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies
— id: 78660, year: 2008, vol: 17, page: S123, stat: Journal Article,

Assessment of neck pain and its associated disorders - Results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders
Nordin, M; Carragee, EJ; Hogg-Johnson, S; Weine, SS; Hurwitz, EL; Peloso, PM; Guzman, J; van der Velde, G; Carroll, LJ; Holm, LW; Cote, P; Cassidy, JD; Haldeman, S
2008 APR ;17(3):S101-S122, European spine journal
Study Design. Best evidence synthesis. Objective. To critically appraise and synthesize the literature on assessment of neck pain. Summary of Background Data. The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. Methods. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontramatic neck pain. Results. We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. Conclusion. The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research
— id: 78659, year: 2008, vol: 17, page: S101, stat: Journal Article,

Comments about "European guidelines for the diagnosis and treatment of pelvic girdle pain"
Nordin, Margareta
2008 Jun;17(6):820-821, European spine journal
— id: 78453, year: 2008, vol: 17, page: 820, stat: Journal Article,

Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Nordin, Margareta; Carragee, Eugene J; Hogg-Johnson, Sheilah; Weiner, Shira Schecter; Hurwitz, Eric L; Peloso, Paul M; Guzman, Jaime; van der Velde, Gabrielle; Carroll, Linda J; Holm, Lena W; Cote, Pierre; Cassidy, J David; Haldeman, Scott
2008 Feb 15;33(4 Suppl):S101-S122, Spine
STUDY DESIGN: Best evidence synthesis. OBJECTIVE: To critically appraise and synthesize the literature on assessment of neck pain. SUMMARY OF BACKGROUND DATA: The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature. METHODS: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain. RESULTS: We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. CONCLUSION: The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research
— id: 78466, year: 2008, vol: 33, page: S101, stat: Journal Article,

Capability and recruitment patterns of trunk during isometric uniaxial and biaxial upright exertion
Sheikhzadeh, Ali; Parnianpour, Mohamad; Nordin, Margareta
2008 Jun;23(5):527-535, Clinical biomechanics
BACKGROUND: Work-related risk factors of low back disorders have been identified to be external moments, awkward postures, and asymmetrical dynamic lifting amongst others. The distinct role of asymmetry of load versus posture is hard to discern from the literature. Hence, the aim of this study is to measure isometric trunk exertions at upright standing posture at different exertion level and degree of asymmetry to further delineate the effects of exertion level and asymmetry on neuromuscular capability response. METHODS: Fifteen healthy volunteers randomly performed trunk exertions at three levels (30%, 60%, and 100% of maximum voluntary exertion and five different angles (0 degrees , 45 degrees , 90 degrees , 135 degrees , and 180 degrees ) of normalized resultant moments. During each trial, the normalized EMG activity of 10 selected trunk muscles was quantified. FINDINGS: The EMG activity of the 10 trunk muscles was significantly (P<0.001) affected by the level of exertion and angle of normalized resultant moment, and their interactions. The controllability of the torque generation was reduced in biaxial exertions. The capability to generate and control the required trunk moments is significantly lowered during biaxial trunk exertions, while all muscles present higher EMG activity. These results suggest that the trunk muscles will be taxed higher while performing biaxial exertion tasks, increasing muscle fatigue possibly leading to a higher probability of low back injury. INTERPRETATION: The prediction of biaxial trunk performance based on uniaxial data will result in an overestimation of capability and controllability of the trunk during physically demanding tasks. This study provides a better understanding of the potential mechanisms of injury during asymmetrical and biaxial trunk exertion during work-related tasks
— id: 76351, year: 2008, vol: 23, page: 527, stat: Journal Article,

Effects of aging on Type II muscle fibers: a systematic review of the literature
Brunner, Florian; Schmid, Annina; Sheikhzadeh, Ali; Nordin, Margareta; Yoon, Jangwhon; Frankel, Victor
2007 Jul;15(3):336-348, Journal of Aging & Physical Activity
The authors conducted a systematic review of the literature for scientific articles in selected databases to determine the effects of aging on Type II muscle fibers in human skeletal muscles. They found that aging of Type II muscle fibers is primarily associated with a loss of fibers and a decrease in fiber size. Morphological changes with increasing age particularly included Type II fiber grouping. There is conflicting evidence regarding the change of proportion of Type II fibers. Type II muscle fibers seem to play an important role in the aging process of human skeletal muscles. According to this literature review, loss of fibers, decrease in size, and fiber-type grouping represent major quantitative changes. Because the process of aging involves various complex phenomena such as fiber-type coexpression, however, it seems difficult to assign those changes solely to a specific fiber type
— id: 76352, year: 2007, vol: 15, page: 336, stat: Journal Article,

Nonspecific low back pain
Hiebert R; Weiser S; Campello M; Nordin M
Environmental and occupational medicine Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins, 2007,
— id: 4809, year: 2007, vol: , page: 924, stat: Chapter,

Association between sitting and occupational LBP
Lis, Angela Maria; Black, Katia M; Korn, Hayley; Nordin, Margareta
2007 Feb;16(2):283-298, European spine journal
Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP
— id: 72171, year: 2007, vol: 16, page: 283, stat: Journal Article,

Treatment options
Nordin, Margareta; Blague, Federico; Cedraschi, Christine
Musculoskeletal disorders in the workplace : principles and practice Philadelphia : Mosby Elsevier, 2007,
— id: 4672, year: 2007, vol: , page: ?, stat: Chapter,

Musculoskeletal disorders in the workplace : principles and practice
Nordin, Margareta; Pope, MH; Andersson, Gunnar
Philadelphia : Mosby Elsevier, 2007,
— id: 1408, year: 2007, vol: , page: , stat: ,

The effect of gender and fatigue on the biomechanics of bilateral landings from a jump: Peak values
Pappas, E; Sheikhzadeh, A; Hagins, M; Nordin, M
2007 MAR ;6(1):77-84, Journal of sports science & medicine
Female athletes are substantially more susceptible than males to suffer acute non-contact anterior cruciate ligament injury. A limited number of studies have identified possible biomechanical risk factors that differ between genders. The effect of fatigue on the biomechanics of landing has also been inadequately investigated. The objective of the study was to examine the effect of gender and fatigue on peak values of biomechanical variables during landing from a jump. Thirty-two recreational athletes performed bilateral drop jump landings from a 40 cm platform. Kinetic, kinematic and electromyographic data were collected before and after a functional fatigue protocol. Females landed with 9 greater peak knee valgus (p = 0.001) and 140% greater maximum vertical ground reaction forces (p = 0.003) normalized to body weight compared to males. Fatigue increased peak foot abduction by 1.7 (p = 0.042), peak rectus femoris activity by 27% (p = 0.018), and peak vertical ground reaction force (p = 0.038) by 20%. The results of the study suggest that landing with increased peak knee valgus and vertical ground reaction force may contribute to increased risk for knee injury in females. Fatigue caused significant but small changes on some biomechanical variables. Anterior cruciate ligament injury prevention programs should focus on implementing strategies to effectively teach females to control knee valgus and ground reaction force
— id: 71044, year: 2007, vol: 6, page: 77, stat: Journal Article,

Biomechanical differences between unilateral and bilateral landings from a jump: gender differences
Pappas, Evangelos; Hagins, Marshall; Sheikhzadeh, Ali; Nordin, Margareta; Rose, Donald
2007 Jul;17(4):263-268, Clinical journal of sport medicine
OBJECTIVE: To determine the effect of landing type (unilateral vs. bilateral) and gender on the biomechanics of drop landings in recreational athletes. DESIGN: This study used a repeated measures design to compare bilateral and unilateral landings in male and female athletes. A repeated measures multivariate analysis of variance (type of landing*gender) was performed on select variables. SETTING: Biomechanics laboratory. PARTICIPANTS: Sixteen female and 16 male recreational athletes. MAIN OUTCOME MEASURES: Kinetic, kinematic, and electromyographic (EMG) data were collected on participants while performing bilateral and unilateral landings from a 40-cm platform. RESULTS: Compared to bilateral landings, subjects performed unilateral landings with increased knee valgus, decreased knee flexion at initial contact, decreased peak knee flexion, decreased relative hip adduction, and increased normalized EMG of the rectus femoris, medial hamstrings, lateral hamstrings, and medial gastrocnemius (P < 0.005). During both types of landing, females landed with increased knee valgus and normalized vertical ground reaction force (VGRF) compared to males (P < 0.009), however, the interaction of landing type*gender was not significant (P = 0.29). CONCLUSIONS: Compared to bilateral landings, male and female recreational athletes performed unilateral landings with significant differences in knee kinematic and EMG variables. Female athletes landed with increased knee valgus and VGRF compared to males during both types of landing
— id: 76353, year: 2007, vol: 17, page: 263, stat: Journal Article,

A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria
Poitras, Stephane; Avouac, Jerome; Rossignol, Michel; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Eric; Hilliquin, Pascal
2007 ;9(6):R126-R126, Arthritis research & therapy
Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument--the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed
— id: 78467, year: 2007, vol: 9, page: R126, stat: Journal Article,

The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis
van der Velde, Gabrielle; van Tulder, Maurits; Cote, Pierre; Hogg-Johnson, Sheilah; Aker, Peter; Cassidy, J David; Carragee, Eugene; Carroll, Linda; Guzman, Jaime; Haldeman, Scott; Holm, Lena; Hurwitz, Eric; Nordin, Margareta; Peloso, Paul
2007 Apr 1;32(7):796-806, Spine
STUDY DESIGN: Systematic review. OBJECTIVE: To determine whether results and conclusions on the effectiveness of exercise for workers with neck pain vary with the Cochrane Back Review Group Guidelines and best-evidence synthesis review methods. To identify methodologic weaknesses associated with these review methods that may impact on the validity of their results. SUMMARY OF BACKGROUND DATA: The Cochrane Back Review Group Guidelines and best-evidence synthesis have different approaches to appraising trial quality and incorporating quality into data synthesis. The impact of different review methods on the reproducibility and validity of review results is unknown. METHODS AND RESULTS: Systematic search of Medline, Embase, CINAHL, and Cochrane databases, without language restrictions. Twelve trials were selected. Two review methods were used to appraise trial quality and to incorporate quality into data synthesis. As recommended by the Cochrane Back Review Group Guidelines, trials were assigned quality scores using a scale. Results of all 12 trials were stratified into levels of evidence according to their scores. Based on these results, no treatment recommendation could be formulated. Best-evidence synthesis critically appraised methodology; trials were accepted on the strength of their scientific merit or rejected due to risk of bias. According to the 4 trials accepted for best-evidence synthesis, workers should be activated with exercise given its beneficial effect on patient-perceived recovery. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis reviews were found to have weaknesses associated with their methods. CONCLUSIONS: Review results and conclusions are sensitive to methods for appraising trial quality and incorporating quality into data synthesis when the evidence consists largely of low-quality trials. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis methods were found to have strengths and methodologic weaknesses that healthcare decision-makers should be aware of when interpreting systematic reviews
— id: 72168, year: 2007, vol: 32, page: 796, stat: Journal Article,

Self-care techniques for acute episodes of back pain
Weiser S; Campello M; Nordin M; Pietrek M
Pain : best practice & research compendium Edinburgh : Elsevier, 2007,
— id: 4808, year: 2007, vol: , page: 83, stat: Chapter,

Osteoporosis
Atik, O Sahap; Korkusuz, Feza; Moskovich, Ronald; Nordin, Margareta
Hagerstown MD : Lippincott Williams & Wilkins, 2006,
— id: 1413, year: 2006, vol: , page: , stat: ,

The potential value of blood biomarkers of intervertebral disk metabolism in the follow-up of patients with sciatica
Balague, Federico; Nordin, Margareta; Schafer, Dominique; Sheikhzadeh, Ali; Lenz, Mary Ellen; Thonar, Eugene M A
2006 May;15(5):627-633, European spine journal
STUDY DESIGN: This is a prospective study with a follow-up period of 4 years. OBJECTIVES: The study aimed to evaluate the possible clinical utility of three biomarkers [i.e., keratan sulfate (KS), hyaluronan, and cartilage oligomeric matrix protein] measured in peripheral blood in severe acute sciatica at intake and follow-up. SUMMARY OF BACKGROUND: Our previous study and others have pointed out the interest of different laboratory tests in the acute phase of sciatica. Several blood biomarkers have been reported useful in the long-term follow-up of patients with osteoarthritis. We have found no information about the potential interest of these tests in spinal disorders. METHODS: Patients were admitted to the hospital for intensive conservative management of acute sciatica (n=82). A subgroup of patients (n=33) was selected based on the duration of symptoms at visit 1, and included those with the shortest (n=24) as well as those with the longest (n=9) duration of sciatica. Blood samples were drawn, centrifuged, and the plasma frozen. Antigenic KS, hyaluronan, and cartilage oligomeric matrix protein were measured by ELISA. Patients were re-evaluated at an average of 4.3 years (range: 2.1-6.8 years). RESULTS: Thirty-three subjects with an average age of 49.2+/-10.2 years participated. At intake, levels of the three biomarkers evaluated were within the range of normal values. No significant differences were found between the results of patients with a short history of sciatica (< or =3 weeks) and those with a long duration of symptoms (>20 weeks). At follow-up, a significant increase (P<0.05) in all three biomarkers was found. CONCLUSIONS: A single measurement of these three biomarker molecules does not seem to have any diagnostic or therapeutic relevance in patients with acute radicular compression. The significance of the increase in all three biomarkers after a mean follow-up of 4.3 years is unclear; it might reflect metabolic processes involved in degenerative spinal disorders. Even though we found no correlation with clinical outcome, we believe that more research is needed
— id: 72172, year: 2006, vol: 15, page: 627, stat: Journal Article,

Work retention and nonspecific low back pain
Campello, Marco A; Weiser, Sherri R; Nordin, Margareta; Hiebert, Rudi
2006 Jul 15;31(16):1850-1857, Spine
STUDY DESIGN: A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidisciplinary rehabilitation program. OBJECTIVE: To identify factors that predict work retention 24 months after treatment in patients with nonspecific LBP. SUMMARY OF BACKGROUND DATA: There is evidence that select physical, psychologic, and psychosocial factors are related to positive outcome for work-related nonspecific LBP. However, there is very little information related to work retention following an episode of nonspecific LBP. This is an exploratory study to identify select physical and psychosocial factors related to work retention. METHODS: Patients who returned to work after treatment (n = 67) were followed for 2 years. Physical baseline measures included tests of flexibility, strength, and functional capacity. Psychosocial baseline measures were The Symptoms Checklist 90-R, The Pain Beliefs and Perceptions Inventory, The Oswestry Scale of perceived disability, The Work Stress Inventory, and The Quality of Life Scale. All physical parameters, perceived disability, and quality of life were tested before and after treatment. The dependent variable, work retention, was defined as the number of days that the subject worked during the 2-year follow-up period. Survival analysis was used to establish the predictive model. RESULT: The average time out of work before treatment was 9 months (standard deviation 12.8) for 67 subjects (mean age 40 years [standard deviation 9.6]), including 18 females and 49 males. There were 18 participants (25%) that had interruption of work retention at follow-up. Average work retention was 362 days (range 47-682). Variables that reached a P value of <0.10 in the bivariate analysis were included in the multivariate analysis. They were trunk flexion (hazard ratio [HR = 2.4], 95% confidence interval [CI] 1.24-4.38; P = 0.01), trunk extension (HR = 2.1, 95% CI 1.02-4.16; P = 0.04), the somatization scale from the Symptom Checklist 90 revised (HR = 2.0, 95% CI 1.03-4.05; P = 0.04), and the obsessive-compulsiveness scale from the Symptom Checklist 90 revised (HR = 0.4, 95% CI 0.12-1.15; P = 0.09). Results showed that post-test trunk flexion, somatization, and obsessive compulsiveness predicted work retention (final trunk flexion HR = 2.5 [95% CI 1.26-4.79; P = 0.01], somatization scale HR = 2.5 [95% CI 1.25-4.93; P = 0.01], and obsessive compulsion HR = 0.2 [95% CI 0.07-0.77; P = 0.02]). CONCLUSION: Psychosocial and physical factors are associated with work retention for patients with nonspecific LBP. The predictive value of certain constructs may vary with the time when they are assessed and how outcome is operationalized. Further studies are needed to confirm these findings
— id: 67009, year: 2006, vol: 31, page: 1850, stat: Journal Article,

The effects of breath control on maximum force and IAP during a maximum isometric lifting task
Hagins, Marshall; Pietrek, Markus; Sheikhzadeh, Ali; Nordin, Margareta
2006 Oct;21(8):775-780, Clinical biomechanics
BACKGROUND: Evidence exists linking breath control to increases in intra-abdominal pressure and lumbar stability. Weight-lifting experts use this evidence as a rationale to suggest that increases in lumbar stability afforded by specific forms of breath control can influence the amount of force produced by the trunk. No studies have examined this issue. Therefore, this study determined whether voluntary control of the breath is related to maximal trunk extension force and if maximal force is correlated to intra-abdominal pressure. METHODS: Thirteen men and 20 women (mean age: 25.6 years (5.5)) performed a maximal isometric trunk exertion in a knee bent posture using voluntary breath conditions: (1) inhalation prior to exertion with hold during exertion; (2) exhalation prior to exertion with hold during the exertion; (3) inhalation prior to the exertion with exhalation during the exertion. A subset of subjects (n=11) were also simultaneously measured for intra-abdominal pressure. Separate repeated measures ANOVA were used to determine the effects of breath conditions on force and intra-abdominal pressure. Pearson coefficients were used to determine the correlation between force and intra-abdominal pressure. FINDINGS: Breath control did not significantly affect isometric force production (P=.089) but did affect intra-abdominal pressure (P=.003). Correlations between force and intra-abdominal pressure in each breath condition were low (range: 0.152-0.583). INTERPRETATION: Although breath control was shown to influence intra-abdominal pressure, it does not appear to influence isometric trunk extension force in a knees bent position. Further, the intra-abdominal pressure produced in such efforts appears to be unrelated to the amount of force produced
— id: 72170, year: 2006, vol: 21, page: 775, stat: Journal Article,

