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Journal of Medical Internet Research Oct 2019Hospital-based back surgery in the United States increased by 60% from January 2012 to December 2017, yet the supply of neurosurgeons remained relatively constant....
BACKGROUND
Hospital-based back surgery in the United States increased by 60% from January 2012 to December 2017, yet the supply of neurosurgeons remained relatively constant. During this time, adult obesity grew by 5%.
OBJECTIVE
This study aimed to evaluate the demand and associated costs for hospital-based back surgery by geolocation over time to evaluate provider practice variation. The study then leveraged hierarchical time series to generate tight demand forecasts on an unobserved test set. Finally, explanatory financial, technical, workload, geographical, and temporal factors as well as state-level obesity rates were investigated as predictors for the demand for hospital-based back surgery.
METHODS
Hospital data from January 2012 to December 2017 were used to generate geospatial-temporal maps and a video of the Current Procedural Terminology codes beginning with the digit 63 claims. Hierarchical time series modeling provided forecasts for each state, the census regions, and the nation for an unobserved test set and then again for the out-years of 2018 and 2019. Stepwise regression, lasso regression, ridge regression, elastic net, and gradient-boosted random forests were built on a training set and evaluated on a test set to evaluate variables important to explaining the demand for hospital-based back surgery.
RESULTS
Widespread, unexplained practice variation over time was seen using geographical information systems (GIS) multimedia mapping. Hierarchical time series provided accurate forecasts on a blind dataset and suggested a 6.52% (from 497,325 procedures in 2017 to 529,777 in 2018) growth of hospital-based back surgery in 2018 (529,777 and up to 13.00% by 2019 [from 497,325 procedures in 2017 to 563,023 procedures in 2019]). The increase in payments by 2019 are estimated to be US $323.9 million. Extreme gradient-boosted random forests beat constrained and unconstrained regression models on a 20% unobserved test set and suggested that obesity is one of the most important factors in explaining the increase in demand for hospital-based back surgery.
CONCLUSIONS
Practice variation and obesity are factors to consider when estimating demand for hospital-based back surgery. Federal, state, and local planners should evaluate demand-side and supply-side interventions for this emerging problem.
Topics: Adult; Back; Hospitals; Humans; Research Design; United States
PubMed: 31663856
DOI: 10.2196/14609 -
International Journal of Environmental... Jul 2023The aim of this study was to assess, for both men and women, the consequences of using different back-support exoskeletons during various manual material tasks (MMH) on...
The aim of this study was to assess, for both men and women, the consequences of using different back-support exoskeletons during various manual material tasks (MMH) on the activity of back muscles and trunk kinematics. Fifteen men and fourteen women performed MMH involving a 15 kg load (a static task, a symmetric lifting task, and an asymmetric lifting task). Four exoskeleton conditions were tested: without equipment (CON) and with three exoskeletons passive (P-EXO), and active (A-EXO1 and A-EXO2)). The electromyographic activity of the lower trapezius (TZ), latissimus dorsi (LD), erector spinae (ES), gluteus maximus (GM), and biceps femoris (BF) muscles was recorded. Trunk kinematics were evaluated to provide average thoracic, lumbar, and hip angles. The use of the P-EXO decreased the activity of LD, GM, and BF from -12 to -27% ( < 0.01) compared to CON, mostly during the static task. The A-EXO1 and A-EXO2 reduced the muscle activity of all studied muscles from -7 to -62% ( < 0.01) compared to CON and from -10 to -52% ( < 0.005) compared to the P-EXO, independently of the modalities of the experimental tasks. A statistical interaction between the sex and exoskeleton was only observed in a few rare conditions. Occupational back-support exoskeletons can reduce trunk extensor muscle activity compared to no equipment being used. However, these reductions were modulated by the exoskeleton technology (passive vs. active), design (weight and anthropomorphism), and the modalities of the task performed (static vs. dynamic). Our results also showed that the active exoskeletons could modify the trunk kinematics.
Topics: Male; Humans; Female; Exoskeleton Device; Electromyography; Muscle, Skeletal; Back Muscles; Lumbosacral Region; Superficial Back Muscles; Lifting
PubMed: 37569010
DOI: 10.3390/ijerph20156468 -
International Journal of Environmental... Jul 2021This study investigated the influence of passive back-support exoskeletons (EXO) design, trunk sagittal inclination (TSI), and gender on the effectiveness of an...
