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PURPOSE: Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. METHOD: This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. RESULTS: High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. CONCLUSIONS: In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant nega

© 2017 Elsevier Ltd Objectives To investigate the efficacy of interventions for the prevention and treatment of low back pain in nurses. Design Systematic review. Data sources The review was registered on the PROSPERO database (CRD42015026941) and followed the PRISMA statement guidelines. A two phase approach was used. In phase one, all randomised controlled trials included in the systematic review of Dawson et al. (2007) which reviewed interventions for low back pain in nurses until 2004 were selected. In phase two, relevant randomised controlled trials and cluster randomised controlled trials published from 2004 until December 2015 were identified by an electronic search of nine databases (Embase, CINAHL, SPORTDiscus, PsycARTICLES, Cochrane Library, Web of Science, PEDro, Scopus and MEDLINE). To be eligible, trials had to examine the efficacy of interventions either for the prevention or treatment of low back pain in nurses. Primary outcomes of interest were any measure of pain and/or disability. Review methods Three reviewers independently assessed eligibility and two reviewers independently conducted a risk of bias assessment (Cochrane Back and Neck Group). Results Four studies were retrieved from phase one. In phase two, 15,628 titles and abstracts were scanned. From these, 150 full-text studies were retrieved and ten were eligible. Fourteen studies (four from phase one, ten from phase two) were eligible for risk of bias assessment. The included trials were highly heterogeneous, differing in pain and disability outcome measures, types of intervention, types of control group and follow-up durations. Only four of the included studies (n= 644 subjects) had a low risk of bias (=6/12). Manual handling training and stress management in isolation were not effective in nurses with and without low back pain (risk of bias, 7/12, n = 210); the addition of a stretching exercise intervention was better than only performing usual activities (risk of bias, 6/12, n = 127); com

© 2018 American Physical Therapy Association. Biomedical approaches for diagnosing and managing disabling low back pain (LBP) have failed to arrest the exponential increase in health care costs, with a concurrent increase in disability and chronicity. Health messages regarding the vulnerability of the spine and a failure to target the interplay among multiple factors that contribute to pain and disability may partly explain this situation. Although many approaches and subgrouping systems for disabling LBP have been proposed in an attempt to deal with this complexity, they have been criticized for being unidimensional and reductionist and for not improving outcomes. Cognitive functional therapy was developed as a flexible integrated behavioral approach for individualizing the management of disabling LBP. This approach has evolved from an integration of foundational behavioral psychology and neuroscience within physical therapist practice. It is underpinned by a multidimensional clinical reasoning framework in order to identify the modifiable and nonmodifiable factors associated with an individual's disabling LBP. This article illustrates the application of cognitive functional therapy to provide care that can be adapted to an individual with disabling LBP.

BACKGROUND: Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain. OBJECTIVES: The purpose of this study was to investigate participants' experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach. DESIGN: This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework. METHODS: Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention. RESULTS: Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic alliance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective. CONCLUSIONS: A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further st

Question: What are physiotherapists’ perspectives on managing the cognitive, psychological and social dimensions of chronic low back pain after intensive biopsychosocial training? Design: Qualitative study design using semi-structured interviews to explore physiotherapists’ perceptions of their identification and treatment of the biopsychosocial dimensions of chronic low back pain after intensive Cognitive Functional Therapy (CFT) training. Participants: Thirteen qualified physiotherapists from four countries who had received specific CFT training. The training involved supervised implementation of CFT in clinical practice with patients. Interviews were audio-recorded and transcribed verbatim. An interpretive descriptive analysis was performed using a qualitative software package. Results: Four main themes emerged from the data: self-reported changes in understanding and attitudes; self-reported changes in professional practice; altered scope of practice; and increased confidence and satisfaction. Participants described increased understanding of the nature of pain, the role of patient beliefs, and a new appreciation of the therapeutic alliance. Changes in practice included use of new assessments, changes in communication, and adoption of a functional approach. Since undertaking CFT training, participants described a greater awareness of their role and scope of practice as clinicians in identifying and addressing these factors. Conclusion: Physiotherapists expressed confidence in their capacity and skill set to manage the biopsychosocial dimensions of chronic low back pain after CFT training, and identified a clear role for including these skills within the physiotherapy profession. Despite this, further clinical trials are needed to justify the time and cost of training, so that intensive CFT training may be made more readily accessible to clinicians, which to date has not been the case.