Methodological aspects of outcomes research
Hiebert, Rudi; Nordin, Margareta
2006 Jan;15 Suppl 1:S4-16, European spine journal
A critical evaluation of existing scientific evidence of treatment efficacy can be an important part of communicating risk and benefits of treatment options to patients during the course of clinical practice. A checklist of key methodological issues to examine when reading a research study is presented and discussed. Steps in reading a paper include: identifying the research question; identifying the manner in which subjects get enrolled in the study; identifying the treatments and outcomes used; identifying the study design and the comparisons being made; evaluating the study methods for the possibility of bias and uncontrolled confounding; assessing whether the statistical analysis used is appropriate for the study design; assessing whether the study has sufficient statistical power to demonstrate hypotheses being tested. Finally, procedures for grading and evaluating evidence, as used by systematic review groups and international best evidence synthesis consensus groups is briefly described
— id: 64580, year: 2006, vol: 15 Suppl 1, page: S4, stat: Journal Article,

Surgical versus nonsurgical management of spinal disorders - Comment
Moskovich, R; Nordin, M
2006 FEB ;44(443):132-134, Clinical orthopaedics & related research
— id: 69823, year: 2006, vol: 44, page: 132, stat: Journal Article,

Nonspecific lower-back pain - Surgical versus nonsurgical treatment - Reply
Nordin, M; Balague, F; Cedraschi, C
2006 NOV ;44(452):287-288, Clinical orthopaedics & related research
— id: 69824, year: 2006, vol: 44, page: 287, stat: Journal Article,

Nonspecific lower-back pain: surgical versus nonsurgical treatment
Nordin, Margareta; Balague, Federico; Cedraschi, Christine
2006 Feb;443:156-167, Clinical orthopaedics & related research
We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized controlled trials (ie, possibly those not previously included in the latest systematic reviews) were reviewed and added based on recommended procedures for the evaluation of methodological quality (ie, strong, moderate, and weak). In acute nonspecific lower-back pain (0-4 weeks duration of pain) there is moderate to strong evidence that self-care with over-the-counter medication and maintaining activity as tolerated or treatment with a limited number of sessions of manipulative therapy is effective for pain relief. In subacute nonspecific lower-back pain (4-12 weeks duration of pain) there is weak to moderate evidence that a graded activity program including exercises and cognitive behavioral treatment in combination is more efficient than usual care with regard to return to work. There is strong evidence that these programs reduce work absenteeism. In cases of chronic nonspecific lower-back pain (> 12 weeks duration of pain) a variety of treatments are available with limited and similar efficacy on pain and disability reduction. There is moderate evidence that surgery in chronic nonspecific lower-back pain is as effective as cognitive behavioral treatment with regard to pain, function, mood and return to work. Surgical indications for chronic nonspecific lower-back pain remain ill defined. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence
— id: 63074, year: 2006, vol: 443, page: 156, stat: Journal Article,

Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS)
Vignon, Eric; Valat, Jean-Pierre; Rossignol, Michel; Avouac, Bernard; Rozenberg, Sylvie; Thoumie, Philippe; Avouac, Jerome; Nordin, Margareta; Hilliquin, Pascal
2006 Jul;73(4):442-455, Joint, bone, spine
The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. METHODS: Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. CONCLUSIONS AND RECOMMENDATIONS: For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C)
— id: 72169, year: 2006, vol: 73, page: 442, stat: Journal Article,

Restoring patients with nonspecific low back pain to gainful employment
Wesiser S; Campello M; Nordin M; Hiebert R
Rothman-Simeone the spine Philadelphia : Saunders Elsevier, 2006,
— id: 4555, year: 2006, vol: , page: 1595, stat: Chapter,

Stent implantation, but not pathogen burden, is associated with plasma C-reactive protein and interleukin-6 levels after percutaneous coronary intervention in patients with stable angina pectoris
Saleh, Nawsad; Svane, Bertil; Jensen, Jens; Hansson, Lars-Olof; Nordin, Margareta; Tornvall, Per
2005 May;149(5):876-882, American heart journal
BACKGROUND: The systemic inflammatory response to percutaneous coronary intervention (PCI) is associated with recurrent cardiac events; however, the pathophysiology of this inflammatory response is not well understood. The present study was performed to investigate the role of pathogen burden of infection in determining the magnitude of C-reactive protein (CRP) and interleukin 6 (IL-6) response to PCI. METHODS: One hundred patients with stable angina pectoris undergoing elective PCI at a single center were recruited. Antibodies against cytomegalovirus, Chlamydia pneumoniae , Epstein-Barr virus, Helicobacter pylori , and herpes simplex virus types 1 and 2 were determined before PCI. Plasma CRP and IL-6 levels were measured before and 6, 24, 48, 72 hours after PCI and data presented as area under the curve. RESULTS: Plasma CRP and IL-6 concentrations increased significantly after PCI. Neither antibodies against single nor multiple pathogens were associated with the CRP or IL-6 response to PCI. No correlations were found between the inflammatory markers and troponin T levels after PCI. With the exception for CRP and body mass index (R = 0.20, P < .05), neither risk factors for coronary heart disease nor medication but stent implantation was associated with increased plasma CRP (76 vs 61 mg/L, P < .005) and IL-6 (74 vs 64 pg/mL, P < .005) levels after PCI. CONCLUSION: Stent implantation, but not pathogen burden, is associated with the plasma CRP and IL-6 response to PCI
— id: 72173, year: 2005, vol: 149, page: 876, stat: Journal Article,

Biomechanica van het spier-skeletsysteem : grondslagen en toepassingen
Frankel, Victor H; Nordin, Margareta; Snijders, Chris J
Maarssen : Elsevier, 2004,
Basic biomechanics of the muscoloskeletal system, 2nd ed, translated into Dutch by Chris J Snijders
— id: 1411, year: 2004, vol: , page: , stat: ,

Musculoskeletal symptom survey among cement and concrete workers
Goldsheyder, David; Weiner, Shira Schecter; Nordin, Margareta; Hiebert, Rudi
2004 ;23(2):111-121, Work: a journal of prevention, assessment, & rehabilitation
Work in construction is associated with a high risk for musculoskeletal disorders and injuries. The symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the cement and concrete workers and identify the most problematic work-related activities and job factors that might have contributed to the occurrence of these disorders. Findings revealed that a large proportion of the laborers (77%) experienced at least one musculoskeletal disorder in the last year. Low back pain was reported as the most frequently experienced symptom (66%). 'Working while in pain' the concrete workers perceived as the major problem in the trade. Other problematic work-related activities included 'bending or twisting the back', 'work in hot, cold or wet conditions', and 'handling heavy objects'. Most of the laborers (82%) requested on-the-job safety training. Survey results combined with the outcomes of focus groups discussions and work site observations were used in the design of a training program aimed at the prevention of musculoskeletal morbidity in the trade. The program incorporated ergonomics principles, hazard recognition, safe work practices, problem solving and personal protection in the training curriculum for membership of the trade
— id: 47812, year: 2004, vol: 23, page: 111, stat: Journal Article,

The effects of breath control on intra-abdominal pressure during lifting tasks
Hagins, Marshall; Pietrek, Markus; Sheikhzadeh, Ali; Nordin, Margareta; Axen, Kenneth
2004 Feb 15;29(4):464-469, Spine
STUDY DESIGN: This was a repeated measures study examining 11 asymptomatic subjects while performing dynamic lifting using various postures, loads, and breath control methods. OBJECTIVES: To examine the effects of breath control on magnitude and timing of intra-abdominal pressure during dynamic lifting. SUMMARY OF BACKGROUND DATA: Intra-abdominal pressure has been shown to increase consistently during static and dynamic lifting tasks. The relationship between breath control and intra-abdominal pressure during lifting is not clear. METHODS: Eleven healthy subjects were tested using lifting trials consisting of two levels of posture and load and four levels of breath control (natural breathing, inhalation-hold, exhalation-hold, inhalation-exhalation). Intra-abdominal pressure was measured using a microtip pressure transducer placed within the stomach through the nose. Timing of intra-abdominal pressure was determined relative to lift-off of the weights. Repeated measures analysis of variance was used to determine the effect of breath control, posture, and load on intra-abdominal pressure magnitude and timing. RESULTS: There was a significant effect of breath control (P < 0.018) and load (P < 0.002), but not of posture (P < 0.434), on intra-abdominal pressure magnitude. The inhalation-hold form of breath control produced significantly greater peak intra-abdominal pressure than all other forms of breath control (P < 0.000 for all comparisons). No other comparisons among levels of breath were significantly different. No significant main effects of breath control were found relative to intra-abdominal pressure timing. CONCLUSIONS: Breath control is a significant factor in the generation of intra-abdominal pressure magnitude during lifting tasks. The effects of respiration should be controlled in studies analyzing intra-abdominal pressure during lifting
— id: 72174, year: 2004, vol: 29, page: 464, stat: Journal Article,

Non-specific low back pain : current issues in treatment
Nordin M; Lis A; Weiser S; Campello M
The adult and pediatric spine Philadelphia : Lippincott Williams & Wilkins, 2004,
— id: 4556, year: 2004, vol: , page: 307, stat: Chapter,

Biomecanica basica del sistema musculoesqueletico
Nordin, Margareta; Frankel, Victor Hirsch
Madrid : McGraw-Hill Interamericana, 2004,
Translation of Basic biomechanics of the musculoskeletal system
— id: 1414, year: 2004, vol: , page: , stat: ,

Low back pain in Mozambican adolescents
Prista, A; Balague, F; Nordin, M; Skovron, M L
2004 Jul;13(4):341-345, European spine journal
Recent literature shows that the prevalence of low back pain (LBP) in adolescents living in Western countries approaches that of adults 18-55 years of age. Moreover, epidemiological studies have also shown that the frequency of different rheumatic disorders in developing countries is similar to that found in Western industrialized regions. The purpose of this study was to ascertain the prevalence of LBP and to explore some risk factors among adolescents living in different zones of Mozambique. A previously validated questionnaire was distributed to schoolchildren of grades 6 and 7 living in three different residential/social regions of the country. Two hundred four (204) children participated in the survey. Median age was 13 years (age range 11-16 years) and 46% were boys. Several episodes of LBP interfering with usual activities during the previous year were reported by 13.5% of the sample. Living in the wealthier urban center (as compared with the peripheral regions) and walking >30 min per day to and from school were associated with an increased risk of LBP (OR 3.1, 95% CI 0.99-9.48, and OR 4.8, 95% CI 1.61-14.28, respectively)
— id: 78468, year: 2004, vol: 13, page: 341, stat: Journal Article,

Low-back pain in children
Balague, Federico; Dudler, Jean; Nordin, Margareta
2003 Apr 26;361(9367):1403-1404, Lancet
— id: 72175, year: 2003, vol: 361, page: 1403, stat: Journal Article,

Work restrictions and outcome of nonspecific low back pain
Hiebert, Rudi; Skovron, Mary Louise; Nordin, Margareta; Crane, Michael
2003 Apr 1;28(7):722-728, Spine
STUDY DESIGN: Retrospective cohort study was conducted. OBJECTIVE: To evaluate the association of prescribed work restrictions with work absenteeism and recurrence in cases of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The efficacy of commonly prescribed work restrictions in limiting sickness-related absence because of back pain has not been evaluated. METHODS: Employees who had back pain-related sickness absence were identified from medical records of a utility company. The workers were grouped into those who had received a work restriction for their back pain and those who had not. The duration of work disability was compared between the two groups. Employees who returned back to regular, full duty within 1 year of onset were followed for one additional year to determine rates of recurrence. The Cox Proportional Hazards model was used to generate hazard ratios adjusted for age, gender, and job category. RESULTS: Restrictions were given to 43% of the workers. Sickness absence duration did not differ between those who had received restrictions and those who had not (adjusted hazard ratio, 1.12; P = 0.41). The median duration of restricted duty was 32.5 days. For 22% of the workers, restricted duty was never lifted. Recurrence appeared less likely to occur among those who had work restrictions in their initial episode. However, this difference was not statistically significant (adjusted hazard ratio, 0.77; P = 0.48). CONCLUSIONS: No evidence of an association between a prescription of work restriction and early return to work was found. More research is needed to clarify the utility of restricted duty in promoting a positive outcome for work-related low back pain
— id: 39255, year: 2003, vol: 28, page: 722, stat: Journal Article,

Measures for low back pain: a proposal for clinical use
Nordin, Margareta; Alexandre, Neusa Maria Costa; Campello, Marco
2003 Mar-Apr;11(2):152-155, Revista latino-americana de enfermagem
Low back pain represents a serious public health problem. Therefore, great efforts have been made in order to improve and assess the efficacy of its treatment. Reports in international literature have presented important studies concerning instruments to assess pain and functional incapacity in patients with low back pain. This study presents a clinical protocol which was developed by a multidisciplinary team. This protocol consists of the evaluation and distribution of pain, The Spitzer Quality of Life, The Oswestry Low Back Pain Disability Questionnaire, and The Center for Epidemiological Studies Depression Scale. Instruments must be urgently developed or adapted in order to be used according to the Brazilian reality
— id: 39144, year: 2003, vol: 11, page: 152, stat: Journal Article,

Biomecanica basica do sistem musculoesqueletico
Nordin, Margareta; Frankel, Victor H
Rio de Janeiro : Guanabara Koogan, 2003,
Basic biomechanics of the musculoskeletal system translated into Portugese by Antonio Carlos Marins Pedroso
— id: 1419, year: 2003, vol: , page: , stat: ,

Arousal increases baroreflex inhibition of muscle sympathetic activity
Wallin, B Gunnar; Donadio, V; Karlsson, T; Kallio, M; Nordin, M; Elam, M
2003 Mar;177(3):291-298, Acta physiologica Scandinavica
AIM: Surprising sensory stimuli causing arousal are known to evoke short-lasting activation of human sympathetic activity in skin but not in muscle nerves. In fact, anecdotal observations suggest that muscle sympathetic activity may be inhibited. To test this hypothesis, the effects of surprising somatosensory (electrical skin pulses) or visual (flash) stimuli on multiunit muscle sympathetic activity were studied in 36 healthy subjects, aged 19-71 years. METHODS: The stimuli were given either 200 or 400 ms after the R-wave of the electrocardiogram. Dummy stimuli, consisting of trigger pulses without sensory stimuli, served as controls. RESULTS: On a group basis, a single sensory stimulus of either type attenuated the amplitude of one or two sympathetic bursts, while no such effects occurred after dummy stimuli. Individually, the inhibition was evoked by at least one stimulus modality or delay in 16 subjects, whereas in three subjects no significant inhibition occurred. Electrodermal signs of skin sympathetic activation were present in all subjects. Compared with one, five repeated electrical skin pulses induced only minor additional inhibition of muscle sympathetic activity, indicating marked habituation of the neural response. In nine subjects, the experiments were repeated once and in three subjects twice (with intervals of 2-3 months); in 11 of the 12 subjects, the sympathetic effects were reproducible. In the group of subjects without significant sympathetic inhibition the stimuli induced a small, transient increase of mean blood pressure, which was not present in the group with sympathetic inhibition. CONCLUSION: The finding that different sensory stimuli induce similar effects that habituate markedly on repetition suggests that the inhibition of muscle sympathetic activity is because of arousal. The interindividual differences in sympathetic and blood pressure effects may be part of interindividual differences in behavioural responses to stress
— id: 78470, year: 2003, vol: 177, page: 291, stat: Journal Article,

Predictors of compliance with short-term treatment among patients with back pain
Alexandre, Neusa Maria Costa; Nordin, Margareta; Hiebert, Rudi; Campello, Marco
2002 Aug;12(2):86-94, Revista panamericana de salud publica = Pan American journal of public health
OBJECTIVE: Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain. METHODS: This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance. RESULTS: We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program. CONCLUSIONS: The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain
— id: 72178, year: 2002, vol: 12, page: 86, stat: Journal Article,

Glycosphingolipid antibodies in serum in patients with sciatica
Brisby, Helena; Balague, Federico; Schafer, Dominique; Sheikhzadeh, Ali; Lekman, Annika; Nordin, Margareta; Rydevik, Bjorn; Fredman, Pam
2002 Feb 15;27(4):380-386, Spine
STUDY DESIGN: Serum antibody titers against 10 different glycosphingolipids were investigated by enzyme-linked immunosorbent assay in three groups of patients: patients with acute sciatica (Group IA, radicular pain for 32 +/- 36 days, n = 68), a subgroup of these patients 4 years later (Group IB, n = 23), and patients undergoing lumbar discectomy because of disc herniation (Group II, n = 37). OBJECTIVES: To investigate the immunologic response in sciatica patients by analyzing circulating autoantibodies against glycosphingolipids, molecules highly expressed in cells from the nervous system, and the possible correlation of such antibodies to clinical and imaging findings as well as to subjective symptoms. SUMMARY OF BACKGROUND DATA: The titers of glycosphingolipid antibodies are elevated in neurologic diseases with autoimmune stimulation such as Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy. METHODS: Antiglycosphingolipid antibodies were assayed by a microtiter enzyme-linked immunosorbent assay method. Antibody titers were related to a healthy population by a method that judges all positive results (positive result = patient sera/pooled blood donor serum >2, at titer 1/400) as indicating a pathologic condition. RESULTS: Increased levels of circulating antibodies against one or more glycosphingolipids were detected in 71% of patients with acute sciatica, in 61% of sciatica patients at a 4-year follow-up visit (eight antigens analyzed) and in 54% in patients undergoing discectomy. These frequencies were somewhat higher than, and in the last group similar to, those reported for generalized nervous system disorders with autoimmune involvement. In the acute sciatica patients, positive neurologic findings were associated with increased levels of two of the examined antibodies: 3'LM1 (immunoglobulin M and/or immunoglobulin G), P = 0.023, and GD1a (immunoglobulin M), P = 0.017. CONCLUSION: The presence of glycosphingolipid antibodies in patients with sciatica and disc herniation suggests an activation of the immune system and thus a process possibly involved in the pathophysiology of sciatica. The autoimmune response was not limited to antibodies against one specific glycosphingolipid target; rather, an overall increase in autoantibodies against nervous system-associated glycosphingolipids was observed. These results encourage further studies of the pathophysiologic and clinical relevance of autoimmune responses in patients with sciatica and disc herniation
— id: 72181, year: 2002, vol: 27, page: 380, stat: Journal Article,