This study investigated the influence of passive back-support exoskeletons (EXO) design, trunk sagittal inclination (TSI), and gender on the effectiveness of an exoskeleton to limit erector spinae muscle (ES) activation during a sagittal lifting/lowering task. Twenty-nine volunteers performed an experimental dynamic task with two exoskeletons (two different designs: soft (SUIT) and rigid (SKEL)), and without equipment (FREE). The ES activity was analyzed for eight parts of TSI, each corresponding to 25% of the range of motion (lifting: P1 to P4; lowering: P5 to P8). The impact of EXO on ES activity depended on the interaction between exoskeleton design and TSI. With SKEL, ES muscle activity significantly increased for P8 (+36.8%) and tended to decrease for P3 (-7.2%, = 0.06), compared to FREE. SUIT resulted in lower ES muscle activity for P2 (-9.6%), P3 (-8.7%, = 0.06), and P7 (-11.1%), in comparison with FREE. Gender did not influence the effect of either back-support exoskeletons on ES muscle activity. These results point to the need for particular attention with regard to (1) exoskeleton design (rigid versus soft) and to (2) the range of trunk motion, when selecting an EXO. In practice, the choice of a passive back-support exoskeleton, between rigid and soft design, requires an evaluation of human-exoskeleton interaction in real task conditions. The characterization of trunk kinematics and ranges of motion appears essential to identify the benefits and the negative effects to take into account with each exoskeleton design.
Topics: Back; Back Muscles; Biomechanical Phenomena; Electromyography; Exoskeleton Device; Humans; Lifting
PubMed: 34360352
DOI: 10.3390/ijerph18158062 -
Radiologia 2006
Topics: Back; Dracunculiasis; Humans; Radiography
PubMed: 17058379
DOI: 10.1016/s0033-8338(06)73140-x -
PeerJ 2023Combined with insufficient physical activity (PA) prolonged and improperly performed sedentary work can lead to musculoskeletal disorders (MSDs). The aim of this study...
PURPOSE
Combined with insufficient physical activity (PA) prolonged and improperly performed sedentary work can lead to musculoskeletal disorders (MSDs). The aim of this study was (I) to evaluate the self-reported level of PA and the prevalence of MSDs in male and female teachers, and (II) to investigate the association between PA and MSDs in teachers in Polish primary and secondary schools.
METHODS
The study included 254 teachers from primary and secondary schools from Upper Silesia, Poland, excluding physical education teachers. The level of PA was assessed using the Seven-Day Physical Activity Recall (SDPAR). A standardized Nordic Musculoskeletal Questionnaire (NMQ) was used to assess the prevalence of MSDs.
RESULTS
A similar percentage of female (80%) and male (90%) teachers met the WHO recommendations on moderate-intensity PA. The recommendations on performing vigorous-intensity PA were met by significantly ( = 0.002) less female than male teachers (50% and 75% respectively). Lower back disorders during the last 12 months and the last 7 days (57% and 45%, respectively) were the most commonly reported MSDs by teachers, followed by neck (53%, 40%), upper back (39%, 28%), and knee disorders (37%, 26%). The highest pain intensity was experienced by the teachers in the lower back and neck. Teachers with a greater number of MSDs were less likely to engage in vigorous-intensity PA and total PA than those with fewer painful areas of the body. Pain intensity in the neck, knees, upper- and lower back, and wrists/hands was negatively related to moderate and total PA. BMI negatively correlated with total PA, moderate-intensity PA vigorous-intensity PA, and high vigorous-intensity PA.
CONCLUSIONS
The study revealed the association between PA and MSDs in studied teachers. The most of the studied teachers met the WHO recommendation, and women were less likely to perform vigorous and high-vigorous PA than men. The lower back and neck disorders were the most common among the teachers.
Topics: Humans; Female; Male; Cross-Sectional Studies; Back; Dendritic Spines; Exercise; Musculoskeletal Diseases
PubMed: 36852223
DOI: 10.7717/peerj.14872 -
International Journal of Environmental... Jan 2023A new ergonomic-risk-assessment tool was developed that combines musculoskeletal-model-based loading estimates with insights from fatigue failure theory to evaluate...
A new ergonomic-risk-assessment tool was developed that combines musculoskeletal-model-based loading estimates with insights from fatigue failure theory to evaluate full-body musculoskeletal loading during dynamic tasks. Musculoskeletal-modeling output parameters, i.e., joint contact forces and muscle forces, were combined with tissue-specific injury thresholds that account for loading frequency to determine the injury risk for muscles, lower back, and hip cartilage. The potential of this new risk-assessment tool is demonstrated for defining ergonomic interventions in terms of lifting characteristics, back and shoulder exoskeleton assistance, box transferring, stoop lifting, and an overhead wiring task, respectively. The MATE identifies the risk of WMSDs in different anatomical regions during occupational tasks and allows for the evaluation of the impact of interventions that modify specific lifting characteristics, i.e., load weight versus task repetition. Furthermore, and in clear contrast to currently available ergonomic assessment scores, the effects of the exoskeleton assistance level on the risk of WMSDs of full-body musculoskeletal loading (in particular, the muscles, lower back, and hips) can be evaluated and shows small reductions in musculoskeletal loading but not in injury risk. Therefore, the MATE is a risk-assessment tool based on a full-body, musculoskeletal-modeling approach combined with insights from the fatigue failure theory that shows the proof of concept of a shoulder and back exoskeleton. Furthermore, it accounts for subject-specific characteristics (age and BMI), further enhancing individualized ergonomic-risk assessment.