Objective: This paper systematically reviews the effect of chair backrests and reducing seated hip flexion on low back discomfort (LBD) and trunk muscle activation. Background: Prolonged sitting commonly exacerbates low back pain (LBP). Several modifications to seated posture and chair design have been recommended, including using chairs with backrests and chairs that reduce hip flexion. Method: Electronic databases were searched by two independent assessors. Part 1 of this review includes 26 studies comparing the effect of sitting with at least two different hip angles. In Part 2, seven studies that compared the effect of sitting with and without a backrest were eligible. Study quality was assessed using the PEDro scale. Results: Significant confounding variables and a relatively small number of randomized controlled trials (RCTs) involving people with LBP complicates analysis of the results. There was moderate evidence that chair backrests reduce paraspinal muscle activation, and limited evidence that chair backrests reduce LBD. There was no evidence that chairs involving less hip flexion reduce LBP or LBD, or consistently alter trunk muscle activation. However, participants in several studies subjectively preferred the modified chairs involving less hip flexion. Conclusion: The limited evidence to support the use of chairs involving less seated hip flexion, or the effect of a backrest, is consistent with the limited evidence that other isolated chair design features can reduce LBP. Application: LBP management is likely to require consideration of several factors in addition to sitting position. Larger RCTs involving people with LBP are required.

Introduction: Non-specific chronic low back pain (NSCLBP) is a very common and costly musculoskeletal disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) represents a novel, patientcentred intervention which directly challenges painrelated behaviours in a cognitively integrated, functionally specific and graduated manner. CFT aims to target all biopsychosocial factors that are deemed to be barriers to recovery for an individual patient with NSCLBP. A recent randomised controlled trial (RCT) demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy combined with exercise. However, several previous RCTs have suggested that class-based interventions are as effective as individualised interventions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to a relatively cheaper exercise and education class. The current study will compare the clinical effectiveness of individualised CFT with a combined exercise and pain education class in people with NSCLBP. Methods and analysis: This study is a multicentre RCT. 214 participants, aged 18-75 years, with NSCLBP for at least 6 months will be randomised to one of two interventions across three sites. The experimental group will receive individualised CFT and the length of the intervention will be varied in a pragmatic manner based on the clinical progression of participants. The control group will attend six classes which will be provided over a period of 6-8 weeks. Participants will be assessed preintervention, postintervention and after 6 and12 months. The primary outcomes will be functional disability and pain intensity. Non-specific predictors, moderators and mediators of outcome will also be analysed. Ethics and dissemination: Ethical approval has been obtained from the Mayo General Hospital Research Ethics Committee (MGH-14-UL). Outcomes will be dissemina

Question: What are physiotherapists' perceptions about identifying and managing the cognitive, psychological and social factors that may act as barriers to recovery for people with low back pain (LBP)? Design: Systematic review and qualitative metasynthesis of qualitative studies in which physiotherapists were questioned, using focus groups or semi-structured interviews, about identifying and managing cognitive, psychological and social factors in people with LBP. Participants: Qualified physiotherapists with experience in treating patients with LBP. Outcome measures: Studies were synthesised in narrative format and thematic analysis was used to provide a collective insight into the physiotherapists' perceptions. Results: Three main themes emerged: physiotherapists only partially recognised cognitive, psychological and social factors in LBP, with most discussion around factors such as family, work and unhelpful patient expectations; some physiotherapists stigmatised patients with LBP as demanding, attention-seeking and poorly motivated when they presented with behaviours suggestive of these factors; and physiotherapists questioned the relevance of screening for these factors because they were perceived to extend beyond their scope of practice, with many feeling under-skilled in addressing them. Conclusion: Physiotherapists partially recognised cognitive, psychological and social factors in people with LBP. Physiotherapists expressed a preference for dealing with the more mechanical aspects of LBP, and some stigmatised the behaviours suggestive of cognitive, psychological and social contributions to LBP. Physiotherapists perceived that neither their initial training, nor currently available professional development training, instilled them with the requisite skills and confidence to successfully address and treat the multidimensional pain presentations seen in LBP. Registration: CRD 42014009964.

Background. Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery. Objective. The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant. Design. A multiple case-cohort study (n_26) consisting of 3 phases (A1–B–A2) was conducted. Methods. Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution. Results. Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention. Limitations. The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. Conclusions. These promising results suggest that cognitive functional therapy should be compared with othe

Few studies have demonstrated that seating modifications reduce low back pain (LBP). One recent study found that a forward-inclined seatpan reduced low back discomfort (LBD), however this was only examined in people with flexion-related LBP. No study has yet investigated its effectiveness among people with extension-related LBP. This crossover study examined 12 subjects with extension-related LBP. Sitting discomfort and surface electromyography of three trunk muscles were recorded during a 10-minute typing task while sitting with two different seatpan inclinations, both with and without a backrest. LBD (p < 0.001) and overall body discomfort (OBD) ( p = 0.016) were significantly greater on the forward-inclined seatpan. The backrest did not alter trunk muscle activation or sitting discomfort. The results demonstrate that in a specific subgroup of people with extension-related LBP, increasing forward seatpan inclination significantly increased LBD and OBD. Future research should consider matching ergonomics prescriptions according to the individual presentation of people with LBP. Practitioner Summary: Sitting on a forward-inclined seatpan resulted in greater low back discomfort and overall body discomfort than sitting on a flat seatpan during a typing task among people with extension-related low back pain (LBP). Future research should examine matching ergonomics prescriptions to the individual presentation of people with LBP.