Musculoskeletal symptom survey among mason tenders
Goldsheyder, David; Nordin, Margareta; Weiner, Shira Schecter; Hiebert, Rudi
2002 Nov;42(5):384-396, American journal of industrial medicine
BACKGROUND: Low back pain (LBP) constitutes a major problem in construction. The magnitude and musculoskeletal injury characteristics in certain construction trades have been studied extensively. Musculoskeletal research targeting mason tenders is limited. High physical demands of the job primarily contribute to an increased risk of LBP experienced by these laborers. METHODS: A symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the mason tenders, and to identify work-related activities perceived by them as contributing to their disorders. RESULTS: The findings revealed that 82% of the mason tenders experienced at least one musculoskeletal symptom in the last year. LBP was the most frequently reported symptom (65%). Due to LBP, 12% of the laborers missed work and 18% of them visited a physician. Bending or twisting the back, working in the same position or in pain, and heavy lifting they perceived as the most problematic work-related activities. The vast majority of the laborers requested job-safety training. CONCLUSIONS: The mason tenders experienced high prevalence of LBP. To address the problem a model for primary prevention of LBP was developed and implemented in the trade. The model incorporated ergonomic principles, hazard recognition, and problem solving in the training curriculum for the union instructors teaching apprentices the trade-specific skills
— id: 72177, year: 2002, vol: 42, page: 384, stat: Journal Article,

Current chemotherapy protocols for childhood acute lymphoblastic leukemia induce loss of humoral immunity to viral vaccination antigens
Nilsson, Anna; De Milito, Angelo; Engstrom, Par; Nordin, Margareta; Narita, Mitsuo; Grillner, Lena; Chiodi, Francesca; Bjork, Olle
2002 Jun;109(6):e91-e91, Pediatrics
OBJECTIVE: To evaluate viral vaccination immunity and booster responses in children treated successfully for acute lymphoblastic leukemia by chemotherapy and to study the response to treatment of antibody-producing plasma cells that are important for persistence of humoral immunity. METHODS: Forty-three children who were in continuous first remission for a median of 5 years (range: 2-12 years) were studied. Before the leukemia was diagnosed, all children had been immunized against measles, mumps, and rubella according to the Swedish National immunization program. We analyzed levels of serum antibodies against measles and rubella by enzyme immunoassays. Avidity tests for measles antibodies were concomitantly performed by enzyme-linked immunosorbent assay for measles virus immunoglobulin G detection. The proportion of plasma cells in bone marrow was studied by flow cytometry at different times during treatment and follow-up. Children who lacked protective levels of antibodies to vaccination antigens were reimmunized. Serum was collected 3 months after immunization to assess vaccination responses. RESULTS: After completion of the treatment, only 26 of the 43 children (60%) were found to be immune against measles and 31 (72%) against rubella. The proportion of bone marrow plasma cells decreased during treatment but returned to normal after 6 months. Revaccination caused both primary and secondary immune responses. Six of the 14 children without immunity failed to achieve protective levels of specific antibodies against measles and 3 against rubella. CONCLUSIONS: Our finding of loss of antibodies against measles and rubella in children treated with intensive chemotherapy suggests that reimmunization of these patients is necessary after completion of the treatment. To determine reimmunization schedules for children treated with chemotherapy, vaccination responses need to be studied further
— id: 72180, year: 2002, vol: 109, page: e91, stat: Journal Article,

Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations
Nordin, Margareta; Hiebert, Rudi; Pietrek, Markus; Alexander, Michelle; Crane, Michael; Lewis, Stuart
2002 Jul;44(7):677-684, Journal of occupational & environmental medicine
We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP
— id: 72179, year: 2002, vol: 44, page: 677, stat: Journal Article,

Self-care techniques for acute episodes of low back pain
Nordin, Margareta; Welser, Sherri; Campello, Marco A; Pietrek, Markus
2002 Jan;16(1):89-104, Bailliere's best practice & research. Clinical rheumatology
Guidelines recommend minimal medical intervention for acute non-specific low back pain. However, patients often request strategies to reduce symptoms and recover quickly. Self-care techniques that do not contradict current evidence-based recommendations may be suggested. Self-care techniques can reduce costs and iatrogenic complications that can occur with medical treatment. They may also increase the patient's perception of control and improve long-term outcome. A shift in paradigm for the health care provider and the patient is required for self-care to be successful. These issues, as well as self-care approaches such as medication, exercises, modalities and mind-body techniques are discussed. Practice points for each approach are given
— id: 39657, year: 2002, vol: 16, page: 89, stat: Journal Article,

A 2-year prospective longitudinal study on low back pain in primary school children
Szpalski, M; Gunzburg, R; Balague, F; Nordin, M; Melot, C
2002 Oct;11(5):459-464, European spine journal
There is increasing evidence that non-specific low back pain (LBP) is common among children and adolescents, but there are few longitudinal studies on this subject. This is a longitudinal prospective study aimed at finding factors associated with the prediction of low back pain in schoolchildren aged 9-12 years, which is a younger age group than has previously been studied. This study was performed on school children in the city of Antwerp, Belgium. A total of 287 children filled out a questionnaire and were examined at the beginning of the study (T1) and 2 years later (T2). The questionnaire asked about back pain, general health, health perceptions, quality of life perceptions, sports, leisure, daily life, school life (weight of satchel.) and some issues related to parents (smoking, LBP). The questionnaire reliability was tested. Logistic regression was used to analyse the data. No predictors for LBP in children could be identified. Using logistic regression techniques, we analysed the children who reported no lifetime episode of LBP at both T1 and T2, the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only (New LBP). At T2 there were 51 children (17.8%) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1. Only one parameter showed a statistical difference: New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001). An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2. It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away. It is extremely interesting to note that among the few significant variables, those related to general well-being and self-perception of health, are prominent. It appears, therefore, that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults. Poor self-perception of health (health belief) could be a factor behind the reporting of LBP. Some variables linked to consequences of LBP (absence from school or from gym and visit to a doctor) play a significant role in reporting LBP, which suggests that those 'health care' factors may reinforce a feeling of disease severity
— id: 78471, year: 2002, vol: 11, page: 459, stat: Journal Article,

Recovery of impaired muscle function in severe sciatica
Balague, F; Nordin, M; Sheikhzadeh, A; Echegoyen, A C; Skovron, M L; Bech, H; Chassot, D; Helsen, M
2001 Jun;10(3):242-249, European spine journal
This is a prospective cohort study of patients with acute treated severe sciatica. The objectives of the study are, firstly, to describe the recovery of muscle performance by manual and isokinetic muscle testing in patients with acute severe sciatica over 1 year, and secondly, to discuss the potential clinical relevance of the isokinetic testing of the ankle for patients with acute sciatica. In clinical daily practice, muscle performance is evaluated by means of isometric manual tests. Different authors using manual muscle tests have reported the long-term outcome of the muscle function in patients with sciatica. Overall, the results are good in terms of the recovery of muscle strength. However, it is not clear whether the isometric strength is sufficiently relevant to evaluate the more complete muscle performance of the affected muscles in patients with sciatica. This study presents data on the muscle recovery measured with manual testing and isokinetic testing of patients with severe sciatica. Consecutive patients admitted to the Cantonal Hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and follow-up at 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires. Imaging and electromyography were conducted at the first visit. Isokinetic muscle tests at 30 degrees/s and 120 degrees/s were performed at discharge and follow-up visits. Manual and isokinetic tests were performed on foot and ankle flexor and extensor muscles. Eighty-two consecutive patients (66% men), with a mean age of 43 (+/-10.3) years, entered the study. The prevalence of major muscle weakness was low, with 7% of patients unable to perform toe walking and 11% unable to walk on the heel at visit one. Moreover, motor deficit defined as a score of 4 or less (out of 5) was found in 15% of subjects at the first evaluation. Such severe deficits were not found during the last three visits. The isokinetic tests showed a higher prevalence of muscle function impairment. At visit 5, the isokinetic test showed impaired muscle function recovery from 23% to 32%, while the manual test showed almost full recovery. The issues of agreement between manual and isokinetic muscle testing are discussed. In this selected and homogeneous cohort of patients, the prevalence of motor deficit was rather low and the outcome excellent according to the results of the manual testing. Isokinetic muscle tests showed a higher prevalence of deficit and a much slower recovery. The manual muscle test is a crude clinical test. For more indepth muscle performance evaluation, additional testing may be necessary, especially for those patients with physically demanding jobs or activities
— id: 76354, year: 2001, vol: 10, page: 242, stat: Journal Article,

Testing apparatus and experimental procedure for position specific normalization of electromyographic measurements of distal upper extremity musculature
Barr, A E; Goldsheyder, D; Ozkaya, N; Nordin, M
2001 Aug;16(7):576-585, Clinical biomechanics
OBJECTIVE: An apparatus and procedure are described to determine position specific normalization coefficients for surface EMG of upper extremity musculature. STUDY DESIGN: Thirty-nine subjects were tested three times. Repeatability of EMG measurements across test sessions was determined by computing intraclass correlation coefficients. Two-way analysis of variance was used to test upper extremity position dependent differences in EMG measurements. BACKGROUND: EMG measurements are susceptible to error from skin movement and muscle length changes, both of which may occur when upper extremity positions vary. Normalization of the EMG signal without consideration for such positional influences may lead to erroneous conclusions regarding muscle activation during functional tasks. METHOD: An apparatus was designed that allowed subjects to perform three repetitions of maximum elbow flexion, forearm pronation, wrist extension, and wrist flexion with the forearm in neutral and pronated positions. Surface EMG was sampled from eight muscles. Mean EMG on maximum voluntary contraction was computed, and resting EMG was subtracted to obtain EMG normalization coefficients. RESULTS: Upper extremity position affected the EMG normalization coefficient for biceps brachii, which was lower in the pronated position, and extensor carpi radialis, which was higher in the pronated position (P<0.00625). CONCLUSIONS: The apparatus accommodates various combined positions of the elbow, forearm and wrist. The normalization procedure is efficient for testing subjects who are being observed during functional tasks. Only two muscles were affected by upper extremity position, but group trends were not always consistent with individual behavior. This method would ensure the use of appropriate EMG normalization coefficients regardless of individual variation. RELEVANCE: This method is effective for normalizing EMG signals using task specific upper extremity positions. It may be used to test isometric exertions of distal upper extremity musculature for clinical and research purposes
— id: 78472, year: 2001, vol: 16, page: 576, stat: Journal Article,

Biomechanica van het spier-skeletsysteem : grondslagen en toepassingen
Frankel, Victor H; Nordin, Margareta; Snijders, Chris J
Maarssen : Elsevier, 2001,
Basic biomechanics of the muscoloskeletal system, 2nd ed, translated into Dutch by Chris J Snijders
— id: 1412, year: 2001, vol: , page: , stat: ,

The test-retest reliability of a new occupational risk factor questionnaire for outcome studies of low back pain
Halpern M; Hiebert R; Nordin M; Goldsheyder D; Crane M
2001 Feb;32(1):39-46, Applied ergonomics
This study reports the test-retest reliability of a 25-item occupational risk factor questionnaire that can be self-administered in clinical settings and used in outcome studies of low back pain or return to work programs. Subjects were 24 patients (workers on sick leave due to acute low back pain), 29 co-workers on active duty in the same jobs in a utility company, and 53 supervisors. Eighty-six subjects were re-tested within a mean interval of 7-10 days; one group of 20 supervisors was re-tested within 81 days. The questionnaire was self-administered during individual interviews. Reliability was estimated by the kappa statistic as the agreement on the scores within the raters in each group. The agreement ranged from 'slight' (0.15) to 'almost perfect' (0.93) when the re-test interval was less than 43 days. Patients and non-patients were consistent in their assessment of the job demands. rights reserved
— id: 26808, year: 2001, vol: 32, page: 39, stat: Journal Article,

Evaluation of the Abbott AxSYM cytomegalovirus (CMV) immunoglobulin M (IgM) assay in conjunction with other CMV IgM tests and a CMV IgG avidity assay
Lazzarotto, T; Galli, C; Pulvirenti, R; Rescaldani, R; Vezzo, R; La Gioia, A; Martinelli, C; La Rocca, S; Agresti, G; Grillner, L; Nordin, M; van Ranst, M; Combs, B; Maine, G T; Landini, M P
2001 Jan;8(1):196-198, Clinical & diagnostic laboratory immunology
The measurement of the avidity of cytomegalovirus (CMV) immunoglobulin G (IgG) antibodies has been shown by several investigators to be useful in identifying and excluding primary CMV infections in pregnant women. In this work, we examined the diagnostic utility of reflex testing of CMV IgM-positive specimens from pregnant women by using a CMV IgG avidity assay. The utility of this approach was directly dependent on the sensitivity of the CMV IgM assay employed during the initial screen. The higher initial reactivity rate of the AxSYM CMV IgM assay was necessary in order to detect CMV IgM in specimens containing low-avidity CMV IgG antibodies, indicative of a primary CMV infection, which other CMV IgM assays (Behring, Vidas, Captia, and Eurogenetics) fail to detect in some cases. The use of the AxSYM CMV IgM assay, followed by an avidity test, should result in more accurate diagnosis of CMV infection in pregnant women
— id: 78473, year: 2001, vol: 8, page: 196, stat: Journal Article,

2000 International society for the study of the lumbar spine presidential address: backs to work: some reflections
Nordin M
2001 Apr 15;26(8):851-856, Spine
— id: 20711, year: 2001, vol: 26, page: 851, stat: Journal Article,

Sleepiness and recovery in schedule change and the eighty-four hour workweek
Nordin, M; Knutsson, A
2001 Dec;30(1-2):143-147, Journal of human ergology
The aims were to evaluate sleepiness and recovery during a schedule change, and during an 84-hours workweek. The control group (16 men) stayed on a six-week schedule, whereas the intervention group (12 men) transferred to a seven-week schedule. Sleepiness was estimated, using the KSS-scale, four times during the first and the third night in the fifth or sixth shift week. Recovery was assessed through four estimations on days one, three and five during the week off. Statistical testing was carried out using repeated measurement ANOVA. Sleepiness at night was affected by night (F = 4.90, p < 0.05) and hour (F = 33.64, p < 0.001) in both groups. The intervention group was sleepier during the first recovery day compared to the control group (F = 4.02, p < 0.05). Analysis of the 84-hour-week showed an effect of night (F = 8.98, p < 0.05) and hour (F = 71.60, p < 0.001) on night work, and day (F = 22.49, p < 0.01) and hour (F = 6.66, p < 0.05) on recovery. Sleepiness was more pronounced on the first recovery day (F = 23.08, p < 0.01). The seven-week schedule showed no effect that differed from that of the control group on sleepiness during the night shift. After the 84-hour workweek the workers recovered in about three days. The new schedules may affect the first recovery day negatively
— id: 78469, year: 2001, vol: 30, page: 143, stat: Journal Article,

Basic biomechanics of the musculoskeletal system
Nordin, Margareta; Frankel, Victor H
Philadelphia : Lippincott Williams & Wilkins, 2001,
— id: 1404, year: 2001, vol: , page: , stat: ,

Baio mekanikusu : seitai rikigaku no genri to oyo
Ozkaya, Nihat; Nordin, Margareta
Tokyo : Enu Ti Esu, 2001,
Fundamentals of biomechanics (Japanese)
— id: 1420, year: 2001, vol: , page: , stat: ,

The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain
Abenhaim, L; Rossignol, M; Valat, J P; Nordin, M; Avouac, B; Blotman, F; Charlot, J; Dreiser, R L; Legrand, E; Rozenberg, S; Vautravers, P
2000 Feb 15;25(4 Suppl):1S-33S, Spine
— id: 78476, year: 2000, vol: 25, page: 1S, stat: Journal Article,

Enhancing the quality of life of a client with severe developmental disabilities through the application of assistive technology. A case study
Goldsheyder D; Nordin M; Loebl D
2000 ;15(3):167-176, Work: a journal of prevention, assessment, & rehabilitation
This paper describes a structural sequential process aimed to enhance the quality of life of a 29 year old man through the application of assistive technology (AT). The client had life-long severe multiple disabilities, showed increasing fragility and decreasing functional abilities that resulted, among other problems, in a problem with toileting. The process involved a thorough assessment and evaluation of the client, his physical, cognitive and perceptual skills involved in the performance of the task, requirements of the task, the technology, and the task environment. A clinical reasoning model for the provision of AT was applied during the process to identify the functional deficits of the client with respect to the problematic task. The approach enabled a multidisciplinary team of university-affiliated professionals including physical and occupational therapists, an ergonomist, a rehabilitation engineer and care providers in an institution for developmentally disabled people to determine the primary attributes of a technological intervention. The process resulted in the selection of an appropriate piece of AT followed by its modification and adaptation in order to address the specific needs of the client. The client's toilet use was improved in a manner that ultimately contributed to enhancing the quality of his life. Projections for further improvements of the quality of life of the client in this institution were also discussed
— id: 72176, year: 2000, vol: 15, page: 167, stat: Journal Article,

[Cytostatic therapy reduces the immune defense. Children treated for leukemia have impaired immunity against measles and rubella]
Nilsson, A; Nordin, M; De Milito, A; Grillner, L; Chiodi, F; Bjork, O
2000 Nov 8;97(45):5116-5118, Lakartidningen
A study is summarized analyzing the levels of serum antibodies against vaccination antigens in 43 children treated for acute lymphoblastic leukemia. Two different therapeutical regimens were used. All children had been immunized against measles and rubella before being diagnosed with leukemia. Eight of the 24 children treated 1986-1991 lacked protective levels of antibodies against measles; four of the 24 children lacked antibodies against rubella. In the second cohort of children (n = 16) treated from 1992 and onwards, nine lacked protective levels of antibodies against measles, eight lacked antibodies against rubella
— id: 78474, year: 2000, vol: 97, page: 5116, stat: Journal Article,

