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KIN 427 lecture 2.docx

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KIN 427
Stuart Mc Gill

KIN 427- Lecture 2- 10 January 2013 - epidemological studies- studies done on back pain, misinterpretation, back pain is homogenous therefore they blame it on psychosocial factors and not mechanical Strength of evidence - psychosocial vairables are most important factors in dertermining LBD - studies of nurses--> link stongly to mechanical factors to back pain - police and body armour--> mechanical loads associated and therefore had higher risk - the legislative landscape- legislative impediments  ama guidelines- based on ROM--> for govt--> use ROM of patient and compare it to normal (but who's normal!?) - none of us are average and it'll be difficult to see progression or decrease - study that says that having more ROM in back is healthy--> but in reality having more ROM is more risk of back pain (driven by lawyers--> they need numbers ie. what it's worth--> how much is back pain worth--> put this in to satisfy legal logic) - (legal convenience) - effect treatment approach (restore ROM)--> therapists are pressured to restore ROM that can increase risk of back pain - power lifters--> have backs in slight elastic extension to lock and make rigid to produce power through hips - The legislative landscape impediments: - human rights (equity) legislations- must prove mismatch btwn capabilities of worker to the job in order to restrict them from work - all people are not physical equals Summary Notes: AMA: is ROM justifiable Human Rights Legislations: is everyone a physical equal?  RCT's on LBP- a call for their discontinuance (illegal to form RCT on homogeneous item)  -->if you subcategorize to stenosis and age then you can find treatment (you cannot get results with RCT without sub categorizing)  -->single treatments may not work- cancer was retarded until chemo combined with radiotherapy  --> some children clinicians are highly skilled- others not (ie. not all profs or doctors are at same skill level)--> some surgeons (not enough care to patient)  --> how can a placebo be administered definition: LBP, LBI, "back ache", disabling or not?  is LBP a fact of life? can come occupations be performed with LBP and not others (cause or artifact)  ppl who study insurance they say they can go back to work (ie. lecturers) but have not studied people with jack hammers "U" shaped function for health- what is optimal?  ie. if you are vitamin D deficient--> rickets, too much is toxic, point: most features of health is U shaped.  physical loading is good or awful ( couch potato= bad!, too much = wear out!)--> confounding variable. therefore have to analze if it was the optimal load Intensity, duration, REST breaks? critical relationships  need good understanding controversy continues- are workers paid to act disabled?  bad doctors blame patients for not working hard enough  hadler 2001 comp system encourages worker to act disabled  --> some docs are not very empathtic (docs dont treat with care ie. not helping them remove shoes)  werneke and hart (2001) showed specific pain patterns were better predictors of who would get better- ie. damage - pain- disability  --> not ROM, not how much they are being compensated  --> beggining of realizing patients emotions and rections to pain reveal a lot In 1979, waddell identified five "nonorganix" signs in LBP  in many cases... these are used to assess the validity of a patients claim of pain  red flag--> cancer get them to th
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