Finnish Institute of Occupational Health, Helsinki, Finland.
Eur J Pain. 2010 Aug;14(7):759-63. doi: 10.1016/j.ejpain.2009.11.009. Epub 2010 Jan 19.
Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist's findings in the low back were associated with local and radiating LBP among a cohort (n=902) of employees in the engineering industry. A systematic non-proportional sample was drawn in strata by age, gender, and occupational class. The non-proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight-leg raising test (SRL), and made assessments of the fingertip-to-floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow-ups of the occurrence of local and radiating LBP at 5, 10, and 28 years from baseline were made. At the 5-year follow-up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4-5.1) and 3.8 (2.0-6.9), respectively, adjusted for age, gender, and occupational class. At the 10-year follow-up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0-3.1) and of local LBP (4.1; 1.9-9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling.
对于正常工作人群中，下背部的临床发现与下背部疼痛（LBP）之间的关系知之甚少。我们研究了在工程行业的员工队列（n=902）中，物理治疗师对下背部的发现是否与局部和放射状 LBP 有关。通过年龄、性别和职业阶层进行分层的系统非比例抽样。这种非比例性旨在增加较小阶层的样本量。物理治疗师进行直腿抬高试验（SRL），并评估指尖到地板的距离以及腰椎棘突间空间触诊时的疼痛。棘突间空间疼痛和 SRL 测试的变量被输入聚类分析。出现了三个聚类：无、轻微和严重临床发现。在基线的逻辑回归分析中，活动度受限和临床发现聚类变量与局部和特别是放射状 LBP 相关。对基线后 5、10 和 28 年的局部和放射状 LBP 发生进行随访。在基线时无放射状 LBP 的受试者中，在 5 年随访时，与无发现相比，轻微和严重临床发现聚类的放射状 LBP 的 OR 分别为 2.7（95%CI 1.4-5.1）和 3.8（2.0-6.9），调整年龄、性别和职业阶层。在 10 年随访时，后者聚类预测了新的放射状 LBP 报告（1.9；1.0-3.1）和新的局部 LBP 报告（4.1；1.9-9.0，在基线时无局部 LBP 的受试者中），同样进行了调整。在新的 LBP 病例中，活动度受限与新病例之间没有关联。因此，在简单临床测量中具有不同发现水平的聚类成员预测了放射状 LBP 的新报告，特别是在员工中。由于抽样的特点，结果的普遍性可能受到限制。