Alf L. Nachemson, MD, PhD: the first ISSLS-stryker spine lifetime achievement award recipient
Nordin M; Szpalski M; Wiesel S; Hanley E
2000 Aug 1;25(15):II-III, Spine
— id: 78475, year: 2000, vol: 25, page: II, stat: Journal Article,

Biomechanical modeling of intra-abdominal pressure generation should include the transversus abdominis
Pietrek, M; Sheikhzadeh, A; Nordin, M; Hagins, M
2000 Jun;33(6):787-790, Journal of biomechanics
— id: 76355, year: 2000, vol: 33, page: 787, stat: Journal Article,

Recovery of severe sciatica
Balague, F; Nordin, M; Sheikhzadeh, A; Echegoyen, A C; Brisby, H; Hoogewoud, H M; Fredman, P; Skovron, M L
1999 Dec 1;24(23):2516-2524, Spine
STUDY DESIGN: A prospective study of patients with acute severe sciatica. OBJECTIVES: To 1) describe the characteristics of patients with acute severe sciatica and the agreement among different diagnostic tests, 2) describe overall recovery during 1 year in terms of perceived disability, and pain, and 3) explore acute-phase predictors of failure to recover at 1 year. SUMMARY OF BACKGROUND DATA: The development of imaging techniques has been very impressive during recent decades. However, different authors have highlighted the prevalence of abnormal images among asymptomatic subjects. These findings increase the difficulty of interpreting the results from the diagnostic techniques used with each individual patient. Furthermore, other clinical and biopsychosocial variables need to be explored for their associations with recovery or failure to recover. This study aimed to explore those associations. METHODS: Consecutive patients admitted to the hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires that included items on demographics, pain, perceived disability, and quality of life. Imaging and blood samples were collected at the first visit, and an electromyogram was taken for sciatica lasting at least 3 weeks. RESULTS: The study included 82 consecutive patients (66% men) with a mean age of 43 +/- 10.3 years. The mean intensity of pain, on a visual analog scale of 0 to 100 (VAS) at Visit 1, was 73. The straight leg raising test was positive in 78% of the patients, with a mean value of 59 degrees +/- 18 degrees. The contralateral straight leg raising test was positive in 20% of the patients. Imaging was positive for disc herniation in 74% and electromyogram was positive in 62% of cases. These two diagnostic tests showed a good to excellent total agreement (58-87%) with the straight leg raising tests and the presence of radiating pain below the knee. The recovery of clinical symptoms and signs was observed mainly within the first 3 months. However, clinical recovery and perceived recovery was not complete in most cases. CONCLUSIONS: In most cases, there was good to excellent agreement among the different diagnostic tests. None of the tests was predictive of recovery. The presence of blood antibodies against 3'LM1 (IgM + IgG) and GD1a (IgM) was significantly associated (P < 0.023) with neurologic symptoms and signs. However, the meaning of these antibodies remains unclear. Only a minority of the patients (29%) had fully recovered after 12 months. Within the 1-year follow-up, one third of the patients had surgery
— id: 76356, year: 1999, vol: 24, page: 2516, stat: Journal Article,

Development of a physical examination for a company-based management program for work-related upper extremity cumulative trauma disorders
Barr, AE; Badenchini, IT; Forsyth-Bee, M; Duff, JM; Herring, KM; Covit, AB; Nordin, M
1999 JUN ;9(2):63-77, Journal of occupational rehabilitation
The purpose of this project was to develop a streamlined upper extremity examination to be used in a company-based upper extremity CTD management program. Thirty-six symptomatic employees were examined by an occupational health nurse and categorized into those requiring further medical evaluation or those appropriate for conservative management. Backward logistic regression showed that the Appearance and Symmetry (AS) and the Neurological and Special Tests (NST) sections of the examination together explained 86.1 % (p = 0.002) of the nurses categorical decisions. Based on these preliminary development data, a short screening examination was proposed
— id: 53959, year: 1999, vol: 9, page: 63, stat: Journal Article,

Low back pain in a population of school children
Gunzburg, R; Balague, F; Nordin, M; Szpalski, M; Duyck, D; Bull, D; Melot, C
1999 ;8(6):439-443, European spine journal
A study was undertaken to analyse the prevalence of low back pain (LBP) and confounding factors in primary school children in the city of Antwerp. A total of 392 children aged 9 were included in the study. All children completed a validated three-page questionnaire and they all underwent a specific lumbar spine oriented medical examination during their annual routine medical school control. This examination was performed by the city school doctors. The questionnaire was composed of easy 'yes/no' questions and visual analogue scales. Statistical analysis was performed using Student's t-test and chi-squared test at the significance level P < 0.05. The prevalence of LBP was high. No gender difference was found. A total of 142 children (36%) reported having suffered at least one episode of LBP in their lives. Of these, 33 (23%) had sought medical help for LBP from a doctor or physiotherapist. Sixty-four percent of children reporting LBP said that at least one of their parents suffered from or complained of LBP. This was significantly higher than for the children who did not report having suffered LBP. The way in which the school satchel was carried (in the hand, on the back) had no bearing on the incidence of LBP. There was significantly more LBP in children who reported playing video games for more than 2 h per day, but this was not so for television watchers. The visual analogue scales concerning general well-being were all very significantly correlated with self-reported LBP, with children who reported LBP being more tired, less happy, and worse sleepers. Of the 19 clinical parameters taken down during the medical examination, only one was significantly more prevalent in the group of children reporting LBP: pain on palpation at the insertion site on the iliac crest of the ilio-lumbar ligament. From this study we can establish that there are few clinical signs that can help to single out school children with LBP
— id: 78477, year: 1999, vol: 8, page: 439, stat: Journal Article,

Physical therapy: exercises and the modalities: when, what, and Why?
Nordin M; Campello M
1999 Feb;17(1):75-89, Neurologic clinics
This article reviews the evidence for using modalities and/or exercise treatment in patients with nonspecific low back pain. Poor evidence of efficacy exists for the use of modalities in this patient group. Exercises are beneficial for patients with subacute and chronic nonspecific low back pain. Further studies are needed for type, frequency, duration, and intensity of exercises
— id: 7416, year: 1999, vol: 17, page: 75, stat: Journal Article,

Fundamentals of biomechanics: Equilibrium, motion, and deformation
Oezkaya, Nihat; Nordin, Margareta
Berlin: Springer-Verlag, 1999,
This book is a textbook on the topic of the fundamentals of biomechanics. The fifteen chapters of this text are divided into three parts. The first part introduces the basic concepts of mechanics with application to the human musculoskeletal system. The next part of the book provides a description of the analytical techniques used to assess material deformation and applications to orthopedic biomechanics. The final part features the analysis of moving systems with applications to the human system and sports mechanics. Each chapter contains detailed coverage of the subject or concept. Several chapters feature exercise problems and suggested readings. A few examples of chapter topics include the force vector, applications of statics to biomechanics and stress analysis. In addition, this text contains three appendices: Appendix A- Plane Geometry; Appendix B- Vector Algebra; and Appendix C- Calculus. This textbook, which is indexed and illustrated with tables and figures, should be a valuable teaching and learning tool for students and professors interested in the study of biomechanics.
— id: 625, year: 1999, vol: , page: , stat: ,

Approaches to improve the outcome of patients with delayed recovery
Campello M; Weiser S; van Doorn JW; Nordin M
1998 Feb;12(1):93-113, Bailliere's clinical rheumatology
The purpose of this chapter is to promote a model to prevent chronicity and disability from non-specific low back pain (NSLBP). Delayed recovery is defined in this chapter as the period between 4 and 8 weeks after onset of NSLBP during which a patient has not yet returned to work. The recognition of predictors associated with delayed recovery at onset of the problem helps health care providers in their treatment plan. An algorithm can be useful for health care providers and employers in guiding the employee back to work. A multidisciplinary return to work programme is an essential part of the algorithm
— id: 7518, year: 1998, vol: 12, page: 93, stat: Journal Article,

Health care providers should use a common language in relation to low back pain patients
Cedraschi, C; Nordin, M; Nachemson, A L; Vischer, T L
1998 Feb;12(1):1-15, Bailliere's clinical rheumatology
Uncertainty is the rule rather than the exception when it comes to the underlying causes of 'common' or 'non-specific' low back pain. It may be called many names, depending on whether the diagnostic term is descriptive, anatomopathological or physiopathological. Classifications have been devised, including various criteria: symptoms and signs, duration, treatment, consequences of low back pain on the patients' daily life, etc. Because back pain frequently runs a recurrent course, functional and pain outcomes need to be considered separately: chronic disability and chronic pain may not be parallel. Thus, pain duration (e.g. acute, transient, recurrent, chronic) is only one element in the definition of chronicity. These difficulties in defining and classifying non-specific low back pain may lead to communication problems among health professionals as well as between patients and health professionals. These difficulties raise questions such as: what kind of diagnostic term should we use to avoid dramatization of non-specific low back pain? how can we improve the definition of long-term low back pain? and how can we assure and reassure the patient that this condition is benign in the majority of the population?
— id: 78478, year: 1998, vol: 12, page: 1, stat: Journal Article,

Postural after-contractions in man attributed to muscle spindle thixotropy
Hagbarth, K E; Nordin, M
1998 Feb 1;506 ( Pt 3):875-883, Journal of physiology
1. It is an old observation that non-volitional arm abduction movements accompanied by a sensation of arm lightness often occur as an after-effect following forceful voluntary arm abductor contractions against a restraint. In the present study we have tested the hypothesis that such non-volitional, so-called 'postural after-contractions' are tonic reflex responses to an enhanced resting discharge in primary muscle spindle afferents which in turn is a consequence of thixotropy-dependent enhanced stiffness of intrafusal muscle fibres. 2. Results obtained in ten volunteers show that the arm abductor after-contraction phenomenon in man is most readily evoked by a type of conditioning procedure which in various respects mimics the procedure proven in animal experiments to be particularly effective in producing thixotropy-dependent excitation of primary spindle endings. 3. It is also shown that changes in arm abductor intramuscular temperature affect the strength of the after-contractions in a direction predicted by the thixotropy hypothesis. 4. Attention is drawn to several similarities between the after-contraction phenomenon with accompanying sensory illusions and the tonic reflex responses and illusions that can be induced when primary spindle endings are excited by muscle vibration. 5. The results support our hypothesis that postural after-contractions are induced by activity in primary muscle spindle afferents as a consequence of thixotropic properties of intrafusal muscle fibres. Central excitability changes following the conditioning voluntary effort may contribute to the phenomenon
— id: 78479, year: 1998, vol: 506 ( Pt 3), page: 875, stat: Journal Article,

Patient-health care provider relationship in patients with non-specific low back pain: a review of some problem situations
Nordin M; Cedraschi C; Skovron ML
1998 Feb;12(1):75-92, Bailliere's clinical rheumatology
Problem situations in the patient-health care relationship may relate to the patient or to the health care provider characteristics or to the way they interact; they may also relate to the general social context. Such situations force the clinician dealing with non-specific low back pain patients to look beyond the traditional biomedical model that assumes a linear connection between pathology and symptomatology. The introduction of the biopsychosocial model approximately 10 years ago has improved the understanding of common low back pain. This chapter gives some insight into areas relating to factors that may hamper the patient-therapist relationship and thus complicate treatment and recommendation outcomes. It emphasizes the necessity to involve the patient in the decision-making. Recognizing the patients' psychological, social and cultural background as well as the level of education and employability are important to make successful recommendations. This knowledge is not new but the difficulty is to implement it in today's cost effectiveness driven society. However the benefit at the end may be the decrease of chronicity and/or permanent disability, suffering for the patient and frustration for the clinician. Identifying the underlying cause of non-compliance or of unexpected delayed recovery is an exciting issue. The cause may or may not be biomedical. If a specific cause can be identified, it has to be diagnosed and evaluated. If the clinical examination has ruled out specific or emergency conditions, another perspective may be needed and the course of action could then be determined
— id: 7716, year: 1998, vol: 12, page: 75, stat: Journal Article,

Fundamentals of biomechanics : equilibrium, motion, and deformation
Ozkaya, Nihat; Nordin, Margareta
New York : Springer, 1998,
— id: 1416, year: 1998, vol: , page: , stat: ,

Low back pain assessment training of industry-based physicians
Harwood, K J; Nordin, M; Heibert, R; Weiser, S; Brisson, P M; Skovron, M L; Lewis, S
1997 Oct;34(4):371-382, Journal of rehabilitation research & development
We have developed an educational program to train industry-based physicians in a new low back pain assessment procedure based on the recommendation of The Clinical Practice Guidelines on Acute Low Back Pain Problems in Adults published by the Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. The clinical classification system based on the findings from the Quebec Task Force was used to categorize the subjects. The educational program included group and individual sessions with an extensive period of active follow-up. Protocol compliance was measured through a computer-based surveillance system that monitored evaluation form completion. The results showed significant change (p < 0.001) in physician compliance in completing a standardized examination following an administrative mandate to change. Little change in clinical practice was recorded with an educational training program only. Further research into the factors responsible for the results is suggested
— id: 67842, year: 1997, vol: 34, page: 371, stat: Journal Article,

Early predictors of delayed return to work in patients with low back pain
Nordin M; Skovron ML; Hiebert R; Weiser S; Brisson PM; Campello M; Harwood K; Crane M; Lewis S
1997 ;5(2):5-27, Journal of Musculoskeletal Pain
— id: 80324, year: 1997, vol: 5, page: 5, stat: Journal Article,

Sympathetic vasoconstrictor outflow to extremity muscles in cluster headache. Recordings during spontaneous and nitroglycerin-induced attacks
Nordin, M; Fagius, J; Waldenlind, E
1997 Jun;37(6):358-367, Headache
To search for evidence of sympathetic dysregulation during cluster headache attacks, microneurographic recordings of muscle nerve sympathetic activity (MSA) were obtained from the peroneal nerve. In three recordings commenced after the onset of spontaneous attacks, MSA was about twice as high during the attack as afterwards. In four nitroglycerin-induced attacks, MSA showed a rise paralleling the pain, preceded by an initial peak. The latter accompanied hypotension, whereas the rise coinciding with cluster headache was associated with rising blood pressure. The normal baroreflex-governed pulse synchrony of MSA was preserved both during spontaneous and provoked attacks. In seven cluster headache patients in whom nitroglycerin did not cause an attack, only an initial peak in MSA occurred. Nor was any late nitroglycerin-induced rise in MSA observed in nine healthy subjects; the initial peak in MSA and heart rate was followed by a rapid return to normal despite a falling blood pressure. It is concluded that cluster headache attacks are associated with an increase in MSA that elevates blood pressure by causing vasoconstriction, and that this increase, rather than indicating sympathetic dysregulation, is a normal pain-evoked secondary phenomenon. The findings in healthy subjects support the notion that nitroglycerin has a central sympatho-inhibitory effect
— id: 78480, year: 1997, vol: 37, page: 358, stat: Journal Article,

Musculoskeletal disorders in the workplace : principles and practice
Nordin, Margareta; Andersson, Gunnar
St. Louis : Mosby, 1997,
— id: 1423, year: 1997, vol: , page: , stat: ,

Primary prevention, education, and low back pain among school children
Balague, F; Nordin, M; Dutoit, G; Waldburger, M
1996 ;55(3):130-134, Bulletin (Hospital for Joint Diseases)
After a survey in 1986, a primary educational prevention program for low back pain (LBP) was implemented over a 3 year period in a primary school setting in Switzerland. In 1989 a second survey was carried out to evaluate the effect of the intervention. One thousand seven hundred and fifty-five (1755) children received a questionnaire, 1716 (97.7%) were returned. Recollection of participation in the prevention program was significantly associated with reported increased prevalence of LBP (p 0.000). Simultaneously, there was a significant reduction in the utilization of medical care for LBP (p < 0.05)
— id: 78482, year: 1996, vol: 55, page: 130, stat: Journal Article,

Training industry-based physicians for the management of low back pain: O.I.O.C. experience
Brisson, P M; Harwood, K J; Nordin, M; Hiebert, R; Weiser, S; Skovron, M L; Lewis, S
1996 ;55(4):207-209, Bulletin (Hospital for Joint Diseases)
— id: 67843, year: 1996, vol: 55, page: 207, stat: Journal Article,

Physical exercise and low back pain
Campello M; Nordin M; Weiser S
1996 Apr;6(2):63-72, Scandinavian journal of medicine & science in sports
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
— id: 12622, year: 1996, vol: 6, page: 63, stat: Journal Article,

Exercises for the patient with low back pain: when and how
Nordin M; Campello M; Weiser S
1996 ;55(3):142-146, Bulletin (Hospital for Joint Diseases)
— id: 12670, year: 1996, vol: 55, page: 142, stat: Journal Article,

Early predictors of outcome
Nordin M; Skovron ML; Hiebert R; Weiser S; Brisson PM; Campello M; Crane M; Lewis S
1996 ;55(4):204-206, Bulletin (Hospital for Joint Diseases)
— id: 12668, year: 1996, vol: 55, page: 204, stat: Journal Article,

Effects of preceding movements and contractions on the tonic vibration reflex of human finger extensor muscles
Nordin, M; Hagbarth, K E
1996 Apr;156(4):435-440, Acta physiologica Scandinavica
The vibration sensitivity of feline muscle spindle endings is known to vary as a result of preceding muscle conditioning manoeuvres. If similar after-effects occur in man they should be expected to influence the strength of the tonic vibration reflex (TVR). To study this issue, vibration was applied over the finger extensor tendons of 11 volunteers who actively held their fingers in a semi-extended position. The TVR, measured as electromyographic responses and angular deflections at the metacarpophalangeal joints, was found to be stronger when the extensors prior to the test had been contracted in a shortened position than when they had been contracted in a stretched position. This difference was reduced when the vibration stimulus was preceded by a strong extensor contraction in the test position. The antigravity extensor EMG activity required to keep the fingers in the test position was weaker when the conditioning contraction was performed at a short muscle length than when it was performed at a long muscle length. The variations in magnitude of the TVR can be attributed to 'thixotropic' properties of intrafusal muscle fibres, resulting in a slack following conditioning at a long muscle length. The different EMG levels required for position holding can be explained by similar properties of extrafusal muscle fibres. In conclusion, the results demonstrate the importance of taking the 'history of movement' into account in the design of all TVR studies
— id: 78481, year: 1996, vol: 156, page: 435, stat: Journal Article,