No study has examined the effectiveness of prescribing seating modifications according to the individual clinical presentation of people with low back pain (LBP). A dynamic, forward-inclined chair ('Back App') can reduce seated paraspinal muscle activation among pain-free participants. This study examined 21 participants whose LBP was specifically aggravated by prolonged sitting and was eased by standing. Low back discomfort (LBD) and overall body discomfort (OBD) were assessed every 15 min while participants sat for 1 h on both the dynamic, forward-inclined chair and a standard office chair. LBD increased significantly more (p = 0.005) on the standard office chair, with no significant difference (p = 0.178) in OBD between the chairs. The results demonstrate that, in a specific flexion-related subgroup of people with LBP, increased LBD during sitting can be minimised through modifying chair design. Mechanisms that minimise seated discomfort may be of relevance in LBP management, as part of a biopsychosocial management plan. Practitioner summary: This study examined low back discomfort (LBD) during a typing task among people with low back pain (LBP). Sitting on a dynamic, forward-inclined chair resulted in less seated LBD than sitting on a standard office chair. Further research is required to examine the long-term effectiveness of ergonomics interventions in LBP. © 2013 Copyright Taylor and Francis Group, LLC.

Physiotherapists perceive upright, lordotic sitting postures to be important in the management of non-specific chronic low back pain (NSCLBP). Little is known about the perceptions of the wider community about seated posture, despite this being an important consideration before attempting to change seated posture. This study investigated perceptions of the best and worst sitting postures among members of the community, both with (n=120) and without (n=235) NSCLBP. Participants with NSCLBP perceived posture to be more important (p<0.001), and reported thinking about their posture significantly more frequently (p<0.001), than those without NSCLBP. 54% of participants selected a "neutral" lordotic sitting posture as their best posture, which was more frequent than any other posture (p<0.001). Sitting postures which were "straight", and were perceived to keep the head, neck and shoulders in good alignment were preferred. However, what people considered "straight" varied considerably. 78% selected a slumped sitting posture as their worst posture, which was more frequent than any other posture (p<0.001). The choice of best and worst sitting postures was not significantly influenced by gender, the presence of NSCLBP, or measures of pain, disability or back pain beliefs. Interestingly, a very upright sitting posture was the second most popular selection as both the best (19%) and worst (15%) posture. Overall, lordotic lumbar postures were strongly favoured among members of the community, which is broadly in line with the previously reported perceptions of physiotherapists. © 2013 Elsevier Ltd.

The purpose of this systematic review was to investigate the effect of dynamic sitting on trunk muscle activation in sitting. Electronic databases were searched by two independent reviewers. Studies were included if they compared the effect of dynamic sitting on trunk muscle activation to a more static sitting condition. Seven studies were eligible for inclusion, six of which were rated as “high-quality” using the PEDro scale. Five studies reported no difference in trunk muscle activation. Two studies reported a difference in trunk muscle activation, yet this was associated with increased discomfort, increased fatigue and greater spinal shrinkage. Furthermore, the changes reported in these two studies may be more related to the absence of a backrest rather than dynamic sitting. Therefore, the findings of this review suggest dynamic sitting does not significantly change trunk muscle activation. No randomised clinical trials or longitudinal design studies were found which evaluated the effect of dynamic sitting on trunk muscle activation, limiting the ability to make definitive conclusions about causality. The implications of the results, and recommendations for future research, are discussed.

While sitting is a common aggravating factor in low back pain (LBP), the best sitting posture remains unclear. This study investigated the perceptions of 295 physiotherapists in four different European countries on sitting posture. Physiotherapists selected their perceived best sitting posture from a sample of nine options that ranged from slumped to upright sitting, as well as completing the back beliefs questionnaire (BBQ). 85% of physiotherapists selected one of two postures as best, with one posture being selected significantly more frequently than the remainder (p < 0.05). Interestingly, these two most frequently selected postures were very different from each other. Those who selected the more upright sitting posture had more negative LBP beliefs on the BBQ (p < 0.05). The choice of best sitting posture also varied between countries (p < 0.05). Overall, disagreement remains on what constitutes a neutral spine posture, and what is the best sitting posture. Qualitative comments indicated that sitting postures which matched the natural shape of the spine, and appeared comfortable and/or relaxed without excessive muscle tone were often deemed advantageous. Further research on the perceptions of people with LBP on sitting posture are indicated.