Topics: Humans; Musculoskeletal Diseases; Ergonomics; Risk Assessment; Back; Shoulder; Occupational Diseases
PubMed: 36674262
DOI: 10.3390/ijerph20021507 -
Medical Science Monitor : International... Mar 2023BACKGROUND The correlation between hamstring muscle shortening and nonspecific low back pain and compensatory lumbar movements is still controversial. The purpose of...
Association Between Hamstring Shortness and Asymmetry, Pain Intensity, Disability Index, and Compensatory Lumbar Movement in 60 Patients with Nonspecific Chronic Low Back Pain.
BACKGROUND The correlation between hamstring muscle shortening and nonspecific low back pain and compensatory lumbar movements is still controversial. The purpose of this study was to evaluate the association between hamstring shortness and asymmetry, pain intensity, the disability index, and compensatory lumbar movement in 60 patients with nonspecific chronic low back pain. MATERIAL AND METHODS Sixty patients with nonspecific low back pain participated in this study. The hamstring shortness and asymmetry, pain intensity, the disability index, and compensatory lumbar movement of the patients were assessed. The pain intensity was evaluated using a numeric pain rating scale (NPRS), active knee extension testing was performed to measure the length of the hamstring, and compensatory lumbar movement was assessed using a digital dual inclinometer. Correlation analysis was used for analysis of the obtained data. RESULTS The hamstring length showed a negative correlation with hamstring length asymmetry, NPRS, and disability index (P<0.05). The asymmetry of the hamstring length was positively correlated with NPRS, disability index, and compensatory lumbar rotation (P<0.05). Lumbar flexion was positively correlated with the hamstring muscle length (P<0.05). However, there was a negative correlation between the hamstring length asymmetry, NPRS, and disability index (P<0.05). There was no correlation between the compensatory lumbar rotation, hamstring length, or disability index. CONCLUSIONS Compensatory flexion movements, NPRS, and disability index in patients with nonspecific chronic low back pain were associated with hamstring shortness and asymmetry. These factors should be considered when planning physical therapy for patients with nonspecific low back pain.
Topics: Humans; Low Back Pain; Hamstring Muscles; Pain Measurement; Movement; Lumbosacral Region; Chronic Pain
PubMed: 36949625
DOI: 10.12659/MSM.939657 -
The British Journal of Radiology 2016Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the... (Review)
Review
Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the differential diagnosis of these masses. Elaborate on clinically relevant features that may affect biopsy or surgical approach, of which the radiologist should be aware. A review of current literature regarding the diagnosis and treatment of retrorectal/presacral masses was performed with attention to specific findings, which may lend refinement to the differential diagnosis of these masses. Cases were obtained by searching through a radiology database at a single institution after Institutional Review Board approval. Recent advances in imaging and treatment methods have led to the increased role of radiology in both imaging and tissue diagnosis of retrorectal masses. Surgical philosophies surrounding the treatment of these masses have not significantly changed in recent years, but there are a few key factors of which the radiologist must be aware. The radiologist can offer refinement of the differential diagnosis of retrorectal masses and can elaborate on salient findings which could alter the need for neoadjuvant chemoradiation therapy, pre-surgical tissue diagnosis and surgical approach. This article presents an imaging approach to retrorectal/presacral masses with emphasis on findings which can dictate the ultimate need for neoadjuvant therapy and pre-surgical tissue diagnosis and alter the preferred surgical approach. This article consolidates key findings, so radiologists can become more clinically relevant in the evaluation of these masses.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pelvic Neoplasms; Sacrococcygeal Region; Tomography, X-Ray Computed
PubMed: 26828969
DOI: 10.1259/bjr.20150698 -
Folia Morphologica 2020Detailed measurement of lumbar spine, despite the many years of study, still provides new information, especially due to low back pain, which is increasing and... (Review)
Review
Detailed measurement of lumbar spine, despite the many years of study, still provides new information, especially due to low back pain, which is increasing and unresolved worldwide health problem. This review includes historical background and evolution of measurement methods. The paper also focused on searching optimal animal model of lumbar spine and summarizes current knowledge and essential tips. In addition, practical application of lumbar metric analysis was presented. This summary is a starting point for further consideration.
Topics: Animals; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Models, Animal
PubMed: 32020579
DOI: 10.5603/FM.a2020.0008 -
BMJ Case Reports Dec 2019
Topics: Back; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Plastic Surgery Procedures; Skin Neoplasms
PubMed: 31888909
DOI: 10.1136/bcr-2019-233305