Occupational orthopedics
Pope, MH; Andersson, Gunner; Nordin, Margareta
St. Louis : Mosby, 1996,
— id: 1421, year: 1996, vol: , page: , stat: ,

Low back pain in schoolchildren. A study of familial and psychological factors
Balague, F; Skovron, M L; Nordin, M; Dutoit, G; Pol, L R; Waldburger, M
1995 Jun 1;20(11):1265-1270, Spine
STUDY DESIGN. The results of a survey organized in the school system of the Swiss canton of Fribourg. An original questionnaire was developed for this study are reported. OBJECTIVES. The goal of this study was to evaluate the possible role of familial or psychological factors in schoolchildren reporting nonspecific low back pain. SUMMARY OF BACKGROUND DATA. Previous surveys have shown a high prevalence of nonspecific low back. pain among schoolchildren, particularly teen-agers. The reported familial incidence raises, among others, the question of a possible role of psychological or behavioral factors. METHODS. This survey was performed with a validated 43-item self-administered questionnaire eliciting information about back pain history, family characteristics, children's activities, and psychological parameters. All schoolchildren (n = 615), ages 12-17 years, in two secondary schools (Fribourg, Switzerland) were surveyed. The response rate was 98%. RESULTS. Reported lifetime prevalence of back pain was 74%. Lumbar pain was the most frequent localization of pain (69% of back pain). The measured psychological factors were significantly associated with reported nonspecific low back pain and its consequences as well as with sibling history of low back pain. CONCLUSIONS. The study suggests that psychological factors play a role in children's reporting of nonspecific low back pain
— id: 78487, year: 1995, vol: 20, page: 1265, stat: Journal Article,

Biomechanica van het spier-skeletsysteem : grondslagen en toepassingen
Frankel, Victor H; Nordin, Margareta; Snijders, Chris J
Utrecht : LEMMA, 1995,
Basic biomechanics of the muscoloskeletal system, 2nd ed, translated into Dutch by Chris J Snijders
— id: 1410, year: 1995, vol: , page: , stat: ,

Endotoxaemia and inflammatory mediators in febrile patients with haematological disease
Gunther, G; Gardlund, B; Hast, R; Kimby, E; Nordin, M; Wretlind, B
1995 Jan;237(1):27-33, Journal of internal medicine
OBJECTIVES. To study the pattern of plasma levels of endotoxin, tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6) and C-reactive protein (CRP) in febrile neutropenic patients and to assess the potential diagnostic value of these analyses. DESIGN. Consecutive prospective study. SETTING. Patients treated at the haematology ward at Danderyd Hospital, Sweden. SUBJECTS. Ninety-four patients with fever and haematological disease entered the study (male/female: 59/35) with 176 febrile episodes. INTERVENTIONS. Blood samples were drawn at days 0, 1, 2 and 6 after onset of fever for analysis of, endotoxin, TNF-alpha, IL-6 and CRP. RESULTS. Infectious aetiology was established in 62.5% of the febrile episodes. Blood cultures showed significant growth in 71/176 (40.3%) febrile episodes. Nonbacteraemic bacterial infections were diagnosed in 34/176 (19.3%) episodes. Endotoxin was detected in plasma in 40% of febrile episodes regardless of aetiology. TNF-alpha was detected in 61% and IL-6 in 94% of all febrile episodes. The initial TNF-alpha and IL-6 levels were significantly higher in patients with Gram-negative bacteraemia than in patients with other causes of fever (P < 0.001). In episodes evaluated as successful after empirical antibiotic treatment, a significant (P < 0.001) decrease in CRP concentrations were found on day 6 after onset of fever. CONCLUSIONS. The sustained, low-grade endotoxaemia and persistently elevated levels of TNF-alpha and IL-6 found in febrile patients may reflect a failing mucosal barrier that allows endogenous bacterial products to reach the circulation. The diagnostic value of endotoxin, TNF-alpha, IL-6 and CRP to discriminate between bacteraemic and nonbacteraemic febrile episodes was very limited. The study supports the present policy of broad, empirical antibiotic treatment in patients with haematological disease and fever
— id: 78490, year: 1995, vol: 237, page: 27, stat: Journal Article,

Reduced servo-control of fatigued human finger extensor and flexor muscles
Hagbarth, K E; Bongiovanni, L G; Nordin, M
1995 Jun 15;485 ( Pt 3):865-872, Journal of physiology
1. In healthy human subjects holding the index finger semi-extended at the metacarpophalangeal joint against a moderate load, electromyographic (EMG) activity was recorded from the finger extensor and flexor muscles during different stages of muscle fatigue. The aim was to study the effect of muscle fatigue on the level of background EMG activity and on the reflex responses to torque pulses causing sudden extensor unloadings. Paired comparisons were made between the averaged EMG and finger deflection responses under two conditions: (1) at a stage of fatigue (following a sustained co-contraction) when great effort was required to maintain the finger position, and (2) under non-fatigue conditions while the subject tried to produce similar background EMG levels to those in the corresponding fatigue trials. 2. Both the unloading reflex in the extensor and the concurrent stretch reflex in the flexor were significantly less pronounced and had a longer latency in the fatigue trials. Consequently, the finger deflections had a larger amplitude and were arrested later in the fatigue trials. 3. It is concluded that--with avoidance of 'automatic gain compensation', i.e. reflex modifications attributable to differences in background EMG levels--the servo-like action of the unloading and stretch reflexes is reduced in fatigued finger extensor and flexor muscles
— id: 78486, year: 1995, vol: 485 ( Pt 3), page: 865, stat: Journal Article,

After-effects on stiffness and stretch reflexes of human finger flexor muscles attributed to muscle thixotropy
Hagbarth, K E; Nordin, M; Bongiovanni, L G
1995 Jan 1;482 ( Pt 1):215-223, Journal of physiology
1. While the subject maintained a weak contraction in his finger flexor muscles, holding the metacarpophalangeal joints in 45 deg flexion, test torque pulses were applied which caused rapid finger extension movements and electromyographic (EMG) stretch reflex responses. Before each test pulse the fingers were passively flexed or extended ('post-short' and 'post-long' trials) for about 10 s. The EMG and joint deflection responses in the two types of trial were compared after averaging. 2. In the 'post-long' trials, the EMG reflex response showed a comparative increase in latency, with a reduction of the short-latency (M1) component and an enhancement of the medium-latency (M2) component. 3. The angular deflections were larger, and the turning points of the deflections, which indicated the start of the mechanical reflex responses, occurred later in the 'post-long' trials. These differences were not seen when the torque pulse was immediately preceded by a strong, brief isometric finger flexor contraction in the test position. 4. Immediately following the return to the test position the background finger flexor EMG activity was larger in the 'post-long' trials, a difference which gradually subsided over 15-20 s. A strong, brief contraction in the test position also eliminated this inter-trial difference. 5. The results are interpreted as manifestations of thixotropic after-effects in intra- and extrafusal muscle fibres. It is proposed that the M1 component of the stretch reflex is largely a response to the 'initial burst' of impulses in primary spindle afferents.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 78491, year: 1995, vol: 482 ( Pt 1), page: 215, stat: Journal Article,

Physical and psychological workload in men with and without low back pain
Hultman, G; Nordin, M; Saraste, H
1995 Mar;27(1):11-17, Scandinavian journal of rehabilitation medicine
Current and retrospective physical and psychological workload was studied in 148 mean, 45-55 years old. The men represented three groups with respect to low back health status: Healthy low back (Group 1, n = 36), intermittent low back pain (LBP) (Group 2, n = 91) and chronic LBP (Group 3, n = 21). The methods used were a self administered questionnaire, a rating scale of perceived exertion, and blind expert assessment built on a classification of job titles. Group 1, the back-healthy subjects, had been less exposed to heavy physical work than subjects with intermittent LBP (Group 2) and chronic LBP subjects (Group 3) through their whole working-career and in their present work (p < or = 0.05, p < or = 0.01). Group 2 tended to be significantly less exposed in their present work than Group 3 (p < or = 0.06). Non-neutral working postures were reported more often in Groups 2 and 3 than in Group 1 (p < or = 0.05, p < or = 0.001). Both groups 2 and 3 perceived present and earlier work to be more strenuous than Group 1, with respect to the low back (p < or = 0.000). Subjects in the healthy low-back group had lower values in the qualitative demand index ('too difficult working tasks' and 'too great responsibility') than subjects in Groups 2 and 3 (p < or = 0.01). This study indicates that more attention should be given to the individual's perception of physical workload
— id: 78488, year: 1995, vol: 27, page: 11, stat: Journal Article,

Back pain: lessons from patient education
Nordin, M
1995 Sep;26(1-3):67-70, Patient education & counseling
Education for the patient with back pain is currently being discussed and reassessed. In the 1970s and 1980s, the clinical and scientific communities were convinced that patient education as a sole treatment for back pain was most beneficial. In the 1990s outcome studies, randomized controlled trials, meta analysis and best synthesis evidence have moderated this view. This brief overview summarizes important aspects put forward in recently published articles about the education of patients with non-specific, low back pain in industrialized societies
— id: 78485, year: 1995, vol: 26, page: 67, stat: Journal Article,

Effect of noxious stimulation on sympathetic vasoconstrictor outflow to human muscles
Nordin, M; Fagius, J
1995 Dec 15;489 ( Pt 3):885-894, Journal of physiology
1. In fifteen healthy volunteers, muscle nerve sympathetic activity (MSA) was recorded from the peroneal nerve using microneurography. Blood pressure and electrocardiogram were also recorded. 2. Painful stimuli, adjusted to the subject's tolerance level, were delivered over 30-60 s via (a) pressure to the nail-bed of different digits, and to the trigeminal region, (b) electrical stimulation (5 Hz) of digital nerves and of the supraorbital nerve, or (c) instillation of soap solution into one eye. Non-painful ocular pressure was also applied. 3. All procedures except electrical stimulation of digital nerves caused a marked increase in MSA (mean, 160-248%) with preserved pulse synchrony and a rise in blood pressure. Stimulation of digits induced tachycardia, whereas stimulation of the trigeminal region tended to cause bradycardia. 4. Despite similar pain ratings, electrical stimulation of digital nerves caused a smaller MSA response than the other stimuli (mean increase, 40%). 5. It is concluded that sustained noxious stimulation in awake humans evokes a generalized MSA increase; the activity is still under baroreflex control, but the inhibitory level is reset. Both spinal and brainstem reflexes may contribute; a defence reaction is an unlikely explanation. It is suggested that the number of afferent C fibres activated by electrical stimulation of digital nerves was insufficient to induce any marked MSA response. 6. The non-painful oculo-cardiac reflex is associated with a strong increase in MSA
— id: 78483, year: 1995, vol: 489 ( Pt 3), page: 885, stat: Journal Article,

Health care utilization for low back pain in Belgium. Influence of sociocultural factors and health beliefs
Szpalski, M; Nordin, M; Skovron, M L; Melot, C; Cukier, D
1995 Feb 15;20(4):431-442, Spine
STUDY DESIGN. A population-based survey was undertaken. OBJECTIVES. To describe health care utilization for low back pain (LBP) in a culturally diverse society with universal access to health care; to describe how LBP chronicity influences health care utilization; and to describe how sociocultural and demographic factors and health beliefs influence health care utilization. METHODS. A probability sample of approximately 5,000 Belgian adults stratified by gender, age, social class, and habitat was surveyed by trained interviewers. Information on demographics, health beliefs, frequency of LBP, and health care utilization was elicited. Statistical analysis was conducted by means of univariate and multivariate logistic regression. Analysis was restricted to 2,660 respondents with history of LBP. RESULTS. Of subjects with LBP, 38% reported daily LBP. Sixty-three percent had seen a health professional for the most recent episode; 11% had been on bed rest. Forty-four percent had at sometime undergone radiography; three and a half percent had ever undergone spinal surgery. Eighty-six percent considered themselves in good health. Controlling for LBP frequency, all forms of health care utilization examined were associated with health beliefs. CONCLUSIONS. LBP frequency, health beliefs, and sociocultural factors influence health care behaviors and utilization among adults with a history of LBP in a society with universal access to health care. The association of history of spinal surgery with reports of daily LBP suggests that spinal surgery has failed, at least partly, to relieve LBP
— id: 78489, year: 1995, vol: 20, page: 431, stat: Journal Article,

World congress on low back pain : integrated function of the lumbar spine and sacroiliac joints, tape 1
Vleeming, Andry; Nordin, Margareta; Snijders, Chris J; Alexander, R McNeill; Adams, Michael A; Willard, Fred; van Wingerden, Jan Paul
Mt. Laurel NJ : CME Conference Video, Inc, 1995,
— id: 1422, year: 1995, vol: , page: , stat: ,

Preventive and promotive medicine in ambulatory clinical practice: a prospective simulated patient study
Wong, Y Y; Nordin, M; Suleiman, A B
1995 Dec;7(4):333-341, International Journal for Quality in Health Care
OBJECTIVE: This study examines the extent to which preventive and promotive advice is integrated into the clinical practice of doctors. STUDY DESIGN: Using a cross-sectional descriptive survey design, the study compares the performance of doctors in giving healthy lifestyle advice for five clinical conditions, their perceived practice and their rating on the importance of disseminating selected key lifestyle messages. DATA EXTRACTION METHODS: A total of 28 volunteers were trained to simulate the five clinical conditions which required related health advice and to rate the doctors' performance with the use of a prepared checklist. Simulated patient ratings of 343 doctor-patient encounters provided the data on doctors' health promotion efforts for the selected clinical conditions. A post-visit self-administered questionnaire survey of a sub-sample of 100 doctors gave an insight into their opinions and perceived practice. PRINCIPAL FINDINGS: Only in 49% of the instances was a health promotion message given. The doctors' encouraging interest in health education and health promotion and their positive perceptions of their volume of healthy lifestyle counselling were not borne out in actual clinical practice. CONCLUSIONS: The results indicate that the extent of preventive and promotive health education in both the public and private health sectors is unacceptably low. The matter needs to be addressed through training programmes as well as the formulation of clear health promotion priorities and strategies in Malaysia
— id: 78484, year: 1995, vol: 7, page: 333, stat: Journal Article,

Non-specific low-back pain among schoolchildren: a field survey with analysis of some associated factors
Balague, F; Nordin, M; Skovron, M L; Dutoit, G; Yee, A; Waldburger, M
1994 Oct;7(5):374-379, Journal of spinal disorders
A study population composed of 1,755 children 8-16 years of age were surveyed using a 15-item, self-administered questionnaire. The response rate was 97.7%. The purpose of the survey was to evaluate the possible association between low-back pain and certain social factors and predicaments. Descriptive statistics and logistic regression analysis showed that parental history of treated low-back pain (adjusted odds ratio 2.10; p < 0.001), competitive sports activity (adjusted odds ratio 1.73; p = 0.003), and time spent watching television (adjusted odds ratio 1.23; p = 0.05) significantly increased the risk for low-back pain among children, controlling for the child's age and gender
— id: 78492, year: 1994, vol: 7, page: 374, stat: Journal Article,

Intrafascicular recordings of afferent multi-unit activity from the human supraorbital nerve
Nordin, M
1994 Aug;151(4):507-514, Acta physiologica Scandinavica
Intrafascicular recordings of afferent multi-unit activity were obtained from the supraorbital nerve in 40 healthy human volunteers, using tungsten micro-electrodes inserted percutaneously at the eyebrow. Seventy-seven fascicular receptive fields were mapped; their area ranged from 2 to 76 cm2, with a median of 19 cm2. The smallest fields were found in the eyebrow region, and the largest on the scalp. In response to non-painful electrical intradermal stimulation, the conduction velocity of the fastest nerve fibres was calculated to be 40 +/- 2 m s-1 (mean +/- SEM), and the later part of the afferent volley corresponded to a velocity of 20 +/- 1 m s-1. The responses to skin indentation indicated that the density of mechanoreceptive innervation was higher in the lower part of the forehead than in the upper/posterior part of the innervation territory of the nerve. A rapid mechanical tap on the forehead and scalp evoked two major afferent volleys corresponding to the on- and off-phase of the stimulus. Manipulation of hairs resulted not only in dynamic responses to hair movement, but also in a static discharge during sustained hair displacement. When a fascicular field included the eyebrow region, skin stretching during blinking movements evoked distinct afferent activity. Following mechanical and electrical stimuli there were no signs of 'trigeminal antidromic potentials' of the type described in the cat and monkey
— id: 78493, year: 1994, vol: 151, page: 507, stat: Journal Article,

WHOLE-BODY VIBRATION EXPOSURE EXPERIENCED BY SUBWAY TRAIN OPERATORS
OZKAYA, N; WILLEMS, B; GOLDSHEYDER, D; NORDIN, M
1994 JAN ;13(1):13-18, Journal of low frequency noise & vibration
Purposes of the study were to measure mechanical vibrations transmitted to train operators, to calculate daily whole-body vibration exposure levels, to compare measured levels with maximum acceptable exposure levels according to the international standard on whole-body vibration, to identify factors that influence vibration levels, and to quantify the effects of these factors on the measured levels. As a result of this study, it was determined that six out of twenty subway lines had vibration levels higher than the daily exposure limits recommended by the international standard, and that train speed was the most significant factor influencing the vibration levels
— id: 87460, year: 1994, vol: 13, page: 13, stat: Journal Article,