Dynamic sitting has been proposed to reduce low back pain (LBP) and/or low back discomfort (LBD) while sitting. This is supported by studies suggesting that subjects with LBP assume more static, sustained postures while sitting. This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects. Electronic databases were searched by two independent assessors. All prospective studies which compared the effect of a dynamic sitting condition on LBP or LBD to another sitting condition were eligible, with no minimum follow-up period applied. The quality of the included studies was assessed using the PEDro scale. Seven high-quality studies were eligible, including five crossover studies and two randomised controlled trials. The results suggest there is currently no evidence to support the use of dynamic sitting as a stand-alone approach in the management of LBP.

Many factors are associated with low back pain (LBP), including provocative spinal postures. Consequently, lumbo-pelvic posture is commonly assessed in LBP patients. A novel wireless monitor (Body-Guard™) can monitor lumbo-pelvic sagittal plane movements reliably, and has demonstrated concurrent validity during non-functional tasks. This study evaluated the concurrent validity of this monitor during functional tasks, as a precursor to LBP field studies. Twelve painfree participants performed a series of postural tasks (in sitting and standing) three times. Simultaneous postural measurements were obtained by the wireless monitor and a laboratory-based system (CODA™). Postural measurements were strongly correlated (rs = 0.88, r2 = 0.78). The mean difference observed was small (<10% lumbo-pelvic ROM), however some tasks displayed greater error. The results support the concurrent validity of the wireless monitor for analysing lumbo-pelvic posture during functional tasks. Specific limitations of the monitor for certain postural tasks were identified, and should be considered before implementation in future field studies.

Introduction: Nearly everyone is affected by low back pain at some point in time. The presence of pain can cause adaptive or protective altered movement and motor control impairments. Ongoing mal-adaptive motor control behaviour can lead to a chronic state of pain. A significant cause of non specific chronic low back pain is lumbar segmental instability. Patients with lumbar segmental instability demonstrate an inability to reposition the lumbar spine accurately. A newly introduced dynamic sitting device measures how accurately a subject completes different tracks by using lumbar stabilizing muscles, and thereby provides insight into the ability to coordinate lower back muscles. The present study was set up to estimate the reliability and agreement parameters over the test scores given by the TBT. Methods: Four therapists tested six patients (mean age: 43,8 SD ±7,7 years) with low back pain, on two days with at three-week intervals. Whilst sitting on a dynamic sitting device the patients had to cover a presented track. The movements in the lower back were measured by a computer, the precision with which the movements were made was scored. The inter-rater reliability was calculated using intraclass correlation (ICC), test retest data were analyzed using a paired t-test for four different tracks. Results: The number of completed cycles showed a good to excellent reliability (ICC: 0.87-0.90). Differences in time spent between opposite sides of the track gave good reliability scores (ICC: 0.72-0.97). Over three weeks a significant (p<0.05) improvement was found in the number of cycles covered. Conclusion: It is legitimate to compare scores measured by different raters. This instrument seems useful to objectively quantify the ability to reposition the lumbar spine. Future research needs to focus on a larger sample size of patients with LBP to enforce knowledge about this instrument as a diagnostic device.

Introduction: Nearly everyone is affected by low back pain at some point in time. The presence of pain can cause adaptive or protective altered movement and motor control impairments. Ongoing mal-adaptive motor control behaviour can lead to a chronic state of pain. A significant cause of non specific chronic low back pain is lumbar segmental instability. Patients with lumbar segmental instability demonstrate an inability to reposition the lumbar spine accurately. A newly introduced dynamic sitting device measures how accurately a subject completes different tracks by using lumbar stabilizing muscles, and thereby provides insight into the ability to coordinate lower back muscles. The present study was set up to estimate the reliability and agreement parameters over the test scores given by the TBT. Methods: Four therapists tested six patients (mean age: 43,8 SD ±7,7 years) with low back pain, on two days with at three-week intervals. Whilst sitting on a dynamic sitting device the patients had to cover a presented track. The movements in the lower back were measured by a computer, the precision with which the movements were made was scored. The inter-rater reliability was calculated using intraclass correlation (ICC), test retest data were analyzed using a paired t-test for four different tracks. Results: The number of completed cycles showed a good to excellent reliability (ICC: 0.87-0.90). Differences in time spent between opposite sides of the track gave good reliability scores (ICC: 0.72-0.97). Over three weeks a significant (p<0.05) improvement was found in the number of cycles covered. Conclusion: It is legitimate to compare scores measured by different raters. This instrument seems useful to objectively quantify the ability to reposition the lumbar spine. Future research needs to focus on a larger sample size of patients with LBP to enforce knowledge about this instrument as a diagnostic device.

