Zusammenfassung
Die Konzeption von kausalen Präventionsmaßnahmen zur Verhinderung von unspezifischen Rückenschmerzen und ihren sozialmedizinischen Konsequenzen wird durch die ungeklärte Ätiologie des Beschwerdebildes erschwert. Interventionen richten sich in erster Linie gegen modifizierbare Risikofaktoren, wobei konventionelle Programme mit schwachem bis mäßigem Erfolg v. a. auf den Ausgleich von körperlichen Risikofaktoren und die Stärkung von körperlichen Ressourcen ausgerichtet sind. Ergebnisse neuerer Risikoanalysen deuten jedoch an, dass Einflüsse von Risikofaktoren aus den psycho-sozialen Dimensionen vermutlich die wichtigste Rolle bei der Entstehung und Chronifizierung von Rückenbeschwerden spielen. In diesem Sinne zeigen multidimensionale Programme, die als bio-psycho-soziale Interventionen neben Trainingsmodulen kognitiv-behaviourale Komponenten enthalten, erste viel versprechende Erfolge.
Abstract
The conception of preventive measures against non-specific back pain is complicated by the unknown aetiology of the condition. Most interventions address modifiable physical risk factors and so far they have only been moderately successful in preventing new episodes of back pain and its consequences. Results from recent risk analyses though point to the fact that for the development and chronification of non-specific back pain risk factors from psycho-social dimensions may be of greater importance than physical factors. Therefore it is not surprising that results from the few trials evaluating multidimensional prevention programs (combining exercise and cognitive-behavioural interventions) show promising results.
Stichworte:
Vorbeugung - Schulkinder - Erwachsene - Risikofaktoren - Training - Rückenschule
Key words:
Prevention - children - adults - risk factors - exercise - back school
Literatur
-
1 Ärztliche Zentralstelle Qualitätssicherung (ÄZQ) .Leitlinien Clearingbericht Akuter Rückenschmerz. Schriftenreihe der Ärztlichen Zentralstelle, Bd. 7. Qualitätssicherung. Berlin 2001
-
2
Balague F, Nordin M, Dutoit G, Waldburger M.
Primary prevention, education, and low back pain among school children.
Bull Hosp Jt Dis.
1996;
55
130-134
-
3
Buchbinder R, Jolley D, Wyatt M.
Population based interventions to change back pain beliefs and disability: three part evaluation.
BMJ.
2001;
322
1516-1520
-
4
Cardon G, Balague F.
Low back pain prevention's effects in schoolchildren. What's the evidence?.
European Spine Journal.
2004;
13
663-679
-
5
Cardon G, De Clercq D, De Bourdeaudhuij I, Breithecker D.
Sitting habits in elementary schoolchildren: a traditional versus a Moving school.
Patient Educ Couns.
2004;
54
133-142
-
6
Cardon G, De Clercq D, De Bourdeaudhuij I.
Back education efficacy in elementary school children: a 1-year follow-up study.
Spine.
2002;
27
299-305
-
7 Cost B13 Working Group .Cost B13 Working Group on guidelines for the prevention of low back pain. November 2004. backpaineurope.org
-
8
Croft P, Macfarlane G, Papageorgiou A C, Thomas E, Silman A J.
Outcome of low back pain in general practice: a prospective study.
BMJ.
1998;
316
1356-1359
-
9
Feingold A J, Jacobs K.
The effect of education on backpack wearing and posture in a middle school population.
Work.
2002;
18
287-294
-
10
Gatty C M, Turner M, Buitendorp D J, Batman H.
The effectiveness of back pain and injury prevention programs in the workplace.
Work.
2003;
20
257-266
-
11
Glomsrod B, Lonn J H, Soukup M G, Bo K, Larsen S.
Active back school, prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial.
J Rehabil Med.
2001;
33
26-30
-
12
Hüppe A, Raspe H.
Zur Wirksamkeit von stationärer medizinischer Rehabilitation in Deutschland bei chronischen Rückenschmerzen: Eine systematische Übersicht 1980-2001.
Die Rehabilitation.
2004;
42
143-154
-
13
Jones G T, Macfarlane G J.
Epidemiology of low back pain in children and adolescents.
Arch Dis Child.
2005;
90
312-316
-
14
Jones M A, Stratton G, Reilly T, Unnithan V B.
A school-based survey of recurrent non-specific low-back pain prevalence and consequences in children.
Health Educ Res.
2004;
19
284-289
-
15
Kovacs F M, Gestoso M, Gil del Real M T, Lopez J, Mufraggi N, Mendez J I.
Risk factors for non-specific low back pain in schoolchildren and their parents.
Pain.
2003;
103
259-268
-
16
Lahad A, Malter A D, Berg A O, Deyo R A.
The effectiveness of four interventions for the prevention of low back pain.
Spine.
1996;
21
2908-2917
-
17
Linton S J, Ryberg M.
A cognitive-behavioural group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial.
Pain.
2001;
90
83-90
-
18
Linton S J, van Tulder M W.
Preventive interventions for back and neck pain problems: what is the evidence?.
Spine.
2001;
26
778-787
-
19 Lühmann D, Müller V, Raspe H. Prävention von Rückenschmerzen. Expertise im Auftrag der Bertelsmann Stiftung und der Akademie für Manuelle Medizin, Universität Münster 2004. www.bertelsmann-stiftung.de
-
20
Maher C G.
A systematic review of workplace interventions to prevent low back pain.
Australian Journal of Physiotherapy.
2000;
46
259-268
-
21
Mendez F J, Gomez-Conesa A.
Postural hygiene program to prevent low back pain.
Spine.
2001;
26
1280-1286
-
22 Rosen M. Back Pain Report of a CSAG Committee on Back Pain. London: HMSO; 1994
-
23
Storr-Paulsen A.
The body-consciousness in school - a back pain-school.
Ugeskr Laeger.
2002;
165
37-41
-
24
Symonds T, Burton A, Tillotson K, Main C.
Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place.
Spine.
1995;
20
2738-2745
-
25
Tveito T H, Hysing M, Eriksen H R.
Low back pain interventions at the workplace: a systematic literature review.
Occupational Medicine.
2004;
54
3-13
-
26
Waddell G, Burton K.
Occupational health guidelines for the management of low back pain at work: evidence review.
Occupational Medicine.
2001;
51
124-135
-
27
Westgaard R H, Winkel J.
Review article ergonomic intervention research for improved musculosceletal health: A critical review.
International Journal of Industrial Ergonomics.
1997;
20
463-500
Korrespondenzadresse
Dr. med. D. Lühmann
Institut für Sozialmedizin · Universitätsklinikum Schleswig-Holstein · Campus Lübeck
Beckergrube 43/47
23552 Lübeck
Phone: 04 51/7 99 25 38
Fax: 04 51/7 99 25 22
Email: dagmar.luehmann@sozmed.uni-luebeck.de