Sociocultural factors and back pain. A population-based study in Belgian adults
Skovron ML; Szpalski M; Nordin M; Melot C; Cukier D
1994 Jan 15;19(2):129-137, Spine
A population-based survey of approximately 4000 adults in Belgium, a bi-cultural country with a uniform health care system, explored the relationships of socio-cultural and employment factors to the reported experience of low back pain (LBP). Predictors of 1) history of LBP, 2) first LBP, and 3) daily LBP were examined by multiple logistic regression analysis. Thirty-three percent of the population had current LBP, including 5% experiencing their first episode; 26% had past but not current LBP, and 41% had never had LBP. Increasing age (OR > 2.0, P = .000) and female gender (OR 2.16, P = .000) were associated with history of LBP; only gender (OR 1.40, P = .02) was associated with first episode; neither was associated with daily LBP. Language was associated with history (OR 1.80, P = .000) and first occurrence (OR 1.77, P = .000) but not daily LBP. Among those employed, work dissatisfaction was associated with history of LBP (OR > 2.4, P = .02) and daily LBP (OR 3.85, P = .02), but not with first episode. The results suggest that sociocultural factors influence the expression of LBP, but not the risk of chronicity once LBP is reported, and that work satisfaction may not be causally related to LBP, but may intervene along with type of occupation in the possibility of continuing employment once LBP is present. Prospective studies are needed to confirm these results and elucidate causal relationships
— id: 13002, year: 1994, vol: 19, page: 129, stat: Journal Article,

The hand in neck manoeuvre as a tool to analyze pain-generating mechanisms in the subacromial impingement syndrome
Solem-Bertoft, E; Nordin, M; Rahme, H; Westerberg, C E
1994 Jun;26(2):59-64, Scandinavian journal of rehabilitation medicine
A scoring system for a standardized composite movement of the shoulder--the Hand in Neck (HIN) manoeuvre--is presented. The EMG activity of the supraspinatus muscle was studied in 5 healthy subjects at different performance levels of this test. It is shown that the supraspinatus muscle is about four times more active during normal performance than at the subnormal levels, which among themselves do not differ. EMG activity was also studied during normal performance of another standardized manoeuvre--the Pour out of a Pot (POP) test. Based on a comparison of the EMG data with clinical data from patients with the subacromial impingement syndrome it is suggested that an abnormal HIN test indicates the presence of a traction responsive pain generator in the supraspinatus tendon. In the same patient group, the combination of a normal HIN test and an abnormal POP test indicates pain generated by compression of subacromial structures
— id: 78494, year: 1994, vol: 26, page: 59, stat: Journal Article,

Cross-sectional study of the isokinetic muscle trunk strength among school children
Balague, F; Damidot, P; Nordin, M; Parnianpour, M; Waldburger, M
1993 Jul;18(9):1199-1205, Spine
Our surveys have shown lifetime prevalence of L.BP. over 30% among schoolchildren. The purpose of this study was to evaluate the relationship between back and isokinetic trunk strength, anthropometric parameters, and sports activities. One hundred and seventeen healthy children aged 10-16 years were included. All these volunteers had semi-structured interview, anthropometric and dynamic strength measurements. Lifetime prevalence of back pain was 44.5% and point prevalence was 13%. In this cross-sectional study, anthropometric and strength profiles were significantly related to age and gender. Non specific low back pain was not correlated to trunk muscle strength and/or sports activities
— id: 78496, year: 1993, vol: 18, page: 1199, stat: Journal Article,

Quantification of trunk muscle performance in standing, semistanding and sitting postures in healthy men
Cartas, O; Nordin, M; Frankel, V H; Malgady, R; Sheikhzadeh, A
1993 Apr;18(5):603-609, Spine
The purpose of this study was to determine trunk muscle performance in the sitting, semistanding, and standing postures during isometric and dynamic extension and flexion movements. Twenty-five male subject volunteers, with no previous history of back pain participated in the study. A triaxial dynamometer that measures torque, angular position, and velocity was used to measure isometric and dynamic motor output. The dynamometer allows testing in the sitting and standing postures. A custom-designed module also allowed testing in the semistanding posture. Each subject was tested in two sessions. The first session included the physical examination and three trials of isometric maximum voluntary contractions in the three postures. The second session included the dynamic performance against a resistance equal to 50% of the effort, as measured in the first session. Subjects were instructed to perform five repetitive flexion and extension cycles as fast and accurately as possible with maximum effort. An analysis of variance with repeated measures design was used to investigate the effects of the postures (standing, semistanding and sitting), the direction of exertion (flexion and extension), and the interaction effects of the isometric and dynamic parameters (maximum and average torque, velocity, power, and range of motion). The effects of direction (F = 98, P < 0.0001) and the interaction of posture and direction (F = 7.9, P < 0.001) were significant. The maximum isometric flexion strength was significantly higher in the standing posture than in semistanding and sitting. The maximum isometric extension was not affected by the posture (sitting, semistanding and standing).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 76357, year: 1993, vol: 18, page: 603, stat: Journal Article,

Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain
Hultman, G; Nordin, M; Saraste, H; Ohlsen, H
1993 Apr;6(2):114-123, Journal of spinal disorders
Thirty-six 45-55-year-old men with healthy low backs were studied with respect to body composition, isokinetic and isometric trunk strength, trunk muscle endurance, and cross-sectional area and radiological density of mm erector spinae. Results were compared to those of men in the same age group with intermittent low back pain (LBP) (n = 91) and with chronic LBP (n = 21). The back healthy group was significantly stronger and had longer trunk muscle endurance times than men with chronic LBP. Men with intermittent LBP had strength and endurance values in between the back healthy and chronic groups. There were no significant differences between any of the groups with respect to body composition and cross-sectional area of mm erector spinae. Radiological density for mm erector spinae was significantly decreased in the chronic LBP group compared to the back healthy and intermittent LBP groups. The deconditioning syndrome and its relationship to intermittent and chronic LBP is discussed
— id: 78497, year: 1993, vol: 6, page: 114, stat: Journal Article,

Isometric maximal and submaximal trunk extension at different flexed positions in standing. Triaxial torque output and EMG
Tan, J C; Parnianpour, M; Nordin, M; Hofer, H; Willems, B
1993 Dec;18(16):2480-2490, Spine
Thirty-one healthy men were tested for the effects of trunk-flexion positions (0 degrees, 15 degrees, and 35 degrees) in standing on triaxial torques and electromyogram of 10 trunk muscles during voluntary maximal and submaximal isometric trunk extension. At a more flexed position, both erector spinae and latissimus dorsi showed significantly higher RMS-EMG. The abdominal obliques were coactivated only during 100% maximum voluntary exertion at each posture. In all tests, the rectus abdomini were quiet. Mean maximum extension torque increased significantly at 15 degrees and 35 degrees of trunk flexion. The ratio of extension torque over RMS-EMG of the trunk extensor muscles, called the neuromuscular efficiency ratio (NMER), also increased in the more flexed posture. However, NMER has to be interpreted with caution because it is affected both by posture and exertion levels. The effects of posture on the torque generation capability of the trunk question the validity of the current lifting recommendations
— id: 78495, year: 1993, vol: 18, page: 2480, stat: Journal Article,

Back pain in children and teenagers
Balague, F; Nordin, M
1992 Oct;6(3):575-593, Bailliere's clinical rheumatology
Controversial opinions have been published concerning the frequency of LBP among children and adolescents. Studies from orthopaedics or neurosurgical departments have reported low figures for prevalence of specific LBP due to serious disorders. Field surveys, on the contrary, have shown that cumulative life prevalence of non-specific LBP in children and teenagers can be comparable to the prevalence data for adult populations. Some specific diagnoses are more common or characteristic of children complaining of LBP. Age, gender, sports activities and family history of LBP have been found to be significantly associated with an increased prevalence in non-specific LBP among children. Low back pain among children and teenagers is common and should be recognized. This chapter provides guidelines for a clinical approach and differential diagnoses. Most back pain in these age groups is benign and should be treated as such
— id: 78499, year: 1992, vol: 6, page: 575, stat: Journal Article,

Back schools in prevention of chronicity
Nordin, M; Cedraschi, C; Balague, F; Roux, E B
1992 Oct;6(3):685-703, Bailliere's clinical rheumatology
This chapter has reviewed the role of back school and educational programmes for the common and non-specific acute and subacute low back pain patient. The following seems to come out of this review. Education is an important part of patient care. However, several questions arise about the content of the education, the selection of patients, the patient compliance to instruction given, how the information is retained, and which outcome measures should be used. It is also important to realize that the back school is a modality or a tool that may be used as an adjunct, but as a sole treatment it seems to have less impact than in combination with other structured or goal-oriented programmes. When a back school is instituted in a hospital or in industry, it requires administrative and budgetary support and a multidisciplinary staff to successfully carry out the programme. The information given must be adapted to the needs of the participants and all members of the team must give the same information to the patient. A poorly structured back school where patients are dumped because the physician or other health care provider has nothing else to offer is a poor solution for the patient, a poor solution for the health care provider, and can only increase the patient's discomfort and health care costs
— id: 78498, year: 1992, vol: 6, page: 685, stat: Journal Article,

COMMON LOW-BACK-PAIN - PREVENTION OF CHRONICITY - FOREWORD
NORDIN, M; VISCHER, TL
1992 OCT ;6(3):R9-R10, Bailliere's clinical rheumatology
— id: 51821, year: 1992, vol: 6, page: R9, stat: Journal Article,

The DNA-binding protein P52 of human cytomegalovirus reacts with monoclonal antibody CCH2 and associates with the nuclear membrane at late times after infection
Plachter, B; Nordin, M; Wirgart, B Z; Mach, M; Stein, H; Grillner, L; Jahn, G
1992 Aug;24(3):265-276, Virus research
Monoclonal antibody CCH2 is commonly used for the detection of human cytomegalovirus (HCMV) infected cells in tissue sections as well as in cultured cells. The specificity of CCH2 was determined by screening a recombinant lambda-gt11 cDNA gene bank from HCMV-infected fibroblasts. By sequencing a reactive clone, the antigen was identified to be the non-structural DNA binding protein p52 of HCMV (UL44 reading frame). The viral insert from the lambda clone was recloned in bacterial expression vectors. For this, a new vector, pRos-RS, was constructed. The resulting clones were tested in immunoblot analyses. They were reactive with CCH2 as well as with reconvalescent sera positive for antibodies against HCMV, by this proving the specificity of CCH2. Using this monoclonal antibody in confocal microscopy, the subcellular localization of p52 in infected cells was analyzed. In these analyses, p52 was found to be nuclear and to be associated with the nuclear membrane at late times after infection
— id: 78500, year: 1992, vol: 24, page: 265, stat: Journal Article,

Role of physical therapy in the treatment of cervical disk disease
Tan, J C; Nordin, M
1992 Jul;23(3):435-449, Orthopedic clinics of North America
Table 4 summarizes how physical therapy should be implemented during the acute and chronic phase of cervical disk disease. From the outset of treatment, the patient should be encouraged to return to work or other productive activities and should be taught how to be responsible for their own recovery. If passive modalities are used, they must be an adjunct to the active modalities. As soon as the patient is able to continue with an active program without unbearable pain, the passive modalities should be discontinued gradually. If neck pain becomes chronic, the accompanying psychosocial dysfunction must be addressed through behavioral modification techniques, preferably in a multidisciplinary setting. Modification of the work place, work habits, and lifestyles must be emphasized at both the acute and chronic stages. The modalities presented in this article are commonly used by physical therapists. Unfortunately, the clinical efficacy of most of these modalities has yet to be proved. A literature search on the effectiveness of various physical therapy modalities by Sievers et al showed that only 4% of the studies published from 1979 to 1985 were controlled clinical trials. This scientific output of physical therapists needs to be corrected
— id: 78501, year: 1992, vol: 23, page: 435, stat: Journal Article,

Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients
Elnaggar, I M; Nordin, M; Sheikhzadeh, A; Parnianpour, M; Kahanovitz, N
1991 Aug;16(8):967-972, Spine
It has been estimated that one fourth to one half of all patients treated in physical therapy clinics suffer from low-back pain. The purpose of this study was to compare the effects of spinal flexion (Group I) and extension (Group II) exercises on low-back pain severity and thoracolumbar spinal mobility in chronic mechanical low-back pain patients. Both groups had significantly less low-back pain after treatment (P less than .10). There was no significant difference, however, between the spinal flexion and extension exercises in reduction of low-back pain severity. The results indicated a significant difference between the groups in increasing the sagittal mobility (P less than .10). The results did not indicate any significant difference between and within groups in increasing the coronal and transverse mobility of the thoracolumbar spine. Either the spinal flexion or extension exercises could be used to reduce chronic mechanical low-back pain severity, but the flexion exercises had an advantage in increasing the sagittal mobility within a short period of time
— id: 76358, year: 1991, vol: 16, page: 967, stat: Journal Article,

Menarche 1990 in Stockholm schoolgirls
Lindgren, G W; Degerfors, I L; Fredriksson, A; Loukili, A; Mannerfeldt, R; Nordin, M; Palm, K; Petterson, M; Sundstrand, G; Sylvan, E
1991 Oct;80(10):953-955, Acta paediatr scandinavia
— id: 78502, year: 1991, vol: 80, page: 953, stat: Journal Article,

Fundamentals of biomechanics : equilibrium, motion, and deformation
Ozkaya, Nihat; Nordin, Margareta
New York : Van Nostrand Reinhold, 1991,
— id: 1407, year: 1991, vol: , page: , stat: ,

Low-threshold mechanoreceptive and nociceptive units with unmyelinated (C) fibres in the human supraorbital nerve
Nordin, M
1990 Jul;426:229-240, Journal of physiology
1. In recordings from the human supraorbital nerve with tungsten microelectrodes, eleven afferent units with unmyelinated (C) axons were identified on the basis of their conduction velocities (0.6-1.4 m/s). 2. Eight units had low mechanical thresholds (less than or equal to 0.23 g) and could be activated up to their maximal firing rates of about 100 impulses/s by weak tactile stimuli, whereas three units had higher thresholds (5.5 g) and responded vigorously to noxious stimuli only. 3. During a skin indentation the low-threshold units adapted to an irregular low-frequency discharge, and release of the stimulus elicited a prominent off-response often ending with an after-discharge. Slow stroking was a particularly effective stimulus, even when done with cotton wool, whereas rapid stroking reduced the response. All types of stroking stimuli were occasionally followed by after-discharges. Repeated mechanical stimulation at short intervals resulted in a decline of the response, indicating receptor fatigue. For two units a response to skin cooling was observed. 4. The above low-threshold C units have all the main characteristics of the C mechanoreceptors known from the cat and primates but not previously proven to exist in man. The high-threshold C units are similar to the polymodal nociceptors found in other human skin areas
— id: 78504, year: 1990, vol: 426, page: 229, stat: Journal Article,

Sympathetic discharges in the human supraorbital nerve and their relation to sudo- and vasomotor responses
Nordin, M
1990 Apr;423:241-255, Journal of physiology
1. Sympathetic nerve activity occurring as bursts of multi-unit impulses was recorded with tungsten microelectrodes in the supraorbital nerve of awake healthy subjects. Within the fascicular innervation zone on the forehead, skin resistance was measured as an indicator of sweat gland activity, and skin blood flow was measured with laser-doppler flowmetry. 2. At room temperature, there was little or no background burst activity, but arousal stimuli or mental stress evoked bursts followed by a vasodilator response. Provided repeated arousal stimuli were delivered, individual bursts were followed by a decrease in skin resistance. 3. Body heating induced increasing background burst activity. After an initial period without associated electrodermal activity, there were decreases in skin resistance, which showed a positive linear correlation with the amplitude of the preceding burst. Individual bursts were followed by a vasodilator response with an average onset latency of 2.8 s and an average duration of 9.1 s, and rapid increases in blood flow coincided with a marked increase in burst activity. Arousal stimuli evoked bursts followed by both vasodilator and skin resistance responses. 4. During body cooling, there was no background burst activity, but signs of relatively weak, probably neurally mediated vasoconstriction were observed and arousal-evoked bursts were reduced or abolished, as were the associated vasodilator and skin resistance responses. 5. It is concluded that body heating induces active sympathetic vasodilatation in the skin of the human forehead, and that this is either sudomotor-mediated or caused by vasodilator fibres firing in synchrony with sudomotor fibres. A similar sympathetic mechanism probably underlies the vasodilator responses evoked by arousal stimuli and mental stress
— id: 78505, year: 1990, vol: 423, page: 241, stat: Journal Article,

The relationship of torque, velocity, and power with constant resistive load during sagittal trunk movement
Parnianpour, M; Nordin, M; Sheikhzadeh, A
1990 Jul;15(7):639-643, Spine
Strength and fitness studies have been used to determine the predictability of back pain episodes. Tests have demonstrated that isometric strength displays little prognostic value in the development of low-back pain. Static isometric tests have achieved widespread usage due to the simplicity and safety of protocols, the readily available technology, and the low administrative costs. Dynamic lifting models have, however, predicted significantly higher spinal loads than those derived from static models. The objectives of this study were twofold: to investigate the relationship of the torque, velocity, and power to the resistive load during trunk flexion and extension, and to develop predictive models for these relationships for the subject's performance of the 10th, 50th, and 90th percentile distribution. The results of the study found that the flexion/extension torque had a positive linear correlation with the set resistance; the velocity displayed a negative linear correlation, while power had a quadratic relationship with the resistance
— id: 76359, year: 1990, vol: 15, page: 639, stat: Journal Article,

Environmentally induced disorders of the musculoskeletal system
Parniapour, M; Nordin, M; Skovron, M L; Frankel, V H
1990 Mar;74(2):347-359, Medical clinics of North America
The human suffering and economic cost attributable to musculoskeletal disorders cannot be overemphasized. Biomechanical principles have been introduced to explain the microtrauma and macrotrauma as mechanisms of injury. Stress-induced remodeling is a useful paradigm in the study of environmentally induced disorders. The concept of environment should include psychosocial and organizational factors with respect to musculoskeletal complaints and chronic pain. Low back pain, osteoarthritis, osteoporosis and its associated fractures, and cumulative trauma disorders are the most critical and common musculoskeletal disorders. The risk factors for low back pain have been identified, and preventive measures for reducing the chronicity of low back pain have been discussed. Preventive approaches to control or limit the fractures associated with osteoporosis and loss of bone mass are preferred to simple management of the fracture of osteoporotic patients. It can be concluded that too little or too much stress can disturb the homeostatic or the equilibrium state of health and that much remains to be researched to quantify the optimal stress levels
— id: 78506, year: 1990, vol: 74, page: 347, stat: Journal Article,