Lumbar posture is commonly assessed in non-specific chronic low back pain (NSCLBP), although quantitative measures have mostly been limited to laboratory environments. The BodyGuard (TM) is a spinal position monitoring device that can monitor posture in real time, both inside and outside the laboratory. The reliability of this wireless device was examined in 18 healthy participants during usual sitting and forward bending, two tasks that are commonly provocative in NSCLBP. Reliability was determined using intraclass correlation coefficients (ICC), the standard error of measurement (SEM), the mean difference and the minimal detectable change (MDC90). Between-day ICC values ranged from 0.84 to 0.87, with small SEM (5%), mean difference (<9%) and MDC90 (<14%) values. Inter-rater ICC values ranged from 0.91 to 0.94, with small SEM (4%), mean difference (6%) and MDC90 (9%) values. Between-day and inter-rater reliability are essential requirements for clinical utility and were excellent in this study. Further studies into the validity of this device and its application in clinical trials in occupational settings are required.

Chronic Low Back Pain (LBP) remains a common, recalcitrant and costly problem for the individual sufferer and for society. Effective treatments that reduce the social and economic burden have yet to be established for the majority of chronic LBP cases. Lack of evidence for specific interventions has been blamed on the heterogeneity of the chronic LBP population as well as a lack of a patient centred biopsycho-social approach. This issue of heterogeneity has resulted in classification being considered the highest research priority in the area of chronic LBP. The potential for a ‘wash-out effect’ caused by the heterogeneity of the chronic LBP populations sampled for randomised controlled clinical trials (RCTs), has driven the need for classifying patients with nonspecific chronic LBP. A summary of a series of studies is outlined in this review paper. They represent a comprehensive investigation into the validity of O’Sullivan’s proposed mechanism-based classification system (CS) for a sub-group of localized mechanically provoked nonspecific chronic LBP with motor control impairment (MCI). Further, the findings of these studies are discussed in relation to the relevant literature and the clinical implications arising are presented. Finally, the limitations of this research are outlined and recommendations for future research are made.

Background There is lack of evidence for specific treatment interventions for patients with non-specific chronic low back pain (NSCLBP) despite the substantial amount of randomised controlled clinical trials evaluating treatment outcome for this disorder. Hypothesis It has been hypothesised that this vacuum of evidence is caused by the lack of subclassification of the heterogeneous population of patients with chronic low back pain for outcome research.Methods A systematic review with a meta-analysis was undertaken to determine the integration of subclassification strategies with matched interventions in randomised controlled clinical trials evaluating manual therapy treatment and exercise therapy for NSCLBP. A structured search for relevant studies in Embase, Cinahl, Medline, PEDro and the Cochrane Trials Register database, followed by hand searching all relevant studies in English up to December 2008. Results Only 5 of 68 studies (7.4%) subclassified patients beyond applying general inclusion and exclusion criteria. In the few studies where classification and matched interventions have been used, our meta-analysis showed a statistical difference in favour of the classification-based intervention for reductions in pain (p=0.004) and disability (p=0.0005), both for short-term and long-term reduction in pain (p=0.001). Effect sizes ranged from moderate (0.43) for short term to minimal (0.14) for long term. Conclusion A better integration of subclassification strategies in NSCLBP outcome research is needed. We propose the development of explicit recommendations for the use of subclassification strategies and evaluation of targeted interventions in future research evaluating NSCLBP.

Posture and movement are thought to be important risk factors for the development of work-related musculoskeletal disorders. Whole day occupational exposure assessment has typically used self-report or observation techniques, but the need for more accurate measurement is now recognised. The aim of this study was to compare the kinematic recordings of a frequently used field system (physiometer) with two laboratory-based systems (Fastrak and Peak) in vivo. Head, thorax and right arm kinematics were recorded simultaneously by the three systems whilst a subject performed 27 single and multiple plane physiological and simulated daily living task movement trials. Errors observed in the Fastrak and Peak data included gimbal lock and quadrant errors. Physiometer data errors included undervalues, overvalues and temporal errors of slow response and resonance. All three systems showed some cross-talk. Agreement between the physiometer and the other systems was generally high for physiological movements (R2 > 0.8) and less for functional movements (R2 > 0.5).