[Physical activity has a certain positive effect on the skeleton]
Zetterberg, C; Annerstedt, M; Nordin, M; Skovron, M L; Zuckerman, J
1990 Oct 17;87(42):3393-3395, Lakartidningen
— id: 78503, year: 1990, vol: 87, page: 3393, stat: Journal Article,

Mechanoreceptive units in the human infra-orbital nerve
Nordin, M; Hagbarth, K E
1989 Feb;135(2):149-161, Acta physiologica Scandinavica
Eighty-four low-threshold mechanoreceptive afferents innervating facial hairy skin or the red zone of the lip were recorded with micro-electrodes from the human infra-orbital nerve. Based on their responses to skin indentations, the units were classified as slowly or fast-adapting, with small or large receptive fields. The responses to hair movement, skin stretching and contraction of facial muscles were also studied. Both hairy skin and the red zone were innervated by slowly and by fast-adapting units. The innervation density was found to be highest at the corner of the mouth and on the upper lip. Slowly adapting units with small fields in hairy skin were most common and included units responding to sustained hair displacement. These units are suggested to have two types of end-organs, either pilo-Ruffini endings or Merkel cell-neurite complexes. The slowly adapting units with large fields were spontaneously active stretch receptors and may have corresponded to Ruffini corpuscles, although the possibility of other, intramuscular, receptors could not be ruled out. Only one afferent possibly innervated a Pacinian corpuscle. Most mechanoreceptors were also activated by skin stretching or contraction of facial muscles. Many of the slowly adapting units with small fields responded to the onset and release of stretch, whereas their discharge in response to sustained stretching adapted more or less completely. Spontaneously active units had the most sustained stretch response. It is concluded that several types of cutaneous mechanoreceptors can operate as sensitive proprioceptors of importance for facial kinaesthesia and motor control
— id: 78509, year: 1989, vol: 135, page: 149, stat: Journal Article,

Intrafascicular multi-unit recordings from the human infra-orbital nerve
Nordin, M; Thomander, L
1989 Feb;135(2):139-148, Acta physiologica Scandinavica
Intrafascicular micro-electrode recordings were made from the human infra-orbital nerve close to the infra-orbital foramen. The fascicular organization was studied and multi-unit activity from low-threshold mechanoreceptive afferents was recorded during tactile stimuli, vibration and facial movements. Attempts were also made to record C-fibre activity. Innervation zones corresponding to 66 fascicles were mapped with tactile stimuli on facial hairy skin and the red zone of the lip. Most of these fields were located on the upper lip, where they overlapped, indicating a high innervation density. The fields had a median size of 3.8 cm2. Skin indentation evoked dynamic on- and off-responses and a much less pronounced static discharge. The afferent double-peaked responses to an oscillating probe applied to the peri-oral region induced similar grouping of the EMG activity during sustained lip protrusion. Contraction of facial muscles and stretching of the skin evoked on- and off-responses, whereas the static discharge was less pronounced, especially during sustained stretching. The dynamic sensitivity to minor variations in contraction and stretching was high, and during normal facial movements, as in speech, there was a barrage of impulses originating from mechanoreceptors within large facial areas. Functional implications of these sensorimotor interactions are discussed. Sympathetic C-fibre activity, frequently seen in recordings from the supra-orbital nerve, was never encountered in the infra-orbital nerve recordings, indicating a lack of such fibres. Failure to detect afferent C-fibre activity could be explained by methodological difficulties
— id: 78510, year: 1989, vol: 135, page: 139, stat: Journal Article,

Basic biomechanics of the musculoskeletal system
Nordin, Margareta; Frankel, Victor H
Philadelphia : Lea & Febiger, 1989,
— id: 79, year: 1989, vol: , page: , stat: ,

Basic biomechanics of the musculoskeletal system
Nordin, Margareta; Frankel, Victor H
Baltimore : Williams & Wilkins, 1989,
— id: 1417, year: 1989, vol: , page: , stat: ,

Reproducibility of trunk isoinertial performances in the sagittal, coronal, and transverse planes
Parnianpour, M; Li, F; Nordin, M; Frankel, V H
1989 Fall;49(2):148-154, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
A new triaxial dynamometer to quantify the performance of trunk muscles has been developed, and a study was conducted to determine the best control parameters to use with this triaxial isodynamic mode of testing. Nine male subjects were tested at three resistance levels in the sagittal, coronal, and transverse planes. The purpose was to establish the reproducibility of the performance parameters in each plane at all resistance levels, and to identify those parameters which gave the most reliable information for objective assessment of the low back functional state. Measured torque had the highest reproducibility rate, and the most reliable assessments were obtained at the highest resistance level
— id: 78511, year: 1989, vol: 49, page: 148, stat: Journal Article,

A database of isoinertial trunk strength tests against three resistance levels in sagittal, frontal, and transverse planes in normal male subjects
Parnianpour, M; Li, F; Nordin, M; Kahanovitz, N
1989 Apr;14(4):409-411, Spine
Spatial joint complexes, such as the spine, require multiaxial systems to adequately assess their functional capacity. The B200 Isostation (Isotechnologies, Inc., Carrboro, North Carolina) is a triaxial system that has three hydraulic pumps under control of an IBM-XT. The transducers measure the torque, angular position, and velocity for all axes simultaneously. There is no isoinertial data base available for strength at different resistances in the sagittal, coronal, and transverse planes. A normal data base for dynamic performance against resistances equal to 30%, 50%, and 70% of the maximum isometric strength of trunk muscles in all three planes was established
— id: 78507, year: 1989, vol: 14, page: 409, stat: Journal Article,

Histochemistry and morphology of erector spinae muscle in lumbar disc herniation
Zhu, X Z; Parnianpour, M; Nordin, M; Kahanovitz, N
1989 Apr;14(4):391-397, Spine
The purpose of this study was to detect any changes in the erector spinae muscles in patients undergoing surgery for lumbar disc herniation (LDH) and to analyze which factors (sex, age, the level and site of disc protrusion, and duration of symptoms) would be related to these changes. The percentage of mean area of the type I fibers was significantly larger in males and in the older age group (P less than 0.05), due to the decreasing size of type IIa and IIb fibers. Patients with LDH have: 1) angulated and selective atrophy of type II fibers with a higher type IIb/IIa ratio; 2) with increasing age and duration of symptoms, more marked atrophy of type II fibers; and 3) other unspecific pathologic changes
— id: 78508, year: 1989, vol: 14, page: 391, stat: Journal Article,

Three-dimensional spinal motion measurements. Part 2: A noninvasive assessment of lumbar brace immobilization of the spine
Buchalter, D; Kahanovitz, N; Viola, K; Dorsky, S; Nordin, M
1988 ;1(4):284-286, Journal of spinal disorders
The purpose of this study was to evaluate the limitation of motion as well as comfort provided by four different types of lumbar braces. The four braces were the Raney jacket, the Camp lace-up corset, a molded-polypropylene thoracolumbar-sacral orthosis (TLSO), and a common elastic corset. The data revealed that all braces significantly restrict free lumbar and thoracic motion in the sagittal and frontal planes. All braces restricted lumbar motion more in the frontal than in the sagittal plane. The rigid TLSO and Raney jackets were most restrictive when compared with the Camp corset and the elastic corset. Axial rotation in the lumbar spine is normally minimal and further limitation by a brace would be negligible. All braces restricted thoracic motion despite the fact that lumbar braces were used. The elastic corset was rated the most comfortable and the Raney jacket the least comfortable. This verifies that there is an inverse relationship between a brace's ability to restrict motion and comfort
— id: 78514, year: 1988, vol: 1, page: 284, stat: Journal Article,

Three-dimensional spinal motion measurements. Part 1: A technique for examining posture and functional spinal motion
Buchalter, D; Parnianpour, M; Viola, K; Nordin, M; Kahanovitz, N
1988 ;1(4):279-283, Journal of spinal disorders
This study examines the application of a new noninvasive technology capable of accurately, reproducibly, and reliably measuring spinal motion, in real time, with 3 df. The mean values and SD of range of motion in the lumbar, thoracic, and cervical regions compares favorably with results reported by other authors. Pearson correlations yielded a statistically significant weak inverse relationship between age and range of motion in the sagittal and frontal planes (p less than .02). No correlation between sex, height, or weight and range of motion was found. There was no statistically significant evidence of organized coupling. However, a relationship between rotation and lateral motion in the thoracic region was noted
— id: 78515, year: 1988, vol: 1, page: 279, stat: Journal Article,

1988 Volvo award in biomechanics. The triaxial coupling of torque generation of trunk muscles during isometric exertions and the effect of fatiguing isoinertial movements on the motor output and movement patterns
Parnianpour, M; Nordin, M; Kahanovitz, N; Frankel, V
1988 Sep;13(9):982-992, Spine
Previous studies have shown that reduction of precise motor control accompanies local muscular fatigue. The effects of isodynamic fatiguing of flexion and extension trunk movements on the movement patterns and the motor output of the trunk were investigated. Twenty male subjects with no history of low-back pain for the past 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position and velocity of each axis. Resistances were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a sagittal plane resistance equal to 70% of their maximum isometric extension strength in the upright position. The minimum resistances in the coronal and transverse planes were set up at 7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Analysis of variance, the MANOVA procedure with a repeated measure design, was performed among the selected parameters of the first, middle and last three repetition cycles. The selected parameters are the trunk motor output and movement patterns; the total angular excursion, range of motion, maximum and average torque and angular velocity of the trunk. All the selected parameters were significantly reduced in the sagittal plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction in the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structure is loaded in a more injury prone pattern, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries
— id: 78512, year: 1988, vol: 13, page: 982, stat: Journal Article,

Population studies of Huntington's disease in Wales
Quarrell, O W; Tyler, A; Jones, M P; Nordin, M; Harper, P S
1988 Mar;33(3):189-195, Clinical genetics
Long-term surveillance of Huntington's disease families living in South Wales has been undertaken since 1973. We report the updated data on prevalence and births in 101 kindreds. The trend in the births at risk of Huntington's disease has been compared with a control population in North Wales
— id: 78513, year: 1988, vol: 33, page: 189, stat: Journal Article,

Motor-unit responses in human wrist flexor and extensor muscles to transcranial cortical stimuli
Calancie, B; Nordin, M; Wallin, U; Hagbarth, K E
1987 Nov;58(5):1168-1185, Journal of neurophysiology
1. Transcranial cortical stimuli (TCCS) were used to elicit motor responses in contralateral wrist flexor and extensor muscles of healthy adult subjects. The motor responses were assessed by surface EMG recordings, by needle recordings of single motor-unit discharges, and by measurements of wrist twitch force. Our main aim was to analyze the single-unit events underlying those changes in latency, amplitude, and duration of the compound EMG responses, which could be induced by voluntary preactivation of target muscles and by changes in stimulation strength. 2. Different stimulus strengths were tested with and without background contractions in the flexor or extensor muscles. For each test (consisting of a series of 20 stimuli) the compound EMG responses were averaged and displayed together with the averaged wrist force signals. Responses of individual flexor and extensor motor units were displayed in raster diagrams and peristimulus time histograms. For units exhibiting a background firing, the mean background interdischarge interval was calculated and compared with the subsequent poststimulus intervals. 3. In relaxed muscles, a shortening of onset latency of evoked compound EMG responses was observed when raising stimulation strength. A similar latency reduction was not seen in any of the single-unit recordings. This would be consistent with the size principle of motoneuron recruitment. 4. A shortening of onset latency of evoked EMG potentials was observed also as a result of a voluntary preactivation. Such latency shifts, which were seen also in single-unit recordings, might be attributed to variations in the time required for D and I wave temporal summation at the anterior horn cell. 5. When raising stimulation strength or when adding voluntary background contraction, the evoked compound EMG potential grew not only in amplitude but also in duration, as later peaks of activity were added to the initial ones. Under optimal conditions (strong stimulus + background contraction), the period of excitation (termed E1) had an onset latency of approximately 15 ms and a duration of approximately 35 ms and was similar for wrist flexor and extensor muscles. 6. We never saw the same flexor or extensor unit fire more than once during the E1 period. For units preactivated by a background contraction, the stimulus-triggered impulse exhibited latency shifts, which, to a large extent, depended on the timing of the stimulus in relation to a preceding background discharge and which could be influenced by a change in stimulation strength.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 78516, year: 1987, vol: 58, page: 1168, stat: Journal Article,

Prediction of outcome after cardiac arrest
Edgren, E; Hedstrand, U; Nordin, M; Rydin, E; Ronquist, G
1987 Sep;15(9):820-825, Critical care medicine
Neurologic outcome of hypoxic ischemic coma after cardiac arrest was studied in 32 patients. Observations were made and samples collected 24 and 48 h after the ischemic insult. The Glasgow-Pittsburgh coma score was assessed for its prognostic value. Other variables studied were the EEG and adenylate kinase, lactate and glutathione in the cerebrospinal fluid (CSF). Outcome was termed good if the patients resumed an independent life within a 6-month follow-up period. The closest correlations between prediction and good outcome occurred with the Glasgow-Pittsburgh coma score (94%) and the EEG (77%) at the 48-h examination, a modified coma score (96%) at 48 h, and CSF lactate (78%) at 24 h. Some simple neurologic signs (e.g., no withdrawal response to pain) at stated points in time was 100% associated with a bad outcome, although their absence was not associated necessarily with a good prognosis
— id: 78518, year: 1987, vol: 15, page: 820, stat: Journal Article,

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: Comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance
Kahanovitz, N; Nordin, M; Verderame, R; Yabut, S; Parnianpour, M; Viola, K; Mulvihill, M
1987 Mar;12(2):112-118, Spine
Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform
— id: 78523, year: 1987, vol: 12, page: 112, stat: Journal Article,

Peripheral neural correlates of cutaneous anaesthesia induced by skin cooling in man
Kunesch, E; Schmidt, R; Nordin, M; Wallin, U; Hagbarth, K E
1987 Feb;129(2):247-257, Acta physiologica Scandinavica
The effect of local skin cooling on the behavior of low- and high-threshold mechanoreceptive afferents innervating glabrous and non-glabrous skin was studied in microneurographic recordings on awake human subjects. Cooling with ice or ethyl chloride to a skin surface temperature below 10 degrees C caused a reduction of receptor sensitivity in 49 out of 52 studied low-threshold afferents. This effect was reversible upon warning but some reduction often persisted for a few minutes after normal skin temperature had been reached. The subjects' sensations of application and removal of von Frey hair stimuli were more resistant than had reappeared before the sensation of sustained pressure. This could be explained by shorter recovery times for fast than for slowly adapting units and by a relative preservation of the dynamic responses of the slowly adapting units. During the recovery phase some low-threshold mechanoreceptive afferents exhibited a transient 'spontaneous' discharge in the absence of external mechanical stimulation. The suppression of afferent C-fibre responses to needle strokes was more pronounced and long-lasting than the effect on A-fibre responses and largely paralleled the recovery of sensation of pain. It is concluded that the local anaesthetic effect of skin cooling is to a large extent explicable in terms of receptor desensitization although other mechanisms may contribute
— id: 78524, year: 1987, vol: 129, page: 247, stat: Journal Article,

Evaluation of the workplace. An introduction
Nordin, M; Frankel, V H
1987 Aug;(221):85-88, Clinical orthopaedics & related research
To reduce and optimize the work load imposed on the musculoskeletal system in a given situation, three main areas of interest are work technique, workplace design, and the produced work itself. Ergonomically sound work techniques should be taught early and should be repeatedly evaluated and encouraged. Workplace and tool design must be adapted and modified according to the task performed at the workplace. The work produced has to be evaluated in terms of handling comfort and discomfort by the employee: the greater the comfort, the greater the productivity will be. Especially in the rehabilitation of patients with back injuries, these factors must always be considered to avoid recurrent episodes of pain and disability
— id: 78519, year: 1987, vol: , page: 85, stat: Journal Article,

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 1: Normal endurance and trunk muscle strength in 101 women
Nordin, M; Kahanovitz, N; Verderame, R; Parnianpour, M; Yabut, S; Viola, K; Greenidge, N; Mulvihill, M
1987 Mar;12(2):105-111, Spine
The lack of trunk muscle strength and endurance has frequently been cited as a suspected factor in the etiology of low-back pain. Several investigators have suggested that asymptomatic patients have stronger trunk muscles than patients with low-back pain. People who are physically fit appear to have a decreased incidence of low-back pain. Increased trunk muscle endurance also have been observed to decrease the incidence of low-back pain. The objective evaluation of the strength and endurance of trunk musculature may, therefore, be significant. Part 1 of this study was designed to develop a reproducible strength-endurance screening procedure and to establish normal isometric-isokinetic trunk muscle strength and endurance parameters for women. This study showed that isometric trunk flexion varied from 19-109 Nm and trunk extension from 38-168 Nm. Peak values for isokinetic trunk flexion at two speeds (30 degrees per second and 60 degrees per second) varied from 17-191 Nm and isokinetic trunk extension from 14-208 Nm. The average endurance time for trunk extensors tested with the Sorensen test was 196 seconds
— id: 78522, year: 1987, vol: 12, page: 105, stat: Journal Article,

The effect of endogenous opioids on blood pressure during stress
Nordin, M; Morat, P; Zainora, M
1987 Apr;14(4):303-308, Clinical & experimental pharmacology & physiology
1. A series of experiments were conducted to investigate the effect of endogenous opioids on blood pressure of laboratory rats during stress. 2. Rats subjected to 120 min immobilization showed a significant drop in systolic pressure which could be prevented by pretreatment injections of naloxone. 3. Adrenalectomized rats subjected to the same kind of stress showed a drop in systolic pressure equivalent to only 30% of the systolic pressure drop in the intact animals. This decrease in systolic pressure could also be prevented by pretreatment injections of naloxone. 4. It was concluded that the decrease in systolic pressure in intact rats during immobilization was mostly due to endogenous opioids released from the adrenal glands, whereas opioids of other origins such as the pituitary gland, were also important
— id: 78520, year: 1987, vol: 14, page: 303, stat: Journal Article,

DIFFERENT TRUNK STRENGTH MEASURES AND THEIR INNER-CORRELATION
PARNIANPOUR, M; NORDIN, M; MORITZ, U; KAHANOVITZ, N
1987 SEP ;20(9):915-915, Journal of biomechanics
— id: 51244, year: 1987, vol: 20, page: 915, stat: Journal Article,

ENDURANCE TIME OF BACK MUSCLE IN RELATION TO EXTERNAL LOAD
PARNIANPOUR, M; SCHECTER, S; MORITZ, U; NORDIN, M
1987 SEP ;20(9):894-894, Journal of biomechanics
— id: 51243, year: 1987, vol: 20, page: 894, stat: Journal Article,

Work organization and low back pain in nursing personnel
Skovron, M L; Mulvihill, M N; Sterling, R C; Nordin, M; Tougas, G; Gallagher, M; Speedling, E J
1987 Feb;30(2):359-366, Ergonomics
— id: 78525, year: 1987, vol: 30, page: 359, stat: Journal Article,

Continuous measurements of spine movements in normal working situations over periods of 8 hours or more
Snijders, C J; van Riel, M P; Nordin, M
1987 Apr;30(4):639-653, Ergonomics
— id: 78521, year: 1987, vol: 30, page: 639, stat: Journal Article,

Seat features recommendations for workstations
Tougas, G; Nordin, M C
1987 Sep;18(3):207-210, Applied ergonomics
This paper makes general recommendations for workstation design. To prevent back problems, a chair should maintain a 105 degrees angle between the trunk and the thighs. For bent-forward work, a seat pan that can tilt forward allows the critical angle to be maintained
— id: 78517, year: 1987, vol: 18, page: 207, stat: Journal Article,

Gu ge xi tong ji ben sheng wu li xue = Basic biomechanics of the skeletal system
Frankel, Victor H; Nordin, Margareta
Tianjin Shi : Tianjin ke xue ji shu : Xin hua shu dian Tianjin fa xing suo fa xing, 1986,
— id: 1418, year: 1986, vol: , page: , stat: ,

Gamma loop contributing to maximal voluntary contractions in man
Hagbarth, K E; Kunesch, E J; Nordin, M; Schmidt, R; Wallin, E U
1986 Nov;380:575-591, Journal of physiology
A local anaesthetic drug was injected around the peroneal nerve in healthy subjects in order to investigate whether the resulting loss in foot dorsiflexion power in part depended on a gamma-fibre block preventing 'internal' activation of spindle end-organs and thereby depriving the alpha-motoneurones of an excitatory spindle inflow during contraction. The motor outcome of maximal dorsiflexion efforts was assessed by measuring firing rates of individual motor units in the anterior tibial (t.a.) muscle, mean voltage e.m.g. from the pretibial muscles, dorsiflexion force and range of voluntary foot dorsiflexion movements. The tests were performed with and without peripheral conditioning stimuli, such as agonist or antagonist muscle vibration or imposed stretch of the contracting muscles. As compared to control values of t.a. motor unit firing rates in maximal isometric voluntary contractions, the firing rates were lower and more irregular during maximal dorsiflexion efforts performed during subtotal peroneal nerve blocks. During the development of paresis a gradual reduction of motor unit firing rates was observed before the units ceased responding to the voluntary commands. This change in motor unit behaviour was accompanied by a reduction of the mean voltage e.m.g. activity in the pretibial muscles. At a given stage of anaesthesia the e.m.g. responses to maximal voluntary efforts were more affected than the responses evoked by electric nerve stimuli delivered proximal to the block, indicating that impaired impulse transmission in alpha motor fibres was not the sole cause of the paresis. The inability to generate high and regular motor unit firing rates during peroneal nerve blocks was accentuated by vibration applied over the antagonistic calf muscles. By contrast, in eight out of ten experiments agonist stretch or vibration caused an enhancement of motor unit firing during the maximal force tasks. The reverse effects of agonist and antagonist vibration on the ability to activate the paretic muscles were evidenced also by alterations induced in mean voltage e.m.g. activity, dorsiflexion force and range of dorsiflexion movements. The autogenetic excitatory and the reciprocal inhibitory effects of muscle vibration rose in strength as the vibration frequency was raised from 90 to 165 Hz. Reflex effects on maximal voluntary contraction strength similar to those observed during partial nerve blocks were not seen under normal conditions when the nerve supply was intact.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 78527, year: 1986, vol: 380, page: 575, stat: Journal Article,

Spinal configuration during lifting
Nordin, M; Greenidge, N; Tauber, C; Ngai, J
1986 Spring;46(1):31-36, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
The change in spinal configuration of the cervical, thoracic, and lumbar regions in relation to an amount of weight lifted was determined using videophotogrammetry. Fifteen healthy male subjects, 20-38 years of age, with no previous history of back pain participated in the study. The subjects lifted a crate containing 0, 10, and 20 kg weights using the straight-legs, bent-over-back method of lifting. The results showed that cervical and thoracic spinal segment configurations were not significantly influenced by the amount of weight lifted and that the mobility of the lumbar spinal segment was significantly decreased with increasing load (p = .03)
— id: 78528, year: 1986, vol: 46, page: 31, stat: Journal Article,

Microelectrode recordings from the facial nerve in man
Nordin, M; Hagbarth, K E; Thomander, L; Wallin, U
1986 Nov;128(3):379-387, Acta physiologica Scandinavica
Microneurographic recordings have for the first time been obtained from the human facial nerve trunk, close to its exit from the stylomastoid foramen. The aim was to search for evidence of an afferent or sympathetic component of the facial nerve at this level and to study the fascicular organization of motor fibres. Single unit discharges of motor axons were occasionally discerned, and all recordings showed multiunit motor impulses preceding the EMG activity of the appropriate facial muscles by about 5 ms during both blink reflexes and voluntary contractions. No evidence of low-threshold mechanoreceptive afferents was found. Electron microscopic studies at the level of recording showed unmyelinated axons but attempts to record nociceptive and sympathetic activity failed. However, deep facial pain evoked by intraneural stimulation suggested the presence of nociceptive afferents of non-cutaneous origin. Intrafascicular recording and stimulation showed that most fascicles were composed of motor axons innervating muscles within the whole ipsilateral half of the face
— id: 78526, year: 1986, vol: 128, page: 379, stat: Journal Article,

Introduction to problem solving in biomechanics
von Heijne Wiktorin, Christina; Nordin, Margareta
Philadelphia : Lea & Febiger, 1986,
— id: 1406, year: 1986, vol: , page: , stat: ,

Thixotropic behaviour of human finger flexor muscles with accompanying changes in spindle and reflex responses to stretch
Hagbarth, K E; Hagglund, J V; Nordin, M; Wallin, E U
1985 Nov;368:323-342, Journal of physiology
Prompted by previous reports on muscle thixotropy, we have investigated changes in inherent and reflex stiffness of the finger flexor muscles of human subjects at rest, following transient conditioning manoeuvres involving contractions and/or length changes of the finger flexors. The stiffness measurements were combined with electromyographic recordings from forearm and hand muscles and with microneurographic recordings of afferent stretch responses in finger flexor nerve fascicles. Finger flexor stiffness was evaluated by measuring (a) the flexion angle of the metacarpo-phalangeal joints at which the system during rest balanced the force of gravity and (b) the speed and amplitude of angular finger extensions induced by recurrent extension torque pulses of constant strength delivered by a torque motor. In the latter case, extension drifts in the resting position of the fingers were prevented by a weak flexion bias torque holding the fingers in a pre-determined, semiflexed position against a stop-bar. Stiffness changes following passive large amplitude finger flexions and extensions were studied in subjects with nerve blocks or nerve lesions preventing neurally mediated contractions in the forearm and hand muscles. Inherent stiffness was enhanced following transient finger flexions and reduced following transient finger extensions. The after-effects gradually declined during observation periods of several minutes. Similar results were obtained in subjects with intact innervation who succeeded during the pre- and post-conditioning periods in keeping the arm and hand muscles relaxed (i.e. showed no electromyographic activity). In these subjects it was also found that the after-effects were similar for active and passive finger movements and that isometric voluntary finger flexor contractions loosened the system in a way similar to finger extensions. In some subjects electromyographic reflex discharges appeared in the finger flexors in response to the extension test pulses. When elicited by small ramp stretch stimuli of constant amplitude, the stretch reflex responses were found to vary in strength in parallel with the changes in inherent stiffness following the various conditioning manoeuvres. The strength of the multi-unit afferent stretch discharges in the muscle nerve, used as index of muscle spindle stretch sensitivity, varied in parallel with the changes in inherent stiffness. Post-manoeuvre changes in muscle spindle stretch sensitivity were seen also when the spindles were de-efferented by a nerve block proximal to the recording site. The results can be explained in terms of thixotropic behaviour of extra- and intrafusal muscle fibres.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 78529, year: 1985, vol: 368, page: 323, stat: Journal Article,

Surgical or conservative treatment of the acutely torn anterior cruciate ligament. A randomized study with short-term follow-up observations
Odensten, M; Hamberg, P; Nordin, M; Lysholm, J; Gillquist, J
1985 Sep;(198):87-93, Clinical orthopaedics & related research
In a prospective study, 90 consecutive patients with total midstructural tears of the anterior cruciate ligament (ACL) were assigned at random to surgical (Group I) or conservative (Group II) treatment. Within 18.2 months of operation, 95% of the patients in Group I and 11% of those in Group II had a stable knee. The mean knee function score in Group I was 89 points, and 75% achieved more than 84 points (good or excellent). In Group II the mean score was 85; only 53% achieved more than 84 points (p less than .05). Group II patients showed greater mean quadriceps strength than those in Group I. The ability to perform a one-leg jump and to run a figure eight was similar in both groups. Early primary suture of the acutely torn ACL usually resulted in a stable knee, whereas conservatively treated patients showed knee instability. At the 18-month interval, however, the patients' functional performance seemed to be comparable in the two groups
— id: 78530, year: 1985, vol: , page: 87, stat: Journal Article,

Biomechanica van het skeletsysteem : grondslagen en toepassingen
Frankel, Victor H; Nordin, Margareta; Snijders, Chris J
Lochem : De Tijdstroom, 1984,
Basic biomechanics of the musculoskeletal system translated into Dutch by Chris J Snijders
— id: 1409, year: 1984, vol: , page: , stat: ,

The influence of a preventive educational programme on trunk flexion in janitors
Hultman, G; Nordin, M; Ortengren, R
1984 Jun;15(2):127-133, Applied ergonomics
The influence of a preventive educational back care programme on the movement patterns of the spine during work was assessed objectively and subjectively in six janitors. Trunk flexion was measured in the subjects using a flexion analyser before they attended a preventive educational back care programme and twice afterwards. The results show that the subjects increased the amount of time spent in an upright position by about a third after the educational programme and maintained this change two and a half to three months later. They also decreased the time spent in moderate and deep forward flexion (37-72 degrees ) by about half and also maintained this decrease at three months. These changes are consistent with a decrease of the mechanical load on the spine. The study emphasises that it is possible to alter movement patterns of the spine, and thereby decrease the load during janitorial work, by a suitably designed educational programme
— id: 78533, year: 1984, vol: 15, page: 127, stat: Journal Article,

The effect of a patella brace on performance in a knee extension strength test in patients with patellar pain
Lysholm, J; Nordin, M; Ekstrand, J; Gillquist, J
1984 Mar-Apr;12(2):110-112, American journal of sports medicine
The object of this study was to analyze the quadriceps muscle peak strength with the Cybex-II isokinetic dynamometer in patients with patellofemoral arthralgia with and without a patella brace. Twenty-four patients, 18 women and 6 men, were studied. All had patellofemoral arthralgia. The diagnosis was made on typical clinical findings, but was supplemented with arthroscopy in seven patients with pain also over the medial joint line. After a 2 week adaptation period with the brace, a Cybex-II test was done with and without the brace. The other leg was tested as control. Twenty-one patients (88%) improved their performance in the strength test with the brace (mean difference 13.7 +/- 9.1%). With the brace, 14 patients (58%) performed at 95% of their control leg or more compared to 6 (25%) without the brace. Patients under the age of 30 years had a better effect than patients over that age
— id: 78534, year: 1984, vol: 12, page: 110, stat: Journal Article,

Intra-abdominal pressure measurements using a wireless radio pressure pill and two wire connected pressure transducers: a comparison
Nordin, M; Elfstrom, G; Dahlquist, P
1984 ;16(4):139-146, Scandinavian journal of rehabilitation medicine
Intra-abdominal pressures were measured simultaneously with a wireless radio pill and two wire-connected pressure transducers introduced orally and rectally respectively. Measurements were made on 8 men during common postures, simple activities and static and dynamic lifting. An acceptable correspondence was found in wave forms of the generated pressure curves in time and shape. The three systems showed, however, a less good agreement in recorded peak differences, i.e. highest and lowest pressure responses to each task. The radio pill is simple to use, but more difficult to calibrate and expensive, compared to the wire-connected methods, which however are less attractive for use in the work environment
— id: 78535, year: 1984, vol: 16, page: 139, stat: Journal Article,

Ectopic sensory discharges and paresthesiae in patients with disorders of peripheral nerves, dorsal roots and dorsal columns
Nordin, M; Nystrom, B; Wallin, U; Hagbarth, K E
1984 Nov;20(3):231-245, Pain
Ectopically generated and antidromically conducted nerve impulses were recorded in 5 patients with tungsten microelectrodes inserted into skin nerve fascicles. All patients had mainly positive sensory symptoms and reported paresthesiae which could be provoked by different maneuvers which suggested increased mechanosensitivity of the primary sensory neurons at different anatomic levels. Ectopic multiunit nerve activity correlating in intensity and time course to the positive sensory symptoms was recorded: when Tinel's sign was elicited in a patient with entrapment of the ulnar nerve at the elbow, when paresthesiae were provoked by elevation of the arm in a patient with symptoms consistent with a thoracic outlet syndrome, when paresthesiae were evoked by straining during chin-chest maneuver in a patient with an S1 syndrome due to a herniated lumbar disc, when a painful Lasegue's sign occurred during the straight-leg raising test in a patient with an S1 syndrome due to root fibrosis, and when Lhermitte's sign was elicited by neck flexion in a patient with multiple sclerosis. The sites for the ectopic impulse generation in these cases are suggested to be peripheral nerve, brachial plexus, dorsal root or dorsal root ganglion and dorsal columns. The paresthesiae were non-painful except in the patient with Lasegue's sign and the ectopic impulses were probably recorded from large myelinated afferent fibers
— id: 78531, year: 1984, vol: 20, page: 231, stat: Journal Article,

Measurements of trunk movements during work
Nordin, M; Ortengren, R; Andersson, G B
1984 Jul-Aug;9(5):465-469, Spine
To study spinal movements during work, an instrument that measured angles and angle changes in relation to a vertical plane was adapted to continuously measure forward flexion of the trunk. The instrument, which is battery-powered and worn on the back, registers the amount of flexion and its distribution over time during a work cycle by recording the time spent in each of five 18 degrees intervals between 0 degrees and 90 degrees. Also the number of times that the angle of flexion changed from one interval to another is recorded. A total of 43 subjects from three occupations--dentistry, nurses' aide work, and warehouse work--were each tested during a 60 minute work cycle. On the average, the dentists spent most of the time (52.2 minutes) in a semi-flexed position not exceeding 36 degrees and performed eight deep forward flexions (greater than 73 degrees). The nurses' aides spent one-half of the work cycle (34.4 minutes) in an upright position (0-18 degrees) and performed 70 deep forward flexions. The warehouse workers spent less than one-half of the work cycle in an upright position (27.5 minutes) and performed 153 deep forward flexions that nearly always were associated with lifting
— id: 78532, year: 1984, vol: 9, page: 465, stat: Journal Article,

Methods for studying work load : with special reference to the lumbar spine
Nordin, Margareta
Goteborg : University of Goteborg, 1982,
— id: 1415, year: 1982, vol: , page: , stat: ,

Analysis and measurement of lumbar trunk loads in tasks involving bends and twists
Schultz, A B; Andersson, G B; Haderspeck, K; Ortengren, R; Nordin, M; Bjork, R
1982 ;15(9):669-675, Journal of biomechanics
Ten subjects performed isometric weight-holding and force-resisting work tasks while standing upright, both with and without a twist of the trunk; with the trunk bent laterally; and in postures involving combinations of bending and twisting. The lumbar trunk muscle contraction forces and the lumbar spine compression and shear forces imposed by these tasks were predicted using a biomechanical model. Myoelectric activity was recorded quantitatively at eight locations over the back muscles and at four locations over the abdominal wall muscles. Correlation coefficients from 0.67 to 0.88 were found between the predicted muscle contraction forces and the measured myoelectric activities when the predictions were made so as to minimize muscle contraction force per unit area. Trunk twisting and lateral bending were found to load the spine and trunk muscles less than trunk flexion or holding of weights in front of the body
— id: 78537, year: 1982, vol: 15, page: 669, stat: Journal Article,

Analysis and quantitative myoelectric measurements of loads on the lumbar spine when holding weights in standing postures
Schultz, A; Andersson, G B; Ortengren, R; Bjork, R; Nordin, M
1982 Jul-Aug;7(4):390-397, Spine
Ten subjects executed a number of weight-holding and force-resisting work tasks while standing either upright or with their trunks in 30 degrees of forward flexion. All tasks involved sagitally symmetric body configurations and were performed isometrically. A simple calculation scheme was devised to predict the lumbar trunk muscle contraction forces and the lumbar spine compression forces required for execution of each task. The myoelectric activity was recorded quantitatively at eight sites over the lumbar trunk muscles and at four sites over the abdominal muscles. Good correlation was found between the predicted muscle contraction forces and the myoelectric activities
— id: 78536, year: 1982, vol: 7, page: 390, stat: Journal Article,

Basic biomechanics of the musculoskeletal system
Frankel, Victor H; Nordin, Margareta
Philadelphia : Lea & Febiger, 1980,
— id: 1405, year: 1980, vol: , page: , stat: ,

[The "walking school"--a rehabilitation center for leg amputees]
Goldie, I; Jerndahl, A; Nordin, M; Renstrom, P
1978 Jul 26;75(30-31):2712-2716, Lakartidningen
— id: 78538, year: 1978, vol: 75, page: 2712, stat: Journal Article,